Mascarenhas Dwayne, Goyal Medha, Raghavendra Prashanth Ranya, Raman Radhika, Talawadekar Pradnya, Muckaden Mary Ann, Deodhar Jayita, Nanavati Ruchi, Haribalakrishna Anitha
Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.
Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Canada.
Indian J Pediatr. 2025 Apr 2. doi: 10.1007/s12098-025-05508-8.
To describe the planning and implementation of the neonatal palliative care (NPC) program in the neonatal intensive care unit (NICU) in a major referral hospital in western India.
The authors describe the neonatal characteristics, components of NPC care delivered and outcomes, along with barriers and enablers of the program. This was a retrospective, single-center observational study conducted in a level IIIB NICU from December 2021 to December 2022.
Two hundred and sixty-six neonates were enrolled and 65 (24.4%) received NPC, of which 33 (50.8%) were enrolled at admission and 32 (49.2%) were re-directed from critical care towards palliation. The median enrollment was at 2 d of life. The most common conditions for initiating palliative care were severe sepsis with multi-organ dysfunction, complex congenital heart diseases and severe hypoxic-ischemic encephalopathy. For minimizing pain, all received non-pharmacological measures, however 8 (12.31%) additionally received pharmacological agents. The majority received enteral feeding during palliation (66.15%), frequently with the mother's milk (93.02%). Nearly three-fourths (76.92%) were ventilated, with 90% of them receiving invasive ventilation. Memorabilia including footprints, photographs or infant personalized items were accepted by 53 families (81.53%). One hundred and nineteen (44.74%) neonates died, and bereavement support was extended to 113 (95%) of them.
Parallel care model integrating NPC in NICU settings is achievable in collaboration with pioneering centers. This model helps support a large number of neonates in high-burden NICUs ensuring early initiation of NPC.
描述印度西部一家大型转诊医院新生儿重症监护病房（NICU）中新生儿姑息治疗（NPC）项目的规划与实施情况。
作者描述了新生儿特征、所提供的NPC护理的组成部分及结果，以及该项目的障碍和促进因素。这是一项于2021年12月至2022年12月在一家IIIB级NICU进行的回顾性单中心观察性研究。
共纳入266例新生儿，其中65例（24.4%）接受了NPC，其中33例（50.8%）在入院时被纳入，32例（49.2%）从重症监护转向姑息治疗。中位纳入时间为出生后2天。启动姑息治疗最常见的情况是伴有多器官功能障碍的严重脓毒症、复杂先天性心脏病和重度缺氧缺血性脑病。为了尽量减轻疼痛，所有患儿均接受了非药物措施，然而8例（12.31%）还接受了药物治疗。大多数患儿在姑息治疗期间接受肠内喂养（66.15%），且经常使用母乳（93.02%）。近四分之三（76.92%）的患儿接受了通气，其中90%接受有创通气。53个家庭（81.53%）接受了包括脚印、照片或婴儿个性化物品在内的纪念品。119例（44.74%）新生儿死亡，其中113例（95%）获得了哀伤支持。
通过与先驱中心合作，在NICU环境中整合NPC的并行护理模式是可行的。该模式有助于在高负担的NICU中为大量新生儿提供支持，确保尽早启动NPC。
