Neonatal End-of-Life Symptom Management
Purpose of review: Despite advances in technology and treatment options, over 15,000 neonates die each year in the United States. The majority of the deaths, with some estimates as high as 80%, are the result of a planned redirection of care or comfort measures only approach to care. When curative o...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Pediatrics |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fped.2020.574121/full |
| _version_ | 1830410916745707520 |
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| author | DonnaMaria E. Cortezzo DonnaMaria E. Cortezzo DonnaMaria E. Cortezzo DonnaMaria E. Cortezzo Mark Meyer Mark Meyer Mark Meyer Mark Meyer |
| author_facet | DonnaMaria E. Cortezzo DonnaMaria E. Cortezzo DonnaMaria E. Cortezzo DonnaMaria E. Cortezzo Mark Meyer Mark Meyer Mark Meyer Mark Meyer |
| author_sort | DonnaMaria E. Cortezzo |
| collection | DOAJ |
| description | Purpose of review: Despite advances in technology and treatment options, over 15,000 neonates die each year in the United States. The majority of the deaths, with some estimates as high as 80%, are the result of a planned redirection of care or comfort measures only approach to care. When curative or life-prolonging interventions are not available or have been exhausted, parents focus on preserving quality of life and eliminating needless suffering. Parents hope their child will have a peaceful death and will not feel pain. A significant component of end-of-life care is high quality symptom evaluation and management. It is important that neonatal providers are knowledgeable in symptom management to address common sources of suffering and distress for babies and their families at the end-of-life (EOL).Recent findings: Medically complex neonates with life-threatening conditions are a unique patient population and there is little research on end-of-life symptom assessment and management. While there are tools available to assess symptoms for adolescents and adults, there is not a recognized set of tools for the neonatal population. Nonetheless, it is widely accepted that neonates experience significant symptoms at end-of-life. Most commonly acknowledged manifestations are pain, dyspnea, agitation, and secretions. In the absence of data and established guidelines, there is variability in their clinical management. This contributes to provider discomfort and inadequate symptom control.Summary: End-of-life symptom assessment and management is an important component of neonatal end-of-life care. While there remains a paucity of studies and data, it is prudent that providers adequately manage symptoms. Likewise, it is important that providers are educated so that they can effectively guide families through the dying process by discussing disease progression, physical changes, and providing empathetic support. In this review, the authors make recommendations for non-pharmacological and pharmacological management of end-of-life symptoms in neonates. |
| first_indexed | 2024-12-20T19:38:35Z |
| format | Article |
| id | doaj.art-94a0acbae315439db44fccd9bdc3c8fd |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-20T19:38:35Z |
| publishDate | 2020-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-94a0acbae315439db44fccd9bdc3c8fd2022-12-21T19:28:35ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602020-09-01810.3389/fped.2020.574121574121Neonatal End-of-Life Symptom ManagementDonnaMaria E. Cortezzo0DonnaMaria E. Cortezzo1DonnaMaria E. Cortezzo2DonnaMaria E. Cortezzo3Mark Meyer4Mark Meyer5Mark Meyer6Mark Meyer7Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United StatesDivision of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United StatesDepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United StatesDepartment of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United StatesDivision of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United StatesDepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United StatesDepartment of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United StatesDivision of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United StatesPurpose of review: Despite advances in technology and treatment options, over 15,000 neonates die each year in the United States. The majority of the deaths, with some estimates as high as 80%, are the result of a planned redirection of care or comfort measures only approach to care. When curative or life-prolonging interventions are not available or have been exhausted, parents focus on preserving quality of life and eliminating needless suffering. Parents hope their child will have a peaceful death and will not feel pain. A significant component of end-of-life care is high quality symptom evaluation and management. It is important that neonatal providers are knowledgeable in symptom management to address common sources of suffering and distress for babies and their families at the end-of-life (EOL).Recent findings: Medically complex neonates with life-threatening conditions are a unique patient population and there is little research on end-of-life symptom assessment and management. While there are tools available to assess symptoms for adolescents and adults, there is not a recognized set of tools for the neonatal population. Nonetheless, it is widely accepted that neonates experience significant symptoms at end-of-life. Most commonly acknowledged manifestations are pain, dyspnea, agitation, and secretions. In the absence of data and established guidelines, there is variability in their clinical management. This contributes to provider discomfort and inadequate symptom control.Summary: End-of-life symptom assessment and management is an important component of neonatal end-of-life care. While there remains a paucity of studies and data, it is prudent that providers adequately manage symptoms. Likewise, it is important that providers are educated so that they can effectively guide families through the dying process by discussing disease progression, physical changes, and providing empathetic support. In this review, the authors make recommendations for non-pharmacological and pharmacological management of end-of-life symptoms in neonates.https://www.frontiersin.org/article/10.3389/fped.2020.574121/fullPerinatal palliative careneonatalend-of-lifesymptom managementpharmacological management |
| spellingShingle | DonnaMaria E. Cortezzo DonnaMaria E. Cortezzo DonnaMaria E. Cortezzo DonnaMaria E. Cortezzo Mark Meyer Mark Meyer Mark Meyer Mark Meyer Neonatal End-of-Life Symptom Management Frontiers in Pediatrics Perinatal palliative care neonatal end-of-life symptom management pharmacological management |
| title | Neonatal End-of-Life Symptom Management |
| title_full | Neonatal End-of-Life Symptom Management |
| title_fullStr | Neonatal End-of-Life Symptom Management |
| title_full_unstemmed | Neonatal End-of-Life Symptom Management |
| title_short | Neonatal End-of-Life Symptom Management |
| title_sort | neonatal end of life symptom management |
| topic | Perinatal palliative care neonatal end-of-life symptom management pharmacological management |
| url | https://www.frontiersin.org/article/10.3389/fped.2020.574121/full |
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