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End of life care in a level IV outborn neonatal intensive care unit.
OBJECTIVE: Describe care surrounding the end of life (EOL) in the neonatal intensive care unit (NICU).
STUDY DESIGN: Retrospective chart review of 208 infants who died in a level IV referral-only NICU over 5 years.
RESULTS: A goals of care (GOC) conversation was documented before the day of death for 63% of infants. 73% died following withdrawal of life-sustaining treatment (WD); 13% died in a code. The median age at death was 17.5 days. 72% were held by a parent at EOL. 94% of families desired formal memory-making. We identified associations with mode of death and parental holding at death, including: WD was associated with palliative care consultation, early GOC conversations, and increased unit-specific length of stay. Holding was associated with chaplain visits, memory-making, and increased home-to-hospital distance.
CONCLUSION: We present a detailed description of EOL care in an outborn NICU, including novel data on parental holding and memory-making.
STUDY DESIGN: Retrospective chart review of 208 infants who died in a level IV referral-only NICU over 5 years.
RESULTS: A goals of care (GOC) conversation was documented before the day of death for 63% of infants. 73% died following withdrawal of life-sustaining treatment (WD); 13% died in a code. The median age at death was 17.5 days. 72% were held by a parent at EOL. 94% of families desired formal memory-making. We identified associations with mode of death and parental holding at death, including: WD was associated with palliative care consultation, early GOC conversations, and increased unit-specific length of stay. Holding was associated with chaplain visits, memory-making, and increased home-to-hospital distance.
CONCLUSION: We present a detailed description of EOL care in an outborn NICU, including novel data on parental holding and memory-making.
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