435 - Operationalizing a definition of neonatal serious illness

Poster Number: 435
Publication Number: 435.147

Katherine Guttmann, Icahn School of Medicine at Mount Sinai, Larchmont, NY, United States; Rachel Silverman, The Mount Sinai Kravis Children's Hospital, New York, NY, United States; Andrea Weintraub, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Background: Palliative care services are underutilized for seriously ill neonates despite well-documented benefit. This may relate to difficulty in defining which neonates are seriously ill. To begin to address this problem, we previously developed a conceptual definition of neonatal serious illness. Still, it is clear that the development of a meaningful operational definition of neonatal serious illness is important to the progression of neonatal palliative care as a field.

Objective: 1) To operationalize our definition by applying it to a patient cohort 2) To evaluate timing of palliative care consultation and goals of care (GOC) discussions and meeting serious illness criteria and 3) To assess associations between diagnosis and meeting serious illness criteria.

Design/Methods: This was a retrospective chart review. Inborn neonates delivered between January 1, 2006 and December 31, 2020 who died prior to discharge from our NICU were identified through EPIC query. Kruskal-Wallis and Mann-Whitney-U tests were used to compare time intervals relating to transition to serious illness across causes of death and other factors. Chi-squared tests were used to examine the frequency of GOC conversations by key factors.

Results: Two hundred thirteen patients met study inclusion criteria and 88% of patients met criteria for neonatal serious illness within 48 hours of life (Table 1). There were no significant differences in transition to serious illness between preterm and term infants (Table 2). Time to diagnosis of serious illness was significantly different across causes of death. There were significant differences in the frequency of GOC conversations by cause of death with fewer GOC conversations documented for infants whose cause of death was ‘extreme prematurity’ (p=0.001), and significantly more documented when the cause of death was ‘complex congenital heart disease’ (p=0.028) or ‘neurologic catastrophe’ (p=0.02). Although nearly half the study cohort transitioned to comfort care at end-of-life, significantly fewer full term than preterm infants were transitioned to comfort care at end-of-life (Table 3). Palliative care was consulted for only 5.7% of patients.

Conclusion(s):

All patients met criteria for serious illness prior to death based on our definition. This definition may be useful for identifying neonates with serious illness in time to provide support including palliative care consultation. Additional work is needed to apply this definition prospectively to explore its utility for clinical care and research.