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Neonatal-Perinatal Health Care Delivery: Practices and Procedures

Neonatal-Perinatal Health Care Delivery 2: Practices: Monitoring, Devices, Respiratory Care

743 - Provider Perception of Care at the End of Life in a Quaternary Neonatal Intensive Care Unit

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 743
Publication Number: 743.245

Lauren Imai, Childrens Colorado Hospital, Denver, CO, United States; Brennan JH. Kim, Seattle Children's/University of Washington, Seattle, WA, United States; Megan Gray, University of Washington School of Medicine, Seattle, WA, United States; Allison N. Lyle, University of Washington School of Medicine, Renton, WA, United States; Amber Bock, Seattle Children's, Seattle, WA, United States; Elliott Weiss, University of Washington, Seattle, WA, United States

Presenting Author(s)

BK

Brennan JH Kim, MD (she/her/hers)

Neonatal Fellow
Seattle Children's/University of Washington
Seattle, Washington, United States

Background: Care for neonates at the end of life is often challenging, performed less well than hoped, and requires an experienced and compassionate provider. Much literature exists on adult and pediatric end of life care, but limited studies examine the neonatal process.

Objective: We aimed to describe the experiences of clinicians around end-of-life care in a single quaternary neonatal intensive care unit as we implemented a standard guideline, using a modified survey developed to assess end of life experiences in the pediatric ICU.

Design/Methods: We developed an end of life guideline using literature and through discussion with a multi-site, multidisciplinary team. Care members for patients who died at a single quaternary care NICU were surveyed using the PICU-QODD-20 survey instrument with additional questions regarding guideline satisfaction and demographics. Care members were surveyed both before and after the implementation of the guideline to evaluate end of life care in this quarternary care NICU and the impact of guideline implementation.

Results: Our surveys were completed by 115 providers (neonatologist, fellows, residents, and nurses) caring for 18 infants at the end of life. We did not find meaningful differences before compared to after implementation of our guidelines, however many staff reported not being aware of or using the guidelines. We did find key areas of lower scores around end-of-life care, including management of non-pain symptoms, parent preparation for death, clear presentation of information, and response to conflicts.

Conclusion(s): These findings can aid researchers aiming to learn how to best support families of infants dying in the NICU and the members of the medical team. These findings can also guide clinicians creating best practices around neonatal end of life care.