Table of Contents

HK J Paediatr (New Series)
Vol 9. No. 2, 2004

HK J Paediatr (New Series) 2004;9:138-143

Occasional Survey

End of Life Decision and Care in Neonatal Care Unit

MSC Wong, BCC Lam


Purpose: To identify the different causes of neonatal death and the proportion preceded by end of life decision. To review the end of life practice including consensus building, comfort care program, bereavement support and autopsy in our neonatal unit. Methods: A retrospective chart review on infants died in the neonatal care unit in Queen Mary Hospital in the period between July 1998 to October 2002. Findings: During the study period, there were a total of 793 neonatal intensive care admissions with 40 deaths. Among these 40 death cases, 28 (70%) deaths were preceded by end of life decision with futile treatment (54%) and poor quality of life (46%) as the motives. The end of life decision was followed by withdrawal and withholding support in 43% and 57% respectively. Sixty-eight percent of end of life group received opioid analgesia for pain relief, sedation or respiratory distress. The median time between withdrawal and death was 2.75 hours (range from 3 minutes to 28 hours). Forty-five percent of our patients had postmortem or paramortem examination. Conclusion: With advancement of neonatal intensive care technology, similar to most modern neonatal intensive care units, majority of our neonatal deaths were preceded by end of life decision. The decision was mostly based on futility of treatment or quality of life issues. Consensus building within the management team and parental involvement is of utmost importance. Adequate analgesia and comprehensive care including comfort care, provision of private environment, family and bereavement support are essential.

目的:探討新生兒死亡的各種不同病因,以及死亡前臨終決定病兒的比例。回顧在我們瑪麗醫院新生兒病房包括醫生患者建立共識、舒適護理、喪親者心理支持和屍體檢查在內的臨終護理施行的情況。方法:將瑪麗醫院新生兒病房 1998 年 7 月至 2002 年 10 月期間死亡的病例進行回顧性列表分析。結果:在研究期間,共有 793 例病兒收住新生兒重症監護病房,其中 40 例死亡。在這 40 例死亡病兒中,死亡前臨終決定的病兒有 28 例(70%),其動機主要是基於醫療無效(54%)或生存質量差( 46%)。臨終決定後,分別對 43% 和 57% 的病兒採取了終止或維持生命支持。在這些病兒中,68% 的病例為了緩解疼痛、鎮靜或緩解呼吸窘迫而使用了類阿片藥物治療。從終止生命支持至最終死亡之間的時間間隔的中位數是 2.75 小時(從 3 分鐘到 28 小時不等)。45% 的病例進行驗屍。結論:隨著新生兒重症監護技術的不斷進展,和許多現代的新生兒監護病房一樣,瑪麗醫院新生兒重症監護病房的多數新生兒死亡病例在臨終前實施了臨終決定。做出這一決定的原因多數是由於醫療無效或生存質量的問題。醫療小組和病兒家長之間達成一致的意見尤其重要。足夠的止痛治療,以及舒適護理、為家長提供和病兒獨處的環境、家庭其他成員的安慰和喪親後的心理支持等多方面的措施是實施臨終護理的關鍵。

Keyword : Analgesia; End of life decision; Neonates



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