Creation of a neonatal end-of-life palliative care protocol

J Perinatol. 2002 Apr-May;22(3):184-95. doi: 10.1038/


Objective: To create a protocol delineating the needs of patients, families, and staff necessary to provide a pain-free, dignified, family-, and staff-supported death for newborns who cannot benefit from intensive, life-extending, technological support.

Study design: Using Internet e-mail, a Delphi study with sequential questionnaires soliciting participant response, investigator analysis, and follow-up responses from participants was conducted to build a consensus document. Institutional review was granted and respondents gave consent. Recruitment was conducted at medical, ethics, nursing, and multidisciplinary organization meetings. Synthesis of 16 palliative care/end-of-life protocols developed by regional, institutional, and parent organizations was included. Participants from 93 locations in the US and 4 abroad gave feedback to 13 questions derived from clinical experience and the literature. The data underwent four rounds of analysis with 95% retention of the 101 participants over an 18-month period.

Results/conclusion: Specific consensus-based recommendations are presented with a description of palliative care; categories of candidates; planning and education needed to begin palliative care services; relationships between community and tertiary centers; components of optimally supported neonatal death; family care, including cultural, spiritual, and practical needs; ventilator withdrawal, including pain and symptom management; recommendations when death does not occur after cessation of life-extending interventions; family follow-up care; and necessary ongoing staff support.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Protocols*
  • Counseling
  • Culture
  • Delphi Technique
  • Empathy
  • Euthanasia, Passive / psychology
  • Family / ethnology
  • Family / psychology
  • Humans
  • Infant, Newborn
  • Internet
  • Neonatology / standards*
  • Palliative Care / standards*
  • Professional-Family Relations
  • Social Support
  • Surveys and Questionnaires
  • Terminal Care / standards*
  • Tissue and Organ Procurement
  • United States
  • Ventilator Weaning