Published in:
01-03-2016 | Original Article
Experiences in palliative home care of infants with life-limiting conditions
Authors:
Michaela Kuhlen, Jessica I. Höll, Hemmen Sabir, Arndt Borkhardt, Gisela Janßen
Published in:
European Journal of Pediatrics
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Issue 3/2016
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Abstract
The aim of this study was to determine the distinct issues neonates/infants with life-limiting conditions and their families face during palliative home care and to enable physicians/caregivers to carefully address their needs. Data on home-based palliative care of all neonates and infants, who were being taken care of by our paediatric palliative care team between 2007 and 2014, was analysed. A total of 31 patients (pts) were analysed. The majority of patients (n = 17) were diagnosed with congenital malformations or chromosomal abnormalities. Twenty pts died, five of them in hospital. A high percentage of pts presented with swallowing incoordination (83.9 %) and was fed either by nasogastric tube or percutaneous endoscopic gastrostomy. Of the pts, 71.0 % were treated with analgesics, 45.2 % were oxygen dependent, and 9.7 % required mechanical ventilation. Highest mortality was seen in pts with perinatal complications (75 %). In four (12.9 %) pts, palliative home care could come to an end as their conditions substantially improved.
Conclusions: Palliative treatment of neonates/very young infants with terminal conditions at home seems to be similar to that of older children and feasible in children even with unstable conditions. The spectrum of diagnoses, signs and symptoms varies from older children with swallowing incoordination and artificial nutrition being of particular importance.
What is Known:
• Only very limited data on home-based palliative care in neonates and young infants exist; data from Germany are still completely lacking.
• A recent Polish study showed neurological symptoms and dysphagia being the most common clinical problems of infants in a palliative home care setting.
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What is New:
• Perinatal home-based palliative care can similarly to older children be offered to neonates and infants with life-limiting diseases and unstable conditions.
• Artificial nutrition and PEG tube placement is of particular psychological importance for parents but should be thoroughly discussed in each individual case.
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