[End of life in neonatology: palliative care integration]

Today the limitation of therapeutic effort and the neonatal palliative care are extremely important and had been increasingly done by several countries. Nevertheless, in Portugal, studies and guidelines regarding end of life attitudes are still a shortage.

We analyzed 49 files in a retrospective review of neonatal deaths between 2010 and 2012; the results were compared with those from a previous study made in the same NICU that included the neonatal deaths of 1992-1995 and 2002-2005.

The results show that congenital anomalies were the cause of death for 57.1% newborns, extreme prematurity for 18.4% and 16.3% died with infection. Regarding to the mode of death, 57.1% of newborns died after cardiopulmonary resuscitation failure, 20.4% after withholding treatment and 22.4% of deaths followed therapy withdrawal. Differences were found between the three groups classified according to the 'mode of death', length of stay and parental presence during death. Therapeutic limitation practices and palliative care were reported in 28.6% of the files and a Do-Not-Resuscitate Order was included in 16.3%. The former two increased during the three periods analyzed. The use of a neonatal pain scale, opioids and sedatives administration, parental presence during death, clinical meetings with neonatologists, interdisciplinary meetings and psychological support for parents also increased.

This study shows a trend towards an increase in therapeutic limitation practices and palliative care in this NICU in the last three decades. However, there is still a lot to do regarding the clinical research, medical education and ethical discussion.