Transitions from Curative Efforts for Neonates

Over the past few weeks, I seem to have collected quite a pile of recent articles on end-of-life decision making for neonates.  I will briefly blog about each separately.  

In Advances in Neonatal Care, Anita Catlin identifies several barriers to the process of providing palliative care for infants with lethal conditions.  At the top of the list are parents and parental hopes.  But, just as frequently as parents, physician colleagues are also perceived as a barrier when they are unwilling to accept that the infant was dying.  

When technological support was futile but parents did not agree to transition of care, nearly half of providers said they would do whatever the parents wished.  Indeed, many providers continued all sorts of treatments that they thought inappropriate, explaining "we need to stand up," we need courage."  Catlin recommends an automatic palliative care consult for anyone admitted to an ICU -- a proposal that is increasingly made and even implemented across the US.