The impact of a perinatal palliative care on length of stay, ICU days and invasive procedures

Abstract

Objectives * Describe the history, epidemiology, and role of perinatal palliative care. * Examine the impact of perinatal palliative care on neonatal outcomes at the University of Minnesota. * Explore the potential benefits of perinatal palliative care for the infant, the parent, and the healthcare system. Original Research Background. The Perinatal Palliative Care Program (PPCP) at the University of Minnesota is a multidisciplinary program involving maternalfetal medicine, neonatology, genetics and social work. This team coordinates palliative care services for families whose infants have prenatally diagnosed lifelimiting conditions. Research Objectives. The aim of this study was to investigate the impact of perinatal palliative care planning on care provided for infants born with a life-limiting condition. We hypothesized that perinatal palliative care planning would decrease length of stay (LOS), number of neonatal intensive care unit (NICU) days, and number of invasive procedures. Methods. This was a retrospective chart review of infants with life-limiting conditions treated from 1/01/ 11-9/30/14. Infants were identified through PPCP records and NICU death records. Descriptive statistics were used to describe the patient populations, continuous data was analyzed using the Mann-Whitney U test, and categorical data were analyzed with Fischer’s exact test. Results. Twenty-seven infants were identified, 18 in the PPCP cohort and 9 in the No PPCP cohort. Infants with an active palliative care plan at birth had a statistically significant decrease in number of NICU days (p=0.001), invasive procedures performed (p=0.0008), CPR (p=0.002) and resuscitation medication administration (p=0.008). Conclusion. Perinatal palliative care is a relatively recent concept in the field of palliative care medicine. This study provides novel data that a perinatal palliative care program can alter interaction with the healthcare system after birth for newborns with life-limiting conditions. Implications for Research, Policy, and Practice. Given the alteration in interaction with the medical system after birth, perinatal palliative care planning may lead to a decreased stress burden on families, caregivers and the infant. Additionally, perinatal palliative care planning may decrease cost of care for these infants. Future research involving families and caregivers would be informative.