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Advance care planning: outpatient antenatal palliative care consultation
  1. Brian Scott Carter
  1. Correspondence to Dr Brian Scott Carter, Department of Neonatology, Children's Mercy Hospital, Kansas City, MO 64108, USA; bscarter{at}cmh.edu

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Kukora and colleagues1 report on their single centre study of antenatal palliative care consultation (APCC) and reveal that this practice—though applied in a limited number of cases—contributed to a greater use of postnatal palliative/comfort care regimens. Additionally, while not altering the ultimate outcome for referred fetuses/neonates, those who received APCC often died after a shorter in-hospital course. What are we to think of such a practice? How can APCC improve patient, family and staff experiences when a grievous outcome is anticipated?

Perinatal and neonatal palliative care has received increasing attention in the last 15 years.2 Yet a persistent matter of concern for many physicians has been ‘When should I get a palliative care consult?’ Paediatricians have been reported to equate palliative care with hospice care and make referrals late.3 Neonatologists may employ palliative care precepts and accept the provision of comfort care after birth, but little has been provided from the neonatology community to denote when, and why, prenatal palliative care consultation (APCC) might prove helpful. Neonatologists, after all, will attend the delivery and perform the resuscitation, stabilise the infant and initiate supportive intensive care in the neonatal intensive care unit (NICU). In one study, the seemingly obvious value of a neonatologist's perspective in prenatal consultation for pregnancies affected by fetal malformations was clarified when investigators sought parental perspectives both before and after delivery.4 Parents …

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