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Original article
Antenatal palliative care consultation: implications for decision-making and perinatal outcomes in a single-centre experience
  1. Stephanie Kukora1,2,
  2. Nathan Gollehon3,
  3. Naomi Laventhal1,2
  1. 1Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Division of Neonatology, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
  1. Correspondence to Dr Stephanie Kukora, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Mott Children's Hospital, University of Michigan Medical Center, 1540 E. Hospital Drive, SPC 4254 Ann Arbor, MI 48109-4254, USA; skukora{at}med.umich.edu

Abstract

Background Some pregnant patients with complex fetal anomalies meet with paediatric palliative care subspecialists prior to delivery, but referral to antenatal palliative care consultation (APCC) is not standard. Little is known about its role in perinatal decision-making.

Methods A single-centre retrospective cohort study was undertaken for patients referred for outpatient antenatal counselling by a neonatologist over a two-and-half-year period. Patients also receiving APCC were compared with infants with similar prognoses who did not. Outcomes assessed included antenatal decision-making, obstetric and neonatal outcomes.

Results 24 (17%) of the 144 referred fetuses received APCC; nearly all had been given the prognoses of ‘non-survivable’ or ‘uncertain, likely poor’. Fetal or neonatal outcome included: fetal demise 5 (21%), in-hospital death 16 (67%) and survival to discharge (DC) 3(12%). 24 fetuses with similarly poor prognoses were not referred, but had similar outcomes: fetal demise 5 (21%), in-hospital death 16 (67%) and survival to DC 3 (12%). Those with APCC were more likely to choose comfort care than those without (67% vs 17%, p<0.01) and those who died in hospital had a shorter time to death than those who did not receive APCC. Less racial diversity was noted in the group receiving APCC. Infants with identified/suspected genetic syndromes were more likely to receive consultation despite similar mortality to the remaining cohort.

Conclusions Long-term outcomes with and without APCC were similar for infants with poor prognoses, though non-survivors with APCC were more likely to have a comfort care plan and shorter time to in-hospital death.

  • Neonatology
  • Ethics
  • Fetal Medicine
  • Palliative Care
  • Congenital Abnorm

https://doi.org/10.1136/archdischild-2016-311027

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    Footnotes

    • Twitter Follow Naomi Laventhal at @NaomiNeoEthics

    • Contributors SK conceptualised the project, reviewed medical records and compiled data, analysed the data, drafted the initial manuscript, reviewed and revised the manuscript and approved the final manuscript as submitted. NG assisted in the project design, reviewed medical records and compiled data, assisted in analysis of the data, reviewed and revised the manuscript and approved the final manuscript as submitted. NL assisted in the project design, assisted in analysis and interpretation of data, reviewed and revised the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Competing interests None declared.

    • Ethics approval University of Michigan eResearch Regulatory Management Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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