Neonatal Palliative Care

A baby deserves to experience and witness life’s beauties. If the mother tragically loses her life during childbirth, it is well worth it.

Infant mortality rate constitutes the death of a baby before their first birthday. Mortality rates around the world differ tremendously with America leading the first world countries at an alarming rate of 6.1 deaths per 1,000 births. Conversely, Finland and Japan secure the last, most desirable position, with deaths totaling 2.3 per 1,000 births, as of 2010. (Ovaska-Few, 2015) In 2014, over 23,000 babies died in the United States. (CDC, 2016) Exploring the mortality rates in America brings light to a dire need for additional interventions and research as to why this developing nation has the highest rate of infant deaths before the age of 1 year old. African Americans face the worst outcomes of infant death compared to whites, Latino, and their Native American peers in North Carolina. (Ovaska-Few, 2015) This paper will explore why African American are the leading race for infant mortality and the steps that health communities need to take to address this devastating occurrence.

Before I started this class I thought palliative care was only used as end of life care, or for when a curative treatment was unavailable or had failed. As we learned about the different models of care, and how they have changed over the years, it became evident that the use of palliative care has changed drastically over the past several decades. In the 1800s to 1900s, palliative care was only used once the patient had reached the dying stage, and only included the patient in this care, not their families1. Before taking this course, this is what I thought of palliative care as well. Since the late 1900s though, palliative care has been used in a more proactive approach. From the moment an individual receives a life threatening illness, palliative care begins. This includes caring for the family of the patient as well. This care increases as the patient’s illness progresses, and even continues for the family after the death of the patient. Learning this has really made an impact on how I would like to work as a

According to Allen et al. (2012), “millions of people with chronic illnesses endure unrelieved pain, uncontrolled physical symptoms and unresolved psychosocial or spiritual problems.” This issue occurs because palliative care is often considered a form of end-of-life care. Palliative care is a treatment that can be used for patients who suffer from chronic illnesses and diseases while receiving curative treatment. (Horowitz, Grambling & Quill, 2014) purposely states the misconceptions of palliative care and advocated for seriously ill patients that education must bring under control the misconceptions. Some patients do not receive appropriate symptom management because the palliative care treatment needed is often confused with end-of-life care. However, end-of-life care attempts to relieve pain and suffering when a disease is no longer responsive to curative treatment. Pain and suffering could ultimately be controlled or even eliminated through the proper utilization of palliative care. Patients who are not referred to palliative care in a timely manner is more likely to have poor quality of life, uncontrolled symptom management and increased amounts of visits to the emergency room during the disease process. Patients with life limiting illnesses bear the burden of increased discomfort and increased suffering. Nurses experience clinical practice issues and difficulties in the clinical setting during the delivery of comfort and symptom management. These issues

 Based on an article written by the “Committee on Early Childhood, Adoption and Dependent” Care draws your attention to the fact that during the first

In 2006, data was collected on 303 babies who were diagnosed with anencephaly and were not terminated. Of those 303 babies, about 40% were born prematurely (before 37 weeks) and 4% beyond 42 weeks. Two-thirds of the mothers were either induced or had a planned cesarean section for those born at term. Polyhydramnios was present in 30% of the cases which accounted for 60% of those born prematurely. When delivered by cesarean section, 4% died during birth, 53% died within twenty-four hours, 30% lived up to five days, and 13% lived longer than six days. For vaginal births, 37% of babies died during birth when a doctor or midwife ruptured the amniotic bag, opposed to 18% if the amniotic bag ruptured naturally.

Summary: This article describes how emotionally and physically challenging stillbirth can be to its victims. Stillbirth which is “the birth of an infant that has died in the womb after having survived through at least the first 28 weeks of pregnancy”, is not only challenging for the mother of the baby, but it affects the whole family as well. Per to this article, stillbirth affects about 1 in 200 pregnancy and that’s in the U.S only, because

What was once believed to be a form of neglect has resulted in a change in practice with the idea that doing less is more. Culture is an important factor in how care is rendered and thus, the limitations of palliative and hospice care lie within the desires of the family and patients. A thorough understanding of our surrounding demographics helps to ensure a seamless approach to providing care without bias or imposition of ones beliefs. However, just as with all things, providing care for the sick and comforting the dying should be rendered in moderation as to prevent the effects of burn out. Likewise, the same effects occur in the caregivers who sacrifice their responsibilities in order to care for their love ones. Finally, and with some closing thoughts, the writer wishes to express with gratitude the benefit of having taken this course to better understand oneself and others in the realm of healthcare. The lessons learned throughout have expanded this writer's knowledge and understanding of the human desire to make a connection through communication, emotion, compassion, and spiritually - the platform from which this writer wishes to continue seeking further knowledge and

Palliative care is a relatively new concept. Palliative care programs have become more numerous and better utilized since 2000 and continue to grow. It is now accepted that the palliative care model is appropriate for patients with life-limiting illnesses. Chan et al. (2013) stated that the ultimate goal of palliative care is to relieve suffering and to maximize the quality of life for dying patients and their families, regardless of the stage of illness or the need for other medical treatments (p. 133). As life-expectancy increases, there is a growing need for these services. People are living longer with chronic diseases and palliative care services can provide an extra layer of support to patients and their families. Evidence has shown that 13% - 36% of hospital inpatients qualify for palliative care services (Robinson, Gott, & Ingleton, 2014).

Infant Mortality Rate (IMR) also known as infant death rate, is the death of an infant before his or her first birthday. Infant mortality is calculated, by the number of children who die under a year of age divided by the number of live births that year. Infant mortality rate is very important as it relates to the health of pregnant women, children and infants and it’s associated with maternal health, quality and access to medical care, socioeconomic conditions, and public health practices. The most important purpose of this review is to examine and understand why African American infants are disproportionately affected and the factors(Low birth weight, preterm birth weight and very low birth weight and infant mortality)

For the past two decades, the limit of gestational viability has been 22-24 weeks (Bhat, Weinberger, & Hanna, 2012). Around 50 years ago, a premature infant born between 22-24 weeks was not considered viable and resuscitation was only considered at 27-28 weeks (Kushchel & Kent, 2011). Medicine and technology advances have improved neonatology drastically and infants are surviving at lower gestational ages. However, many studies show very low survival rates of 22-week neonates and some physician refuse to resuscitate and provide only comfort care. In the NICHD Neonatal Network between 2003 and 2007, infants that were incubated and resuscitated had a 6% survival rate at 22 weeks and a 55% survival rate at 24 weeks (Bhat et al, 2012). Another study followed a hospital for many years were they delivered 85 infants at 22-week

Integrative neonatal palliative care provided by a dedicated interdisciplinary team needs to be part of the continuum of care for patients with complex and/or life limiting conditions. Care teams need expertise in communication, training in palliative care, the ability to provide psychosocial as well as spiritual support and pain management.

According to the parents, physicians mainly focused on the physical symptoms of the child. Most of the psychological symptoms of both the child and the parent were not acknowledged by health professionals (Theunissen et al., 2007). Despite this result, there have been substantial research conducted to create measures that can gauge the quality and effect of palliative care mostly for adults. However, data collected from these studies may be applied to interventions created to help children with cancer.

“Each year in the USA about 500,000 children are coping with life-threatening illnesses” (Huang et al., 2010). The standard of care for children living with life-threatening conditions is vital for these children as well as their families. Palliative care, which is treatment aimed at reducing pain and other symptoms, rather than treatment aimed at a cure, is extremely important early on. An improvement with earlier access to palliative care involves

Late-term abortions are often times the most controversial, because the baby can survive outside the womb. James Elgin Gill was born on May 20, 1987, and he became the earliest baby to ever survive at twenty-one weeks and five days gestation. While most people define viability around twenty-five to twenty-six weeks, one little girl also defied the odds and survived despite her early arrival. Emily Kay Browning was born at twenty-four weeks and she is now four years old. Around 1.3 percent of all abortions occur after twenty-one weeks. These abortions are truly killing babies that could survive in the outside world, and they are legal in twenty-four U.S. states and Washington