Medications to manage infant pain, distress and end-of-life symptoms in the immediate postpartum period

ABSTRACT

Introduction

Perinatal palliative care (PnPC) is a growing field where healthcare providers from multiple disciplines are supporting families and providing holistic care for their babies with life-limiting illnesses. It is important to have an approach that includes the standardized management of end-of-life symptoms that are anticipated around the time of birth.

Areas covered

A need was identified to develop medication orders for the initial pharmacological management of symptoms at end-of-life for infants with life-limiting conditions intended for use outside of an intensive care setting. The choice of medications was based on a review of the literature, discussion with content experts and guided by their ease of use, accessibility and noninvasive route of delivery. The recommendations can be used as a guide for the initial management of common symptoms encountered in perinatal palliative care.

Expert opinion

There are studies looking at many qualitative aspects of perinatal palliative care including perceptions of care, decision-making, and bereavement; however, few specifically focus on symptom management in the delivery room and postpartum ward settings. There is a need for standardization of the medical management of infants born with life-limiting conditions whose parents choose to pursue palliative care.

KEYWORDS:

• Comfort care
• life-limiting condition
• medications
• palliative care
• perinatal palliative care
• symptom management

Article highlights

• Perinatal Palliative Care (PnPC) is increasingly becoming recognized as part of the holistic care provided during pregnancy, birth and postnatally to infants diagnosed with a life-limiting condition and their families and focuses on maximizing quality of life and comfort, regardless of the length of perinatal survival.

• There is evidence of an important knowledge gap for management of end-of-life in this population.

• The paucity of peer-reviewed articles regarding the specific pharmacologic management of PnPC designed for use outside of intensive care settings, calls for the standardization of medical management of infants who need perinatal palliative care.

• Administration of medications via non-invasive routes is very well tolerated with little to no side effects in this fragile population and works best when combined with comfort measures such as skin-to-skin care provided by the families.

• Therapeutic weight-based titration of opioids and non-opioids for newborns, including those with extremely low birth weights, is an indispensable tool to help clinicians provide high-quality palliative care.

Acknowledgments

We would like to thank Dr. Mireille Guillot, for her collaboration in reviewing part of the literature and drafting the first version of the medication table. The authors would also like to give thanks to Drs. Gerri Frager and Marie-Claude Gregoire for sharing their end-of-life medication expertise developed at the IWK Health Centre in Halifax, Nova Scotia, Canada.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.