Faculty Bibliography

BACKGROUND:Research evaluating the impact of pediatric palliative care (PPC) consultation on care utilization in the NICU is limited. OBJECTIVES/OBJECTIVE:Describe the impact of PPC on care utilization during admission and end-of-life (EOL). METHODS:Retrospective review of infants who died in a level IV NICU (2014-2024). Mann-Whitney U, Chi-square, and Fisher's exact tests and regression analysis were used to evaluate associations between PPC and medical intensity. RESULTS:65/127 (51.2%) infants received PPC. Infants with PPC had significantly longer lengths of stay (LOS), more subspecialty consultations, more do-not-resuscitate orders (DNR), fewer codes, and differences in mode of death. In regression analyses, PPC predicted higher odds of DNR orders, fewer EOL ICU/surgical interventions and codes at EOL. CONCLUSION/CONCLUSIONS:PPC is associated with longer LOS and more subspecialists throughout admission but lower medical intensity at EOL. Different measures of care utilization may reflect dynamic interactions between PPC consultants and medically complex infants over time.

CONTEXT/BACKGROUND:Pediatric palliative care (PPC) consultation for infants with life-limiting conditions provides parents and caregivers with opportunities to participate in advance care planning, shared decision-making, and to receive appropriate psychosocial and spiritual supports. OBJECTIVES/OBJECTIVE:To evaluate the impact of PPC consultation on spiritual, psychosocial, and communication outcomes for infants that died in the NICU. METHODS:Retrospective chart review of infants who died in a level IV NICU over a 10-year period (2014-2024). Mann-Whitney U and Chi-square or Fisher's exact tests were used to evaluate demographic and medical differences between infants with and without PPC consultation. Regression analyses were used to evaluate the impact of PPC on psychosocial, spiritual, and communication outcomes after adjusting for relevant covariates. RESULTS:There were significant medical and demographic differences between infants with PPC and no PPC consultation. Infants with PPC consultation had significantly higher odds of referral to child life, participation in memory making activities, documentation of family meetings and advance care planning discussions, and a higher incidence rate ratio of NICU social work visits and family meetings during their admission after adjusting for potential confounders. CONCLUSION/CONCLUSIONS:PPC consultation is associated with improved psychosocial, spiritual, and communication support utilization for seriously ill NICU infants and their families.

Management of sepsis in the pediatric patient is guideline driven. The treatment occurs in two phases, the first hour being the most crucial. Initial treatment consists of timely recognition of shock and interventions aimed at supporting cardiac output and oxygen delivery along with administration of antibiotics. The mainstay of treatment for this phase is fluid resuscitation. For patients in whom this intervention does not reverse the shock medications to support blood pressure should be started and respiratory support may be necessary. Differentiation between warm and cold shock and risk factors for adrenal insufficiency will guide further therapy. Beyond the first hour of treatment patients may require intensive care unit care where invasive monitoring may assist with further treatment options should shock not be reversed in the initial hour of care.