Comfort care for infants in the neonatal intensive care unit at end of life

When the death of a baby becomes inevitable, the greatest priority of care is to provide pain relief and comfort for the dying infant. Physical, environmental, and social needs are derived from assessment and knowledge of the infant's stage of development and the context of the individual infant's experiences within the neonatal intensive care unit. Assessment parameters for pain often rely on physiologic measures at end of life (EOL), whereas comfort is assessed through physiologic/autonomic, motor, and state behavioral cues exhibited by the infant. EOL care is best provided by using an integrated interdisciplinary, palliative approach in partnership with the infant's parents. Although opioids remain central to EOL care, nonpharmacologic measures for pain relief and comfort enhancement may provide additive or synergistic benefits. A case example applies the concepts of comfort care to an extremely preterm infant at EOL.