Comfort/palliative care guidelines for neonatal practice: Development and implementation in an academic medical center

Objective: To report the multidisciplinary developmental process of a comfort care guideline for the neonatal intensive care unit (NICU) addressing palliative care measures in a tertiary academic medical center. The guideline was developed to be (1) practical, (2) family-centered, (3) respectful of the infant patient, and (4) educational. Methods: A consensus-building process involving medical, nursing, administrative, and ancillary professional staff integral to the NICU and Obstetrics units using naturalistic inquiry. Results: An approved hospital guideline was formulated and implemented over a 16-month period. It described candidates for comfort care, the locale for such care to be rendered, and the construct of essential services to the infant and family. Early reports attest to staff acceptance and it is currently incorporated into trainee education. Conclusion: Clinically practical guidelines, comprehensive in their scope of providing comfort care to newborns with life-limiting conditions, can be institutionally derived and locally implemented for both consistency in patient care and educational value for staff and trainees.