engleski

Clinical content of guidelines for end-of-life decision-making in pediatric and neonatal intensive care units: a systematic review

The aim of this study was to search for all available reviews, guidelines and analyses and make a literature overview and comparison between countries as a corner stone for a further research with a goal of making our national pediatric and neonatal end-of-life guidelines. We conducted a literature search in February 2018 and in September 2019 in bibliographic databases and grey literature sources for the time period from 1990 to 2019. Search strategies in were conducted using MeSH terms and keywords related to ‘pediatric’, ‘neonatal’, ’ guidelines’, ‘end of life’, ‘palliative care’ and ‘intensive care unit’ terms. Only documents satisfying all of the inclusion and exclusion criteria were included in the review. This resulted in 11 eligible documents. Most of the articles, eight of them are focused on neonatal issues and only three mention specificity of pediatric problems. Among all articles five are general guidelines with examples of diagnosis, five have week by week algorithm and classification of neonatal interventions and three have obstetrical algorithms of prenatal interventions, one article talks about perinatal prognostic factors, four about starting provisional intensive care and reassessment when in doubtful cases, six have a list of clinical procedures in end-of-life decisions, four articles point out a prevalence of neurological impairment after survival as a relevant clinical factor in future end-of-life decisions, four tackle with question of active euthanasia, two recommend palliative care after forgoing life-sustaining treatment with examples of diagnosis, three distinguish different modes of forgoing life- sustaining treatment and two mention organ donation after death. Clinical guidelines on EOLD are intended as a general framework to help all decision-making parties, but because of uniqueness of every physician, parent, child, diagnosis and underlaying background there are still grey zones that tackle with ethical issues and individual decisions outside the guidelines are always possible.

clinical content ; guidelines ; pediatric ICUs

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