Abstract 187

Comfort care measures have long been provided for newborns who have been assessed to be beyond any perceived benefit of continued intensive care in the Neonatal Intensive Care Unit (NICU). While such measures may seem self evident, in fact they are poorly delineated and described in the literature. Instruction for trainees is variable, depending on their encounters with infants warranting such care, specific family interactions and attending physician role-modeling. The object of this project was to develop rational and clinically practical guidelines for staff and trainees which could be consistently applied in practice. The need for criteria to provide hospice measures was recognized in our institution in order to: a) support families, b) demonstrate respect for the fetus/newborn, and c) educate and support OB-GYN and NICU staff and trainees. The methodology used to derive these hospice care guidelines was consensus building and stepwise reassessment over a sixteen month period. Participants included an interdisciplinary staff from perinatal medicine, nursing, social work, chaplaincy, administration, and legal counsel. The resultant guideline is directed towards three categories of patients: extreme prematurity and extreme LBW (≤23 wks and <500gm), lethal birth anomalies (e.g. anencephaly, Potter's syndrome, thanatophoric dwarfism, Tris 18), and those newborns with overwhelming illness who have exceeded the benefit of intensive care and for whom life support or sustaining measures are being withdrawn in the NICU. The guideline addresses staff and family steps/measures to be addressed. Parental input into withholding or withdrawal of support decisions is called for in all cases. The guideline has been in effect for one year. Hospice measures have been employed for ten newborns, representing all three categories. Staff have received the guidelines well; families deal with such circumstances with great variation; trainees remark that the consistency such guidelines offer help them deal with an "uncomfortable" and difficult situation.