Symptom management at the end-of-life is common place for older adults. However, end-of-life symptom management practices for neonates are inconsistent. Many institutions do not have a policy or standard of practice regarding neonatal end-of-life symptom management. Many of the symptoms, particularly seizure activity, can be very distressing for parents to witness. Multidisciplinary collaboration is necessary to improve overall outcomes and eliminate needless suffering. A synthesis of evidence-based neonatal end-of-life symptom management guide can be downloaded here.
Common Neonatal End-of-Life Symptoms
Seizures
Neonatal seizure activity is the most commonly reported distressing end-of-life symptom reported by parents. For adequate pharmacological management of seizure activity, the healthcare team must adopt a proactive approach. While more research is needed in this area, studies have demonstrated the efficacy of buccal/oral lorazepam in managing neonatal seizure activity.
Pain
Historically, neonatal pain is undertreated. Adequate pain control begins with a high-quality pain assessment. Neonatal pain assessment tools are available and should be routinely utilized to enhance pain management. Visit this resource for further information on neonatal pain assessment tools.
Agitation
Agitation is an adverse end-of-life symptom and should be treated to promote quality of life. Agitation should be suspected if parents report increased activity, restlessness, and disturbed sleep. If restlessness or agitation is noted, pharmacological management may be utilized to decrease distress.
Shortness of Air
Subjective signs of increased work of breathing or dyspnea may be reported by parents or observed by the nurse. The nurse may note an increased respiratory rate and/or hypoxia. Pharmacological management of shortness of air may be necessary.
Secretions
Neonates may experience increased secretions at the end-of-life. When increased secretions are noted, active management should be initiated. Oral and sublingual agents are available to manage secretions.