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Neonatal palliative care: a practical checklist approach
  1. Naomi Taylor1,
  2. Yi Fan Liang1 and
  3. Robert Tinnion2
  1. 1 Department of paediatrics, James Cook University Hospital, Middlesbrough, UK
  2. 2 Neonatal department, Royal Victoria Infirmary, Newcastle, UK
  1. Correspondence to Dr Robert Tinnion, Neonatal department, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK; Robert.Tinnion{at}


Objectives Following publication of detailed national neonatal palliative care guidance, practical regional guidance, in the form of multidisciplinary ‘checklists’, was implemented aiming to improve the quality of neonatal palliative care.

Methods Case note audit was used to examine the quality of locally delivered neonatal palliative care before and after regional guidance implementation.

Results 27 patients were allocated to the ‘before’ cohort and 10 to the ‘after’ cohort. Introduction of the checklists was apparently associated with improvements in domains of pain relief and comfort care, monitoring, fluids and nutrition, completion of diagnostics, treatment ceiling decisions, resuscitation status and discussion with parents. Other support for parents was poorly adhered to.

Conclusion Regional guidance improved some aspects of palliative care delivery though other areas remained suboptimal. Other strategies, for example, consultation with paediatric palliative care services, need to be considered to further improve the quality of palliative care delivered to babies with life-limiting illnesses.

  • neonatal
  • paediatrics
  • palliative care

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  • Contributors NT contributed to design of the work, was responsible for data collection, analysis and interpretation and drafting the article. YFL was co-author of the 'checklists' and contributed to revision of the article. RT was responsible for supervision of design of the data collection, data collection, analysis and interpretation; was co-author of the 'checklists' and responsible for revision of the article. All 3 co-authors are responsible for final approval of the version of the article to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This work was done as clinical audit rather than clinical trial. Individual patient data including data dictionaries is not available as this was an anonymised review of quality of clinical documentation. The original audit data collection form will be available on request, as will any of the raw results to anyone who provides a methodologically sound reason to want to view the documentation/data. Requests for either, or regarding access to the study materials for other purposes should be made in writing from the corresponding author within 12 months of publication of the study. The Checklists used are available as online supplements and the most up-to-date version of the Neonatal Comfort Care Bundle designed and used by the Northern Neonatal Network is freely available at