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.