Pastel Red Illustration Why Babies Cry Infographic

WENDY CORDOBA-NATALIA
GUALTEROS-LEIDY PERDOMO
End-of-Life
Management in the
Neonatal ICU
WHAT IS THE FINAL STAGE OF A
1
NEWBORN?
It occurs in the first four weeks of life; this in turn is
subdivided into early, when death occurs in the first
7 days of life and late when it occurs between 7 and
28 days.
Diagnostic Methods
2 Health professionals use a

combination of methods to confirm
the death of a newborn:
1. Direct observation: The

presence of breathing,
pulse, and muscle
movements is assessed.
2. Cardiac auscultation: A
stethoscope is used to listen to
the heartbeat.
3.Electrocardiogram (ECG):
Records the electrical activity of
the heart.
4. Laboratory tests: Blood tests

may be performed to confirm
death and look for possible
causes
Why is an accurate diagnosis important?

An accurate diagnosis of the death of a newborn is essential for:
Providing support to the family: It allows parents to begin the grieving
process.
Investigating the causes: It helps to identify possible risk factors and prevent
future deaths.
cita https://www.msdmanuals.com/es-co/professional/pediatr%C3%ADa/infecciones-en-reci%C3%A9n-
nacidos/sepsis-neonatal
End-of-Life
Management in the
Neonatal ICU
SIGNS AND SYMPTOMS
INeonatal death is a devastating loss and,
unfortunately, can occur for a variety of reasons. It is
important to note that there are not always clear
and obvious signs
3
Early signs
1. Decreased fetal movement
2. Changes in breathing pattern
3. Decreased heart rate
4. Changes in skin color (pale, bluish, or grayish)
5. Decreased body temperature
Late signs
1. Absence of movement
2. Absence of breathing
3. Absence of pulse
4. Very pale or bluish skin color
5. Muscle rigidity
Symptoms at the time of death

1. Cardiac arrest
2. Respiratory arrest
3. Decreased body temperature
4. Muscle relaxation
5. Changes in facial expression
Common causes of neonatal death
4
1. Prematurity
2. Respiratory disease
3. Infection
4. Congenital abnormalities
5. Birth trauma
6. Perinatal asphyxia
7. Sudden infant death syndrome
(SIDS)
cita https://www.msdmanuals.com/es-co/professional/pediatr%C3%ADa/infecciones-en-reci%C3%A9n-
nacidos/sepsis-neonatal
End-of-Life
Management in the
Neonatal ICU
CARES AND SUPPORT

Comforting Techniques: Techniques such as
swaddling, skin-to-skin contact (kangaroo care),
and non-nutritive sucking (using a pacifier) can
help soothe infants and reduce perceived pain
during procedures
Topical Anesthetics: Local analgesic can be

effective for specific procedures, helping to
minimize pain at the site of intervention
Comfortable Environment: Families can request

adjustments to the ICU environment to make it
more peaceful, such as reducing noise and allowing
personal items to be brought in, which can help
create a more comforting atmosphere
Opioid Analgesics: Acetaminophen and ibuprofen

can be utilized for mild to moderate pain relief.
However, their efficacy in neonates is still under
investigation, and they should be used cautiously
Parental Involvement: Engaging parents in the care

process can provide emotional support for the infant.
Parents can participate in comforting techniques,
which can enhance the infant's sense of security and
reduce stress levels
Open Communication: Establishing clear and

compassionate communication between healthcare
providers and families is crucial. This allows parents
to make informed decisions about their infant's care
Tomado de: https://www.msdmanuals.com/es-co/professional/pediatr%C3%ADa/infecciones-en-reci%C3%A9n-nacidos/sepsis-neonatal

https://www.sands.org.uk/sites/default/files/Neonatal_Care_And_End_Of_Life_March_2023.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254489/
End-of-Life
Management in the
Neonatal ICU
DECISIONS AND OPTIONS
if the treatment is not useful for the preservation of life
and only serves to prolong the dying process, modulation of
the therapeutic intensity should be undertaken.
Since the newborn does not have the capacity to decide, it is the
parents or guardians acting on their behalf and the professionals
responsible for their care who decide for them based on the
responsibility to protect their welfare according to the “best
interest” or “best benefit” criterion.
Withdrawal of Life-Sustaining Treatments: In many cases,

families may choose to withdraw aggressive life-sustaining
treatments such as mechanical ventilation, inotropes, or invasive
procedures. This decision is often based on the prognosis of the
infant's condition and the desire to prevent further suffering
Withdrawal of mechanical ventilation: Withdrawal of mechanical

ventilation is considered a form of suspension of a treatment that, by
failing to achieve the recovery of a patient or his disease, has become
a way of prolonging life in precarious conditions.
Flexible Visiting Policies: Allowing family members to visit

and spend time with the baby as needed can provide
emotional support. This may include extended family
members, ensuring they can say goodbye in a manner
that feels right for them
Spiritual Support: If desired, families can be connected

with chaplains or spiritual leaders, respecting the family's
religious or spiritual beliefs
The family has to accomplish the whole

process in order to understand what is
happening to their baby and why the
profesionals are making those procedures
Tomado de: https://www-sciencedirect-com.proxy.bidig.areandina.edu.co/science/article/abs/pii/S1695403312003396

https://bdigital.uncu.edu.ar/objetos_digitales/8471/02-grzonarmu4-08.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10943284/
End-of-Life
Management in the
Neonatal ICU
emotional support: We explain to them that it is healthy to
allow themselves to cry, share their emotions with other trusted
people or with other affected couples, and give themselves
space and time to accept the thoughts, emotions, and reactions
that appear.
Manifestaciones frecuentes:
Emocionales:
Físicas:
Cognitivas:
perceptivas :
conductuales:
1PROCESSES OF THE MOTHER

. GOODBYE TO THE BABY AND CREATE MEMORIES
2. ATTEND SUPPORT GROUPS
3. COUNT AND EXPRESS LOSS
4. EVALUATION BY PSYCHOLOGY
conlcussion The final stage of a newborn, which

manifests itself during the first four weeks of life, is
subdivided into two crucial phases: the early phase, the
late phase, the final stage of a newborn and the correct
confirmation of its death require a comprehensive
approach that combines diagnostic accuracy,
understanding of common causes of neonatal death, and
appropriate emotional and physical support for both the
baby and his or her family. Effective implementation of
these practices can improve neonatal care and provide
valuable support at critical times.
Cómo superar la muerte de un hijo en el embarazo o poco después de nacer. (s/f). inatal - El embarazo semana a
semana. Recuperado el 16 de septiembre de 2024, de https://inatal.org/noticias/reportajes/578-como-superar-la-
muerte-de-un-hijo-en-el-embarazo-o-poco-despues-de-nacer.html
Duelo perinatal: fallecimiento de mi bebé. (s/f). Blogs Quirónsalud. Recuperado el 16 de septiembre de 2024, de
https://www.quironsalud.com/blogs/es/psicologia-salud/duelo-perinatal-fallecimiento-bebe

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WENDY CORDOBA-NATALIA

2 Health professionals use a

1. Direct observation: The

4. Laboratory tests: Blood tests

Why is an accurate diagnosis important?

Symptoms at the time of death

Common causes of neonatal death

CARES AND SUPPORT

Topical Anesthetics: Local analgesic can be

Comfortable Environment: Families can request

Opioid Analgesics: Acetaminophen and ibuprofen

Parental Involvement: Engaging parents in the care

Open Communication: Establishing clear and

Tomado de: https://www.msdmanuals.com/es-co/professional/pediatr%C3%ADa/infecciones-en-reci%C3%A9n-nacidos/sepsis-neonatal

Withdrawal of Life-Sustaining Treatments: In many cases,

Withdrawal of mechanical ventilation: Withdrawal of mechanical

Flexible Visiting Policies: Allowing family members to visit

Spiritual Support: If desired, families can be connected

The family has to accomplish the whole

Tomado de: https://www-sciencedirect-com.proxy.bidig.areandina.edu.co/science/article/abs/pii/S1695403312003396

1PROCESSES OF THE MOTHER

conlcussion The final stage of a newborn, which

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