52: Death of an Infant

I. PROBLEM

A newborn infant is dying or has just died. The mortality rate in the United States for newborns is 4.56 per 1000 live births. Recent reviews have focused on the importance of bereavement support and the profound effect health care providers can have on parents who have lost an infant. Studies have shown that a health care provider's insensitivity to a parent can contribute to difficulties in coping and may increase the risk of a complicated grief reaction. Nurses who received training for bereavement care were more likely to have a positive attitude toward perinatal bereavement care. Studies show that more physicians than nurses never received any formal training in bereavement care. Hospitals should establish training and protocols for an infant death so they can potentially decrease the traumatic effects.

II. IMMEDIATE QUESTIONS

1. Has the family been prepared for the death, or was it unexpected? It is important to prepare the family in advance, if possible, for the death of an infant and to be ready to answer questions after the event.

2. Was this an early or late neonatal death? Early neonatal death describes the death of a live-born infant during the first 7 completed days of life. Late neonatal death refers to the death of a live-born infant after 7 but before 28 completed days of life. After 28 days, it is considered an infant death.

3. Which family members are present? Usually, several immediate family members in addition to the parents are present at the hospital, which is good for emotional support. Each of the family members may adopt a special role. The family should be allowed to go through the immediate process of grieving the way they feel most comfortable (eg, on their own, with the chaplain, with their favorite nurse, or with the physician they trust) and in the location they feel most comfortable (eg, the neonatal intensive care unit [NICU] or family conference room). Attention should focus on both parents.

4. If the family members are not present, is a telephone contact available? It is standard practice to ensure there is a contact telephone number available for any sick infant. If the family members are not present, telephone contact must be made as soon as possible to alert the family that their infant is dying or has already passed away. In either case, urge the family to come in and be with their infant.

5. Are there any religious needs expressed by the family? The religious needs must be respected and the necessary support provided (eg, priest, rabbi, chaplain, or pastoral care). Every hospital has pastoral services, and it is useful to inform the chaplain in advance because some parents may request that their child be baptized before death. Remember that a patient's culture or religion may influence the families' decision on how to handle the time of death, autopsy, and funeral.

III. DIFFERENTIAL DIAGNOSIS