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I. PROBLEM

A newborn infant is dying or has just died. Even though the overall infant mortality rate in the United States has improved, >23,000 infants die each year, with >15,000 dying in the neonatal intensive care unit (NICU). The mortality rate in the United States for newborns is 5.82 per 1000 live births. The leading causes of infant death are shown in Table 57–1, with the top 5 being birth defects/congenital malformations, preterm birth and low birthweight, sudden infant death syndrome (SIDS), maternal pregnancy complications, and infant accidents (unintentional injuries).

Some researchers found that parents experience more intense grief reactions for an infant who died in the NICU than earlier pregnancy losses, possibly because of the longer time for a stronger attachment. Studies show that bereaved parents who experience an infant death or stillbirth have an increased mortality for up to 25 years compared to parents who did not experience an infant death or stillbirth. Infants in the NICU are usually very ill, and parents may experience prolonged grief. Many bereaved families lack the necessary support at critical times. Recent studies have focused on the importance of bereavement support and the profound effect healthcare providers can have on parents who have lost an infant. A healthcare provider’s insensitivity to a parent can contribute to difficulties in coping and may increase the risk of a complicated grief reaction. Nurses, who are more likely than physicians to have received bereavement training, are more likely to have a positive attitude in these difficult situations. Hospitals should be encouraged to establish formal training and defined protocols for an infant death to improve everyone’s experience. Good-quality bereavement care decreases the negative psychological, emotional, and social effects for parents. Every bereaved parent is entitled to the best possible care.

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. Be ready and available 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 at <7 days of age. Late neonatal death is the death of a live-born infant at 7 to 27 days of age. A postnatal death is a live birth that results in death at 28 to 364 days. Late neonatal deaths result in more protracted grief reactions than early neonatal deaths.

  3. Which family members are present? Usually, several immediate family members in addition to the parents are present at the hospital, which is usually beneficial 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 NICU or family conference room). Attention should focus on both parents if appropriate.

  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 ...

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