Reorientación del esfuerzo terapéutico en neonatos al final de la vida: una revisión de alcance

Abstract

Background: Reorientation of therapeutic efforts seeks to provide comfort measures to patients and relatives during the end of life stage; however, there are no standardized guidelines or protocols to guide health professionals in the management they should follow when the end of life situation involves newborns. Methods: This review included all types of methodological approaches. Quality of evidence was graded with GRADEpro GDT. Results: Following the Joanna Briggs Institute (JBI) methodology, 104 articles were included. 75% of these were observational studies, 20.2% were literature, narrative, and bibliographic reviews, 1.9% were systematic reviews, 1.9% were clinical practice guidelines, and 1% were an expert panel. All evidence were grouped into 12 domains: Communication, comfort, monitoring, fluids and nutrition, decision-making, place of care, spiritual support, social support, grief support, emotional and psychological support, autopsy and donation, and education and quality. 46.9% of these recommendations were graded as low quality and 53.1% very low quality. Discussion: Research on end-of-life care for neonates was focused on key elements in all categories reviewed. However, some gaps were detected, such as the limitation about the dosage of some medications used in this management, in addition, there was a poor information about what type of nutrition and in which cases it should be started in these neonates, especially about parenteral feeding and hydration.