Kangaroo Cuddle Transport for Neonatal Palliative Care: A Service Evaluation.

Abstract

Background: Newborn infants represent a significant percentage of childhood deaths (>60%) with over 90% of newborn end-of-life care taking place in an acute hospital setting. This is in direct contrast to adults and children where specialised hospital or hospice care is used during their palliative care experience. To support family choice, a neonatal retrieval service developed a new model of care to transfer babies from a hospital to a hospice, a hospital closer to home or a private residence for palliative care while being cuddled by a parent.

Aim: Identify and evaluate (i) service workflows, (ii) clinical characteristics of babies, (iii) safe and effective experiences, (iv) processes required and (v) personnel for kangaroo cuddle transport for end-of-life care.

Study design: Service evaluation utilising the Plan-Do-Study-Act (PDSA) cycle with outcomes grouped in five pragmatic domains: (i) workflow establishment, (ii) service population (clinical characteristics), (iii) safe and effective experiences, (iv) process and equipment and (v) personnel. Safety measures were assessed with individual PDSA cycles after each transfer, including referring and receiving service acceptability. Outcomes were reported in descriptive frequency.

Results: Of 21 cases, 13 families elected to cuddle for transfer. Most neonates were term gestation (n = 9, 69%) and were greater than 1200 g (n = 13, 100%). Care provided included Paediatric Acute Resuscitation Plans (100%), mechanical ventilation (n = 7, 54%), oxygen supplementation (n = 4, 31%) and subcutaneous vascular access devices (n = 9, 69%). No adverse events occurred. Qualitative staff feedback was universally positive. Median preparation time was 0.5 h (range: 0.25-1.4), and transport time was 4 h (range: 2.75-12).

Conclusions: Babies being transferred for palliative care can be safely managed while receiving kangaroo cuddle, with the support of an experienced neonatal transfer team.

Relevance to clinical practice: This model of transport demonstrates an effective and meaningful additional service for neonatal patients requiring end-of-life care. Further evaluation is required for more preterm neonates, as transport and service requirements may be increasingly complex for this population.