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**12**

**15**

**Chapter 2**

**Abstract**

**1. Introduction**

Care Unit

*Julie Edwards and Suzanne Crowe*

paediatric intensive care environment.

input of palliative care medicine [1].

neurodegenerative disease)

(e.g. malignancy)

Palliative Care of the Infant and

Child in the Paediatric Intensive

*Maeve McAllister, Ann-Marie Crowe, Roisin Ni Charra,* 

In this chapter we discuss the delivery of palliative care in the paediatric intensive care unit environment. Illustrated by challenging cases, we describe the role of intensive care in symptom management for the child with terminal or life-limiting illness. We detail the importance of a multidisciplinary team and their roles in the provision of individualised care for the child and their family. The importance of family-centred care and advance care planning is expanded upon. In addition, we explore end of life issues that are particular to children in intensive care such as withdrawal of life-sustaining therapies and organ donation. Finally, we discuss how to ensure the delivery of high-quality palliative care in the

**Keywords:** Paediatrics, PICU, Palliative Care, Family- centred, Symptom control

Although modern medicine has undoubtedly improved survival among children with life- limiting disease, there remains a substantial requirement for paediatric palliative care. Approximately 21 million children per year need the

their care fall into four patterns of disease progression [2, 3]:

premature death still occurs (e.g. cystic fibrosis)

1.Conditions for which potentially curative treatments have failed

Infants, children and adolescents who may benefit from a palliative approach to

2.Life- limiting conditions for which certain treatments may prolong life, but

3.Conditions for which treatment is almost exclusively palliative but their progression may be slow and protracted (e.g. congenital cardiac defects,

4.Non progressive neurological conditions which result in an increased suscepti-

bility to complications and premature death (e.g. cerebral palsy)
