Soins palliatifs aux nouveau-nés : une réponse aux questions posées par le diagnostic anténatal ?

In France during the last 30 years, termination of pregnancy was largely used in women bearing a severely ill fetus. In the recent years, a new parental demand appeared in prolonging the pregnancy to term, meeting the baby and providing palliative care after birth. Most parents think that the baby will die soon after birth and caregivers must point out the fact that this may take time as neonatal euthanasia is forbidden in France. The only legal way of caring for these babies is to develop a palliative care program aiming at bonding and creating meaning and memories. A frank and open discussion must take place between parents, obstetricians and neonatologists to make the expected condition of the baby as clear as possible. Therefore, parents have to cope with uncertainty of the expected length and comfort of life. The creation of a birth plan, including term and mode of delivery may help. A “comfort care only” procedure should be designed avoiding futile care, venous access and artificial nutrition. Nevertheless intravenous medications may sometimes be beneficial for pain relief. This would determine the localization of the baby as intravenous procedures are more commonly managed in neonatal wards than in maternity wards or at home. For babies who are able to go back home, the intervention of a specialized palliative care network would be of great help.