Palliative Care in the Management of Critically Ill Patients Across the Pediatric Age Spectrum: How, Where, When, Who, and Why?

A Special Issue of Children (ISSN 2227-9067) belonging to the section "Pediatric Anesthesiology, Pain Medicine and Palliative Care".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 594

Editors


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Guest Editor
1. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
2. Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H Lurie Childrens Hospital of Chicago, Chicago, IL 60611, USA
Interests: lymphoma

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Guest Editor
1. Department of Hospice and Palliative Medicine, University of Tennessee Health Science Center, Memphis, TN 38103, USA
2. Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
Interests: pediatric palliative care

Special Issue Information

Dear Colleagues,

Palliative care arose from the modern hospice movement and was originally focused on the care of adults.  However, over the past several decades, there has been a growing body of literature that demonstrates the importance of dedicated pediatric palliative care in children across the age spectrum from prenatal to adolescent and young adults. 

The principles of palliative care include holistic care for patients and families focusing on symptom management, optimizing quality of life, communication, assisting with goals of care establishment, end-of-life care where indicated, and grief and bereavement support.

Palliative care can be described as primary (provided by primary healthcare professionals and basic-to-good practice) and specialty for more complex patient needs.

The palliative care professional can also help address the emotional burden on parents and other caregivers by providing guidance in difficult situations and providing care for the moral distress that often accompanies the management of medically complex patients.

Challenges remain in providing an adequate work force, integration of palliative care, ethical issues and providing equitable care to all patients in need of high-quality, evidence-based palliative care.

Prof. Dr. Elaine R. Morgan
Dr. Michael J. McNeil
Guest Editors

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Keywords

  • palliative care
  • hospice
  • critical illness
  • symptom management
  • quality of life
  • end-of-life care
 

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Published Papers (1 paper)

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Research

13 pages, 407 KB  
Article
Pediatric Palliative Care Utilization Following Out-of-Hospital Cardiac Arrest at a Large US Quaternary Hospital
by Suzanne R. Gouda, Emily J. Upham, Rachel D’Anna, Suzanne E. Dahlberg, Jennifer M. Snaman, Abby R. Rosenberg and Danielle D. DeCourcey
Children 2026, 13(9), 1142; https://doi.org/10.3390/children13091142 - 26 Aug 2026
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Abstract
Background/Objective: Pediatric out-of-hospital cardiac arrest (OHCA) carries high morbidity and mortality, placing immense psychosocial and sudden decision-making burdens on families. Subspecialty pediatric palliative care (SPPC) can provide crucial support for these multifaceted needs, but its utilization and timing in this population remain poorly [...] Read more.
Background/Objective: Pediatric out-of-hospital cardiac arrest (OHCA) carries high morbidity and mortality, placing immense psychosocial and sudden decision-making burdens on families. Subspecialty pediatric palliative care (SPPC) can provide crucial support for these multifaceted needs, but its utilization and timing in this population remain poorly characterized. This study aimed to characterize the current rate, timing, and care domains addressed by SPPC utilization in pediatric patients admitted to the pediatric intensive care unit (PICU) following OHCA. Methods: This was a 13-year retrospective cohort study (2012–2024) conducted at Boston Children’s Hospital, a quaternary academic children’s hospital. This study included 126 patients up to 21 years of age who experienced an OHCA and were admitted to a PICU for at least 24 h. Primary outcomes included the rate of SPPC consultation, timing of the initial consultation, and documented domains of care addressed. Exploratory correlates included patient demographics and clinical factors associated with consultation. Results: Among 126 patients included, 23 (18.3%) received an SPPC consultation. SPPC utilization was significantly higher for Black or African American patients (47% of the SPPC group vs. 9.9% of the non-consult group) and patients with a greater number of pre-existing complex chronic conditions (median: 1 vs. 0). The SPPC cohort had a longer observed median PICU length of stay (22 days vs. 5 days) and hospital length of stay (36 days vs. 6 days) in unadjusted comparisons. The median time from admission to the first SPPC consult was 8 days. When consulted, SPPC addressed goals of care in 96% of cases, medical decision making in 83%, and psychosocial support in 74%. Conclusions: SPPC is not often utilized and is typically introduced later in the illness course during the care of children following OHCA, often associated with patients with prolonged or complex clinical courses. The significant demographic-associated variances in consultation rates highlight the risks of subjective referral practices, underscoring the need for standardized, proactive integration of palliative care to support all families navigating this devastating event. Full article
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