What Pediatric Palliative Care Offers to Pediatric Surgeons

jpedsurg.org

Imagine caring for Harmony, a mono–mono twin girl born emergently via C-section at 30 weeks gestation. Prenatal work-up suggested an anorectal malformation and cystic pelvic kidneys. At delivery, she was found to have a cloaca and non-functioning kidneys; she had survived in utero because her twin had effectively acted as her dialysis machine. The pediatric surgery team was consulted to consider colostomy and hemodialysis line placement – a technical feat in this 1.2 kg baby. How might you guide this family through decision-making that aligns with their goals and values?

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Article · Dec 2024 · 1 min read

In brief

This article explores how pediatric palliative care supports surgical teams in managing complex neonatal cases with life-limiting conditions. Using a case of a premature twin with cloacal malformation and renal failure, it demonstrates approaches to family-centered decision-making that align medical interventions with patient values and quality of life goals.

Mono-mono twins can share physiologic functions in utero; one twin may compensate for another's organ failure until delivery.
Complex congenital anomalies (cloaca, renal agenesis) require early multidisciplinary discussion of surgical feasibility and prognosis.
Pediatric palliative care helps families navigate goal-concordant decisions when technical intervention may not align with quality of life.
Extremely low birth weight (<1.5 kg) adds surgical risk; consider whether aggressive intervention serves the patient's best interest.
Shared decision-making in neonatal surgery must balance parental values, clinical realities, and the infant's projected suffering.

Written by the GCMD Library team from the article.

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