What Pediatric Palliative Care Offers to Pediatric Surgeons

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?