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CHHSXX/XXX (number will be allocated by Policy Register Manager after final

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Canberra Hospital and Health ServicesClinical Guideline Neonatal Death, Bereavement, Palliative Care and Borderline of ViabilityContents

Contents....................................................................................................................................1

Guideline Statement.................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Perinatal Loss-Management...................................................................................2

Section 2 – Babies at the Borderline of Viability 23+0 – 25+6 Weeks Gestation..........................4

Section 3 – Palliative Care in the Department of Neonatology.................................................5

Section 4 – Perinatal Loss: Clinical and Bereavement Digital Images......................................10

Implementation...................................................................................................................... 12

Related Policies, Procedures, Guidelines and Legislation.......................................................12

References.............................................................................................................................. 13

Search Terms.......................................................................................................................... 14

Attachments............................................................................................................................14

Attachment B – Muscle & Nerve Biopsies...........................................................................14

Attachment A – Neonatal Loss Clinical Pathway.................................................................15

Attachment B – Muscle & Nerve Biopsies...........................................................................19

Attachment C – Borderline of Viability................................................................................21

Attachment D – Instructions on taking clinical photographs...............................................23

Attachment E – CRIS Help sheet - Importing eNotes and Images........................................26

Doc Number Version Issued Review Date Area Responsible Page<xxxxx/xxx> X <XX/XX/XXXX> <XX/XX/XXXX

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register


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Guideline Statement

BackgroundDeath is used to describe the "cessation of life" and may have a devastating impact on all involved including parents, family, friends and staff. The death of a patient and the bereavement process is specific to each family's individual needs and the guideline should be used according to these needs.

Key ObjectiveTo provide a guideline for the management of babies who die in the Department of Neonatology. This includes babies nursed in the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN). To provide staff with information in relation to supporting family members through the bereavement process.

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Scope

This document is applicable to Clinical staff who are working within their scope of practice, including: Medical Officers caring for dying babies in the Department of Neonatology Registered Nurses (RN) and Registered midwives (RM) Allied Heath Staff Student nurses under direct supervision.


Section 1 – Perinatal Loss-Management

This section outlines the management of the baby and family in the period leading up to the baby’s death and the management immediately after death. Follow Perinatal Loss Pathway for documentation of neonatal deaths (see attached

Attachment A) If after hours notify After Hours Nursing Coordinator ext 42560

Documentation:Medical officer to complete: Medical record progress notes documenting clearly the time of death Perinatal loss follow-up arrangements ‘Medical Certificate of Cause of Perinatal Death Form B’ kept in the draw at the

registrar’s desk ‘Request and Permission’ for Post Mortem Examination kept in the draw at registrar’s

desk (consultant to discuss with family). See section 3 for further details re post-mortem





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‘Deceased person’s checklist’ forms kept in the draw at registrar’s desk Permission for cremation form kept in the draw at registrar’s desk Organ donation where applicable (consultant to discuss with family)

Care PlanEnsure the following: An understanding of the baby’s medical situation and that the family also understands

the medical condition The family contact details have been documented correctly Who the family members are and who the parents request to be present at the baby’s

death Family are supported as appropriate with the following:

o Social Worko Chaplaincy page via switch o Aboriginal &Torres Strait Islander Liaison officer o Interpreter serviceso Red nose

Options available to the family include: Creating mementos (photos, plaster casts, handprints and locks of hair – equipment may

be found in the quiet room in NICU) Baptism – contact appropriate religious denomination representative through switch or

the family may prefer to contact their own representative Spending time with their baby (dressing, music, bathing, holding, reading to, time away

from ward, rituals and blessings) Involvement of siblings Following religious and cultural customs ﾠTransfer of baby to mortuary Ensure that the baby has two name tags attached Ensure all relevant paperwork has been completed including provisional discharge

summary Deceased babies are taken to the mortuary by either nursery staff or wardsman Deceased babies may also be placed in the mortuary fridge in the Angel room in Birthing Funeral Directors usually collect the baby from the mortuary, however if the parents

choose, the baby can remain with them until transfer. This can be arranged following discussion with the mortuary staff

Parents are aware that they may view their baby again after transfer to the mortuary





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Discharge and Follow-up Parents are provided with an appointment for review by Obstetricians and

Neonatologists, as well as other appropriate staff, in the perinatal loss clinic or other location as appropriate (usually 6 weeks after the baby’s death).


Section 2 – Babies at the Borderline of Viability 23+0 – 25+6 Weeks Gestation

Borderline of viability refers to those babies born at 23+0 – 25+6 weeks gestation.1. Confirm gestational age 2. Gestational age (if known) is the key determinant as to whether treatment should be

provided.

Note: The following recommendations apply to the otherwise normal fetus. If congenital malformations or other perinatal complications exist then an individual plan will be made between the family and perinatal/neonatal staff

3. Where time allows an antenatal consult will be arranged to allow the parents to be fully informed and will discuss: Mortality morbidity resuscitation palliative care, and later withdrawal of care.

Staff must complete the antenatal counselling form to be included in the medical record.

4. Secondary decision makers include: parity estimated fetal weight antenatal steroid cover magnesium sulphate congenital anomalies perinatal complications including reason for likely preterm birth.

5. If there is no time for a resuscitation plan to be made, then the “presumption of treatment” plan should be followed

6. Below 23+0 (i.e. < 22+6) weeks resuscitation will not be offered or attempted7. Between 23+0 and 23+6 weeks careful consideration is given to the parent’s wishes and

clinical condition to ascertain whether resuscitation is offered at this time, if the parents request this after appropriate counselling





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8. In an otherwise normal baby between 24+0 and 25+6 weeks gestation there is an increasing obligation to treat. However, it is acceptable medical practice not to initiate intensive care if parents do not want this, following appropriate counselling

9. In an otherwise normal baby at >26+0 weeks gestation the obligation to treat is very high and treatment should be initiated unless there are exceptional circumstances

10. The use of adrenaline during cardiopulmonary resuscitation is generally not recommended below 26+0 weeks and is at the discretion of the medical team given the clinical situation at the time

11. Parents should be informed that active treatment usually consists of respiratory support: lung inflation intubation ventilation, and surfactant

12. The resuscitation plan will be clearly documented in the notes on the neonatal consult sheet. In the event a decision differs from the usual recommendations this should clearly be documented in the notes and communicated to all staff

13. Where time allows, a full discussion between two neonatologists is recommended if resuscitation is being considered <24+0 weeks, or non-resuscitation is being considered >25+6 weeks gestation and a consensus should be reached

14. The resuscitation plan should be revised at 1-2 weekly intervals15. When active treatment is planned at 23+0-25+6 weeks: A Neonatologist (Staff Specialist in

addition to Neonatal Fellow/Registrar) should be present at all deliveries <26+0 weeks 16. When active treatment is not planned a Neonatologist/Neonatal Registrar will not

usually attend the birth but may be involved in making an appropriate palliative care plan and be available to provide support and advice to the family and perinatal team where necessary

17. When a baby dies the parents should be offered bereavement counselling including a discussion about post-mortem examination. Referral to social work and chaplaincy for bereavement support should be offered

18. If gestational age is uncertain then fetal ultrasound and fetal weight will be markers of viability. A neonatologist should attend the birth and a decision made in the best interests of the baby whether to initiate active treatment

19. See Attachment C


Section 3 – Palliative Care in the Department of Neonatology

The aim of palliative care is to keep the baby comfortable while dying and to support the parents in caring for their baby according to their wishes and beliefs. Despite advances in neonatal medicine and intensive care there are some situations where, after discussion with their parents, it is decided that the use of intensive or 'extraordinary' care to maintain life is not appropriate. This may involve the withdrawal or limitation of active treatment in favour of a palliative care approach.





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Babies considered for palliative care (this list includes but is not limited to) Babies born extremely prematurely <25 weeks Babies with known Trisomy 18 or 13 and other lethal congenital anomaly Babies with severe perinatal asphyxia Babies with a grade IV intra-ventricular haemorrhage (IVH) Babies with severe cardiac anomaly

BackgroundWhere the diagnosis of a lethal fetal anomaly or extreme prematurity has been made antenatally, discussions may take place with parents before the baby is born. These discussions should include the likely course for the baby after birth and allow planning of Birthing room management.

Parents Must be part of the decision making process Must be given Information in simple language regarding their baby’s condition Must be told how long their baby is expected to survive and available treatments Must be informed of the likely outcome if treatment is continued and how this will

impact on their baby Should be told that all efforts will be undertaken to keep their baby comfortable

Discussion should include: How the baby may die, though predictions of how long it will take for a baby to die are

difficult to make Descriptions of what the baby will look like and what changes are expected as the baby

deteriorates, e.g. colour changes, gasping etc. Acknowledgement of anxiety and fear, for many parents this may be their first

encounter with death

Parents should be encouraged and assisted to plan for: The birth, care and death of their baby Presence of friends and family members Any rituals that are important to them, e.g. naming ceremony or baptism The place of death, (clinical area, quiet room or outdoors, at home) If time permits it is advantageous to introduce parents to the team who will be caring

for them - this should include nurses, doctors, social workers and religious support Parents should be reassured that they will be well supported emotionally and in caring

for their baby It is also possible to arrange photos to be taken by a professional photographer through

the CNC / Team Leader in the NICU (please see Section 4 for further information)





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Procedures Neonatal CareImmediate Management in Delivery Suite1. In the delivery room the baby should be dried, warmed, and wrapped in warm blankets 2. Baby should be kept with parents where possible3. Assessment of baby and further pathology may be necessary to confirm diagnosis

Confirmation of Diagnosis1. If diagnosis or prognosis is uncertain or a clear antenatal plan has not been made, it is

important for an experienced clinician, either a Neonatologist or senior Neonatal Fellow to be present at birth or as soon as possible, to assess the actual gestational age or to confirm the diagnosis

Management of babies in NICU/SCN1. The discussion with parents about the withdrawal of active treatment must include the

multi-disciplinary team2. This discussion must include the points as above3. Carry out parent’s requests as discussed

Pain and symptom management One of the main aims of palliative care is to keep the baby comfortable. This can often be achieved by simple nursing care measures:1. Keeping the baby swaddled and warm2. Nappy is clean and dry3. Cuddling the baby4. Feeding the baby if hungry and able to suck - most babies who are dying do not

experience hunger. When a baby is expected to die within a short period of time tube feeding may not be appropriate but with prolonged life this should be considered a comfort measure

5. Pain relief medications and antianxiolytics may be prescribed for the baby as per the treating clinician

6. If pain relief medication is currently being administered this should continue unless otherwise ordered by neonatologist

Family support1. Parents may wish to have their baby stay with them on the ward and should be given a

private room wherever possible 2. Other babies are cared for in the neonatal nursery - utilise the quiet room as much as

possible3. Some families may wish to care for the baby at home with the support of Newborn and

Parent Support Service (NAPSS) and the Palliative Care Service – the team includes Palliative care nurse specialist 62444269 Clinical Nurse Consultant (CNC) Home based palliative Care (HBPC) & Medical staff CNC Claire Holland House 62730336





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CNC Oncology Unit CH page 50049 Paediatric Palliative Care Nurse (page through switch) This information is kept in a red book in Special Care

4. When families care for the baby at home: Parents will be taught how to care for their baby, particularly if tube feeding or

suctioning is required They need to know who to ring if they are concerned or need help and numbers to

contact for emotional and practical support when the baby dies. This plan may vary depending on the family, but each family will be given instructions about who to contact if the baby dies at home

They need to be reassured that they can bring their baby back to the hospital at any time if they feel they need to

If this is the case, the Emergency Department should be alerted via the Clinical Director

5. It is important to have regular updates with parents to discuss their baby's care, answer questions and address any issues that may arise Support for families may be provided by extended family, close friends, general

practitioner, the multidisciplinary team from the hospital, clergy, NAPSS and Maternal and Child Health (MACH) nurses

Creating memories is important for families and their grieving process Some things which can help include

o Encouraging parents to name and spend time with their baby o Parents and siblings should be given opportunities to hold, bath, dress and feed

their baby where appropriate - some parents may not wish to do so and should not be forced

o Sometimes it is for cultural reasons or some parents may just need extra time, reassurance and support to overcome their fear.

Care after deathMementosSpecial Memory boxes or books are valued by parents and may include:1. Details of the baby's birth including date, time, weight etc.2. Details of baby's death including date, time, weight and those present3. Photographs – contact ‘Heartfelt’ 4. Videos5. Handprints and footprints6. Locks of hair7. Plaster imprints of hands and feet8. Cord clamps 9. Cot cards 10. Measuring tapes 11. Nametags 12. Clothes the baby has worn 13. Quilts and other mementoes that the family find significant





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Some families may have unusual requests e.g. a small container of the hand washing solution used in the nursery as the smell reminded the family of their baby. Try to accommodate requests where possible. Parents may not want these mementos at the time but, they should be retained as often parents come looking for them later. It is always worth inquiring about the importance of blessing, baptism, or other rituals including cultural practices for the family. Some families will desire religious or cultural ceremonies which can be provided by hospital pastoral care workers, or the appropriate representatives of the family's religion or culture. Some religions require a funeral to be held as soon as possible, ideally this needs to be discussed with the family before death occurs.

Spending time with the baby after deathFamilies may choose to spend time with their baby after death - this varies from family to family. Parents need to know that they can come back to the hospital and be supported in viewing their baby once it has gone to the Mortuary. Usually they would need to phone and make an appointment so that the baby can be prepared for viewing.

Staff support The experience of caring for a baby receiving palliative care can be rewarding for some

and distressing and challenging for others Communication and continuity of care among the multidisciplinary team is both essential

and supportive for both the family and the team Families benefit greatly from a coordinated approach with as few carers involved as

possible. For these reasons, continuity of nursing and medical team members needs to be planned for

It is valuable to have a multidisciplinary care team meeting as part of the decision making process so that a care plan can be developed and a care team arranged. It gives opportunity to answer questions and to offer support

All staff involved should have the opportunity to access peer and professional support and formal debriefings should be arranged as required

Post Mortem A post mortem examination should be discussed with all parents. Refer to ‘Post-Mortem

Examinations and Retention of Body Tissue Procedure’ Muscle and nerve biopsies may be required to confirm a diagnosis. See attachment B The aim of a post mortem is not only to confirm a diagnosis but to also have objective

evidence of the reason for palliative care and may alleviate concerns and doubt for years to come

The discussion about a post mortem should be done by a Consultant, ideally before death occurs but can happen after

Appropriate paperwork should be given to the parents, and consent signed with detailed explanation

Results of the post mortem (macroscopy) can be fed back to the parents soon after the post mortem, detailed results take 6-8 weeks





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Follow-up The General Practitioner and Maternal and Child Health Nurse should be notified of the

death of the baby and the circumstances surrounding it, so that they can support the family in the community.

Community care for the mother should be arranged and she should be given advice on suppressing lactation

Offer the Australian Breastfeeding Association brochure 'Lactation Suppression' Offer support through Red Nose Follow-up with the team who have cared for the baby should always be arranged with

families after the death of a baby - schedule this at a time when autopsy results will be available

This follow-up appointment provides an opportunity to answer questions that the family may have about the death of their child

Organise grief counselling or genetic counselling if appropriate Involve genetic counselling if appropriate


Section 4 – Perinatal Loss: Clinical and Bereavement Digital Images

BackgroundFollowing perinatal loss, two different types of photographs are taken of the baby.

Bereavement photographs are taken as mementos for parents. The baby is usually clothed and may also be wrapped in colourful blankets and sheets. Families are often involved in the activity, and photographs are given to them.

Clinical photographs of the baby may be taken to assist in external examinations to determine cause of death, including diagnosing syndromes or other congenital anomalies. These photographs should be taken of the naked baby on white or green drapes and include identification details and a tape measure to indicate size and length. Clinical photographs are not to be given to family members. However, clinical photos may be viewed by the family as part of a discussion with a health professional. For more information please see the Perinatal Society of Australia and New Zealand’s (PSANZ) Clinical Practice Guideline for Perinatal Mortality.

To ensure that privacy and confidentiality is respected, these photographic images must be transferred from the camera to the clinical record in a secure manner.


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Collection and Transfer of Images to CRISEquipment Digital Camera in Birthing, Birth Centre or Neonatal Intensive Care Unit

Procedure 1. Obtain verbal consent for clinical and/or bereavement photographs from parents and

document consent in medical record. 2. Check that camera settings are changed to save photographs as small files.3. Take a photograph of the baby or maternal ID sticker as the first photograph in

sequence.4. Take clinical photographs as described in the PSANZ Clinical Practice Guideline for

Perinatal Mortality (see Attachment D).5. Take bereavement photograph as requested by the family.6. Take a photograph of the baby or maternal ID sticker as the last photograph to end

sequence.7. Create a folder in the Documents Library on the hard drive with the mother’s surname.

Download photographs to Documents Library of a computer in Birthing (Angel Room), Birth Centre or Neonatal Intensive Care Unit. Save the images as jpeg files to the folder in the following way: For babies less than 20 weeks gestation: Maternal ID Number_Baby of Mother’s

Name - Clinical.001 or Maternal ID Number_Baby of Mother’s Name – Bereavement.001.

For babies greater than 20 weeks gestation save the images into the folder in the following way – BabyID Number_Baby of Mother’s Name – Clinical.001 or Baby ID Number_Baby of Mother’s Name – Bereavement.001.

8. Each image should be labelled clinical or bereavement depending on the photograph type with the number changing to the next consecutive number with the addition of new photographs. Once the images have been downloaded and saved to the folder, send the jpeg files in an email to the generic email address: Perinatal Loss Team.

9. Save bereavement photos on to a disc or thumb drive for providing to the family. 10. Remove the images from the Digital Camera.11. Once notified by the Perinatal Loss Team that the images have been successfully

uploaded against the patient’s record, remove the images from the Documents Folder.

Perinatal Loss Team Inbox12. Staff members with access to the Perinatal Loss Team email address will then upload the

clinical images directly onto the medical record according to Clinical Records Information System (CRIS) Help Sheet – Importing e-notes and images into CRIS instructions (See Attachment E).

13. Following successful uploading of the images to CRIS, the staff members of the Perinatal Loss Team will: Email the staff member from Birthing, Birth Centre or Neonatal Intensive Care Unit to

remove the images from the Documents Library where they were initially saved.


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Save the images into a folder (named as per dot point 7 above) in the Perinatal Loss Folder on the Q drive.


Implementation

This guideline will be discussed in existing education ie. in-service education and orientation of new staff.


Related Policies, Procedures, Guidelines and Legislation

Policies Health Directorate Nursing and Midwifery Continuing Competence Policy Health Directorate Clinical Records Management Policy Consent and Treatment Policy Post-Mortem Examinations and Retention of Body Tissue Policy

Procedures CHHS Healthcare Associated Infections Clinical Procedure Photo, Video and Audio: Capture, Storage, Disposal and Use procedure CHHS Patient Identification and Procedure Matching Policy When Death Occurs Procedure Post-Mortem Examinations and Retention of Body Tissue Procedure

Guidelines Birth requiring the presence of a neonatal registrar Premature labour Care of the woman with preterm (i.e. prior to 37 weeks) premature rupture of

membranes (PPROM) Neonatal resuscitation Guidelines for the care of women experiencing pregnancy loss CRIS Help Sheet – Importing e-notes and images into CRIS

Legislation Health Records (Privacy and Access) Act 1997 Human Rights Act 2004



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References

1. Lui K, Bajuk B, Foster K, Gaston A, Kent A, Sinn J, Spence K, Fischer W, Henderson-Smart D. Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop. Med J Aust. 2006 Nov 6;185(9):495-500.

2. Bolisetty S, Bajuk B, Abdel-Latif ME, Vincent T, Sutton L, Lui K. Preterm outcome table (POT): a simple tool to aid counselling parents of very preterm infants. Aust N Z J Obstet Gynaecol. 2006 Jun;46(3):189-92.

3. Kent AL, Casey A, Lui K; NSW and ACT Perinatal Care at the Borderlines of Viability Consensus Workshop Committee. Collaborative decision-making for extreme premature delivery. J Paediatr Child Health. 2007 Jun;43(6):489-91.

4. Keogh J, Sinn J, Hollebone K, Bajuk B, Fischer W, Lui K; Consensus Workshop Organising Committee. Delivery in the 'grey zone': collaborative approach to extremely preterm birth. Aust N Z J Obstet Gynaecol. 2007 Aug;47(4):273-8

5. Janvier A, Barrington KJ. The ethics of neonatal resuscitation at the margins of viability: informed consent and outcomes. J Pediatr. 2005 Nov;147(5):579-85.

6. Wilkinson AR, Ahluwalia J, Cole A, Crawford D, Fyle J, Gordon A, Moorcraft J, Pollard T, Roberts T. Management of babies born extremely preterm at less than 26 weeks of gestation: a framework for clinical practice at the time of birth. Arch Dis Child Fetal Neonatal Ed. 2009 Jan;94(1):F2-5. Epub 2008 Oct 6. PubMed PMID:

7. Critical care decisions in fetal and neonatal medicine: ethical issues, Nuffield council on bioethics 2006

8. Jankov RP, Asztalos EV, Skidmore MB. Favourable neurological outcomes following delivery room cardiopulmonary resuscitation of infants < or = 750 g at birth. J Paediatr Child Health. 2000 Feb;36(1):19-22.

9. Håkansson S, Farooqi A, Holmgren PA, Serenius F, Högberg U. Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies. Pediatrics. 2004 Jul;114(1):58-64

10. Merenstein GB, & Gardner SL (2011). Handbook of Neonatal Intensive Care 6th Ed. Mosby. Missouri.

11. SIDS Western Australia. (2001). Support for Parents and Families of babys Who Have Died.

12. Perinatal Society of Australia & New Zealand. Perinatal Mortality Audit Guidelines: Section 3, Psychological and Social Aspects of Perinatal Bereavement.

13. Perinatal Society of Australia and New Zealand - Clinical Practice Guideline for Perinatal Mortality https://psanz.com.au/guidelines/



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https://psanz.com.au/guidelines/


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Search Terms

Death, Bereavement, Baby, Neonatal loss, Perinatal loss, Digital images, Bereavement images, Bereavement photograph, Clinical photo, Clinical photographs


Attachments

Attachment A – Neonatal Loss Clinical PathwayAttachment B – Muscle & Nerve BiopsiesAttachment C – Borderline of ViabilityAttachment D – Instructions on taking clinical photographs Attachment E – CRIS Help sheet - Importing eNotes and Images

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 26/02/2018 Complete Review ED WY&C CHHS Policy Committee

This document supersedes the following: Document Number Document NameCHHS12/095 Department of Neonatology Death and BereavementCHHS13/485 Department of Neonatology Borderline of ViabilityCHHS12/123 Department of Neonatology Palliative Care CHHS16/185 Perinatal Loss Clinical and Bereavement Digital Images


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Attachment A – Neonatal Loss Clinical Pathway


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Attachment B – Muscle & Nerve Biopsies

Muscle & Nerve BiopsiesACT Pathology coordinates a referral service of muscle biopsy specimens to the Neurology Laboratory at the University of Sydney

The protocol for collection, handling and transport of these specimens is as follows: Arrange a surgeon to perform the biopsy. You may also be required to contact the

relevent hospital registrar. Please consult the surgeon for advice Arrange hospital admission of patient if necessary Alert ACT Pathology by phoning Specimen Referrals 62442845 at least 24 hours prior to

the procedure Notify Min Wong at the Neurology Laboratory, University of Sydney on (02) 93512167 or

(02) 9515 8852 or fax (02)93516363 that you are sending a biopsy specimen. If quantitative bichemistry is required in addition to histochemistry please notify the clinical biochemistry Muscle Biopsy Unit on (02) 95158572 (Neurology Lab. Staff at the University of Sydney will arrange transfer of the specimen to Clinical Biochemistry).

The Specimen Ideally the muscle specimen should be 1cm long and approximately 0.5-1cm in diameter,

and the nerve specimen should be 3cm long It is important that no local anaesthetic comes in contact with the specimen. (Fascia

may be included if mictoscopic examination is required, otherwise it is generally not necessary).

For quantitative biochemistry in addition to histochemistry, a separate specimen is not required

Wrap the specimen in cotton gauze dampered with normal saline (do not soak the specimen in saline) and place in a steile yellow top specimen container

Packing Packing of the specimen is the responsibility of ACT Pathology. ACT Pathology arranges

transport of muscle and nerve biopsy specimens and must take responsibility for their packing

Packing must be done in accordance with IATA packing instructions 650 (IATA Dangerous goods Regulations 47th Edition Effective 1 January 2006)

Suitable packaging may be collected in Pathology Specimen Reception on Level 2 Building 10 (Contact 62442845)

The yellow container containing the specimenmust be placed inside a plastic screw top container. It should be wrapped in bubble wrap or similar to protect it from damage

The plastic screw top container is to be placed inside the styrofoam box provided. Ice bricks may ge packed around the container. Ice should not be used as the styrofoam box is not watertight and any sign of leakage will result in the shipment being rejected by the airline

The styrofoam box is then placed inside the fibreboard outer box


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Arrange transport to ACT Patholgy by contacting the enquiry line, ext 42930. Specimen MUSTbe delivered to pathology by 0900 to ensure same day shipment. Any delays need to be discussed with the referral department on 62442845 and the Neurology Laboratory, University of Sydney on (02) 93512167

ACT Pathology will add address details and appropriate labelling of the prescribed Air Eligibility Marking to the outside of the package to comply with IATA regulations and will complete the necessary cinsignment note.

Transport of Specimen ACT Pathology will arrange transport by courier for Same Day Delivery. Please note that

due to airline regulations and the limited availablity of flights from Canberra to Sydney, the fastest courier service usually takes five to six hours. Any delay may result in the specimen arriving at the University of Sydney after normal working hours. This will mean that testing will not take place until the following day.

Request for InformationThe following information MUST accompany all specimens: Exact time and date of biopsy Pricise indentification of biopsy site eg. Name of muscle, right or left etc Patient demographic details (Full patient Name, DOB and /or UR number) Referring doctor(s) (to whom reports may be sent and their provider number(s),

telephoneand fax numbers Relivant clinical information and tests including nerve conduction studies and EMG’s

Code of TestingThe expenses associated with this testing are journalled to the appropriate unit are as follows: Cost of testing – Approximately $175 Cost of transport & packaging – Approximately $170

For any additional information please contact: Min Wang Neurology Laboratory (02) 93512167Brett Loiterton Pathology Reception 62443992Specimen Referrals Pathology Reception 62442845


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Attachment C – Borderline of Viability

Gestation weeks

Presumption of treatment if no discussion

Usual Recommendation to parents Antenatal Consult Action plan comments

260+ Active treatment providedActive treatment WILL be provided in the otherwise normal fetus.

Antenatal consult by neonatal team

Parents will be made aware of obligation to treat. Unless exceptional circumstances active treatment WILL be provided.

250-256 Active treatment providedActive treatment recommended in usual circumstances

Antenatal consult by neonatal team. Must be neonatologist if non-treatment requested.

Usually active treatment will be provided (neonatologist to attend birth)

If parents request palliation then neonatologist will consult with neonatal team before agreeing a management plan. If non-resuscitation agreed neonatal team will Usually be involved to provide support.

240-246 Active treatment

Full discussion of mortality/morbidity. Recommendations guided by parent’s wishes.

Antenatal consult by neonatologist

If Active treatment plan: neonatologist to attend birthIf Palliative care plan: neonatal staff will not usually attend birth but neonatologist may provide support and advice as necessary.

230-240 Possible resuscitation after intensive counselling

Active treatment only after intensive counselling

Antenatal consult neonatologist recommendations

If active treatment is agreed following intensive counselling: Neonatologist to be present at birth


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Gestation weeks

Presumption of treatment if no discussion

Usual Recommendation to parents Antenatal Consult Action plan comments

to assess response to lung inflation and respiratory support.

<23 No active treatment Active treatment will NOT be provided

Neonatology team not usually involved in discussions.

Neonatal input not required


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Attachment D – Instructions on taking clinical photographs Taken from Section 2 of the PSANZ Clinical Practice Guideline for Perinatal Mortality


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Attachment E – CRIS Help sheet - Importing eNotes and Images


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Neonatal Death, Bereavement, Palliative Care and … · Web viewResults of the post mortem...

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Transcript of Neonatal Death, Bereavement, Palliative Care and … · Web viewResults of the post mortem...