Guidelines to achieve a state
of comfort for newborns treated with palliative care


  • Holding, skin-to-skin care

  • Provide parents the opportunity to take care of their baby’s needs (breast/bottle feeding, nutrition via NG/OG/G-tube, diaper change, bath, dressing, etc.)

  • Provide parents the opportunity to help with their baby’s medical needs (taking temperature, suctioning, help with medical dressing, etc.)

  • Bonding is promoted in delivery room, on the post-partum floor while the baby rooms-in with the mother or in the NICU. A private space should be provided. If no family members are available, the baby is held by health care personnel or trained volunteers.


  • Skin-to-skin care, holding

  • Warmer, heat lamps, swaddled in blankets


  • Breast/bottle feeds (breastfeeding/lactation consultant/speech pathologist support)

  • Special nipples or devices (speech pathologist support)

  • Use of NG/OG/G-tube as appropriate

  • Infant NPO or end-of-life care: colostrum care, sucrose drops, non-nutritive strategies (speech pathologist support)


  • Assessment of respiratory distress (air hunger, agitation, increased work of breathing, gasping) and use of non-pharmacological strategies (gentle suctioning upper airways, positioning) or pharmacological treatment (Morphine Sulfate PO/IV; Fentanyl IN; Lorazepam PO/IV; Midazolam IN)

  • Assessment of pain by validated clinical scores (NIPS or PIPP) and use of nonpharmacological strategies (positioning, skin-to-skin, sucking) or pharmacological treatment (Acetaminophen PO/PR; Morphine Sulfate PO/IV; Fentanyl IN; Lorazepam PO/IV; Midazolam IN)

NG: nasogastric; OG: orogastric; G-tube: gastric tube; NPO: nil per os; PO: per os; PR: per rectum; IV: intravenous; IN: intranasal; NIPS: neonatal infant pain scale; PIPP: premature infant pain profile.