Implicaciones clínicas de la retirada de alimentación e hidratación artificial en pacientes pediátricos en el final de vida

Introduction: In the literature on adult patients, there is evidence that continuing artificial nutrition and hydration (ANH) during end of life is associated with numerous adverse effects. The withdrawal of ANH could lead to a reduction in these negative effects, without resulting in a reduced survival time. In pediatrics, evidence regarding this subject is sorely lacking. The objective of this study is to describe the use of ANH in pediatric patients at end of life, along with the clinical implications of continuing or withdrawing it. Methodology: Observational (prospective and retrospective) study in a tertiary pediatric hospital. Patients older than 24 hours who died at our center or at home between 07/15/2019 and 07/15/2020 were included. The information was collected via interviews with the healthcare team and by reviewing clinical records. Results: Of the patients who received ANH, in half of them this support was reduced or withdrawn prior to death. ANH was withdrawn/reduced in a higher percentage in patients who died in the hospital versus at home. A greater incidence of clinical signs of dehydration was seen in the groups that did not receive ANH. When compared with the groups that did receive ANH, a slight increase in these signs was observed for the group in which ANH was withdrawn versus that in which it was continued, without this difference being statistically significant. The median time elapsed between withdrawing ANH and death was one day. Conclusions: The reduction or withdrawal of ANH in pediatric patients does not appear to increase the signs of dehydration.