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Comfort care – severe HIE — RACP Paediatrics MCQ

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HardNeonatalComfort care – severe HIERACP Paediatrics

A term neonate with a severe hypoxic brain injury (Sarnat III HIE) has been on cooling for 72 hours. MRI at day 7 shows extensive bilateral cortical and basal ganglia injury. EEG is severely abnormal. At 2 weeks, the infant remains ventilator-dependent with no neurological improvement. The family and medical team agree to transition to comfort care. What is the most appropriate approach?

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Correct answer: C — Comfort care discussion

When intensive care is considered to be prolonging suffering without meaningful benefit, and the family and medical team are aligned, redirection to comfort care is appropriate. This involves a compassionate, family-centred discussion, withdrawal of non-beneficial treatments (ventilation, inotropes), and excellent symptom management (pain, distress). Palliative care team involvement is recommended.

Reference: RACP – 2021 – Decision-Making at End of Life in Infants, Children and Adolescents; ANZCOR – 2025 – Guideline 13.10