Society of Critical Care Medicine 2026 Guidelines on the Care and Management of Pediatric and Neonatal Intensive Care Patients at the End of Life

Authors

Sabrina Derrington, Department of Anesthesiology Critical Care Medicine and Center for Bioethics, Children's Hospital Los Angeles, Los Angeles, CA.
Elizabeth G. Broden Arciprete, Boston College Connell School of Nursing, Chestnut Hill, MA.
Matthew C. Lin, NYU Grossman School of Medicine, New York, NY.
Simon J. Oczkowski, McMaster University, Hamilton, ON, Canada.
Amanda Alladin, Division of Pediatric Critical Care, Department of Pediatrics, University of Miami Miller School of Medicine and Holtz Children's Hospital, Miami, FL.
Uchenna E. Anani, Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Amanda K. Borchik, Department of Spiritual Care, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN.
Cassandra A. Collins, OSF Healthcare Children's Hospital of Illinois, Peoria, IL.
Claudia Delgado-Corcoran, University of Utah, Salt Lake City, UT.
Mindy J. Dickerman, Nemour's Children's Health, Wilmington, DE.
Christopher G. Harrod, Society for Critical Care Medicine, Mount Prospect, IL.
Natalia Henner, Lurie Children's Hospital, Chicago, IL.
Alexander A. Kon, Ethics Consultants, Inc., San Diego, CA.
Mithya Lewis-Newby, Seattle Children's Hospital and University of Washington, Seattle, WA.
Blyth T. Lord, Courageous Parents Network, Boston, MA.
Ashley-Anne Masters, Presbyterian Campus Ministry of Raleigh, Raleigh, NC.
Sarah McCarthy, Boston Children's Hospital, Boston, MA.
Katie M. Moynihan, Boston Children's Hospital, Boston, MA.
Sara M. Munoz-Blanco, Johns Hopkins School of Medicine, Baltimore, MD.
Lauren Rissman, Advocate Health - MidwestFollow
Kathryn E. Roberts, Nemour's Children's Health, Wilmington, DE.
Amy B. Schlegel, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
Ashleigh Schopen, Child Life Consulting, LLC, Philadelphia, PA.
Linda B. Siegel, Northwell Health, New Hyde Park, NY.
Harriett Swasey, Boston Children's Hospital, Boston, MA.
Sarah E. Wawrzynski, Nemour's Children's Health, Wilmington, DE.
David J. Zorko, McMaster University, Hamilton, ON, Canada.
Danielle D. DeCourcey, Boston Children's Hospital, Boston, MA.

Recommended Citation

Derrington S, Broden Arciprete EG, Lin MC, et al. Society of Critical Care Medicine 2026 Guidelines on the Care and Management of Pediatric and Neonatal Intensive Care Patients at the End of Life. Pediatr Crit Care Med. Published online March 20, 2026. doi:10.1097/PCC.0000000000003914

Affiliations

Advocate Children's Hospital, Park Ridge

Abstract

Rationale: Ensuring high-quality end-of-life (EOL) care for neonatal and pediatric patients and their families in the ICU requires a comprehensive, evidence-based, multidisciplinary approach.

Objectives: To develop and provide evidence-based recommendations for EOL care and management of critically ill neonatal and pediatric patients and their families.

Design: The American College of Critical Care Medicine Board convened a 21-member multidisciplinary panel of experts in pediatric critical care medicine, nursing, neonatology, psychology, spiritual care, social work, child life, respiratory care, bioethics, cardiology/cardiac intensive care, palliative care, and bereaved parents. The panel included two expert methodologists specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were followed during all phases of guidelines development including task force selection and voting.

Methods: The panel members identified and formulated five Population, Intervention, Comparator, and Outcome questions. We conducted a systematic review of literature (2000-2025) for each question to identify best available evidence, then statistically analyzed and assessed the certainty of evidence using the GRADE methodology. We used the GRADE evidence-to-decision framework to formulate the recommendations.

Results: The panel generated five conditional recommendations and one good practice statement, focused on advance care planning, pediatric palliative care consultation and education, systematic symptom management, bereavement support, and health equity in EOL care.

Conclusions: The recommendations were derived from the best available evidence at time of publication and provide valuable guidance to support EOL care for PICU and neonatal ICU patients and their families.

Type

Article

PubMed ID

41860325