• Aleksandra Korzeniewska-Eksterowicz, Łukasz Przysło, Wojciech Fendler, Małgorzata Stolarska, and Wojciech Młynarski.
• Pediatric Palliative Care Unit, Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland; Gajusz Foundation, Pediatric Palliative Care Center - Home Hospice for Children of Lodz Region, Lodz, Poland. Electronic address: aleksandra.korzeniewska-eksterowicz@umed.lodz.pl.
• J Pain Symptom Manage. 2014 Nov 1;48(5):968-74.

ContextThe presence of symptoms that are difficult to control always requires adjustment of treatment, and palliative sedation (PS) should be considered.ObjectivesWe analyzed our experience in conducting PS at home for terminally ill children with cancer during a seven-year period.MethodsWe performed a retrospective analysis of medical records of children with cancer treated at home between the years 2005 and 2011.ResultsWe analyzed the data of 42 cancer patients (18% of all patients); in 21 cases, PS was initiated (solid tumors n = 11, brain tumors [5], bone tumors [4], leukemia [1]). Sedation was introduced because of pain (n = 13), dyspnea (9), anxiety (5), or two of those symptoms (6). The main drug used for sedation was midazolam; all patients received morphine. There were no significant differences in the dose of morphine or midazolam depending on the patient's sex; age was correlated with an increase of midazolam dose (R = 0.68; P = 0.005). Duration of sedation (R = 0.61; P = 0.003) and its later initiation (R = 0.43; P = 0.05) were correlated with an increase of the morphine dose. All patients received adjuvant treatment; in patients who required a morphine dose increase, metoclopramide was used more often (P = 0.0002). Patients did not experience any adverse reactions. Later introduction of sedation was associated with a marginally higher number of intervention visits and a significantly higher number of planned visits (R = 0.53; P = 0.013).ConclusionSedation may be safely used at home. It requires close monitoring and full cooperation between the family and hospice team. Because of the limited data on home PS in pediatric populations, further studies are needed.Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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