Abstract / Summary
Background: Perinatal Palliative Care (PPC) is a specialized approach designed to support families facing a prenatal or postnatal diagnosis of a life-limiting or life-threatening condition. Despite the publication of authoritative international guidelines, a significant translational gap persists between aspirational recommendations and consistent, reproducible clinical practice. Structured and operational frameworks may contribute to PPC implementation in real-world clinical settings. This Perspective aims to provide a practical, operational instrument for PPC, derived from and aligned with international guidelines, that translates their principles into concrete clinical steps. Methods: We developed and implemented a structured PPC protocol at our tertiary academic center through a multidisciplinary review of existing PPC guidelines and an iterative internal institutional consensus process informed by clinical experience and feedback from parents and healthcare providers; this is a descriptive clinical Perspective rather than a formal research study. Results: The “Super Micky” PPC protocol provides a comprehensive family-centered framework incorporating: (1) clear eligibility criteria for PPC, derived from international guidelines and Italian recommendations; (2) multidisciplinary assessment integrating neonatology, obstetrics, psychology, nursing, and social work; (3) clear, empathetic, and continuous communication integrated with family values and priorities; (4) development of a personalized Palliative Birth Plan co-constructed with the family and reassessed after birth in the light of the infant’s clinical course; (5) ongoing emotional and psychological support; and (6) structured support for the clinical team through regular debriefings and ethical discussions. The protocol defines specific actionable steps across the entire care continuum, from antenatal diagnosis through labor, birth, neonatal hospitalization, and bereavement. Challenges observed in our clinical experience included prognostic uncertainty, variability in protocol application across clinical teams, and moral distress among staff. Conclusions: The “Super Micky” protocol is intended to translate the principles of family-centered care into a structured, practical instrument, derived from international guidelines, that other centers may adapt into routine perinatal practice; prospective evaluation of its feasibility, adherence, and family and staff outcomes is needed to confirm its impact. Its success depends on continuous team engagement, transparent communication with families, and robust support systems for healthcare professionals.