Congratulations on publishing two recent articles on end-of-life care of newborns. "A Case Study in Caring: Trisomy 18 Syndrome" (Ethical Issues, July 2003) and "Ethics and Palliative Care in Pediatrics" (April) are tremendous contributions to the nursing literature, eloquently describing the latest approaches to caring for sick newborns. As Cynda Hylton Rushton wrote in the latter article, despite significant progress in these areas, most children still die without hospice care, and many die with symptoms such as pain or dyspnea left unmanaged.

Two freestanding hospices-the San Diego Hospice and Palliative Care Center and Alexandra's House in Kansas City, Missouri-care for dying children and their families. Also, I have helped to develop the Neonatal End-of-Life Palliative Care Protocol, which describes all areas of care for terminally ill infants and their families, as well as for caregivers. 1 And the National Perinatal Association will sponsor a major perinatal ethics conference in San Diego, October 14 to 16.

Readers who are interested in more information may contact me at [email protected]. While nurses strive to keep up with innovative life-support technology for children, we must also explore the ethical use of that technology. AJN should be commended for keeping us informed.

Anita Catlin, DNSc, FNP, FAAN

Rohnert Park, CA

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