If your patient is experiencing any of the following, please contact Hospice & Community Care’s Sunflower Pediatric Team at (844) 422-4031 to discuss whether hospice, or hospice with concurrent care, may be appropriate.

 General Advanced Illness:
Presence of a chronic, complex or life-threatening illness/condition and one or more of the following:

• Conflicts regarding use of medical nutrition/hydration in cognitively impaired, seriously ill or dying patients
• New diagnosis of life-limiting or life-threatening disease
• Three or more hospitalizations within six months
• Difficult pain or symptom management
• Patient, family or physician uncertainty regarding prognosis
• Family with limited social supports
• AND (Allow Natural Death)/DNR order or other ethical conflicts
• Complex care coordination and/or homegoing needs
• Prolonged hospitalization for more than three weeks
• Need for support of Hospice Interdisciplinary Team

Cancer:
Presence of malignant disease with any one of the following:

• Progressive metastatic cancer
• Bone marrow/stem cell transplant
• Diffuse intrinsic pontine glioma
• Stage IV neuroblastoma
• Relapsed malignant disease following stem cell/bone marrow transplant
• Any newly diagnosed malignant disease in the setting of poor functional status and frailty
• Any relapsed malignant disease
• Metastatic solid tumors

Pulmonary Criteria:
Presence of compromised pulmonary status with any one of the following:

• Patients with CF with FEV1 <30%
• Patients with CF with vent dependence or those ineligible for lung transplant
• Bronchiolitis obliterans
• Patients with CF with multiple hospitalizations
• Central hypoventilation syndromes
• Patients who are chronically ventilator dependent

Genetic Criteria
Presence of any of the following:

• Trisomy 18, 13, 15
• Asphyxiating thoracic dystrophy
• Severe forms of osteogenesis imperfecta (type 3 or 4)
• Potter Syndrome
• Epidermolysis Bullosa
• Rett’s Syndrome
• Other rare chromosomal anomalies with known poor neurologic prognosis

Neonatal Criteria
Presence of one of the following:

• Extreme prematurity with concomitant severe BPD, Grade IV IVH, PVL, etc.
• Severe birth asphyxia
• Hypoxic ischemic encephalopathy (moderate to severe)
• VLBW infants

Cardiac Criteria
Presence of one of the following:

• Single ventricle cardiac physiology
• Severe pulmonary hypertension
• Down syndrome with significant cardiac abnormality
• Ebstein’s anomaly
• Eisenmanger’s syndrome
• Cardiomyopathy: hypertrophic or severe dilated
• Pulmonary atresia (especially if associated with hypoplastic pulmonary arteries)
• Ongoing discussion of cardiac transplant
• Combination of cardiac diagnosis with underlying neurologic/chromosomal diagnosis
• Complex congenital heart disease
• ECMO candidate
• Severe myocarditis