higher frequency of visits by siblings and other family members. However, no charts documented how the siblings and other relatives coped with the death, although sibling support is an important component of compassionate and holistic neonatal palliative care.20 Access to honest and complete information, appropriate communication, and coordination of care are important priorities that have been identified by parents to achieve quality care under end-of-life conditions.17,21,22 One decade later, our data revealed a positive evolution in the commu- nication between parents and their neonatologists. Although this issue is critically significant in defining what is in the child’s best interest, no charts documented parental involve- ment in decision-making. Additionally, we found no information concerning interdisciplinary meetings, although it has been found that the parents are critically important to the proper management of the illness.20 The opinion of an ethics committee was not sought in any of the charts in our study, consistent with a study by Cook and Watchko.23 Their physical presence during infant death is a spiritual need felt by grieving parents.24 Our data showed that in the final four years (more than in the previous decade), 21.5% of the parents were present at the moment of death, which suggests better support and preparation for infant death. Meert, Thurston and Sarnaik showed that more than 50% of parents studied stayed with their child in the PICU at the time of death. Although none regretted being present, 63% of the parents who were not present later wished that they had been present.25 CONCLUSION Despite an increase in the withholding of therapy and reduction in therapeutic approaches, and improvements in pain management and family support, a large number of neonates in intensive care units still receive curative and aggressive treatments at the end of life. Additionally, psychosocial support for families and bereavement follow- up care, such as interdisciplinary meetings for discussing the best intervention plan to follow, are woefully lacking. A holistic and specialized team approach to care for newborns with life-limiting diseases is suggested to improve the conditions of the infants and families during the dying process. Caregivers should be trained in the basic principles of pediatric palliative care and should be prepared with the skills, confidence and expertise to provide consistent and high-quality end-of-life care. This research concerns only what was documented in neonatal charts; therefore, we cannot know if additional measures were taken during the actual care of the infants and their families. However, it is crucial that consistent and complete documentation be taken during end-of-life care. Research into the care of infants who do not benefit from intensive and life-extending support is needed to develop action plans that ensure that every child receives the best possible care, regardless of the outcome. REFERENCES 1. Instituto Nacional de Estat´ıstica (Portugal). Mortalidade Neonatal 2009. 2010. 1572 CLINICS 2011;66(9):1569-1572 2. Moro T, Kavanaugh K, Okuno-Jones S, Vankleef JA. Neonatal End-of- Life Care: A Review of the Research Literature. J Perinat Neonatal Nurs. 2006;20:262-73. 3. Cuttini M, Nadai M, KaminsKi M, Hansen G, de Leeuw R, Lenoir S, et al. Endof- Life decisions in neonatal intensive care: physicians’self-reported practices in seven European countries. 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