Subcutaneous Drug Administration in Pediatric Palliative Home Care: A Multicenter Prospective Study.

CONTEXT: Pediatric palliative care patients frequently present with complex, life-limiting conditions and a high symptom burden requiring effective therapeutic strategies. The subcutaneous route is an important alternative for symptom control care when enteral or intravenous administration is not feasible. However, evidence supporting its use in children remains limited.

OBJECTIVES

To describe real-world use, safety, and administration characteristics of subcutaneous drug administration for symptom control in children receiving palliative home care.

METHODS

A multicenter, prospective observational study was conducted between April 2023 and June 2024 across Pediatric palliative care Units from nine Spanish hospitals. Pediatric patients receiving home-based palliative care and requiring subcutaneous drug administration were included. Data were collected at patient, catheter, and treatment levels. Descriptive statistics and mixed-effects logistic regression models were used to evaluate factors associated with catheter-related complications.

RESULTS

Forty patients, 140 subcutaneous catheters, and 214 treatment episodes were analyzed. The main indication for subcutaneous use was inadequate symptom control with other routes (75%). Median catheter dwell time was 6 days (IQR, 2.7-12.2). Catheter-related complications occurred in 40% and were predominantly mild local reactions, mainly induration. Most treatments consisted of single-drug regimens administered by continuous infusion. Midazolam (58.9%) and morphine (33.6%) were the most commonly administered drugs. Scopolamine was associated with increased complication risk (OR, 6.94; 95% CI, 1.14-42.18; P = .035).

CONCLUSION

Subcutaneous drug administration was a feasible and generally safe strategy for symptom control in pediatric palliative home care. These findings support collaborative research to standardize pediatric subcutaneous therapy.