Breaking bad news in the context of neonatal death: synthesis of evidence from an integrative review

Abstract

Neonatal mortality remains one of the major global health challenges, accounting for nearly half of deaths among children under five years of age. In this context, communicating neonatal death is an ethical, relational, and humanized process that directly affects both parental grieving and healthcare professionals’ well-being. This study aimed to analyze, through an integrative review, the strategies used by healthcare professionals in delivering news of neonatal death, highlighting humanizing practices, recurrent weaknesses, and emotional impacts. The review was conducted in March 2025 in PubMed, LILACS, SciELO, BDENF, and CINAHL, using DeCS/MeSH descriptors, and included studies published between 2015 and 2025 in Portuguese, English, and Spanish. From 742 initially retrieved articles, six met the inclusion criteria, carried out in Brazil, the United Kingdom, Belgium, and India. The analysis revealed three main axes: humanized strategies, such as acknowledging parenthood and offering farewell opportunities; structural and training barriers, including lack of formal preparation, inadequate settings, and absence of post-death support; and emotional impacts on professionals, who reported psychological suffering and overload, fitting the “second victim” perspective. Structured protocols like SPIKES proved relevant but are still incompletely applied. In conclusion, communicating neonatal death is a critical act of care, and its qualification requires investments in formal training, development of institutional protocols, and implementation of public policies that guarantee comprehensive and humanized support for both families and healthcare teams.