Author: Rizwana Hussain, Dr Kiran Shrivastava and Dr Smriti Khanna
The Applied Perinatal and Neonatal Palliative Care for Clinicians in LMICs ECHO is a structured seven-week, novel training initiative designed to strengthen competencies in delivering compassionate and context appropriate care for fetuses and newborns with life limiting conditions.
The course is a Two Worlds Cancer Collaboration (TWCC) initiative, in collaboration with ICPCN, endorsed by RCPCH and is run online on the Project ECHO platform. It commenced on 6 March 2026 and was conducted weekly on Fridays at 7:30 pm IST, bringing together healthcare professionals from diverse low- and middle-income country settings.
Interest was evident from an October 2025 TWCC webinar, moderated by neonatologist Dr Kiran Shrivastava on perinatal and neonatal palliative care which had over 100 attendees. Building upon this expression of interest, course lead Dr Shrivastava, along with Dr Smriti Khanna designed this 7-session program, targeting an interdisciplinary cohort of neonatologists, pediatricians, obstetricians, fetal medicine specialists, and palliative care physicians. With a total of 255 registered participants from multiple countries, it reflected a growing recognition of the need to integrate palliative approaches into perinatal and neonatal care systems, particularly in resource constrained settings.
The curriculum was carefully designed to address both clinical and ethical complexities of perinatal palliative care. Over the course of seven weeks, participants engaged with key themes including foundational concepts, clinical decision making, symptom management, and system level implementation. The sessions began with an introduction to the principles of palliative care and decision-making frameworks in fetal medicine, followed by focused discussions on obstetric care pathways, and pain management in neonatal intensive care settings. Subsequent sessions explored chronic and end of life care models for neonates, and ethical and legal considerations in high-risk perinatal care.
Importantly, the program also emphasized family centered care. Dedicated sessions addressed communication strategies and bereavement support, highlighting the emotional and psychosocial dimensions of care that are often overlooked in clinical training. The final session focused on designing and implementing perinatal palliative care units in LMICs, encouraging participants to translate knowledge into practice within their own institutional contexts.
The programme was strengthened by a multidisciplinary faculty with deep expertise across neonatal medicine, fetal medicine, obstetrics, pediatric palliative care, psychosocial care, law,
and global health. Dr. Pratima Radhakrishnan, a seasoned fetal medicine expert with experience in both India and the UK, emphasised patient- and family-centered approach, while Dr. Navya KC contributed thoughtful case-based discussions focused on common scenarios in low-resource settings. The obstetric and maternal-fetal medicine perspective was enriched by Dr. Surbhi Nanda, a tertiary-care clinician managing complex antenatal and obstetric cases, alongside Dr. Neelam Gupta, a senior neonatologist in UK and lead for the BAPM Neonatal Pain Management Guidelines. Dr. Kiran More, senior neonatologist added valuable insights from extensive international experience across varied resource settings.
The faculty also brought together leaders in palliative care, ethics, communication, and advocacy. Dr. Veronique Dinand and Dr. Archana Iyengar shared their expertise in pediatric palliative care, including community, home-based, perinatal, and hospice care in low-resource environments. Camara van Breemen, nurse practitioner from Canada, was instrumental in serious illness communication and clinician training for difficult conversations, while Joanna Pinto contributed her culturally grounded expertise in grief, bereavement, and maternal psychology. The programme further benefited from Dhvani Mehta’s legal advocacy in end-of-life care, and course co-ordinators, Dr. Kiran Shrivastava’s combined experience in neonatology, pediatrics, and perinatal palliative care, and Dr. Smriti Khanna’s work in perinatal ethics, advocacy and simplifying advance care planning and end-of-life care in India. Dr Spandana Rayala’s feedback was instrumental in course design.
Together, this diverse faculty ensured that the program bridged clinical knowledge with practical application, while remaining sensitive to the realities of low resource settings.
Overall, the ECHO model enabled interactive, case-based learning and fostered a global community of practice. By connecting clinicians across regions, the program not only built individual capacity but also contributed to strengthening health systems. In contexts where curative options may be limited, such initiatives play a critical role in ensuring that care remains compassionate, dignified, and patient centered.
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