Simeoni U
Service de pédiatrie 2, hôpitaux universitaires de Strasbourg, France.
Arch Pediatr. 1999 Apr;6(4):447-56. doi: 10.1016/s0929-693x(99)80229-2.
Advances in neonatology have been consistent in recent years, both from practical and theoretical points of view. Improved outcome is the result of major developments in neonatal intensive care, but also of the improved organization of perinatal care. Recent concepts on the inflammatory mechanisms of preterm labor and periventricular leukomalacia are opening a new area for preventive intervention. The observed association between the occurrence of diseases such as hypertension in adulthood and intrauterine growth retardation offers a particular insight into the long term programming of physiologic regulations in the fetus. At the bedside, advances in neonatal intensive care have been significant, especially in treating neonatal respiratory failure. This review will focus on recent developments in premature anemia, and in fluid-electrolyte therapy in very low infant birth weights, as both topics have been less frequently reviewed in the pediatric literature. Finally, ethical issues have deserved considerable attention, such as therapeutic intervention in extremely low birth weight infants, decision-taking, and practices in withholding or withdrawing therapy during neonatal intensive care, along with the need for long term follow up and assistance to the patients and their families.
近年来，无论从实践还是理论角度来看，新生儿学都取得了持续进展。新生儿重症监护的重大发展以及围产期护理组织的改善带来了更好的治疗结果。早产和脑室周围白质软化炎症机制的最新概念为预防性干预开辟了新领域。观察到的成年期疾病（如高血压）与宫内生长迟缓之间的关联，为深入了解胎儿生理调节的长期编程提供了特别的视角。在临床方面，新生儿重症监护取得了显著进展，尤其是在治疗新生儿呼吸衰竭方面。本综述将重点关注早产儿贫血以及极低出生体重儿液体电解质治疗的最新进展，因为这两个主题在儿科文献中较少被综述。最后，伦理问题值得高度关注，例如对极低出生体重儿的治疗干预、决策制定以及新生儿重症监护期间停止或撤销治疗的做法，同时还需要对患者及其家庭进行长期随访和援助。
