Partridge J C, Freeman H, Weiss E, Martinez A M
Department of Pediatrics, Mailstop 6E, University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
J Perinatol. 2001 Jan-Feb;21(1):27-33. doi: 10.1038/sj.jp.7200477.
To characterize physician-parent counseling and delivery room resuscitation of extremely low birthweight (ELBW) infants.
Cross-sectional survey of 473 California neonatologists detailing counseling patterns, resuscitation thresholds, and acceptance of parental decision making.
The response rate was 61%. After 23 weeks' gestation, > 80% of neonatologists counseled parents expecting ELBW infants. All (> 99%) counseled parents about mortality; > 25% reported not discussing limiting resuscitation or death despite resuscitation. Decisions to limit resuscitation were affected by congenital anomalies, parents' wishes, or perceptions of pain, suffering, and quality of life. Nearly 70% of neonatologists supported parental decision making at 22 to 23 weeks, whereas 66% to 74% responded that parents should not be allowed to make nonresuscitation decisions after 26 weeks. Median resuscitation thresholds were 23 weeks (range 20-28) and 500 g (range 350-1000).
Neonatologists' failure to discuss nonresuscitation options, variations in resuscitation thresholds, and unwillingness to accept nonresuscitation decisions for more mature ELBW infants may restrict parental decision making.
描述极低出生体重（ELBW）婴儿的医生-家长咨询情况及产房复苏情况。
对473名加利福尼亚新生儿科医生进行横断面调查，详细了解咨询模式、复苏阈值以及对家长决策的接受程度。
回复率为61%。妊娠23周后，超过80%的新生儿科医生会为预计生下ELBW婴儿的家长提供咨询。所有医生（超过99%）都向家长咨询了死亡率；超过25%的医生报告称，尽管进行了复苏，但未讨论限制复苏或死亡情况。限制复苏的决定受先天性异常、家长意愿或对疼痛、痛苦及生活质量的认知影响。近70%的新生儿科医生支持家长在22至23周时做出的决策，而66%至74%的医生回应称，26周后不应允许家长做出不复苏的决定。复苏阈值的中位数为23周（范围20 - 28周）和500克（范围350 - 1000克）。
新生儿科医生未讨论不复苏选项、复苏阈值存在差异以及不愿接受更成熟的ELBW婴儿的不复苏决定，可能会限制家长的决策。
