Bhatia J
Section of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta, GA 30912, USA.
J Perinatol. 2006 May;26 Suppl 1:S24-6; discussion S31-3. doi: 10.1038/sj.jp.7211468.
The changing environment in neonatology and perinatology has led to the examination of issues surrounding palliative care. Newborn palliative care should be considered in three general areas: (1) Neonates at the limits of viability. As advances in technology and outcomes become available, it is the responsibility of the health-care community and society to reach a consensus regarding the limits of viability. (2) Neonates with lethal congenital anomalies. When appropriate, and diagnosis and prognosis are certain, why should a family be deprived the opportunity to choose palliative care for the unborn child? (3) Neonates not responsive to aggressive medical management where continuing therapy may prolong suffering and postpone death. The question 'Are you doing for the neonate or to the neonate?' should be asked. These complex issues, along with best interest issues, site, mode and timing of delivery, and the development of palliative care are the subject of this manuscript.
新生儿学和围产医学环境的变化促使人们对围绕姑息治疗的问题进行审视。新生儿姑息治疗应从三个总体方面来考虑：（1）处于存活极限的新生儿。随着技术进步和治疗效果的显现，医疗界和社会有责任就存活极限达成共识。（2）患有致命先天性异常的新生儿。在适当情况下，且诊断和预后明确时，为何要剥夺家庭为未出生胎儿选择姑息治疗的机会？（3）对积极医疗管理无反应的新生儿，持续治疗可能会延长痛苦并推迟死亡。应提出“你是在为新生儿做治疗还是对新生儿做治疗？”这个问题。这些复杂问题，连同最大利益问题、分娩地点、方式和时间，以及姑息治疗的发展，都是本手稿的主题。
