Eidelman Arthur I
Department of Pediatrics, Shaare Zedek Medical Center, Hebrew University School of Medicine, Faculty of Health Sciences, Jerusalem, Israel; Ben Gurion University of the Negev, Beer Sheva, Israel.
Rambam Maimonides Med J. 2011 Oct 31;2(4):e0066. doi: 10.5041/RMMJ.10066. Print 2011 Oct.
As more reports emerge of improved mortality and morbidity rates in infants born at the edge of viability, there may be need to reassess protocols and recommendations that encourage only comfort care for infants who are born at less than 24 weeks' gestation. Analysis of those studies that report extremely poor survival of these infants reveals that, all too often, the results are measures of a self-fulfilling prophesy that reflects a predetermined non-aggressive global policy of no resuscitation and minimal investment in intensive care. Furthermore, little distinction is made between high- and low-risk infants of the same gestational age despite repeated studies that indicate that one can identify subpopulations that have as much as a 20-50% increased chance of surviving with little if any long-term neurodevelopmental impairment. Thus, the need to reassess current policies is discussed.
随着越来越多关于出生时处于存活临界状态的婴儿死亡率和发病率有所改善的报告出现，可能有必要重新评估那些鼓励仅对妊娠不足24周出生的婴儿进行舒适护理的方案和建议。对那些报告这些婴儿存活率极低的研究进行分析后发现，结果往往是一种自我实现的预言的衡量标准，反映了一种预先确定的不积极的整体政策，即不进行复苏且在重症监护方面投入极少。此外，尽管反复有研究表明可以识别出亚群体，这些亚群体存活几率增加20%至50%且几乎没有长期神经发育损害，但对于相同孕周的高风险和低风险婴儿几乎没有区分。因此，讨论了重新评估现行政策的必要性。
