Pennaforte T, Moussa A, Janvier A
Service de néonatologie, CHU Sainte-Justine, université de Montréal, 3175, chemin de la côte Sainte-Catherine, H3T 1C4 Montréal, QC, Canada; Centre de recherche, CHU Sainte-Justine, université de Montréal, 3175, chemin de la côte Sainte-Catherine, H3T 1C4 Montréal, QC, Canada.
Service de néonatologie, CHU Sainte-Justine, université de Montréal, 3175, chemin de la côte Sainte-Catherine, H3T 1C4 Montréal, QC, Canada; Centre de recherche, CHU Sainte-Justine, université de Montréal, 3175, chemin de la côte Sainte-Catherine, H3T 1C4 Montréal, QC, Canada; Département de pédiatrie, CHU Sainte-Justine, université de Montréal, 3175, chemin de la côte Sainte-Catherine, H3T 1C4 Montréal, QC, Canada.
Arch Pediatr. 2017 Feb;24(2):146-154. doi: 10.1016/j.arcped.2016.11.002. Epub 2016 Dec 15.
Technological progress and improved clinical knowledge have increased survival of neonates who would previously have died. Survival is sometimes accompanied by a risk of short- or long-term adverse outcomes, which may lead to complex decisions about withholding or withdrawing life-sustaining interventions. These decisions are among the most difficult decisions in pediatric practice. They also involve communicating with parents and are emotionally charged. Many articles examining end-of-life decisions in neonatology state the need for healthcare providers to be caring, compassionate, and human without offering clear, practical advice. In this article, the way in which neonates die and the ethical decision-making surrounding these decisions will be reviewed. Guidelines to reflect on the life trajectories of neonates will be offered, as well as recommendations to optimize communication with families during these difficult moments.
技术进步和临床知识的改善提高了以往可能会死亡的新生儿的存活率。存活有时伴随着短期或长期不良后果的风险，这可能导致在停止或撤销维持生命的干预措施方面做出复杂的决定。这些决定是儿科实践中最困难的决定之一。它们还涉及与父母沟通，且充满情感因素。许多探讨新生儿科临终决策的文章都指出医疗服务提供者需要有爱心、有同情心且有人情味，但却没有提供明确、实用的建议。在本文中，将回顾新生儿死亡的方式以及围绕这些决定的伦理决策。将提供用以思考新生儿生命轨迹的指导方针，以及在这些艰难时刻优化与家庭沟通的建议。
