Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Pediatr. 2019 Apr;31(2):182-187. doi: 10.1097/MOP.0000000000000731.
Medical decision making and practices surrounding extremely premature birth remains challenging for parents and care providers alike. Recently, concerns have been raised regarding wide practice variation, selection bias, and the limitations of outcomes data in this population. The purpose of this review is to summarize the recent literature relevant to deliveries at extreme prematurity with a focus on outcomes, approaches, and institutional variation.
Newer data suggest that evidence-based clinical guidelines and protocols for both pregnant women and infants at extreme prematurity are emerging and may improve care and outcomes at lower gestational ages. It has also been recently shown that wide practice variation, selection bias, and methodological limitations of outcomes data reporting with respect to deliveries at extreme prematurity exist.
Counseling at extreme prematurity should prioritize eliciting parental values and preferences with the goal of personalized shared decision-making. Providers should recognize limitations in counseling families at extreme prematurity, including selection bias, institutional variation, outcomes inaccuracies, prognostic uncertainty, and implicit biases. Standardized reporting of perinatal outcomes should be developed to help alleviate current outcomes misrepresentations and improve counseling at extreme prematurity. Education for providers in advanced communication skills is needed when counseling at extreme prematurity.
极早产儿的医疗决策和实践仍然是父母和医护人员面临的挑战。最近，人们对该人群中广泛的实践差异、选择偏倚以及结局数据的局限性表示担忧。本文的目的是总结与极早产儿分娩相关的最新文献，重点关注结局、方法和机构差异。
新的数据表明，针对极早产儿孕妇和婴儿的循证临床指南和方案正在出现，这可能会改善较低胎龄的护理和结局。最近还表明，极早产儿分娩存在广泛的实践差异、选择偏倚以及结局数据报告的方法学局限性。
极早产儿的咨询应优先考虑引出父母的价值观和偏好，以实现个性化的共同决策。医护人员应认识到极早产儿家庭咨询的局限性，包括选择偏倚、机构差异、结局数据不准确、预后不确定和隐含偏见。应制定围产期结局的标准化报告，以帮助减轻目前的结局数据失真，并改善极早产儿的咨询。在极早产儿的咨询中，需要对医护人员进行高级沟通技巧的教育。
