Department of Neonatology, GFO Kliniken Bonn, Bonn, Germany.
Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
J Pediatr. 2019 Apr;207:154-160. doi: 10.1016/j.jpeds.2018.12.064. Epub 2019 Feb 13.
To assess changes in attitudes of neonatologists regarding the care of extremely preterm infants and parental involvement over the last 20 years.
Internet-based survey (2016) involving 170 tertiary neonatal intensive care units in Austria, Switzerland, and Germany using the European Project on Parents' Information and Ethical Decision Making in Neonatal Intensive Care Units questionnaire (German edition) with minor modifications to the original survey from 1996 to 1997.
The 2016 survey included 104 respondents (52.5% response rate). In 2016, significantly more neonatologists reported having ever withheld intensive care treatment (99% vs 69%) and withdrawn mechanical ventilation (96% vs 61%) or life-saving drugs (99% vs 79%), compared with neonatologists surveyed in 1996-1997. Fewer considered limiting intensive care as a slippery slope possibly leading to abuse (18% vs 48%). In the situation of a deteriorating clinical condition despite all treatment, significantly more neonatologists would ask parental opinion about continuation of intensive care (49% vs 18%). In 2016, 21% of German neonatologists would resuscitate a hypothetical infant at the limits of viability, even against parental wishes.
Withholding or withdrawing intensive care for extremely preterm infants at the limits of viability with parental involvement has become more acceptable than it was 20 years ago. However, resuscitating extremely preterm infants against parental wishes remains an option for up to one-fifth of the responding neonatologists in this survey.
评估过去 20 年来，新生儿科医生对极早产儿护理和家长参与的态度变化。
互联网调查（2016 年），涉及奥地利、瑞士和德国的 170 个三级新生儿重症监护病房，使用欧洲父母信息和新生儿重症监护伦理决策项目问卷（德语版），对 1996 年至 1997 年的原始调查进行了轻微修改。
2016 年的调查包括 104 名受访者（52.5%的回复率）。与 1996-1997 年接受调查的新生儿科医生相比，2016 年有更多的新生儿科医生报告曾拒绝提供重症治疗（99% vs 69%）和撤回机械通气（96% vs 61%）或救命药物（99% vs 79%）。认为限制重症治疗可能导致滥用的新生儿科医生较少（18% vs 48%）。在尽管所有治疗仍病情恶化的情况下，有更多的新生儿科医生会征求家长对继续重症治疗的意见（49% vs 18%）。2016 年，21%的德国新生儿科医生会在极限存活的情况下对假设的婴儿进行复苏，即使这违背了家长的意愿。
在有家长参与的情况下，对极早产儿在极限存活的情况下拒绝或撤回重症治疗已经比 20 年前更容易被接受。然而，在这项调查中，仍有五分之一的新生儿科医生表示会违背家长的意愿对极早产儿进行复苏。
