Interfaculty Centre for Biomedical Ethics and Law,
Academic Centre for Nursing and Midwifery, and.
Pediatrics. 2019 Jun;143(6). doi: 10.1542/peds.2018-3972. Epub 2019 May 10.
Whether to resuscitate extremely premature infants (EPIs) is a clinically and ethically difficult decision to make. Indications and practices vary greatly across different countries and institutions, which suggests that resuscitation decisions may be influenced more by the attitudes of the individual treating physicians. Hence, gaining in-depth insight into physicians' attitudes improves our understanding of decision-making regarding resuscitation of EPIs.
To better understand physicians' attitudes toward resuscitation of EPIs and factors that influence their attitudes through a systematic review of the empirical literature.
Medline, Embase, Web of Science, and Scopus.
We selected English-language articles in which researchers report on empirical studies of physicians' attitudes toward resuscitation of EPIs.
The articles were repeatedly read, themes were identified, and data were tabulated, compared, and analyzed descriptively.
Thirty-four articles were included. In general, physicians were more willing to resuscitate, to accept parents' resuscitation requests, and to refuse parents' nonresuscitation requests as gestational age (GA) increased. However, attitudes vary greatly for infants at GA 23 to 24 weeks, known as the gray zone. Although GA is the primary factor that influences physicians' attitudes, a complex interplay of patient- and non-patient-related factors also influences their attitudes.
Analysis of English-only articles may limit generalizability of the results. In addition, authors of only 1 study used a qualitative approach, which may have led to a biased reductionist approach to understanding physicians' attitudes.
Although correlations between GA and attitudes emerged, the results suggested a more complex interplay of factors influencing such attitudes.
是否对极早产儿（EPIs）进行复苏是一个临床和伦理上都难以做出的决策。不同国家和机构之间的复苏指征和实践差异很大，这表明复苏决策可能更多地受到治疗医生个体态度的影响。因此，深入了解医生的态度可以提高我们对 EPIs 复苏决策的理解。
通过系统回顾实证文献，更好地了解医生对 EPIs 复苏的态度以及影响这些态度的因素。
Medline、Embase、Web of Science 和 Scopus。
我们选择了报告医生对 EPIs 复苏态度的实证研究的英语文章。
文章反复阅读，确定主题，并对数据进行制表、比较和描述性分析。
共纳入 34 篇文章。一般来说，随着胎龄（GA）的增加，医生更愿意复苏，接受父母的复苏请求，拒绝父母的非复苏请求。然而，GA 为 23 至 24 周的婴儿（被称为灰色地带）的态度差异很大。尽管 GA 是影响医生态度的主要因素，但患者和非患者相关因素的复杂相互作用也会影响他们的态度。
仅分析英语文章可能会限制结果的普遍性。此外，只有 1 项研究的作者使用了定性方法，这可能导致对医生态度的理解存在有偏见的简化方法。
尽管 GA 与态度之间存在相关性，但结果表明影响这些态度的因素之间存在更复杂的相互作用。
