Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Arch Dis Child Fetal Neonatal Ed. 2020 Mar;105(2):209-214. doi: 10.1136/archdischild-2019-316951. Epub 2019 Jun 14.
There is a high incidence of preterm birth in low-income and middle-income countries where healthcare resources are often limited and may influence decision making. We aimed to explore the interplay between resource limitations and resuscitation practices for extremely preterm infants (EPIs) in neonatal intensive care units (NICUs) across the Philippines.
We conducted a national survey of NICUs in the Philippines. Institutions were classified according to sector (private/public), region and level. Respondents were asked about unit capacity, availability of ventilators and surfactant, resuscitation practices and estimated survival rates for EPIs of different gestational ages.
Respondents from 103/228 hospitals completed the survey (response rate 45%). Public hospitals reported more commonly experiencing shortages of ventilators than private hospitals (85%vs23%, p<0.001). Surfactant was more likely to be available in city hospitals than regional/district hospitals (p<0.05) and in hospitals classified as Level III/IV than I/II (p<0.05). The financial capacity of parents was a major factor influencing treatment options. Survival rates for EPIs were estimated to be higher in private than public institutions. Resuscitation practice varied; active treatment was generally considered optional for EPIs from 25 weeks' gestation and usually provided after 27-28 weeks' gestation.
Our survey revealed considerable disparities in NICU resource availability between different types of hospitals in the Philippines. Variation was observed between hospitals as to when resuscitation would be provided for EPIs. National guidelines may generate greater consistency of care yet would need to reflect the variable context for decisions in the Philippines.
在医疗资源有限的中低收入国家，早产发生率较高，这可能会影响决策。我们旨在探讨菲律宾新生儿重症监护病房（NICU）中资源限制与极度早产儿（EPI）复苏实践之间的相互作用。
我们对菲律宾的 NICU 进行了全国性调查。根据部门（私立/公立）、地区和级别对机构进行分类。调查对象被问及单位容量、是否有呼吸机和表面活性剂、复苏实践以及不同胎龄 EPI 的估计存活率。
103/228 家医院的调查对象完成了调查（应答率 45%）。公立医院比私立医院更常报告呼吸机短缺（85%比 23%，p<0.001）。城市医院比地区/地区医院（p<0.05）和三级/四级医院比一级/二级医院（p<0.05）更有可能有表面活性剂。父母的财务能力是影响治疗选择的主要因素。EPI 的存活率估计在私立机构比公立机构更高。复苏实践有所不同；对于 25 周胎龄的 EPI，积极治疗通常被认为是可选的，通常在 27-28 周胎龄后提供。
我们的调查显示，菲律宾不同类型医院的 NICU 资源可用性存在相当大的差异。各医院之间在何时为 EPI 提供复苏治疗方面存在差异。国家指南可能会产生更一致的护理，但需要反映菲律宾决策的不同背景。
