Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom.
John Radcliffe Hospital, Oxford, United Kingdom.
J Paediatr Child Health. 2019 Sep;55(9):1023-1028. doi: 10.1111/jpc.14552. Epub 2019 Jul 25.
While the vast majority of preterm births globally occur in low- and middle-income countries, existing published guidelines relating to the decision-making and resuscitation of extremely preterm infants (EPIs) largely focus on high-income countries. In 2018-2019, a working group of the Philippine Society of Newborn Medicine aimed to develop the first national guideline relating to the care of EPIs. The working group reviewed data on the outcomes of EPIs in the Philippines, surveyed paediatricians and neonatologists in the Philippines about current practice and held a consensus workshop. This paper describes the guideline development process and presents a summary of the guidelines. The national guidelines endorse consistency in decision-making. Health professionals should take into consideration the views and wishes of the infant's parents and the availability of resources to treat the newborn infant. Active management would be appropriate to provide for potentially viable preterm infants at moderate to high risk of poor outcomes, where parents have expressed their wish for this management (and where there are resources available to provide this treatment). For such infants, where parents have expressed their wish to withhold active management, palliative management would also be appropriate to provide. The guideline endorses a grey zone for neonatal resuscitation from approximately 24 to 28 weeks' gestation in the Philippines, reflecting the context for resuscitation in low- and middle-income countries. Disparities in resource availability are themselves an ethical concern for neonatologists and should be a stimulus for advocacy and improvements in health-care delivery.
虽然全球绝大多数早产儿出生在中低收入国家，但现有的关于极早产儿（EPI）决策和复苏的已发表指南主要集中在高收入国家。2018-2019 年，菲律宾新生儿医学学会的一个工作组旨在制定第一份关于 EPI 护理的国家指南。该工作组审查了菲律宾 EPI 结局的数据，调查了菲律宾的儿科医生和新生儿科医生当前的实践情况，并举行了共识研讨会。本文描述了指南制定过程，并总结了指南内容。国家指南支持决策的一致性。卫生专业人员应考虑婴儿父母的意见和愿望以及治疗新生儿的可用资源。对于有中度至高度不良结局风险的潜在有活力的早产儿，积极管理是合适的，只要父母表达了他们对这种管理的愿望（并且有资源提供这种治疗）。对于表达了拒绝积极管理愿望的此类婴儿，姑息治疗也是合适的。该指南支持菲律宾约 24 至 28 周胎龄新生儿复苏的灰色地带，反映了中低收入国家复苏的背景。资源可用性的差异本身就是新生儿科医生关注的伦理问题，应该成为倡导和改善医疗保健提供的动力。
