Tan Alvin H K, Shand Antonia W, Marsney Renate L, Schindler Timothy, Bolisetty Srinivas, Guaran Robert, Cruz Melinda, Chow Sharon S W, Lui Kei
Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2021 Jan;57(1):52-57. doi: 10.1111/jpc.15115. Epub 2020 Aug 17.
This study aimed to explore clinician and parent opinions of risk limits on resuscitation and intensive care (IC) for extremely premature infants born at the margin of viability.
Two anonymous on-line surveys were conducted from August 2016 to January 2017. Survey participants were: (i) clinicians affiliated with neonatal intensive care units in Australia; and (ii) parents or individuals who expressed interest in premature babies through the Facebook page of Miracle Babies Foundation.
A total of 961 responses were received. Among 204 clinicians, 52% were neonatologists, 22% obstetricians, 20% neonatal intensive care unit nurses and 4% were midwives. Among 757 parents, 98% had a premature baby. Only 75% of clinicians responded to the risk limits questions. Median mortality risk above which they would not recommend resuscitation/IC was 70% (interquartile range (IQR) 50-80%); major disability risk in survivors 60% (IQR 50-75%); and composite risk of mortality and major disability 70% (IQR 50-80%). All parents answered the risk limit questions. The median mortality risk for not planning resuscitation was 90% (IQR 60-90%); major disability risk in survivors 50% (IQR 30-90%); and composite risk 90% (IQR 50-90%). Most clinicians (82%) stated that decisions should be guided by parent opinions if there are uncertainties. Parents had varying perception of previous counselling, and 57% stated that both their viewpoint and doctor's predicted risk influenced their decision-making.
Clinicians and parents had different views on mortality and major disability risks when deciding on resuscitation/neonatal IC treatment. When there was uncertainty, both agreed on working together.
本研究旨在探讨临床医生和家长对于处于存活边缘的极早产儿复苏及重症监护（IC）风险界限的看法。
2016年8月至2017年1月进行了两项匿名在线调查。调查参与者包括：（i）澳大利亚新生儿重症监护病房的临床医生；（ii）通过奇迹宝宝基金会脸书页面表达对早产儿感兴趣的家长或个人。
共收到961份回复。在204名临床医生中，52%为新生儿科医生，22%为产科医生，20%为新生儿重症监护病房护士，4%为助产士。在757名家长中，98%育有早产儿。只有75%的临床医生回答了风险界限问题。他们不建议进行复苏/IC的中位死亡风险为70%（四分位间距（IQR）50 - 80%）；存活者出现严重残疾的风险为60%（IQR 50 - 75%）；死亡和严重残疾的综合风险为70%（IQR 50 - 80%）。所有家长都回答了风险界限问题。不计划进行复苏的中位死亡风险为90%（IQR 60 - 90%）；存活者出现严重残疾的风险为50%（IQR 30 - 90%）；综合风险为90%（IQR 50 - 90%）。大多数临床医生（82%）表示，如果存在不确定性，决策应以家长意见为指导。家长对先前咨询的看法各不相同，57%表示他们的观点和医生预测的风险都影响了他们的决策。
在决定是否进行复苏/新生儿IC治疗时，临床医生和家长对死亡及严重残疾风险的看法不同。当存在不确定性时，双方都同意共同协作。
