Departments of Pediatrics, Community Health & Epidemiology, Dalhousie University & IWK Health Centre, Halifax, Canada.
Department of Nutrition, Texas A&M University, College Station, TX, USA.
Semin Fetal Neonatal Med. 2021 Feb;26(1):101194. doi: 10.1016/j.siny.2021.101194. Epub 2021 Jan 18.
Neonatal care largely follows clinical practice guidelines and position statements developed locally by respective institutions as well as by national and international organizations. One might expect that adoption of clinical guidelines based on best available research evidence would make neonatal care practices mostly uniform. However, wide variation in clinical practice is still noted in neonatal care. Neonatal clinical guidelines are developed almost exclusively by healthcare professionals, with little or no input from families of the infants being cared for. Therefore, such variation in practice may stem not only from how the evidence is interpreted but also how caregivers and families value different outcomes that are affected by particular interventions. Acknowledging and incorporating the variability in patient and family values and preferences in clinical guidelines is an important step towards allowing shared decision making while reducing unwarranted practice variation, and thereby helping clinicians practice family-centered evidence-based medicine.
新生儿护理主要遵循临床实践指南和各机构制定的立场声明，以及国家和国际组织制定的指南和声明。人们可能期望，根据现有最佳研究证据采用临床指南，会使新生儿护理实践基本保持一致。然而，在新生儿护理中仍存在广泛的实践差异。新生儿临床指南几乎完全由医疗保健专业人员制定，很少或没有婴儿家属的参与。因此，这种实践上的差异不仅可能源于对证据的解释方式，还可能源于护理人员和家庭对不同结果的重视程度，而这些结果受到特定干预措施的影响。在临床指南中承认和纳入患者和家庭价值观和偏好的变异性，是朝着允许共同决策的方向迈出的重要一步，同时减少不必要的实践差异，从而帮助临床医生实践以家庭为中心的循证医学。
