Thomas Sumesh, Asztalos Elizabeth
Department of Pediatrics, Section of Neonatology, University of Calgary, C536-1403 29St Nw, Calgary, AB T2N 2T9, Canada.
Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, M4-230, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada.
Children (Basel). 2021 Jul 13;8(7):593. doi: 10.3390/children8070593.
Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-trimester scans, which offer an accuracy of ±3-7 days, and depend on the timing of the scans and the measurements used in the calculations. Most published literature on the outcomes of babies born prematurely have reported on short- and long-term outcomes based on completed gestational weeks of fetal maturity at birth. These outcome data change significantly from one week to the next, especially around the margin of gestational viability. With a change in approach solely from decisions based on survival, to disability-free survival and long-term functional outcomes, the complexity of the parental and care provider's decision-making in the perinatal and postnatal period for babies born at less than 25 weeks gestation remains challenging. While sustaining life following birth at the margins of viability remains our priority-identifying and mitigating risks associated with extremely preterm birth begins in the perinatal period. The challenge of supporting the normal maturation of these babies postnatally has far-reaching consequences and depends on our ability to sustain life while optimizing growth, nutrition, and the repair of organs compromised by the consequences of preterm birth. This article aims to explore the ethical and medical complexities of contemporary decision-making in the perinatal and postnatal periods. We identify gaps in our current knowledge of this topic and suggest areas for future research, while offering a perspective for future collaborative decision-making and care for babies born at the margins of viability.
大多数临床医生在进行产前和产后咨询时，尤其是针对出生时处于存活临界期的早产儿，依赖基于胎儿成熟孕周数的结局数据。基于超声的当代孕周估计依赖于孕早期扫描，其提供的准确度为±3 - 7天，且取决于扫描时间和计算中使用的测量值。大多数已发表的关于早产儿结局的文献都是基于出生时完成的胎儿成熟孕周数报告短期和长期结局。这些结局数据每周都会有显著变化，尤其是在孕周存活临界期附近。随着方法从单纯基于生存的决策转变为无残疾生存和长期功能结局的决策，对于孕周小于25周出生的婴儿，父母和护理人员在围产期和产后的决策复杂性仍然具有挑战性。虽然在存活临界期出生后维持生命仍然是我们的首要任务，但识别和减轻与极早早产相关的风险始于围产期。产后支持这些婴儿正常成熟的挑战具有深远影响，并且取决于我们在维持生命的同时优化生长、营养以及修复因早产后果而受损器官的能力。本文旨在探讨围产期和产后当代决策中的伦理和医学复杂性。我们识别了当前对此主题认识的差距，并提出了未来研究的领域，同时为未来针对出生在存活临界期的婴儿的协作决策和护理提供一个视角。
