Schuler Rahel, Bedei Ivonne, Oehmke Frank, Zimmer Klaus-Peter, Ehrhardt Harald
Department of General Pediatrics and Neonatology, Justus-Liebig-University, Feulgenstrasse 12, 35392 Giessen, Germany.
Department of Obstetrics and Gynecology, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.
Children (Basel). 2022 Feb 24;9(3):313. doi: 10.3390/children9030313.
Decision-making at the border of viability remains challenging for the expectant parents and the medical team. The preterm infant is dependent on others making the decision that will impact them for a lifetime in hopefully their best interest. Besides survival and survival without neurodevelopmental impairment, other relevant outcome measures, such as the quality of life of former preterm infants and the impact on family life, need to be integrated into prenatal counselling. Recommendations and national guidelines continue to rely on arbitrarily set gestational age limits at which treatment is not recommended, can be considered and it is recommended. These guidelines neglect other individual prognostic outcome factors like antenatal steroids, birth weight and gender. Besides individual factors, centre-specific factors like perinatal treatment intensity and the attitude of healthcare professionals significantly determine the futures of these infants at the border of viability. A more comprehensive approach regarding treatment recommendations and relevant outcome measures is necessary.
对于准父母和医疗团队而言，在可存活边界进行决策仍然具有挑战性。早产婴儿依赖他人做出的决策，而这一决策将有望以他们的最大利益影响其一生。除了存活以及无神经发育障碍地存活之外，其他相关的结果指标，如 former preterm infants 的生活质量以及对家庭生活的影响，也需要纳入产前咨询。建议和国家指南仍然依赖于任意设定的胎龄限制，在这些胎龄下不建议治疗、可以考虑治疗以及建议治疗。这些指南忽视了其他个体预后结果因素，如产前使用类固醇、出生体重和性别。除了个体因素外，中心特定因素，如围产期治疗强度和医护人员的态度，也显著决定了这些处于可存活边界的婴儿的未来。对于治疗建议和相关结果指标，需要一种更全面的方法。
