JDLConsulting, USA.
Semin Fetal Neonatal Med. 2022 Apr;27(2):101343. doi: 10.1016/j.siny.2022.101343. Epub 2022 Apr 22.
Debates about treatment for the tiniest premature babies focus on three different approaches - universal non-resuscitation, selective resuscitation, and universal resuscitation. Doctors, hospitals, and professional societies differ on which approach is preferable. The debate is evolving as studies show that survival rates for babies born at 22 and 23 weeks of gestation are steadily improving at centers that offer active treatment to these babies. Still, many centers do not offer such treatment or, if they do, actively discourage it. The doctors and centers that discourage treatment have concerns about the chances for survival, neurodevelopmental impairment among survivors, and cost. Centers that offer and encourage treatment cite evidence that many babies born at 22 weeks can survive, that most survivors have good neurodevelopmental outcomes, and that NICU care for tiny babies is cost-effective compared to many common and uncontroversial treatments. The debate touches on many fundamental ethical issues that have been present in neonatology since its inception as a medical specialty.
关于最小早产儿的治疗方案存在广泛争议，主要有三种不同的方法：普遍不复苏、选择性复苏和普遍复苏。医生、医院和专业协会在哪个方法更可取上存在分歧。随着研究表明在积极治疗这些婴儿的中心，妊娠 22 周和 23 周出生的婴儿的存活率稳步提高，这一争论也在不断发展。然而，许多中心不提供这种治疗，或者如果提供，也积极劝阻。不鼓励治疗的医生和中心对生存机会、幸存者的神经发育损伤以及成本存在担忧。提供和鼓励治疗的中心则引用了证据，证明许多在 22 周出生的婴儿可以存活，大多数幸存者的神经发育结果良好，与许多常见且无争议的治疗方法相比，NICU 对微小婴儿的治疗具有成本效益。这场争论涉及到自新生儿学作为一个医学专业成立以来就存在的许多基本伦理问题。
