Carroll Katherine, Thorvilson Megan, Collura Christopher
School of Sociology, College of Arts and Social Sciences, Australian National University, Canberra, Australian Capital Territory, Australia.
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Sociol Health Illn. 2025 Feb;47(2):e13852. doi: 10.1111/1467-9566.13852. Epub 2024 Oct 10.
Caring for the extremely premature infant born in the grey zone of viability is the most difficult area of neonatal medicine. Little research has been done on antenatal communication between neonatologists and parents anticipating the birth of a periviable infant. This article analyses 25 antenatal consultations between neonatologists and parents in one Midwestern hospital in the United States of America. It explores how neonatologists position comfort care as one of two predominant care trajectories for extremely premature infants born into the grey zone of viability. We found comfort care featured minimally in and was often marginalised by neonatologists' language. The two dominant discourses contributing to this were acute medicine's life-saving capacity and a limited temporal window marked by gestational age where comfort measures were deemed appropriate. Antenatal consultations framed by shared decision-making could be approached as a form of care characterised by a relational openness and responsiveness to parents' views on care. This asks neonatologists to enter antenatal consultations for periviability without knowing ahead of time which care trajectory will necessarily call one's attention or the particular response one should take, thus highlighting the skills of reflexivity in addition to an attentiveness and openness towards those receiving care.
照顾出生在可存活灰色地带的极早产儿是新生儿医学中最具挑战性的领域。对于新生儿科医生与预期将诞下接近可存活孕周婴儿的父母之间的产前沟通，目前研究甚少。本文分析了美国中西部一家医院的新生儿科医生与父母之间的25次产前会诊。研究探讨了新生儿科医生如何将舒适护理定位为出生在可存活灰色地带的极早产儿两种主要护理路径之一。我们发现，舒适护理在新生儿科医生的表述中占比极小，且常常被边缘化。造成这种情况的两种主要话语是急性医学的救命能力以及以胎龄为标志的有限时间窗口，在这个时间窗口内，舒适护理措施被认为是合适的。以共同决策为框架的产前会诊可以被视为一种护理形式，其特点是具有关系开放性，并对父母对护理的看法做出回应。这要求新生儿科医生在进行关于接近可存活孕周婴儿的产前会诊时，事先并不知道哪种护理路径一定会引起关注，也不知道应该做出何种具体回应，从而除了要对接受护理的人保持关注和开放态度外，还凸显了反思能力。
