Sabljak Jessica, Brinsmead Tammy
Department of Paediatrics, Mercy Hospital for Women, Melbourne, Victoria, Australia.
Department of Obstetrics, University of Melbourne, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2025 Jan;61(1):66-74. doi: 10.1111/jpc.16712. Epub 2024 Nov 2.
Safer Care Victoria updated a clinical guideline on extreme prematurity in 2020, reducing the threshold for offering resuscitation from 23 to 22 weeks gestation. The zone of parental discretion is the interval of shared decision-making between parents and doctors regarding resuscitation decisions. It is especially relevant at this periviable gestation. Our study aimed to establish current practices in antenatal counselling and steroid administration at this cusp of viability, and examine the decisions made during the zone of parental discretion.
Single centre retrospective cohort study. Sixteen thousand three hundred fifty-four admissions and emergency department presentations between January 2021 and July 2023 were retrieved from Birthing Outcomes System (BOS) and patient details were imported and manually reviewed on Microsoft Excel, with particular note to the gestation at admission/emergency department presentation and duration of admission. Eighty-seven patients were identified as present in the hospital between 21 + 0 and 22 + 6 weeks gestation. These 87 scanned records on Clinical Patient Folder (CPF) were then manually reviewed to identify if antenatal counselling occurred during this window. Thirty-six patients were included who received antenatal counselling between 21 + 0 and 22 + 6 weeks gestation (the remaining patients did not receive antenatal counselling during this window), and relevant data was subsequently extracted from the scanned medical record and analysed using SPSS software (IBM SPSS Statistics 29).
Thirty-six women received antenatal counselling between 21 + 0 and 22 + 6 weeks. 58% decided on full resuscitation and 39% opted for comfort care if their infant was to be born between 22 + 0 and 22 + 6 weeks. All but one baby born premature were exposed to steroids, with 83.3% receiving a full course. Twenty-eight infants (62.2%) were fully steroid loaded at the time of delivery. In those fully steroid loaded, 31.1% of the time steroids were initiated prior to transfer, 50% of the time deferred until neonatal review and a decision regarding the resuscitation status of the baby, and on one occasion requested by the neonatologist before counselling.
Patients at risk for premature birth who attended our hospital at the cusp of viability were generally counselled about the opportunity for resuscitation between 22 + 0 and 22 + 6 weeks gestational age, and offered steroids. Further studies are required to establish whether the content of antenatal counselling, and the timing of steroids, are consistent in this population.
维多利亚州安全护理组织于2020年更新了关于极早早产的临床指南，将进行复苏的孕周阈值从23周降至22周。父母自主决定区间是指父母与医生就复苏决策进行共同决策的时间段。在这个可存活孕周附近尤其重要。我们的研究旨在确定在这个存活临界点上产前咨询和类固醇给药的当前做法，并研究在父母自主决定区间内所做的决策。
单中心回顾性队列研究。从分娩结局系统（BOS）中检索了2021年1月至2023年7月期间的16354例入院和急诊科就诊病例，并将患者详细信息导入Microsoft Excel进行人工审核，特别注意入院/急诊科就诊时的孕周和住院时间。87例患者被确定在孕21 + 0至22 + 6周期间在医院就诊。然后对这87份临床患者文件夹（CPF）中的扫描记录进行人工审核，以确定在此期间是否进行了产前咨询。纳入36例在孕21 + 0至22 + 6周期间接受产前咨询的患者（其余患者在此期间未接受产前咨询），随后从扫描的病历中提取相关数据，并使用SPSS软件（IBM SPSS Statistics 29）进行分析。
36名女性在孕21 + 0至22 + 6周期间接受了产前咨询。如果她们的婴儿在孕22 + 0至22 + 6周出生，58%的人决定进行全面复苏，39%的人选择舒适护理。除一名早产婴儿外，所有早产婴儿都接受了类固醇治疗，83.3%接受了完整疗程。28名婴儿（62.2%）在分娩时已充分接受类固醇治疗。在那些已充分接受类固醇治疗的婴儿中，31.1%的情况下类固醇在转运前开始使用，50%的情况下推迟至新生儿评估并就婴儿的复苏状态做出决定，还有一次是新生儿科医生在咨询前要求使用。
在存活临界点到我院就诊的早产风险患者通常在孕22 + 0至孕22 + 6周期间接受了关于复苏机会的咨询，并接受了类固醇治疗。需要进一步研究以确定该人群中产前咨询的内容和类固醇的使用时间是否一致。
