Peterson J, Southwood G, Smith D M, Johnstone E D, Mahaveer A
Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
Neonatal Intensive Care Unit, St Mary's Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
Front Pediatr. 2025 May 15;13:1553033. doi: 10.3389/fped.2025.1553033. eCollection 2025.
Survival rates and clinical approach to periviable infants are rapidly evolving at certain centres, but there remains variation in definition, approach and management of these infants worldwide. This review aims to narratively review and discuss professional guidelines, position statements and frameworks for management of periviable infants (22 + 0-25 + 0 weeks gestation) born in countries with the highest relative spending on healthcare.
Eligible countries were determined using the Organisation for Economic Co-operation and Development database. The top 10 countries with highest spend on healthcare as a proportion of their gross domestic profit were selected. A comprehensive search of relevant databases and search engines (MEDLINE, Embase, CINAHL, PsycINFO, Google Scholar) was performed to identify professional guidance documents for each eligible country. The primary outcome was the delivery room management recommendation (survival-focused or end of life care). The secondary outcomes were survival rates, disability rates and whether shared decision-making with parents was recommended.
There was variation in definition of periviable and approach to management across the 10 professional guidelines. There was a four-week difference across countries for where the limits of viability lie (22 + 0-25 + 6 weeks). At 22-weeks, eight guidelines recommended comfort care and only one country recommending active care as the default management position at birth. By 24-weeks gestation, no country recommended comfort care as the standard approach at birth.
Despite the included countries having the highest spend on healthcare as a proportion of their GDP, there is marked international variation in recommended practice in relation to the definition of and management for periviable infants. The majority of included guidelines recommended a shared decision-making approach between professionals and parents facing periviable birth, however, there were scant details about how this should be actualized and only two guidelines included decision-making aids for use with parents. The pre-birth discussion between perinatal professionals and parents facing periviable labour is complex and challenging for all involved. Further research is required to explore how best to facilitate parental understanding and involvement in these discussions to ensure parents are empowered to make the most appropriate decisions for their baby and their family.
在某些中心，可存活边缘期婴儿的存活率及临床处理方式正在迅速演变，但全球范围内对这些婴儿的定义、处理方法及管理仍存在差异。本综述旨在对医疗保健支出相对较高国家中出生的可存活边缘期婴儿（妊娠22 + 0至25 + 0周）的管理专业指南、立场声明及框架进行叙述性综述和讨论。
使用经济合作与发展组织数据库确定符合条件的国家。选取医疗保健支出占国内生产总值比例最高的前10个国家。对相关数据库和搜索引擎（MEDLINE、Embase、CINAHL、PsycINFO、谷歌学术）进行全面检索，以确定每个符合条件国家的专业指导文件。主要结果是产房管理建议（以存活为重点或临终关怀）。次要结果是存活率、残疾率以及是否建议与父母进行共同决策。
在10份专业指南中，可存活边缘期的定义及管理方法存在差异。各国对于可存活极限的界定相差四周（22 + 0至25 + 6周）。在妊娠22周时，8份指南推荐采取舒适护理，只有一个国家建议将积极护理作为出生时的默认管理方式。到妊娠24周时，没有国家推荐将舒适护理作为出生时的标准方法。
尽管纳入的国家医疗保健支出占国内生产总值的比例最高，但在可存活边缘期婴儿的定义和管理的推荐实践方面仍存在显著的国际差异。大多数纳入的指南建议在面临可存活边缘期分娩的专业人员和父母之间采取共同决策方法，然而，关于如何实际实施这一方法的细节很少，只有两份指南包含了供父母使用的决策辅助工具。围产期专业人员与面临可存活边缘期分娩的父母之间的产前讨论对所有相关方来说都很复杂且具有挑战性。需要进一步研究以探索如何最好地促进父母对这些讨论的理解和参与，以确保父母有能力为其婴儿和家庭做出最合适的决定。
