Mangarov Iliya, Iliev Simeon, Voynikov Yulian, Petkova Valentina, Parvova Iva, Tsvetkova Antoaneta, Nikolova Irina
Department of Neonatology, University Hospital "SofiaMed", Faculty of Medicine, Sofia University St. Kliment Ohridski, 1504 Sofia, Bulgaria.
Independent Researcher, 1680 Sofia, Bulgaria.
Antibiotics (Basel). 2025 Sep 16;14(9):936. doi: 10.3390/antibiotics14090936.
Premature infants are an especially vulnerable group that often needs extended intensive care. Prematurity naturally hampers the development of the immune system, significantly increasing the risk of infections. In the Neonatal Intensive Care Unit (NICU), antibiotic treatment is often a crucial, life-saving measure. For parents, the birth of a very preterm infant (before 32 weeks of gestation) turns what should be a happy event into a period filled with deep uncertainty and distress. Maintaining hope amid these difficulties relies heavily on maintaining regular communication with and trusting the medical team. Clinical realities in the NICU include a high risk of infection that requires multiple medications, including antibiotics. There is an inverse relationship between gestational age and pharmaceutical exposure. Parents worry about the amount of medication their child receives and the potential long-term effects on development. Over the past thirty years, initiatives such as antimicrobial stewardship programs have worked to reduce antibiotic use and treatment duration in the NICU, emphasizing proper care for premature infants worldwide. This article examines the ethical landscape from the perspectives of three primary stakeholders: parents, healthcare providers, and regulatory bodies. The key ethical question is whether these groups achieve meaningful cooperation or if institutional and professional priorities overshadow clinical practice. In the NICU, decision-making responsibility mainly lies with the medical team, as parents often have limited influence over treatment decisions, and regulatory oversight usually occurs indirectly. This concentration of authority underscores the complex and critical nature of neonatal intensive care.
早产儿是一个特别脆弱的群体，常常需要长期的重症监护。早产自然会阻碍免疫系统的发育，显著增加感染风险。在新生儿重症监护病房（NICU），抗生素治疗往往是一项关键的救命措施。对父母来说，极早产儿（妊娠32周前）的出生将本应是一件喜事变成了一个充满深深不确定性和痛苦的时期。在这些困难中保持希望很大程度上依赖于与医疗团队保持定期沟通并信任他们。NICU的临床现实包括感染风险高，这需要多种药物治疗，包括抗生素。胎龄与药物暴露之间存在反比关系。父母担心孩子接受的药物剂量以及对发育的潜在长期影响。在过去三十年里，诸如抗菌药物管理计划等举措致力于减少NICU中的抗生素使用和治疗时长，在全球范围内强调对早产儿的妥善护理。本文从三个主要利益相关者的角度审视了伦理格局：父母、医疗服务提供者和监管机构。关键的伦理问题是这些群体能否实现有意义的合作，或者机构和专业优先事项是否会凌驾于临床实践之上。在NICU中，决策责任主要在于医疗团队，因为父母通常对治疗决策影响有限，而监管监督通常是间接进行的。这种权力的集中凸显了新生儿重症监护工作的复杂性和关键性。
