Martinez A M, Weiss E, Partridge J C, Freeman H, Kilpatrick S
Department of Pediatrics, University of California, San Francisco, 94110, USA.
Obstet Gynecol. 1998 Oct;92(4 Pt 1):520-4. doi: 10.1016/s0029-7844(98)00285-3.
To determine physician opinions, parental counseling, and medical practices for extremely low birth weight (LBW) infants.
A retrospective survey was sent in August 1996 to 450 California physicians practicing obstetrics.
There was a 41% response rate. The mean thresholds for antenatal steroid administration, cesarean delivery for fetal distress and delivery room resuscitation were gestational age between 23 and 24 weeks and weight close to 500 g. Most obstetricians counsel parents regarding survival, resuscitation, and possible death in the delivery room before delivery of an extremely LBW infant. Just over 60% of obstetricians believe that parents have a role in deciding not to resuscitate an infant born at 22 weeks' gestation, this decreases to less than 50% at 24 weeks, and decreases further to less than 30% by 26 weeks' gestation. Just over 40% of obstetricians report their counseling is affected by pediatric opinion, 33% by previous maternal perinatal losses, and less than 20% by maternal drug use or lack of prenatal care, and young maternal age. Language barriers, parental education level, and family insurance affect treatment options in less than 10% of obstetricians.
Obstetric opinions about delivery room resuscitation of extremely LBW infants are influenced by birth weight and gestational age thresholds, infant, and parental factors. There is a limited willingness by physicians to allow a parental role in decision making in the delivery room for extremely LBW infants.
确定医生对于极低出生体重（LBW）婴儿的看法、对家长的咨询指导以及医疗实践。
1996年8月，对450名在加利福尼亚州从事产科工作的医生进行了一项回顾性调查。
回复率为41%。产前使用类固醇、因胎儿窘迫进行剖宫产以及产房复苏的平均阈值为孕龄23至24周，体重接近500克。大多数产科医生在极低出生体重婴儿出生前，会就其存活、复苏以及产房内可能出现的死亡情况向家长提供咨询。略超过60%的产科医生认为家长在决定是否对孕22周出生的婴儿进行复苏方面有一定作用，到孕24周时这一比例降至不到50%，到孕26周时进一步降至不到30%。略超过40%的产科医生报告称他们的咨询会受到儿科意见的影响，33%受产妇既往围产期损失情况影响，受产妇药物使用情况、缺乏产前护理以及产妇年龄较小影响的比例不到20%。语言障碍、家长教育水平和家庭保险对不到10%的产科医生的治疗选择有影响。
产科医生对极低出生体重婴儿产房复苏的看法受到出生体重、孕龄阈值、婴儿及家长因素的影响。医生允许家长在极低出生体重婴儿产房决策中发挥作用的意愿有限。
