背景:新生儿护理的进展改善了极早产儿的预后。考虑积极治疗的胎龄在全球范围内已经下降。尽管实施了指导方针,一些研究表明在实践中存在可变性。这项研究的目的是了解葡萄牙新生儿学家和产科医生对极端早产儿管理的观点。
方法:2023年8月至9月,通过葡萄牙新生儿学会和葡萄牙妇产科和母胎医学学会发送了一项在线调查。
结果:我们获得了117个响应:53%的新生儿专家,18%的儿科医生,29%的产科医生,62%的人有10年以上的经验。大多数(80%)熟悉葡萄牙新生儿学会关于生存能力极限的共识,46%的人在实践中使用了该共识;62%的人不知道与极端早产儿相关的葡萄牙发病率-死亡率统计数据。大多数(91%)在入院时更频繁地告知父母有关胎龄的死亡率(64%),并在生存能力极限情况下考虑了他们的意见(95%)。胎龄22周时,71%的人只建议舒适护理,在25周和26周的时候,大多数人建议积极护理(80%和96%,分别)。在23周和24周观察到较少的共识。24周时,大多数产科医生提供积极护理,并选择父母选择的舒适护理(59%),而新生儿科组提供积极护理(65%),p<0.001。关于宫内移植的胎龄下限,皮质类固醇给药,剖宫产胎儿指征,新生儿科医生在分娩过程中的存在,和气管插管;新生儿学家认为胎龄比产科医生低(分别为23周和24周;p=0.036;p<0.001;p<0.001;p=0.021;p<0.001)。
结论:确定了产科医生和新生儿学家在生存能力限制方面的观点差异。新生儿学家在各种情况下都考虑了较低的胎龄,并提出了更早的积极护理。对极度早产儿进行规范化的咨询对于避免模棱两可至关重要,父母的困惑,和围产期保健的冲突。
BACKGROUND: Advances in neonatal care have improved the prognosis in extremely preterm infants. The gestational age considered for active treatment has decreased globally. Despite implemented guidelines, several studies show variability in practice. The aim of this study was to understand theperspectives of Portuguese
neonatologists and obstetricians regarding the management of extremely preterm infants.
METHODS: An online survey was sent through the Portuguese Neonatology Society and the Portuguese Society of Obstetrics and Maternal-Fetal Medicine from August to September 2023.
RESULTS: We obtained 117 responses: 53%
neonatologists, 18% pediatricians, and 29% obstetricians, with 62% having more than 10 years of experience. The majority (80%) were familiar with the Portuguese Neonatology Society consensus on the limits of viability and 46% used it in practice; 62% were unaware of Portuguese morbidity-mortality statistics associated with extremely preterm infants. Most (91%) informed parents about morbiditymortality concerning the gestational age more frequently upon admission (64%) and considered their opinion in the limit of viability situations (95%). At 22 weeks gestational age, 71% proposed only comfort care, while at 25 and 26 weeks, the majority suggested active care (80% and 96%, respectively). Less consensus was observed at 23 and 24 weeks. At 24 weeks, most obstetricians offered active care with the option of comfort care by parental choice (59%), while the neonatology group provided active care (65%), p < 0.001. Regarding the lower limit of gestational age for in utero transfer, corticosteroid administration, cesarean section for fetal indication, neonatologist presence during delivery, and endotracheal intubation;
neonatologists considered a lower gestational age than obstetricians (23 vs 24 weeks; p = 0.036; p < 0.001; p < 0.001; p = 0.021; p < 0.001, respectively).
CONCLUSIONS: Differences in perspectives between obstetricians and
neonatologists in limits of viability situations were identified.
Neonatologists considered a lower gestational age in various scenarios and proposed active care earlier. Standardized counseling for extremely preterm infants is crucial to avoid ambiguity, parental confusion, and conflicts in perinatal care.