Neonatologists' preferences regarding guidelines for periviable deliveries: do we really know what we want?
Neonatologists' preferences regarding guidelines for periviable deliveries: do we really know what we want?
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DOI：
10.1038/s41372-019-0313-1
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发表时间：
2019-03-01
影响因子：
2.9
通讯作者：
Feltman, Dalia M.
中科院分区：
文献类型：
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作者：
Krick, Jeanne A.;Feltman, Dalia M.
目的了解新生儿科提供者对围产期护理指南的偏好。研究设计美国儿科学会新生儿-围产期医学分会在线横断面调查。结果480名受访者中，大多数人希望提供复苏和舒适护理的胎龄上限(85%)和胎龄下限(87%)的标准化指南。标准化在国家、机构和区域各级最受欢迎或最不受欢迎。在父母偏好与机构指南冲突的情况下，受访者更多地选择父母偏好的选项(66%对34%)。总体而言，复苏(48%)和舒适护理(52%)几乎是同等的选择。在紧急情况下，更多和更少经验的受访者更喜欢父母优先选择的方案，而不是指南(55%比46%，p=0.003)，选择复苏而不是舒适护理(50%比36%，p<；0.001)。结论新生儿提供者希望获得基于年龄的围生期指南，但在标准化水平上不一致。这些限制可能不足以指导临床实践。政策应包括通过公平、透明的决策来指导提供者的程序。
Objective To examine neonatology providers' preferences regarding periviability guidelines.Study design An online cross-sectional survey of American Academy of Pediatrics Section on Neonatal-Perinatal Medicine members.Results Most of the 480 respondents desired standardized guidelines for upper (85%) and lower (87%) gestational age limits for offering resuscitation and comfort care. Standardization was most to least frequently desired at the national, institutional, and regional levels. Within scenarios involving parents' preferences conflicting with institutional guidelines, respondents chose parent-preferred options more often (66 vs. 34%). Overall, resuscitation (48%) versus comfort care (52%) were nearly equally chosen. In emergency scenarios, more versus less experienced respondents favored parent-preferred options over guidelines (55 vs. 46%, p = 0.003) and chose resuscitation over comfort care (50 vs. 36%, p < 0.001).Conclusions Neonatal providers desire age-based periviability guidelines, but do not agree on the level of standardization. Such limits may be insufficient to guide clinical practice. Policies should include processes that direct providers through fair transparent decision-making.