LIMITS OF VIABILITY: SHOULD WE PLAY GOD?
LIMITS OF VIABILITY: SHOULD WE PLAY GOD?
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生存能力的限制：我们应该扮演上帝吗？
DOI：
10.5005/sar-1-1-2-46
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发表时间：
2021
影响因子：
--
通讯作者：
M. Stanojevic
中科院分区：
文献类型：
--
作者：
M. Stanojevic
其目的是表明，在国家内，在生存能力极限时出生的婴儿的定义取决于婴儿出生时的社会和医疗条件，即使在一个提供新生儿重症监护的国家，也取决于出生地点和围产期护理的组织。随着胎龄死亡率的降低，早产儿的短期和长期发病率都在增加，而其出院存活率却在下降。如何定义生存能力以及生存能力的极限在哪里是值得怀疑的。生存能力极限的定义并不十分清楚。至少有两种理解方式：第一，定义胎龄和/或出生体重，在这个年龄，人类胎儿有能力在子宫外存活；第二，胎龄和/或出生体重，超过50%的婴儿存活到出院。在发展中国家，没有新生儿重症监护的妊娠少于28周的婴儿死亡的概率为95%，而在发达国家，妊娠22至25周的婴儿存活率达到90%。到目前为止，对细胞活力极限的定义还没有建立起来，更没有科学准确的对细胞活力的定义。目前，世界卫生组织规定的生存能力下限为妊娠22周，或500克出生体重，或25厘米出生长度。对生存能力的极限作出普遍的定义可能是不可能的，因为它因人而异，从一种环境到另一种环境，从一个社区到另一个社区都有差异。
Aim is to show that the definition of the infants born at the limits of viability within the countries is dependent on the social and medical conditions in which the infant is born, and even in one country in which neonatal intensive care is available, it depends on the place of birth and organization of perinatal care. With decreasing gestational age mortality, short- and long-term morbidity of preterm infants are increasing while their survival to discharge is decreasing. It is questionable how to define viability and where the limit of viability can be set. The definition of the limits of viability is not quite clear. There are at least two ways of understanding it: the first, defining the gestational age and/or birth weight at which human fetus has the capability of survival outside the uterus; and the second, gestational age and/or birth weight at which more than 50% of infants survive to discharge home from the hospital. While in developing countries infants of less than 28 weeks of gestation without neonatal intensive care have 95% probability of dying, survival of infants between 22 and 25 gestational weeks in developed countries is reaching 90%. Up to now the definition of the limits of viability has not be established, and precise definition of viability scientifically has not been produced yet. Currently, the World Health Organization sets lower limit of viability at 22 weeks of gestation, or 500 g birth weight, or 25 cm of birth length. The universal definition of the limit of viability is probably not possible, because of its variability from one individual to the other, from one setting to the other and from one community to the other.
DOI：
10.1001/jama.2015.10244
发表时间：
2015-09-08
期刊：
JAMA
影响因子：
--
作者：
Stoll BJ;Hansen NI;Bell EF;Walsh MC;Carlo WA;Shankaran S;Laptook AR;Sánchez PJ;Van Meurs KP;Wyckoff M;Das A;Hale EC;Ball MB;Newman NS;Schibler K;Poindexter BB;Kennedy KA;Cotten CM;Watterberg KL;D'Angio CT;DeMauro SB;Truog WE;Devaskar U;Higgins RD;Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network