[Newborn at the limit of viability. Part 2: Recommendations regarding treatment of mother and newborn at the limit of viability considering ethical aspects].
[Newborn at the limit of viability. Part 2: Recommendations regarding treatment of mother and newborn at the limit of viability considering ethical aspects].
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[新生儿处于生存极限。
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
M. Rutkowska
中科院分区：
文献类型：
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作者：
M. Rutkowska
波兰关于治疗生命极限母亲和婴儿的第一个建议是围产期伦理建议小组经过 1.5 年工作的结果，该小组不仅由妇产科医生和新生儿学家组成，还包括遗传学家、心理学家、伦理专家、哲学家和律师。它们的开发基于其他欧洲国家以及澳大利亚、加拿大和美国已有的类似标准。这些建议被国家新生儿学顾问、波兰妇科学会、波兰围产期医学学会和波兰儿科学会接受。这些建议指出了伦理问题，并提出了治疗小组成员之间以及治疗小组与极不成熟新生儿父母之间的信息传递。强调了告知父母婴儿生存机会的必要性，以及听取他们的意见和期望的必要性。建议中附有产前咨询卡和新生儿治疗卡，作为表达决定和父母意见的工具。还讨论了准确确定胎龄和胎儿生物成熟度的问题。此外，根据国际研究，还提供了生存能力极限婴儿的发病率和死亡率数据。该文件还提出了以下建议：根据胎龄对新生儿进行子宫内转运、剖腹产和复苏，而不是姑息治疗。人们强调，胎龄不能成为决策过程中的唯一标准。还应考虑影响预后的个体产前和产后因素。建议同时考虑到孕龄精确确定和不确定的情况。人们已经注意到对这一群体儿童的发展进行长期评估的必要性。还讨论了婴儿死亡时的处理程序。
The first Polish recommendations regarding the treatment of mothers and infants born at the limit of viability are the result of 1,5 years of work by the Team for Ethical Recommendations in Perinatology, consisting not only of gynecologists-obstetricians and neonatologists, but also geneticists, psychologists, ethics specialists, philosophers and lawyers. Their development was based on similar standards already existing in other European countries, as well as in Australia, Canada and the USA. The recommendations were accepted by the National Consultant for Neonatology, Polish Gynecological Society, Polish Perinatal Medicine Society and Polish Pediatric Society. The Recommendations indicate ethical problems and presented transfer of information among the members of the treatment team as well as between the team and the parents of extremely immature newborns. The necessity of informing parents about their infant's chances for survival has been emphasized, as well as the need to hear their opinions and expectations. A Prenatal Consultation Card and Newborn Treatment Card have been attached to the recommendations, as a tool for presenting decisions and parents' opinions. Problems concerning accurate determination of gestational age and biological maturity of the foetus have also been discussed. Furthermore, on the basis of international research, morbidity and mortality data on infants born at the limit of viability have been presented. The paper also presents recommendations concerning: in utero transport, cesarean section and undertaking resuscitation as opposed to palliative care in newborns depending on their gestational age. It has been emphasized that gestational age cannot be the only criteria in the course of making decisions. Individual pre- and post-natal factors influencing the prognosis should also be taken into account. Recommendations allow both for the situation when the gestational age is precisely determined and when it is uncertain. Attention has been drawn to the need of long-term assessment of development in this group of children. The procedure in case of the infants' death has also been discussed.