National Variability in Neonatal Resuscitation Practices at the Limit of Viability
National Variability in Neonatal Resuscitation Practices at the Limit of Viability
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DOI：
10.1055/s-0033-1354566
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发表时间：
2014-06-01
影响因子：
2
通讯作者：
Meadow, William
中科院分区：
文献类型：
--
作者：
Arzuaga, Bonnie H.;Meadow, William
目的极早产儿产房管理缺乏专业规范。在美国，对人的生存能力的法律的定义和规范选择性堕胎的法规因州而异，这使得提供者在面对22至25周妊娠婴儿的分娩时，在是否尝试复苏方面往往处于困难的境地。本研究的目的是描述2012年美国围产期婴儿产房复苏实践的变化。研究设计电子调查发送给美国儿科学会围产期医学部的成员。结果共回收758份调查问卷，其中637份完成。总体而言，68%的提供者认为妊娠23周是应父母要求复苏的最小年龄，而51%的提供者认为妊娠25周是即使父母拒绝也必须复苏的最小年龄。当供应商根据美国人口普查局划分为地理区域时，反应各不相同（p < 0.05）。当提供产房场景时，父母的偏好显著影响22至25周的复苏尝试，但不影响26周的婴儿。在围手术期选择性终止的情况下，供应商的个人信仰体系影响管理的流产fetus.Conclusions区域实践的差异存在独立的具体国家的法律。父母的要求是提供者复苏22至25周婴儿的最重要因素。提供者的个人信仰系统很少影响婴儿管理。
Objective Delivery room management of extremely premature infants is not subjected to professional regulations. In the United States, legal definitions of human viability and statutes regulating elective abortions vary by state, placing providers in an often difficult position regarding whether to attempt resuscitation when faced with the delivery of an infant of 22 to 25 weeks gestation. The objective of this study was to delineate variations in delivery room resuscitation practices of periviable infants in the United States in 2012.Study Design Electronic survey was sent to the members of American Academy of Pediatrics Section of Perinatal Medicine. Chi-square, Fisher exact test, and multivariate logistic regression were performed.Results A total of 758 surveys returned out of which 637 were complete. Overall 68% of providers consider 23-week gestation to be the youngest age that should be resuscitated at parental request, while 25-week gestation is considered by 51% to be the youngest age of obligatory resuscitation even with parental refusal. Responses varied when providers were separated into geographical regions based on the U.S. Census Bureau (p < 0.05). When provided with delivery room scenarios, parental preference significantly affected resuscitation attempts of 22 to 25 weeks, but not 26-week infants. In scenarios of periviable elective terminations, providers' personal belief systems influenced management of aborted fetuses.Conclusions Regional practice variation exists independent of specific state laws. Parental request is the most important factor to providers resuscitating 22 to 25-week infants. Providers' personal belief systems influence infant management infrequently.