Addressing or reinforcing injustice? Artificial amnion and placenta technology, loss-sensitive care and racial inequities in preterm birth.
Addressing or reinforcing injustice? Artificial amnion and placenta technology, loss-sensitive care and racial inequities in preterm birth.
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解决或强化不公正现象？
DOI：
10.1136/jme-2023-109821
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发表时间：
2024
影响因子：
4.1
通讯作者：
Adams,April
中科院分区：
文献类型：
--
作者：
Schott,SophieL;Fletcher,Faith;Story,Alice;Adams,April
早产的定义是在怀孕37周之前分娩。1早产婴儿一生中发病和死亡的风险增加，特别是在第一年。这些风险随着出生时胎龄的降低而增加。2此外，早产率存在明显的种族和民族差异。2022年，非西班牙裔黑人妇女的早产率大约比非西班牙裔白人妇女的早产率高出50%。1这些婴儿的结局也是不同的--早产和低出生体重是婴儿死亡(1岁前死亡)的第二大原因。值得注意的是，在早产儿中，非西班牙裔黑人妇女所生婴儿的死亡率是非西班牙裔白人母亲所生婴儿的两倍多。3重要的是，有一小部分但意义重大的新生儿可以被归类为严重早产儿(出生28周的新生儿)。28周前出生的婴儿结局多种多样且不确定。虽然这一群体仅占早产儿的0.4%，但它也占早产儿死亡的40%。4正如Romanis和Adkins所指出的，人工羊膜和胎盘技术(AAPT)的出现有望通过引入模拟体内胎盘氧合和底物输送的羊膜替代品来解决极端早产的生理并发症和死亡风险。与传统的新生儿重症监护干预措施不同，AAPT旨在通过保留胎儿肺生理来降低极早产儿的发病率和死亡率。
Preterm birth is defined as delivery occurring before 37 weeks gestation. 1 Infants born prematurely have increased risks of morbidity and mortality throughout life, especially during the first year. These risks increase as the gestational age at birth decreases. 2 Additionally, there are significant racial and ethnic differences in preterm birth rates. In 2022, the rate of preterm birth among non-Hispanic black women was approximately 50% higher than that observed in non-Hispanic white women. 1 The outcomes for these infants are also disparate–preterm birth and low birth weight are the second-leading causes of infant mortality (deaths before 1 year of age). Notably, among preterm neonates, infants born to non-Hispanic black women have a mortality rate more than double that of infants born to non-Hispanic white mothers. 3Importantly, there is a small but significant group of neonates that can be classified as severely premature (those born< 28 weeks). Infants born before 28 weeks have varied and uncertain outcomes. While this group accounts for only 0.4% of preterm births, it also accounts for 40% of deaths among preterm neonates. 4 As noted by Romanis and Adkins, the advent of artificial amnion and placenta technology (AAPT) holds promise for its potential to address the physiologic complications and mortality risks of extreme prematurity by introducing amniotic substitutes that mimic in vivo placental oxygenation and substrate delivery. In contrast to conventional neonatal intensive care interventions, AAPT aims to mitigate morbidity and mortality among extremely preterm infants by preserving fetal pulmonary physiology.