Ethical issues in fetal therapies of life-threatening malformations.

IF 3 3区 医学 Q1 PEDIATRICS European Journal of Pediatrics Pub Date : 2024-12-30 DOI:10.1007/s00431-024-05922-8
Alexandra Benachi, Alexandre J Vivanti
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Abstract

Unlike any other medical field, fetal medicine addresses two patients: the fetus and the mother. Its primary goal is to improve neonatal outcomes, specifically by reducing mortality and morbidity, including long-term impacts, while minimizing risks to the mother. The aim of fetal interventions for life-threatening malformations is to decrease morbidity and mortality by mitigating the impact of the malformation on fetal growth and development. Although some randomized controlled trials have evaluated fetal medicine procedures, they have faced challenges such as the rarity of most conditions and ethical concerns related to clinical equipoise. Prematurity, an intrinsic risk of membrane puncture, remains a significant burden of fetal surgery, and maternal safety must always be prioritized when considering such procedures. Despite 50 years of research in fetal medicine, many questions remain, due to advancements in ultrasound technology and genetics, the inherent risks associated with fetal procedures, the lack of appropriate medical device for rare diseases and the cost associated with conditions that require complex multidisciplinary neonatal care. Justice and parental autonomy must be respected but the principle of non-maleficence should prevail.

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危及生命的畸形胎儿治疗中的伦理问题。
与其他医学领域不同,胎儿医学针对两种患者:胎儿和母亲。其主要目标是改善新生儿结局,特别是通过降低死亡率和发病率,包括长期影响,同时尽量减少对母亲的风险。对危及生命的畸形进行胎儿干预的目的是通过减轻畸形对胎儿生长发育的影响来降低发病率和死亡率。虽然一些随机对照试验已经评估了胎儿医学程序,但它们面临着挑战,如大多数情况的罕见性和与临床平衡相关的伦理问题。早产,膜穿刺的内在风险,仍然是胎儿手术的一个重要负担,在考虑这种手术时,母亲的安全必须始终优先考虑。尽管在胎儿医学方面进行了50年的研究,但由于超声技术和遗传学的进步,与胎儿手术相关的固有风险,缺乏针对罕见疾病的适当医疗设备以及与需要复杂的多学科新生儿护理的条件相关的费用,许多问题仍然存在。正义和父母的自主权必须得到尊重,但非恶意原则应该占上风。
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来源期刊
CiteScore
5.90
自引率
2.80%
发文量
367
审稿时长
3-6 weeks
期刊介绍: The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics. EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned. The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics. EJPE is active on social media (@EurJPediatrics) and we invite you to participate. EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.
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