生命力的极限:葡萄牙新生儿学家和产科医生的观点。

IF 0.8 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Acta medica portuguesa Pub Date : 2024-09-02 Epub Date: 2024-07-26 DOI:10.20344/amp.21473
Inês Pais-Cunha, Sara Peixoto, Henrique Soares, Sandra Costa
{"title":"生命力的极限:葡萄牙新生儿学家和产科医生的观点。","authors":"Inês Pais-Cunha, Sara Peixoto, Henrique Soares, Sandra Costa","doi":"10.20344/amp.21473","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Advances in neonatal care have improved the prognosis in extremely preterm infants. The gestational age considered for active treatment has decreased globally. Despite implemented guidelines, several studies show variability in practice. The aim of this study was to understand theperspectives of Portuguese neonatologists and obstetricians regarding the management of extremely preterm infants.</p><p><strong>Methods: </strong>An online survey was sent through the Portuguese Neonatology Society and the Portuguese Society of Obstetrics and Maternal-Fetal Medicine from August to September 2023.</p><p><strong>Results: </strong>We obtained 117 responses: 53% neonatologists, 18% pediatricians, and 29% obstetricians, with 62% having more than 10 years of experience. The majority (80%) were familiar with the Portuguese Neonatology Society consensus on the limits of viability and 46% used it in practice; 62% were unaware of Portuguese morbidity-mortality statistics associated with extremely preterm infants. Most (91%) informed parents about morbiditymortality concerning the gestational age more frequently upon admission (64%) and considered their opinion in the limit of viability situations (95%). At 22 weeks gestational age, 71% proposed only comfort care, while at 25 and 26 weeks, the majority suggested active care (80% and 96%, respectively). Less consensus was observed at 23 and 24 weeks. At 24 weeks, most obstetricians offered active care with the option of comfort care by parental choice (59%), while the neonatology group provided active care (65%), p < 0.001. Regarding the lower limit of gestational age for in utero transfer, corticosteroid administration, cesarean section for fetal indication, neonatologist presence during delivery, and endotracheal intubation; neonatologists considered a lower gestational age than obstetricians (23 vs 24 weeks; p = 0.036; p < 0.001; p < 0.001; p = 0.021; p < 0.001, respectively).</p><p><strong>Conclusion: </strong>Differences in perspectives between obstetricians and neonatologists in limits of viability situations were identified. Neonatologists considered a lower gestational age in various scenarios and proposed active care earlier. Standardized counseling for extremely preterm infants is crucial to avoid ambiguity, parental confusion, and conflicts in perinatal care.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"617-625"},"PeriodicalIF":0.8000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Limits of Viability: Perspectives of Portuguese Neonatologists and Obstetricians.\",\"authors\":\"Inês Pais-Cunha, Sara Peixoto, Henrique Soares, Sandra Costa\",\"doi\":\"10.20344/amp.21473\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Advances in neonatal care have improved the prognosis in extremely preterm infants. The gestational age considered for active treatment has decreased globally. Despite implemented guidelines, several studies show variability in practice. The aim of this study was to understand theperspectives of Portuguese neonatologists and obstetricians regarding the management of extremely preterm infants.</p><p><strong>Methods: </strong>An online survey was sent through the Portuguese Neonatology Society and the Portuguese Society of Obstetrics and Maternal-Fetal Medicine from August to September 2023.</p><p><strong>Results: </strong>We obtained 117 responses: 53% neonatologists, 18% pediatricians, and 29% obstetricians, with 62% having more than 10 years of experience. The majority (80%) were familiar with the Portuguese Neonatology Society consensus on the limits of viability and 46% used it in practice; 62% were unaware of Portuguese morbidity-mortality statistics associated with extremely preterm infants. Most (91%) informed parents about morbiditymortality concerning the gestational age more frequently upon admission (64%) and considered their opinion in the limit of viability situations (95%). At 22 weeks gestational age, 71% proposed only comfort care, while at 25 and 26 weeks, the majority suggested active care (80% and 96%, respectively). Less consensus was observed at 23 and 24 weeks. At 24 weeks, most obstetricians offered active care with the option of comfort care by parental choice (59%), while the neonatology group provided active care (65%), p < 0.001. Regarding the lower limit of gestational age for in utero transfer, corticosteroid administration, cesarean section for fetal indication, neonatologist presence during delivery, and endotracheal intubation; neonatologists considered a lower gestational age than obstetricians (23 vs 24 weeks; p = 0.036; p < 0.001; p < 0.001; p = 0.021; p < 0.001, respectively).</p><p><strong>Conclusion: </strong>Differences in perspectives between obstetricians and neonatologists in limits of viability situations were identified. Neonatologists considered a lower gestational age in various scenarios and proposed active care earlier. Standardized counseling for extremely preterm infants is crucial to avoid ambiguity, parental confusion, and conflicts in perinatal care.</p>\",\"PeriodicalId\":7059,\"journal\":{\"name\":\"Acta medica portuguesa\",\"volume\":\" \",\"pages\":\"617-625\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2024-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta medica portuguesa\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.20344/amp.21473\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta medica portuguesa","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.20344/amp.21473","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/26 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

简介新生儿护理的进步改善了极早产儿的预后。在全球范围内,考虑进行积极治疗的胎龄有所降低。尽管已实施了相关指南,但一些研究仍显示在实践中存在差异。本研究旨在了解葡萄牙新生儿科医生和产科医生对早产儿管理的看法:方法:2023 年 8 月至 9 月,我们通过葡萄牙新生儿学会和葡萄牙产科与母胎医学学会进行了在线调查:结果:我们获得了 117 份回复:新生儿科医生占 53%,儿科医生占 18%,产科医生占 29%,其中 62% 的医生拥有 10 年以上的工作经验。大多数人(80%)熟悉葡萄牙新生儿学会关于存活极限的共识,46%的人在实践中使用该共识;62%的人不了解葡萄牙与极早产儿相关的发病率-死亡率统计数据。大多数人(91%)在入院时(64%)更频繁地向父母告知有关胎龄的发病率和死亡率,并在出现存活极限的情况下考虑他们的意见(95%)。在胎龄 22 周时,71%的医生只建议进行舒适护理,而在胎龄 25 周和 26 周时,大多数医生建议进行积极护理(分别为 80% 和 96%)。23周和24周时的共识较少。在 24 周时,大多数产科医生提供积极护理,并由父母选择舒适护理(59%),而新生儿组则提供积极护理(65%),P < 0.001。关于宫内转运、皮质类固醇用药、因胎儿指征进行剖宫产、新生儿科医生在分娩时在场以及气管插管的孕龄下限,新生儿科医生认为孕龄比产科医生低(分别为23周 vs 24周;p = 0.036;p < 0.001;p < 0.001;p = 0.021;p < 0.001):结论:产科医生和新生儿科医生对胎儿存活极限的看法存在差异。新生儿科医生在各种情况下都会考虑较低的胎龄,并更早地提出积极的护理建议。针对极早产儿的标准化咨询对于避免围产期护理中的歧义、父母困惑和冲突至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Limits of Viability: Perspectives of Portuguese Neonatologists and Obstetricians.

Introduction: Advances in neonatal care have improved the prognosis in extremely preterm infants. The gestational age considered for active treatment has decreased globally. Despite implemented guidelines, several studies show variability in practice. The aim of this study was to understand theperspectives of Portuguese neonatologists and obstetricians regarding the management of extremely preterm infants.

Methods: An online survey was sent through the Portuguese Neonatology Society and the Portuguese Society of Obstetrics and Maternal-Fetal Medicine from August to September 2023.

Results: We obtained 117 responses: 53% neonatologists, 18% pediatricians, and 29% obstetricians, with 62% having more than 10 years of experience. The majority (80%) were familiar with the Portuguese Neonatology Society consensus on the limits of viability and 46% used it in practice; 62% were unaware of Portuguese morbidity-mortality statistics associated with extremely preterm infants. Most (91%) informed parents about morbiditymortality concerning the gestational age more frequently upon admission (64%) and considered their opinion in the limit of viability situations (95%). At 22 weeks gestational age, 71% proposed only comfort care, while at 25 and 26 weeks, the majority suggested active care (80% and 96%, respectively). Less consensus was observed at 23 and 24 weeks. At 24 weeks, most obstetricians offered active care with the option of comfort care by parental choice (59%), while the neonatology group provided active care (65%), p < 0.001. Regarding the lower limit of gestational age for in utero transfer, corticosteroid administration, cesarean section for fetal indication, neonatologist presence during delivery, and endotracheal intubation; neonatologists considered a lower gestational age than obstetricians (23 vs 24 weeks; p = 0.036; p < 0.001; p < 0.001; p = 0.021; p < 0.001, respectively).

Conclusion: Differences in perspectives between obstetricians and neonatologists in limits of viability situations were identified. Neonatologists considered a lower gestational age in various scenarios and proposed active care earlier. Standardized counseling for extremely preterm infants is crucial to avoid ambiguity, parental confusion, and conflicts in perinatal care.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Acta medica portuguesa
Acta medica portuguesa MEDICINE, GENERAL & INTERNAL-
CiteScore
1.90
自引率
16.70%
发文量
256
审稿时长
6-12 weeks
期刊介绍: The aim of Acta Médica Portuguesa is to publish original research and review articles in biomedical areas of the highest standard, covering several domains of medical knowledge, with the purpose to help doctors improve medical care. In order to accomplish these aims, Acta Médica Portuguesa publishes original articles, review articles, case reports and editorials, among others, with a focus on clinical, scientific, social, political and economic factors affecting health. Acta Médica Portuguesa will be happy to consider manuscripts for publication from authors anywhere in the world.
期刊最新文献
[Disease Caused by Filoviruses: An Update]. Iron Skin Staining: A Rare but Permanent Complication Following IV Iron Infusion. [Anxiety and Generalized Anxiety Disorder in Elite Athletes]. Translation and Adaptation of the STOPP/START Criteria Version 3 for Potentially Inappropriate Prescribing in Older People to European Portuguese: A Study Protocol. Purple Urine Bag Syndrome: Reporting a Case of Rare Incidence in Portugal.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1