Ethical considerations regarding the treatment of extremely preterm infants at the limit of viability: a comprehensive review.

IF 3 3区医学 Q1 PEDIATRICS

European Journal of Pediatrics Pub Date : 2025-01-16 DOI:10.1007/s00431-025-05976-2

Takeshi Arimitsu, Kazuki Hatayama, Kaori Gaughwin, Satoshi Kusuda

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引用次数: 0

Abstract

Advancements in perinatal care have improved survival rates of extremely preterm infants born at 22 to 23 weeks of gestation, thus introducing new ethical challenges associated with their treatment. Therefore, we reviewed the epidemiological prognosis, treatment evolution, and ethical considerations associated with the care of preterm infants at the limit of viability. We comprehensively searched PubMed to find relevant English-language articles published between January 2014 and July 2024. Survival rates of infants born at 22 to 23 weeks of gestation have improved but remain low. Proactive treatment can result in survival rates exceeding 50% for infants born at 22 weeks; however, these infants are at high risk for complications and neurodevelopmental impairment. Advancements in obstetric and neonatal care have contributed to improved outcomes. Ethical challenges include balancing survival with the disability risk, managing patients with uncertain prognoses, and considering parental wishes.Conclusion: The care of preterm infants at the limit of viability presents complex ethical dilemmas. Shared decision-making between healthcare providers and families as well as engaging in societal discourse are crucial to addressing these challenges.

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关于在生存能力极限的极端早产儿治疗的伦理考虑：全面审查。

围产期护理的进步提高了在妊娠22至23周出生的极早产儿的存活率，从而引入了与他们的治疗相关的新的伦理挑战。因此，我们回顾了流行病学预后，治疗的演变，以及与生存能力极限的早产儿护理相关的伦理考虑。我们全面检索了PubMed，找到了2014年1月至2024年7月期间发表的相关英语文章。妊娠22至23周出生的婴儿存活率有所改善，但仍然很低。积极治疗可使22周出生的婴儿的存活率超过50%；然而，这些婴儿出现并发症和神经发育障碍的风险很高。产科和新生儿护理的进步有助于改善结果。伦理挑战包括平衡生存与残疾风险，管理预后不确定的患者，以及考虑父母的意愿。结论：生存极限早产儿的护理存在着复杂的伦理困境。医疗保健提供者和家庭之间的共同决策以及参与社会话语对于解决这些挑战至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pediatrics 医学-小儿科

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.