tailieunhanh - Extreme Prematurity - Practices, Bioethics, And The Law Part 2

Bệnh nhân của các bác sỹ nhi sơ sinh là trẻ sơ sinh (dưới 28 ngày tuổi) bị bệnh hoặc cần chăm sóc y khoa đặc biệt do đẻ non, trọng lượng lúc sinh thấp, chậm phát triển trong tử cung, dị tật bẩm sinh, nhiễm trùng huyết hoặc ngạt lúc sinh. | 4 INFLUENCE OF OBSTETRIC MANAGEMENT How physicians in particular obstetricians view and assess viability can affect perinatal survival figures. In an American study 44 that examined the relationship between obstetric care during labor and delivery and the survival of EPTIs the authors compared the outcomes of those who were considered viable ante-natally and those who were not. The factors evaluated in the judgment of viability were estimated age 26 weeks and estimated weight 650g lethal anomalies and parental requests. In the total population studied some were misclassified usually weight estimation or parents had requested aggressive management or the opposite. This allowed the authors to study the survival of infants who by their standards would have been considered non-viable but who received antenatal and perinatal care as if they were viable. Although in some groups the numbers were small the chances of survival were strongly associated with the antenatal assessment of viability. The odds of survival for all fetuses treated as viable were 17 times the odds for those considered non-viable. Birth weight alone did not explain wholly the relationship between antepartum viability assessment and outcome. Thus in 16 INFLUENCE OF OBSTETRIC MANAGEMENT this study survival of the EPTI was related to judgments of viability that determined their care. Silver et al. also published similar findings. 45 These studies which had relatively small numbers do not suggest that there is no limit to fetal viability but they do caution the reader to take into account obstetric management strategies when examining figures concerning the outcome of the EPTI. Obstetricians evaluate antenatal data to make decisions concerning the management of an anticipated extremely preterm delivery. Bottoms et al. 46 47 evaluated whether antenatal information could accurately predict the survival of ELBW infants with and without major morbidity using data collected in 1992-1993. The reported findings

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