Resumos
Os limites de viabilidade na prematuridade e a sobrevivência com mínimo de sequela são temas atuais de grande importância ética. A prematuridade extrema pode resultar em inúmeras sequelas e danos crônicos que limitam a funcionalidade. Ao se optar pelo prolongamento da vida de recém-nascidos muito imaturos, há maior exposição do prematuro e da família a situações de dor, desconforto e estresse. A presente revisão trata dos aspectos éticos relacionados a essa tomada de decisão considerando o limite de viabilidade e as sequelas neuropsicomotoras decorrentes da prematuridade extrema. Atualmente, a questão gira em torno da importância da valorização não só da sobrevivência desses prematuros, mas também da manutenção de sua qualidade de vida, uma vez que são mais predispostos a sequelas em curto, médio e longo prazos.
Prematuro; Ética; Recém-nascido de peso extremamente baixo ao nascer; Desenvolvimento infantil
Limits of viability for premature infants and survival with minimal consequences are current themes of great importance for ethics and bioethics. Extreme prematurity may result in many consequences and chronic injuries that limit the infant functionality. When prolongation of a very immature newborn's life is opted, there is a greater exposure of premature infants and their family to pain, distress and physiological stress situations. The present review approaches ethical aspects related to this decision-making, considering the limit of viability and neuromotor sequelae derived from extreme prematurity. At present, it is considered not only the survival of extreme premature infants, but also the maintenance of their quality of life, since they are more likely to have sequelae at short, median and long time.
Premature infant; Ethics; Extremely low birth weight infant; Child development
Los límites de la viabilidad de la prematuridad y la supervivencia con secuelas mínimas son las principales cuestiones éticas de actualidad . La prematuridad extrema puede dar lugar a numerosas secuelas y daños crónicos que limitan la funcionalidad. Cuando se opta por la prolongación de la vida de los recién nacidos muy inmaduros, aumenta la exposición del prematuro y de la familia a situaciones de dolor, malestar y estrés. Esta revisión discute los temas éticos relacionados con esta toma de decisión teniendo en cuenta el límite de la viabilidad y las secuelas neuropsicomotoras como consecuencia de la prematuridad extrema. En la actualidad, la cuestión gira en torno a la importancia de valorar no sólo la supervivencia de los bebés prematuros, sino también el mantenimiento de su calidad de vida, ya que son más propensos a las secuelas en el corto, mediano y largo plazo.
Prematuro; Ética; Recién nacido con peso al nacer extremadamente bajo; Desarollo infantil
-
1Kaempf JW, Tomlinson MW, Campbell B, Ferguson L, Stewart VT. Counseling pregnant women who may deliver extremely premature infants: medical care guidelines, family choices, and neonatal outcomes. Pediatrics. 2009 jun;123(6):1.509-15.
-
2Committee on Fetus and Newborn. Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics. 2007 fev;119(2):401-3.
-
3Pignotti MS, Donzelli G. Perinatal care at the threshold of viability: an international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics. 2008 jan;121(1):e193-8.
-
4Seri I, Evans J. Limits of viability: definition of the gray zone. J Perinatol. 2008 maio;28 (Suppl 1):S4-8.
-
5Marlow N, Wolke D, Bracewell MA, Samara M, EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med. 2005 jan 6;352(1):9-19.
-
6Vincer MJ, Allen AC, Joseph KS, Stinson DA, Scott H, Wood E. Increasing prevalence of cerebral palsy among very premature infants: a population-based study. Pediatrics. 2006 dez;118(6):e1.621-6.
-
7Wilson-Costello D, Friedman H, Minich N, Siner B, Taylor G, Schluchter M et al. Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002. Pediatrics. 2007 jan;119(1):37-45.
-
8Poon WB, Ho SKY, Yeo CL. Short-and long-term outcomes at 2, 5, and 8 years old for neonates at borderline viability: an 11-year experience. Ann Acad Med Singapore. 2013 jan;42(1):7-17.
-
9Hack M. Consideration of the use of health status, functional outcome, and quality-of-life to monitor neonatal intensive care practice. Pediatrics. 1999 jan;103(1 Suppl E):319-28.
-
10Simard M, Gagné AM, Lambert RD, Tremblay Y. A transdisciplinary approach to the decision-making process in extreme prematurity. BMC Res Notes. 2014 jul 14;7:450-8.
-
11Lorenz JM. The outcome of extreme prematurity. Semin Perinatol. 2001 out;25(5):348-59.
-
12Charafeddine L, Ammous F, Kayle M, Arawi T. Survival at the threshold of viability: a nationwide survey of the opinions and attitudes of physicians in a developing country. Paediatr Perinat Epidemiol. 2014 maio;28(3):227-34.
-
13Chervenak FA, McCullough LB, Levene MI. An ethically justified, clinically comprehensive approach to peri-viability: gynecological, obstetric, perinatal and neonatal dimensions. J Obstet Gynaecol. 2007 jan;27(1):3-7.
-
14Hack M, Fanaroff AA. Outcomes of children of extremely low birth weight premature infants in the 1990s. Early Hum Dev. 1999;53:195-218.
-
15García-Muñoz FR, García-Alix AP, García Hernández JA, Figueras JA. Morbidity and mortality in newborns at the limit of viability in Spain: a population-based study. An Pediatr (Barc). 2014 jun;80(6):348-56.
-
16Doyle LW, the Victorian Infant Collaborative Study Group. Neonatal intensive care at borderline viability: is it worth it? Early Hum Dev. 2004 nov;80(2):103-13.
-
17Markestad T, Kaaresen PI, Rønnestad A, Reigstad H, Lossius K, Medbø S et al. Early death, morbidity, and need of treatment among extremely premature infants. Pediatrics. 2005 maio;115(5):1.289-98.
-
18Moriette G, Rameix S, Azria E, Fournié A, Andrini P, Caeymaex L. et al. Very premature births: Dilemmas and management. Part 1. Outcome of infants born before 28 weeks of postmenstrual age, and definition of a gray zone. Arch Pediatr. 2010 maio;17(5):518-26.
-
19Parikh DO, Arnold C, Langer J, Tyson JE. Evidence-based treatment decisions for extremely preterm newborns. Pediatrics. 2010 abr;125(4):813-6.
-
20Singh J, Fanaroff J, Andrews B, Caldarelli L, Lagatta J, Plesha-Troyke S et al. Resuscitation in the "gray zone" of viability: determining physician preferences and predicting infant outcomes. Pediatrics. 2007 set;120(3):519-26.
-
21Rocha G, Guimarães H. On the limit of viability extremely low gestational age at birth. Acta Med Port. 2011 dez;24(Suppl 2):181-8.
-
22Shah PS, Sankaran K, Aziz K, Allen AC, Seshia M, Ohlsson A et al. Outcomes of preterm infants <29 weeks gestation over 10-year period in Canada: a cause for concern? J Perinatol. 2012 fev;32(2):132-8.
-
23Msall ME, Park JJ. The spectrum of behavioral outcomes after extreme prematurity: regulatory, attention, social, and adaptive dimensions. Semin Perinatol. 2008 fev;32(1):42-50.
-
24Bremmer P, Byers JF, Kiehl E. Noise and the premature infant: physiological effects and practice implications. J Obstet Gynecol Neonatal Nurs. 2003 jul-ago;32(4):447-54.
-
25Brown G. NICU noise and the preterm infant. Neonatal Netw. 2009;28(3):165-73.
-
26Perlman JM. Neurobehavioral deficits in premature graduates of intensive care: potential medical and neonatal environmental risk factors. Pediatrics. 2001 dez;108(6):1.339-48.
-
27Williams AL, Sanderson M, Lai D, Selwyn BJ, Lasky RE. Intensive care noise and mean arterial blood pressure in extremely low-birth-weight neonates. Am J Perinatol. 2009 maio;26(5):323-9.
-
28Atkinson J, Braddick O. Visual and visuocognitive development in children born very prematurely. Prog Brain Res. 2007;164:123-49.
-
29Braddick O, Atkinson J, Wattam-Bell J. VERP and brain imaging for identifying levels of visual dorsal and ventral stream function in typical and preterm infants. Prog Brain Res. 2011;189:95-111.
-
30Graven SN. Early visual development: implications for the neonatal intensive care unit and care. Clin Perinatol. 2011 dez;38(4):671-83.
-
31Ramenghi LA, Ricci D, Mercuri E, Groppo M, De Carli A, Ometto A et al. Visual performance and brain structures in the developing brain of pre-term infants. Early Hum Dev. 2010 jul;86 (Suppl 1):73-5.
-
32Msall ME, Tremont MR. Measuring functional outcomes after prematurity: developmental impact of very low birth weight and extremely low birth weight status on childhood disability. Ment Retard Dev Disabil Res Rev. 2002;8(4):258-72.
-
33Van der Weijer-Bergsma E, Wijnroks L, Jongmans MJ. Attention development in infants and preschool children born preterm: a review. Infant Behav Dev. 2008 set;31(3):333-51.
-
34Christoffersen-Deb A. Viability: a cultural calculus of personhood at the beginnings of life. Med Anthropol Q. 2012 dez;26(4):575-94.
-
35Kletemberg DF, Mantovani MF, Lacerda MR. Entre a teoria e as práticas do cuidar: que caminho trilhar? Cogitare Enferm. 2004;9(1):94-9.
-
36Gaiva MAM. O cuidar em unidades de cuidados intensivos neonatais: em busca de um cuidado ético e humanizado. Cogitare Enferm. 2006;11(1):61-6.
-
37Ribeiro CDM, Rego S. Bioética clínica: contribuições para a tomada de decisões em unidades de terapia intensiva neonatais. Ciênc saúde coletiva. 2008 dez;13 (Suppl 2):2.239-46.
-
38Schramm FR. Cuidados paliativos: aspectos filosóficos. Rev Bras Cancerol. 1999;45(4):57-63.
-
39Spittle A, Orton J, Anderson P, Boyd R, Doyle LW. Early developmental intervention programs post-hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database of Systematic Reviews. 2012 dez;12:1-103.
Datas de Publicação
-
Publicação nesta coleção
05 Jan 2015 -
Data do Fascículo
Dez 2014
Histórico
-
Aceito
28 Out 2014 -
Recebido
06 Fev 2014 -
Revisado
09 Maio 2014