Naissances très prématurées : dilemmes et propositions de prise en charge. Première partie : pronostic des naissances avant 28 semaines, identification d’une zone « grise »

Quality of life assessment in preterm children: physicians’ knowledge, attitude, belief, practice - a KABP study

“…Data on QoL would shed light on public decisions through better appreciation of the social and economic impact of extremely preterm birth. Moreover, the idea of “burden” appears in the literature [16,18,23] in relation to the heavy demands of medical and rehabilitation management, the inadequacy of support and assistance, the occupational impact and the impact on siblings. This raises questions on the intensive measures that are implemented in the perinatal period and are then reduced, both in human terms (limited number of places in medical and social facilities, recent and limited development of follow-up networks to support and assist the children and their families, difficulties in the provision of schooling) and in economic terms (non-reimbursement of some rehabilitation treatments, low benefits).…”

“…Given the specific nature of the problem raised by extreme prematurity, in particular the decisional dilemma of the limits of viability [23], the experts could wish for a tool to rationalize individual decision-making, notably to reflect on the “burden-benefit” balance of neonatal management. A very large majority of the physicians questioned considered that such data could rekindle the ethical debate on neonatal resuscitation practices.…”

Is there a role of palliative care in the neonatal intensive care unit in India?

“…According to Moriette et al .,[12] the decision to withhold resuscitation and/or intensive care at birth, which is an option at the margin of viability, implies allowing babies to die, although some of them would have developed normally if they had received resuscitation and/or intensive care. The likelihood of survival without significant disabilities decreases as gestational age at birth decreases.…”

“…In France today, the gray zone corresponds to deliveries at 24 and 25 weeks of postmenstrual age. [12]…”

Réseau de suivi des enfants vulnérables dans les Pays de la Loire (Grandir Ensemble – Cohorte LIFT) : dix ans d’activité de 2003 à 2013

“…C'est une question difficile car, au fil des années de l'étude, la population des nouveaux-nés a évolué avec la prise en charge d'enfants d'âge gestationnel de plus en plus bas qui décé-daient auparavant (23, 24 et 25 SA) et le fait que certains enfants gravement atteints, prématurés ou non, qui décé-daient en début de période d'étude ont survécu avec le progrès des soins. Par ailleurs, cette évaluation doit aussi tenir compte des arrêts de soins ou, plus précisément, de la mise en place de soins palliatifs durant cette période[16][17][18]. Il faut donc suivre les incidences en stratifiant selon l'âge gestationnel et la gravité de l'état des nouveaux-nés en néonatologie.…”