Periviabilidad neonatal
[Neonatal periviability]Osvaldo Reyes1
1. Maternidad del Hospital Santo Tomás, Panamá, Panamá;Sistema Nacional de Investigadores de Panamá (SNI).
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Resumen
La prematuridad es la primera causa de muerte a nivel mundial en menores de 5 años. Aquellos que logran sobrevivir y adaptarse a la vida extrauterina, según el grado de afección, pueden verse condenados a una larga vida de discapacidades y a una calidad de vida reducida. Cuando el parto pretérmino es extremadamente temprano, el grado de compromiso es mucho mayor. Eso obliga al médico tratante a plantearse dos escenarios: ser agresivo y darle todas las oportunidades al neonato, con la esperanza de que sobreviva sin un compromiso mayor, o darle un manejo de soporte mínimo, aceptando que la posibilidad de muerte es elevada y el riesgo de discapacidad demasiado alto como para condenar a todo el núcleo familiar a lidiar con el problema. La decisión no es fácil, ya que los médicos tienen visiones diferentes del problema, algunas veces sustentado en información errónea. Con este motivo en mente se hace una revisión del tema de periviabilidad y nos centramos en mostrar evidencia de los resultados a corto, mediano y largo plazo de estos neonatos.
Abstract
Prematurity is the leading cause of death worldwide in children under 5 years of age. Those who manage to survive and adapt to extrauterine life, depending on the degree of the condition, may be condemned to a long life of disabilities and reduced quality of life. When the delivery is extremely preterm, the degree of compromise is much greater. In these cases, the attending physician should consider two scenarios: to be aggressive and give the newborn every chance, in the hope that he or she will survive without major compromise, or to provide minimal supportive management, accepting that the possibility of death is high and the risk of disability too great to condemn the entire family to deal with the problem. The decision is not easy, since physicians have different views of the problem, sometimes based on erroneous information. With this in mind, we review the issue of periviability, showing evidence of the short, medium and long term outcomes of these neonates.
Citas
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