Granice preživljavanja izrazito nezrele nedonoščadi

master's thesis

• Title (english): Limits of survival in extremely preterm infants
• Author: Tea Rosandić
• Mentor: Boris Filipović-Grčić (mentor)
• Committee member: Mirta Starčević (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Boris Filipović-Grčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2023-09-19, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Posljednjih pet desetljeća dolazi do neprestanog porasta preživljenja izrazito nezrele nedonoščadi. Razlog je tomu golemi napredak u područjima perinatologije i neonatologije te razumijevanju problematike izrazito prijevremenog poroda. Napredak je također postignut i u neurorazvojnim ishodima ove ranjive nedonoščadi, no tempo napretka u području neurorazvojnih morbiditeta zaostaje za onim u preživljenju. Izrazito nezrela nedonoščad čine vrlo mali mali udio ukupno prijevremeno rođenih, no unatoč tome upravo ta podskupina najviše pridonosi neonatalnom i dječjem morbiditetu i mortalitetu. Jedan od osnovnih izazova s kojim se perinatalna i neonatalna medicina susreću jest jasno definirati razinu zrelosti fetusa ispod koje su preživljenje i/ili prihvatljivi neurorazvojni ishod vrlo malo vjerojatni. Tu se govori o periodu perivijabilnosti, ali i o granici preživljavanja kao dogovorenoj vrijednosti dobi trudnoće pri kojoj polovica novorođenčadi preživi, a polovica ne. Ove je termine nužno poznavati i istraživati kako bi se mogla donijeti pravilna i opravdana odluka o postupanju kod izrazito nezrele nedonoščadi, osobito one rođene oko granice preživljavanja. Također, velika je potreba za razvijanjem jasnih i jedinstvenih smjernica i novih kliničkih koncepcija za ovu populaciju. Kod razvijanja smjernica kao pomoći za donošenje odluke važno je poštivati etička načela te analizirati glavne moguće ishode izrazitog prematuriteta i ključne faktore koji na njih utječu. Danas je u razvijenom svijetu dostupno mnogo nacionalnih smjernica i smjernica zdravstvenih društava, koje se sukladno različitim izvorima podataka, više ili manje razlikuju. Zato je nužno nastaviti istraživati i međusobno se uspoređivati s glavnim ciljem pružanja najbolje moguće skrbi i podrške izrazito nezreloj nedonoščadi i njihovim obiteljima.

Abstract (english)

Survival of extremely preterm neonates has continuously improved over the past five decades. The reason for this is the tremendous progress in the fields of perinatology and neonatology, as well as the understanding of the issues related to extremely preterm birth. Although the neurodevelopmental outcome of these extremely vulnerable preterm infants has also significantly improved, the pace of its improvement appears to have lagged behind that of survival. Extremely premature infants make up a very small proportion of the total premature births, but despite that contribute the most to both neonatal and infant morbidity and mortality. One of the main challenges faced by perinatal and neonatal medicine is to define the level of fetal maturity below which survival and/or acceptable neurodevelopmental outcomes are highly unlikely. This refers to the period of periviability, as well as the threshold of viability, which is the agreed-upon gestational age at which half of the newborns survive and half do not. It is necessary to understand and explore these terms in order to make proper and justified decisions regarding the management of extremely preterm infants. Furthermore, there is a significant need for the development of uniform guidelines and new clinical concepts for this population. When developing guidelines, it is important to respect ethical principles and analyze the main outcomes of extreme prematurity and the key factors that influence them. In the developed world, there are numerous national guidelines and guidelines from healthcare societies available, which, based on different sources of data, may vary to a greater or lesser extent. Therefore, it is necessary to continue researching and comparing findings with the main goal of providing the best possible care and support for extremely preterm infants and their families.

• Keywords: izrazito nezrela nedonoščad; granica preživljavanja; ishodi
• Keywords (english): extremely preterm infants; limits of survival; outcomes
• Language: croatian
• URN:NBN: urn:nbn:hr:105:314317
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-31 08:55:03