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¿Se necesitan directrices? Perspectivas internacionales sobre la toma de decisiones y la variación de la práctica en

Rosa Geurtzen¹, Simone Klijntjes², Maureen Stegeman²

¹Division of Neonatology, Department of Pediatrics, Amalia Children's Hospital, Nijmegen, Radboud University Medical Centre, Nijmegen, The Netherlands. Rosa.Geurtzen@radboudumc.nl.

Journal of perinatology : official journal of the California Perinatal Association

|February 10, 2026

Resumen

Los neonatólogos de todo el mundo prefieren pautas flexibles para los bebés extremadamente prematuros (EPI), incorporando factores más allá de la edad gestacional. Se acepta la variación de la práctica por razones parentales o de recursos, pero no por diferencias institucionales.

Área de la Ciencia:

Medicina neonatal La medicina neonatal es una especialidad de la medicina neonatal.
Ética médica La ética médica es la ética médica.
La política de salud de la política de salud.

Sus antecedentes:

Las directrices para el cuidado de bebés extremadamente prematuros (EPI) son cruciales para un manejo consistente.
Las perspectivas internacionales sobre la necesidad y la forma de estas directrices no están bien establecidas.
Comprender la variación de prácticas aceptables es clave para desarrollar directrices de aplicación universal.

Objetivo del estudio:

Evaluar las opiniones de los neonatólogos internacionales sobre la necesidad de directrices de atención de EPI.
Determinar las estructuras preferidas para dichas directrices, incluyendo factores más allá de la edad gestacional.
Para evaluar el grado de variación de la práctica que los neonatólogos consideran aceptable en la toma de decisiones de EPI.

Principales métodos:

Se realizó una encuesta internacional anónima, en línea y transversal.
La encuesta se dirigió a neonatólogos de todo el mundo, explorando las pautas actuales y preferidas.
Se utilizaron escenarios hipotéticos para probar la aceptación de la variación de la práctica en la atención de EPI.

Principales resultados:

127 neonatólogos de 47 países respondieron.
El 55% favoreció las pautas que combinan la edad gestacional con otros factores de pronóstico; el 13% prefirió ninguna pauta.
Se aceptó la variación de la práctica para los deseos de los padres, las normas culturales o las limitaciones de recursos, pero no para las diferencias hospitalarias o individuales.

Conclusiones:

Los neonatólogos abogan por directrices adaptables y estructuradas para EPIs, teniendo en cuenta múltiples factores de pronóstico.
La variación de la práctica aceptable en la atención de EPI está vinculada a consideraciones éticas como los valores parentales y la asignación de recursos.
Las directrices deben tener en cuenta los factores contextuales en lugar de la variabilidad institucional o individual.

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