Experts warn that every day there are more premature births and they are getting more and more precocious ...
The possible reasons are the most varied, the increase in the mother's age when facing motherhood, assisted reproductive techniques, advances in medicine that allow pregnancies that previously did not exceed the first weeks to continue ...
Apart from everything that prematurity implies, no one escapes us that a premature baby that is two weeks away from term is not the same as another that is 12 weeks away.
The possibility of survival, the possible sequelae, are worse the less time the baby has been in its mother's womb.. There is a time when the baby's lungs are formed and the future of the premature baby is much clearer, but what happens when the baby is born in a viability limit week of pregnancy?
Today we are going to stop to look at all those babies born in a few weeks considered the limit of viability, children born in the "gray zone".
Prematurity
Pregnancy in humans lasts for 40 weeks. A baby is considered to be born "full term" when delivery occurs between 37 and 42 weeks of pregnancy.
The earlier the birth, the more structures of the fetus will still not be adequately developed. Specifically, lung development is what marks the limit of that baby's viability.
What do we understand by "limit of viability"
The limit of viability is the time of pregnancy when the fetus reaches the minimum maturity of its organs and systems necessary for it to have a reasonable chance of survival without major sequelae outside the womb.
Although the development of the embryo and fetus is more or less the same in all human beings, the viability of the baby is not a "closed" concept, we cannot establish a week in which all premature babies are viable.
There are several factors to assess when faced with premature birth: gestational age, sex, single or multiple pregnancy, fetal lung maturation, and estimated baby weight.
Baby lung maturation
When we talk about fetal lung maturity, we mean the ability of the baby's lungs to breathe.
It is the most important aspect of fetal development to assess whether or not the baby can be born and whether or not it can be viable.
The human lung begins to form from the first stages of pregnancy and continues its development process until 3 years of age.
Before week 23 the cells that make up the fetal lung are not capable of gas exchange, from week 25 of pregnancy the lung structures that are responsible for gas exchange begin to form, along with a fundamental substance for respiration, lung surfactant.
Therefore, currently, In our environment, it is considered necessary to attempt the resuscitation of the Newborn from week 25, but it is not recommended below week 23.
From week 30, survival without major sequelae is more than likely, since the lung has an acceptable development. Starting at week 26, with the current intensive care units, we can give the premature baby all the care to complete its development.
What happens to other fundamental organs or systems in the human being?
The maturity of the lung marks us the possibility of surviving in the moment. Possible major sequelae are due to the lack of maturity of another fundamental system, the nervous system., which together with the eye and the ear are the most affected by very premature birth.
The gestational gray area
The gestational gray area is understood to be the time between the 23rd and 24th week of pregnancy. Weeks in which it is difficult to determine whether or not a fetus is viable.
At this time the professionals will try to avoid birth by all means, trying to stop the birth as long as possible.
But what if it is impossible to prolong the pregnancy? What if delivery happens anyway?
In this case we are faced with an ethical and human dilemma. Health professionals must be guided by the basic principles of ethics.
The duty to preserve life can conflict with the duty to provide the highest quality of life, but we never know in advance the quality of life that that baby could achieve.
Who can know whether or not he will have disabilities because he was born so premature? Who can know in advance whether or not it will survive? Every day there are more cases of babies born with great prematurity and who have managed to live without major sequelae.
Trying to find the middle ground between the two principles is never easy.
It is important to try to avoid extreme suffering for the baby who is born with such extreme prematurity, but it is also important to give him the opportunity to live.
In all cases, it is advisable to adequately inform parents and have their opinion. In this “gray area” the expectations, values and beliefs of the parents are fundamental when it comes to making a decision or facing the care that will be given to that baby.
The final decision must have the consensus of obstetricians, pediatricians and the family, the way forward is not easy so we must be informed and prepared ...
Ugh, ugh! What a delicate subject, and what a delicate situation that of those babies with extreme prematurity, makes my hair stand on end and I wish that no one had to go through making such a decision, because of the implications it has. I often hear the experience of families, but right now I can't stop thinking about those babies: being about to be born between those weeks of gestation, and the risks it will have for future health, but at the same time realizing how helpless that they are.
Thank you Nati for bringing us this topic.
It is a difficult issue ... Not only medical reasons but also beliefs, convictions, cultural factors conflict ... The decision to reamimate the baby or not cannot fall only to the medical professional, it must be agreed with the parents and put in the place of that poor baby, not make him suffer unnecessarily but give him a chance to live.