研究發(fā)現(xiàn)22周早產(chǎn)兒有機(jī)會(huì)存活

Premature Babies May Survive at 22 Weeks if Treated, Study Finds

研究發(fā)現(xiàn)22周早產(chǎn)兒有機(jī)會(huì)存活

A small number of very premature babies are surviving earlier outside the womb than doctors once thought possible, a new study has documented, raising questions about how aggressively they should be treated and posing implications for the debate about abortion.

一項(xiàng)新研究提出證據(jù)表明，少數(shù)極度早產(chǎn)兒能在子宮外存活，而醫(yī)生過去認(rèn)為這是不可能的。這一發(fā)現(xiàn)提出了究竟應(yīng)該怎樣努力護(hù)理這些早產(chǎn)兒的問題，也可能會(huì)影響有關(guān)墮胎的爭(zhēng)論。

The study, of thousands of premature births, found that a tiny minority of babies born at 22 weeks who were medically treated survived with few health problems, although the vast majority died or suffered serious health issues. Leading medical groups had already been discussing whether to lower the consensus on the age of viability, now cited by most medical experts as 24 weeks.

這項(xiàng)對(duì)數(shù)千早產(chǎn)兒的研究發(fā)現(xiàn)，極少數(shù)在妊娠22周時(shí)出生的嬰兒，經(jīng)過醫(yī)療護(hù)理后存活了下來，而且?guī)缀鯖]有影響他們健康的后遺癥。雖然絕大多數(shù)如此早產(chǎn)的嬰兒死亡，或有嚴(yán)重的健康問題。一些知名的醫(yī)學(xué)團(tuán)體已經(jīng)在討論是否要降低公認(rèn)的可獨(dú)立存活胎齡，目前絕大多數(shù)醫(yī)學(xué)專家引用的是24周。

The Supreme Court has said that states must allow abortion if a fetus is not viable outside the womb, and changing that standard could therefore raise questions about when abortion is legal.

美國(guó)最高法院曾表示，如果胎兒不能在子宮外存活，各州必須允許墮胎。因此改變可獨(dú)立存活胎齡的標(biāo)準(zhǔn)可能會(huì)催生何時(shí)墮胎合法的問題。

For most parents and doctors, the new study will intensify the agonizing choices faced about how intensively to treat such infants.

對(duì)于大多數(shù)家長(zhǎng)和醫(yī)生來說，新研究將使他們面臨的究竟要在多大程度上特別護(hù)理這些嬰兒的選擇變得更加艱難。

The study, one of the largest and most systematic examinations of care for very premature infants, found that hospitals with sophisticated neonatal units varied widely in their approach to 22-week-olds, ranging from a few that offer no active medical treatment to a handful that assertively treat most cases with measures like ventilation, intubation and surfactant to improve the functioning of babies’ lungs.

這項(xiàng)研究是對(duì)極度早產(chǎn)兒護(hù)理的最大范圍也是最系統(tǒng)的考察之一。研究發(fā)現(xiàn)，有先進(jìn)新生兒病房的醫(yī)院在對(duì)22周出生嬰兒的護(hù)理方法上差異很大。有為數(shù)不多的醫(yī)院不提供任何積極的醫(yī)療護(hù)理，也有極少數(shù)的醫(yī)院果斷地治療大多數(shù)早產(chǎn)兒，對(duì)他們使用呼吸機(jī)、氣管插管，以及表面活性劑來提高嬰兒的肺部功能等措施。

“It confirms that if you don’t do anything, these babies will not make it, and if you do something, some of them will make it,” said Dr. David Burchfield, the chief of neonatology at the University of Florida, who was not involved in the research. “Many who have survived have survived with severe handicaps.”

“研究證實(shí)，如果你什么都不做，這些早產(chǎn)兒不可能活，而如果你做點(diǎn)什么，其中一些能活下來，”佛羅里達(dá)大學(xué)新生兒科主任醫(yī)生大衛(wèi)·伯奇菲爾德博士 (Dr. David Burchfield)說，“但許多活下來的早產(chǎn)兒有嚴(yán)重的身體障礙。”伯奇菲爾德博士沒有參與這項(xiàng)研究。

Results of the study, published Wednesday in The New England Journal of Medicine, are likely to influence a discussion taking place among professional medical associations about how to counsel parents and when to offer treatment to such tiny babies.

該研究的結(jié)果周三發(fā)表在《新英格蘭醫(yī)學(xué)雜志》(The New England Journal of Medicine)上，很可能會(huì)影響專業(yè)醫(yī)學(xué)協(xié)會(huì)就如何為家長(zhǎng)提供咨詢、以及在什么情況下該對(duì)這些特別早產(chǎn)的嬰兒提供醫(yī)療護(hù)理的問題所進(jìn)行的討論。

The study, involving nearly 5,000 babies born between 22 and 27 weeks gestation, found that 22-week-old babies did not survive without medical intervention. In the 78 cases where active treatment was given, 18 survived, and by the time they were young toddlers, seven of those did not have moderate or severe impairments. Six had serious problems such as blindness, deafness or severe cerebral palsy.

這項(xiàng)研究涉及近5000名在妊娠22周到27周出生的嬰兒，研究發(fā)現(xiàn)，22周出生的嬰兒在沒有醫(yī)療干預(yù)的情況下不能生存。在進(jìn)行了積極治療的78個(gè)病例中，有18個(gè)活了下來。他們長(zhǎng)到兩、三歲時(shí)，有七人沒有中度或重度身體障礙，有六人有嚴(yán)重的問題，如失明、失聰或嚴(yán)重腦癱。

Of the 755 born at 23 weeks, treatment was given to 542. About a third of those survived, and about half of the survivors had no significant problems.

在23周出生的755個(gè)早產(chǎn)兒中，有542個(gè)得到了醫(yī)療護(hù)理。其中大約有三分之一存活，約一半存活者沒有明顯的健康問題。

As techniques for keeping babies alive improve, parents face wrenching choices that are sometimes based on whether the estimated age is 22 weeks and one day or six days. The study found that hospitals tend to “round up,” with babies closer to 23 weeks more likely to receive treatment.

隨著讓嬰兒能存活技術(shù)的改善，父母面臨著痛苦的選擇。有時(shí)這種選擇是基于對(duì)可獨(dú)立存活胎齡的估計(jì)是22周零一天還是零六天。這項(xiàng)研究發(fā)現(xiàn)，醫(yī)院往往會(huì)“四舍五入”，接近23周出生的早產(chǎn)兒更有可能得到醫(yī)療護(hù)理。

But the authors and other experts also noted that gestational age is an educated guess, based on women’s recollection of their last menstrual period and estimated fetal size. Other factors, including prenatal care and the fact that girls are often a week more mature than boys, should also influence decisions, experts say.

但是，論文作者和其他專家也指出，胎齡只是一個(gè)有根據(jù)的推測(cè)，根據(jù)的是孕婦對(duì)自己最近一次月經(jīng)來潮日期的回憶，以及所估計(jì)的胎兒大小。專家說，其他因素，包括產(chǎn)前檢查，以及女胎兒往往比男胎兒早成熟一周的事實(shí)，也應(yīng)該影響決定。

“It’s very difficult to say to a mother, ‘If you deliver today, I’m going to do nothing, but if you deliver tomorrow, I’m going to do everything,’ ” said Dr. Neil Marlow, a neonatologist at University College London.

倫敦大學(xué)學(xué)院(University College London)的新生兒專家尼爾·馬洛博士(Dr. Neil Marlow)說，“很難對(duì)一位母親說，‘如果你今天生，我會(huì)什么都不做，但如果你明天生，我會(huì)盡一切努力。’”

The study, which evaluated cases from 2006 to 2011 at 24 hospitals in a neonatal network supported by the National Institute of Child Health and Human Development, found that four of the hospitals intervened for no 22-week-olds, five intervened for all 22-week-olds and the rest varied. In all, about a fifth of the 357 babies that age were treated. The reasons could include family preferences and hospital policy, the authors wrote.

這項(xiàng)研究評(píng)估了由美國(guó)兒童健康和人類發(fā)展研究所支持的24家醫(yī)院參與的新生兒網(wǎng)絡(luò)中，從2006年至2011年期間的病例，發(fā)現(xiàn)四家醫(yī)院對(duì)22周出生的早產(chǎn)兒沒有進(jìn)行醫(yī)學(xué)干預(yù)，五家醫(yī)院對(duì)22周出生的嬰兒進(jìn)行了干預(yù)，其他的醫(yī)院視情況而定?？偟膩碚f，所有接受醫(yī)療護(hù)理的357名22周出生的嬰兒中大約有五分之一接受了護(hù)理。是否治療的原因可能包括家庭的選擇和醫(yī)院的政策，作者寫道。

“We can’t really say whether the differences revolve around differences in values, that for some physicians or parents the risk of impairment might outweigh the decision for treatment,” said Matthew Rysavy, a medical student at the University of Iowa, who led the study with Dr. Edward Bell, a pediatrics professor there. At Iowa, Dr. Bell said, treatment is offered to most 22-week-olds, and he considers 22 weeks a new marker of viability.

“我們確實(shí)不能說，治療選擇上的差異是否是價(jià)值觀上的差異。對(duì)一些醫(yī)生或家長(zhǎng)來說，(孩子存在)身體障礙的風(fēng)險(xiǎn)可能在做治療決定時(shí)起較大作用，”艾奧瓦大學(xué)醫(yī)學(xué)院學(xué)生馬修·萊薩維(Matthew Rysavy)說，他和醫(yī)學(xué)院的小兒科教授愛德華·貝爾博士(Dr. Edward Bell)一起領(lǐng)導(dǎo)了這項(xiàng)研究。貝爾說，在艾奧瓦州，大多數(shù)22周的早產(chǎn)兒都得到?醫(yī)療護(hù)理，他認(rèn)為22周是獨(dú)立存活的新標(biāo)準(zhǔn)。

“That’s what we think, but this is a pretty controversial area,” Dr. Bell said. “I guess we would say that these babies deserve a chance.”

“我們這樣認(rèn)為，但這是一個(gè)非常有爭(zhēng)議的領(lǐng)域，”貝爾說。 “我想我們會(huì)說，這些嬰兒應(yīng)該得到一個(gè)機(jī)會(huì)。”

Dr. Jeffrey M. Perlman, medical director of neonatal intensive care at NewYork-Presbyterian Hospital Weill Cornell Medical Center, takes a different view. He said it was important to consider that long months in neonatal units can be “like riding an obstacle course or flying in a plane with bad turbulence, and each of these down spirals can have an impact on the brain.”

紐約長(zhǎng)老會(huì)醫(yī)院威爾康奈爾醫(yī)學(xué)中心(NewYork-Presbyterian Hospital Weill Cornell Medical Center)負(fù)責(zé)新生兒特別護(hù)理的醫(yī)務(wù)主任杰弗里·M·佩爾曼(Jeffrey M. Perlman)則有不同看法。他表示，很重要的一點(diǎn)是，要考慮到新生兒待在特護(hù)室的長(zhǎng)達(dá)數(shù)月的時(shí)間里，可能會(huì)“像參加障礙賽，或是坐飛機(jī)時(shí)遇到了嚴(yán)重的氣流，每一次下降都可能會(huì)影響大腦”。

At his hospital, “we go after the 24-weekers,” he said. “If it’s 23, we will talk to the family and explain to them that for us it’s an unknown pathway. At 22 weeks, in my opinion, the outcomes are so dismal that I don’t recommend any interventions.”

在他所在的醫(yī)院，“我們會(huì)救治24周出生的早產(chǎn)兒，”他說。“如果是23周，我們會(huì)和家人溝通，向他們解釋，我們不知道未來會(huì)發(fā)生什么。如果是22周，我個(gè)人認(rèn)為，結(jié)果非常悲觀，我不建議進(jìn)行任何干預(yù)。”

Dr. Bell pointed to success stories, including Chrissy Hutchinson, 32, of Manchester, Iowa. Her water broke in 2010 when she was 21 weeks and six days pregnant. The first hospital she went to “said there really was no chance of survival, and if the baby was born not breathing that they weren’t going to resuscitate or anything,” she said.

貝爾醫(yī)生列舉了一些成功的例子，比如艾奧瓦州曼徹斯特的克麗茜·哈欽森(Chrissy Hutchinson)。哈欽森現(xiàn)年32歲，2010年，她在懷孕21周零六天之后羊水破了。她去就診的第一家醫(yī)院“說不可能存活，如果胎兒出來之后沒有呼吸，他們也不會(huì)采取復(fù)蘇措施，”她說。

The Hutchinsons called the University of Iowa, and there, at 22 weeks and one day, Alexis was delivered, weighing 1.1 pounds. Alexis was treated and stayed in neonatal intensive care for almost five months. Now, Ms. Hutchinson, a pharmacy technician, said, aside from being more vulnerable to respiratory viruses, Alexis is a healthy 5-year-old.

哈欽森一家給艾奧瓦大學(xué)打了電話，在那里，亞力克西絲(Alexis)在孕育22周零一天后誕生了，當(dāng)時(shí)體重之有1.1磅(約0.5公斤)。她在新生兒重癥監(jiān)護(hù)室待了近五個(gè)月，并接受了治療。如今，從事藥劑師工作的哈欽森女士說，亞力克西絲五歲了，除了呼吸系統(tǒng)比較容易受到細(xì)菌侵襲之外，她很健康。