Lantos John D
JLConsulting (
Semin Perinatol. 2022 Mar;46(2):151531. doi: 10.1016/j.semperi.2021.151531. Epub 2021 Nov 9.
Survival rates for babies born at 22 weeks of gestation are steadily improving at centers that offer active treatment to these babies. Still, many centers do not offer such treatment or, if they do, actively discourage it. Thus, parents will be given very different advice at different centers for babies born at the borderline of viability. Those doctors and centers that discourage treatment have concerns about the chances for survival, neurodevelopmental impairment among survivors, and cost. Yet there is strong evidence that many babies born at 22 weeks can survive, most survivors have good neurodevelopmental outcomes, and neonatal intensive care for tiny babies is cost-effective compared to many common and uncontroversial treatments. Given this growing body of evidence, policies discouraging or forbidding treatment of babies born at 22 weeks will require stronger ethical justification than has been given to date.
在为妊娠22周出生的婴儿提供积极治疗的医疗中心，这些婴儿的存活率正在稳步提高。然而，许多医疗中心并不提供这种治疗，或者即便提供，也会积极劝阻。因此，对于处于存活临界期出生的婴儿，不同的医疗中心会给家长提供截然不同的建议。那些不鼓励进行治疗的医生和医疗中心，担心婴儿的存活几率、存活者的神经发育障碍以及成本问题。然而，有强有力的证据表明，许多妊娠22周出生的婴儿能够存活，大多数存活者具有良好的神经发育结果，而且与许多常见且无争议的治疗方法相比，为极小的婴儿提供新生儿重症监护具有成本效益。鉴于这一越来越多的证据，不鼓励或禁止治疗妊娠22周出生婴儿的政策将需要比迄今为止给出的更强有力的伦理依据。
