“22 weeks of pregnancy” Unhelpful life Oct. 8 at 17:57
Until I heard the fact from a neonatal doctor, I thought that every life I was born would be lifesaving. However, even if you come out from your mother's tummy and raise her birth, there is a life that cannot be saved. (Shinka Ikebata, journalist of the Science and Culture Department)
Strict line “22 weeks of pregnancy”
Usually, babies are born around 40 weeks of pregnancy. On the other hand, premature birth is born for some reason before full development in the tummy. With the advancement of medical technology, babies who gave birth at the 22nd week of pregnancy, which is said to be extremely premature, are able to leave the hospital and grow by stimulating their development with a respirator. According to the latest statistics of the country, 298 babies were born at the 23rd week of pregnancy per year. There were 130 people in 22 weeks.
However…. If you are 21 weeks pregnant, you are 0 people. Between weeks 21 and 22, there is a strict line that can be called the “line of life”.
“I have no chance of living”
Babies younger than 22 weeks of pregnancy are considered poorly developed in their mother's tummy and are not expected to be born. In medical practice, lifesaving measures such as attaching a ventilator, which are necessary for raising a very premature baby, have not been basically taken and have been treated as a miscarriage.
“A newborn doctor who gives life-saving measures is not present for childbirth before 22 weeks of pregnancy.”
“Baby born in less than 22 weeks of pregnancy will be watched and die”
In fact, I heard such stories from doctors at the interview site. However, it has been pointed out that advances in medical technology can help babies born in less than 22 weeks of pregnancy.
A girl born in the 21st week of pregnancy
Is the current standard appropriate? When I started the interview, I heard a rumor that “There seems to be a child who was born and saved before 22 weeks of pregnancy”. However, it was not reported at all, and I went around a large hospital.
I was able to meet a girl who was born in the 21st week of pregnancy for 2 months. Shigemi Ariga, 13 years old. When going to see home to live in the family, they gave me greeting cheerfully as "Hello ~!".
Life saved by chance
At the time of childbirth, her mother, Mami, was told by her doctor that she would not save her life if she was born in less than 22 weeks of pregnancy. Mami gave birth one week before the 22nd week, 21st week and 6th day. A baby born at only 508 grams should not have been saved.
“I thought I couldn't help me anymore because of the labor I had stopped with drugs. I went to the stand while crying.” (Mami)
However, a new nurse who attended childbirth called a doctor different from the attending physician, and lifesaving measures were taken. Shigemi was saved by accident. Although Shigeru has been pointed out that development has been delayed, he goes to the special support classes in Tokyo every day. I had a chance to visit a piano lesson that I loved.
"That girl's piano is a mess."
Mami, her mother, laughed saying that, but her eyes were moist when she saw her child's growth. Shigemi's serious expression and a slightly muscular tone. I was full of breasts for her performance.
“I am grateful to the teachers who helped me even now. I'm really grateful. I think it was a coincidence that there were many accidents, but thanks to this child, I was very happy.” (Mami)
“Drawing of life” Growth limit
In fact, the “line of life” line, “Babys born less than 22 weeks of pregnancy will not save lives” is based on the “growth limit” stipulated by the law. The government has established a “growth limit” that indicates how long a pregnant baby can live under the “Maternal Protection Law”. This "growth limit" is provided for the line drawing that an artificial abortion is recognized, because the baby cannot live below that number of weeks.
However, this drawing is used in a way that can be used as a criterion for whether or not to save lives in the neonatal medical field. The “growth limit” has been changed according to the progress of medical technology. Changed to 28 weeks in 1953 and then to 24 weeks in 1976. In 1990, 29 years ago, the current pregnancy was 22 weeks.
Can the growth limit be advanced?
Can the “growth limit” be further advanced? National research teams centered on doctors at the National Center for Child Health and Development are investigating. We are now investigating the subsequent situation of children born at 22 and 23 weeks of pregnancy and trying to statistically determine where the real growth limits are based on current medical technology. The survey results are expected to be finalized in the next fiscal year, and depending on the results, there is a possibility that discussions for the advancement of the growth limit may begin.
“Children 22 and 23 weeks of pregnancy are more likely to survive. It may be necessary to rethink whether it is correct to define that you can't live under 22 weeks.”
Challenges in medical practice to save even more premature babies
On the other hand, doctors at the forefront of medical practice say that there is a big challenge when it comes to pushing the growth limit ahead and saving premature babies. At the Nagano Children's Hospital, which boasts the highest lifesaving rate in Japan, more than 90% of babies born at the 22nd week of pregnancy have saved their lives with lifesaving measures and have been discharged from the hospital.
However, about 30% of them have serious respiratory problems and cerebral palsy. If you are able to save life even under 22 weeks of pregnancy, it is highly likely that there will be more disabled babies.
“Some children have serious disabilities and need medical care. In medical practice, it is necessary to draw a line somewhere in operation, but I am worried every day how much I really want to save my baby's life. is"
Is there enough support for premature infants and families?
Voices pointing out issues are also received from parents of premature infants. I interviewed the “Nkko Network Kangaroo Association” held in Fukuoka City, where children born prematurely and their parents gathered. “N kid” means “NICU = child admitted to the neonatal intensive care unit”. It is said that children born prematurely often have disabilities or develop more slowly than other children, but there is little information to be helpful, and it is good to have difficulty in consulting The
“Premature birth, small body, weak feeding ability, don't drink breasts. Health check-ups pointed out that you are not gaining weight and you wo n’t even know you do n’t drink.” I knew the risks and could hardly get out of my house until about 2 years old. "
Looking at the mothers who were crying and worried about their worries, I learned that the support for families raising children who were born prematurely was not complete.
Advancing growth limits and discussing with support systems
What kind of support is needed when the growth limit is advanced? I visited the Kanagawa Children's Medical Center, which provides long-term care for children born prematurely. This hospital provides medical checkups for children who have been admitted to NICU for premature birth, regularly exercise and intelligence tests, and give advice on treatment and daily life. We had a visit to a 5th grade boy and parents who were visiting for a medical checkup.
Dr. Katsuaki Toyoshima of the neonatal department, in response to the question “I had premature birth but my lungs were weak, but can I do exercise as usual?” Because the functions were normal, it ’s okay to do physical education and club activities. ”
Children who are born prematurely are said to have a higher percentage of developmental disabilities. In another child's health checkup, there was a consultation such as "I am good at reading characters but I am not good at writing. Is there a tendency for developmental disabilities?" I advised my parents about the characteristics and contact.
It is not clear how the growth limit will be affected if the growth limit is advanced. It is said that it is necessary to support not only in childhood but also as long as possible after attending school in a way that is suitable for the child's development and disability.
“Whether or not to lower the growth limit is determined not only by the results of neonatal medical treatment, but it is also necessary to consider the future support system of the helped children.”
Life that can be saved, and subsequent support
Japan is said to have the world's top level of neonatal medical technology and the best lifesaving rate in the world. On the other hand, continuous care after discharge is not adequately carried out and is left to the autonomy of each medical institution. The rate of screening for prematurely born children is only about 60% even for 3-year-olds who have not had much time since discharge, and the rate is expected to be even lower as the age increases.
I think it's wonderful to have the potential to save more lives. However, when thinking about the “line of life” line, I felt through interviews that it was indispensable to consider the structure that supports the life saved in order to be able to live in your own way in society.
Reporter, Faculty of Science and Culture
Coverage centered on reproductive medicine and perinatal medicine in 2010
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