Nature Vs Technological Nurture
That old science debate involving ethics and knowledge applies in this case. Just because we can do something should we do something that nature would otherwise not have allowed? Example. A famous story emerged this week about Dylan Benson, his infant son Iver, and his (now deceased) wife Robyn. Dylan put it into better words than I can: Iver is healthy and is the cutest and most precious person….it will still be a bumpy ride….as he continues to grow under the care of the wonderful staff at the hospital.” Therein lies the rub.
There are two issues here: Iver is healthy, and a bumpy ride ahead. How healthy is a baby who is born 28 weeks premature? That is the quivalent of 4 months, or half a pregnancy. Before we had the type of technology we now have (including life support equipment for Robyn), Iver would have most certainly died with his mother. 32-year-old Robyn suffered an irreparable cerebral hemorrhage that left her brain-dead. She was 22 weeks pregnant. 6 weeks later, doctors delivered Iver at the approximate age of 5 months. It’s rather freakish if you think about it. A comatose woman who, for all intents and purposes is dead, acts as an incubator for her fetus for several weeks until doctors remove him and place him in intensive care. Nature may or may not have meant for the baby to die with his mother but it certainly made its decision about Robyn Benson.
How does daddy know the infant is healthy? Infants born even one week premature can suffer consequences although probably have few or no truly long-term problems. Those who are very premature and who have a stormy start to life often suffer serious problems. I refuse to believe that a 28-week old infant is the picture of health and I’ll tell you why. Regarding infants born at 33 weeks or less:
- Hypothermia is a great risk. A premature baby is less able to shiver and to maintain homeostasis.
- Maternal death, especially in teenage mothers, is a higher risk than in babies born at term.
- Hypoglycaemia is also a risk. There may also be hypocalcaemia. Both can cause convulsions that may produce long-term brain damage.
- The more premature the baby, the greater the risk of respiratory distress syndrome. Steroids before delivery may reduce the risk. If the baby requires oxygen it must be monitored very carefully as the premature baby is susceptible to retrolental fibroplasia and blindness.
- The premature baby is more susceptible to neonatal jaundice and to kernicterus at a lower level of bilirubin than a more mature baby.
- They are susceptible to infection and to necrotising enteritis.
- They are susceptible to intraventricular brain haemorrhage with serious long-term effects.
- Severe problems such as cerebral palsy, blindness and deafness may affect as many as 10 to 15% of significantly premature babies. There is some evidence that the incidence of cerebral palsy is falling in premature babies born between 28-31 weeks
- About half of infants born at 24-28 weeks of gestation have a disability at 5 years.
- In the infants born later (29-32 weeks’ gestation), about a third have a disability at 5 years.
- Over 30% had developmental co-ordination disorder (DCD) compared with 6% of classmates.
- Far more very premature children do poorly in school than their healthier peers.
- The preterm children were significantly more likely be overactive, easily distractible, impulsive, disorganised and lacking in persistence. They also tended to overestimate their ability.
One important thing to keep in mind: although major disabilities have been reduced, the levels of disability tested in the quoted study did not seem lower than those found in children born 10 or 20 years earlier despite improvements in care of the newborn. I will allow for the fact that stats and percentages are generalities and not entirely precise. Still, I am grateful that my own child was born term and not at 28 weeks. Had she been that premature would I have wanted doctors to keep her alive? Absolutely. This is part of the dilemma of welcoming an extremely premature infant into one’s family. The love is there long before the birth. The problems are only just beginning.
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