Our children have so many premature delivery, should I give up? About premature babies (1)

I wrote a lot of content of ordinary pediatrics and intended to write some newborns.

From the beginning of studying pediatrics, I have dealt with premature babies, and I have also been exposed to many family members of premature babies and premature infants.

In 1961, the World Health Organization (WHO) defined the concept of premature babies as newborns born in the fetal age less than 37 weeks.For the classification of premature babies, the classification of my country and the World Health Organization is slightly different.The World Health Organization The Global Action Report on Preterm Birth 2012 was divided into three categories.Late premature babies/light premature babies (32-weeks-37 weeks of fetal age), extremely premature babies (28 weeks-31+6 weeks), super premature babies (tire age less than 28 weeks).Most of the late premature babies can survive after appropriate care.Extremely premature babies, in addition to proper care, special support treatment is needed, and most of them can survive.For super -early birth, higher technology is required to partially survive, and the mortality rate and sequelae incidence rate is relatively high.

Global Premature Parement Report 2012

my country’s classification methods further classify the advanced premature infants of the World Health Organization into a medium term (32 weeks-33+6 weeks) and late premature babies (34 weeks-36+6 weeks).

Practical Newborn P57

In medical work, as a doctor (what I said here, some of my personal views may be biased), in the medical work, there is a moment of "one thought of becoming a Buddha, one thought into a demon".Faced with premature babies, I will not talk about the problem of giving up treatment at the age of 28 weeks of the fetus (and 1000g of weight line).But I will definitely not mention the active abandonment of the treatment. Generally speaking, this kind of child is unless merged some special diseases (congenital diseases, genetic metabolic diseases, severe deformity, etc.).In fact, it is good. There may be some minor nerve functional damage in the later stage, such as emotional disorders, behavior problems, learning problems, and so on.When I was studying, my instructor once said, "Some children may be destined to get the Nobel Prize in this life when they are born, but if you work hard the day after tomorrow, you can still take Tsinghua Peking University." In factThe physical function of the newborn is still very powerful. Many times, nerve cells cannot be regenerated, but the nervous system is plastic. The surviving nerve cells can replace the function of the damaged nerve cells by establishing a new synapse contact., Restore the function of the nervous system (I will talk about an article in the nervous system alone).

Development of premature infants and nervous system

The other is the limits of the current medical care. The youngest who has been rescued in China is 22+2 weeks of fetal age (370g in the Nanjing Maternal and Child Health Hospital 550G hospitalized for more than 3 months).Maternal and Child Health Hospital, 24 weeks of fetal age and 7 months), the minimum weight of the world record is 252g (Germany).This is the category of the limits of today’s medical care.If I am currently a newborn who encounters less than 25 weeks (500g of weight is 500g), unless my family members are extremely active, when I explain the condition, I still give up treatment priority, because under the current medical conditions, the treatment of this baby is difficult to treat.It is huge with medical expenses. It must have strong psychological preparation, firm family team, economic foundation and other conditions, and there is a hope of rushing, because it is most likely that "people and wealth are empty".If the family is too much hope, it is easy to cause family collapse.At this time, instead of actively rescue, it is better to let the child stay with the mother to stay with the mother for a "small meeting".

Finally, there is a category in the middle. The age of the fetus is 25 weeks and 28 weeks (weighs between 500-1000g). Generally speaking, children of this category will collect some family members first.Because of what happens, whether it is a test tube baby, what job does it, there are no children on it, boys and girls, healthy and unhealthy, because this information will affect our choice.When we explain the condition, we will list the common complications of such super premature babies (here are involved in the name of many diseases, I will further further related articles in the back, if you need to pay attention to me)

"Your child has a premature child for 26 weeks. It is only more than 6 months. It belongs to extremely premature babies. The development of each system is extremely immature. Each system may have many diseases.

① Respiratory system: Newborn respiratory distress syndrome (RDS) requires supplementation of lung surface active substances, ventilator auxiliary breathing, respiratory suspension, bronchial lung development, long -term support for ventilator and oxygen.

② Neurological system: intracranial hemorrhage, white quality softening (PVL) around the brain, audiovisual dysfunction, long -term included cerebral palsy, epilepsy.

③ Circular system: shock, hypotension, arterial ducts are not closed (PDA), and sometimes surgery is needed.

④ Gastrointestinal: Feeding and impatient, necrotic necrotic small intestinal colonitis (NEC).

⑤ Infection: Infected infection is unavoidable, and the severe infection of death.

⑥ Internal environmental disorders: low/hyperglycemia, hypertrophy, hypertrophy, hyperkalemia, and the convulsions caused by these, arrhythmia, intracranial lesions.

⑦ Premature baby retinopathy

⑧The is in hospital for a long time, and it costs high, and there may be risk of death and prognosis.

This big set will basically be covered by all family members.Most of their reactions are "uh, uh".I will see the subsequent reactions of my family members. If they show the meaning of giving up, I will ask if they make a decision with my lover or make my own decision.Family information, if this child is the first child, and the mother has more serious obstetrics complications, early stage of severe epilepsy, will inevitably abortion, IVF, etc. Because these diseases, they may often have premature birth in the next child.The situation is not even as good as this child. I will choose to persuade the family as much as possible.Give up, he doesn’t even have a chance to enter the venue. If you can persist, see that this child may improve after the rescue "," This child is your blessing.Poor, you should give him a chance. "Most family members choose to continue treatment in this language.If there are already children on it, I will generally persuade it, but I won’t do a lot of persuasion.In fact, there are two kinds of special family members here. One is that the family conditions are really poor, but they are very poor, that is, it is impossible to pay 20,000 in the hospital. I will not persuade this.The other is the high expectation of the child and cannot accept any complications. I have encountered one example. The early birth of the early birth of the early weeks is very smooth in the early days, but there is a heavy infection in the back.Vecent, infected toxic shock, fasting, high -grade antibiotics, reduced platelet reduction, infusion of propion globulin and platelets. On the second day when the condition changes, family members come to give up treatment.Good possibility, in fact, the child’s whole body was improved at that time. After actively fighting infection, he was ready to withdraw a ventilator, but the family members had to give up, and there was really no way.

Another thing is that after the family members gave up, the child was going to take away. This incident was quite complicated. I had encountered a premature child with a 690g of 690g in 25 weeks.It is also saved, and there is no serious complications.If the baby wants to take it away, tell the family, "Pay attention not to cover the child’s mouth and nose, keep warm, and let the mother hold the baby (kangaroo care).You can support it yourself. Or if your child is fighting, you can also take it back. "

I remember when I was a neonatal doctor, I discussed this issue with my sister.

"I think our job is a bit counter -sky"

"How to say?"

"Darwin’s evolution theory is about the selection of things and the survival of the fittest. Nature will eliminate those bad genes through the laws of nature. We will rescue these small premature births. They have not survived in the natural state.It has reduced the quality of the entire birth population. "

"You can’t say that it is wrong, but in fact, every premise, especially a small premature infant, you see a patient, but in fact, this is a family, or even several families. Maybe this child is gone. This family is gone. This family is gone. This family is gone.It’s gone. We give these children a chance, and life will often create miracles "


Many times when premature babies will involve economic issues, because too much money and too little money, there is no need to consider this problem at all.Generally speaking, if the child’s fetal age is more than 32 weeks (1,500g birth weight), the hospitalization fee is less than 100,000. If the child’s fetal age is more than 28 weeks (1,000g birth weight), the hospitalization fee is less than 200,000 less.It is more difficult to estimate by 28 weeks (weighing less than 1000g), but generally less than 400,000.(There is little chance of occurrence here, not that these are enough. If you combine other diseases, there are surgery, and there are many recurred diseases. It is hard to say).).And now the medical insurance coverage is widely covered, most children can cover it. What the family members want to do is to have a child to get a birth certificate, go to the household registration, and then go through the medical insurance procedures.It can be more than 50%(this is related to the medication, some special drugs cannot be reported).

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