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.
一项新研究提出证据表明，少数极度早产儿能在子宫外存活，而医生过去认为这是不可能的。这一发现提出了究竟应该怎样努力护理这些早产儿的问题，也可能会影响有关堕胎的争论。
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.
这项对数千早产儿的研究发现，极少数在妊娠22周时出生的婴儿，经过医疗护理后存活了下来，而且几乎没有影响他们健康的后遗症。虽然绝大多数如此早产的婴儿死亡，或有严重的健康问题。一些知名的医学团体已经在讨论是否要降低公认的可独立存活胎龄，目前绝大多数医学专家引用的是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.
美国最高法院曾表示，如果胎儿不能在子宫外存活，各州必须允许堕胎。因此改变可独立存活胎龄的标准可能会催生何时堕胎合法的问题。
For most parents and doctors, the new study will intensify the agonizing choices faced about how intensively to treat such infants.
对于大多数家长和医生来说，新研究将使他们面临的究竟要在多大程度上特别护理这些婴儿的选择变得更加艰难。
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.
这项研究是对极度早产儿护理的最大范围也是最系统的考察之一。研究发现，有先进新生儿病房的医院在对22周出生婴儿的护理方法上差异很大。有为数不多的医院不提供任何积极的医疗护理，也有极少数的医院果断地治疗大多数早产儿，对他们使用呼吸机、气管插管，以及表面活性剂来提高婴儿的肺部功能等措施。
“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.”
“研究证实，如果你什么都不做，这些早产儿不可能活，而如果你做点什么，其中一些能活下来，”佛罗里达大学新生儿科主任医生大卫·伯奇菲尔德博士(Dr. David Burchfield)说，“但许多活下来的早产儿有严重的身体障碍。”伯奇菲尔德博士没有参与这项研究。
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.
该研究的结果周三发表在《新英格兰医学杂志》(The New England Journal of Medicine)上，很可能会影响专业医学协会就如何为家长提供咨询、以及在什么情况下该对这些特别早产的婴儿提供医疗护理的问题所进行的讨论。
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.
这项研究涉及近5000名在妊娠22周到27周出生的婴儿，研究发现，22周出生的婴儿在没有医疗干预的情况下不能生存。在进行了积极治疗的78个病例中，有18个活了下来。他们长到两、三岁时，有七人没有中度或重度身体障碍，有六人有严重的问题，如失明、失聪或严重脑瘫。
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个早产儿中，有542个得到了医疗护理。其中大约有三分之一存活，约一半存活者没有明显的健康问题。
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.
随着让婴儿能存活技术的改善，父母面临着痛苦的选择。有时这种选择是基于对可独立存活胎龄的估计是22周零一天还是零六天。这项研究发现，医院往往会“四舍五入”，接近23周出生的早产儿更有可能得到医疗护理。
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，论文作者和其他专家也指出，胎龄只是一个有根据的推测，根据的是孕妇对自己最近一次月经来潮日期的回忆，以及所估计的胎儿大小。专家说，其他因素，包括产前检查，以及女胎儿往往比男胎儿早成熟一周的事实，也应该影响决定。
“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.
伦敦大学学院(University College London)的新生儿专家尼尔·马洛博士(Dr. Neil Marlow)说，“很难对一位母亲说，‘如果你今天生，我会什么都不做，但如果你明天生，我会尽一切努力。’”
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.
这项研究评估了由美国儿童健康和人类发展研究所支持的24家医院参与的新生儿网络中，从2006年至2011年期间的病例，发现四家医院对22周出生的早产儿没有进行医学干预，五家医院对22周出生的婴儿进行了干预，其他的医院视情况而定。总的来说，所有接受医疗护理的357名22周出生的婴儿中大约有五分之一接受了护理。是否治疗的原因可能包括家庭的选择和医院的政策，作者写道。
“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.
“我们确实不能说，治疗选择上的差异是否是价值观上的差异。对一些医生或家长来说，（孩子存在）身体障碍的风险可能在做治疗决定时起较大作用，”艾奥瓦大学医学院学生马修·莱萨维(Matthew Rysavy)说，他和医学院的小儿科教授爱德华·贝尔博士(Dr. Edward Bell)一起领导了这项研究。贝尔说，在艾奥瓦州，大多数22周的早产儿都得到医疗护理，他认为22周是独立存活的新标准。
“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.”
“我们这样认为，但这是一个非常有争议的领域，”贝尔说。 “我想我们会说，这些婴儿应该得到一个机会。”
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.”
纽约长老会医院威尔康奈尔医学中心(NewYork-Presbyterian Hospital Weill Cornell Medical Center)负责新生儿特别护理的医务主任杰弗里·M·佩尔曼(Jeffrey M. Perlman)则有不同看法。他表示，很重要的一点是，要考虑到新生儿待在特护室的长达数月的时间里，可能会“像参加障碍赛，或是坐飞机时遇到了严重的气流，每一次下降都可能会影响大脑”。
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.”
在他所在的医院，“我们会救治24周出生的早产儿，”他说。“如果是23周，我们会和家人沟通，向他们解释，我们不知道未来会发生什么。如果是22周，我个人认为，结果非常悲观，我不建议进行任何干预。”
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.
贝尔医生列举了一些成功的例子，比如艾奥瓦州曼彻斯特的克丽茜·哈钦森(Chrissy Hutchinson)。哈钦森现年32岁，2010年，她在怀孕21周零六天之后羊水破了。她去就诊的第一家医院“说不可能存活，如果胎儿出来之后没有呼吸，他们也不会采取复苏措施，”她说。
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.
哈钦森一家给艾奥瓦大学打了电话，在那里，亚力克西丝(Alexis)在孕育22周零一天后诞生了，当时体重之有1.1磅（约0.5公斤）。她在新生儿重症监护室待了近五个月，并接受了治疗。如今，从事药剂师工作的哈钦森女士说，亚力克西丝五岁了，除了呼吸系统比较容易受到细菌侵袭之外，她很健康。
Some of the study’s results suggest that among 22-week-olds who are treated, experiences like the Hutchinsons’ would be exceedingly rare because Ms. Hutchinson delivered so close to 22 weeks and did not have time for corticosteroids beforehand.
这项研究的一些结果显示，在接受治疗的22周的胎儿中，哈钦森家这样的例子极其罕见，因为哈钦森女士分娩时孕期才刚过22周，产前也没来得及给她服用皮质类固醇激素。