The Gestational Gray Zone, The Delicate Limit Of Premature Babies

There is a very delicate as well as dramatic area, where it is very difficult to ascertain whether a premature baby will be able to live or not. We are talking without a doubt about the gestational gray area, the one that occurs between weeks 22 and 24, and where despite everything, wonderful miracles still take place that fill us with hope.

Today’s neonatology was born with the introduction of exogenous surfactant in the early 90s, along with other advances that make it possible for a large part of premature babies, that is, every child born before 37 weeks, to survive to lead a normal life. . The morbidity associated with prematurity has been reduced remarkably in the last decades in an exceptional way.

However, currently another type of problem is occurring that health institutions are echoing: more and more babies are arriving in the world before 37 weeks. We are not going to analyze here what causes determine this phenomenon, because without a doubt, it would give for another article on which to reflect.

This time we want to talk to you about a very complicated situation that many moms and dads already know. We are talking about all those children who are born at 22, 23 or 24 weeks. They are babies who have not reached term, weak lives on which ethical questions are opened, many fears, dramas as well as many emotions and hopes.

In a study published by the World Health Organization (WHO) it was shown that perinatal prematurity accounts for about 10% of births worldwide. A good part of them occur in the gestational gray zone. It is a challenge for medical institutions, which do not stop investing time, efforts and resources to be able to respond to such dramatic situations for many families.

In “You are Mom” we suggest you reflect on the subject.

The complex world of the gestational gray zone

There is a fact that you need to understand first about prematurity. Although the development of the embryo and later of the fetus is similar in all humans, it is not entirely clear when a baby is viable. That is, to know if he will be able to survive despite being born early.

There are babies who can die at 34 weeks and others who at 28 weeks succeed. There are therefore several factors that need to be analyzed in order to get an idea about the probabilities that a baby born before term may have.

The importance of lung maturation

Lung maturation is the key aspect when assessing the viability of a premature baby. So much so, that it is always convenient to remember that a child’s lungs undergo a slow maturation process from the beginning of conception, until they are about 3 or 4 years old (it must be remembered, as always, that each child has a particular development, we therefore speak in general terms).

• If a baby is born before 23 weeks gestation, it will not be viable. It won’t be because your lungs can’t yet carry out the necessary gas exchange. It will therefore be from week 25 when most fetuses begin to carry out this process.

Therefore, and this data is important, it will be from week 25 when a fetus has a greater chance of succeeding. That is to say, one week after that limit included in the gestational gray area.

From week 30 on, the survival of a baby without sequelae is more possible.

Other organs affected by the prematurity of the fetus

We already know that the lungs are a fundamental part for the baby to survive. Likewise, organs such as the eyes, ears or the nervous system itself are also greatly affected by prematurity of birth.

Hence, in intensive care units, professionals take care of the condition and protection of these organs so that there are no sequelae, so that the child grows normally.

Ethical issues regarding the gestational gray zone

Neonatologists have a very specific consensus: a baby born at 22 weeks should not be resuscitated. It may sound tough, no question, but these are kids who don’t have a chance to get ahead.

In addition, another factor that must be taken into account is the ethical aspect. Many of these children born in the gestational gray zone are subjected to sometimes unnecessary suffering because they die within a few days. Neurological sequelae can be very serious and it is also common to have to undergo several resuscitations since their hearts are very weak.

Therefore, the doctors are obliged to give all the information to the parents about what can happen. A 24-week-old premature baby is not the same as a 30-week preterm baby. It is a very difficult trance for a family that dreamed, like any other, of enjoying a healthy child that comes into the world full-term.

Miracles do happen there is no doubt, but the rates are low. However, and this must be taken into account, Advances continue to be made and there are babies born in the gestational gray zone who are currently leading normal lives. 

We can never lose hope, and medical help is as necessary as the constant closeness of those parents who, day after day, give their affection to premature babies through their incubators and when they can feel them on their breasts.