Page 13 - 104-105山醫學倫理暨人文醫學圖書心得精選集

stage of development when a baby would have more than 50%
chance of survival. Medical studies also have shown that the
risk of cerebral palsy, mental retardation, hearing and visual
impairment is about 62% at 23 weeks of gestation, 38% at 24
weeks of gestation and 31% at 25 weeks of gestation.

In light of such data, the American Academy of Pediatrics
(AAP) recommends that intensive care should not be given at a
gestational age of less than 23 weeks, but should always be
initiated if the gestational age is older than 25 weeks. However,
within the grey zone of 23-25 weeks of gestational age, it is
difficult to predict which infants would benefit from aggressive
resuscitation. In these situations the American Academy of
Pediatrics currently advocates the “start and reevaluate”
approach, meaning that resuscitation should be started initially,
but may be stopped when the infant does not respond on
reevaluation.

As mentioned before, this book presents a premature baby
who was born emergently at 24 weeks of gestational age. The
pediatrician in charge initiated resuscitation, but stopped after
10 minutes when he felt the resuscitation was unsuccessful.
Because the patient’s gestational age fell within the “grey
zone” of viability (23-25 weeks of gestation), the pediatrician
started resuscitation immediately and stopped after
reevaluation. His practice is actually within current pediatric

104-105 年度〃醫學倫理〃人文醫學〃心得 5