Fetal Awareness

Kurjak, Asım; Kadić, Aida Salihagić; Barišić, Lara Spalldi; Jakovljević, Miro; Stanojević, Milan

doi:10.5005/jp-journals-10009-1700

Cited by 4 publications

(3 citation statements)

References 88 publications

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“…Conscious awareness is categorized, according to a stepwise developmental process beginning with basic awareness of the external environment, followed by awareness of one's body, and finally, higher-order internal awareness of oneself (such as mind-wandering or daydreaming, associated with the Default Mode Network) ( 97 ). The emergence of consciousness occurs along a continuum ( 27 ) and has been likened to a dimmer switch beginning with a minimum basic consciousness, mediated by subcortical structures ( 98 , 99 ) and possibly the subplate ( 4 ), to higher order consciousness associated with cortical processing and decision-making ( Figure 9 ) ( 98 , 100 ). Neuroscientists hold that basic conscious awareness requires the subjective ability to evaluate the environment and form coordinated responses ( 101 ) and may be demonstrated via action planning, learning, and purposeful movement ( 100 ).…”

Section: The Emergence Of Consciousnessmentioning

confidence: 99%

“…The emergence of consciousness occurs along a continuum ( 27 ) and has been likened to a dimmer switch beginning with a minimum basic consciousness, mediated by subcortical structures ( 98 , 99 ) and possibly the subplate ( 4 ), to higher order consciousness associated with cortical processing and decision-making ( Figure 9 ) ( 98 , 100 ). Neuroscientists hold that basic conscious awareness requires the subjective ability to evaluate the environment and form coordinated responses ( 101 ) and may be demonstrated via action planning, learning, and purposeful movement ( 100 ).…”

Section: The Emergence Of Consciousnessmentioning

confidence: 99%

“… The emergence of consciousness. Consciousness has been likened to a dimmer switch beginning with a minimum basic level of consciousness mediated by the brainstem ( 100 ), thalamus ( 99 ), and possibly the cortical subplate ( 4 ) increasing to higher-order consciousness mediated by the cortex ( 100 ). Basic consciousness requires responsiveness to the environment ( 101 ), demonstrated by action planning, purposeful movements, and leaming ( 100 ), while higher-order consciousness involves memory, self-reflection, and imagining the future ( 98 ).…”

Section: The Emergence Of Consciousnessmentioning

confidence: 99%

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The fetal pain paradox

Thill

2023

Front. Pain Res.

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Controversy exists as to when conscious pain perception in the fetus may begin. According to the hypothesis of cortical necessity, thalamocortical connections, which do not form until after 24–28 weeks gestation, are necessary for conscious pain perception. However, anesthesiologists and neonatologists treat age-matched neonates as both conscious and pain-capable due to observable and measurable behavioral, hormonal, and physiologic indicators of pain. In preterm infants, these multimodal indicators of pain are uncontroversial, and their presence, despite occurring prior to functional thalamocortical connections, has guided the use of analgesics in neonatology and fetal surgery for decades. However, some medical groups state that below 24 weeks gestation, there is no pain capacity. Thus, a paradox exists in the disparate acknowledgment of pain capability in overlapping patient populations. Brain networks vary by age. During the first and second trimesters, the cortical subplate, a unique structure that is present only during fetal and early neonatal development, forms the first cortical network. In the third trimester, the cortical plate assumes this function. According to the subplate modulation hypothesis, a network of connections to the subplate and subcortical structures is sufficient to facilitate conscious pain perception in the fetus and the preterm neonate prior to 24 weeks gestation. Therefore, similar to other fetal and neonatal systems that have a transitional phase (i.e., circulatory system), there is now strong evidence for transitional developmental phases of fetal and neonatal pain circuitry.

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Section: The Emergence Of Consciousnessmentioning

confidence: 99%

Section: The Emergence Of Consciousnessmentioning

confidence: 99%

Section: The Emergence Of Consciousnessmentioning

confidence: 99%

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The fetal pain paradox

Thill

2023

Front. Pain Res.

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Fetal Pain in the First Trimester

Thill

2021

Linacre Q

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Fetal pain perception has important implications for fetal surgery, as well as for abortion. Current neuroscientific evidence indicates the possibility of fetal pain perception during the first trimester (<14 weeks gestation). Evidence for this conclusion is based on the following findings: (1) the neural pathways for pain perception via the cortical subplate are present as early as 12 weeks gestation, and via the thalamus as early as 7–8 weeks gestation; (2) the cortex is not necessary for pain to be experienced; (3) consciousness is mediated by subcortical structures, such as the thalamus and brainstem, which begin to develop during the first trimester; (4) the neurochemicals in utero do not cause fetal unconsciousness; and (5) the use of fetal analgesia suppresses the hormonal, physiologic, and behavioral responses to pain, avoiding the potential for both short- and long-term sequelae. As the medical evidence has shifted in acknowledging fetal pain perception prior to viability, there has been a gradual change in the fetal pain debate, from disputing the existence of fetal pain to debating the significance of fetal pain. The presence of fetal pain creates tension in the practice of medicine with respect to beneficence and nonmaleficence.

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