Medical debate rages over when premature babies should be saved

Pregnancy in the 26th week.
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Almost three years ago, experts on medical ethics provoked public outrage when they published guidelines advising doctors not to resuscitate premature babies born before 22 weeks in the womb.

The Nuffield Council on Bioethics had stepped gingerly into an area which was already the topic of fierce debate.

During a two-year inquiry, its working party took evidence not just from doctors and nurses in neonatal medicine, but from professors of philosophy, and religious leaders.

But however carefully the debate was handled, the categorical nature of its final recommendations had an incendendiary effect.

The guidelines were clear: no baby below 22 weeks gestation should be resuscitated.

If a child was born between 22 and 23 weeks into pregnancy it should not be standard practice to offer medical intervention, which should only be given if parents requested it, and following a through discussion about the likely outcomes, the document said.

The debate became yet more heated some months later, when it emerged that weeks before the guidance was published, a new world record had been set, with the birth of the youngest ever premature baby to survive.

Amillia Taylor was born in Florida on 24 October 2006, just 21 weeks and 6 days after gestation. She would not have been given intensive care at all, if doctors, who later described her as “a miracle baby”, had not wrongly assumed that she was at least a week older.

Instantly, the baby became the poster girl for a quite different debate raging in this country, as Parliament prepared to debate whether the abortion limit should be reduced.

In 1990, the limit had been cut from 28 weeks to 24 weeks, in line with scientific evidence that foetuses could exist outside the womb at a younger age.

If any babies were viable at 22 weeks, the abortion limit must drop in line with it, argued many religious leaders and Tories and some medics. It was an argument that was lost in Parliament.

However, many paediatricians believe that an intense focus on miracle babies who “defy the odds” has distorted public opinion about what those statistics really are.

As a result, parents facing the trauma of premature birth are holding on to false expectations, some fear.

The latest major study on survival of premature babies shows that at 23 weeks, just 16 per cent will survive – a statistic which has barely changed in a decade.

Given such poor odds, the use of procedures like ventilation on babies of even lower gestation, who have poorly developed lungs and weak major organs, can amount to cruel “experimentation” paediatricians and ethicists say.

They also point out that of all babies born before 26 weeks, 40 per cent will have significant disabilities, such as cerebral palsy – a percentage which increases with prematurity.

But for many parents desperate to give their child any hope of survival, knowledge of the grim lottery they face makes no difference.

The grief and anger of bereaved mothers like Sarah Capewell underlines one of the few points where most agree: when it comes to matters of life and death, sensitive and honest conversations are essential, however difficult.

Source: Telegraph
By Laura Donnelly, Health Correspondent
Published:  06 Sep 2009

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2 Comments (+add yours?)

  1. BloggerDude
    Oct 09, 2009 @ 05:39:50

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    Reply

  2. prem2pram
    Oct 17, 2009 @ 19:46:31

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