Tuesday, July 26, 2011

Should we try to save extremely preterm babies?

Neonatologist John Wyatt gives his arguments, as presented in Christian Medical Comment:

First he argues that gestational age cannot be measured with accuracy other than in IVF pregnancies when fertilisation occurs in the laboratory. In addition other clinical variables besides gestational age are crucially important in determining the likelihood of survival and the risks of disability. These include birth weight (the higher the better), gender (girls do better than boys), multiple pregnancies (singletons do better than twins and triplets), and whether antenatal steroids were given prior to delivery (antenatal steroids improve survival and reduce brain injury). It is a basic principle of medicine that we should individualise treatment to the specific patient we are caring for;.so making blanket resuscitation rules based on gestational age alone is scientifically and medically indefensible.

Second, Outcome figures vary between different neonatal units. A statistic repeated in the programme was that nine out of 100 babies born at 23 weeks will survive and
only one will reach adulthood without disability. It is not at all clear where this figure came from but it is highly contestable. A study based at University College London Hospitals, found an overall survival rate of 46% as a proportion of all live births at 23 weeks for the period 1996 to 2000 3 and other published studies have reported survival rates of 66% from USA4 and 41% in Australia.

Third, most extremely preterm survivors rate their own quality of life highly. The BBC programme gave the strong implication that the majority of extremely preterm survivors were significantly handicapped. It is in fact very unusual for ex-preterm survivors to be so severely disabled that they are unable to interact with others and engage actively in life. Studies of health related quality of life in adolescents and adults have shown that ex-preterm survivors give similar self-ratings to those who were born at term without medical problems.