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Premature Babies - a Success Story
One of the success stories in modern medicine has been the increasing survival of very premature babies. Over the past decade survival has improved dramatically for babies born at 26 weeks of gestation and above so that now over 80% survive. Normal pregnancy lasts 40 weeks, but babies may survive from as early as 22 weeks, although at these extremely low gestations (22-24 weeks) most babies die. As with all advances in care, there is a cost in terms of disability suffered by some children among those that survive.
For parents faced with the prospect of delivering a child before 26 weeks gestation, there has been little information available which describes outcomes from large numbers of children. Thus, it has been difficult to give parents accurate information regarding the chances of survival and the possibility of disability or long term problems amongst survivors.
Why do we need to study extreme prematurity?
We know that disability increases as gestation at birth gets shorter. In view of the rarity of birth and survival at such a low gestation, previous studies have been regionally based and the data collected over a long period which may not reflect up to date outcomes.Therefore, these studies showed a wide variation in the numbers that survived and the rates of disability.
The decision to admit a preterm baby for intensive care is made by doctors after discussion with the parents but until 2000 there were no national guidelines ( http://www.bapm-london.org/) or data on which to build them. Some of these guidelines have been based on the results of the EPICure studies.
The attitude of individual neonatologists and obstetricians may influence the management of different babies. The information on which that management is based needs to be impartial as possible as, on the basis of such decisions, treatments that are thought to be effective may be withheld. Clinicians, healthcare planners and parents need population based data relevant to modern intensive care practices for informed decision making.