Youngest Preterm Babies Get More Care, Not Likelier to Live
About 69 percent of the infants died after being born at 22 weeks to 24 weeks of a mothers pregnancy during the period 2001 to 2003, compared with 72 percent who died from 1993 to 1995, research in the October issue of Archives of Pediatrics and Adolescent Medicine showed. More than twice as many babies from 2001 to 2003 received interventions such as specialized ventilation than those in the early 1990s, the study found.
Medical treatment for preterm babies in the U.S. costs $26 billion each year, according to the March of Dimes Foundation. Even with a greater ability to provide treatment, doctors may have hit a biological limit for survival, said Pamela Donohue, lead study author and director of clinical research in neonatology at Johns Hopkins University School of Medicine.
“The take-home message is that we shouldnt preclude treatment for babies at this gestational age, but we should be very clear in discussing with families the low levels of survivability and the high rates of morbidities,” Alan Fleischman, medical director of the March of Dimes, said today in an e-mail.
The study, by researchers from Johns Hopkins Hospital in Baltimore, showed increased care prolonged the babies lives to an average seven days in the 2001-2003 period compared with two days in the earlier time period.
Increased Preterm Births
About 13 percent of births in the U.S., or more than 500,000 a year, are preterm, according to the White Plains, New York-based March of Dimes. The number of U.S. premature births has increased 36 percent in the past 25 years, the foundation said in a report released yesterday. Preterm labor occurs from 20 to 37 weeks of pregnancy, while births from 38 to 42 weeks are considered full term.
About 6 percent of preterm babies are born at fewer than 28 weeks of pregnancy, the March of Dimes said. Most of these babies are born weighing less than 2 pounds, 3 ounces (992 grams).
Babies born that early require oxygen and mechanical assistance to help them breathe. They must be fed through a vein and often cant cry. They have a higher risk of complications similar to other preterm babies, including respiratory distress, bleeding in the brain, apnea in which they stop breathing and heart and intestinal problems, according to the National Institutes of Health.
Enormous Toll
If preterm babies survive, they face serious health problems including cerebral palsy, blindness, hearing loss and learning disabilities.
“Premature births are an enormous global problem that is exacting a huge toll emotionally, physically and financially on families, medical systems and economies,” Jennifer Howse, president of the March of Dimes, said yesterday in a statement.
Research Findings
The researchers found that 72 babies died from 2001 to 2003, while 54 died from 1993 to 1995. All the babies born at 22 weeks of pregnancy died in both time periods, while 85 percent of those born at 23 weeks and 46 percent of those at 24 weeks died among the 2001 to 2003 births. In the 1993 to 1995 group, 73 percent of those born at 23 weeks and 46 percent of those born at 24 weeks died, the study showed.
Pregnant women in the later period were more likely to be monitored by sonogram, receive antibiotics and be given steroids in the hospital, according to the study.
Of the 2001-2003 births, 86 percent of the babies received high-frequency ventilation in the neonatal intensive care unit compared with 26 percent in the 1990s. Twenty-nine percent of the preterm infants received chest tubes in the later period versus 11 percent in the earlier time period; 55 percent were given hydrocortisone for blood pressure support compared with 6 percent and 100 percent received umbilical catheters compared with 86 percent in the earlier time period, the study found.
“The chance of survival at 22 weeks is probably 1 percent and the chance of having a normal outcome is around that as well,” said Donohue, in a telephone interview.
“The question for me becomes not so much cost, although that is something we need to talk about, its pain and suffering. Part of this becomes how you view life and is all life the goal or do you consider quality of life in your decision making. Those are decisions we need to ask parents to consider and we as health care providers need to think about that as well.”