By Dave Andrusko
Kudos to Liz Essley Whyte for a top-drawer story about preemies that is both encouraging and heartbreaking.
The headline in the Wall Street Journal is revealing: “Doctors Can Now Save Very Premature Babies. Most Hospitals Don’t Try. Babies born 22 weeks into pregnancy have increasingly better odds of survival—but parents often don’t know what’s possible.”.
The story is two-thirds encouragement, one third about how most hospitals are not equipped to handle the tiniest preemies. Speaking of encouragement, Whyte writes
Medical advances over the past several decades have given hospitals the ability to save younger and younger premature newborns. Yet most hospitals don’t try—and parents often aren’t aware of what’s possible or that other hospitals, even just a few miles away, might offer their newborns a fighting chance.
Doctors are now capable of saving the lives of babies born at 22 weeks and, in rare cases, a week earlier, with improved techniques to help tiny lungs develop and protect fragile skin and organs. Hospitals with extensive experience resuscitating extremely premature babies report survival rates as high as 67% for babies born at 22 weeks.
On the other end of the spectrum some U.S. hospitals
have chosen not to offer the care, saying it is likely to fail, is expensive—typically more than $100,000 a child, and sometimes much more—and subjects tiny, fragile infants to needless pain and the risk of long-term disabilities.
Instead, they often provide comfort care: wrapping the newborn in a blanket, placing it on the mother’s chest and sometimes giving medicines to ease the child’s final moments.
Whyte puts what’s at stake in vivid terms:
“The difference can be a matter of life or death for the roughly 8,000 infants born between 22 and 24 weeks gestation in the U.S. each year.”
One example—The University of Iowa Hospital—“offers parents the option of either active treatment to try to save the baby or comfort care to those born at 22 weeks. The vast majority choose active treatment,” Whyte writes. Success rate? “Out of those it tries to keep alive, 62% end up going home. The hospital has even graduated several 21-weekers from its NICU.”
How does the US match up against other countries?
In Japan and Sweden, treating babies born at 22 weeks is more common, and in some hospitals, every single 22-weeker is treated. Some 63% of babies born at 22 weeks and treated in Japan survived long enough to be discharged from the NICU and go home, according to a study published this year in the BMJ, a U.K. medical journal. In Sweden, the rate was 58% survival until the first birthday, according to a paper published in the journal JAMA in 2019.
Whyte writes about the wide range of experiences that mothers of preemies undergo. The first is Fatima Goines, who was 22 weeks into her pregnancy when her water broke.
The first hospital “said they couldn’t save such a premature baby and that no hospital could. They told her that once the baby girl was born, Goines could hold her until the infant died.”
But Goines was made of sterner stuff. She checked herself out and went to a birthing center connected to a different hospital only 7 miles away.
“After Goines gave birth, doctors there immediately intubated the baby to help her breathe and placed her in an incubator,” according to Whyte.
Goines’s daughter, Me’Lonii, “is now a healthy 4-year-old, and has surpassed all the developmental milestones for her age,” Whyte writes. “’She’s doing wonderfully well,’ said Dr. Thomas George, who directs the Children’s Minnesota neonatal intensive care unit.”
Whyte does not shy away from the truth that extremely premature babies who survive can have significant problems. But…
Supporters of caring for extremely premature babies say that while there are risks, results are now so good at some hospitals that doctors can no longer say treatment is futile simply because a mother is only 22 weeks along. They criticize drawing hard lines on providing treatment based on a baby’s gestational age, because it is inexact and notoriously unreliable. A child with a gestational age of 22 weeks might really be a week older.
It’s hard for parents to know which hospitals offer treatment to 22- or 23-week babies. The U.S. doesn’t have a comprehensive public list. Even for medical professionals, there’s no database that says what certain hospitals offer.
One mother put it this way: “Parents should know extremely premature babies can survive and certain hospitals will pursue lifesaving treatment, Goines said.”
“At least give the parents that fighting chance,” she said.