The survival rate of babies born as prematurely as 22 weeks depends greatly on whether they receive aggressive treatment, rather than palliative care, says a new study which will have implications on how hospitals treat preemies, as well as on the larger debate over abortion,
reports The New York Times.
Published Thursday in the New England Journal of Medicine (NEJM), the study examined nearly 5,000 babies born before 27 weeks at 24 hospitals across the U.S. during April 2006 and March 2011 and then followed their progress to 18-22 months of age.
Authors report that hospital rates of active treatment largely accounted for variations in outcome for the children born at 22 or 23 weeks gestation.
Researchers examined the difference in survival rates between those who were given comfort or palliative care versus active treatment, which included breathing machines, feeding tubes or heart resuscitation. Active treatment was given to 22 percent of babies born at 22 weeks, 72 percent of those at 23 weeks and to a majority of the babies after that.
Of 755 babies, 542 of the babies born at 23 weeks received active treatment and about a third of those survived, and about half of the survivors had no significant problems. Of those who received active treatment, more than 15 percent survived without severe neurological impairment, such as cerebral palsy, and 9 percent were able to live without "severe or moderate neurological impairment,"
reports The Wall Street Journal.
"A large proportion of the variation [in outcome], especially at 22, 23 and 24 weeks, can be explained by differences in whether treatment was initiated," Matthew Rysavy, the first author on the paper and a medical student at the University of Iowa, told The Wall Street Journal.
Approximately 12,000 babies each year in the United States are born between 22 and 25 weeks' gestation. A full-term pregnancy is usually 40 weeks. The Supreme Court has ruled that states are prohibited from banning abortion until a fetus is viable outside of the womb, which is generally accepted by doctors to be at 24 weeks, according to The New York Times.
The study did not look at the role parents played in deciding whether to seek aggressive treatment.
"In an area with many philosophical issues, it is not possible to have a blanket policy on initiation of treatment. Families need to be a part of that discussion as does society," Ian R. Holzman, chief of the division of newborn medicine at New York City's Icahn School of Medicine at Mount Sinai,
told the site MedPage Today.
"Clearly there is little consensus about the appropriate policy for treating infants born at low gestational ages, and yet hospital practices regarding the initiation of active intervention have a dramatic influence on rates of survival and survival without impairment," Neil Marlow, a doctor at University College London,
wrote in an editorial published in the NEJM.
"We just seem to be resuscitating more and more tinier babies, and there are consequences," Jonathan Muraskas, a neonatologist at Loyola University Medical Center in Illinois,
told the Associated Press.
Although the survival rates of premature babies is increasing, the rates of these medical problems, such as cerebral palsy, have not changed.
"How low do we go and what are the implications?" Muraskas asks.