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Preemies -- When should technology intervene to sustain life?
Nearly 425,000 babies are born prematurely each year in the United States, including an increasing number of multiples caused by fertility treatments. Nearly 55,000 of these babies -- called “preemies” -- are born with extremely low birth weights (less than 3 pounds, 4 ounces), according to the National Center for Health Statistics (NCHS).
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The long term prognosis for these babies is uncertain. According to an article in Pediatrics, 25 percent of these babies do not survive the first year of life. Of the ones that survive, many have moderate to severe disabilities. |
Nearly 425,000 babies are born prematurely each year in the United States, including an increasing number of multiples caused by fertility treatments. |
Now, two states are addressing the issue of when to pull out all the stops for these babies’ care and when it’s best to let nature take its course. Wisconsin’s Guidelines for the Responsible Use of Intensive Care Project issued a report in November after studying the issue for three years. The section on preemies articulates the need to establish a protocol for dealing with complex medical decisions while fully involving the parents of the baby. Colorado, the state with the highest rate of low birth weight babies, has taken the issue a step further. It’s become the first state where a community has attempted to establish a guide for making choices when a preemie’s life is in jeopardy.
The Colorado guidelines, spearheaded by the Colorado Collective for Medical Decisions, suggest that in babies born at 26 weeks and older, medical intervention is in their best interest. However, in babies less than 24 weeks, they state that “a decision not to resuscitate is medically and ethically appropriate and in the best interests of the child.”
One of the biggest controversies for medical ethicists is the quality of life issue. Many believe that a preemie born at 24 weeks that is “saved” by technology faces a tough life ahead, with costly and debilitating medical procedures at every turn. Others feel that all babies should be given a chance at life, since outcomes are impossible to predict.
If you are the parent of a very early, extremely low birth weight preemie, you may be faced with a difficult decision in terms of resuscitation. If possible, talk with other parents of preemies. They may be your best source of information for what life is like with a premature infant. Discuss the possible outcomes with your doctor and a neonatologist. Consider the risks and benefits of what technology can offer you and your child. Once you have covered all of these bases, try to make a decision that you can live with for the rest of your life.
| Birth Weight | Mortality Rate (per 1,000 live births) |
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8 lb., 12 oz. - 9 lb., 13 oz. | 1.7 |
| 7 lb., 10 oz. - 8 lb., 12 oz. | 1.9 |
| 6 lb., 9 oz. - 7 lb., 10 oz. | 2.7 |
| 5 lb., 7 oz. - 6 lb., 9 oz. | 5.1 |
| 4 lb., 6 oz. - 5 lb., 7 oz. | 13.4 |
| 3 lb., 4 oz. - 4 lb., 6 oz. | 30.3 |
| 2 lb., 11 oz. - 3 lb., 4 oz. | 52.7 |
| 2 lb., 3 oz. - 2 lb., 11 oz. | 77.2 |
| 1 lb., 10 oz. - 2 lb., 3 oz. | 167.2 |
| 1 lb., 1 oz. - 1 lb., 10 oz. | 512.4 |
| Less than 1 lb., 1 oz. | 889 |
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