Born too soon - what is the outlook for severely premature babies?

 
baby in intensive care Kai was born at 24 weeks

Fragile, tiny and battling for life. That is the fate of Kai and other babies born too soon. I met him with his parents Becky and Robert at Homerton hospital in east London.

"When I found out Becky had gone into labour I thought that's impossible" Robert told me. "It's still shocking to see how small he is but Kai is putting on weight and seems to be getting stronger every day."

Kai was born at 25 weeks and five days gestation and weighed 690g (one and a half pounds). He has put on 80g (three ounces) in the two weeks since his birth so was born even smaller than in the image above.

New research published in the British Medical Journal shows that there have been improvements in the survival rate of severely premature babies. My colleague James Gallagher has written about the research here.

But the toll on families, the NHS and the children themselves is immense with the outcomes worsening the earlier the baby is born. In 2006, of 442 live births at 24 weeks, 178 survived. Of 339 live births at 23 weeks, just 66 survived.

Doctors have to decide - in consultation with the parents - whether to intervene and offer life support to such seriously ill babies.

As you can see from the graph there is a huge difference in the odds of survival or disability between being born after 22 and 25 weeks gestation.

Graph Changes in outcome of babies born severely premature in 1995 and 2006 in England (BMJ)

Report author Kate Costeloe, Prof of paediatrics at Queen Mary, University of London, said: "Many of the babies have such a poor prognosis it would not be in their best interests to put them into intensive care. Their lungs and brain and skin are immature, they are very vulnerable to infection and we can't get (intravenous) lines in to deliver the medicine they need."

There is no hard and fast cut-off for hospitals as to when they will intervene and offer what's known as 'active stabilisation'

Neil Marlow, Prof of neonatal medicine at UCL Institute for Women's Health, said: "At 24 weeks we have the presumption that we will do something; at 23 weeks much less so".

Prof Marlow said specialists were split across Europe as to whether they provided active care at 23 weeks. France and the Netherlands do not whereas Sweden does.

Sometimes hospitals take the decision to stop treatment. Prof Marlow said: "About 70% of deaths are elective withdrawals of care. We are trying not to cause harm."

But, improved care means many more premature babies are surviving - especially those born after 25 weeks. There has also been a dramatic 44% increase in admissions to neonatal intensive care, which remains largely unexplained.

Neonatal intensive care costs £1,500 a day, and the average stay is around three months, so the burden on the NHS is huge. Then there are the long-term costs of providing specialist treatment to children. One in five will have a life-long serious disability.

BLISS, the charity for premature babies and their families welcomed the research. Its chief executive Andy Cole said it "emphasises the need for a range of community services to be available to support all premature babies after discharge and the increasing demand for follow up care by paediatricians and other specialists which is not yet being fully met.

 
Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • Comment number 52.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    +2

    Comment number 51.

    I was born 43 years ago at 27 weeks. I went to mainstream schools, had normal jobs and a normal life and now have 3 beautiful children of my own, all are fine. My Brother, was born 10 years later at the same hospital. He has mild cerebal palsy, epilepsy, and will never be able to live completely on his own, let alone get a job or have children. No one knows the outcome of being born early.

  • rate this
    +2

    Comment number 50.

    My son was born at 27 weeks weighing 2 pounds.He was also breach delivery and only lived because my wife is a nurse and was at work at the time. After 10 weeks in the special care baby unit in Oxford,he came home.He is now a gorgeous 5 year old and the biggest in his class.A very big thank you to all the magnificent staff that cared for him from the moment of his traumatic and unexpected arrival

  • rate this
    +1

    Comment number 49.

    9.Little_Old_Me
    Congratulations to our daughter in law Julia - a bonny baby girl born last night & I just had to tell the world that grand child number 11 is gorgeous!
    **
    Congrats to you,too!My 9th grandbaby's due next June.Did a commenter ask if 11 grandchildren were a bit too much? I see each one as a unique blessing, myself.And one granddaughter was born premature-doing well now.

  • rate this
    +2

    Comment number 48.

    @44 - Amen, brother!
    @43 - I am not saying NHS should let people die. They saved my wife and son's life. No bigger fan than yours truly!
    I'm saying think very carefully before adding to the numbers of people likely to need high levels of care. True the stats say instances of disability in prem babies are coming down. Excellent. But it's still more likely the other way.

    Not a monster : (

  • rate this
    +3

    Comment number 47.

    I agree with Peter_Sym. and I have a question. Lung cancer has one of the worst survival rates of any cancer, and a high proportion is self inflicted via smoking. Treatment is painful and very expensive and doesnt affect those with 80 years of life ahead of them. Should we stop treating lung cancer? Should we attach restrictions to cancer research donations saing "only if its worth it"

  • rate this
    +2

    Comment number 46.

    #43 No. I don't think it is taken out of context. You seem to saying the NHS should let the disabled die because treating them is expensive. So is treating any disease. Intensive care beds cost £10,000 per 24hr stay. THAT is expensive.

  • rate this
    +2

    Comment number 45.

    As the father of a prem baby I would like to answer Charley Farley's question.

    Premature birth happens naturally, there aren't any doctors that make it happen unless there is a high risk to the mother or baby. When the baby is in neonatal care they are not under one doctor, they are under a specialized team of doctors and nurses, so in effect one doctor can't achieve fame in the suggested way.

  • rate this
    +2

    Comment number 44.

    39.InterestedBystander

    Look at the bigger picture...
    Comments 34, 28 & 23 show that these babies were given the chance of survival and thrived. No one is looking to "cause suffering" it happens sometimes, sure, but as technology improves, less babies will end up disabled (see comment 40). Everyone deserves the chance - we'd have plenty money to pay for care if it wasn't wasted on war...

  • rate this
    +2

    Comment number 43.

    @42 Peter_Sym

    Again a comment taken out of context. The health system drain is absolutely a big factor, especially if the brunt will be borne by NHS, i.e. taxpayers. For those with private medical, knock yourselves out, but (as others have commented on this thread) the economic aspect, though not comfortable, is a very necessary part of this equation for most of us.

  • rate this
    +2

    Comment number 42.

    #39 The doc has the right to refuse treatment if its utterly futile. The parents have the right to decide if their child is treated or not. If you look at the graph nearly 50% of babies born at 25 weeks suffer no disability at all. 50/50 is pretty good odds.

    'huge drain on health system' is a disturbing argument. I might decide my cat's vets bills are too steep, not my kids!

  • rate this
    0

    Comment number 41.

    10.Anna - "Congratulations to Julia, hope mum and new baby doing well - but 11 grandchildren? Isn't it a bit too much?..."


    It is when it comes to buying Xmas presents....especially as half of them live abroad & postage must be paid too.....!

  • rate this
    +2

    Comment number 40.

    There are some very promising signs coming from the trial which use "cooling" to prevent brain damage and disability in premature babies, hopefully the prognosis for these poor little mites will continue to improve.

  • rate this
    +1

    Comment number 39.

    @36 - I agree you are probably right about what people in that situation will choose. However, we're not talking about that situation. We are talking about very prem babies - the odds are not good. Ongoing suffering for the child and family, plus huge drain on health system is most likely.

    Not sure why what the doc would choose is a factor, though. They won't have to live with that disability.

  • rate this
    +1

    Comment number 38.

    My Cousin was born 28 years ago, at 24 weeks, weighing in at just 1lb 6oz! back then its was something of a miracle and she even ended up in the newspapers as Britains smallest surviving baby! It seems a shame that, in this day and age, it can depend on the country you live in, or the doctor you see, as to whether or not your baby is given a chance! All babies deserve a chance, dont they?

  • rate this
    +1

    Comment number 37.

    As a father of 2 there is nothing I wouldn't do for my kids so I understand the sentiments of many of the posters here.

    It is good to see the increased number of babies born with no disability from '95 to '06 though personally I think there is a need for more education on likely outcomes following intervention for the extremely premature births - especially pre-23wks and earlier.

  • rate this
    +1

    Comment number 36.

    #33 If you had lung cancer odds are the surgeon will remove the lung and you'll be whacked full of chemo and radiotherapy (both of which can have horrendous side effects) . When the choice is disability or death most docs (and virtually all patients) will accept disability.

  • rate this
    +5

    Comment number 35.

    Peter_Sym @ 32

    Refer to my earlier response @ 24.

    And please don't make immature assumptions regarding my opinions by leading with "So, basically....."

    Is that how you conduct your research?

  • rate this
    +1

    Comment number 34.

    My daughter was born ar 24 + 2 days, and I can have nothin but admiration for all of the doctors and nurses who looked after her in NICU. We were told at the time that there was a likelihood of disbilities and tough times ahead. We now have a daughter who not only survived but also prospered as well. I have just come back from her nativity play, she is a wonderful bright and active girl of 5.

  • rate this
    +3

    Comment number 33.

    Lots of comments slating @12 CharleyFarley on this thread. Mostly out of context. Don't want to put words in mouths, but I think there are degrees of this.

    Developing and using medicines and cures for cancer are good, even if they 'fight nature'. Be reasonable. Purpose is to alleviate suffering.

    But doing stuff which causes suffering (i.e. likely long-term disability) isn't good. I reckon.

 

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