Mostly that (the good survival rate) is good news. I say "mostly" because babies born at 23 weeks gestation cause ambivalent feelings in those of us who care for premies. Twenty-three weeks is pretty much the lowest gestation at which a baby has a real chance of surviving. Nationwide, the survival rate for them is about 30%. Approximately 50% to 60% of the survivors will have moderate to severe impairments, and some of the remainder will have a mild impairment. Putting those numbers together means that a baby born at 23 weeks has about a 15% chance of surviving with no impairment or a mild impairment, and thus the ambivalence. Should we be resuscitating these babies? Should we do everything we possibly can to make them survive?
We spend lots of time and energy discussing this question. If we have time, we try to discuss this with the parents prior to delivery, but even with the best discussion, it's hard to make the parents really comprehend all the issues involved in the short time we tend to have before delivery. In our hospital almost all of the parents opt for full resuscitation and support.
Personally, I'm pretty comfortable with full resuscitation of these babies, although I know others in the neonatal field disagree. I think it's fair to resuscitate them because at almost any other time in life, except at the very beginning or end of life, we would usually opt to give full support to someone with a 30% chance of survival. I am also influenced by a study done several years ago in Canada. In that study, the investigators compared the feelings of self worth of impaired adolescent survivors of premature birth with those of a control group of normal adolescents who had been born at full term. Interestingly enough, the impaired survivors had higher feelings of self worth than the control group. Granted, there were some survivors so impaired they could not be tested, but still the study sure has to make us wonder: who are we to judge the worth of a child with handicaps?
This post only scratches the surface of this huge neonatal issue; I suspect we'll return to it in some future posts.
P.S. The latest edition of Grand Rounds is up at Emergiblog.