Neither article looked at things such as school performance, but the commentary relates that even in kids with birthweights less than 1,000 grams who escape major neurodevelopmental disability, more than 50% "struggle in school performance and have difficulty with academic competitiveness."
As you may have noticed from the comments on my "Ignored" post of ex utero, a practicing neonatologist, and Helen Harrison, a mother of a disabled NICU survivor, one can take an optimistic or pessimistic view of outcome statistics. 77% of them don't have major neurodevelopmental impairment? That's good. More than 50% of them have school performance problems (and many have things such as ADHD and emotional problems)? That's bad. Some studies suggest that NICU graduates with neurodevelopmental problems rate themselves as having a good quality of life - that's good. Another study says that more that 40% of premies less than 33 weeks gestation will not be able to live independently as adults - that's bad. Anecdotally, too, we know that some kids with impairments are a huge burden to their parents, while others are the light and joy of their parents' lives. (Some kids are probably both at the same time.)
What do we do with these outcome statistics? Some things we can all agree on: We should use them to give potential NICU parents honest information. We can follow NICU graduates carefully for neurologic problems so interventions can be started as early and optimally as possible. Also, the data show we need to continue to try to improve our care of tiny babies, especially as it relates to optimizing their brain development.
It's when we start to use these statistics to make decisions about resuscitating or not resuscitating very premature babies that things get sticky. Not resuscitating a baby because there is a high chance of death or severe neurodevelopmental impairment, as is the case with 22 to 23 weekers, is one thing (although, technically, in the U.S it's illegal to discriminate against someone on the basis of handicap), but should the fact that they might have school performance problems be used to argue against their resuscitation? Should a child's increased risk of attention deficit disorder play a part in that decision? I'm not sure that I'm ready to slide that far down a slippery slope.