In the past 10 years, survival rates for premature babies have doubled. In 2008, a baby born at 23 weeks – four months early – would have just a two in 10 chance of surviving. That figure is now four in 10.
This is wonderful news for prospective parents going through a distressing, and frequently tragic, event. Being born at this stage is termed ‘extremely premature’ – and just a few weeks can have a huge impact on survival rates.
At 22 weeks, 30% of children will survive, while at 26 weeks that rises to 80%. Similarly, at 22 weeks a third of the babies that survive will do so with ‘severe impairments’, while at 26 weeks that figure is 10%.
These improvements and advances in treatments for extremely premature babies have prompted new guidance allowing doctors to try to save babies born as early as 22 weeks.
Doctors are being advised by the British Association of Perinatal Medicine (BAPM) to assess each case individually to determine – based on factors including perceived likelihood of survival and predicted quality of life – whether to opt for palliative care or active, potentially invasive treatment in a bid to prolong the baby’s life.
Previously, extremely premature infants born at 22 weeks were not generally attempted to be resuscitated. Babies born before this generally don’t have the ability to get oxygen into their blood due to their lungs not having developed, so don’t tend to survive.
Dominic Wilkinson, professor of medical ethics at the University of Oxford, said: “What we encourage is the idea that decisions have to be made on a case-by-case basis. What we have to acknowledge is that it is appropriate to attempt intensive care for some babies born this early, those who have favourable risk factors where parents have been counselled and wish this to be tried.
“Other babies at 22 weeks with unfavourable risk factors may be at extremely high risk of dying or of suffering very severe complications and, in that situation, the framework recommends that palliative care would be the normal approach.”
Under these new guidelines, babies with less than a 10% chance of survival (or survival without severe impairments) would be given palliative care, while those deemed to have more than a 50% chance of survival would receive treatment. For infants in neither of these categories, it would be a case-by-case decision based on doctors’ judgements and parents’ wishes.
A doubling of survival rates in a decade is great news, but there are limits on how much higher survival rates for extremely premature babies are likely to get, as being born at that early stage in development reaches what Professor Wilkinson calls “the limits of physiology”.