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    Very Small Babies, Very Big Dilemmas


    Many people don't equate the philosophy of saving lives with the high cost, says Speer. "There's a legal precedence to protect these babies, and many of us hold the philosophical thought that everyone's life is sacred and that one should do everything in one's power to maintain that life, but they don't want to pay for it. To me that's very illogical."

    At the present time, what is important for parents to understand is that there is no way of knowing which babies will do well -- and which will not. Right now, says Cole, well-informed family members who are involved with the baby's care, as well as the baby's response to treatment, are the best guideposts for making decisions about whether or not therapy is fruitless. "No parent or physician wants to give therapies to babies which are invasive, painful, and futile," he says. "But it's sometimes difficult to know, until you give the therapy, whether the baby will respond."

    "The prevention or amelioration of disability in survivors of extreme prematurity," write the researchers, "remains one of the most important challenges in medicine."

    However, both Cole and Speer believe that prevention of a premature birth in the first place is the most important goal, and far superior to dealing with the premature baby once it's born.

    For pregnant women, that means:

    • Alerting the doctor to signs of premature labor, such as increased vaginal discharge, bleeding, cramping, backache, pain in the thigh, and tenderness of the uterus
    • Seeking prenatal care early -- and keeping appointments
    • Informing all health care providers about high-risk conditions, including previous preterm labor and vaginal and cervical infections

    The challenge for physicians, says Cole, is clear -- not to worry so much about cost issues, but instead, to try to better understand the reasons for premature birth and then prevent it.

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