Very Small Babies, Very Big Dilemmas
Aug. 9, 2000 -- In 1963, President John F. Kennedy and his family mourned the untimely passing of their infant son, Patrick. Born nearly six weeks premature, he survived only two days before succumbing to a respiratory infection. If a baby is born today under the same circumstances, he or she has an excellent chance for a normal life. Modern medicine has made breathtaking advances in the survival of premature infants, and many born prematurely have improved chances of surviving and growing up to be normal, healthy children.
However, the picture is much more dismal when it comes to infants born at between 20 and 25 weeks of gestation. These are among babies considered extremely premature. A full-term pregnancy is 38 to 42 weeks of gestation; this is based on the 40 weeks between a woman's last menstrual period and her due date.
These extremely preterm babies are so early that they are often born with their eyes fused shut, their skin almost transparent, and their weight under 1.5 pounds. Most are so frail that they have difficulty just surviving labor and delivery. Often, their arms can fit through their father's wedding band.
More than three-quarters of these extremely premature babies will be stillborn or die before they ever get to the neonatal intensive care unit, and an additional 12% die before being discharged from the hospital. Of the 8% who survive long enough to leave the hospital, up to 1% will die before the age of two and a half. The small number who survive face a high risk of having some type of disability.
In a new study appearing in the current issue of The New England Journal of Medicine, nearly half of such extremely premature babies ended up with a disability. Of this group, half had a disability that was considered severe. However, the other half of those surviving to two and a half years of age had no disability.
Some of the disabilities the researchers found included:
- Problems with neuromotor skills, such as the ability to walk
- Cerebral palsy, a serious condition that affects multiple parts of the nervous system and the ability to move and speak
- Problems communicating; several were unable to speak at all
- Hearing loss
"The take-home message from this study," says Michael Speer, MD, "is that if you're going to have a baby at 24 or 25 weeks' gestation, the risks of a significant handicap are definitely there." Speer, who was not involved in the study, is a professor of pediatrics at Baylor College of Medicine in Houston.
Led by Nicholas S. Wood, MB, ChB, of the University of Nottingham in England, the research team examined the records of all babies born between 20 and 25 completed weeks of gestation in the U.K. and Ireland during a nine-month period in 1995. Of those who survived, about 280 met the criteria for the study, and the children were assessed to see how well they were developing. This was done when the children were at a corrected age of two and a half years. The corrected age is the age the child would be if delivered on his or her due date.