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Very Small Babies, Very Big Dilemmas

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Speer points out that some disabilities may lessen over time. "Some mild disability at age 2 may resolve at age 5, but a severe disability is not going to be resolved."

Learning disabilities are quite common in premature children, he adds, and some small studies have indicated that the very small premature babies may have even more learning disabilities.

The ethics of whether or not to save such a small baby, coupled with the high costs for immediate and long-term care, are two issues which remain a source of debate.

In an editorial of the study, L. Sessions Cole, MD, writes that the average cost for an infant born at less than 26 weeks' gestation who survives and who stays over four months in an intensive care unit is $250,000. He agrees that it is a lot of money to spend on a single hospitalization, but argues that cost issues need to be looked at in the full context of health care.

"The entire health care budget in the United States for children is only a small fraction of what it is for older people," he says. "I'm not denying that it's expensive, but when you look at how money is spent in other places, it's not unreasonable." Cole is a professor of pediatrics and division director of newborn medicine at Washington University School of Medicine in St. Louis.

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

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