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Very Small Babies, Very Big Dilemmas

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"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.

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.

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