Premature babies. How far should doctors go?

Advances in technology during the last 45 years have allowed neonatologists to provide premature infants, even of 23-24 weeks, mechanical ventilation, intravenous nutrition and supplies of an artificial protein called surfactant, involved in the oxygen capture inside the lungs but produced only at 30-31 weeks.

Such invasive treatments have reduced mortality for all major born-related disease and complications. All that, however, has come to a price.

As reported by the University of Washington School of Medicine, long-term follow up studies of very premature babies demonstrate that while many of them grow healthy (16%), there are significant numbers of children with mild (39%), moderate (31%) and severe (14%) disability conditions. Major handicaps include movement disorders, mental retardation, blindness and deafness. Less severe ones include lower IQ and learning problems.

And it’s not only a problem of neurological or physical disabilities. Preterm neonatal intensive care causes pain at a time when it is developmentally unexpected. Neonates are in general more sensitive to pain than older infants and adults, and this hypersensitivity is even greater in premature neonates. Scientific evidences suggest that repeated and prolonged pain exposure alters their long-term pain perception, cognitive development and behaviour.

There is a precarious balance between the aim of saving lives and overtreatment, a limit beyond which neonatal technology is of no benefit and much pain. Finding this balance is a challenge faced every day by physician and parents in any neonatal unit of intensive care around the world.

Further readings

(posted by Nicola Quadri)

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Un pensiero su “Premature babies. How far should doctors go?

  1. A new need emerges from this post. When in the first trimester obstetricians talk with pregnant women and their partners about testing for genetic anomalies, they should include discussion of values and attitudes toward life, death and disability, or at least recommend such discussions. Indeed parents are free to consider the withdrawal of life-sustaining treatments in premature babies either a way of stopping suffering or a murder (depending on their own values) but they MUST know in order to make an informed decision. They must know what resuscitating a tiny premature baby means and what continuing life-sustaining treatment means. It is time to engage in more comfortable and conscious talking about end-of-life issues in premature births.
    Veronica Ruberti

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