A new study published in The New England Journal of Medicine, entitled “Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants,” has led to revelations about how premature babies born as young as 22 weeks can survive; such findings will impact the abortion debate and hospital treatment policies. The study, funded by the National Institute of Health, involved 5,000 infants born between 22 and 27 weeks, and is one of the largest and most systematic studies performed.
Some background: the Supreme Court has ruled that states must permit abortion if the fetus cannot survive outside of the womb. Since this study has shown that infants may survive at weeks earlier than previously thought, the results fuel pro-life arguments to legally end abortions or restrict them to a more narrow timeframe. About 18,000 babies are born prematurely in the U.S. with around 5,000 born at 22 or 23 weeks.
In the study, 22-week-old infants did not survive without intense medical care. 18 of 78 who did receive intervention survived, with seven developing without impairment. Six of the seven then developed serious problems that included blindness, deafness, or cerebral palsy. As for the babies born at 23 weeks, about 33 percent of them survived, and of the surviving group about 50 percent had significant developmental issues.
One of the hardest decisions parents and medical professionals have to make is what kind of treatment to provide for such fragile babies, and at what age that line is drawn. The lack of a set protocol has led both the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists to recommend making “individualized decisions… based on parental preference and the latest available data on survival and morbidity,” according to Ob.Gyn. News.
At the present time, babies born at 22 to 23 weeks make up a gray area; important factors, such as infant weight and the mother’s medical treatment, are the defining aspect of whether the infant thrives.
“Clearly there is little consensus about the appropriate policy for treating infants born at low gestational ages, and yet hospital practices regarding the initiation of active intervention have a dramatic influence on rates of survival and survival without impairment,” said Neil Marlow, D.M., a neonatologist at University College London, in an editorial that accompanied the study in NEJM. The editorial, titled “The Elephant in the Delivery Room,” discusses the complexity parents face when considering treatment options.
The published study focuses on the variation in treatment approaches between different hospitals; this fluctuation is what the authors point to as an obstacle in treatment counseling. Any potentially lifesaving intervention provided post-birth is considered “active treatment.”
“Hospitals at which active treatment was more often initiated had higher rates of risk-adjusted survival both with and without impairment than did hospitals at which active treatment was less frequently initiated,” the study authors wrote, according to University of Alabama Birmingham News.
This has significant implications in counseling sessions with parents who are trying to make plans. Hospital statistics include data from a wide range of hospitals with accompanying variation in treatment protocols; these statistics are a key part of treatment decisions and projections for the babies. Using data from hospitals that did not treat 22 week old premature babies can skew numbers and present an inaccurate picture of the pros and cons of preterm delivery and treatment.
Even as technology advances, the very validity and role of such progress is held to question in the abortion debate. If such a small minority of infants survived—only 15 percent without impairment— should the standard of when abortion is “acceptable” still change?
Further complicating the matter is the estimation of gestational age and the variation in treatment approaches by different hospitals. The study found that out of 24 hospitals, four did not intervene for any 22-week-olds, five did for all 22-week-olds, and the rest had different approaches. The reasons as to why involve both the family’s decision and hospital policy, according to the study. The older the baby was, the more likely it was to receive active treatment.
When it comes to deciding treatment options, time is of the essence. Since infant age is a defining factor as to whether they receive treatment or not, redefining health protocols is essential. The study observed the difference in approaches to babies born in the same week, and revealed that many parents and doctors may “round up” when it comes to guessing gestational age in order to increase the infant’s chances of getting the medical attention it needs to survive.
“It’s very difficult to say to a mother, ‘If you deliver today, I’m going to do nothing, but if you deliver tomorrow, I’m going to do everything,’” said Marlow to the New York Times.
Increasingly, technology plays a controversial role in prenatal and neonatal healthcare decisions. This has already been seen in politics, such as the ultrasound and defect screening processes. With the viability standard being tentatively pushed earlier as the power of intervention is brought to light, perception will inevitably change. If a new line is drawn at 22 weeks, the chance to restrict abortion will emerge and medical personnel will have a new consideration when deliberating their plans of action with parents.
The first cited author of the study is Matthew Rysavy, a fourth-year medical student. He and the corresponding author, Edward Bell, M.D., are of the University of Iowa. Wally Carlo, M.D., is director of the Division of Neonatology and Newborn Nurseries at the University of Alabama at Birmingham. The other 14 co-authors come from the University of Iowa; RTI International in Research Triangle Park in North Carolina and Rockford, Maryland; Stanford University; Emory University; Brown University; Wayne State University; Case Western Reserve University; the University of Texas Medical School; Duke University; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.