Researchers have found that the chance of survival without severe health conditions for prematurely-born babies has improved in the last 17 years. This has potential implications for when and how intensively to resuscitate such ‘periviable’ infants.

“A lot of medical societies are struggling with this, what to do about babies born at 22 and 23 weeks,” said Prakesh S. Shah, University of Toronto neonatologist and health policy researcher.

“The majority would say 22 weeks is the age of nonviability.”

Another look at the threshold of foetal viability

A recent study analysed the records of more than 4,200 babies born at 22 to 24 weeks of pregnancy between 2000 and 2011. It was revealed that the high mortality rate for babies born at 22 weeks was maintained, but the outlook for the rest of these infants steadily improved over the 12-year period.

In the last four years of the study, the survival rate of infants born at 23 and 24 weeks exceeded a third of those studied. One in five of these survivors showed no developmental impairments at toddlerhood.

These findings suggest the need for a revision of the limit of foetal viability – the stage at which the foetus has a reasonable chance of survival outside the womb - which is currently fixed at 24 weeks.

Other studies from developed countries prove how drastically foetal stages of development and chances of extrauterine survival can change in a week. For infants born at 22 weeks, the rate of death or developmental impairments was over 94%; these improved for those born at 23 weeks and 24 weeks at 80% to 90% and 51% to 72% respectively.

Prevent mothers from “watching [their babies] die”

Such findings are good news for mothers like 26-year-old Ashley Glass, who are campaigning for a change in the abortion limit. The stay-at-home mother from Scotland, claims that her newborn son Dylan was “left to die" by medical personnel as he was born at 23 weeks, despite having a strong heartbeat.

"My son was born alive and spent four minutes gasping to breathe but no one helped. The doctors had already made up their minds they weren't going to help him,” she said.

"It was so traumatic hearing him trying to breathe and watching him struggle and wriggle in pain in my mum's arms - we just had to watch in horror.”

Glass is determined not to let other mothers and babies undergo the same fate. "I am fighting for justice for my son and every other baby that never had the chance at life - the law needs to be changed, something needs to be done," she declared.

Results could “reflect random variation alone”

The argument to revise the abortion limit must be qualified. Most survivors of premature birth have lifelong disabilities such as cerebral palsy, hearing and vision loss, mental impairment, and movement problems. It is also said that the average IQ of babies born at 24 weeks is 70.

“They’re at risk for brain injury because of bleeding in the brain. The lungs are very immature as well. They just haven’t developed enough to sustain life,” said Duke University neonatologist Noelle Younge, lead author of the new study.

The study may also have overestimated the survival rate of premature infants, as the 4,200 babies were born in academic medical centres, which are part of a federally funded neonatal research network. Although the study is currently one of the largest, it represents just 5% of periviable babies in the US. Hence, researchers warn that the improvements could “reflect random variation alone.”

Nevertheless, medical technology to support premature babies has undeniably seen advancement, for instance, steroids and gentler ventilation reduce the risk of bleeding in premature infants.

“We think we saw a significant change in outcomes over time,” said Younge. “This needs to continue to be tracked. But this really is moving in the right direction.” MIMS

Read more:
A doctor’s dilemma: clash between duty and personal values
Doctors suggest 30-second pause before cutting the umbilical cord of newborns
Should euthanasia for infants be legalised?

Sources:
http://www.philly.com/philly/health/Progress-saving-preemies-on-the-edge-of-viability.html
http://www.mirror.co.uk/news/uk-news/mum-watch-premature-baby-left-9816512