This is a speech I wrote about the research I did on the subject of very premature babies and how doctors decide whether it is worth it to treat them. This is one of two genres in which I presented this information, the other being a pamphlet.
Making the decision to treat or not treat a baby who was born very prematurely can be difficult. It is important for parents to feel that they are making the right choice for their child. This is why it is so crucial to know how the decision is often made, how doctors usually decide whether a baby is viable and should be treated. The decision is too often based on just one deciding factor. Many hospitals and doctors never resuscitate or treat babies born before 24 weeks of pregnancy without even considering other information about the baby or the pregnancy, such as estimated fetal weight, sex of the fetus, whether it’s a single or multiple pregnancy, or whether corticosteroids have been administered in utero to help the fetus’s lung development. Some hospitals judge the viability of a baby not by gestational age but by weight, only allowing babies to be treated if they are born weighing at least 500 grams, or 1 pound, 1.637 ounces. However, this policy is also only based on one criterion and doesn’t take into account any other factors. This is not the way that doctors should decide which babies should be treated and which shouldn’t. These cut-offs based on birthweight or gestational age result in babies weighing 499 grams or born at 23 weeks, 6 days being made comfortable as they die, while babies born just one gram heavier or one day later have everything possible done for them to help them survive. This should not be happening, because the survival rate does not suddenly, drastically increase from a 0% chance for a 499 gram, 23 week baby to a much higher chance for a 500 gram, 24 week baby. It is possible for babies born earlier than 24 weeks or lighter than 500 grams to survive, and the increase in the survival rate from, say, 499 to 500 grams, or 23 weeks, 6 days to 24 weeks is small.
Some people have the idea that a baby will show whether they “want” to live, that some very premature babies are born moving, trying to breathe, fighting for life, while others are born seeming lifeless, not moving, not trying to live. While it is true that babies can present in very different ways at birth, it is not true that this predicts a baby’s chance of survival. How well a baby is doing at birth is measured by the APGAR score, which stands for Appearance, Pulse, Grimace, Activity, and Respiration. Studies have shown that babies’ APGAR scores do not predict whether they will survive or die while in the hospital. Babies with low APGAR scores can respond to treatment and improve. They should not be denied treatment just because of their initial presentation at birth.
Many factors should be taken into account when deciding whether to treat an extremely premature baby. There are several determinants that affect survival rate. Not just one should be considered, and not just one negative criterion should be enough to make the decision to not treat a baby. Sometimes a baby born at an earlier gestational age or a lower weight has a higher chance of survival than one born at a later age or heavier weight, depending on other factors. For example, a baby born at 22 weeks who is female, the only baby in the pregnancy, weighs 1000 grams (about 2 pounds, 3.27 ounces) and received steroids in utero has a greater chance of survival, according to the National Institute of Child Health and Human Development’s calculator, than a baby born at 25 weeks who is a male in a multiple pregnancy weighing 401 grams, or about 14.14 ounces, who had not been treated with steroids. This shows that the general principle that survival rate increases with gestational age, while usually true, is not always the case in certain circumstances, such as when a baby at a very early gestational age who has several other indicators of a positive outcome is compared to a baby at a later age who has several other indicators of a negative outcome. This idea is also true of birthweight. A baby with the extremely low birthweight of 401 grams but other positive factors (born at 25 weeks, female, singleton, treated with steroids) is more likely to survive than a 1000 gram male baby in a multiple pregnancy who was born much earlier at 22 weeks and had not received steroids in utero.
The decision to treat or not to treat must take into account every aspect of the pregnancy or birth that could affect a baby’s chance of survival, as well as the fact that observations of the baby very early in their life are not good predictors of long term outcome. The decision needs to be more individualized and doctors shouldn’t make this choice for all babies based on just one criterion.
