Born too soon - what is the outlook for severely premature babies?

baby in intensive care Kai was born at 24 weeks

Fragile, tiny and battling for life. That is the fate of Kai and other babies born too soon. I met him with his parents Becky and Robert at Homerton hospital in east London.

"When I found out Becky had gone into labour I thought that's impossible" Robert told me. "It's still shocking to see how small he is but Kai is putting on weight and seems to be getting stronger every day."

Kai was born at 25 weeks and five days gestation and weighed 690g (one and a half pounds). He has put on 80g (three ounces) in the two weeks since his birth so was born even smaller than in the image above.

New research published in the British Medical Journal shows that there have been improvements in the survival rate of severely premature babies. My colleague James Gallagher has written about the research here.

But the toll on families, the NHS and the children themselves is immense with the outcomes worsening the earlier the baby is born. In 2006, of 442 live births at 24 weeks, 178 survived. Of 339 live births at 23 weeks, just 66 survived.

Doctors have to decide - in consultation with the parents - whether to intervene and offer life support to such seriously ill babies.

As you can see from the graph there is a huge difference in the odds of survival or disability between being born after 22 and 25 weeks gestation.

Graph Changes in outcome of babies born severely premature in 1995 and 2006 in England (BMJ)

Report author Kate Costeloe, Prof of paediatrics at Queen Mary, University of London, said: "Many of the babies have such a poor prognosis it would not be in their best interests to put them into intensive care. Their lungs and brain and skin are immature, they are very vulnerable to infection and we can't get (intravenous) lines in to deliver the medicine they need."

There is no hard and fast cut-off for hospitals as to when they will intervene and offer what's known as 'active stabilisation'

Neil Marlow, Prof of neonatal medicine at UCL Institute for Women's Health, said: "At 24 weeks we have the presumption that we will do something; at 23 weeks much less so".

Prof Marlow said specialists were split across Europe as to whether they provided active care at 23 weeks. France and the Netherlands do not whereas Sweden does.

Sometimes hospitals take the decision to stop treatment. Prof Marlow said: "About 70% of deaths are elective withdrawals of care. We are trying not to cause harm."

But, improved care means many more premature babies are surviving - especially those born after 25 weeks. There has also been a dramatic 44% increase in admissions to neonatal intensive care, which remains largely unexplained.

Neonatal intensive care costs £1,500 a day, and the average stay is around three months, so the burden on the NHS is huge. Then there are the long-term costs of providing specialist treatment to children. One in five will have a life-long serious disability.

BLISS, the charity for premature babies and their families welcomed the research. Its chief executive Andy Cole said it "emphasises the need for a range of community services to be available to support all premature babies after discharge and the increasing demand for follow up care by paediatricians and other specialists which is not yet being fully met.

Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • Comment number 52.

    This comment was removed because the moderators found it broke the house rules. Explain.

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    Comment number 51.

    I was born 43 years ago at 27 weeks. I went to mainstream schools, had normal jobs and a normal life and now have 3 beautiful children of my own, all are fine. My Brother, was born 10 years later at the same hospital. He has mild cerebal palsy, epilepsy, and will never be able to live completely on his own, let alone get a job or have children. No one knows the outcome of being born early.

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    Comment number 50.

    My son was born at 27 weeks weighing 2 pounds.He was also breach delivery and only lived because my wife is a nurse and was at work at the time. After 10 weeks in the special care baby unit in Oxford,he came home.He is now a gorgeous 5 year old and the biggest in his class.A very big thank you to all the magnificent staff that cared for him from the moment of his traumatic and unexpected arrival

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    Comment number 49.

    Congratulations to our daughter in law Julia - a bonny baby girl born last night & I just had to tell the world that grand child number 11 is gorgeous!
    Congrats to you,too!My 9th grandbaby's due next June.Did a commenter ask if 11 grandchildren were a bit too much? I see each one as a unique blessing, myself.And one granddaughter was born premature-doing well now.

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    Comment number 48.

    @44 - Amen, brother!
    @43 - I am not saying NHS should let people die. They saved my wife and son's life. No bigger fan than yours truly!
    I'm saying think very carefully before adding to the numbers of people likely to need high levels of care. True the stats say instances of disability in prem babies are coming down. Excellent. But it's still more likely the other way.

    Not a monster : (


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