Sarah Hall, health correspondent 

Let premature babies under 23 weeks die, doctors told

Premature babies born before they have been in the womb for 23 weeks should only be resuscitated in exceptional circumstances, according to recommendations expected to be adopted in hospitals throughout the UK.
  
  


Premature babies born before they have been in the womb for 23 weeks should only be resuscitated in exceptional circumstances, according to recommendations expected to be adopted in hospitals throughout the UK.

An infant born this early would only be given intensive care if the parents repeatedly requested it, while understanding the high likelihood that the baby could be severely disabled, and if the doctor agreed it was in the child's best interests.

But the assumption is that these cases would be exceptional, and that babies born at this stage should be allowed to die.

Fewer than 300 babies a year are born this early, but of these just 1% survive to leave hospital. The controversial "quasi legal" recommendation, by the Nuffield Council of Bioethics, forms part of a week-by-week breakdown advising doctors how to treat babies born between 22 and 25 weeks - the borderline of "viability".

The report, which was welcomed by the Royal College of Paediatrics and Child Health, but which drew criticism from the BMA and some neonatologists, recommends that because it is "extremely rare" for babies born at or below 22 weeks to survive, such infants should not be resuscitated except as part of an approved research study.

It adds that once a baby reaches 23 weeks, experts are in a "real zone of uncertainty", and parents should be given the final say. For babies born between 24 and 25 weeks resuscitation should be routine unless parents and doctors both agree there is no hope of survival, or if the babies' level of suffering outweighs its benefit in living. Once a baby reaches 25 weeks intensive care should normally be given, the guidelines say.

Vivienne Nathanson, head of ethics at the BMA, said: "We would not be so happy about an overall recommendation on resuscitating babies at 22 weeks. It has always been our position that every case is individual and should be judged on its own merits."

The report follows concern at the increasing number of extremely premature babies being born and a lack of uniformity in their treatment. At present, hospitals vary widely, with some not resuscitating those born at 24 weeks, and some actively treating those born as early as 22 weeks.

The latest figures suggest 16% of those born at 23 weeks, 44% at 24 weeks, and 66% at 25 weeks, will survive. Two-thirds born at 23-24 weeks will have moderate or severe disabilities.

Church of England and Catholic church representatives, and leading neonatalogists, criticised the guidelines from the 14-strong Nuffield committee, for setting out too stringent cut-off points.

John Wyatt, professor of neonatal paediatrics at University College, London, warned: "Cut-off times don't necessarily fit neatly with clinical practice and doctors must continue to individualise care."

 

Leave a Comment

Required fields are marked *

*

*