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Preemies may live with intensive care, but at what cost?

The birth of a child is not like setting a bone or suturing a cut. It’s a nine-month process. That’s capped by a period of labor and pain for the mother. If everything goes according to nature, the baby is born and all is good.

Most of the time, that’s what happens. When complications do develop during a delivery, health care providers are faced with challenges that may threaten both the mother and the child. If there is a failure to deliver a proper standard of care, that negligence can result in life-altering injury to both mother and child.

Not all situations can be anticipated. At any time during gestation, issues can arise that can mean a premature delivery. While advances in care have pushed the limits of viability earlier, that has raised questions about whether it’s appropriate and the decision is one only parents can make.

There are two problems. One is that most parents can’t know all the implications of a decision. The other is that they typically have such an emotional investment in the situation that it’s difficult to make a rational choice.

Making things more difficult may be results of a recent government study showing that if a child is born early, even as early as 22 or 23 weeks, they are more likely to live if given intensive care. The alternative might typically be to provide palliative care to keep the newborn comfortable for the short duration of his or her life.

The issue of aggressive treatment is a controversial one in the medical community. Extreme preemies may respond to lifesaving care, as the study indicates, but there is no way of knowing what the long-term issues might be.

Researchers found that only 5 percent of infants born at 22 weeks survived. Of those who received aggressive treatment for breathing or heart rhythm, 23 percent lived. Nine percent survived with moderate or severe neurological problems, such as cerebral palsy. Just over 15 percent had some neurological impairment.

By comparison, more than 80 percent of infants born at 26 weeks survived whether they received active care or not. And most of them, nearly 60 percent, had no moderate or severe neurological issues.

As one doctor puts it, the study shows babies can live with care, but there’s no way to know what the nature of that life will be.