No Easy Answer: The Dilemma Over Treating Premature Babies

The decision about whether to care for micro-preemies isn't easy.

By Nancy Flory Published on January 27, 2017

The lower age of viability for premature babies is creating an ethical dilemma for healthcare providers and parents as they struggle with whether the premature infant is too young to receive the often-painful lifesaving treatment and resuscitation, should it be necessary.

Younger Preemies Surviving

As I wrote in an earlier story, questions surrounding viability have arisen as more and more premature babies are surviving, with adequate care.

In a 2015 study published in The New England Journal of Medicine, researchers found that premature infants born before 27 weeks had a greater chance of survival with active treatment (defined by the study as any potentially lifesaving intervention administered after birth) than those who did not receive active treatment — and a key determining factor of treatment was the hospital and its policies on whether to treat very early premature infants.

Of the 24 hospitals examined, five were consistently active at treating babies born at 22 weeks, while four never actively treated babies born that early. Sixty-five percent of infants receiving active treatment survived; all of those not receiving active treatment died. On record, no infant born prior to 21 weeks has survived.

But survival is only the beginning, according to the study. The rate of survival without severe impairment for infants born at 22 weeks’ gestation was only 3.4 percent. For babies born at 26 weeks, the rate of survival without severe impairment was 75.6 percent. Babies born this early may still spend months in intensive care at the hospital.

These odds have healthcare providers and parents wondering if they are doing the right thing by resuscitating infants who may not survive and if they do, have a good chance of having a serious impairment.

‘Serious, Dangerous Medical Condition’

Tammy Ruiz Ziegler, a Catholic Neonatal Intensive Care nurse for 30 years, has seen her share of preemie babies — most of whom, she said, received full neonatal care. However, Ruiz Ziegler is concerned that people are misinformed about the viability of such fragile infants. “We have tossed around the ‘24-weekers-can-survive’ idea so freely that people mistakenly believe that 24 weeks is ‘home free’ for the baby,” she said in her Catholic Stand article. “Being born at 24 weeks is a serious, dangerous medical condition that is harrowing for the baby and family, and even with perfect medical care nearly half do not survive … we need to never consider it in any casual manner.” Her concern is that parents believe, based on a few “miracle stories” that their infant will survive, when in most cases, they will not.

The Dilemma

Kelley Benham, Pulitzer Prize finalist for her series “Never Let Go,” a detailed account of her daughter’s birth at just 23 weeks, described in detail the agonizing she and her husband endured while trying to decide whether to provide active treatment to their daughter, just before the birth, teetering at the edge of viability. “Would we try to keep her alive?” Benham wrote. “If she lived, would she walk or talk? Would she one day give us a look that said, Why did you put me through this?”

One doctor told her to go home — since her baby wasn’t viable, she might as well have her at home. Another doctor was clear about the statistics her daughter faced. When it was all said and done, if she lived, the premature baby had about a 20 percent chance of being okay. That meant an 80 percent chance of a moderate disability. “I contemplated that figure: 20 percent,” Benham recalled. “It didn’t seem hopeless. Then again, imagine a revolver with five chambers. Now put four bullets in it and play Russian roulette. Would we bet on a 20 percent chance if losing might mean losing everything we cared about? Would we torture our baby with aggressive treatment just so she could live out her life in a nursing home or on a ventilator? Would we lose our house? Would our marriage fall apart?” She thought that perhaps treating her daughter “might be the most selfish act in the world.”

‘No Easy Answers’

Courtney Reissig, in her Christianity Today article, “The Micro-Premie Dilemma,” described how her experience as a Christian mom of twin premature babies in the NICU changed her outlook on the pro-life issue regarding viability. “I’ve been pro-life since God saved me in college,” Reissig wrote, “but the NICU opened up a whole new world for me regarding the value of human life.”

Benham’s experience challenged Reissig’s beliefs about the age of viability and the Christian response to life and death decisions of a premature baby. Reissig responded to Benham’s observation that the smallest of lives in the NICU, in some cases, “die by decision”:

This death by decision poses a hard question for pro-life Christians. Is it permissible to be pro-life and decline intervention? In a lot of ways, this is not a clear black and white issue. Sometimes accepting intervention is only postponing the inevitable. Sometimes it’s not. The choice to take a child off life support is as agonizing in the NICU as it is in any other ward in the hospital. There are no easy answers.

Living in Hope

One mother of a 23-week baby wasn’t willing to give up easily. “You just live in hope,” she recalled. She delivered in a hospital where the doctors provided active care to her micro-preemie and is adamant that infants be assessed on more than just their biological age. “I don’t believe there should be a deadline on anybody’s offer of intensive care: babies need to be shown a chance … I really feel passionately that a borderline can’t be set.” 

A Baptist minister and his wife also chose treatment for their 22-week baby in July, 2012. Clayton and Danielle Pickering of Newton, Iowa said that, although he was “one of the sickest babies” in the NICU, “We figured he was our baby, and he was what the Lord had given us, and we would just do everything we could.”

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