Born Early, Born Small
MILLIONS of couples the world over are expecting a certain precious “package.” Most of them know the approximate date that their baby is due to arrive. Some, however, are quite surprised when theirs is delivered early and is much smaller than anticipated.
On March 22, 1980, a baby was born to a couple near Middletown, New York, more than three months sooner than expected. She weighed 1 pound 12 ounces [794 g] and was a mere 13 3/4 inches [35 cm] long, about the span of these two pages.
The parents named their little one Kelly. She was born early, born small. Kelly arrived after only 26 weeks of gestation, instead of after the normal 40 weeks. Gestation is counted from the first day of the mother’s last normal menstrual period.
Premature and Underweight Babies
An infant is premature if born more than three weeks early, or prior to the 37th week of pregnancy. Previously, a baby was called a preemie if it weighed less than 5 1/2 pounds [2,500 g]. But the definition was changed, since some full-term babies also weigh less than 5 1/2 pounds [2,500 g]. Significantly, the epidemic of births among teenagers, and even preteens, has resulted in more and more underweight babies.
In the United States, about 10 percent of all live births are premature. Indeed, up to 300,000 of such babies are born in the United States each year! These are thrust from the womb into an environment for which they are not yet fully suited. They can be compared to Arctic explorers who have been deprived of their tents and sleeping bags.
True, these premature babies have all the organs of the body, although these are in an immature state. In fact, by the 15th week of pregnancy, a baby’s heart, brain, kidneys, and digestive system are formed and recognizable. Why, at three weeks the partly developed heart even starts beating!
But, of course, a baby cannot survive outside its mother’s womb during the very early weeks of pregnancy. Yet, because of advances in medical science, even preemies born during the 22nd week of gestation are now being saved. This, however, has resulted in a dilemma, and a very costly one at that. Consider how this has come about.
Recent Medical Developments
In the early 1960’s, more than half of all preemies weighing from about two to three pounds [900 to 1,400 g] died. In 1963 the nation’s finest doctors could not save Patrick, the three-pound [1,400 g] newborn son of U.S. president John F. Kennedy.
The fact is, until very recently there was a hands-off approach in the treatment of preemies. Those who were too underdeveloped or sick were allowed to die naturally. Of course, they were fed and cared for, but no aggressive treatment was initiated. Then, zealous medical personnel decided to make a career of trying to save these newborns.
In 1975 the new medical specialty called neonatology (a branch of medicine concerned with the care, development, and diseases of newborn infants) was formed by the American Academy of Pediatrics. Modern NICUs (neonatal intensive care units) were created to simulate some of the functions of the womb. Now about 90 percent of the infants weighing from about two to three pounds [900 to 1,400 g] survive!
The treatment, however, is neither pleasant nor pretty. A preemie may have half a dozen tubes inserted into his body, and his skin may be mottled purple from being stuck with needles. The science magazine Discover describes a modern NICU:
“Most of the infants lie naked on padded, electrically warmed tables, hooked up to an array of bottles and machines. Each one usually has his or her own nurse. . . . Their chests heave tremendously; their ribs and breastbones are so soft that they bow inward with each breath. According to their monitoring devices, most of their hearts beat 150 times a minute, and they take anywhere from 30 to 90 breaths in that time.”
A Real Dilemma
According to a survey, some 17,000 preemies weighing less than about two pounds [900 g] are annually admitted to the hundreds of special infant care units now operating in the United States. Now, even these very tiny ones are said to have about a 70-percent chance of survival! But at what price?
The estimates for severe mental and physical handicaps for preemies range from 5 to 20 percent, which is much higher than for full-term babies. And, of course, the smaller the baby, the greater the risks. The major risks include mental retardation, visual and hearing problems, and cerebral palsy. But that is not all. The author of The Premature Baby Book says: “I’ve seen a lot of kids born under 1500 grams [3 pounds 5 ounces] who have dyslexia, behavior problems, eye problems, or other problems the doctors call ‘minor.’”
Even preemies that doctors say are normal have difficulties. Dr. Forest C. Bennett, director of the high-risk infant follow-up program at the University of Washington in Seattle, observes: “Our tests of premature babies were all coming up normal. But parents kept telling us these babies were different from their brothers and sisters. They tended to smile less, to communicate with their mothers less, to pay less attention to light or sounds, and to be more fussy than other children. And when they grew up and went off to school, they didn’t do very well.”
In addition, it is very hard on families to have a preemie in an NICU perhaps many miles away and to make frequent trips to visit—only to see the baby suffering so. And when the little one is finally taken home, it can be especially trialsome. Sandy E. Garrand, president of a network known as Parent Care, notes:
“It’s unbelievable that hospitals will spend $300,000 to keep a baby in intensive care for two or three months, but when the baby goes home, the parents are left totally on their own without even knowing if the child will be disabled. That creates a tremendous feeling of isolation. Families are stressed. Marriages are stressed.”
One father of a tiny preemie was moved to say: “There was a time when we were afraid she would die. Now there are times when we’re afraid she’ll live. Without this technology, she would have died naturally, and we wouldn’t have had to ask ourselves these questions. Maybe that would have been better.”
Dr. Constance Battle, as medical director of the Hospital for Sick Children in Washington, D.C., says she is “immersed in the tragic outcomes of well-intentioned treatment.” Her advice to neonatologists? “I say give it some thought when you whip something into life you never see again. You don’t understand the limbo the child lives in.”
With the physical and mental outcome for many preemies so uncertain and the cost of care so high, you can understand why one magazine calls preemies “A $2 Billion Dilemma.”
Another Facet of the Dilemma
When is a baby considered a person? Some babies are legally aborted at up to 24 weeks of gestation, about the same age at which others are being saved. Thus, Omni magazine says: “The line between abortion and lifesaving care is becoming increasingly slim—so slim that many hospitals abort fetuses in one wing while saving preemies just a couple of weeks older in another.”
The magazine pointed to what would heighten the dilemma, noting: “Lungs are the only organs unable to function in preemies 16 to 20 weeks of age. Thus, with either high-pressure chambers or ECMO [extra corporeal membrane oxygenation], the plateau of viability would take another step down,” so that even younger babies would be saved. Indeed, on July 27, 1985, a 12-ounce [340 g] baby was delivered to a mother 22 weeks pregnant, and it is still alive!
When the heart of an aborted baby continues to beat for more than a few minutes, in some hospitals the baby is taken over to the NICU, where it is kept warm and comfortable until it dies. Yet, Dr. Elizabeth Brown of Boston City Hospital explains that one such aborted baby survived and was later adopted. Dr. Brown said regarding the mother who gave birth: “She was very happy that the child lived.”
Indeed, life is precious. And nothing is so heartwarming, especially to a mother and a father, as seeing their baby live and become a happy, healthy child. This is true whether the baby is full-term or premature. But what happened in the case of Kelly, mentioned in the introduction? How can parents of preemies be helped to cope? Is there anything a prospective mother can do so that she does not give birth prematurely? What is the source of the problem of premature births, and is there a truly satisfactory solution?
[Box on page 5]
Saving the Very Premature
“Parents didn’t cry out saying they wanted this. Physicians, I among them, were the ones who wanted to go ahead. Doctors have their own agendas, their own academic ladders to climb. If you talk to parents, you find they’re much more fearful of having malformed, handicapped children than they are of stillbirths.”—Dr. William Silverman, retired professor of pediatrics at the College of Physicians and Surgeons at Columbia University.