So true. Maybe we should be like other countries and not try to "save" every premature baby. Then the US infant mortality statistics would be better in comparison and our health care costs would be lower.

Parents who take extreme measures to save their premature babies also have to give up some of the bonding that a newborn normally enjoys, because they have to stay in the hospital hooked up to machines. They don't really get to experience the world in those early stages of life. And there's no guarantee that the treatments will pay off, or that survival will entail a normal quality of life. Past generations didn't have to make that call. There was nothing a parent could do, except take home their baby, hold it and show their affection for its brief life. I feel sorry for all the parents who opted to save their tiny newborns, but instead ended up sacrificing the few hours they might have had to bond with their babies. What a difficult decision. My husband and I decided that if we had an extremely premature baby, that we would opt out of treatment and instead nurture it the best we could for as long as we could. I don't think it's "giving up" on the baby; it's just giving priority to the short term, which is all that most of these babies will ever have. Luckily we never had a preterm baby, so I can't be certain that we'd stick to our plan. Perhaps after seeing the baby, we'd have such a compulsion to keep it that we'd opt for extreme measures instead. And in that case, I would just hope it worked out for the best.

Being a mom of a 6 week premature baby I can assure you you would do ANYTHING to help your child survive. I didn't even have to lay eyes on my angel to know there is nothing that would keep me from fighting for his life. Granted he was extremely healthy and his only issue was him not knowing how to eat just yet (that is something a fetus learns in their 36 week).

Now he is 7 months and he is a huge healthy baby that is in the 75-95th percentile in growth. He is not delayed in growth nor in learning. It's so sad to think that had we chosen NOT to fight for him we would have lost out on beautiful blessing.

Another thing is if we had let nature take it course ... chances are I would have lost my life as well. I had developed pre-eclampsia in my pregnancy causing me to have an early c-section.

I pray that others do have to make the decision we did that glorious day my angel came into my life but I will tell you ... if I had to ... I would do it all again. Seeing his smile is worth every penny spent!

There is a huge difference between a baby born at 34 weeks and a baby born at 20 or 22. Saving preemies is not the question. Saving "extreme" preemies is.

nonbelieve- have you ever had to make that decision?? To deliver your child and say "Oh well he/she is too early, lets just end things". If you were a parent, and it doesnt sound like you are.. you wouldnt just give up on the child you have been carrying for months. I work in a birthing pavilion and I cant tell you ONE parent who would have rather let their child pass. We are not birds, we dont just throw our kids away.

Cehmmh2, I am a parent and I understand your position. As a first-time parent, I may have experienced the "save this child at any cost" impulse too. But as a mother of two, I now know that the most precious time with our babies is just holding them, loving them, and sensing that peace and security they get from bonding with their parents. No one lives forever, and most of these babies won't live past infancy, so I think I would make the most of the time we did have, and hold them instead of put them in an incubator. It's not "throwing your kids away." It's being realistic and making the most of the time you do have.

OH MY GAWD!! Don't let a teabagger hear you say that.....dey lubs JESUS an da preechr says that's sinnin!

@nonbeliever, I hope you're never faced with the birth of a pre-term child.

Wow, grouchy. Not all of us "teabaggers" are religious zealots. Let's just be rational about this. If someone (newborn or otherwise) is so severely ill that the only way to keep them breathing is with massive amounts of medical intervention at an astronomical cost and that individual will never have any recognizable quality of life, why would it be wrong to let nature take its course?

Sometimes you have to allocate resources in the way that benefits the most people. So do you spend millions on an infant that really is too small to survive or do you spread those same health care dollars to hundreds of people with lesser ailments? If we ever go to a single payer system, this is a question that will have to be asked and answered as there are not unlimited funds to go around.

Not all preterm infants are "damaged" and beyond living normal lives. I have 2 babies born at 28 weeks that are perfectly normal at 12 years old. My daughter weighed a little over 600 grams and is excelling at school and doing well. It was worth the cost for us.

There was another group that shared your thinking. And they lost in WW2 and their leader shot himself in a Berlin bunker, but you prove that some of their warped thinking survived....

Angie, well worth the cost to us you say.....But you didnt bear the cost....insurance paid the cost.

That is what insurance is FOR.

madness, how do you know how much I paid???? You own an insurance company? I paid my premiums and my co-pays, maybe you should mind your own business.

you can actually afford to pay even the co pays from a sick baby's lengthy hospital stay! wow i bet you must have your personal secretary typing this for you! no i don't own an insurance co but I am damn tired of insurance going up to cover for those who don't pay their bills!

Insurance doesn't pick up the bill when patients fail to make their co-pays. Insurance only ever pays their 20% (or whatever your plan is), and any remaining balance is hashed out between the provider and the patient - through payment plans, collections, or a court ruling. Your insurance isn't "going up to cover for those who don't pay their bills." It goes up because medical costs go up, fewer people purchase policies, or they command a higher profit margin. In fact, most policies specify that if a provider waives any of the cost for a patient, the insurance companies must get a proportional discount too.

The likely incidence and cost of premature baby care for covered patients is factored into the premiums these parents pay, so you really have no reason to resent people who opt for the treatment. Just like they have no grounds to complain when you opt for a heart transplant instead of succumbing to preventable death for the sake of every one else's insurance premiums. That is the POINT of insurance. If you don't want to pay for others' risks, then don't risk-pool. Of course, that means others won't be offsetting your costs either.

it was probably the fetal alcohol syndrome that had more of a negative affect than the prematurity.

Angie, I have also heard stories about fetal alcohol babies and crack babies that grew up just fine and overcame their rough start in life. You have no way to know which caused the greater harm and even suggesting one try to make that determination is ridiculous. Both undoubtedly left their damage on this poor child. I am very glad for you that your preemies were among the lucky ones (no sarcasm intended there at all!), but to deny the reality of health and developmental problems other children suffer as a result of extreme prematurity is pure, willful ignorance.

As the mother of a 3 lb 9 oz 34-week preemie twin (IUGR, single-artery umbilical cord, twin-twin transfusion donor, vellementous insertion of cord, multiple midline defects to heart (repaired VSD, ASD, DORV), stomach (pyloroplasty, Nissen Fundoplication) and pancreas (anular, not requiring surgery))....I have to say, sometimes it *is* worth it. My child is normal, intelligent, creative, artistic, and an invaluable part of my life.

But I won't pretend she wasn't tortured in the name of keeping her alive. CPAP, wires, surgeries, feeding tube to the age of 4 1/2 years, therapies....she experiences pain much more intensely than any of my other children, and will become helpless in the face of pain or frustration much more quickly than they. She was 9 years old before she would come to me at night to ask for a hot rice pack for her growing pains, rather than just lie in bed, crying from the pain in her lower legs. She endured torture in order to live. I would do it again. But I'll never pretend to anybody that it was easy, or it didn't matter, or "she didn't feel it" or "she didn't remember it." She remembers it, all right. It has affected her permanently. Mostly, she gets along fine anyway - kids are adaptable - but her body remembers.

In my subsequent pregnancy, I was hospitalized at 24 weeks because they thought I would deliver at any moment (I am a daughter of DES and have an incompetent cervix). They asked me if I wanted them to do "everything possible". Damn right I did, even knowing what I knew from the twins. But, I did everything *I* could do (ie, complete bedrest for 13 weeks), and fortunately that baby was born full term, no NICU, no torture. I'd have put her through it all if I had to. I'm very grateful I didn't have to.

piece of work

My daughter was born at 28 weeks, 2lbs, 1oz. On a respirator for a month, several times the doctors told us she may not survive, even watched them try to save her for several hours one night after her lung collapsed, and they couldn't get her oxygen levels up. If you haven't had a NICU baby, you don't know what torture this is. The doctors kept us informed, and told us they may have to ask us to make that horrible decision at some point. Thank God we did not have to. Our baby is alive and well 2 years later. The baby next to us was not so lucky. We saw the mother hold for the last few moments of life.

The point is, this is not an easy decision. A preemie baby MAY end up with problems, or MAY be perfectly healthy. Nobody pushed us to extend life beyond what was reasonable. They prepared us for the worst, and hoped for the best. All treatment was done with the expectation that it would help life, not hurt. Some treatments (large amounts of steroids after birth) are no longer done specifically because they do cause mental problem, even though they are shown to save the life. Do you let the child die because she MAY have problems later. Apparantly some of you would, but let us know after it actually happens to you.

.

Angela and Desert,

I can only imagine the gut reaction the two of you must have to the term preemie, given your respective experiences. However, you have to acknowledge that what you went through and what this article is about are not really the same thing, not entirely. Your children had to go through a lot to live, and I am happy for you that they did, but you are talking about children of a couple pounds in size -- that is very different from the micro-preemies in this article. The article is most definitely not saying don't give preemies or sick babies a chance at all. But micro-preemies are a whole other issue.

Err...you might want to do some research before you talk out of your arse. The goal of IVF is ONE healthy baby. Even a twin pregnancy is not seen as the desirable outcome by medical professionals. The trend is more toward eSET (elective single embryo transfer) than pulling a Kamrava and producing a litter. People who birth high order multiples following fertility treatment in general chose the much less expensive IUI and fertility medication option. Speaking for myself, I certainly would not have risked a twin pregnancy and million+ hospital bills before they ever left the NICU had fertility treatment not been so expensive to begin with. My insurance company paid for the bulk of their expenses and what little it did not cover, Virginia's institutional medicaid (available to ALL parents with a child hospitalized over 30 days) did.

As far as their NICU experience, they were born at 1 lb 13 oz/1 lb 14 oz and spent 122/118 days in the NICU. No, it was not a pleasure cruise for anyone. But now at 14 months adjusted they are healthy and developmentally at or ahead of target. Should I have not let them suffer on the chance we'd not have such an excellent outcome?

It truly is a crapshoot. Babies born much closer to term than mine can turn on a dime and have devastating issues. And babies born earlier can have a shorter NICU stay than mine did. I am glad not to be the one deciding who deserves a chance and who doesn't. And am truly surprised anyone posting here who objects to treating micropreemies (unless you've actually been there) is so presumptuous as to think their opinion is of any merit. It's not.

I'm sorry, acethestace, but you comment struck me as unnecessarily defensive. No one, not anyone, is suggesting here that a baby like your sister in law should not be allowed to live. You say it was worth it for her -- but, what, exactly, was worth it? By your own account, no extreme measures taken to keep her alive and she thrived. That is great for her! A small heart problem is no big thing and she seems to have done very well. This is not the kind of case this article is talking about! When people ask if it is worth it, they are talking about multiple corrective surgeries for severe defects, months spent on respirators, anti-clotting drugs that can cause brain bleeds, drugs to artificially mature lung tissue and other medications that lead to hearing loss and blindness, so many wires and tubes that the child cannot be held (in the palm of the hand or otherwise) and experience the necessary early stage bonding that comes with physical contact... the list goes on and on... treatments that in-and-of themselves can cause extreme physical and psychological problems that will follow these children through life if they do happen to survive. Those are the things that people wonder if it is worth it or not -- not simply use of the "neonatal box" you mention. No one is questioning if a neonatal incubator is "worth it."

Many ignorant comments were left for this article. Unless you've seen a very or extremely birth weight infant grow into a happy, healthy child - as most do - you probably can't understand that there's little harm in being on a ventilator for the first few weeks of life. That although anti-clotting drugs increase the risk of brain bleeds, simply being born also carries a risk of brain bleeds. That preemies are not emotionally traumatized if they can not be held during the first weeks of life; their immature nervous systems prefer minimal stimulation. That lung surfactant and steroids that increase lung maturity is a wonderful, life-giving and non-invasive intervention. That although prematurity carries an increased risk of neurological disorders, some preemies grow up to be perfectly healthy while some full-term infants have autism, ADHD, CP, etc.

The reality is that babies are amazing and can recover from almost anything. I'm very biased, of course, because I have a healthy, beautiful 5-month-old son who was born 3 months early. Yes, he needed lung surfactant, CPAP, intravenous nutrition, gavage feedings, and medication to close his PDA and mitigate his apnea. Yes, his 73-day NICU stay cost over half a million dollars. But no one who saw him today would know he was a preemie unless I told them that he is already 5 months old. He has his whole life ahead of him, and no one has ever told me to expect any long-term issues related to his prematurity. So I think it was half a million dollars well spent. Money spent in a NICU have a *much* better return on investment than money spent in geriatrics. If you're going to advocate that interventions should not be made to keep premature babies breathing, you have no right to advocate for surgery or chemotherapy spent on cancer patients, regardless of the patient's age.

You're absolutely right: at 5 months old, I have no idea what challenges lay ahead for my son. However, I have seen my sister, who has CP, learning disabilities, and other issues related to her premature birth, grow into a wonderful, amazing young women. And no one in my family would prefer that she had not been "saved" when she was born dusky blue.

The research you read is more than likely outdated. Statistics on the outcomes of premature births continue to get better each year. From a book on preemies published in 2000: "Best available estimates - which do not take into account the most recent improvements in neonatal intensive care - indicate that about 40% of surviving 26- to 29-weekers will be normal. Another 40% will have mild or moderate disabilities, such as respiratory difficulties requiring oxygen at home for a number of months, mild cerebral palsy involving poor control of some movements, vision problems that necessitate glasses, hearing problems that necessitate a hearing aid, or or learning disabilities like hyperactivity or dyslexia. About 20% will have a severe disability, perhaps requiring years of ventilator support for chronic respiratory distress, having severe cerebral palsy and needing a wheelchair, or being blind, deaf or mentally retarded."

Statistics are worse for babies born earlier than my son and better for babies born after him. My sister was a 33-weeker and had a much worse than avererage outcome. My son was a 27-weeker and - so far - has had a better than average outcome. If it turns out that he has autism, would I wish he had never been born? Absolutely not. And I have an uncle who is severely autistic, functioning on the level of a 3-year-old.

I'm sorry that your preemie has not done well, but you can not criticize others for choosing to provide neonatal intensive care to their children when there is a greater than 40% chance that there will be absolutely no long-term effects related to their prematurity. "Many (about half of the premature babies born before 32 weeks) will never live independently as adults." - That may have been true 50 years ago, but it certainly is not true now.

Also, you might actually go look at the Tiniest Babies Registry. Some of the babies do have serious long-term medical issues. Others, however, are doing better than even I would have thought possible. Just to pull out a random example:

Baby 13, female, born in 1997 weighing 349 grams at 24 weeks gestation. Click "View most recent information", and you will find that at 5 years old, she had no known physical limitations, behavior problems, or learning problems. Health problems listed: Mild asthma; dental caries. Yes, preemies are more likely to have asthma and teeth problems than full-term babies, but there are also plenty of full-term babies that develop these issues. These are not things that can't be easily treated. And they are completely overshadowed by the fact that at age 5, baby 13 "counts to 20; sings ABCs; prints her name; knows shapes and colors; excellent language skills."

Oh! I like Tiniest Baby #9, too!

She was born in 1989 at 26 weeks gestation weighing 280 grams.

She scored at 83rd percentile nationally on high-school entrance examination; she enjoys playing the violin, horseback riding, and in-line skating.

At age 18, her health problems are listed: Wears glasses to correct vision (since age 5); rare reactive airway disease (asthma). She has normal motor skills, no learning problems, and no behavior problems.

I'm sad to think that some of those commenting on this article would not have provided neonatal intensive care to Tiniest Baby #9.

Alright, now that I'm in a better mood, I should give you some credit:

Dexamethasone treatment after the first week of life *is* associated with an increased risk of CP. High levels of oxygen in respiratory therapy *can* cause ROP. Half of all neurological disabilities are associated with preterm birth. I agree wholeheartedly with your statement, "Premature birth has many costs -- financial, and most importantly, human." It's much better to work to prevent preterm birth in the first place than to treat fragile newborns.

But neonatal intensive care has improved drastically in recent decades. The epidemic of ROP that used to blind preemies such as Stevie Wonder has been largely mitigated by improvements in respiratory therapy and laser eye surgery. And if no one had tried to care for preemies in past decades, neonatologists wouldn't be able to care for preemies nearly as effectively as they do today.