Doctors should routinely attempt to save the lives of babies born as early as 22 weeks, according to new clinical guidance
- In 2008, around two in 10 babies born at 23 weeks survived after being treated
- Around four in 10 infants born and treated at this point now survive, data shows
- Around 60,000 babies are born prematurely each year in the UK, figures show
Doctors should routinely attempt to save the lives of babies born as early as 22 weeks, according to new clinical guidance.
Medical advances mean survival chances for extremely premature babies are better than ever before.
Guidelines published today say doctors should change their practice as a result.
But the announcement also triggered outcry from pro-life campaigners, who said the 24-week abortion limit should also be lowered to reflect the viability of a baby at this stage of pregnancy.
The number of extremely premature babies who are treated and survive has doubled in just over a decade.
Around 60,000 babies are born prematurely each year in the UK, a small proportion of which are considered extremely premature
A decade ago it was virtually unheard of for babies to survive if they were born before 23 weeks of pregnancy – and previously guidelines suggested doctors should simply give them palliative care to make them comfortable.
But by 2016 some 35 per cent of those who received ‘active care’ to save their life were still alive a year later.
New guidelines published today by the British Association of Perinatal Medicine say improved survival chances mean doctors should routinely attempt to resuscitate babies born this early.
They stress that parents’ wishes should be taken into account in a case-by-case basis – and point out that the majority of babies born this early will not make it.
And of those who survive, a third will be left with severe disabilities.
But the guidelines say it is ‘appropriate’ to attempt to extend their lives.
Guideline author Dominic Wilkinson, professor of medical ethics at the University of Oxford, said these ‘complex ethical decisions’ cannot be reduced into simple rules.
But he added: ‘What we encourage is the idea that decisions have to be made on a case by case basis, what we have to acknowledge is that it is appropriate to attempt intensive care for some babies born this early, those who have favourable risk factors where parents have been counselled and wish this to be tried.
‘Other babies at 22 weeks with unfavourable risk factors may be at extremely high risk of dying or of suffering very severe complication and in that situation the framework recommends that palliative care would be the normal approach.’
Professor Wilkinson added: ‘One of the issues is that medicine is continually evolving and what we have put together is a framework based on what we know at this point in time.
‘We can’t say what might be possible in the future but we are coming up against the limits of physiology.
‘So babies developing in the womb are only developing the very earliest parts of the lung able to exchange oxygen at 22 weeks gestation, and because of that some can just survive at 22 weeks but before that point they have no ability to get oxygen into their blood.’
John Deighan, deputy chief executive of the Society for the Protection of Unborn Children, said efforts to save babies born before the 24-week abortion limit expose a ‘shocking contradiction’.
‘We rightly recognise the value of tiny premature lives in these new policies, so how can we continue to permit laws which allow the killing of babies at the same age through elective abortion?’
But a British Pregnancy Advisory Service spokeswoman said: ‘There is no contradiction between doing all we can so that babies born long before they are ready for the world have a chance of living, and ensuring that the very small number of women who need to end pregnancies in the final weeks of the second trimester, often in incredibly tragic and desperate circumstances can do so.’
Professor Wilkinson said the abortion threshold is a ‘sensitive’ question for society as a whole – but said it was not his place to comment on whether the limit should be lowered.
WHAT IS A PREMATURE BIRTH, AND WHAT ARE THE RISKS TO BABIES?
Around 10 per cent of all pregnancies worldwide result in premature labour – defined as a delivery before 37 weeks.
When this happens, not all of the baby’s organs, including the heart and lungs, will have developed. They can also be underweight and smaller.
Tommy’s, a charity in the UK, says this can mean preemies ‘are not ready for life outside the womb’.
Premature birth is the largest cause of neonatal mortality in the US and the UK, according to figures.
Babies born early account for around 1,500 deaths each year in the UK. In the US, premature birth and its complications account for 17 per cent of infant deaths.
Babies born prematurely are often whisked away to neonatal intensive care units, where they are looked after around-the-clock.
What are the chances of survival?
- Less than 22 weeks is close to zero chance of survival
- 22 weeks is around 10%
- 24 weeks is around 60%
- 27 weeks is around 89%
- 31 weeks is around 95%
- 34 weeks is equivalent to a baby born at full term