UCL News


Press cutting: Against all odds

21 February 2007

Babies born prematurely face a daunting array of problems, both immediately and in the long term.

At less than 23 weeks, foetuses have very little in the way of lungs, or brains.

In fact, says John Wyatt, Professor of Neonatal Paediatrics at UCL, who also has a longstanding interest in medical ethics, "All the organs are extremely immature. The critical issue is the lungs. Even with machines, it's impossible to get oxygen in because the lungs are almost solid. Trying to keep the baby alive may involve inflicting a very high degree of irretrievable damage. The skin is often very thin, and the kidneys underdeveloped. The brain is extremely immature, and very prone to injury, especially bleeding. Furthermore, follow-up studies suggest that babies who survive below 23 weeks have a very high chance of developmental or neurological problems. …

"If you take the case of all very premature babies," says Wyatt, "the majority do well and go to normal schools, and do the normal things. However, the studies confirm that there is a high incidence of educational and behavioural problems. Of babies less than 28 weeks that figure is about 50% - but that doesn't mean to say it would be better not to have given them a chance."

At the same time, he, along with many others, is uncomfortable about "this idea of a record-breaking Olympics, which is not in the best interests of patients and children. I think this is clearly an extremely unusual case, and entirely outside our experience. Most parents, when given the facts, would accept that the best thing for a baby born below 23 weeks is to allow nature to take its course, and most neonatalogists would agree that they shouldn't be resuscitated. And yet ... we need to decide what is best for each individual baby. A premature baby is as much a member of the human community as anybody else, and deserves the best care that's available. By and large this care has been extremely successful. There are thousands going into adulthood who previously wouldn't have done so. There are some children at the extremes, for whom intensive care can't provide hope, and who will not survive. In those circumstances it's best not to start." …

Joanna Moorhead, 'The Guardian'