I read an article in the paper about setting a line for whether or not to treat premature babies. There’s this doctor in Rotterdam that wants to look individually rather than setting a strict line, which is the current policy: in the Netherlands, kids born before the 25th or 26th week gestation aren’t treated. I find this to be very rigid, because there are a lot more determiners for how a baby will do, such as birthweight, gender (girls to better than boys) and so on.
Fetter, a neonatologist in Amsterdam who has had thirty years og expereince treating preemies (he worked in Sophia Children’s in Rotterdam when I was born and “has brought me into the world”, as Mum points it), says there should at least be a national policy on whether or not to treat preemies. As another neonatologist says: if this is not in place, parents may insist on treatment “because that’d happen in Rotterdam, also”. Yes, I think there should be national guidelines, but not the rigid ones we have now. A few years ago, there was one hospital in Leiden that treated babies born at 24 weeks, but it quit that policy, because according to their research, many kids would be severely disabled as they grew up. Fetter also says in the article that there are these grown-up preemies he meets now of which he really thinks: “What have we done?!”
Many very premature kids indeed get behaviour, learning or social problems later in life. And according to research, at least that’s what I read in the article, 25% have “severe disabilities”. What’s a severe disability, I wonder. But, just because this is the outcome of research, doesn’t mean we need to set a rigid line at 25 or 26 weeks gestation. Probably, these severely disabled children had an extremely low birthweight, and may have had additional problems and complications. As I said, gestational age isn’t the sole determinr of one’s outcome.
One may further question what’s considered a too great risk. I don’t agree with the dominating opinion in America to treat virtually all preemies from a gestational age of 22 weeks on, because not all outcomes are worth living. But is it a problem that a child may have behaviour problems, or a learning disability. And if it is, is it a problem to the extent that we don’t want to treat these preemies? I don’t think so. And when a child reallly risks severe disabilities - what are “severe disabilities”, I wonder -, it depends on many, many factors.
At the time when I was born, the Dutch folks mostly didn’t treat babies born before the 26th gestational week. I was, according to the doctors, born at 26 weeks and 4 days, and had a birthweight of 850 grammes (1lb, 14oz). I later found out that I was probably born at a younger gestational age - I caclulated 25 weeks and 2 days. I felt pretty bad when I found out about the “mistake”, because as I reasoned, I didn’t have the right to live, for I was born too prematurely. If one may believe one of the neonatologist’s statements in the article, the line’s indeed that strict as to tell parents that their preemies is too young to be treated. I find that really so reidculous!
I think that the Rotterdam neonatoligist’s point of looking at the individual rather than at strict lines is much better. If a child wants to live, one can determine that within a few days after birth. And outcomes are never fully predictable: what one can see at one day, two weeks or even four years of age may change as the child grows older, but it is better to try to “select” those babies that have a great risk for disability (based on their gestational age, birthweight, how welll they’re developed, etc.) than to let children born at a certain gestational age live, while they may have a greater risk for complications than younger preemies who are left to die.
Astrid
