Preemies Among World's Smallest Surviving Newborns Beating Odds


Gender, Steroids, Gestational Age and Education Likely Played a Role

"Females do better than males, and giving mothers steroids before they deliver a baby can accelerate the maturation of babies' lungs and brains in utero, which leads to better outcomes," said Muraskas.

Current recommendations are for mothers to receive steroids, which help the lungs develop, before pre-term birth when a fetus is between 24 and 34 weeks of age.

The fact that both babies were older than 25 weeks also played a role in their successful outcomes, he also said.

"The single best predictor for outcome as far as how well the brain is working is maternal educational attainment," said Dr. F. Sessions Cole, director of the division of newborn medicine at Washington University of St. Louis Children's Hospital.

While the study did not give any details on the mothers' backgrounds and the families did not want to be interviewed, Campbell said it's obvious these women were able to receive excellent perinatal care.

"If we're talking in terms of developmental outcome over time, parental education is synonymous with environment, meaning they're better able to provide good resources and access to care," she said.

Ethical Issues Surround Gestational Age

Muraskas and his colleagues wrote that a baby born older than 25 weeks old must be resuscitated because at that age, the baby is considered viable. Resuscitation is "obligatory on the ethical grounds of the 'best interests' of the newborn," they wrote.

The Supreme Court generally considers a fetus viable at around 24 weeks of age or when doctors make the determination of viability, which Cole explained sometimes dictates institutional policy on keeping certain premature newborns alive.

"Some institutions, in the interest of trying to put structure around these decisions, decide, regardless of the likelihood of survival, if a baby is born 16 weeks early or in that range, that baby would be given full life support regardless of parents' opinions," he said.

But he added that it may be better for these complex and delicate decisions to be made by the parents and health professionals involved on a case by case basis.

Advances in technology have made it possible for smaller babies to survive, wrote the authors. When a baby is near the age of questionable viability, they also say gender, gestational age and the use of steroids before birth should be considered as contributors to the ability to survive and do well.

And while the pressures of dealing with the health issues that often plague premature infants can be overwhelming, Francis wants other parents to know there is plenty of support out there.

"It's important for them to know they are not alone. There's help out there."

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