Survival rates of severely premature babies have doubled over the last decade, leading to some doctors to call to changes in protocol.

The most recent clinical guidance, drafted in 2008, advises against resuscitating a baby born before 23 weeks or earlier in the UK even if there are signs of life (some hospitals choose not to intervene before 23 + 6, or 24 weeks, this may vary between hospitals) on the basis that it may not be in the best interests of the baby. However, leading experts have now changed the clinical guidance as there is increasing evidence that babies born at 22 weeks may have a fighting chance of survival with the right intervention, and rates of survival of extreme prematurity have doubled over the last 10 years due to medical advances. 4 in 10 babies born at 23 weeks now survive!

We’re sure that this is very bittersweet news for parents of very premature babies who missed the cut-off for medical assistance; many more babies may now survive extreme prematurity with this change in guidance!

The new guidance set by The British Association of Perinatal Medicine (BAPM) advises that doctors should decide whether to intervene at 22 weeks after consulting the baby’s family first.

Dr Helen Mactier, President of the British Association of Perinatal Medicine and Consultant Neonatologist at the Princess Royal Maternity in Glasgow, has stated:

“We’ve got better at keeping extremely premature babies alive and we know clinicians are increasingly willing to consider survival-focused care for the most extremely premature babies. We have a responsibility to offer the best possible care to the baby and consistent advice and guidance to worried parents. Sometimes this will mean that the mother should be moved before birth to a maternity care centre alongside a neonatal intensive care unit.”

What is classed as ‘extreme prematurity’?

A birth between 22 weeks and 26 weeks is considered to be ‘extremely premature’.

7 out of 10 babies born at 22 weeks die even with intensive treatment.
8 out of 10 babies born at 26 weeks now survive.

Even with a high rate of loss with babies born at 22 weeks, there is still scope for survival… If 3 in 10 22 week preemies can survive with intensive treatment, then babies who may not have previously been offered intervention could potentially survive now, which is an amazing achievement.

Some experts are discussing the ethics of intervening at 22 weeks…

With extreme prematurity, comes the high risk of complications and long term disability; it’s distressing but an unfortunate fact that should be considered. Some doctors are wondering if intervening in the case of a 22 week birth is the right thing for the baby… This is such a multi faceted topic and it will vary from baby to baby, family to family, so we feel that the fact that there will now be more choice and opportunities to save babies who could survive is very positive.

Dominic Wilkinson, Professor of Medical Ethics at the University of Oxford, feels that the change in guidance has come at a time when we are moving more towards individualised care; ‘complex decisions’ can’t be reduced simply by adhering to guidance.

He has stated…

“It is possible, in 2019, to save babies who could not previously have survived. That is fantastic news, but the very high risks mean that it is not always the right thing to do to provide intensive medical treatment. We can’t say what might be possible in the future but we are coming up against the limits of physiology.”

This is a good point; what the right thing is for one baby, may not be for another.

Will babies born before 22 weeks ever be able to survive?

It is worth noting that 22 weeks is the very earliest point where the parts of the lung that can exchange oxygen have developed, so it is unlikely that any baby born before 22 weeks will survive (unless their dates have been miscalculated). At the point of 22 weeks, some babies may ‘just’ survive as they can get oxygen into their blood, but before this point, it very sadly won’t happen. There is a limit as to how early a baby can be saved.

It is incredible to think that a baby who has only been developing for around 20 weeks (as we add 2 weeks on for our cycle) can actually survive these days, and we are so proud of the scientists and doctors who work to make this miracle happen.

Babies who could survive with intervention deserve the chance to fight!

Tell us your thoughts in the comments!

Love from Katie & Team BBY. Xx