In 2000, 7.6% of all babies born in Canada were premature (Health Canada). And approximately 6.1% of babies born in 2005–2006 weighed less than 2,500 grams (Canadian Institute for Health Information). Since the 1970’s, medicine has made such progress in the care of premature and low birth weight babies that health care professionals are now turning their attention to extremely premature and extremely low birth weight babies.
Almost forty years later, we now have a better understanding of the long-term consequences of prematurity and low birth weight for these babies, as well as the ethical, social and legal implications involved.
What do the terms “premature” and “low birth weight” mean?
Normally, babies are born at approximately 40 weeks’ gestation. Babies born at less than 37 weeks’ gestation are considered premature. Very premature babies are those born before 32 weeks’ gestation, and extremely premature babies are those born before 28 weeks’ gestation.
Although low birth weight is generally linked to prematurity, some babies born at full term also have low birth weights. In fact, only 70% of low birth weight babies were born premature.
Low birth weight is defined as less than 2,500 grams, very low birth weight as less than 1,500 grams and extremely low birth weight as less than 1,000 grams.
Despite all the preventive measures and available information, not all cases of prematurity and low birth weight can be prevented. This is because the main causes of prematurity and low birth weight include preeclampsia, infection, multiple pregnancy (e.g., twins), high blood pressure, and drug and alcohol abuse. In fact, the rate of preterm births has been increasing for almost twenty years. So what happens to babies who are born prematurely?
In the hospital…
As mentioned above, tremendous progress has been made in the care of premature and low birth weight babies. This has been particularly noticeable in the area of health technologies, which today are omnipresent and play an essential role in the survival of premature and low birth weight babies. Technologies used in the neonatal intensive care unit include resuscitation devices, incubators, gavage feeding tubes, respirators, monitors to check vital signs and medications to help organs mature, to name but a few.
But beyond the medical challenges of saving babies born before 28 weeks’ gestation, there are a variety of ethical, social and legal issues. For example, the parents of a premature baby find themselves faced with a host of treatments, diagnoses and prognoses. Before their eyes, doctors are making complex clinical decisions concerning their baby on a daily basis. While doctors and other health professionals do accompany parents during the decision-making process, it is not easy to ensure that parents are giving their informed consent. These are exceptional circumstances, a time when parents can be overwhelmed by fear and uncertainty.
After the hospital… out of the woods?
Being born premature or with a low birth weight has long-term health consequences. Studies suggest that only 20% of premature babies are free of health problems later in life. The other 80% face problems like cerebral palsy, vision or hearing impairment, cognitive or behavioural problems, and learning disabilities. When the neonatologist’s job is done, physiotherapists, speech therapists, educational therapists and, of course, parents, have to take over. How do these children develop in later years? What resources are available for them and their families? And what is the impact on family life and the relationship of the couple?
To address these and other issues, many countries have started passing legislation. For example, The Netherlands has passed a law preventing doctors from resuscitating babies born before 25 weeks’ gestation. The guidelines of the Society of Obstetricians and Gynaecologists of Canada recommend that the care of premature babies aged 22 to 26 weeks’ gestation be tailored to the needs of both the baby and his/her family. These guidelines are currently being updated.
In our topic of the month, we examine how parents cope with the consequences of premature birth in an interview with journalist Sylvie Louis. We also discuss the decision-making process in the neonatal intensive care unit with Dr. Antoine Payot from Sainte-Justine’s Hospital, a paediatric hospital in Montreal. Finally, Kristina Orfali debates the social and ethical issues, and Louise Seguin provides an epidemiological portrait of low birth weight babies.
|Author :||Stéphanie Tailliez, Ph.D.|
Giroux, Michel T (ed) (2005). La prématurité : Les enjeux parentaux, éthiques et légaux. Presses de l’Université du Québec.