EPICure is a series of Medical Research Council funded studies on the survival and later health among babies and young people who were born at extremely low gestations, from 22 to 26 weeks. The latest results were published on 4th December, and the Press Release headline contains a mixture of good and bad news,
“More babies survive before 27 weeks, but severe disability rates remain unchanged”
While the focus of the BBC and other reports was the rates of survival, (“Severely premature babies: More survive being born early”), The Independent highlighted the implications of the results on assessments of the abortion limit, and Cabinet ministers’ claims that the abortion limit should be lowered because “the science has moved on”, (“Science refutes ministers’ abortion claims”).
However, the findings also raise other issues of medical ethics and resources. Commenting on the report, Dr Simon Newell, a consultant in neonatal medicine at Leeds General Infirmary and vice-president of the Royal College of Paediatrics and Child Health, is quoted as saying that:
“these studies were “essential” when it came to difficult decisions about whether to pursue intensive care, or even to withdraw care”
“It’s not what we can do, but should we do it … without these sorts of data how would we know what to say to parents, what to do?”
While 11 per cent more severely premature babies survived to age three without disability, the proportion of survivors born between 22–25 weeks with severe disability was about the same. Consequently, since the rates of premature birth are increasing in many European countries, particularly in the UK, the total number with the most serious problems has also increased.
Background
The EPICure results relate to two studies led by UCL (University College London) and Queen Mary, University of London, which compared a group of babies born between 22-26 weeks’ gestation in 2006 with those born between 22-25 weeks over a 10-month period in 1995. They do not include more recent data, and the researchers did not indicate whether subsequent improvements had been made.
The first study addressed the immediate survival rates and health of extremely pre-term babies born in 2006 (i.e. until they went home from hospital) and compared these with the same measures taken in 1995. This found no significant increase in survival of babies born before 24 weeks – the current legal limit for abortion – and the number of babies who experienced major health complications remained unchanged. However, there was an increase by 44 per cent of these babies admitted to intensive care, and this was accompanied a 13 per cent increase in overall survival (from 40 to 53 per cent).
The second study concerned the health of the 2006 babies at three years of age and compared this with findings from the 1995 cohort at a similar age. It found there was a relationship between gestation and the risk of disability, with babies born earlier being more likely to have serious health complications at three years of age.
The studies are reported in the British Medical Journal, here, and here.
Comment
The EPICure research considered only the medical issues related to babies born at extremely low gestations and was concerned with survival rates and not the criteria for late abortion. Nevertheless, the ministers’ assertion the “the science has moved on” on two counts is not supported by the survival statistics, i.e. up to the point when a baby is discharged from hospital: 2% at 22 weeks; 19% at 23 weeks; 40% at 24 weeks; 66% at 25 weeks; and 77% at 26 weeks.
Although there is an increased survival of these babies, that increase is all happening in the first week of life, i.e. developments in “the science” (the 13% increase in survival rate) relate the medical care given to mothers who are likely to deliver prematurely as well as to the premature baby.
The increased number of children with problems related to their prematurity has risen is significant in relation to the planning of services to provide the necessary support that the children and their parents. As Andrew Whitelaw, professor of neonatal medicine at the University of Bristol, said
“The average survivor was in hospital for over three months and this represents an investment of scores of thousands of pounds per baby.
“Having made this commitment it is clearly important that this is followed up by a smaller investment in support for the minority that have extra needs because of learning difficulties, visual impairment &c.”
The EPICure study results concerned the practical issues associated with the survival of severely premature babies, and although an important concern in informing the debate on abortion limits, it did not address this in relation to the state of development at 22 to 26 weeks.
An earlier post summarized the religious, medical and legal issues from conception until after the birth. Whilst these new results address only one of these components, they do provide evidence that will ensure that decisions in this area are based upon “sound science”.