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The very tiny baby, multiple births, and other questions about preterm deliveries
1Hopital Cochin, Université René Descartes, Paris, France.
Insights
Advances in intensive care improve survival for very preterm infants but increase costs and handicap rates. Limiting supermultiple births, often caused by ovulation drugs, is crucial for ethical and economic reasons.
Area of Science:
- Neonatalogy
- Public Health
- Reproductive Medicine
Background:
- The evolving limit of viability for very preterm infants has led to improved survival rates.
- This progress, however, is associated with increased intensive care costs and a higher incidence of severe handicaps.
- Multiple births, particularly triplets and quadruplets, significantly contribute to premature births, mortality, healthcare expenses, and developmental risks.
Purpose of the Study:
- To analyze the impact of changing viability limits on preterm infant outcomes and healthcare costs.
- To investigate the role of multiple births in preterm delivery complications and associated economic burdens.
- To advocate for preventative strategies regarding supermultiple pregnancies to mitigate ethical and economic concerns.
Main Methods:
- Review of survival and handicap data for very preterm infants.
- Analysis of healthcare costs associated with intensive care for premature neonates.
- Examination of the correlation between ovulation-inducing drugs and supermultiple pregnancies.
Main Results:
- Improved survival for very preterm babies is linked to higher intensive care costs and increased rates of severe handicaps.
- Supermultiple births (triplets, quadruplets) are strongly associated with severe prematurity, high mortality, elevated costs, and significant handicap risks.
- Ovulation-inducing drugs are a primary cause of supermultiple pregnancies, highlighting a key area for intervention.
Conclusions:
- Prevention of supermultiple pregnancies, often drug-induced, is a more effective and ethical solution than solely relying on acute care.
- Limiting supermultiple births offers significant ethical and economic benefits by reducing premature births, mortality, and long-term care needs.
- A focus on prevention is paramount for addressing the challenges posed by very preterm births and multiple gestations.
Abstract:
The progressive change of the limit of viability accepted for very preterm babies has resulted in a progressive improvement of survival, but also in costs for days spent in intensive care and for numbers of severely handicapped babies. Multiple births, including twins but especially triplets and quadruplets, result in severely premature births, high death rates, high costs, and severe risk of handicap. As most supermultiple pregnancies are the result of ovulation-inducing drugs, this rise has to be limited. More than acute care, prevention is the only good solution, from both an ethical and an economical standpoint.