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Ethical issues in treatment of babies born at 22 weeks of gestation

John D Lantos1

  • 1Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri, USA jlantos@cmh.edu.

Archives of Disease in Childhood
|April 15, 2021
PubMed

Insights

Many 22-week premature babies survive and are neurocognitively intact, yet some centers withhold life-sustaining treatment. This essay argues against this practice, citing ethical concerns and advocating for improved care and research for extremely preterm infants.

Area of Science:

  • Neonatal Medicine
  • Bioethics
  • Perinatal Research

Background:

  • Survival rates for infants born at 22 weeks gestation have improved significantly, with over half now surviving.
  • A majority of these survivors are neurocognitively intact, challenging previous assumptions.
  • Despite improved outcomes, many medical centers still do not offer life-sustaining treatment to extremely premature infants.

Purpose of the Study:

  • To examine the ethical arguments against providing life-sustaining treatment to 22-week infants.
  • To evaluate concerns regarding survival rates, neurodevelopmental impairment, and cost.
  • To propose changes in institutional practices and research focus for extremely preterm neonates.

Main Methods:

  • Ethical analysis of current arguments against treatment for 22-week infants.
  • Review of contemporary data on survival and neurodevelopmental outcomes.
  • Examination of cost-effectiveness in neonatal intensive care.

Main Results:

  • Arguments against active treatment for 22-week infants are ethically problematic.
  • Current data support the survival and intact neurodevelopment of many extremely preterm infants.
  • Concerns about survival rates, neurodevelopmental impairment, and cost do not ethically justify withholding treatment.

Conclusions:

  • Institutional culture must evolve at centers that deny treatment to 22-week infants.
  • Further research is essential to establish best practices for the care of extremely preterm babies.
  • Ethical considerations necessitate a re-evaluation of treatment thresholds for neonatal care.

Keywords:
ethicshealth care economics and organizationsneonatologypalliative care

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