Jeremy Laurance: Survivors who put pressure on welfare state
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Your support makes all the difference.The survival of babies born three months early and weighing less than a bag of sugar is a modern medical miracle.
They enter the world with immature organs and skin, under-developed lungs and fledgling immune systems. Their first few months are a roller-coaster - doing well one minute, their lives in the balance the next - yet survival rates have improved dramatically. Ten years ago, three quarters of babies born at 25 weeks died. Now less than half do so.
This success has created a problem: there are more premature babies who make more demands on the health and education services. Children born prematurely are more likely to have premature babies themselves when they become parents, fuelling the increase. And the growing popularity of IVF - putting back more than one embryo in the womb increases the chance of a multiple, and hence premature, birth - is also driving the trend.
Concern has focused on the growing number of extremely premature babies, of 23 and 24 weeks gestation, who are at highest risk of suffering severe long-term impairment. Is everything being done that should be for these babies, or is too much being done because it is technologically possible?
Optimists point out that while the attrition rate at these ages is very high, it is lower than it was and improving all the time. A decade ago, babies born at 28 weeks had similar outcomes to those now born at 24 weeks. That is testimony to medical advance and there is no reason why it should not continue.
Pessimists say that though the successes are impressive, the price of failure, for the parent of a child who grows up profoundly disabled, is too great.
Both sides agree, however, that research is needed to understand the causes of the increase and the measures needed to curb it.
Some experts say it is the less severely affected babies that are most worrying because the effects on them are more subtle - revealed in educational problems and conditions such as diabetes. The dangers of extreme prematurity are well known.
Andrew Shennan, the professor of obstetrics at St Thomas' Hospital, said: "If you want to address the big health problems affecting society, this is where to start."
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