Two articles in the July issue of Pediatrics address the issue, and they are, I think, for the most part reassuring to those of us who routinely resuscitate extremely premature babies.
Both articles are from Sweden. One of them looks at how preterm infants born in 1973 to 1979 are doing at the age of 23 to 29 years. Not surprisingly, the more preterm you are the greater your chances of having a disability. However, the percentage of people born at 24 to 28 weeks with disabilities was only 13.2%, and only 18% of them live with their parents. Sure, there's still room for improvement, but it's good to see that the large majority of 24 to 28 weekers were reasonably functioning adults.
The second study examined mental health and social competencies of 10 to 12 year old children born at 23 to 25 weeks gestation. Again, to some degree it's a good news/bad news report. On the one hand, the extremely preterm born children were more likely to have problems with anxiety, depression, attention, thought, and social problems, and more that one-half were experiencing school problems. On the other hand, though, 85% of them were attending mainstream schools, and the majority were not having major adjustment difficulties.
I find these studies reassuring and am especially glad to have them in light of the Epicure study, a study done in the 1990's in Great Britain of 23 to 25 weekers that, frankly, demonstrated pretty crummy outcomes. There are many of us neonatologists who believe that the Epicure results are not truly representative of outcomes of most 23 to 25 weekers, and these Swedish studies provide data to support that belief.
This hardly, of course, ends the discussion about resuscitating these kids, but perhaps it will help some people understand why I feel a little funny if I don't resuscitate a 23 weeker.