By Liz Szabo, USA TODAY  When their son Andrew was only 5 days old, Rachel and Kyle Fox had to make one of the most painful of all decisions: whether to continue aggressive medical treatment to try to save him.  Andrew and his twin sister were born after only 23 weeks in the womb — just over halfway through a typical pregnancy. Andrew was especially fragile and needed an operation to repair a hole in his colon, a procedure that left the 1½-pound boy even sicker than before.  Andrew's doctors, reluctant to cause him any more pain, asked the Houston couple whether they would prefer to provide only "comfort care" rather than additional invasive measures.  Discussions such as this aren't uncommon. About 40,000 extremely small babies — less than 2.2 pounds — are born each year, says the National Institute of Child Health and Human Development.  The institute financed a study, published in today's New England Journal of Medicine, that aims to provide the parents and doctors of very premature newborns with a better way to assess children's chances of survival or disability.  "All parents want to fight for their children, but parents and doctors are also afraid of doing too much," says Michele Walsh, medical director of the neonatal intensive care unit at Rainbow Babies & Children's Hospital at Cleveland's Case Western Reserve University. Walsh participated in the study.  Today, doctors estimate a newborn's chances of survival based on gestational age, says study co-author Nehal Parikh of the University of Texas Medical School at Houston. Parikh, who treated Andrew, says hospitals also should consider four additional factors: birth weight, sex, whether a mother was given steroids before delivery to mature the baby's lungs, and whether infants are "singletons" or part of a multiple birth such as twins.  That allows doctors to predict survival with a 3% margin of error, according to the study, which followed 4,400 infants. Gestational age has a 12% margin of error.  Estimates of gestational age can be off by a week or two, Parikh says.  For extremely premature babies, however, every week is crucial. Hospitals provide intensive care routinely to babies born at 25 weeks, but rarely at 22 weeks, when newborn lungs are typically too immature to function outside the womb, he says. Babies are considered full-term at 37 to 42 weeks.  But all preemies aren't the same.  The study notes that a girl born at 24 to 25 weeks at 1.7 pounds who was treated with steroids has a 33% chance of dying or being profoundly impaired. That risk rises to 87% for a twin boy of the same age who weighs 1.2 pounds and who didn't get steroids.  Rachel Fox says her daughter Hannah fared better than her son from the beginning. Hannah left the hospital after 6½ months and is now a healthy 5-year-old in prekindergarten.  Ann Stark and Eric Eichenwald, pediatricians at Houston's Baylor College of Medicine who wrote an accompanying editorial, note that the study was conducted at hospitals with top-tier neonatal units. Babies may not fare as well at medical centers with less expertise.  Rachel Fox says she found solace in knowing that her children got the best treatment. After her son's surgery, she and her husband decided to stop intensive treatments. He died later that day.  "I had peace," Fox says, "knowing they had done everything they could do."  You share in the USA TODAY community, so please keep your comments smart and civil. Don't attack other readers personally, and keep your language decent. Use the "Report Abuse" button to make a difference.
A new study provides better ways for doctors and parents to decide which extremely premature babies need intensive care, and which ones could suffer needlessly from interventions with no chance of survival. Doctors already make these decisions every...