In extremely early births, making life-or-death decisions

Melinda Guido
This undated photo provided by Melinda Guido's family shows Melinda in the neonatal intensive care unit at the Los Angeles County-USC Medical Center. Melinda was born premature at 24 weeks weighing 9.5 ounces.
AP Photo/Haydee Ibarra

About 30,000 American babies are born so prematurely each year that they will face serious, lifelong problems, according to an op-ed in The New York Times.

Advances in neonatal medicine have allowed preemies as young as 23 weeks' gestation to survive. But these cases raise thorny questions about how doctors and families make the difficult decisions concerning the lives of these children.

So how do doctors help parents decide whether to treat an extremely premature baby with a bleak prognosis?

"Our culture is slowly growing more comfortable talking about end-of-life issues as they relate to the elderly: whether to allow a natural death or prolong life even if it means suffering," April R. Dworetz, a neonatologist at Emory University, writes in the Times op-ed.

But parents of preemies "are still completely unprepared. It's time we broaden the discussion to include them."

Many parents do not fully grasp the severity of the situation involving their critically ill newborns, according to research at Johns Hopkins Children's Center.

"It really boils down to: Make two-way communication with parents a top priority. Period," says Dr. Renee Boss, a neonatologist at Johns Hopkins Children's.

Dworetz also recommends that pregnant women and their partners discuss their values about life, death and disability with their ob/gyns or others.

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"One thing that we, clinicians, must always keep in mind is that talk doesn't equal communication, and just because we spoke with a parent we cannot assume that our message got across," says senior investigator Renee Boss, M.D., M.H.S., a neonatologist at Hopkins Children's Center. (

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