Bioethics Essay: “Long-Term Complications for Premature Infants”

Welcome to this week's installment of my ongoing essay series about contemporary bioethics issues. As always, constructive feedback is welcome. Here is a list of the previous topics I've treated so far:

• “The Evil Effects of Legalizing Euthanasia”
• “The Moral Implications of Artificial Wombs”
• “Mandatory Organ Donation Initiatives”
• “Human-Animal Hybrids and the Catholic Response”

This week's topic:

"Long-Term Complications for Premature Infants"

One of the current debates in bioethics is whether or not it is permissible to induce the early delivery of an unborn child. Unfortunately, when considering the various good and bad effects of inducing labor prematurely, the question of “viability” is sometimes absolutized. While it is true that viability is normative for determining the legitimacy of any early induction, it is also true that the possibility of adverse long term side-effects must also be taken into account, especially when relative goods – such as physical comfort – are the reasons for inducing labor.

These facts are especially relevant to the debates as women more frequently decide to chemically-induce labor rather than have the inconvenience of carrying a child to full gestation.

Rob Stein, writing for the Washington Post (May 20, 2006) notes a sobering statistic: “The percentage of babies born slightly early has been increasing steadily for more than a decade and is now at an all-time high.” He then gives an explanation:

“The increase is driven by a combination of social and medical trends, including the older age of many mothers, the rising use of fertility treatments and the decision by more women to choose when they will deliver. At the same time, medical advances are enabling doctors to detect problem pregnancies earlier and to improve care for premature babies, prompting them to deliver more babies early when something threatens their lives or those of their mothers.”

These babies, he goes on to note, are more prone to a long list of potentially life-threatening complications. The statistics on the long-term effects of being born prematurely are still being gathered. After all, until recently most premature babies had a very poor chance of survival. As a result, only now have the “first generation” of premature babies begun to reach maturity. (In 2002, the largest study of extremely premature babies and their side-effects had been published in the New England Journal of Medicine, January 17th 2002. The children in this study were mostly born between 1977-79.)

While the viability point (normally defined, incidentally, as the point at which a child is at least 50% likely to survive) continues to require less gestation by the mother, Stein notes that “lungs, brains and other organs of babies born even a week or two early are often underdeveloped.” In addition to requiring the services of expensive “Neonatal Intensive Care”, these babies are “about five times as likely to die in the first week of life and about three times as likely to die in the first year than full-term babies.” A quotation from Steven B. Morse of the University of Florida sums-up the situation well: “The thinking had been that these babies were basically the same as term babies. Now it looks like they really are different."

Most long-term medical complications among premature infants have to do with higher brain function. A BBC article from 2003 notes that blindness, underdevelopment, learning difficulties and developing asthma are possible. The online encyclopedia provided by the U.S. National Library of Medicine and National Institute of Health adds many more possible complications, including “bleeding into the brain, mental-motor retardation, heart disease, sever intestinal inflammation, etc.” The March of Dimes website says that premature birth is “a serious health problem” and mentions the possibility of lasting disabilities, notably cerebral palsy. Newborn premature infants are especially susceptible to apnea and chronic lung disease [source].

In short, premature birth is an unnatural, potentially unhealthy occurrence that should not be chosen except for the most serious of reasons. Parents of premature children, however, are not bereft of support. Websites such as Prematurity.org and ComeUnity provide a wealth of resources. The later especially aids in ensuring that premature infants at a high risk for development delays are given “development follow-ups” to ensure that they are keeping up to overall peer standards. +++