Europe's doctors grapple with infant viability

By Eric Johnson Aug 28, 2006, 11:32 GMT

Prague - Europe's trend toward mothering at a more mature age is contributing to a new wave of ethical challenges for doctors in the delivery room.

Medical researchers in Norway, Belgium and other countries say doctors are facing increasingly difficult questions about the limits of post-delivery care for extremely premature babies.

Along with parents, doctors find themselves grappling with questions about how and when to withdraw or withhold care for those newborns whose chances of survival are slim.

It's a growing concern because premature birth rates are rising in many areas, according to researchers. One reason is that more European women over 35 years of age are choosing to have babies, despite studies that say older women are at higher risk of giving birth prematurely.

At a recent neonatal medical conference in Prague, researchers described the variety of paths doctors and hospitals are taking to meet the challenges posed when babies are born 12, 14 or even 16 weeks early.

Advances in medical technology have given doctors more options for administering life support. But the tough decisions about how far to treat a premature baby cannot be made by machines.

The largest study on the topic at the European Congress of Perinatal and Neonatal Medicine found that more than 100 hospitals in 10 countries have custom-tailored their policies for dealing with very pre-term babies.

'Wide variations' in policies were cited in the study, whose lead researcher was Dr Louis Kollee of the University Medical Centre in Nijmegen, Netherlands. Kollee made headlines two years ago by calling for governments to protect doctors who give deadly injections to unviable newborns.

The study found doctors in only one third of the hospitals, across Europe from Poland to Portugal, follow written protocols when deciding when to withhold treatment. The rest have no administrative guidelines.

Parents may share in the decision-making in 76 per cent of the hospitals, the study found, but only a handful of hospitals have ethics committees that get actively involved in decisions surrounding premature births.

A separate survey from the University of Bergen in Norway found most of the 15 Norwegian doctors interviewed think parents should be consulted when deciding whether to begin or withdraw life support for critically ill newborns.

Yet the study said the 'common agreement' among those surveyed was that 'the decision of whether or not to stop treatment of a critically sick newborn should rest upon the doctor.'

But consensus about such life-or-death decisions is difficult to find among Europe's medical professionals. A report by Belgian researchers for example found doctors 'are attempting to reflect on the difficult topic of the extreme limits of viability' for premature babies.

In France, the study says a medical protocol recommends that a baby should not be considered viable if born more than 15 weeks early. In Belgium, however, no similar guideline exists.

The report also cited the difficult case of a health professional who had a premature baby and decided to have care withheld, but clashed with other hospital doctors who sought to save the baby. A court case ensued.

These examples showed 'these is still much work to be done,' the study concluded, raising the possibility of forming a European 'task force' to tackle the issue.

Such a task force could be formed if premature birth rates continue to rise - a possibility raised by another group of Belgian researchers. They reported 'a constant increase in the rate of prematurity' over the past decade in Flanders, Belgium.

'The primary cause of the increase seems to be the age of the mother,' the study said, adding that in Flanders, the number of mothers over age 35 rose by one-third over the period.