Cost 'dilemma' posed by premature babies

ADVANCES in the care of very premature babies have led to a growing number of handicapped children who are costing the NHS significant sums to care for, and who may need lifelong support, health economists said yesterday.

The capacity of medical science to save low birth-weight babies is creating a new ethical dilemma for doctors and parents, according to a report. One in five of very premature babies suffers some form of neurological impairment. The report says the cost of saving such lives, and caring for them in childhood, would be better invested in trying to stop pre-term births or in other areas of health care.

George Teeling Smith, director of the Office of Health Economics (OHE), which published the report, said that a balance had to be struck 'between the creation of suffering and the advance of science'. Doctors were guilty of 'almost experimenting' with babies weighing 500g (about 1lb).

Improvements in neonatal intensive care have enabled the survival of many babies born well before term. In 1980, at the Hammersmith Hospital, London, there were only two out of eight survivors (25 per cent) among babies born between 26 and 27.9 weeks. By 1991, five out of nine (56 per cent) of this age survived.

The improvement is most marked when looking at the survival of babies weighing less than 749g (about 1lb 10 ozs), the report says. Between 1980 and 1983, there were no survivors at this weight at the Hammersmith; by 1991, although numbers were small, six out of nine (67 per cent) survived.

But improved survival - even for a small number of pre-term babies - does not come cheap. In 1990, neonatal intensive care for babies weighing less than 1,500g (3lb 4oz), cost the NHS between pounds 42m and pounds 70m - about pounds 20,000 per infant. For a child left handicapped as a result of pre-term birth, there are the additional social and health care costs in childhood, the costs of education - pre-term babies are up to 50 per cent more likely to need special education - and lifelong support if the individual is unable to work.

Jane Griffin, an OHE researcher who compiled the report, said: 'The ability to preserve the lives of these infants must be weighed against the resultant increase in the numbers of impaired children, the distress and suffering caused by lengthy treatment and hospitalisation, their eventual expected quality of life, and the socio-economic consequences for society as a whole.'

Ms Griffin said that pre-term birth prevention programmes should be considered to educate the public about risk factors associated with premature births. These include failure to attend ante-natal care clinics, smoking and alcohol abuse, emotional and physical stress. Such a programme in France reduced the pre-term birth rate from 8.2 to 5.6 per cent over 10 years.

Born too soon; OHE, 12 Whitehall, London SW1A 2DY, pounds 5.