Doctors should attempt to save premature babies born after 22 weeks, medical leaders say

Mason Boycott-Owen
Previous guidance included a presumption against attempting to provide life-saving treatment to a baby born before 23 weeks - PA

Doctors should attempt to save premature babies born after just 22 weeks, medical leaders have said. The change in official guidelines follows a doubling of survival rates among severely preterm births in the last 10 years.

The policy shift from the British Association of Perinatal Medicine (BAPM), which suggests babies have a fighting chance of survival two weeks before the legal abortion limit, last night prompted calls to review the current law.

The previous clinical guidance, drafted in 2008, included a presumption against attempting to provide life-saving treatment to a baby born before 23 weeks, on the basis it would not be in the child’s best interests.

However, since then the survival rate for babies born at 23 weeks has increased from two in ten to four in ten.

This is due to a raft of technical advances, the increased use of steroids and better planning so mothers who go into preterm labour go straight to specialist units.

The new guidance states that, after consulting the family, doctors should try to save the child if they judge it is in their best interest.

Dr Helen Mactier, President of the British Association of Perinatal Medicine and Consultant Neonatologist at the Princess Royal Maternity in Glasgow, said: “We’ve got better at keeping extremely premature babies alive and we know clinicians are increasingly willing to consider survival-focused care for the most extremely premature babies.

“We have a responsibility to offer the best possible care to the baby and consistent advice and guidance to worried parents.

“Sometimes this will mean that the mother should be moved before birth to a maternity care centre alongside a neonatal intensive care unit.”

Babies born between 22 and 26 weeks are considered extremely premature, and there is a large variance in the outcomes of babies born over this period.

Around seven out of 10 babies born at 22 weeks die despite receiving intensive treatment, while eight out of 10 babies born at 26 weeks now survive.

Although the new guidance makes no mention of the laws surrounding abortion, pro-life groups have seized on the evidence contained within it.

Right To Life UK spokesperson Catherine Robinson said: “There is a real contradiction in British law.

“In one room of a hospital, doctors could be working to save a baby born alive before 24 weeks whilst in another room a doctor could perform an abortion which would end the life of a baby at the same age. Surely this contradiction needs to end?”

A spokesperson for pro-choice charity, British Pregnancy Advice Service said: "There is no contradiction between doing all we can so that babies born long before they are ready for the world have a chance of living, and ensuring that the very small number of women who need to end pregnancies in the final weeks of the second trimester, often in incredibly tragic and desperate circumstances can do so. 

“We must not pit women who have premature babies and women who have later abortions against one another.”

The BAPM committee said perinatal medicine may continue to advance at a rapid pace, but that current evidence suggested babies born at less than 22 weeks would not survive.

Dominic Wilkinson, Professor of Medical Ethics at the University of Oxford said that the guidance comes as medicine moves towards individualised medical care where “complex decisions can’t be reduced to simple rules.”

“It is possible, in 2019, to save babies who could not previously have survived. That is fantastic news,” he said.

“But the very high risks mean that it is not always the right thing to do to provide intensive medical treatment.

"We can't say what might be possible in the future but we are coming up against the limits of physiology.”

Babies developing in the womb have usually only grown the very earliest parts of the lung able to exchange oxygen by 22 weeks gestation.

Professor Wilkinson said that for this reason some can just survive at 22 weeks but before that point they have no ability to get oxygen into their blood.