As technological interventions for prematurity have improved, treatment options have increased. In the past, there was very
little to do for a premature baby, and, as a result, many premature babies did not survive. In the 1940s and 1950's, a baby
with severe respiratory problems fared poorly. There was little that could be done to intervene and improve breathing. Now,
the number of techniques to improve breathing is much greater, and outcomes have improved dramatically.
Because such technological interventions are largely responsible for improved survival, there is often a temptation to try
each technological intervention no matter what. It is difficult for parents and physicians alike to watch a premature baby
in distress and not think they must “do something". However, some premature babies, most commonly those who are extremely
premature, will not be saved despite aggressive intervention. Others may survive, but with devastating disabilities and the
prospect of a severely impaired quality of life. Even when people understand that a baby’s outcome is overwhelmingly likely
to be very poor, the temptation to continue technological intervention can be very strong.
In these situations, parents and the staff of the Neonatal Intensive Care Unit (NICU) must struggle to find a balance between
hope and realism. Every parent wants their baby to survive and grow to be a thriving child. The realization that this is unlikely
to happen is hard to come to terms with. At times, it means accepting that “not doing something” can be a better option than
continuing interventions that are unlikely to have any positive effect and may cause prolonged suffering for the baby. Faced
with these dilemmas, many parents and physicians feel that that a certain level of quality of life is more important than
simply life itself. This may be especially true when that life can only be made to continue through constant interventions
and discomfort or suffering for the baby and family.
These life-and-death issues are complex and involve other emotional and ethical considerations. Parents may have to make difficult
decisions and may have to accept that discontinuing aggressive life-sustaining measures and providing comfort or end-of-life
care may be the best option for their premature baby.
