There are many types and degrees of intervention that premature babies may go through. The amount and type of treatment a
baby may need depends on the condition of that baby. Most premature babies are only mildly so. For these babies, usually any
treatments will be minor. However, the more premature a baby is, the more likely she will require some form of intervention
due to her condition.
Recreating the environment of the womb
As much as possible, the experience and treatments in the Neonatal Intensive Care Unit (NICU) are done to provide time so
that a baby can mature as naturally as possible outside the womb. Often, the stay in the NICU is precautionary: once the baby
has settled into her artificial environment, she is simply monitored while she catches up on the time that would have been
spent maturing in the womb.
Simulating as much as possible the environment of the womb in a NICU can be seen as a treatment. Like the womb, the NICU is
dark, quiet, and warm, and the baby is protected from knocks and infection. Depending on her degree of prematurity, a baby
may require other support, particularly with breathing and cardiovascular issues. Premature babies may also require support
for their body chemistry in some way. Frequently this may mean ensuring the right balance of fluids and electrolytes that
the premature baby’s body cannot yet regulate on its own.
All these interventions may occur even though there is nothing “wrong” with the premature baby. Often, the only thing “wrong”
with premature babies, especially those who are only a few weeks premature, is that they are in the wrong place and still
need time to develop and adjust to the outside world.
The combination of all these treatments can be considered an “intensive care package” in that the benefits of each individual
intervention may not be as apparent as the package as a whole. In other words, the sum of treatments in the NICU is often
greater that the individual parts.
Treating specific conditions
Beyond creating an environment that will encourage premature babies to develop normally, treatments address distinct problems
or conditions. Usually, treatment follows diagnosis. However, if doctors deem that the risk of waiting for a diagnosis outweighs
the risks of beginning treatment, an intervention may begin right away even if a diagnosis has not been confirmed. For example,
if an infection is suspected, the doctor will likely not wait the hours needed for a laboratory to confirm the infection and
antibiotics, the usual treatment for infection, will begin right away.
This concept of risk versus benefit applies to all treatments. Although it is usually extremely small, all treatments carry
some risk. However, the probable benefit of treatment often outweighs the risk of not doing anything.
Group statistics and the individual premature baby
When a premature baby has a certain condition, physicians often know the right course of treatment because of research. Over
time, evidence has built up that for a particular condition, a certain treatment tends to work. But there is a measure of
uncertainty: what generally works for the majority of patients, even the overwhelming majority, may not work in an individual
case. It can be difficult to know whether a particular baby will respond to a certain treatment and how well.
When treatment does not work
The goal of treatment is to improve the condition of the baby. If a premature baby has an infection, the goal of the treatment,
antibiotics, is to fight off the infection.
Sometimes, usually only in the more severely premature babies, treatment does not work and the prospect for success using
further treatments is not good. In these cases, which are sad for all involved, the temptation may be to continue treatment
anyway. These temptations are usually motivated by emotional considerations of the parents. In these situations, parents may
feel a need to “do something” even though doing something will not make the premature baby well and may subject the baby to
further risks and additional discomfort.
It must be remembered that treatment is not a goal unto itself. Rather, it is a method to try and reach the goal: improving
the condition of the premature baby. The desire to continue treating a premature baby despite the overwhelming likelihood
that the treatment will fail is understandable, given the circumstances. Parents want to feel that they did everything they
could. They often feel that they could not live with the guilt if they did not do everything. However, this is not a rational
response to what is undoubtedly a difficult situation. Treatment decisions must be made in the premature baby’s best interest
and, in some rare cases, the decision not to continue treatment may in fact be in the baby’s best interest.
