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(Agencies)
Updated: 2008-04-17 08:59

ATLANTA - Doctors now have a better way of helping parents make an agonizing decision — whether to take heroic steps to save a very premature baby. The number of weeks in the womb has generally been the chief factor.

Clara Elaine Tuley, born Jan. 4, 2008, was 1-pound 6-ounces when she was delivered by emergency Caesarean section, to Jolene Tuley, left, who was 23 1/2 weeks into her pregnancy. Clara, who is shown with her parents Jolene and Sean Tuley of Mount Juliet, Tenn., at Vanderbuilt Children's Hospital, in Nashville, Tenn., Tuesday, April 15, 2008, is now 5-pounds 5-ounces and is scheduled to go home soon. [Agencies]

But a new study shows others are important, too — including whether the infant is a girl and whether the child gets lung-maturing steroids shortly before birth.

Those extra factors can count as much as an extra week of pregnancy.

The new information could change how doctors and parents decide what kind of care to provide to tiny, fragile premature infants, said John Langer, a co-author of the study being published this week in the New England Journal of Medicine.

Besides being a girl and getting the steroids, an extra 3 1/2 ounces or so of weight and being a single birth also helped as much as an extra week of pregnancy, the study found.

"For the first time, parents and their doctors will have the best available information on which to base one of the most difficult and time-sensitive decisions they are ever likely to face," said Langer, who works in Maryland as a statistician for the North Carolina-based Research Triangle Institute.

The research focused on extremely premature babies, those born after 22 to 25 weeks in the womb. A full term is about 40 weeks.

Extremely premature babies face some of the longest odds of survival and often are placed on breathing machines or given other special help. They often weigh just 1 1/2 pounds and measure 10 or 11 inches — not much longer than an average adult's hand.

These births present parents with a terrifying choice — whether to take extreme measures to save the child, possibly destined for a life of severe disability, or stop treatment and allow the child to die.

The new study focused on nearly 4,200 extremely premature infants born at hospitals across the country.

Half died within two years after birth. About 12 percent survived but had significant impairments like blindness, deafness or cerebral palsy. About the same number had even more severe physical or mental disabilities.

Gestational age — the number of weeks from fertilization to birth — is closely connected to chances of survival. In the study, of babies with a gestational age of 22 weeks, 95 percent died. At 23 weeks, about three-quarters died. At 24 weeks, less than half died, and at 25 weeks, only about a quarter died.

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