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Better outlook for the earliest preemies?

The tiniest preemies, born between 22 and 26 weeks of pregnancy, now have a better chance of surviving the first year of life. The new findings appear in a study published this week in the Journal of the American Medical Association.

These infants face stark challenges to survival. Their lungs are immature, their skin so fragile that their parents can't cuddle them. Their underdeveloped digestive systems can put them at risk of life-threatening infection if they are fed by mouth. Yet the research team, studying infants born in Sweden between 2004 and 2007, found that 70 percent of early preemies who survived birth also made it to their first birthday. That figure, which improves significantly on previous reports, is a testament to changes in neonatal intensive care and to the fact that doctors are increasingly likely to recommend aggressive treatment of even the earliest babies, the researchers say.

Though encouraging, the findings raise an ethical quandary. Many "survivor" preemies will suffer medical complications such as blindness, paralysis and hearing loss. A 2007 study by a team at Lucile Packard Children's Hospital at Stanford also shows preemies tend to struggle in school. And the experience of having a child hospitalized in the neonatal intensive care unit is very stressful for parents, as research by Packard Children's child psychiatrist Richard Shaw, MD, recently demonstrated.

In short, the toll of preemies' early arrival is still high. And doctors and families still struggle to decide how best to care for the earliest, most fragile babies. As the lead researcher of the Swedish team, Karel Marsal, MD, PhD, told the BBC, "We do not think that intervention should come at any cost."

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