Is it wrong to save them? In the rapidly advancing field of neonatology, doctors have found miraculous ways to save even the tiniest of newborns. Many worry that the implications could be graver than they seem.
Debate over care for tiniest babies
Is it wrong to save them? In the rapidly advancing field of neonatology, doctors have found miraculous ways to save even the tiniest of newborns. Many worry that the implications could be graver than they seem.
Four weeks after conception a human embryo is about the size of a full stop. By week eight it is the size of a raisin, with a heartbeat, minuscule feet and a nose just beginning to grow. By week nine it has toes and by week 12 it has fingernails.
By week 16 a foetus can move and grow tiny hairs. By week 21 it has eyebrows and eyelashes. It finally resembles a tiny human.
At 22 weeks a baby is around the size of a sweet potato. Its lungs and kidneys are still developing. Its immune system is still fragile. And for most of history, babies born at 22 weeks - known as extremely premature - had no chance of survival outside the uterusThe organ in which a foetus (unborn baby) develops. Also known as the womb. . Now, everything has changed.
Doctors call it the "grey zone", the period when a baby is at the very edge of viabilityThe ability to live, grow, and develop.. A baby born at 22 weeks now has a chance of life, with some doctors saying as many as one third could survive where treatment is available.
NeonatologyThe branch of medicine concerned with the treatment and care of newborn babies. has been one of the fastest-paced fields of medical advancement over the past few decades. Back in the 1960s, more than half of all infants born before 32 weeks died.1
However, many of the extremely premature babies saved today will develop long-term health problems, with as many as a quarter suffering from a "severe disability".2 And doctors are keen to emphasise that even though a third may now survive, that still means two-thirds will die.3
There is no predicting how any individual baby will fare with treatment. Doctors are responsible for a weighty moral decision: should they focus on relieving the baby's pain and allowing it to pass peacefully, or on resuscitatingReviving someone from unconsciousness. them to prolong their life with no way to determine the long-term implications?
With an outer layer of skin just a few cells thick, extremely premature babies are prone to injury and bleeding even at the gentlest touch. Their body temperature is volatileCan change quickly and unpredictably. and they can easily develop hypothermiaA dangerous drop in body temperature caused by exposure to cold.. Their immune systems are underdeveloped and they can suffer disastrous infections. They may be in unspeakable pain.
Neonatologists say that almost every parent with an extremely premature baby opts to have medics do any possible procedure to keep their child alive. But among those who have firsthand experience of these painful procedures, opinions differ hugely.
In fact, a 2023 survey of paediatriciansDoctors specialising in children and their diseases. with specialist understanding of neonatal intensive care found that 94% would not choose for their own baby to be offered active care if born at 22 weeks.4
It cuts to the centre of one of humanity's greatest conundrumsConfusing or difficult problems.: how much is it worth to save a human life? Should we expend what could be considerable resources extending the life of a tiny, frail, struggling being whose quality of life might never be good?
Some say it puts doctors in a position where they have to play God, throwing the dice on life and death. Extremely premature babies need around-the-clock care. The pressures are immense and survival is still against the odds.
But others contend that we have a moral obligation to do all we can to preserve each and every soul. As writer George Bernard Shaw said: "Life itself is the miracle of miracles."
Is it wrong to save them?
Yes: Just think of how much pain these tiny, helpless newborns are being subjected to, sometimes for months on end. Think of the grief and uncertainty of their parents. And after all of that, the odds of survival still remain slim.
No: We are not human if we do not do all we can to save a life. It is less a medical question than a philosophical one. That the vast majority of parents opt to actively treat their extremely premature babies shows that it is the only correct choice.
Or... The field cannot develop if we do not allow doctors to treat patients and refine their techniques. Perhaps now only one third of extremely premature newborns survive, but with time and experience treatments will develop and the odds will be better.
Uterus - The organ in which a foetus (unborn baby) develops. Also known as the womb.
Viability - The ability to live, grow, and develop.
Neonatology - The branch of medicine concerned with the treatment and care of newborn babies.
Resuscitating - Reviving someone from unconsciousness.
Volatile - Can change quickly and unpredictably.
Hypothermia - A dangerous drop in body temperature caused by exposure to cold.
Paediatricians - Doctors specialising in children and their diseases.
Conundrums - Confusing or difficult problems.
Debate over care for tiniest babies

Glossary
Uterus - The organ in which a foetus (unborn baby) develops. Also known as the womb.
Viability - The ability to live, grow, and develop.
Neonatology - The branch of medicine concerned with the treatment and care of newborn babies.
Resuscitating - Reviving someone from unconsciousness.
Volatile - Can change quickly and unpredictably.
Hypothermia - A dangerous drop in body temperature caused by exposure to cold.
Paediatricians - Doctors specialising in children and their diseases.
Conundrums - Confusing or difficult problems.