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74   The Premature Baby Starts
     Life in Precarious Condition
     The Washington Post, Saturday, December 9, 1967

     The degree of risk of dying within the first year of life is the
most obvious way to assess the public health significance of immature
births.

     We have a certain amount of scientific information on which to
base intelligent programs of prenatal care, but these are still far
from being widely enough available to mothers who need them most.

     We also have much to learn about the causes of premature delivery
and of retarded fetal development.  For example, the most common
disease of pregnancy, which leads to prematurity, maternal toxemia or
eclampsia, is still a medical enigma. 

     The care of immature babies is one of our major health problems.
More of such children are being saved by the painfully slow progress
in techniques of care.  The risk of dying is then gradually replaced 
by a risk of survival--with the possibility of lifelong impairments.

     "Are these babies worth saving?" some have asked.  Apart from
the moral imperatives that relate to our responsibilities for human
life, is this an area that warrants a high priority for investment
of our material and intellectual resources?  Whether we perceive it
clearly or not, we do ultimately make choices, and cannot completely
evade making some comparative judgments about values of human lives.

     There is no doubt about the statistical association of low birth-
weight and a range of physical abnormalities, of which the most   
important reflect damage to the brain: blindness, deafness, cerebral
palsy with impairment limb movements and of speech to varying degrees.

     Our health statistics are too disorganized to give very good
quantitative data of much use for predictive purposes.  They are even
less useful for scientific analysis, and we are still puzzled how
much brain damage is the result of premature delivery and how much
accompanies growth retardation caused by something else.

     For several years, the National Institute of Neurological
Diseases and Blindness has been sponsoring a comprehensive 
prospective study, involving the collaboration of about 15 hospitals 
throughout the United States.

     More than 50,000 randomly selected births will be followed up in
hopes of obtaining the first sound statistics on the prevalence of 
congenital diseases and the pre and post-natal factors associated 
with them. This study probably only barely large enough to give a few
hints about our most urgent questions, and it will be some years
before the data are fully assembled and analyzed.

     Dr. Alison McDonald of Guy's Hospital, London, recently published
a survey of 1128 children born at four pounds or less.  About a
quarter of a million births would have to be scanned to identify this
number of low-birthweight children.  They were from 6 to 8 years old
at the time of the followup, and therefore old enough so that their 
physical health could be assessed.

     Researchers located 1066 of the children for the followup.  Of
these, 111 were diagnosed as severely blind, deaf or palsied.  
German measles may have been involved in prenatal damage to some of 
these children.

     The brain-damaged children often had associated difficulties in
their intellectual development.  Even so, more specialized training
might have helped them.

     Perhaps the most optimistic finding was the virtually normal 
average I.Q. of the remaining 90 per cent of the children.  This
suggests that the main manifestations of immaturity will be revealed
by careful neurological examinations of the infant, and that later
intellectual development is unlikely to be impaired without obvious
early signs.

     The importance of careful early examination for defects in
hearing and sight is underscored by these studies of immature infants,
but obviously applies just as strongly for every young child.

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