Professor Malcolm Levene

Dr Malcolm Levene wrote an article in the medical journal Acta Paediatricia called "Is intenstive care for very immature babies justified".

He is calling for further debate and honesty on the subject. Here are his views on saving extremely premature babies.

In the early days we had the belief that if they survived, the risk of severe handicap was relatively small.

Then, simply having a surviving baby was seen initially to be a success. But of course as more babies survived we became more concerned about those who did survive but had severe brain damage.

In fact, one of the disappointments over the last 15 to 20 years, is that we really have not made a significant impact in terms of reducing brain damage.

My views on intensive care for extremely premature babies have changed a lot over the years.

It is very easy to believe that as a baby goes home and the parents are very grateful to the staff for everything that they have done that it has been a great success.

Probably there is an outcome that is worse than death

Actually seeing the babies who come back with severe disability makes you realise that probably there is an outcome that is worse than death.

Certainly it is time to reassess, because as we have got better at keeping babies alive, it has emerged that the outcome is not as good as we initially thought it would be.

Greatest risk

The area of greyness where I think that we have to re-evaluate is in babies born at 22, 23 and 24 weeks gestation.

Those babies are 16 to 18 weeks premature - and the data that we are getting is suggesting that there is a significant risk of significant handicap.

We should not be inhibited about letting people know that there is a significant risk of disability if the baby survives at very, very immature gestation.

I think one of our problems is that the attitude that the public have towards neonatal intensive care is that it is a great success story: "miracle baby - tiny baby survives".

We have to ask ourselves whether society... feels that this is appropriate

And I think we now have to approach that openly and honestly and ask ourselves whether society, not the medical profession, but society, feels that this is appropriate to treat all these babies as aggressively as we do.

Having said that, I think having blanket decisions (like in Holland) that we must not ventilate 23 week babies is not the way I would like to see things go.

I personally think the Dutch approach is not the approach that we should be adopting. I think it is very difficult to take arbitrary gestation cut-off limits.

Family's views

We as doctors are also not in an appropriate position to decide whether the family has the wherewithal to be able to support a severely disabled child. That has to come from the family.

When I see babies who are severely disabled, effectively babies who remain babies all their life, it is an enormous responsibility that the parents have.

There is no doubt that there are some families who have said to me that they wished that intensive care had never been started because their baby, their child, is so severely disabled.

And that has put such a strain on their family, not just the mother and father, but the other children, the extended family.

But equally I've seen children who have apparently been of equal severity in disability who receive the most wonderful loving care from their family.

Panorama: Miracle baby grows up is broadcast on BBC One on Wednesday, 22 September, 2004 at 21:00 BST.