Helping premature babies born before 24 weeks

A study carried out by teams at Evelina London’s neonatal unit, and recently published in the BMJ Paediatrics Open, has helped to improve understanding about how neonatal units can help premature babies born before 24 weeks.  

Over recent years, there has been in increase in babies born before 24 weeks and then treated in Evelina London’s neonatal unit. One of the reasons for this has been the change in national guidance (in October 2019) about extremely premature babies, including those born at 22 weeks.

The Evelina London team wanted to increase understanding of the diagnostic and treatment options for such premature babies and how these impact these babies.

Clinicians at Evelina London reviewed their experience of treating 56 babies born before 24 weeks between January 2015 and December 2021. The team focussed on the treatment of necrotising enterocolitis, a serious illness that affects approximately 1 in 10 babies born prematurely. The condition causes tissues in the intestine to become inflamed, and this can cause a dangerous infection.

They compared the outcomes of babies born before 24 weeks that underwent surgery for necrotising enterocolitis with those receiving only medical management against a control group of babies without the condition. The study showed that ultrasound can be helpful in the diagnosis of necrotising enterocolitis and that surgery can be offered as a reasonable treatment option.

Mr Iain Yardley, a consultant paediatric surgeon at Evelina London Children’s Hospital, and lead author of the study, said: “Having a baby born so prematurely is distressing and uncertain for families. The more experience we have looking after these vulnerable babies, the more accurately we are able to make diagnoses of potential problems such as necrotising enterocolitis and have honest, evidence-based conversations with parents and carers. We have seen that the signs of necrotising enterocolitis can differ in extremely premature babies to more mature babies so an individualised approach to diagnosing it and to subsequent decision-making is important. We have found that ultrasound scanning can be a really helpful tool in diagnosing necrotising enterocolitis in babies born before 24 weeks.

“Sadly, we know there is a lower chance of survival and an increased risk of problems when babies are born extremely prematurely. We have found that surgery can be a reasonable option for babies born even as early as 22 weeks into pregnancy and decisions about operating on these babies should be made following discussion with the family, taking into account the overall status of the baby. Further research is needed and we hope our findings will provide the impetus for a large scale, forward-looking study that continues to follow up babies after their initial hospital stay. This would be very helpful to understanding treatment options and the long-term neurological outcomes for these infants.”  

Read our patient leaflet (PDF) about necrotising enterocolitis.