PEDIATRICS Vol. 99 No. 5 May 1997, pp. 753-754
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To the Editor.
We applaud Meadow, Reimshisel, and Lantos'1 attention to mortality risk in extremely low birth weight (ELBW) infants and its ethical implications. The authors have emphasized that illness severity and risk of mortality among ELBW infants are not static. This has important implications for clinical decision-making, ethics, and health policy.
We have a number of concerns about the authors' analyses. The study
population is drawn from 5 to 7 years ago in an era when surfactant was
still an investigational therapy and high-frequency ventilation was not
widely used. These and perhaps other technologies have resulted in
significantly enhanced survival of ELBW infants in the current era. If
there is better survival in this era, has there been a change in the
timing of death and the