We Feel, However, That the Recent Series By

neonatal unit; 18 of these infants had been born outside the hospital. While the overall survival rate was 47%, out of 17 normally formed infants born at 23-25 weeks' gestation only 2 (12%) survived. Both are so far neurodevelopmentally normal but one has severe bronchopulmonary dysplasia necessitating frequent admissions to hospital. The survival rate of 12% is in keeping with that of Professor Yu and his colleagues. However, in Professor Yu's series half the survivors in the 23-25 weeks' gestation group were handicapped. There were no handicapped survivors in this group in our series, perhaps because ofthe small number ofbabies; but, even at 26 weeks' gestation, out of 13 normally formed infants admitted to our unit during the same period 9 survived, ofwhom 6 were handicapped. We find these figures both worrying and disappointing. Intensive care of these extremely premature infants is demanding on resources and manpower and on the parents. However, the return is very poor, especially since the small number of survivors are at high risk of being handicapped. We wonder whether the "routine" institution of intensive care is justified in babies born at 25 weeks' gestation or less. Caring for these babies is still very much at research level although many neonatal intensive care units offer it as a clinical service. Ifintensive care is to be offered to these infants it should be on a research basis in properly funded units, thus avoiding the risk of precious resources being drained away from the needs ofmore mature infants, who have a much better prognosis given adequate treatment. Standardised long term follow up on a multicentre basis, as is happening in Scotland on a "one off basis" (Scottish perinatal study 1984), is essential if we are to determine whether our efforts in treating these babies are justified in this country. C SKEOCH P GALEA