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California’s smallest baby raises host of really big questions

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On Aug. 30, 2011, doctors at the Los Angeles County/USC Medical Center delivered Melinda Star Guido, the smallest baby ever to be born in the state of California and the second smallest baby to be born in the United States.

Fully four months premature, Melinda weighed 9 oz. at birth; just one ounce more than a can of soda. Three and a half months later, Melinda is up to 4 lbs., 1 oz. Doctors are happy with her progress, but plan on monitoring her for the long term—at least until she hits the age of six, barring any complications. Melinda’s parents, Haydee Ibarra, 22, and Yovani Guido, 24, are overjoyed.

The story of the happy family has another side to it, however, and the ethical questions are beginning to percolate, beginning with whether or not it’s in anyone’s best interests to establish a policy of saving babies that might be prone to health problems for the rest of their lives. Also on the table are questions of economics and access — the total cost of raising Melinda is estimated at a half million dollars, most of which will be paid by the county and the state, due to the fact that her parents are on Medi-Cal.

According to Dr. Rangasamy Ramanathan, who treated baby Guido, babies that weighed less than 700 grams were not resuscitated 20 years ago. Now, the weight limit has come down to 400 grams. Melinda was so small that when she was first born, doctors could not fit a tube into her trachea to help her breathe. Melinda's case raises difficult dilemmas. If keeping preemies born this early were to actually become a trend — even just a few — would publicly-funded health care programs be able to absorb the costs? And if not, would that mean a whole demographic group left without access to these options?

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said that money shouldn't drive the decision, but some forget to factor in the millions of dollars that go into taking care of a baby after it leaves the prenatal care unit.

"I think these families need more support. We rescue the babies, but they go out there and they need the wheelchair, they need the special toys, the stress on the family's big," he said. "That's an area that we need to think about hard. If we rescue them, are we rescuing them for futures that can be better?"


What are your thoughts on the ethical factors involved in premature births, and why? Do you have similar feelings about end-of-life care?


Dr. Rangasamy Ramanathan, professor of clinical pediatrics; director, Neonatal Fellowship Program and Neonatal Intensive Care Unit, LACounty+USC Women's & Children's Hospital

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania