Editor—Aidan MacFarlane argues that further funding for neonatal and paediatric intensive care should not be provided unless funding for the long term needs of severely handicapped children is guaranteed.1 His comments imply that neonatal intensive care produces more neurologically impaired survivors, which in turn leads to greater cost in the long term.

In fact, improved survival in very low birthweight (VLBW) infants has been accompanied by a fall in intracranial haemorrhage and cerebral palsy, probably owing to a combination of antenatal steroids and postnatal surfactant replacement treatment. Cooke studied 1722 VLBW infants born between 1982 and 1993 and showed an increase in survival rates (from 69.2% to 79.7%) with a decrease in intracranial haemorrhage (from 14.9% to 10.5%) and cerebral palsy (from 10.9% to 7.3%).2

Although some technological advances, such as surfactant, high frequency oscillation ventilation, and extracorporeal membrane oxygenation are expensive, their impact on mortality has been shown in well conducted randomised controlled trials with either a decrease or no increase in neurological morbidity.3-5

Dr MacFarlane's view is an oversimplified one. A baby born at 28 weeks' gestation who is denied intensive care may well still survive but is then more likely to be neurologically damaged. Survival rates may be lower and disability rates higher with diminishing maturity, but a considerable number of infants born at 24 weeks' gestation survive neurologically intact. We note that Dr MacFarlane avoids specifying a gestational age below which resuscitation should not be offered.