I've never really enjoyed the NICU as a service but as I go through my residency and routinely deal with its graduates it brings up some very conflicted feelings for what we do there. Sure, everyone has heard a story of a 25-weeker that's now in college or something, I do too. Stories like that get attention but the fact remains that a very significant portion of NICU graduates don't do so hot. Unfortunately, a 4 month stay in the NICU with ongoing complex medical care (probably) for life is an immense burden to society. To me this is still acceptable as long as the percentage of overall children is low and the fact remains that we do oblige ourselves to provide for these children if choose to (sometimes unmercifully) keep them alive. I have low standards too, any NICU graduate who is mostly neuro-intact is a huge success story to me and deserves whatever resources we can provide. However, the trend continues and even though we're getting better at preserving the biological lives of these extreme preemies, multiple congenital anomaly kids, and the severely neurodevastated..... I wonder if it's really the right thing to do. We created a rapidly expanding population of children that continue to require a larger percentage of finite resources, which would all be okay if we were improving their quality of life - we aren't. The untold story also remains that often the burden of a child who requires round-the-clock medical care destroys marriages and leads to sacrificing the livelihood of siblings that actually have a chance. I certainly wouldn't want to be a parent who has to make these decisions, but it doesn't seem right. It's fraught with ethical complication and before I get flamed, I know there are plenty of exceptions, but what we choose to do for these children has lifelong implications - and not just for the infant itself. I think that sometimes the right decision is to do nothing. I'm open to other opinions, I'd like to hear arguments for all the work that goes into this.