A SEVERELY handicapped toddler, whose parents have fought the medical establishment for two years to not let her die, may be put into foster care when she is discharged from hospital.
Charlotte Wyatt has been in St Mary's hospital in Portsmouth since she was born in October 2003, three months premature at 26 weeks gestation, weighing just 1lb and measuring the length of a ballpoint pen.
After surviving against the odds, Charlotte is expected to be well enough to leave hospital next month but may no longer have a stable home to go to. Her parents, Darren and Debbie Wyatt, have been involved in a gruelling High Court battle to stop doctors having the right to withhold life-saving treatment from their daughter.
Eventually they succeeded in having the "do not resuscitate" order lifted. They then underwent training to learn how to look after their daughter, who breathes through nasal tubes attached to a special oxygen supply.
But the couple's marriage is now under severe strain. Darren, 34, took an overdose earlier this month after his wife walked out with their other three young children.
Portsmouth city council social services are helping to look after Debbie, 24, and children Daniel, 3, David, 1, and two-month-old Christina at an unknown address.
Hospital managers are concerned that Charlotte's parents may not be able to look after her if she is discharged from hospital as planned next month. Although Charlotte's lungs have grown stronger, and she is believed to have gained limited sight and hearing, her brain has not grown.
One manager, who did not want to be named, said: "We have a duty of care to make sure that Charlotte is going to be safe and well looked after. Given the family situation at the moment we could not allow Charlotte to go home to them.
"We would look at fostering options. Once Charlotte no longer needs St Mary's hospital, there is the fostering option, if the parents agree to her being fostered."
The average cost of looking after a child at St Mary's is £530 a day. Hospitals cannot afford to keep patients who do not need medical treatment.
Sir Alan Craft, the president of the Royal College of Paediatrics and Child Health, and professor of child health at Newcastle University, said Charlotte's plight highlighted the ethical dilemma of striving to keep extremely disabled babies alive.
"For a child in this situation, the issue is not just keeping them alive for the first years of life. The child may go on to live for many years. There is a burden on the family and the other siblings. The stress can lead to marital break-up. Profoundly handicapped children can be an enormous social and financial burden.
"Dutch society has taken the decision that doctors will not do anything for very small babies, babies born under 26 weeks of gestation. We resuscitate at 23 weeks but in Holland they would not resuscitate babies under 26 weeks unless the baby was breathing on its own.
"This is what Dutch society has decided and, as a result, the Netherlands does not have as many children with profound handicaps."
Darren Wyatt, who is taking antidepressants and sleeping tablets following a psychiatric assessment, said last week that he wanted a reunion with his wife and hoped Charlotte could still be looked after at home with the family's other children. He said he would fight any attempts to put Charlotte into foster care.
"I want to have all my kids and Charlotte at home but we will need a lot of support," he said. "I do not want Charlotte to be fostered. I am well enough to look after her. We have done the training to look after her. If the hospital or social services want Charlotte to be looked after by foster parents they will need to take me to court."
However, Mary MacLeod, the chief executive of the National Family and Parenting Institute, said recent research on children requiring high-tech equipment in the home to keep them alive showed that parents underestimated the appalling strains they would face as carers.
"They may have to get up at night to move the child, they may have to perform regular painful procedures on the child, which can be immensely stressful and the focus on the child with the disability deprives other children of attention," said MacLeod.
Portsmouth Hospitals NHS Trust, said: "We will work with social services to find a solution."
Portsmouth city council confirmed that fostering was an option, but the authority still hoped Charlotte's family would be able to look after her when she is discharged.
"Our social services are in attendance with Debbie and the children daily, caring for Debbie and for the children," said a spokesman.
Margaret Geary, the council's strategic director for health, housing and social care, said: "The circumstances of this case are very fluid, extremely complex, sensitive and confidential and are changing daily, and sometimes more frequently than that."