Great subject Tom!

Questions for your guests:
1)ONE NICU baby’s care = 20yrs of care for 20 regular children. Is it ethical to save ONE life at the cost of poor health to 20 others?

2) Universal health coverage can happen if we cut down on “expensive” services such as multiple NICUs, Cath labs, PET & CT scans in EACH town. Do your guests agree or disagree?

Thanks

I agree that this is a great subject but disagree with Ann-Marie’s ethic question…here’s mine…
If that one baby was yours Ann-Marie (or insert any name here) would you want it to be saved?
and
No expense is too big if it means saving a life!
Thank you

Many preemies are the result of inductions and scheduled Cesarean deliveries performed before 39 weeks.
We now know that much brain development occurs between 35 – 40 weeks. What we need is knowledge and patience.

As a parent of a preemie, born in University of San Francisco, in 2002, this is a subject that’s close to home. First of all, in regards to Ann-Marie, I guess we could dismantle the neo-natal ICU’s and have everyone fend for themselves when they break water early, but as of now, what happens is you’re rushed to a very competent team of nurses and doctors. In the words of one of our nurses, “We’re all adrenaline addicts here.” ALL the moms had been flown in; there were three hospitals in the US that could handle it: one in SF, one in MN and another in FL.

Those nurses and doctors are AMAZING. The stuff of documentaries. They all had such respect for the power of Woman. They got out of the way and honored the birthing process. Not power trippers in the least. One parent’s experience. . .

I in no way want to dismiss the very important discussion of health insurance in this country. But a successfully delivered preemie in the long run costs less than a high needs, injured individual. Now on to the health insurance issues. . .

I am a nurse and was really put off by your first comment that the doctors are amazing heroes saving all these babies. What about all the NICU nurses; they are there 24 hours a day making equally important contributions to the care of these babies. Not to mention, many babies would not survive the care of brand new, inexperienced interns and resident doctors if there weren’t experienced nurses there to stop fatal errors. Give the NICU nurses the huge credit they deserve.

Sharon Romich

Listeners may also be interested to hear some parents talk about their experiences of the first year of life with a preterm infant in this 13-minute on-line video produced by Vida Health Communications:
http://courseware.vida-health.com/capb/capbParentProgram.htm.

(supported by grant #HD55045 from NICHD)
Allison Morrill

I was glad to hear that your guest would like to be “out of business” by having the numbers of premature infants decrease. The relationship between reduced rates of prematurity and early, consistent prenatal care has been well known for decades. In 1986, I published a book (Mixed Blessings: Intensive Care for Newborns, Oxford University Press) the first study of nicus in the US and also abroad. All this talk about ethical dilemmas were there in 1986. One wonders if this author has read anything over her years of practice. Why is this all such a surprise.

The conservative nature of the nicu invention is clear: emergency intervention after the fact, rather than prevention is its basis. As for technological advances, neonatologists have been claiming this for years. The missing evidence is in follow-up studies, which have never been well done and always leave room for claims of improvement. A one pound baby with a “will to live”–is this the subtext for a right to life ethos? Survival isn’t enough. What is the predictable brain damage of an infant like this?

Someone should ask the author about burn-out among nicu clinicians and nurses. The mortality and morbidity rates are high and difficult to handle. And is this author always honest with parents. All cases are not different. There are trends and predictable outcomes about which families should be advised. There is an entire literature. To say there is no way to predict borders on dishonesty or an extreme and unprofessional naivete.

The credit about premature babies care have to go to nurses in the NICU.

I have a history of preterm birth and I now have a three year old son that was born at 27 weeks, 4.5lbs. I am so appreciative of the technology and care I had to be able to see my son live. 10 years ago I gave birth to a 2lbs 24 weeks baby that lived for 20 days, it was a very difficult time in my life that I did not think I would get over. But as time went on I was able to talk about the experience and be happy again about life.

As the mother of a preemie I have to credit the health and success of my son to BOTH the nurses and doctors as well as the interns, volunteers, and everyone in the hospital where my son was born. This is truly a case of the village helping the child.

My son was born at 35 weeks, 3 lb. 2 oz., and was a healthy little boy. His birth was not hastened due to my choice or his health, he was early due to my health and diagnosis of preeclampcia with complications. The doctors and nurses at the hospital not only ensured the health of my son by saved my life as well and they ALL deserve every bit of thanks we can give them.

The comment that “Doctors” are working hard in NICUs, does not address the 8 to 12 hour shifts that nursing and resp therapists spend tending to what tends to be an enormous amt of procedures required to “save” many babies who have no chance of a life without constant care and family disruption.

Infants are subjected to much trauma. Probing, needle sticks, and constant airway suctioning is common place.

I recall a child a year into this process. As I approached the child to place a nasal cannula on him, he would recoil, screaming and crying. I had to come from behind to place the cannula. This reaction was a result of being constantly approached by the staff with suction catheter in hand, shoving it down the airway which causes terrible coughing and trauma if not done as gently as possible.

The biggest problem I see is the push to keep absolutely terrible situations alive for no good reason other than medical practice and misguided notions of what humanity is.

The argument that we cannot forecast what will come out of a given situation is often bogus. A crack baby with severe birth problems and defects with a mother that is incapable of caring for herself or a healthy child is “saved” rather than allowed to expire as nature would have it, to live a miserable life.

A friends child born with the rarest of retardation disorders (a mal-developed lower brainstem) remains alive and extremely difficult to manage 14 years later at enormous cost to family and society.

Life is tough enough. We should be more selective so as not to bring in a life of retardation, chronic lung
disease and compromised organ systems. We should also give more thought to the cost to health care for those who could receive this money and recover uneventfully.

Some 73 years later, I still miss and wonder how my life would have been enhanced had my twin sister survived. She lived only one day and my parents never offered details of our birth or where she was buried.
About 6 years ago, I located her grave and have since replace the mostly broken grave marker by giving her a name. I visit her grave each year and still mourn the life that was denied, yet am so grateful for my life.

My premie (at Boston Children’s) is doing great now, but my husband and I (both medical professionals) certainly had our guilt severely aggravated by the staff (mostly nursing) and our child was basically ignored and the cause of his problems (severe anemia, difficulty breathing, jaundice) were not well addressed, it seems because there were other more ill neonates in the ICU.

Is it possible that by saving the premature babies we may be allowing, some possible Genetic defect that may be the root cause of the baby being premature, to continue which nature intend to eliminate?

I’ve been listening to your show and I’m so happy you are talking about this subject. My daughter was born 14 years ago at 1 pound 5 oz. 620 grams. The nurses at the hospital took such wonderful care of her and explained to my husband and I what to expect while we were there. We feel blessed to have been at a great hospital with a great staff.

“As nature would have it”? What would nature require? I don’t know how to look at each situation, I’m young and inexperienced in many matters of life. And I do think each situation demands painful questions.

And yet, it seems a sort of savagery to extingquish life based on the assessed desire to have the child. And I think, within this discussion, it is an issue of whether or not children should be either allowed to die or, even further, allowed to live (in the case of unwanted children). What separates the 25 week old NICU baby who is kept alive and the 25 week old healthy baby who is aborted? Simply that there is someone who wants him or her?

I am forever astounded when the “magic” of doctors is heralded without a hint of the enormity of contribution of nurses. This only perpetuates the stereotype that nurses are little more than back round spectres rather than the pros who save an equal number of lives, in all types ICUs.

MDs and RNs are a team, each unable to practice without the other.

I’m the mother of a preemie baby. Thankfully he was only six weeks early. The amniotic membranes ruptured in the middle of the night and Jack was born 9 fast hours later. He did have problems with breathing, temperature regulation and with feeding. The most prominent emotion I felt following his birth was guilt. I knew that I had done everything right and that I’d had excellent care. I worked for my OB/GYN. Why had my body failed to give Jack the home he needed? Jack is 4 months old now and I still wonder what happened that caused him to be born early. Unfortunately, I will never know the answer.
Thank you for this topic. I think that the general population take it for granted that all babies are born healthy. I hope that this brings people’s awareness back to a problem that all too many families have to overcome.

Having worked in Neonatology for almost 30 years, I feel blessed for having been able to experience the miracles of which I been a part or have watched. The advances in field of Neonatology truly have been amazing. From the engineering aspect of creating tubes and lines designed for infants of <1 pound (500g) to the bench research that has enabled improvement in nutrition and micronutriton and the development of surfactant replacement for lung prematurity to surgical improvements that allow once deadly cardiac, neurosurgical and intestinal issues to be paliated to clinical research that has improved family input and support, and on and on, the advances in Neonatology have been awesome. Not only are more babies surviving, the quality of survival is more hopeful. As with most things,these improvements are often double edged and provide extreme surgical questions. i.e. Sometimes because a baby can be saved, does not always mean that he/she should be saved. Parents are asked to make the decisions about a baby’s life when they have no idea what the true outcome of an multiply handicapped infant will mean for the rest of the family. I am not talking about simple handicaps. I am talking about kids that will face a life of pain and repeated major surgical procedures with little or no hope of an independent or productive life. The line “a fate worse than death” comes to mind. There are some fates that are much worse that death not only to the child but to the survival of the family. By the way the show was terrific, very balanced

Be careful about your comments here. On the show about prostate cancer I commented and asked some questions. Next thing you know they posted on the internet that I had prostate cancer and had it removed. I have asked them to remove this but they don’t seem to care. This news has caused much grief to an elder relative. One more time. I do not or ever have had prostate cancer and it is still there in good working condition. Way to go OnPoint and WBUR. You are incompetent!

One thing that was not addressed is the cost. From what I understand it can cost as much as million dollars per baby in some cases. Without good health insurance is it correct to assume that people without insurance end up not being helped?

My mother was born at around 34 weeks in 1917, or about 45 years b-e-f-o-r-e incubators. She was very small and the doctor told my grandmother that she probably wouldn’t survive, but to take her home and make her as comfortable as possible and wished her luck. My grandmother was from Greece and (we) pretty much use Olive Oil for everything from salad dressing to furniture polish. From what my mother says, several times a day, my grandmother would feed her (of course), change her, slather her in olive oil, wrap her in swaddling, put her in a shoe box and place her on the floor behind the coal stove. From what I understand Olive Oil has some very nutritious and moisturizing proporeties and that’s probably what gave my mother the little leverage she needed to thrive.

Thanks for taking the time …

Unfortunately, not all NICU stories are happy stories and not all babies ever get to leave the NICU. I want to make sure that every parent out there knows that if it looks like your baby isn’t going to make it, there is a free service for families called “Now I Lay Me Down To Sleep” that provides a professional portrait session (the photographer will come to the NICU for a private session) for your baby and your family to make sure that you will forever have those memories of your baby. You can go to http://www.nilmdts.org to learn more.

This was a wonderful piece. I hope many many preemie parents who are currently experiencing the NICU are able to hear it. I am mom to 2 1/2 year old twin girls who were unexpectedly born at 27 weeks. 2 lbs 3 oz each. 2 months and 3 months in the NICU. Such a scary first year, but the nurses and doctors were amazing, and because of them my two girls are thriving today with no known lingering effects of their prematurity. I was surprised there was not much mention of multiples, as they are at a much higher risk of being born early. Kudos to all those trying to work to prevent premature births.