Monday, June 25, 2007

On Despair and Miracles.

My condolences to the Morrisons. Their grief must be immense with the death of the fourth of their children. The hospital still isn't releasing information about the remaining 2, aside from the fact that they are still in critical condition. I would speculate that they will remain in critical condition for 6-8 more weeks at a minimum - if they survive at all. The family has my prayers for this struggle.

We've had 23-24 week infants from singleton or twin pregnancies who were in our NICU for 7-8 months, and rarely longer. Some have been transferred to other hospitals and more commonly to extended care pediatric facilities - not getting home for the first time until as long as 2.5 years after birth. Surfactants and improvements in technology tend to shorten this for many of the survivors, but the reality is that many weeks, often months, and sometimes years of medical attention (inpatient and/or at home) is needed for virtually all babies born so early.

I read an interesting piece on Errant Thoughts from a Disquieted Mind today on the costs of short and long-term care of micropreemies. There are some errors in the first part of the story. She describes the release of even 2 eggs spontaneously as "exceptionally, unbelievably rare" when the actual number is 1 in 80 pregnancies and who really knows how many cycles. Spontaneous triplets are 1 in 8000, which I wouldn't call unbelievably rare either. Relatively minor gripes, those. What you should look at is her estimate of the costs -- in 1994 dollars -- of neonatal care. It is staggering -- and in line with what I know of the costs.

She then goes on to describe what she expects will be the complications. I'd take exception to describing Necrotising Enterocolitis as an expected event, although it's certainly very high risk for such tiny babies. She doesn't say where she gets the numbers for her statistics, but I think they're pretty close. My description of their challenges was described by another blogger as chilling - hers is even more so. Go read it.

In view of all that pessimism, why would anyone even bother to try to save such tiny babies -- or any other desperately ill infant, for that matter? It's because we all know at least one child who has beaten those odds. If you ask anyone who has worked in neonatology for any significant time, they have at least one story. I've already written about one in my post titled Thanksgiving. To me, that child clearly represents a miracle, but I've seen others as well in the 25+ years I've been a NICU nurse. That's what makes it possible for me to do what I do when I don't believe that a baby has a chance. I've been wrong before. I live with the hope that I will be again.

This field requires such a delicate balance. Sometimes neonatologists have to tell families that the hope for survival is very small -- and for intact survival even smaller. Sometimes they must approach families to offer them the option of withdrawing life support when it appears that there is very little hope of recovery. Occasionally it is the parents who approach us when they believe that it is time to let go. Never is it an easy choice, but sometimes it is in the best interests of the baby.

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