By Dave Andrusko
Editor’s note. A friend of long standing dropped me a note this morning. He’d been looking for material about premature births and, lo and behold, ran across this article from many years ago. In subsequent years the good news about ever-younger preemies surviving has only gotten better. Personally, I believe this story’s content are an evergreen. See if you agree.
Among the most important lessons I’ve learned in my life is that the more you look around you, the more you will see. That’s hardly profound, unless you add that by turning to the left and to the right instead of staring straight ahead, you will be presented with opportunities to help. Sometimes, as was the case this morning, there will be little that can be done.
My middle daughter, Joanna, is the most sensitive, caring human being I know. (She also is possessed of the most uncanny ability to find a four-leaf clover you will ever see.)This morning her discovery was, in the cosmic scheme of things, not that big a deal. Except to her.
We were at the annual party that our eldest daughter, a gifted teacher, throws each year for her special needs students. How she could have seen it is beyond me, but while walking our dogs around the park, Jo spotted this tiny two-three inch long baby bird lying on the ground.
The chick had obviously fallen out of its nest. It was so fragile there was nothing we could do, although Jo tried for the better part of an hour to figure out some way to reunite the chick and its mother.
Although the bird was only hours or days old with no chance of surviving, knowing my daughter, that will be no consolation. And while it may sound almost ludicrous to say about a bird, in lieu of that, Jo at least didn’t want the chick to die unattended.
I have often written in this space how something that happens outside the office will seamlessly link up to something I subsequently encounter in my work as the editor of NRL News Today and National Right to Life News. Sure enough, when I got to the office, as I perused my stacks of emails, I ran across several stories about a study on premature babies coming out of Sweden.
Here are the first few sentences of a story that appeared in HealthDay News about the study which ran in the Journal of the American Medical Association (JAMA):
“Advances in the care of extremely premature infants mean that about 70 percent of these tiny newborns now survive their first year of life, Swedish researchers report. The number of preterm births is increasing worldwide, and advances in perinatal medicine have increased survival. That means that neonatal intensive care can now be lifesaving even for the most premature infants — those born between 22 and 26 weeks of gestation.
“The news is important, the researchers said, because if parents and doctors believe a preemie’s chances for survival are already slim, less aggressive care might be extended.”
Dr. Karel Marsal, a professor of obstetrics and gynecology at Lund University, was the lead researcher of the study published in the June 3 issue of JAMA. The new results, he said, suggest that the evaluation of “extremely preterm babies should be done individually, considering both the survival chances and the morbidity risks.” The survival rates “of extremely preterm infants are high,” he said, “even at the borders of viability.”
All infants born before 27 weeks gestation in Sweden during 2004-2007 were the subject of the study. “Of the 707 live-born infants, 70% were still alive at the end of the year-long observation period of the study, which is many more than have been previously reported in studies,” HealthDay News reported.
Now what’s fascinating about the study is that, depending on the news outlet, the reader comes away either elated or with the unmistakable message that it’s still not necessarily a good idea to aggressively treat extreme preemies!
Obviously, babies born at 22 weeks are more likely not to survive than older babies, and with more problems. For example, only 10% of the Swedish babies born at 22 weeks “survived to a year and only one of these without any major illness,” according to the BBC. That’s one “fact.”
But consider that “In comparison, 53% of those born at 23 weeks and 85% of those born at 26 weeks reached their first birthday, and up to half of them without serious illness.” That’s another fact. (And, by the way, results at 23 weeks today will, in a few years, likely be the same results for babies then born at 22 weeks.)
Likewise, there were “104 deaths that occurred at least 24 hours after admission to a neonatal intensive care unit.” But “42 (40%) involved a decision to withdraw intensive care due to anticipated poor long-term prognosis.”
Put another way, certain British medical authorities the BBC contacted were concerned–-may I say obsessed–-with the possibility that aggressive treatment might lead to the survival of children with subsequent disabilities. By contrast (as the BBC’s account explained), “Medical interventions did appear to make a big difference to survival odds and probably explain why Sweden had such an impressive record. Babies born at hospitals with the best intensive care facilities and expertise and where active treatment was given–something common-place in Sweden–were far more likely to survive.”
It really is a matter of attitude and culture. Reading the stories, the British medical personnel talked first and foremost about costs and then mixed it up with gloom-and-doom stories about premature babies who survived.
By contrast, “We believe that the good Swedish results are due to the excellent collaboration between obstetricians and neonatologists, a high degree of centralization of very preterm deliveries to tertiary level perinatal centers, and proactive perinatal management,” Dr. Marsal said.
I would end with this question. In the hospitals of which country would Joanna feel most at home?