Ethical Issues in Neonatal Care

babyNP., APRN · Oct 22, 2012

We help AFTER the fact. If you want to help premature birth, you should put this in the OB section.

Tell these OBs that they are not allowed to c-section for fun at 37 weeks and get these mothers better prenatal care and get them off the street drugs.

The disparities are likely correlated with that minorities have less access to healthcare=less/no prenatal care. Lack of support systems and more likely to turn to drugs.

My hope is that the new health care laws should start to change this.

edit: the fact that we have a higher infant mortality would point more to the fact that other countries don't resuscitate the micropreemies at 23-24 weeks nearly as much as we do. They wouldn't count it as a live birth and we would. That skews the numbers.

Elvish, BSN, DNP, RN, NP · Oct 22, 2012

edit: the fact that we have a higher infant mortality would point more to the fact that other countries don't resuscitate the micropreemies at 23-24 weeks nearly as much as we do. They wouldn't count it as a live birth and we would. That skews the numbers.

It would depend on which countries you're referring to. I did some looking into that a while back after hearing this repeated several times on allnurses and found that many places in Europe resuscitate preemies starting about the same gestation, as does Australia, and if they are born with signs of life, they count as a live birth. My friend the surgeon in Finland recalls operating on several former 24-weekers. If you're talking about developing countries, though, we might agree.

We also agree that neonatal mortality/morbidity ethics start in OB offices, maybe even in reproductive endocrinology offices.

One thing the article mentioned was risk/benefit ratio when discussing interventions with families. I am extremely grateful at my place for neos who shoot straight with parents about this, both when they are inpatient as antepartums as well as after delivery. They are extremely good at being realistic without making people angry that their baby is not likely to be the miracle baby. That's an extremely difficult job, one that I don't think I could do.

babyNP., APRN · Oct 22, 2012

Well, do they resuscitate 22 and 23 weekers? Because my facility picks them up from outlying hospitals only to declare them a few days later...

Elvish, BSN, DNP, RN, NP · Oct 22, 2012

Well, do they resuscitate 22 and 23 weekers? Because my facility picks them up from outlying hospitals only to declare them a few days later...

Which part of the post are you referring to? My place or other countries?

babyNP., APRN · Oct 22, 2012

I'm talking about other countries.

Elvish, BSN, DNP, RN, NP · Oct 22, 2012

Since the original parameters were 23-24 weeks, that's what I looked for. This is what I found:

http://www.ncbi.nlm.nih.gov/pubmed/11060524

An article from 20 years ago in the UK, suggesting that extreme preemie resus is not a new thing. Mentions significant increase in mortality = 24 weeks, and the range in vented babies ranged from 22-28 weeks in the study.

http://www.springerlink.com/content/l357270446152573/

The BBC has also made a documentary called '23 Week Babies: The Price of Life'. The implication is that 23-weekers, at least in the UK, are resuscitated.

From Australia, implication that they resus beginning at 23 weeks:

http://home.vicnet.net.au/~garyh/outcome.html

I believe the earliest preemie that survived to adulthood was a 21+change weeker born in Canada.

Miracle child

umcRN, BSN, RN · Oct 23, 2012

Since the original parameters were 23-24 weeks, that's what I looked for. This is what I found:
http://www.ncbi.nlm.nih.gov/pubmed/11060524
An article from 20 years ago in the UK, suggesting that extreme preemie resus is not a new thing. Mentions significant increase in mortality = 24 weeks, and the range in vented babies ranged from 22-28 weeks in the study.
http://www.springerlink.com/content/l357270446152573/
The BBC has also made a documentary called '23 Week Babies: The Price of Life'. The implication is that 23-weekers, at least in the UK, are resuscitated.
From Australia, implication that they resus beginning at 23 weeks:
http://home.vicnet.net.au/~garyh/outcome.html
I believe the earliest preemie that survived to adulthood was a 21+change weeker born in Canada.
Miracle child

I do have to say, 623g seems pretty big for a 21+ weeker...

babyNP., APRN · Oct 23, 2012

yeah...I don't believe that either (they must've gotten the dates wrong). Perhaps I'm a bit off-base, but my old exchange partner in Germany a few years back, her dad was an OB and he's told me that they don't resuscitate at

Regardless of it all, we only help things after the fact. How do we get these women appropriate primary care? Through universal access to healthcare. And if your findings are pointing to it in Europe/Australia, then better on them, since they do have universal health care.

ER care for "abdominal pain" is not cutting it.

Elvish, BSN, DNP, RN, NP · Oct 23, 2012

yeah...I don't believe that either (they must've gotten the dates wrong). Perhaps I'm a bit off-base, but my old exchange partner in Germany a few years back, her dad was an OB and he's told me that they don't resuscitate at
Regardless of it all, we only help things after the fact. How do we get these women appropriate primary care? Through universal access to healthcare. And if your findings are pointing to it in Europe/Australia, then better on them, since they do have universal health care.
ER care for "abdominal pain" is not cutting it.

I think the Netherlands doesn't resus before 25 weeks. That's the only one that I could find that definitely would not do anything at 24 or before.

I agree that better preventive care and access thereto such as you'd find in Europe/Australia/NZ is a great start to keeping the dilemmas surrounding prematurity to a minimum. Sometimes we have the antes that do everything right, have no risk factors, and still deliver early, but more often than not there is some factor that augments their risk. One thing I have noticed is that we have a high incidence of IVF pregnancies that end up delivering preterm. I don't know if that's just us or if it's everywhere. That's not an indictment of people who choose it, just an observation from the trenches.

SJerseygrle · Oct 28, 2012

My proposed solution to help is to increase the number of Nurse Midwives and competant OBGyns (preferably female). I had my first two babies under the charge of male OBGyns, both who discounted my pre-enclamypsia symptoms. I thought with a track record of enclampsia the second would take me seriously, but alas. A 1 pounder, then a 2 pounder. My third child, under a wonderful female OBGyn, was 8 pounds 10 ounces. She saw me constantly, tested me thoroughly, and addressed any problems promptly.

In medicine, just like in a lot of places, women's voices are often discounted, to everyone's detriment.

NicuGal, MSN, RN · Oct 29, 2012

I have to disagree about more female providers. The majority of our docs, especially our high risk docs, are male. If you were a patient at our hospital you would have been flagged high risk from your first baby and only been seen by high risk docs. Male or female, it shouldn't matter, if they are over looking something then you need a new doc.