17 April 2008

New Calculator Factors Chances for Very Premature Infants

One of the most difficult questions about the survival of premature babies is how to best help them. Babies are now able to survive life outside the womb much earlier than before because of advances in medicine about how to best treat neonates. And now, doctors and researchers have come up with a formula for determining a baby's chances for survival and potential complications later in life.

The New York Times reports today that the new method uses an online calculator developed for such cases factoring in traits like birth weight and sex as well as gestational age and whether or not the baby was a multiple birth. (Incidentally, baby girls born early have a better chance for survival than do boys.)

In theory, at least, the calculator would seem to favor treating girls, because, all else being equal, their odds for survival are better.

From the New York Times article: The study included 4,446 infants born at 22 to 25 weeks at 19 hospitals in the Neonatal Research Network; 744, generally the smallest and most premature, did not receive intensive care, and all died. The babies were assessed at birth, and the survivors were examined again shortly before turning 2. Over all, half the infants died, half the survivors had neurological impairments, and half the impairments were severe. Many survivors spent months in the hospital, at a typical cost of $3,400 a day. The researchers estimated that if all babies born at 22 to 23 weeks received intensive care, for every 100 infants treated there would be 1,749 extra hospital days and zero to nine additional survivors, with zero to three having no impairment.

What is most compelling about this study is that based on this data, researchers are able to make projections about what kind of future these children will face, and what the social cost will be to care for them long-term, not only medically, but educationally as well. We know that low birth weight children face many more educational obstacles and often need special attention in school, and that students with disabilities - including those with Individualized Educational Plans - cost the school system and community more.

These problems are especially relevant for our community since Memphis has an exceptionally high rate of low birthweight babies and infant mortality - a well-known problem that was publicized in a Commercial Appeal article in 2005.

One of the researchers - Dr. Nehal Parikh - said the following about how the new formula will help parents decide what is the best treatment option for their child: “We lay out the facts, rather than our own opinions,” Dr. Parikh said, “because we’re not the ones taking these babies home.” This is only partly true. The choice of treatment for a child is an individual decision, but the implications for society are far-reaching, especially considering the care and cost associated with children with disabilities throughout their lifetimes - not only the family's personal cost but society's investment in their future.

An element of forward thinking which is not covered in the article is the root causes of pre-term births, low birth weight and infant mortality. Prenatal care - including access to and use of health care and routine doctor's visits - and proper nutrition are essential to growing and delivering healthy babies, and the community at large must take a more proactive role in promoting healthy pregnancies.

We need to intervene in the lives of the children before they are delivered early, and before we have to make the decision whether 22 weeks or 23 weeks is a viable gestational age for a child. We need to intervene in the lives of the children in utero - investing in the mothers and assuring that they have routine, quality, available medical care and proper nutrition so that their babies are healthy from the start.

The Child Well-Being Data Book written and published by The Urban Child Institute has more information about the health conditions of infants and children in Memphis and Shelby County.

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