21 6/7 weeker goes home from NICU

[tiredmom]

Anybody see this??? A 21 6/7 week baby just went home from the hospital!



http://www.npr.org/templates/story/story.php?storyId=7500743

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[starayamoskva]

Anybody see this??? A 21 6/7 week baby just went home from the hospital!



http://www.npr.org/templates/story/story.php?storyId=7500743

Actually the baby didn't go home, they cancelled the discharge at the last minute due to abnormal CBC.
The hype around this case gives a huge amount of false hope. They portray this baby as having no long term affects due to the prematurity.
No one ever stops to think that just because they can save a baby this premature doesn't mean they should!

 

[Pfannenstiel]

21 6/7 weeker... but not really. This baby was conceived by IVF, so we know the exact amount of time from conception - which was 21 weeks and 6 days - BUT, this same duration of pregnancy in a patient who did not use IVF would be described based on LMP. So, what they're calling a 21 6/7 weeker really corresponds to the same duration of pregnancy that we would usually call a 23 6/7 weeker (assuming 14 days between ovulation (and likely fertilization) and menstruation). Right?

 

[tiredmom]

21 6/7 weeker... but not really. This baby was conceived by IVF, so we know the exact amount of time from conception - which was 21 weeks and 6 days - BUT, this same duration of pregnancy in a patient who did not use IVF would be described based on LMP. So, what they're calling a 21 6/7 weeker really corresponds to the same duration of pregnancy that we would usually call a 23 6/7 weeker (assuming 14 days between ovulation (and likely fertilization) and menstruation). Right?

Good catch!!! I completely missed that! I was trying to figure out why they attempted rescus in the first place... on a 22 weeker - makes more sense now. I think this is a huge outlier that isn't going to change anything we do, but it is interesting.

 

[dr. know]

age old question of "we have the technology, but should we do it" don't really know why this is an option for any parent. i know "people" want medicine to be less paternalistic, but why the heck do we have to go to all of the school and extra training if we can't make a determination of what is the best solution.

 

[tiredmom]

age old question of "we have the technology, but should we do it" don't really know why this is an option for any parent. i know "people" want medicine to be less paternalistic, but why the heck do we have to go to all of the school and extra training if we can't make a determination of what is the best solution.

I agree completely. I thought my saddest rotation of 3rd year was the NICU - with all the itty bitty babies in plastic boxes and we charted number after number but never got to hold them. Of course, it was heaven for one of my classmates who would prefer if he never had to talk/touch another patient in his life (and he's not doing path or rads either!).

 

[fuzzyerin]

No complications - except a minor brain hemorrhage, respiratory distress, and intestinal problems - at least, that's what I heard on the news.

Not to mention the CP/MR the kid will have growing up...

 

[MichiMO]

CP/MR is not necessarily the given result of a minor brain hemmorrhage...in fact, with a first degree bleed, there is only very rarely neurological problems.

Of course, they don't say what "minor" was in this case and the statistics for this age group would certainly suggest there is going to be major problems.

But, I must also say, I don't think we should necessarily write off the resusitation of early babies. It wasn't twenty years ago that it was considered pointless to resusitate babies below 28-29 weeks. The only way you get advances in medical knowledge is try. It may not be the best outcome for individual babies, but not everyone feels that their baby would be better off dead than with MR and you have to respect that.

There are certainly good arguments to say this sort of thing should not be attempted, but I don't think it is as simple as many people would like to suggest. It is also really difficult to tell a parent that their baby couldn't be one of the lucky ones...who's to say they might not be. A lot of people would want to give their child that chance.

 

[oldbearprofessor]

But, I must also say, I don't think we should necessarily write off the resusitation of early babies. It wasn't twenty years ago that it was considered pointless to resusitate babies below 28-29 weeks.

Sorry, but this is not correct. I completed my board certifying exams in neonatology exactly 20 years ago, so I have some knowledge here. At that time (the mid and late 1980's), the lower limit of viability for resuscitation was generally accepted as being about 24 0/7 to -25 0/7 weeks (some resuscitated 23 weekers, as in the Miller case from about 16 yrs ago), having decreased from 26 0/7 weeks which was generally accepted as the lower limit in the late 1970's and early 1980's. As of 20 years ago, few babies 25 0/7 weeks or more were not resuscitated. I personally have numerous babies that I cared for in that era who were delivered at < 27 weeks whom I remain in contact with.

Discussions of this situation are important, but I like to see them accurately done historically and I am one of the few here old enough to remember that far back in history.

 

[tiredmom]

Thanks for sharing Old Bear!

 

[MichiMO]

Thanks for correcting me Old Bear. I just remember when my cousin was born twenty years ago at 26 weeks, many said he shouldn't have been resussitated, so that was what I was basing my statement on.

 

[oldbearprofessor]

Thanks for sharing Old Bear!

Those who wish to see how this debate is being played out elsewhere in the internet world, can refer to these blog discussions (note that I am not to be found participating anywhere in any of these discussions).

http://theclayexperience.blogspot.com/2007/02/extra-extra-more-media-miracles.html
http://thepreemieexperiment.blogspot.com/2007/02/i-refuse-to-give-up.html

I have no interest in debating the resuscitation and care of extremely preterm infants - as anyone can see, there are plenty others doing that.

I would note that I feel that some of the criticisms of the physicians for their media role MAY be misguided. I have been in their shoes and there is intense pressure from the hospital and the media to build and spin a positive story of medical miracles even when one has doubts.

It is easy to be caught up in this or be misquoted. It is difficult to deliver and have heard a more balanced message.

Regards

OBP

 

[oldbearprofessor]

Thanks for correcting me Old Bear. I just remember when my cousin was born twenty years ago at 26 weeks, many said he shouldn't have been resussitated, so that was what I was basing my statement on.

It was common to say that then (and now....), but neonatologists mostly ignored it. Note that the baby in my avatar was a 700 g infant born in the mid-1980's (when the pic was taken) who is now a successful college student.

 

[thepreemieexper]

The hype around this case gives a huge amount of false hope. They portray this baby as having no long term affects due to the prematurity.
No one ever stops to think that just because they can save a baby this premature doesn't mean they should!

Your honesty is very refreshing.

This particular "miracle" story was very upsetting to me, mostly because of the publicity surrounding the initial comments of the neonatologist. To paint a pretty picture of extreme prematurity negates the experience that parents of older preemies can attest to. The Miami Herald Online has printed my response to their coverage.

Until there are better, and much longer, follow up studies, saving extreme preemies is wrong. I do believe parents need to have the right to choose but how can they make an educated decision based on very outdated and extremely incorrect information?

Yes, there are some ELBW babies that come through with minimal issues. But those numbers are low, very low.

Doctors may see a few survivors, but I see thousands. The picture is not pretty!

If you would like to see "the other side" please feel free to visit my blog. Please comment too. I believe we all can learn from each other. Before I started this blog I never realized how difficult of a job doctors you all have. There are a few doctors on my blog that will admit they were shocked at the long term outcomes; the real outcomes, not what you read in the research from the 2 year follow up clinics.

 

[thepreemieexper]

I would note that I feel that some of the criticisms of the physicians for their media role MAY be misguided. I have been in their shoes and there is intense pressure from the hospital and the media to build and spin a positive story of medical miracles even when one has doubts.

It is easy to be caught up in this or be misquoted. It is difficult to deliver and have heard a more balanced message.

The day after the story broke, the neo was interviewed outside of the "circus" and he was more realistic. He still did say that there was a chance that the baby would be normal but also said that it was highly unlikely, citing the fact that there isn't much data to compare her to.