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06/23/2015

Considering best care for extremely premature babies

A couple of weeks ago I was invited to attend a lecture given by Dr. Mark Mercurio of Yale University on making ethical decisions regarding the treatment of neonatal babies. Dr. Mercurio’s talk focused on the topic of aggressive treatment of extremely premature infants (22 – 25 week gestational age). Although I have devoted much of my time to researching beginning of life issues (predominantly issues focusing on the baby in-utero and the mother), I have only recently started focusing my attention more on ethical issues regarding neonatal topics. Dr. Mercurio’s presentation was extremely thoughtful and brought up some interesting and practical points for consideration; I thought I would share three that stood out to me with all of you this week.

1. Whether treatment is impermissible, permissible, or obligatory should be determined by two factors: prognosis and feasibility.

I appreciated this point because it recognizes that treatment needs to be both appropriate and actually possible. It is important to remember that the baby is the patient, and what is done in the form of treatment should be just that: treatment. Experimentation should not be presented as treatment if it is not known to actually provide treatment to the patient. While there is a time and place for developing experimental treatments, this must be presented as experimental and monitored closely to avoid any unethical conduct, any illegal conduct, or any harm to the patient.

2. Gestational age should not be the only factor used to decide whether or not to treat a premature infant.

Although gestational age seems like a decisive line to use to determine treatment, it is not the best indicator of how a baby will respond. Dr. Mercurio pointed out that although people often speak in definite terms regarding gestational age, it is really more a range with a give-or-take of two weeks from stated gestational age. So for example, a baby thought to be born at 23 weeks, could actually be closer to 25 weeks old. Furthermore, age is not the only factor known to impact a baby’s chances of survival. Gender and birthweight, amongst other things, both are also factors.

3. When determining whether or not treat a premature baby, Dr. Mercurio said the relevant question should be “What are the chances… for this child IF WE TRY?”

Basically, this point comes to not looking at the baby as a statistic, but as an individual that we should consider as such. This requires an honest and thoughtful consideration of each baby born extremely prematurely, both as they are, and as they could be with appropriate treatment given.  Success increases if we try.  And while aggressive treatment may not always be the best option for care, we should always consider what the potential success will be when we try before making that decision.

Every baby is valuable and deserving of the best possible care. I thought Dr. Mercurio brought up some good points for consideration about when pursuing aggressive treatment for babies born extremely prematurely is the best care and when it is not. We must consider each baby individually, and seek to offer the best possible care in every situation.

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