Youngest surviving premature birth without neurological impairment

 
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governator
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PostPosted: Thu Nov 09, 2017 10:29 am    Post subject: Youngest surviving premature birth without neurological impairment

Very impressive...

"unimpaired 2-year outcome of a female infant resuscitated after delivery at 21 weeks’ 4 days’ gestation and 410 g birth weight. She may be the most premature known survivor to date"

http://www.cnn.com/2017/11/08/health/premature-baby-21-weeks-survivor-profile/index.html
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Huey Lewis & The News
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PostPosted: Thu Nov 09, 2017 1:06 pm    Post subject:

That's (bleep) yuge. There are much older premies in NICUs right now with chronic problems who are hanging on by threads.
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PostPosted: Thu Nov 09, 2017 1:30 pm    Post subject:

Very interesting. The TV episode I am currently editing has a story line along that exact same issue - a woman goes into pre-mature labor and has a baby at that same stage and weighs 490 grams (according to our medical consultants, 500g is one of the cut-offs of viability). The episode is about the ethics of trying to resuscitate a baby of at that stage.
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Raijin
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PostPosted: Thu Nov 09, 2017 1:50 pm    Post subject:

Ethically irresponsible. 126 days in the NICU(Over $1 million) who's paying for that? Who would have paid for long term medical care if the child had morbidities? Who would be responsible for that child's QOL secondary to his/her morbidities if he/she had some? Yeah it's amazing that she made it out without morbidity, but consider this idea. How many resources did we use on this one child to the detriment of others?

"Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (< 1000 grams) remain at high risk for death and disability with 30–50% mortality and, in survivors, at least 20–50% risk of morbidity"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438860/
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governator
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PostPosted: Thu Nov 09, 2017 1:59 pm    Post subject:

Raijin wrote:
Ethically irresponsible. 126 days in the NICU(Over $1 million) who's paying for that? Who would have paid for long term medical care if the child had morbidities? Who would be responsible for that child's QOL secondary to his/her morbidities if he/she had some? Yeah it's amazing that she made it out without morbidity, but consider this idea. How much resources did we use on this one child to the detriment of others?

"Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (< 1000 grams) remain at high risk for death and disability with 30–50% mortality and, in survivors, at least 20–50% risk of morbidity"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438860/


That's the ethical dilemma of rescucitation and believe me, doctors have stop or decide not to rescucitate due to this very factor (extremely poor medical prognosis) but money is never part of the reason to decide rescucitating... and yes, it will always fall to the tax payer to provide the resources. This is part of the social safety net cost that we should be able to provide as a country in my opinion

Remember, once you're 'rescucitating', your chance of survival is already low because you are technically dead already but the alternative is to let everybody who can't afford the medical bill die without rescucitation attempt
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Raijin
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PostPosted: Thu Nov 09, 2017 3:07 pm    Post subject:

governator wrote:
Raijin wrote:
Ethically irresponsible. 126 days in the NICU(Over $1 million) who's paying for that? Who would have paid for long term medical care if the child had morbidities? Who would be responsible for that child's QOL secondary to his/her morbidities if he/she had some? Yeah it's amazing that she made it out without morbidity, but consider this idea. How much resources did we use on this one child to the detriment of others?

"Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (< 1000 grams) remain at high risk for death and disability with 30–50% mortality and, in survivors, at least 20–50% risk of morbidity"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438860/


That's the ethical dilemma of rescucitation and believe me, doctors have stop or decide not to rescucitate due to this very factor (extremely poor medical prognosis) but money is never part of the reason to decide rescucitating... and yes, it will always fall to the tax payer to provide the resources. This is part of the social safety net cost that we should be able to provide as a country in my opinion

Remember, once you're 'rescucitating', your chance of survival is already low because you are technically dead already but the alternative is to let everybody who can't afford the medical bill die without rescucitation attempt

No that's not the proper way to frame this and I won't let you pigeonhole this argument in that way. There's quite a bit of nuance between a being that never should have lived and cannot survive on its own with care costing upwards of a million dollars vs a person with an arrythmia that has a good shot of coming back and being a productive member of society with care costing less than $50,000
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governator
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PostPosted: Thu Nov 09, 2017 3:56 pm    Post subject:

Raijin wrote:
governator wrote:
Raijin wrote:
Ethically irresponsible. 126 days in the NICU(Over $1 million) who's paying for that? Who would have paid for long term medical care if the child had morbidities? Who would be responsible for that child's QOL secondary to his/her morbidities if he/she had some? Yeah it's amazing that she made it out without morbidity, but consider this idea. How much resources did we use on this one child to the detriment of others?

"Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (< 1000 grams) remain at high risk for death and disability with 30–50% mortality and, in survivors, at least 20–50% risk of morbidity"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438860/


That's the ethical dilemma of rescucitation and believe me, doctors have stop or decide not to rescucitate due to this very factor (extremely poor medical prognosis) but money is never part of the reason to decide rescucitating... and yes, it will always fall to the tax payer to provide the resources. This is part of the social safety net cost that we should be able to provide as a country in my opinion

Remember, once you're 'rescucitating', your chance of survival is already low because you are technically dead already but the alternative is to let everybody who can't afford the medical bill die without rescucitation attempt

No that's not the proper way to frame this and I won't let you pigeonhole this argument in that way. There's quite a bit of nuance between a being that never should have lived and cannot survive on its own with care costing upwards of a million dollars vs a person with an arrythmia that has a good shot of coming back and being a productive member of society with care costing less than $50,000


What about pt who flat lined due to things other than premature birth such as sepsis/infection, trauma, stroke, heart attack, blood clot, poison, kidney failure, brain bleeding, auto-immune disease, anaphylaxis, chronic illnesses such as AIDS... where do you draw the line? they all have varying degrees of poor prognosis with potential of prolonged expensive medical care. Doctors should not and would not based rescucitation on $... and that is the correct way

When you perform rescucitation, you don't know if your patient will 'make it' or comeback without neurological deficit 100% of the time. What you're suggesting is using previous success rate of specific diseases by cost to decide who should be rescucitated... think about that


Last edited by governator on Thu Nov 09, 2017 4:16 pm; edited 1 time in total
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PostPosted: Thu Nov 09, 2017 4:11 pm    Post subject:

Huey Lewis & The News wrote:
That's (bleep) yuge. There are much older premies in NICUs right now with chronic problems who are hanging on by threads.


Takes a really big heart to walk through there and see all those people struggling to live..

I couldn't do it.. I would feel like such a bad word .. not living my taken for granted days with gratitude for how great my life really is

I am sure the place is a bit better with you around.. maybe darker.. but better..
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