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Premature babies: ‘Most will do very well,’ says expert

When babies are born prematurely, caregivers and hospital staff rightly worry. However, as Dr. Mercurio, a professor of neonatology from Yale School of Medicine, explains, ‘the outcomes will be good’ for most of these babies.

Premature babies are born before 37 weeks of pregnancy. Each year, this is the case for about 15 million babies across the world and 10% of babies born in the United States. For caregivers, a premature birth and the time spent in the hospital afterward can be exceedingly worrying and stressful. But the care of premature babies has improved immensely in the last 50 years.

Dr. Mark Mercurio, a professor of pediatrics (neonatology) and the chief of Neonatal-Perinatal Medicine at Yale School of Medicine in New Haven, CT.

Dr. Mercurio is also the director of the Program for Biomedical Ethics and the director of the Yale Pediatrics Ethics Program explains why taking care of premature babies is challenging, how this care has changed during his career, and what research he is keen to see. He also mentioned what he wants caregivers of premature babies to know.

Better equipment and a better understanding

There are many challenges, really, but we could break these down into the technical and medical challenges and then the psychological and ethical aspects.

There are technical challenges in part just because the patients are so small.

This can make things more difficult. For example, most people are familiar with the fact that sometimes it can be hard to place an IV in an adult or an older child. So you can imagine the technical difficulties in someone who weighs just a pound or two.

In terms of the medical aspects, every organ system is immature.

A primary example is the lungs. The challenge is to ensure that enough oxygen can get into the blood via the lungs, and this is often much more difficult with premature, underdeveloped lungs. To accomplish this, there are various modes of assisted ventilation that might be needed.

In the brain, there is a possibility of injury because the baby is born very early. That has to do with the immaturity of the brain structurally at the time of delivery and possibly further injury during the intensive care course.

We know that premature babies, especially those born extremely premature, are at increased risk for long-term problems with brain function.

A third example would be the gastrointestinal system, which is also immature. So, getting adequate nutrition into these children can sometimes be a challenge.

The care of premature babies has changed in many ways over the years

We are constantly evaluating the data. We are constantly evaluating outcomes. There are controlled trials [happening all the time] to establish which is the better way to [provide care].

So, care evolves based on the new data, based on the outcomes of the studies that we do, and that is always a work in progress. Neonatology, like all of medicine, is rightfully always changing as we learn more.

I think we ventilate babies very differently. For example, the use of respiratory support for babies with immature lungs has evolved significantly over the course of my career and has gotten much better.

We have better equipment, and we also have a better understanding of how to go about it.

Obviously, prevention is always better than a cure, so research into the causes and prevention of prematurity, which is more in the realm of maternal-fetal medicine and obstetrics than in neonatology.

Within neonatology, research that will be very helpful in the years going forward would be that which yields a better understanding of what interventions and what treatments we can use to reduce the neurologic problems and the developmental problems that these children are sometimes left with long term.

In broad strokes, the biggest ethical questions that the neonatologist, and the nurses, and all the clinical staff face, and that the families face as well, is trying to understand how hard to press on with critical care measures when the outlook is poor — when to keep trying and when to say that we shouldn’t push anymore.

That’s sometimes a very, very hard question to answer.

Some of these children are not going to survive. And some of those who survive are going to be left with significant developmental problems, such as permanent cognitive impairment.

[So, we need to understand] when we should push hard, how those decisions should be reached, and how the interaction between the medical staff and the parents should influence decision making.

“The most important thing for parents to know is that most of these children will survive and most will do very well. There will be some who will not survive, and there will be some who will have long-term issues. But they are a small percentage overall.”

– Dr. Mark Mercurio

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