Neonatology has always been a bargain – even when we weren't very good at it!

Buchh, Basharat; Graham, Neil; Harris, Barbara L.; Sims, Sherrol; Corpuz, Maria; Lantos, John D.; Meadow, William

doi:10.1111/j.1651-2227.2007.00247.x

Cited by 7 publications

(10 citation statements)

References 18 publications

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“…These late deaths are particularly tragic to parents and children whose only reality has been intensive care. Previous publications have noted that there has been little recent change in neonatal mortality among very preterm infants (18) and showed that age at death among this population was in general very early (19). Other authors have shown an increase in age at death (20), but there are few published data regarding age at death of extremely preterm infants since 2000.…”

Section: Discussionmentioning

confidence: 90%

Evolving neonatal steroid prescription habits and patient outcomes

et al. 2013

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Section: Discussionmentioning

confidence: 90%

Evolving neonatal steroid prescription habits and patient outcomes

et al. 2013

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“…Figure 1 presents the answer, depicting data from the University of Chicago hospitals [1,2]. At the higher ELBW birth-weights, e.g., >800g, mortality is so low (<20%) that the vast majority of NICU expenses (closely approximated by NICU bed-days) are devoted to infants who survive to discharge.…”

Section: Financial Considerations For Neonatal Resuscitationmentioning

confidence: 99%

The Mathematics of Morality for Neonatal Resuscitation

Meadow

Lagatta

Andrews

et al. 2012

Clinics in Perinatology

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Synopsis We have discussed in this chapter ethical issues surrounding the resuscitation of infants who are at great risk to die or survive with significant morbidity. We have introduced data regarding three separate aspects of the morality of resuscitation for these infants – money, outcomes, and prediction. We have demonstrated that there are no credible financial arguments against NICU care for infants born at the border of viability – rather, the NICU is a bargain in terms of dollars devoted to infants who will survive to discharge as opposed to die in hospital. Moreover, the NICU is particularly cost-effective when compared with medical interventions in adults. We have noted that of the four possible outcomes after birth (comfort care, death in the NICU, survival with NDI, survival without NDI), gestational age influences some (death in the NICU) much more than others (percentage of survivors with NDI). Consequently, for parents who view ‘giving their child a chance’ by starting NICU intervention as a worthwhile option, counseling about resuscitation as a function of gestational age appears to have limited support from the data. Finally, we have noted that prediction is possible at four stages of the resuscitation process – before birth (antenatal counseling), in the delivery room, in the NICU while the child remains on the ventilator (when there are ethical alternatives to continued NICU intervention – namely extubation and palliative care), and at the time of discharge. We have presented data suggesting that antenatal and delivery room predictions are inadequately accurate, and prediction at the time of discharge is too late. Rather, we suggest that learning about individual infants from data collected during the trajectory of their own NICU experience (specifically, abnormal head ultrasound and healthcare professional intuitions that the child will ‘die before discharge’) can offer a positive predictive value of >95% for the combined outcome of death or survival with neuro-developmental impairment. This predictive value is worth talking about.

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“…In this issue of Acta Paediatrica , Buchh et al (1) analyse NICU resources devoted to ELBW babies for a 25 year‐period and study their destination over time. NICU bed days were used as a proxy for evaluating medical expenses and survival was considered as the index to judge the efficiency of NICU resources allocation.…”

mentioning

confidence: 99%

“…First of all, survival cannot be the only mean to judge the effectiveness and the efficiency of neonatal critical care. ELBW major morbidities should also be considered for this purpose and, as Buchh et al (1) stated, to measure them is a much more complex calculation. Because many different morbidities may affect in several ways the quality of life, changing it over time, no simple proxy are available for describing this process.…”

mentioning

confidence: 99%

“…It would be interesting to study resources allocation in smaller centres and in settings with minor resources availability. It seems now that it gets harder for a tiny baby to die: median life of non‐surviving ELBW babies is about 10 days (1). Therefore, give a chance to babies that can have only an anecdotic survival may lead to subtract resources to babies with more chances to survive.…”

mentioning

confidence: 99%

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