[ETWolverine]

I totally agree with you Elliot. The baby does deserve a fighting chance, but do the parents know what they are in for if the baby lives?

Well, they certainly don't know if they are never given the option in the first place.

I know parents like this. While they are happy that their babies survived (one that I know is now 9 years old) they are dealing with mental retardation, hospitalizations every winter because the lungs were not fully developed at birth, etc. They say they love their child, but if they had it all to do over again, they would not want their child to suffer the way he does now.

I have a niece who is one of those babies. I know the costs. I know the pain of the parents. I know the pain of that baby's siblings. And I still say that it is a decision for the parents and for G-d, not the NHS or even the medical staff.

Give the kid the fighting chance that he or she deserves as a human being.

Elliot

[J_9]

We have one of the highest infant mortality rates in the world. Why? Most of it is lack of education on the mother's part, little or no prenatal care, and believing that a fetus is viable at any stage of development. These are all costly mistakes that add to our healthcare bill.

Remember, I am a labor and delivery nurse, so I am all for the baby. It's all about the baby with me and I will do whatever it takes to have a healthy baby no matter the cost.

I have learned though, to take my emotional hat off and put my scientific hat on when it comes to early gestation.

I am not a fan of Wiki... but this explains a lot.

Viability
Stages in prenatal development, showing viability and point of 50% chance of survival at bottom. Weeks and months numbered by gestation.

The lower limit of viability is approximately five months gestational age, and usually later.[31]

About 20 to 35 percent of babies born at 23 weeks of pregnancy survive, while about 50 to 70 percent of babies born at 24 to 25 weeks, and more than 90 percent born at 26 to 27 weeks, survive
Human fetus, age unknown

According to The Developing Human, viability is defined as the ability of fetuses to survive in the extrauterine environment.[32]

There is no sharp limit of development, age, or weight at which a fetus automatically becomes viable. [32] According to data years 2003-2005, 20 to 35 percent of babies born at 23 weeks of gestation survive, while 50 to 70 percent of babies born at 24 to 25 weeks, and more than 90 percent born at 26 to 27 weeks, survive.[33] It is rare for a baby weighing less than 500 gm to survive.[32]

When such babies are born, the main causes of perinatal mortality is that the respiratory system and the central nervous system are not completely differentiated.[32] If given expert postnatal care, some fetuses weighing less than 500 gm may survive, being are referred to as extremely low birth weight or immature infants.[32] Preterm birth is the most common cause of perinatal mortality, causing almost 30 percent of neonatal deaths.[34]

During the past several decades, neonatal care has improved with advances in medical science, and therefore the limit of viability has moved earlier.[35] As of 2006, the two youngest children to survive premature birth are thought to be James Elgin Gill (born on 20 May 1987 in Ottawa, Canada, at 21 weeks and 5 days gestational age),[36][37] and Amillia Taylor (born on 24 October 2006 in Miami, Florida, at 21 weeks and 6 days gestational age).[38][39] Both children were born just under 20 weeks from fertilization, or a few days past the midpoint of an average full-term pregnancy. Despite their premature births, both developed into healthy children.

Darn, the table did not show up. You can see it here... File:Prenatal development table.svg - Wikipedia, the free encyclopedia

[tomder55]

You did not answer my reply about others who get treated even though their prognosis is grim . Why should they be treated and not the premie who ;if they survive ,have a chance for a long productive life ?
Again I ask... is the triage approach to cost containment the best we can do ?

Here is Dr Death Emanuel's chart
Note that he too determines that the young ones should not get to utilize the resources .

[NeedKarma]

Tom,
Do you have a link to a government site that has context with that chart? Pajamamedia isn't a good reference.

[J_9]

You did not answer my reply about others who get treated even though their prognosis is grim . Why should they be treated and not the premie who ;if they survive ,have a chance for a long productive life ?
Again I ask ....is the triage approach to cost containment the best we can do ?

Here is Dr Death Emmanuel's chart
Note that he too determines that the young ones should not get to utilize the resources .

Sorry Tom, I missed that. Even though the progosis is grim, a full term baby gets treated because all of it's organs are developed and should be functioning. The preemie gets treated, depending on gestational age and the level of care the local hospitals provide, not every hospital has a NICU.

I work in a level one nursery at a VERY rural hospital. I not only deliver babies, but also work in the nursery and postpartum units. Level one nurseries are only able to care for full term babies, some preemies, but none under the gestational age of 33 weeks. We cannot have a child on a respirator, nor can we have a neonate who is on IV medications. All of these babies get shipped out to hospitals that have NICUs.

Some of the best NICUs are in California, Florida and New York, there are others, I'm just using these as examples.

Also, Elliott, I am not here to argue, that is the last thing I want to do... please don't think I am trying to start an argument with you, quite the opposite. I believe that this is a great topic of concern as well as good discussion.

I ship every laboring woman out who is below 35 weeks gestation if she is stable. If she is not stable we call The Wing who flies to our hospital in wait for the baby.

[tomder55]

NK ; It was in his Lancet article he published . PJ media was just a convenient place for me to link because I have problems posting stuff from PDF .

But here's a try

http://www.ncpa.org/pdfs/PIIS0140673609601379.pdf.

[excon]

You did not answer my reply about others who get treated even though their prognosis is grim . Why should they be treated and not the premie who ;if they survive ,have a chance for a long productive life ?

Hello tom:

You're not suggesting, are you, that private health insurance would pay for any treatment the premie needs, are you?? Nahhh... You wouldn't be saying that, because it AIN'T true. The little tyke has to go in front of the insurance company "death panel". I'd give him a 50/50 chance of surviving THAT board.

excon

[NeedKarma]

NK ; It was in his Lancet article he published . PJ media was just a convenient place for me to link because I have problems posting stuff from PDF .

But here's a try

http://www.ncpa.org/pdfs/PIIS0140673609601379.pdf.

Got it, thanks. Has that paper been accepted as a position paper for the health care reform?

[tomder55]

Sorry Tom, I missed that. Even though the progosis is grim, a full term baby gets treated because all of it's organs are developed and should be functioning. The preemie gets treated, depending on gestational age and the level of care the local hospitals provide, not every hospital has a NICU.

Actually the example I gave was a lung cancer patient . They face real long odds of survival .And yet they receive radiation and chemo treatment until it is proven that the treatments will not work .
You see where the concerns are when panels ,commissions etc are making these determinations ? The mother of that child would've gladly spent every penny she owned for the chance . The NHS did not give her the option.

[J_9]

Hello tom:

You're not suggesting, are you, that private health insurance would pay for any treatment the premie needs, are you???? Nahhh.... You wouldn't be saying that, because it AIN'T true. The little tyke has to go in front of the insurance company "death panel". I'd give him a 50/50 chance of surviving THAT board.

excon

Most of these women don't even have private insurance. They depend on Medicaid. Us and our tax dollars.

We are really generalizing here that all these babies are born to healthy women. While micro preemies are born to healthy mothers, many of these micro preemies are born to drug addicted mothers. Drugs cause an increasing number of premature labor... placenta abruption is caused by cocaine and crack for example and is deadly to mother and baby if an emergency C-Section is not performed within 15-30 minutes. These babies are going to have problems WiTHOUT being preemies, full term crack/coke babies have problems of their own. Then we have FAS (fetal alcohol syndrome) causes premature labor and delivery as well.

[tomder55]

Got it, thanks. Has that paper been accepted as a position paper for the health care reform?

Zeke Emanuel is a key advisor to the President.He is acting as Special Advisor for Health Policy to Peter Orszag, the Director of the Office of Management and Budget .His brother is Obama's chief of staff.

[J_9]

Actually the example I gave was a lung cancer patient . They face real long odds of survival .And yet they receive radiation and chemo treatment until it is proven that the treatments will not work .
You see where the concerns are when panels ,commissions etc are making these determinations ? The mother of that child would've gladly spent every penny she owned for the chance . The NHS did not give her the option.

I am a cancer patient too. My odds were grim... 13 years ago. You can't compare apples to oranges Tom.

[tomder55]

It's not apples to oranges at all . With all due respect... Why do you deserve the care and not the baby under the logic applied under a centrally controlled "universal system " ? Do you fall within Dr. Death's chart of those worthy of saving ? Would you have accepted their conclusions without a fight ?

[J_9]

Tom. I fought. Went to 7 different doctors to get the correct diagnosis. But it IS apples to oranges. Chemo and radiation are proven to cure and/or lengthen life.

Currently, scientifically, we don't have the ability to save fetuses under a certain gestational age. We are still studying that. We can't go where no man has gone before without a little study or two. Babies are guinea pigs on a daily basis, we try this drug... if it doesn't work we try that drug... many of them are unproven. We use these babies to further our education and our science to save the lives of future babies.

Here's a good page with percentages. It's not Wiki, it's from the Preemie Survival Foundation.

Quint Boenker Preemie Survival Foundation

[excon]

These babies are going to have problems WiTHOUT being preemies, full term crack/coke babies have problems of their own. Then we have FAS (fetal alcohol syndrome) causes premature labor and delivery as well.

Hello J:

If what you're saying, is that doctors themselves ARE "death panels", then I'd agree.

excon

PS> I must apologize for my crassness above, J. Of course, throughout the entire health care system, there's LOTS of decisions made about the care of people that COULD, if you wanted to inflame people, be considered "death panels".

I certainly wouldn't refer to them as such... But, some people want to call ONE part of the PROPOSED health care system death panels, while ignoring the REAL death panels that we've already got. So, I make the comparison above simply to show how dumb some people are

[tomder55]

Currently, scientifically, we don't have the ability to save fetuses under a certain gestational age.

I gave the example of the 4 minute mile for a reason.

My sister was a long term kidney patient (no Excon she was never denied care by the insurance companies even though it was clear her illness would kill her) .

I watched the advancement of treatment of kidney patients up close and personal . When she began she had to hook up to dialysis a few times a week at a hospital for many hours.
Now the units are portable and there are many more treatment options .

All these innovations would not have occurred had they not had patients to treat. Had the "commission " decided she was not worth it then the experimental care she got would not have been developed to benefit future patients.

By trying to save babies like that; even if not successful, the doctors and hospitals learn from the effort. Over time, the success rate of saving premies goes up, and the outcomes are better.

Open heart surgury used to be a costly and risky affair. Why waste the money ? Now the surgeries are less invasive and have a higher success rate. But they are still expensive.

[J_9]

Hello J:

If what you're saying, is that doctors themselves ARE "death panels", then I'd agree.

excon

PS> I must apologize for my crassness above, J. Of course, throughout the entire health care system, there's LOTS of decisions made about the care of people that COULD, if you wanted to inflame people, be considered "death panels".

I certainly wouldn't refer to them as such... But, some people wanna call ONE part of the PROPOSED health care system death panels, while ignoring the REAL death panels that we've already got. So, I make the comparison above simply to show how dumb some people are

I'm all with you Excon!! You're always crass... no need to apologize. I understand you. ;) JK

[J_9]

By trying to save babies like that; even if not successful, the doctors and hospitals learn from the effort. Over time, the success rate of saving premies goes up, and the outcomes are better.

I AgREE!! I AgREE!! But who is going to pay for this? We have been talking about the general population. Teaching hospitals are great for this. We need this happening more in teaching hospitals where there are grants for these studies.

Currently, the insurance money, for those on private insurance, runs out before the baby is discharged home. For others, they rely on our tax dollars, Medicaid, to pay for this, or the hospital takes a cut, a big cut, as these are, in most cases, multi million dollar babies.

Have you ever had the opportunity to visit a NICU? It's heartbreaking to say the least. The technology is amazing, but not near what we need.

[ETWolverine]

We have one of the highest infant mortality rates in the world. Why? Most of it is lack of education on the mother's part, little or no prenatal care, and believing that a fetus is viable at any stage of development. These are all costly mistakes that add to our healthcare bill.

Remember, I am a labor and delivery nurse, so I am all for the baby. It's all about the baby with me and I will do whatever it takes to have a healthy baby no matter the cost.

I have learned though, to take my emotional hat off and put my scientific hat on when it comes to early gestation.

I am not a fan of Wiki...but this explains a lot.



Darn, the table did not show up. You can see it here.....File:Prenatal development table.svg - Wikipedia, the free encyclopedia

Actually, J_9, the reason we have the highest infant mortality rate is because we count babies like the one pictured as having been born ALIVE, while the rest of the world counts them as never having been born at all. We fight hard to keep such children alive, while other countries (including the UK) simply don't bother trying.

We try and fail and count that in our statistics. They don't try and simply IGNORE the fact that the baby was ever born at all.

Consequently, we save more of those babies and they don't. But our medical system's often heroic efforts to save such babies are counted NEGATIVELY against us in terms of the statistics.

Our mothers are no worse educated in terms of pre-natal care than any other country. And they receive better pre-natal care than mothers in other countries, according to studies produced in Lancet. That's not the reason for the seemingly poor statistics.

Or are you prepared to argue that mothers in Colombia or Dominica are better-educated and receive better pre-natal care than the USA, resulting in better infant mortality rates... because that is what the WHO's report on Health Care would have us believe.

No, the real reason for the differences in the infant mortality statistics is that we count babies as alive that other countries do not.

In the UK, my niece (Gabby is her name) would have been considered "unborn" and never counted. And she never would have been treated. And she would have died... and she wouldn't have even become a statistic.

In the USA, she was given treatment from the moment she was born. If she had died, she would have been an infant mortality statistic. Since she lived, she's considered a financial drag on society by our President and his supporters like Zeke Emanuel, and used as an example of where we should be cutting costs.

Whereas we on the right see Gabby instead as a human being, worthy of life, and valued as a living being.

Elliot

[J_9]

Or are you prepared to argue that mothers in Colombia or Dominica are better-educated and receive better pre-natal care than the USA, resulting in better infant mortality rates... because that is what the WHO's report on Health Care would have us believe.

Elliot, I'm not here to argue anything. I'm here for a friendly discussion. No, I don't believe mothers in Columbia or Dominica are better educated. But, then again, where I live is not much different than those places.