Thursday, March 16, 2006

Happy

A regular reader of this blog whom I know personally asked me "Doesn't anything good happen in the NICU?"

"Sure'" I said, "babies get better and go home."

When we think of neonatal units, we tend to think of "micropremies", the extremely small babies who have high rates of complications, or of babies with birth defects. People have commented to me that neonatology must be an interesting but sad specialty, and when I review the subject matter of many of my postings - holoprosencephaly, drug addicted moms, extremely premature babies - I can see why they might think that. The truth, though, is that most of our patients do very well, and that neonatology is actually mostly a happy specialty. The kids are cute and the parents are pleased and (usually) grateful. For every 23 or 24 weeker with residual deficits, there are two or three 31 or 32 weekers who need just a little help and a few weeks of hospitalization and then go home healthy as can be. For every baby with severe birth defects, there are dozens of babies who have transient breathing problems and go home fine after 3 or 4 days.

And many of the babies who do well now would not have done well in the not so distant past. President Kennedy had a premature baby at 34 weeks gestation who died at the age of two days 43 years ago. Today, babies of that size and gestation, even with respiratory distress syndrome, have a survival rate approaching 100%.

The problem - and this is not really a problem - is that these babies who do well usually don't make for interesting stories. They are born, get better, and go home. So those of us who write about neonatology, either on blogs or elsewhere, tend to write about the more complex or ethically vague cases - cases that often have a sad ending.

This post, I guess, is my way of justifying all the stories here about less than happy things. So when you read them, don't get discouraged; just think about all the pleasantly boring babies whose parents are beaming but who didn't make the news.

11 Comments:

Blogger Flea said...

I had the honor of knowing Dr. Berenberg at Children's in Boston, who took care of the Kennedy baby.

Dr. B described the experience as the longest 48 hours of his life.

I know of some neonatologists who sweat just as hard for every patient who gets admitted to their unit. Linda Van Marter at Brigham and Women's comes to mind. I'm sure you are such a doc.

In Dr. B's defense, it could be that the stakes for him felt a lot higher, given he was taking care of the president's son.

best,

Flea

5:10 PM  
Anonymous Anonymous said...

An off the wall question, but I'm curious about your answer because I'm wondering about a friend's newborn (success story so far - 10 days old and went home today). How long do babies born with Trisomy 13 usually live?

10:19 PM  
Blogger That Girl said...

My first son was 27 weeks, 1 lb 12 oz and not a thing wrong with him. Needed to get a little bigger but that was it. He has a learning disability that he inherited from me but no other neo problems. It works out sometimes, thanks to docs like you.

10:38 AM  
Blogger neonataldoc said...

Flea: Thanks. Interesting. I've read some of Dr. Van Marter's workl. It's good to hear she's good.

Anonymous: About 80 to 90 % die before their first birthday. One source said 44% die by age one month, 69% by age six months, and 82% by age one year. See trisomy.org for information about support groups. Google trisomy 13 and lots of info will come up.

That girl: great!

9:24 PM  
Blogger Dave said...

Many of the people who have "good" experiences still don't like to talk about it. I think some of the photos in my kids in the NICU are adorable, but my wife shudders to see them.

We seem to be doing fine, 30 weekers now at 5 months.

9:27 PM  
Blogger wunderkind said...

Good things of NICU. i see some of the most touching elements of humankind that exist on the planet.

First, i am honored to work with nurses and physicians who are committed to the best care for the children. i have seen people work extra hours when staff was short. i've seen teamwork on levels that could move a mountain and i've seen a few mountains move. They have taught me things that could never be found in a textbook - the value and worth of humanity. i haven't always understood decisions and choices. i have sometimes asked unpopular questions in my quest to understand and know what makes them tick. i have to come away with one conclusion - there is no price upon the worth of a human being. There is no sacrifice too high for that of a human being.

i have seen them on the front lines and they allow me to watch and learn.

Yes, we have miracle stories. Yes, we have stories of determination, endurance, and second chances.

NICU is a place of honor and respect.

8:59 PM  
Blogger Janae said...

My baby sister was born at 31 weeks in 1981. She was in the hospital for months. When she finally came home, it was for less than 24 hours because she had an episode of apnea. I'll never forget that winter morning as long as I live. The next time she came home, she came with an apnea monitor. I still remember the times that it went off like yesterday. We were all very aware of it that year that she was on it. I'll never forget the stress I felt when I heard the monitor alarm. Everyone in the family reacted to it, down to my 2 year old brother.

Twenty four years later, she's doing great. She has not had one single problems the drs said she'd have. Academically, she did very well in school, frequently earning straight As. Last summer she became the mom to a beautiful little girl. If she isn't a success story, I don't know what one is.

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