Thursday, March 02, 2006


I recently got some follow-up on a graduate of our NICU - we'll call her Jane - a former 23 weeks gestation patient. I remember this specific patient because one of our nurses, while cutting tape on the baby's face, had accidentally cut off part of her ear, and one of my partners sewed it back on. She is now three years old and a pediatrician friend of mine told me she saw Jane for a check-up.

Respiratorily, Jane has recovered nicely. She had gone home on oxygen but now was having no trouble breathing. Developmentally, she was behiind - saying only a few words at age three - but not so far behind that there was no hope for improvement. Socially, things were not looking so good. The pediatrician heard, from outside the room, the mother yelling at her. It had been seven months since her last pediatric visit, instead of the recommended one month, and her teeth were rotted to the nub by milk bottle cavities. She had been referred to the dental clinic but mom hadn't taken her, so she had some dental abscesses and needed some teeth extracted. Her mother didn't know what medications she was on.

There's an article in the February issue of Pediatrics that confirms what we have seen before: as a group, very premature babies are at risk for lower IQ's and developmental delay. It also showed another discouraging thing. Babies and children who grow up in a home environment where there is lots of stimulation, where they are read to and spoken to often, played with and paid attention to, tend to develop better than children whose home environment lacks those qualities. This difference seems to be exaggerated in premature babies. Premies brought up in "good" homes can overcome, at least partly, the inherent developmental disadvantage of extremely premature birth, but that disadvantage is amplified for premies raised in "bad" homes.

What's going to happen to Jane? I don't know. She's probably not neglected enough that Protective Services would do much. We cannot completely re-engineer society to place every baby in homes to our liking. I guess we can only try to make their lives a little better in the short time we have with them.


Blogger PaedsRN said...

They cut off some of her ear??? Wow. I mean, I've accidentally put a tiny scratch on patients with scissors before, but... that's cringe-making.

So hard to think of 23 weeks as a 'viable' period of gestation. I guess sometimes all you can do is cross your fingers...

4:03 PM  
Anonymous Tara said...

Adore the blog! Question... wouldnt Protective Services be all over this woman if a Doctor called it in? Even if nothing was done, the woman would have to be on her best behavior. Some people really shouldnt be parents.

5:04 PM  
Blogger Flea said...

I'm sad that you're disappointed that children in homes with better stimulation do better. It's not really a surprising finding, is it? In fact, it seems intuitively obvious.

How much more so for former premies!

Doc, the reason I'm a pediatrician is that when they're born there's still hope that they'll rise above their circumstances.

I know that every neonatologist is a pedie so I hope you'll understand what I'm talking about. Keep the faith, man. Someday, one of these kids from a crummy home really is going to rise above.



7:29 PM  
Blogger neonataldoc said...

Thanks, all, for comments. Flea, allow me to clarify some of my unclear writing. I'm not disappointed that children in homes with better stimulation do better. I'm sad that children in worse homes do worse, and that the difference is exaggerated in premies. And I do keep the faith, because the babies and kids are great.

Tara, we are in a large urban area. Protective Services is overworked and understaffed. I'm not sure they would do much, but I'll tell the pediatrician.

Paedsrn, see my post tomorrow.

3:14 PM  
Blogger Yolonda said...

I am the mother of a 23 weeker born in 2005. She did come home on oxygen, and she is a bit nearsighted from stage 3 ROP. She also has Chronic Lung Disese from being on the ventilator 42 days. Today she is a happy healthy 19 month old with very minimal delays. She suffered no brain bleeds while hospitalized and she has had no hospital stays since being discharged. Although we do not know her true outcome, all of her doctors have no question that she will go on to lead a normal happy life. I am so happy and feel blessed that my baby was delivered in a hospital where 23 weeks is viable and a life worth saving.

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