This was the topic of discussion in ethics today, and I thought the lecture beforehand and the small group discussion were very interesting. I don't know a whole lot about neonatology, but it seems like a pretty cool field - lots of (miniature!) medical toys, at any rate, and the opportunity to help people who really need it. I don't consider myself a "baby person" per se, but I could probably tolerate neonates much better than the general peds population (I don't know how pediatricians live through all the screaming).
I did not know prior to this morning that the "limit of viability" has been 24 weeks gestation for at least the past fifteen years or so. Prior to this point in development, a baby simply does not have enough alveoli in the lungs to survive - and in fact, the physicians at the NICU here will not resuscitate an infant born before 24 weeks. After this point, it's anyone's guess - a difference in birth weight by 100 or 200 grams can make all the difference. A "trial of therapy" will be initiated. If the baby does well, great; if not, the physicians can approach the family about initiating comfort care after the ethics committee has discussed the case. My instructor, a neonatologist himself, stated that in 18 years of practice, he has only disagreed with the family's decision to continue or discontinue care in two cases, and both were instances of mental illness and/or misinformation. Pretty impressive.
I did not know prior to this morning that the "limit of viability" has been 24 weeks gestation for at least the past fifteen years or so. Prior to this point in development, a baby simply does not have enough alveoli in the lungs to survive - and in fact, the physicians at the NICU here will not resuscitate an infant born before 24 weeks. After this point, it's anyone's guess - a difference in birth weight by 100 or 200 grams can make all the difference. A "trial of therapy" will be initiated. If the baby does well, great; if not, the physicians can approach the family about initiating comfort care after the ethics committee has discussed the case. My instructor, a neonatologist himself, stated that in 18 years of practice, he has only disagreed with the family's decision to continue or discontinue care in two cases, and both were instances of mental illness and/or misinformation. Pretty impressive.
Was that picture from the NICU at Crouse? Richard O. was a 35-weeker, and still so small (I realize just HOW small when I go back and look at the pictures from the first few weeks -- only 4lbs 3 oz at birth!), but he was colossal in comparison to some of the babies in Crouse's NICU.
ReplyDeleteWe were really impressed with the neonatologists in charge of Richard's care. He was actually in pretty good shape for being early -- came out breathing on his own, didn't need oxygen, none of the nasty bowel problems that some of the wee tiny ones have. He did have a tendency towards apnea & bradycardia while feeding, though, which is why he stayed in the NICU for a week before coming home.
I could see you as a neonatologist. I think the technical demands of the field would be really fascinating for you, and unlike traditional peds, you don't have to worry about them kicking you hard in the shin, or mouthing off at you. Still, I think you're kidding yourself if you think that watching those little ones struggle for life wouldn't pull at your heartstrings at times, even though you don't think yourself a "baby" person.
Keep posting! I miss the updates.
The pic is from Google - bruised heels on the baby from blood draws. :(
ReplyDeleteI think I'd like neonatology, though I'm not sure how I'd enjoy the 3-year general peds residency first. I guess it wouldn't be so bad if I knew I was going to go on for a neonatology fellowship afterward.
I never said I didn't feel very sorry for the poor babies - I definitely do. Just because I'm mostly heartless with adults (many of whom have only themselves to blame for their poor health), I can't exactly apply that same standard to babies and young children. Neonatology would be a very emotionally challenging job, but likely a rewarding one as well. I'm adding it to my list of potential specialties. :)