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Preemie Care: Outside of the Box

Yocheved Lavon

Premature births are on the rise, and thanks to medical advances, survival rates have increased dramatically. Yet, beyond the actual science of neonatal care, studies have shown that an individualized and family-oriented approach in the immediate weeks following delivery can provide conditions that foster healthy brain development at the sensitive newborn stage, and may promise a better prognosis down the road.

Wednesday, May 11, 2011

Sarah wasn’t anticipating any complications in the delivery of her seventh child, as the births of all her previous children had been smooth and full term. Yet, when complications set in during her thirty-first week, she knew she was headed for trouble. In the hospital she was immediately administered a steroid shot to help her unborn baby’s lungs develop, yet surprisingly, the hospital refused to admit her for delivery. All NICU units in Yerushalayim were overbooked, and priority given to women already in labor. Sarah was finally sent by ambulance to Meir Hospital in the center of the country.

To her and her husband, this seemed to be another notch in an already petrifying experience. In the end, she realized how truly fortuitous her choice of hospitals was.…

 

Good Chances

The sight of a baby born many weeks before term, perhaps only a quarter of the size of a robust, full-term infant, is both awe-evoking and petrifying. Who can see such a tiny human being without instinctively offering a silent prayer that Hashem should protect and strengthen this fragile child?

Today, many such prayers are being answered. Babies born at twenty-seven weeks of gestation now enjoy a 90 percent survival rate, and even those born as early as twenty-five weeks — fifteen weeks before term! — stand a good chance of surviving, estimated at 50 to 80 percent. In addition, the incidence of premature births has increased with the growth of reproductive technology, making these numbers all the more significant.

Medical advances have played a central role in this success rate. For example, steroid injections such as Sarah received, work to jump-start the maturation of the baby’s lungs to enable respiration. Alternatively, a surfactant chemical can be delivered directly to the newborn’s lungs via a tube, serving a similar purpose.

Artificial ventilation machinery has been improved to avoid the damage often caused by earlier models. Antibiotics prevent certain infections that are especially life-threatening to premature infants. Effective solutions have been found for nourishing these tiny little ones who don’t yet have the muscular strength to suck and swallow milk. And of course, incubators provide vital warmth, moisture levels, and other basic survival needs. These and other medical interventions have contributed vastly to preservation of life when it hangs by a thread.

Yet, it’s one thing to survive. It’s another to flourish. How can preemies get optimal care so they can start life in the best possible way? The question is posed by Dr. Jonathan Hellman, and it lies at the heart of developmental care, an innovative approach to the treatment of preterm newborns that has been gaining more and more acceptance in hospitals throughout the Western world. Dr. Hellman, clinical director of the Neonatal Intensive Care Unit at the Hospital for Sick Children and professor of pediatrics at the University of Toronto, is one of the leading figures at the vanguard movement to improve conditions in the neonatal intensive care unit (NICU), adapting them more closely to the needs of preemies and their parents and thus heightening their long-term prognosis

 

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