Recent Updates On The Prevention of Premature Delivery and The Treatment of Premature Newborns
« Back to From the Desk of Bruce J. Klores, Esquire
Prematurity is one of the leading reasons for childhood and lifelong disabilities, including Cerebral Palsy. Preventing premature delivery is a problem obstetricians have been facing for decades. Likewise, the premature infant poses significant problems to pediatric specialists, known as neonatologists, who treat these babies in the newborn nursery.
A review of the current medical literature shows that progress may be being made both in preventing premature delivery and in treating premature newborns. A recent article in the prestigious New England Journal of Medicine indicates that pregnant women who have a short cervix and who are treated with the drug Progesterone may have their pregnancies extended. (NEJM, Aug. 2, 2007). In that same journal a review article discusses the various forms of medical therapy currently available for women whose pregnancies are at risk of pre-term delivery or who in fact are showing signs of pre-term delivery.
My Impression:
Although the study cites "critical gaps" in medical knowledge concerning "identification and treatment of women at high risk for pre-term labor," we do know that unless the pregnant woman is attuned to signs and symptoms of pre-term labor, whatever obstetrical care that may be available to her would be of no benefit. Pregnant women need to ask their doctors about the signs and symptoms of possible pre-term labor so that this problem can be addressed as early as possible if it arises.
Regarding the newborn, like the treatment of many other illnesses, it makes common sense that a hospital which has the ability to provide "state of the art" critical care for premature babies would have better outcomes than hospitals which do not. The New England Journal of Medicine reports on May 24, 2007 that "mortality among very low birth weight infants was lowest for deliveries that occurred in hospitals that had a high level of care and a high volume of patients." The study goes on to conclude that "the use of such facilities might reduce mortality among very low birth weight infants."
My Impression:
Having investigated and prosecuted many birth injury cases, we agree with the study. Hospitals with doctors and nurses who are trained to care for premature infants on a day-to-day basis in fact have much better outcomes than smaller hospitals that may be only intermittently staffed by specialists. I remember one case where the mother was actually given the choice by the obstetrician as to hospitals in which to deliver, one being a community hospital, the other being a hospital with a large neonatal intensive care unit. Because the pregnancy was complicated, it was the obstetrician’s fault for even giving the woman a choice of hospitals in which to deliver. Of course Mom chose the hospital closest to her house, unaware of the potential need for intensive care services for her newborn child. Unfortunately when those complications did arise the doctors and nurses at the community hospital were ill-equipped to deal with the baby’s problems. The child unfortunately went too long without oxygen in the nursery and developed Cerebral Palsy. Had that Mom delivered in a "tertiary care" hospital her baby’s Cerebral Palsy would have been prevented.
The lesson from these articles is that the pregnant couple need to be smart medical care consumers. If there is any indication that the delivery is going to be premature or that there are complications that may affect their baby, they need to raise these concerns with their delivering obstetrician to insure that their child receives the best care at the most appropriate facility.
