Status of Premature Babies

Premature Babies:

Medical Advancements vs. Nature

    As care for children has been modified throughout our history, we have seen an increase in the number of children that survive the delivery process. We have seen a greater number of children with little likelihood of surviving pull through into adulthood with the help of medical advancements. As the increasing number of prematurely born children reach adulthood, doctors and medical professionals are recognizing certain complications with their survival. Time has shared opposing opinions in whether medical professionals and individual governments should allow for care of children born preterm to be accessible and honorable in society.

In 1880, a French obstetrician named Stephane Tarnier created the incubator. At this time, children were usually born at home and directed into their mothers care. This made mothers the primary care provider for newborn babies under the supervision of a midwife who helped to deliver the child. Families wanted it to be this way because it left the parents in ultimate control of their baby. Because of the fact that infants were born at home with the wishes of the parents as the major controlling factor, children who were born prematurely before the invention of the incubator really did not have a very great chance of survival. In a study done by Tarnier,  he disclosed that the mortality of children that were born weighing between 1200-2000 grams decreased from 66% to 38% when the incubator was introduced.

When the incubator was introduced, it was very difficult to be implemented as a common medical technique to help with the survival of premature children. The use of an incubator was not very popular at the time because the vast majority of deliveries occurred at home. If the incubator were to become the “next big advancement”, it needed to have public support and there would need to be an adjustment of global views regarding the turnover of a mothers sole care to the assistance of a medical professional. This is exactly what Alexandre Lion began to do.

Lion, a French physician, developed a more advanced version of Tarnier’s incubator in the 1890’s. He created an incubator exhibit and took the exhibit to the Berlin Exposition of 1896. The exhibit caught public attention and ended up becoming the hit of the festival. Lion continued to bring the incubator exhibit to other World Fairs and this really spread the overall awareness of the incubator. Thanks to the advertisements at public events, incubators were gaining headway in the medical industry. As the general public became more aware of the increasing amounts of premature birth and that there was now a way to help preemies survive,  it had become apparent that as a society, it was necessary to devote time and money into creating a way to help babies survive past infanthood.

When incubators reached America, Joseph B. DeLee,  an obstetrician from Chicago, Il., opened the first incubator “station” at the Chicago Lying-in Hospital in 1900. He created a transport system to bring struggling babies into the hospital. Despite the failure of the hospital, the systems that he had implemented are still found in todays health systems.

Julius Hess redeveloped DeLee’s ideas of an incubator station and created the first successful station in the 1920’s. Like DeLee, he made advancements to the incubator and implemented a transport system into his station. Unlike anyone before his time, Hess took the time to learn about what nurses had noticed about premature children and their deliveries and then took the time to train them on special procedures relating to infants. Hess decided to continue learning about the effects of being preterm and published “Premature and Congenitally Diseased Infants” which challenged the outlook on premature children. Suddenly, as new medical practices were becoming more available to people everywhere and information was being spread about children being born so young surviving, worldwide views of preterm babies changed from the “weakling” that was sentenced to death, to a “child” with a chance of survival.

As the opinions surrounding a preterm baby began to change, the concepts surrounding children born in the hospital became more popular and well known. The number of children born in hospitals not only increased because of the change in ideals that accepted medical professionals to assist in the care for their newborn, but as the American Medical Association (founded in 1847) began to be more persistent in the promotion of the overall well being of infants, our government began to develop and pass laws requiring a more strict emphasis on who could practice medicine. These laws limited the number of midwives available to mothers who were expecting. The decrease in number of available midwives caused mothers to turn to the hospital system to deliver their children. The general public was also influenced by educated medical professionals such as Joseph DeLee who wrote articles and spread information about their opinions on the lack of education of a midwife and informed society about the importance of medicine. As the number of children delivered in hospitals increased, more techniques were created to ensure the livelihood of children. Hospitals and infant wards were becoming more available to all families and were supported by the general public.

As doctors and nurses began to deliver infants, they noticed that a large number of the preterm babies faced respiratory issues and developed several techniques to increase their chances of survival. These techniques included the introduction of oxygen therapy and surfactant treatment to help with respiratory illnesses. Nearly 25% of all children born prematurely face one common chronic lung disease called bronchopulmonary dysplasia, this condition is one of many respiratory illnesses prominent in premature births.

Today, we are seeing direct effects of the decision to develop techniques to help more children reach their reproductive ages. We have seen the infant mortality rate drop from nearly 100 deaths/thousand births in 1915 to a slim 6 deaths/1000 births in 2014 in the United States. As medical advancements have increased the number of survivors, we have then seen more issues arising as preterm children reach adulthood.

As babies that were born extremely preterm have reached adulthood, researchers have come to the realization that they are at an increased likelihood for many different illnesses and disorders as a consequence of their early birth. In a study done by the National Institute of Health regarding children born preterm that have reached age 12 (born between 1989-1992), concluded that babies born preterm have an average lower IQ score of 6-14 points lower than full term children. They also concluded that preterm children require more school services (para assistance, special classes, more individualized studies). 76% of 12 year olds that were extremely preterm required school services,  comparatively, 44% of preterm 12 year olds required some sort of school service and 16% of full term 12 year olds required a specialized school service.

    Not only may the rising number of preterm infants impact the number of school service workers, but as children born prematurely have reached school age, we have seen a rise in diagnosed ADHD. In a study published by the American Academy of Pediatrics, they claimed that “the risk for ADHD was doubled for children born at 23-28 weeks gestation”. The study also provided information that noted that infants born small for gestational age were also at an increased risk of ADHD.

Children born preterm are not only at a greater risk for ADHD and the increased use of school services, but they also are more susceptible to educational disabilities and poorer physical conditions. In a study published by Science Direct in “Seminars in Fetal and Neonatal Medicine”, they concluded that fewer very low birth weight children (<1.5kg at birth) had lesser educational achievement. They found that 23% of very low birth rate children had some sort of college degree compared to 58% of normal birth weight children in the United Kingdom. Low birth weight children were also at a greater risk for internalizing problems such as depression or anxiety. Maureen Hack, author of the paper, reported that “Parents of very low birth weight women tended to agree with the internalizing symptoms reported by their daughters in that they reported significantly more anxious/depressed and withdrawn problems than parents of normal birth weight control women.”  Children born with low birth weight were also susceptible to higher blood pressure, and poorer respiratory function. Very low birth weight subjects had a higher mean systolic blood pressure at 114 mmhg compared to normal birth weight subjects at 112 mmhg. Cooke, a doctor researching in this case found that “more very low birth weight subjects were taking a regularly prescribed medication, most commonly for asthma”, he also found that 8% of the very low birth weight children studied had asthma compared to 6% of normal birth weight children.

    Today, countries around the globe are looking for ways to reach a medium in saving children but decreasing the amounts of disability in children reaching adolescence. The Nuffield Council for Bioethics provided ‘guidelines’ around the treatment and survival of children born at different stages of development. They suggested that babies under 23 weeks of gestational age should not be resuscitated unless the parents and clinician agree that it is in the best interest of the child to do so. We have also seen changes in America with the utilization of Obamacare. The intention of Obamacare was to make healthcare more affordable and accessible but we are seeing that for some of the most vital treatments of care for premature infants such as hospitalization and complete usage of medical technology for certain illnesses like Respiratory Syncytial Virus are being put aside and not being fully treated because they are too costly to insurance providers.

    As of right now, the way that governments across the world are acting around the issue of premature birth seems to be different than the opinion of citizens. In a poll organized by debate.org, it was found that 68% of responses suggest that premature infants of all ages should be given all of the resources to survive, one of the respondents suggested that, “It's presumptuous to assume that, simply because the outcome looks bleak, doctors and parents should just immediately give up on premature babies.” On the other hand, 38% of respondents suggested that children born before 23 weeks gestational age should not be given medical treatment, one person came to the conclusion that “Virtually all babies born before 23 weeks will be severely mentally and/or physically disabled and would have pretty much no chance of ever being productive members of society.”

    Throughout our history as a global community, medical advancements have increased the survival rate of children who are born prematurely and children with a medical disability. With this increase, we have seen an increasing number of children with lifelong setbacks including a lower IQ score, an increased use of a school para, a greater risk of higher blood pressure and respiratory illness, and a greater risk of ADHD. Currently, we are seeing changes in opinion on the way that our government is acting on premature births and the public opinion. These newfound increases and changes to medical treatment have the capability to impact families across the world.

Source Analysis 1:

Source: Luu, Thuy Mai, et al. "Lasting effects of preterm birth and neonatal brain hemorrhage at 12 years of age." Pediatrics 123.3 (2009): 1037-1044.

Media Type: Online/ non-print

Target Audience: Medical professionals looking for information regarding premature neurological disabilities

Credibility: Authors had either MD’s, MPH’s, or MS’s.

Author’s Viewpoint: Premature children born in the 1990’s with a brain injury, faced significant neurological deficits which led to the increase in school services of children at 12 years of age.

Source Analysis 2:

Source:Stark, Ann R., et al. "Adverse effects of early dexamethasone treatment in extremely-low-birth-weight infants." New England Journal of Medicine 344.2 (2001): 95-101.

Media Type: Online

Target Audience: Scientists looking for new treatment/adjustments to current plan of treatments regarding Dexamethasone treatments

Credibility: Medical Doctors conducted experiment and published their findings

Author’s Viewpoint: Premature children between 501-1000g are at a higher risk of chronic lung disease if the dosage is improper. Their studies show that: a 10 day tapered course of action will decrease this risk although this will increase gastrointestinal issues.

Source Analysis 3:

Source: Lindström, Karolina, Frank Lindblad, and Anders Hjern. "Preterm birth and attention-deficit/hyperactivity disorder in schoolchildren." Pediatrics 127.5 (2011): 858-865.

Media Type: Online and in print

Target Audience: Parents, neonatal doctors and pharmacists looking to solve the ADHD “puzzle” and to learn new techniques to decrease the number of children diagnosed with ADHD.

Credibility: Authors/Contributors had MD’s as well as PhD.’s

Author’s Viewpoint: Preterm birth increases the risk of ADHD.They believe that more attention must be spent on advancement of care towards infants born prematurely.

Source Analysis 4:

Source: Hack, Maureen. "Young adult outcomes of very-low-birth-weight children."Seminars in fetal and Neonatal Medicine. Vol. 11. No. 2. WB Saunders, 2006.

Media Type: Online and print

Target Audience: Neonatal doctors, bioethicists, and parents searching for the outcomes of children born prematurely.

Credibility: Author is a part of the Division of Neonatology at the Rainbow Babies and Children Hospital in Cleveland, Ohio.

Author’s Viewpoint: Children born prematurely may have poor educational achievement, fewer continue education past high-school, have a higher mean blood pressure, poorer respiratory function, are at greater risk of anxiety and depression, have lower rates of risk taking, and may be less sexually active than those that were born at term.

Source Analysis 5:

Source: Reedy, Elizabeth A. "Care of Premature Infants." Care of Premature Infants. University of Pennsylvania: School of Nursing, n.d. Web. 01 Mar. 2015. <http://www.nursing.upenn.edu/nhhc/Pages/CareofPrematureInfants.aspx>.

Media Type: Online

Target Audience: Historians and medical professionals with an interest in the history of neonatal care and medical advancements regarding premature babies.

Credibility: Author holds a Phd. and is also a faculty member at Immaculata University

Author’s Viewpoint: As we began to recognize that there were increasing numbers of prematurely born children, the general public demanded energy to be spent on developing medical treatments for the children. These specific treatments have shown great advancements to neonatal medicine but have stirred controversy over the treatment of children and the chance of death that resides in saving premature infants.

Source Analysis 6:

Source: Baker, Jeffrey P. "The Incubator and the Medical Discovery of the Premature Infant." Journal of Perinatology 5 (2000): 321-28. Nature America Inc. Web. 3 Mar. 2015. <http://neonatology.org/pdf/7200377a.pdf>.

Media Type: Online and in Print

Target Audience: Historians and specialists such as an urban planner or an entrepreneur interested in the innovations that have lead to modern medical technology and systematics.

Credibility: Author has both a MD and a PhD.

Author’s Viewpoint: As time has passed, we have seen many innovations that have benefit the life of humans including the introduction of industrialized medical technology.