Neonatal Death Quotes

My own choice of a single-variable measure for rapid and revealing comparisons of quality of life is infant mortality: the number of deaths during the first year of life that take place per 1,000 live births. Infant mortality is such a powerful indicator because low rates are impossible to achieve without having a combination of several critical conditions that define good quality of life—good healthcare in general, and appropriate prenatal, perinatal, and neonatal care in particular; proper maternal and infant nutrition; adequate and sanitary living conditions; and access to social support for disadvantaged families—and that are also predicated on relevant government and private spending, and on infrastructures and incomes that can maintain usage and access. A single variable thus captures a number of prerequisites for the near-universal survival of the most critical period of life: the first year.

Surgery is the most masculine of medical disciplines, taking knives and penetrating the body to find disease and destroy it. It is a war game in which cold and shiny stainless steel is pitted against the unseen, sinister but discoverable and conquerable enemy. Pediatrics is in many ways the most feminine of medical disciplines, with its focus on small children, preventive care, nurturing. In terms of gender, neonatology seems to be somewhere in between.

So certain were experts that neonates felt no pain that through the mid-1980s major surgeries on newborn babies were sometimes performed without anesthesia. These included major cardiovascular procedures requiring prying open rib cages, puncturing lungs, and tying off major arteries. Though provided with no pharmacologic agents to blunt the pain that cracking ribs or cutting through the sternum might have induced, babies were given powerful agents to induce paralysis—ensuring an immobile (and undoubtedly terrified) patient on whom to operate. Jill Lawson’s remarkable story of her premature son, Jeffrey, and his unanesthetized heart surgery provides a heartbreaking account of such a procedure. After Jeffrey’s death in 1985, Lawson’s campaign to educate the medical profession about the need to treat pain in the young literally changed the field. And likely led to improved awareness of pain in animals, too. bA technique called clicker training pairs a metallic tick-tock! with a food treat every time the animal performs a desired behavior. Eventually the animal comes to associate the sound of the clicker with the feel-good neurochemical rewards of the food. When the treat is discontinued, the animal will continue doing the behavior, because

From the individual doctor’s perspective, it is far better to do whatever it takes to avoid litigation, even if it doesn’t seem to be the right thing to do, than to risk entanglement in this crazy system.

A whole hospital ward seemed to be crossdressing, nurses pretending to be mothers playing like boys with Tinkertoy babies.

Many NICU survivors have hospital bills of more than a million dollars and cannot be discharged from the hospital because their parents cannot afford a telephone at home.

Because the work that doctors do has moral urgency, doctors have a highly refined, professionally reinforced sense of right and wrong.

No. 1, when you ask who’s interested in this, the usual answer is, terminally ill people with excruciating pain. False. Factually not true. It tends to be a preoccupation of people who are depressed or hopeless for other reasons. No surprise, actually, if you look at what leads to suicide: hopelessness and depression. You have to look at euthanasia or assisted suicide as more like suicide than like a good death. Second, this notion that there’s no slippery slope, as advocates have long claimed? Totally wrong. Look at Belgium and the Netherlands: First, it’s accepted for adults who are competent and give consent. Then, it’s “We’re going to extend it to neonates with genetic defects, and adolescents.” Any time we do anything in medicine, it’s the same way: We develop an intervention for a narrow group of people, and once it’s well accepted, it gets expanded. I think it’s false to say, “We can hold the line here.” It doesn’t work that way. Third, people say this is a quick, reliable, painless intervention. No medical intervention in history is quick, reliable, painless and has no flaws. In the Netherlands, there’s about a 17 to 20 percent rate of problems, something screwing up. Initially, when the Oregon people published — “We have no problems. Every case went flawlessly!” — you knew the data was wrong. It had to be wrong. Either you’re not getting every case, so the denominator was wrong, or people are lying. There’s nobody who does a procedure, not even blood draws, and it’s perfect every time. So this idea that this is quick, reliable and painless is nonsense. And the last and most important point is: You want to legalize these interventions to improve end-of-life care in this country? That’s your motivation and this is your method? PS: I don’t think people argue that–— ZE: [interrupting] Oh, people do argue that! That is the justification for these procedures: It’s going to improve end-of-life care and give people control. The problem is, even in countries that have legalized it for a long time, at best 3 percent of people die this way in the Netherlands and Belgium. At best, 10 percent express interest in it. That is not a way to improve end-of-life care. You don’t focus lots of attention and effort on 3 percent. It’s the 97 percent, if you want to improve care. The typical response is, we can do both. Hmmm. Every system I’ve ever seen has a bandwidth problem: You can only do so much. We ought to focus our attention on the vast, vast majority, 97 percent of people, for whom this is not the right intervention and get that right — and we are far from that. I don’t think legalizing euthanasia and assisted suicide are the way to go. It’s a big, big distraction.

there is something unforgettably compelling about having actually been there, alone, at two in the morning, gloved, masked, and robed like a latex-covered priest, receiving into my hands a blue, bloody, and lifeless baby and having to decide.

Informed consent is probably the most revolutionary, the most rudimentary, the most misunderstood and misused term in all of health law and bioethics.

The likelihood of my baby being injured during co-sleeping was, in reality, significantly lower than it would have been had I left her in the hospital cot. In the UK, 90 percent more babies die alone in baskets or cots – Sudden Infant Death Syndrome – than they do when they securely, rather than hazardously, co-sleep with their mothers.

infant deaths decline from about 100 per 1,000 births in the year 1900 to about 0.1 per 1,000 today as maternal and neonatal care has improved.