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 Posted: Wed Dec 5th, 2007 12:03 am
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Doc C
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Location:  Eastern Shore, Maryland USA
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Just got back from my annual medical meeting in D.C. - Hot Topics in Neonatology. As a bit of background before I pose my question. Neonatology is one of the youngest subspecialties in medicine having its origins in the early 50's but not being recognized as a real specialty until the late 60's - early 70's. I started in the practice during the mid 70's and can vividly remember taking care of infants just 34 weeks gestation (full term 37 - 38 wks) and how precarious their survival was then. Little was written in the literature regarding the care of premature infants much less about the "standard of care". Jumping to the present time, 34 week infants essentially pose no problems for us to care for now and we're currently working with infants (fetuses) 23 - 25 weeks (another ethical discussion which I'd be happy to discuss). At that early period, we were essentially flying by the seat of our pants in caring for these infants, i.e. incorporating treatment modalities which were not verified by studies,(using them because we thought they'd work), using adult treatment modalities and scaling them down to these babies. What was driving us in part was the general public/parents and our own desire to do everything we could for these infants, who left untreated would have died (one of Pres. Kennedy's children was born at 34 weeks and died in the early 60's). We're currently are finding that some of the treatment regiments, rather than doing the babies good, were potentially doing them harm (not intentionally). My question to the lay public, was it right for us to use these unproven treatment modalities, even though we had no proven studies to their effectiveness, to try to save these babies or should we have said we won't use them and potentially let these infants die. Would be interested to see what those individuals out there have to say. (An interesting aside, the McClellen statue was across the street from the meeting on Connecticut Ave.)

Doc C

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