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Limiting treatment for extremely premature, low-birth-weight infants (500 to 750 g)

Article Abstract:

Many advances have been made in the last 10 years in the specialty of neonatology, the medical care of newborn infants. The new techniques and treatments have enabled the survival of infants who formerly would not have lived because of their very low birth weight and extreme prematurity. Recent studies have shown that the overall survival rate for these infants has improved. However, in most individual cases the survival of extremely premature, low-birth-weight infants of 500 to 750 grams (between one and two pounds) is unpredictable. One recent study found that the average survival rate for these infants was less than 34 percent and that 31 percent of the survivors were significantly handicapped. Another study found that the average cost per infant for neonatal care was $158,800, with an average hospital stay of 137 days. These cost figures do not include long-term expenses for the extensive care that handicapped children would need. A dilemma is created for the medical caregiving team when presented with an extremely premature low-birth-weight infant. Aggressive treatment may enable the survival of these babies, but many times the chance of survival is unknown. In addition, if the infant does survive the odds of developing severe neurological deficits are great. Several questions have been posed to stimulate discussion and explore possible ethical solutions to this dilemma. In general, Americans have been more concerned with heroic, high-technology interventions than they have been with prevention; a reduction of premature births is preferable to treating the high-risk infants once they have been born. Also, withdrawal of therapies that are obviously not helping the child should be considered more often. Medical resources in this country are limited; costs are soaring and the elderly population, which needs a great deal of medical support, is growing. Finally, the whole concept of what medical care should be in these cases may need to be redefined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Practice, Infants (Premature), Birth weight, Low, Premature infants, Low birth weight, Neonatology

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Frequency of infections associated with implanted systems vs cuffed, tunneled Silastic venous catheters in patients with acute leukemia

Article Abstract:

Children with cancers such as leukemia often have a need for prolonged feeding and chemotherapy, given intravenously. Cuffed, tunneled Silastic catheters have allowed continued access to central veins in these children, but catheter-related infections are often a problem. In addition, clots, dislocations, and other mechanical problems may occur with such catheters. Fastidious care is essential to prevent such complications. Totally implanted catheters have been used in recent years, with apparently lower infection rates. However, use of these in children with cancer has not been documented well. The different types of cancers are associated with different infection rates; leukemia is associated with a high risk of infection, probably due to neutropenia (low levels of white blood cells) and possibly abnormal white blood cell function. The experiences during a 7.5-year period with 75 central venous catheters in 60 children with acute leukemia are described. Of the catheters, 19 were cuffed, tunneled, single-lumen, 26 were similar but double-lumen, 25 were implanted, and 5 were non-cuffed catheters. Most implanted catheters remained in place, while most cuffed tunneled catheters were removed. The rate of mechanical complications was highest in single-lumen catheters and lowest in implanted catheters, with a 7-fold difference between the two systems. The infection rate was significantly lower, by 4-fold, with implanted than with cuffed tunneled catheters. Of 14 patients who died during the study period, 6 had sepsis (systemic infection) and 1 had pneumonia. Antibiotic therapy was successful, with the catheter in place, in 17 of 21 cases of sepsis. The report suggests that implanted catheter systems are better due to lower infection rates and longer duration, as well as advantages related to catheter care and psychological acceptance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Evaluation, Infection, Pediatric diseases, Intravenous catheterization, Childhood leukemia, Leukemia in children, Infection in children

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