Taking a longer term medical view

Last week I caught part of an extended interview with Dr Marcus Davey on improving health outcomes for premature infants between 24-28 weeks.  The interview was with Kim Hill on Radio NZ.

“Dr Marcus Davey, a developmental physiologist and senior researcher, is part of a team researching pre-birth genetic disorders at the Centre for Fetal Research at the Children’s Hospital of Philadelphia (CHOP).
The team is working on the development of an extra-uterine support device; a womb-like, fluid-filled environment that can give prolonged support of up to four weeks to extremely premature babies.
The device is called EXTEND (Extracorporeal Transitional Environment for Neonatal Development).
The team has been testing the device on lambs, which have a similar physiology to humans, and hope it could offer an alternative therapy for premature babies from 23 to 25 weeks old.”

As Davey explains using the EXTEND environment helps to improve long term health outcomes. The current procedures for caring for premature babies is successful in the short term but the act of putting an infant on a mechanical ventilator causes long term damage.

The interview is fascinating as the research leverages lamb research data from NZ and Australia. The physiology is well understood. All those jokes about NZ being a nation of sheep has finally become a good thing.

What I find fascinating is that some 200 years on from the start of modern medical treatment we are still discovering new ways to manage something as natural as birth.

“All preterm births are not the same from Born Too Soon: The Global Action Report on Preterm Birth

For the report, preterm was defined as 37 weeks of completed gestation or less, which is the standard WHO definition. Preterm babies are defined in 3 categories:
Late preterm – those born between 32 and 37 weeks – account for 84 percent of total preterm births, or 12.5 million. Most survive with supportive care.
Very preterm – those born between 28 and 32 weeks. These babies require extra supportive care. Most will survive
Extremely preterm – those born before 28 weeks. These babies require the most intensive, expensive care to survive. In developed countries, these babies have a 90 percent chance of survival, though they may suffer lifelong physical, neurological, and learning disabilities. In low-income countries, only 10 percent survive”.
“Being born too soon is an unrecognized killer,” says Joy Lawn, M.D., PhD, co-editor of the report and Director, Global Evidence and Policy for Save the Children. “Preterm births account for almost half of all newborn deaths worldwide and are now the second leading cause of death in children under 5, after pneumonia.”

It is that group – Extremely Preterm that this research is aimed at. I very much like that the babies don’t just survive but that the longer term quality of life outcomes are all improved.