Babies that are born before 37 weeks of pregnancy are known to be premature babies. Dr Mercurio, a professor of Neonatology from Yale School of Medicine, explains that the outcomes of most premature babies will be good.
Mercurio said when babies are born prematurely, caregivers and hospital staff rightly worry, adding that this is the case for about 15 million babies across the world and 10 per cent of babies born in the United States.
He said that a premature birth and the time spent in the hospital afterward can be exceedingly worrying and stressful, but the care of premature babies has improved immensely in the last 50 years.
In an interview with Medicalnewstoday, Dr Mercurio, who is also a director of the programme for Biomedical Ethics and director of Yale Pediatrics Ethics programme, explains why caring for premature babies is challenging, and what studies are required to backup new developments in the area.
Speaking about the several challenges healthcare professional face in the care of premature babies, he said the major challenge could be broken down into the technical and medical challenges and then the psychological and ethical aspects.
He noted that the most technical challenge is the size of patients as they are so small and this can make things more difficult. Adding that for example, most people are familiar with the fact that sometimes it can be hard to place an IV in an adult or an older child. So you can imagine the technical difficulties in someone who weighs just a pound or two.
“In terms of the medical aspects, every organ system is immature. A primary example is the lungs. The challenge is to ensure that enough oxygen can get into the blood via the lungs, and this is often much more difficult with premature, underdeveloped lungs. To accomplish this, there are various modes of assisted ventilation that might be needed.
“In the brain, there is a possibility of injury because the baby is born very early. That has to do with the immaturity of the brain structurally at the time of delivery and possibly further injury during the intensive care course.
“We know that premature babies, especially those born extremely premature, are at increased risk for long-term problems with brain function.
A third example would be the gastrointestinal system, which is also immature. So, getting adequate nutrition into these children can sometimes be a challenge, he explained”.
He also explained how the care of premature babies changed during his career and what has made the biggest impact, Dr Mercurio stated that the care of premature babies has changed in many ways over the course of his career.
He said himself and his team are constantly evaluating the data and outcomes, noting that there are controlled trials happening all the time to establish which particular way is the best to provide care.
He also stated that the kind of care given is based on the new data and the outcomes of the studies he and his team embarks on and that is always work in progress. “Neonatology, like all of medicine, is rightfully always changing as we learn more,” he added.
Dr Mercurio further added that they ventilate babies very differently. He said for example, the use of respiratory support for babies with immature lungs has evolved significantly over the course of his career and has even gotten much better. “We have better equipment, and we also have a better understanding of how to go about it.”
Speaking on the research he is interested in seeing at the moment, he said he is interested in research into causes and prevention of prematurity, which is more in the realm of his colleagues in maternal-fetal medicine and obstetrics than in neonatology.
“Within neonatology, I think research that will be very helpful in the years going forward would be that which yields a better understanding of what interventions and what treatments we can use to reduce the neurologic problems and the developmental problems that these children are sometimes left with long term,“ he added.
Dr Mercurio also mentioned that the biggest ethical questions that the neonatologist, and the nurses, and all the clinical staff face, and that the families face as well, is trying to understand how hard to press on with critical care measures when the outlook is poor — when to keep trying and when to say that we shouldn’t push anymore.
He said some of these children are not going to survive, adding that some of those who survive are going to be left with significant developmental problems, such as permanent cognitive impairment.
“So, we need to understand when we should push hard, how those decisions should be reached, and how the interaction between the medical staff and the parents should influence decision making,” he stated.
Speaking on the basic things the parents of the premature babies ought to know, Dr Mercurio said: “The most important thing for parents to know is that most of these children will survive and most will do very well. There will be some who will not survive, and there will be some who will have long-term issues. But they are a small percentage overall.”
“It is a long, hard road to have a premature baby at the hospital. For some of these babies, they will have to be in the hospital for a long time. But for most of them, the outcomes will be good,” Dr Mark Mercurio explained.