sexta-feira, março 31, 2006

Doctors call premature babies ‘bed blockers’

The Sunday Times March 26, 2006

Sarah-Kate Templeton, Medical Correspondent

PREMATURE babies who require months of expensive intensive care in neonatal units have been labelled “bed blockers” by one of Britain’s royal colleges of medicine.

The Royal College of Obstetricians and Gynaecologists (RCOG) says the huge efforts to save babies born under 25 weeks are hampering the treatment of other infants with a better chance of survival and a healthy life.

As the NHS faces an increasing financial crisis, with beds being closed and jobs axed, it says these very premature babies are “blocking” much-needed intensive care cots, sometimes forcing expectant mothers with potentially healthier babies to be transported by ambulance to other hospitals.

In a submission to a two-year inquiry into premature babies by the Nuffield Council on Bioethics, the college says: “Some weight should be given to the economic considerations as there is a real issue in neonatal units of ‘bed blocking’, whereby women have to be transferred in labour to other units, compromising both their and their babies’ care.”

The statement reflects a growing view among child specialists that babies born under 25 weeks should be denied intensive care and allowed to die.Next month the Royal College of Paediatrics and Child Health will debate a motion at its annual conference that it is “unethical” to provide intensive care routinely to babies born under 25 weeks. In practice, they would only be saved in exceptional circumstances.

It would shift Britain towards practice in Holland, the only European country that accepts such babies should die. One paediatrician opposing such a change described it as “involuntary euthanasia”. However, Susan Bewley, chairwoman of the ethics committee of the RCOG, said: “I would prefer that every baby could be treated, but we cannot get away from the fact resources are not endless.”

About 800 babies are born each year under 25 weeks. Medical advances mean about 39% of those born at 24 weeks now survive, and 17% of those at 23 weeks. A normal-term baby is born at 40 weeks.

The cost of treating very premature babies is high. A neonatal intensive care bed costs about £1,000 a day and very premature babies can require intensive care for four months.

Research to be presented at the Royal College of Paediatrics conference shows babies born at 25 weeks or under cost almost three times as much to educate by the time they reach the age of six as those born at full term — £9,500 a year compared with £3,900.

Professor Sir Alan Craft, president of the Royal College of Paediatrics, said: “Many paediatricians would be in favour of adopting the Dutch model of no active intervention for these very little babies. The vast majority of children born at this gestation who do survive have significant disabilities. There is a lifetime cost and that needs to be taken into the equation when society tries to decide whether it wants to intervene.”

Any change to a Dutch model would be opposed by parents such as those of Joey McCormick, born three weeks ago at 24 weeks’ gestation. Doctors say he has a 90% chance of living. His father Daniel McCormick, a chef from Norwich, said: “The doctors behind the proposals must regard Joey as a number and an expense, but to us he is our little boy.”

Joey’s doctor, Paul Clarke, a neonatologist, said: “To me it all sounds too much like attempts to bring in involuntary euthanasia at the opposite end of life.”

David Thomas, from Oxford, was born at 24 weeks, spent 4Å months in hospital but now at two is healthy. His mother Michelle, a psychiatric nurse, said: “Not to have given David the right to life would have been unethical.”