Re: What's next
From: Efrain Ramirez (eramirezt@coqui.net)
Sat Apr 26 07:30:13 2008
http://www.google.com/search?source=ig&hl=en&rlz=&q=steroids+IVH+and+nec
BJOG: An International Journal of Obstetrics and Gynaecology
Volume 113 Issue s3 Page 4-9, December 2006
To cite this article: WM Gilbert (2006) The cost of preterm birth: the
low cost versus high value of tocolysis
BJOG: An International Journal of Obstetrics and Gynaecology 113 (s3) ,
4–9 doi:10.1111/j.1471-0528.2006.01117.x
Prev Article Next Article
Abstract
Review article
The cost of preterm birth: the low cost versus high value of tocolysis
WM Gilbertaa Women’s Services, Sutter Health, Sacramento, CA, USAProf WM
Gilbert, Women’s Services, Sutter Health, Sac-Sierra Region, 5151 F
Street, 2 South, Sacramento, CA 95819, USA. Email
gilberw@sutterhealth.orga Women’s Services, Sutter Health, Sacramento,
CA, USA
Prof WM Gilbert, Women’s Services, Sutter Health, Sac-Sierra Region,
5151 F Street, 2 South, Sacramento, CA 95819, USA. Email
gilberw@sutterhealth.org
Abstract
The consequences of preterm birth (PTB), to the individual and society
at large, remain a major financial and personal burden. Babies born at
the limits of viability, who survive, often have major neurological
impairments, such as cerebral palsy, developmental delay and blindness.
The cost of initial hospitalisation is more than $200 000 for each birth
but takes no account of future costs once they leave the hospital. The
major morbidities associated with extreme prematurity are respiratory
distress syndrome (RDS), intraventricular haemorrhage (IVH) and
necrotising enterocolitis (NEC). With advancing gestational age at
birth, the financial costs and morbidity associated with these
conditions decrease. The major morbidities (RDS, IVH and NEC) are rare
by 34 weeks of gestation, with the exception of RDS, which complicates
7% of deliveries at this gestational age. While the vast majority of
infants survive the first year of life, the infant mortality rate is
markedly increased by three- to five-fold even for the mildly preterm
infants, as compared with that of the term infants. Neonates born after
34 completed weeks of gestation rarely have mortality or major
morbidity, but the financial costs remain significant ($7000 per case),
and efforts to prevent delivery at this gestational age are probably
indicated. Economic costs associated with PTB include the cost of
initial hospitalisation, the cost of any chronic diseases resulting from
the prematurity and social costs including loss of gainful employment by
a family member taking care of the infant or child and loss of potential
future earnings of the affected child. Antenatal steroids, if given to
the mother at least 48 hours prior to a PTB, have shown significant
reductions in RDS, IVH and NEC. Efforts to prevent, or avoid, PTB
include the use of tocolytic agents which have been shown to prolong
gestation for a minimum of 48 hours, or longer in some cases. The range
of tocolytic agents used to delay or prevent PTB work through many
different pathways, with varying degrees of success. Which tocolytic
agent to use depends on many factors including underlying maternal
status, gestational age of the fetus and documented efficacy of agent
used.
At Fri, 25 Apr 2008, Garry E. Siegel, M.D. wrote:
>
>Thanks for the input, Dan and Ef.
>
>Is there evidence to use steroids as you've suggested, or is it just
>based on experience/obstetric horse sense?
>
>Isn't there a bit of a thought that steroids may have long term growth
>consequences? In other words, there may be harm such that one shouldn't
>use them unless clearly indicated.
>
>Garry
>
>At Thu, 24 Apr 2008, Efrain Ramirez wrote:
>>
>>Agree!!!!
>>
>>Ef
>>
>>At Thu, 24 Apr 2008, R. Daniel Braun wrote:
>>>
>>>Steroids do more than prevent RDS. They also decrease incidence of IVH and
>>>NEC, which can still occur after 34 weeks. Risk of giving steroids is ??????
>>>
>>>Dan
>>>
>>>On Thu, Apr 24, 2008 at 9:05 AM, Andrew Folley <agfolley@hotmail.com> wrote:
>>>
>>>> I must have missed how the diagnosis of IUGR was made?agf
>>>>
>>>> > Date: Thu, 24 Apr 2008 06:11:49 -0500
>>>> > From: cdsb@bellsouth.net
>>>> > To: ob-gyn-l@mail.obgyn.net
>>>> > Subject: RE: What's next
>>>> >
>>>> > I don't give steroids after 34 weeks either. And Garry is right, the baby
>>>> > isn't thriving, it's small.
>>>> >
>>>> > But if the fetus were say 30 weeks with IUGR, but with Reactive NST and
>>>> 8/8
>>>> > BPP, then I think there wouldn't be such a rush to delivery.
>>>> >
>>>> > So the real question here I think is given an IUGR fetus with perfect
>>>> > testing, what is the EGA we would electively deliver?
>>>> >
>>>> > Everyone may have a different answer. Here is an example of there being
>>>> 10
>>>> > different ways to do something in medicine and nine of them not being
>>>> wrong.
>>>> >
>>>> > Charles
>>>> >
>>>> > -----Original Message-----
>>>> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
>>>> E.
>>>> > Siegel, M.D.
>>>> > Sent: Wednesday, April 23, 2008 10:47 PM
>>>> > To: Multiple recipients of list OB-GYN-L
>>>> > Subject: Re: What's next
>>>> >
>>>> > Over 34 weeks--no steroids unless amnio done and lung maturity not
>>>> > proven.
>>>> >
>>>> > Yes, the late preterm baby alluded to in ACOG's Committe Bulletin has
>>>> > more morbidity, etc., but this baby is far from thriving inside.
>>>> >
>>>> > Reassuring testing is nice, but nicer is a baby in the nursery.
>>>> >
>>>> > Deliver her, my friend.
>>>> >
>>>> > Garry
>>>> >
>>>> > At Wed, 23 Apr 2008, Efrain Ramirez wrote:
>>>> > >
>>>> > >No fetal weight gain at all in the last 2 weeks.. umbilical artery
>>>> > >doppler normal.. MCA not done.. mother perceives fewer FM's.. just
>>>> > >like the other pregnancy.
>>>> > >Definitive asymmetric IUGR.
>>>> > >Level III NICU .. I had to deliver in the last year to babies at 26
>>>> > >weeks .. doing well..
>>>> > >Steroids? - it's a Democratic Primary..
>>>> > >Legally speaking an unexpected IUFD would be hard to defend... NICU
>>>> > >complications, IMHO, easier.
>>>> > >Thanks to all.. recommendations well taken.
>>>> > >
>>>> > >Ef
>>>> > >
>>>> > >At Wed, 23 Apr 2008, art fougner, md wrote:
>>>> > >>
>>>> > >>Middle cerebral artery doppler? Uterine artery doppler?
>>>> > >>If all normal, would suggest (unencumbered by data) twice weekly nst's
>>>> > >>with AFI's, weekly dopplers and elective delivery at term.
>>>> > >>
>>>> > >>Art
>>>> > >>
>>>> > >>Just my opinion. I could be wrong.
>>>> > >>
>>>> > >>At Wed, 23 Apr 2008, Efrain Ramirez wrote:
>>>> > >>>
>>>> > >>>30 some G2, P1 - previous C/S - IUGR - at 36 weeks - apparently no
>>>> > >>>reassuring FHR's.2 weeks at NICU.. at present 34 w and 5 d.. BPP
>>>> > >>>10/10, EFW - 1500-1600 below 5th.. normal umbilical Doppler .. what's
>>>> > >>>next?
>>>> > >>>
>>>> > >>>Ef
>>>> > >>>
>>>> > >>>--
>>>> > >>>"I can accept failure, but I can't accept not trying." - Michael
>>>> Jordan
>>>> > >>>
>>>> > >>--
>>>> > >>art fougner, md
>>>> > >>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>>> > >>
>>>> > >--
>>>> > >"I can accept failure, but I can't accept not trying." - Michael Jordan
>>>> > >
>>>> >
>>>> > --
>>>> > Garry E. Siegel, M.D.
>>>> > Private Practice
>>>> > Roswell, GA
>>>> >
>>>>
>>>> ------------------------------
>>>> Make i'm yours. Create a custom banner to support your cause.<http://im.live.com/Messenger/IM/Contribute/Default.aspx?source=TXT_TAGHM_MSN_Make_IM_Yours>
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>>>
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>>>--
>>>> ------------------------------
>>>> ------------------------------
>>>R. Daniel Braun, MD FACOG(L) ABMP CMTh
>>>> ------------------------------
>>>Professor Emeritus
>>>> ------------------------------
>>>> ------------------------------
>>>> ------------------------------
>>>Dept. of Obstetrics and Gynecology
>>>Indiana U. School of Medicine
>>>
>>>R. Daniel Braun
>>>
>>>"Science without Religion is LAME; Religion without Science is BLIND"
>>>Einstein 1941
>>>
>>--
>>"I can accept failure, but I can't accept not trying." - Michael Jordan
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
"I can accept failure, but I can't accept not trying." - Michael Jordan
