The American Academy of Pediatrics (AAP) has released a statement pertaining to the prevention and management of procedural pain in babies. Pain that newborns experience from routine medical procedures can be significant, especially in premature infants with more intensive health needs. Research suggests that repeated exposure to pain early in life can create changes in brain development and the stress response systems that can last into childhood. Premature infants are especially at risk. The AAP policy statement recommends that every health facility caring for newborns use strategies to minimize the number of painful procedures performed, and routinely monitor and treat pain with greater emphasis on proven non-drug interventions. The policy statement, “Prevention and Management of Procedural Pain in the Neonate: An Update,” appeared in the February 2016 issue of Pediatrics (published online Jan. 25).
A few years ago we received a request from a family, whose baby had been a patient in our NICU, to speak with the neonatologist who had cared for their child. I remembered the name vaguely, but was unclear about the circumstances of the encounter, so I had to go way back into the database to find the record.
Turns out that the patient was a little boy who had been born extremely premature, and a patient for less than 24 hours before he died. As I recall, those had been some very long hours. He had been born at one hospital, where I was on call, and then transferred to a higher level hospital, where I just happened to be on call the following night. Mom was terribly sick, and too unstable to transfer along with her baby, although the father and some other family members were able to follow the baby to the new location.
Baby Elizabeth was born nine weeks premature. With under-developed lungs, she struggled to breathe and needed to remain in intensive care in the hospital for two and a half weeks. “I couldn’t even hold her for the first five days… We dressed her in doll clothes,” says Jenn, her mother, recalling Elizabeth’s tiny size. Jenn attributes her daughter’s premature birth – and a host of other health complications – to a previous abortion she had, and now shares her story as part of a newly launched educational campaign called Prevent Preterm.
Prevent Preterm (PreventPreterm.org) was launched this June to educate the general public on three known risk factors for preterm, or premature, births: tobacco use, lack of prenatal care, and prior abortion. Despite a large body of medical research showing that abortion increases the risk of a subsequent preterm birth, information on this link is not nearly as accessible to the general public as that of smoking and prenatal care. PreventPreterm.org fills this need by providing a user-friendly, comprehensive chart summarizing more than 100 peer-reviewed published studies that identify abortion as a risk factor for preterm birth.
We deal with it fairly often. Or maybe not that often; perhaps it just seems more frequent than it actually is. But at least a couple times a year, at least for the docs anyway.
Pregnant women get sick. At times very, very sick. And I will forever be grateful for obstetricians and obstetrical nurses, because their job is a difficult one. Very difficult. Often a woman will come in needing an emergency delivery. And sometimes she will need to go to surgery and require general anesthesia. In most cases she will wake up soon afterward, but not always. Sometimes she does not recover. Sometimes she needs the ICU. And there are rare and tragic instances in which she never wakes up again at all.
This report examines the growing body of large, population-based studies which have shown elective pregnancy terminations in the first and second trimesters to be associated with an increased risk of subsequent spontaneous preterm birth.