Several people have noted that the enormous gains in neonatal survival between the 60’s and the 90’s have levelled off. A new publication from our group (not me this time, but Amélie, Rosalie, and Annie, and no, all french-canadian women do not have names that end in -ie) has examined changes in timing of death among babies in our NICU. They show that although the overall mortality, when adjusted for gestation, is unchanged over this period, the average age of death has doubled, from about 11 days to about 21.
So we have got better at preventing early deaths from respiratory failure and metabolic disturbance, but the babies remain at high risk of dying from NEC, sepsis and progressive lung failure.
This may be worse for families, as the initial hope is dashed by serious complications, or it may be better, as parents know that we tried really hard to save their baby; but impacts on families of different pathways to death have not been well studied in the NICU.
I don’t know, but my ‘gut’ feeling is that this makes things harder for families, so we need to work ever harder at ways to reduce sepsis, reduce NEC, and protect the lungs, so the early ‘saves’ become long term survivors.