Sunday, August 26, 2007

Parents, doctors weigh emotions, laws week to week

Lying on his back, in a diaper the size of a Post-it note and a black sleep mask, Wayne Slipka appeared to be in idle repose.

But he was hard at work, beating odds.

Born weighing 14 ounces, Wayne had surprised everyone in Presbyterian/St. Luke's neonatal intensive-care unit by surviving.

Had he been born a few weeks earlier, Wayne might have been considered a miscarriage. A few weeks later, and he would have been one more very premature baby.

At 24 weeks and less than a pound, he is a baby struggling for his life. He is also the embodiment of a legal and emotional struggle over when babies are viable beings.

The struggle is playing out against the backdrop of politics, technology that keeps pushing back the line of viability - and a family's hopes and grief.

"Every hospital that takes care of small, premature babies has had this debate for decades," said Dr. Norman Fost, professor of pediatrics and bioethics at the University of Wisconsin.

Fost was a resident at Baltimore's Johns Hopkins Hospital in 1964 when a 2.2-pound baby boy was born.

At that time, he was told there was nothing that could be done for an infant that small. As far as Fost knows, that baby did not survive.

In February, a Florida baby went home after four months in intensive care. That baby, born at 21 weeks and weighing 10 ounces, may be the country's smallest baby ever to survive.

At Presbyterian/St. Luke's, the current viability line is 25 weeks - most of the time.

"We will resuscitate at 23 weeks under some circumstances," said Dr. Delphine Eichorst, who cares for babies in the intensive-care unit.

Eichorst and her colleague, Dr. Jeffrey Hanson, said when a baby is 23 or 24 weeks from conception, doctors talk with parents, laying out options and potential outcomes.

But often, it is the baby who makes the final call. "If a baby is born at 23 weeks, with no heartbeat, not moving ...," then the outlook is fairly grim, Hanson said.

"There are things in this life, and in this nursery, that are worse than death."

In medical school, Hanson was taught 27 weeks was the cutoff for a baby's survival.

"It keeps moving back," he said. "But I think we've about hit the limit."

In 2002, Congress passed the Born Alive Act, which requires doctors to treat any infant, at any stage of development. Since then, states have been told to investigate any doctor or parent not following the law.

Though the law was aimed at abortion practices, many doctors believe it also applies to them.

Harvard Medical School's Dr. Sadath Sayeed, a lawyer who wrote a 2005 article on the law in the journal Pediatrics, said he doesn't know of any doctors who have been prosecuted. Likewise, Colorado officials know of no doctors being investigated here.

Still, Sayeed said, "There are plenty of neonatologists worried about it."

Hanson termed the law lunacy. "Is the state going to take care of them?"

When Ruby Slipka was about to give birth at 24 weeks, nobody talked about law or politics.

Doctors simply told them, "If the baby comes out struggling, they would hand us the baby and allow it to fade away," Darrel Slipka said.

Instead, Wayne breathed on his own, once.

Since then, a machine has handled the task and the Slipkas don't think about complications he faces.

"We've come this far, we're not going to give up now," Ruby Slipka said.

Source: http://www.denverpost.com/headlines/ci_6715448

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