[tri-med] FYI - Study Says Some Baby Care Not Needed

I am forwarding this article or URL for your information (FYI) as I believe
it may be of interest and is from a reliable source. As always, check the
information with your own doctor or health care professional before starting
or changing any treatments.

Study Says Some Baby Care Not Needed
May 16, 2002
BOSTON (AP) -- A provocative study of newborn death rates finds strikingly
few differences across the country and suggests there are far too many
doctors and hospital units specializing in intensive care of premature or
sickly babies.

Only newborns in areas with the very fewest specialists die at a higher rate
than elsewhere. But once a certain threshold of care is reached, having even
more doctors offers no extra advantage, the study says.

The researchers said this oversupply is not only a profound waste of medical
resources, it may also be harmful, because it may subject babies to
unnecessary tests and treatments.

The researchers "raise disturbing issues regarding the nation's
unquestioning acceptance that more is always better with respect to the
supply of specialist physicians and hospital technology," said Dr. Kevin
Grumbach, a public health researcher at the University of California at San
Francisco.

He wrote an editorial to accompany the findings, published in Thursday's New
England Journal of Medicine.

The researchers at Dartmouth Medical School in Hanover, N.H., knew of big
disparities in the availability of specialized neonatal care from region to
region. They wondered if places with more specialized doctors or beds
relative to the number of births save more newborns.

The study found that, for the most part, they don't. Only newborns in areas
with very few such doctors, 2.7 for every 10,000 births, show a higher death
rate - 7 percent higher than in better-equipped areas.

Other areas - with a supply of doctors ranging from 4.3 to 11.6
neonatologists per 10,000 births - all had about the same death rate. Even
the most premature babies were found to die at roughly the same rate in
these areas.

Moreover, the supply of neonatal intensive care hospital beds made no
difference in death rates around the country.

"Enough may be enough," said Dr. David Goodman, the pediatrician who led the
study.

The neonatal-care specialty has mushroomed since the 1970s, thanks to new
technology and therapies, including ventilators designed for premature
newborns and prenatal drugs that help fetuses' lungs develop. Some babies
born three months early, weighing barely over a pound, can now be rescued.

However, the researchers suggested that social and economic factors have
expanded the field beyond pure medical need. For doctors, the specialty can
be gratifying, exciting and well-paying. For hospitals, it a lucrative and
prestigious business.

The researchers said that because of the oversupply, some relatively healthy
newborns may be subjected to unneeded tests and treatments that can produce
harmful side effects.

"If I have a healthy full-term baby, I actually don't want anyone messing
around with that baby," Grumbach said. "There's a downside where we meddle
too much."

However, he said it would take deep changes in the medical system, with more
government planning, to distribute neonatal doctors and beds much more
uniformly.

An executive at a large for-profit neonatal doctors' group, Pediatrix
Medical Group of Sunrise, Fla., agreed that the distribution of these
specialized doctors "is not ideal."

"There are areas where there are perhaps more than we need and areas where
there are perhaps less than we need," said Dr. Joyce Peabody, vice president
of medical affairs at Pediatrix.

However, she cautioned against drawing broad conclusions from the study,
since it considered only death rates. Many other factors, like a child's
mental and physical development, also reflect quality of care, she said.

Copyright 2002 The Associated Press. All rights reserved.

http://www.intelihealth.com/IH/ihtIH/WSIHW000/333/21343/350103.html

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