Tag: prematurity

Bioethics Blogs

The Very Early Embryo & Its Moral Signifiance

by Andrew J. Prunty

As technology and biological research continue to develop in the twenty-first century, it is necessary to address and further define the ethical considerations of embryonic research and the appropriate rights that may limit the extent of human research on zygotes, blastocysts, and fetal scientific advancement. Because the area of harvesting embryonic stem cells remains significantly undefined, both legally and morally, there are vastly different opinions between researchers and bioethicists, mainly because of ethical limitations, on the rights that should be granted to cells with the potential to develop into human beings and the consequences of neglecting significant scientific research or advancement.

Current laws in the United States differ at the federal and state level, but there is no consistency in recognizing human embryos as humans, or affording them the same legal rights granted to a child; in fact, legal precedent actually detracts certain rights from developing embryos, favoring a human’s ability to destroy a potential human being (i.e. Roe v. Wade[i]) or the categorization of embryos as property (i.e. Davis v. Davis[ii], A.Z. v. B.Z.[iii], Marriage of Dahl[iv], or Reber v. Reiss[v]). These case law samples suggest the courts’ inability to reach a conclusion as to what is the status of an embryo.

The debate is not only circumscribed to matters of research, but to fundamental controversial and intertwined issues of bioethics such as: when life begins, embryonic stem cells, fetal rights, abortion, et cetera. All these topics are contentious and when one topic arises, they begin to comingle.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

She Ain’t Hefty™, She’s My Mother

May 04, 2017

by Sean Philpott-Jones, Chair, Bioethics Program of Clarkson University & Icahn School of Medicine at Mount Sinai

She Ain’t Hefty™, She’s My Mother

Late last week, my social media feed was flooded with videos showing a fetal lamb kicking and squirming inside a large liquid-filled bag. Thankfully, it wasn’t some obscene animal torture video. Rather it was a news article about a recent development in medical technology: the first successful demonstration of an artificial womb.

Developed by researchers at the Children’s Hospital of Philadelphia, the artificial womb is known (descriptively enough) as a Biobag. It is essentially a large Ziploc™ bag that encloses the fetus and bathes it in a protective solution similar to the amniotic fluid inside the uterus. An external tube is used to pump oxygenated blood and nutrients to the growing fetus, replacing the placenta that would normally connect the mother to the unborn child.

So far the Biobag has only been used in the laboratory. To date, eight lambs have been delivered prematurely and then allowed to complete their gestational development in an artificial womb-like environment. All of the lambs developed normally, and researchers hope that Biobag-like technology can soon be used in the clinic to provide care and treatment for premature infants.

Premature birth is the leading cause of death in newborn infants. About 10 percent of all births globally are premature, with the infant born before 37 weeks of pregnancy. Annually, more than 15 million children worldwide are born prematurely. A great many of these children will die from preterm-related ailments, despite receiving intensive support and care (where available).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Biobags for extreme prematurity?

The newsfeeds have been abuzz this week about premature lambs gestated in part in biobags by researchers at The Children’s Hospital of Philadelphia. See “An extra-uterine system to physiologically support the extreme premature lamb” here.  The lamb has provided a model for much of our understanding of fetal and neonatal development in humans (see articles here and here for examples).  Therefore, the news of a… // Read More »

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Cleveland Clinic Performs First U.S. Uterus Transplant

by Craig Klugman, Ph.D.

Almost like Aphrodite herself, surgeons at the Cleveland Clinic this week may have given fertility to a 26-year-old woman through a 9-hour uterus transplant operation. The transplanted uterus was from a deceased woman. This was the first such surgery in the United States, though it has been performed previously in Sweden and Turkey. Of the 9 women in Sweden who had the procedure, 4 have given birth.

The American patient had uterine factor infertility, which result from fibroids, scarification, genetics, or not having developed a uterus. For the surgeons and patients, this technique offers a way for the patient to potentially carry a child to term.

In the U.S., the Cleveland Clinic’s method involved the patient undergoing in vitro fertilization techniques to produce at least 10 frozen embryos. Then a donor was sought and her next of kin had to sign a special informed consent document for the procedure. The patient and her new uterus will be given a year to heal at which point an embryo will be defrosted and doctors will implant it. The embryos will be transferred one at a time. If one does implant, the resulting baby will be delivered by Caesarean section.

The benefit to this involved operation is clear, a woman is given the ability to gestate an embryo. She has a genetically-related child which she carried.

The risks are not slight. The potential mother will have to take immune suppressants—drugs that in the long term are known to include greater risk of infection, cancer, cardiovascular disease, and bone marrow suppression.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The CDC’s Graphic on Women and Alcohol is Flawed: Why That Matters

Last week, as part of its monthly Vital Signs report, the Centers for Disease Control and Prevention (CDC) released an infographic outlining the risks that drinking can pose for women, and advising that they avoid alcohol when not on birth control. On its face, this is a benign – intuitive, even – framework: alcohol is bad for fetal development, and may result in miscarriage, stillbirth, prematurity, fetal alcohol spectrum disorders, or sudden infant death syndrome. CDC’s likely intention was to present in an easily understandable fashion its new guidelines, which come out of the 2011-2013 National Survey of Family Growth. It found data-driven evidence to support the claim that “drinking any alcohol at any stage of pregnancy can cause a range of disabilities for [the] child.” In other words, the most charitable interpretation of what the CDC was trying to do here is to hammer home the idea that women should not drink while pregnant, period.

     

But the CDC’s graphic is not about fetal health: it highlights the risks of excessive drinking for women. The reason it does this is simple: since, according to the new recommendations, any amount of alcohol can harm even the least developed fetuses, and women often do not know that they are pregnant for several weeks after their first missed period, it follows that any woman who might become pregnant (to the CDC, that means any sexually active woman not on birth control) should abstain from alcohol.

The logical train that gets you from “alcohol is bad for fetuses” (which, let me be clear – nobody is questioning) to “sexually active women not on birth control should not drink” is more of a logical rollercoaster, but it’s worth the ride.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

“Fetal assault” and later environment effects on child development: using neuroscience as a tool for political policy

By Carlie Hoffman

Premature infant, courtesy of Wikipedia
“Crack babies,” “crack kids,” and the “lost generation” were all terms used by the public and the press in the 1980s and 1990s to describe children born to mothers who used crack-cocaine during pregnancy. Supported and spurred on by the media’s interpretation of preliminary research performed by Dr. Ira Chasnoff, among others, these children were often born prematurely, had tremors and a small head circumference, and, based on their description in the press, were expected to have neurobehavioral deficits, reduced intelligence, and deficits in social skills. These children were also anticipated to cost educational and social systems thousands of dollars as they matured and entered into schools and eventually the workforce.
Yet, after additional studies have been conducted and as the “crack babies” have grown into adolescents and young adults, it has been found that the negative outcomes widely described by the media were overreaching and unsupported. “Crack babies” did not, in fact, present evidence of severe, broad problems with social development and cognitive functioning and did not prove to have the predicted detrimental social and financial effects on the school system. Instead, many of these children have grown into successful adults over the past two decades. Dr. Claire Coles, a researcher responsible for producing the first studies that challenged Chasnoff’s findings, thought the era of the “crack baby” had finally come to an end. However, as Coles discussed during the December Neuroethics and Neuroscience in the News journal club, “crack babies” and similar stories about children exposed to opiates, have resurged in recent media publications (seen here and here) and are rearing their heads once again.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The SUPPORT Study Case: Not Vindication

Last week’s New England Journal of Medicine featured, and had an editorial about, a short opinion piece by John Lantos about the recent decision in Looney v. Moore. In that case, a Federal District judge dismissed the claims for damages brought by families of babies who had suffered injuries while enrolled in the controversial SUPPORT study. The SUPPORT study was designed to help determine optimal blood-oxygen levels for infants in the NICU. Lantos’ piece characterized the judge’s opinion as a “vindication” of the study.

In the New York Times, NEJM editor-in-chief Jeffrey Drazen was quoted as saying that the judge in Looney “was saying . . .  that being in the trial didn’t cause the bad outcomes for these kids.” But the opinion was no vindication, and that isn’t what the judge was saying.

To be clear: in this post, I will express no opinion about whether the researchers in the SUPPORT study exposed patients to risks beyond those they’d have faced outside the study; and if they did, whether they knew or should have known about any such additional risks when they framed their study. Furthermore, I express no opinion about whether the researchers adequately disclosed risks to patients’ families in the informed consent process. In these particulars, I exactly resemble Judge Bowdre, who, not having conducted a trial on any of these issues, naturally made no findings with regard to any of them.

When a plaintiff sues a defendant in a civil tort case for damages (as in a medical or legal malpractice case or a car-crash case or a toxic-exposure case), the plaintiff must prove four things: First, that the defendant had some duty to the plaintiff.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

In vitro fertilization risks : medical complications in heart problems women

Risks have been evaluated for the first time

In vitro fertilization risks (IVF) are the medical complications that can be associated with it. In this respect, women with heart disease are known to have an increased risk of suffering medical complications compared to healthy women (Circulation 2001: 104; 515-21/Eur Heart J 2010; 31, 2124-32). But does this risk increase when women with heart problems undergo IVF?

A recently published article (JACC 2014; 64,1862-6) evaluated this risk for the first time, confirming that it really exists. The study included 20 women, mean age 37 ± 4 years, with 22 pregnancies. Fifteen pregnancies (68%) occurred in women with congenital heart problems and 7 (32%) in women with acquired heart disease.

At least one complication was detected in 73% of the pregnancies. Eighteen percent of the heart patients suffered ovarian hyperstimulation syndrome, compared to 1% of the healthy women. Adverse cardiac maternal outcomes were detected in 27% of the cardiac patients, compared to 13% in pregnant women with heart disease not conceiving with assisted reproductive technologies (ART). Foetal or neonatal problems were detected 45% of the cardiac patients compared to 20% of pregnant women with heart disease not conceiving with ART. Foetal prematurity was also higher in the heart patients (32%) than in a reference ART population (13%). As the authors state, ovarian hormonal hyperstimulation is a “potentially serious complication of ART“, which is more dangerous in heart patients, in which moderate forms of ovarian hyperstimulation can be poorly tolerated.

From an ethical point of view (said eh authors), it seems clear that the poor response to ART in women with heart disease must be considered.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Inside the Gray Zone: Reflections on Gautham Suresh’s Narrative Matters Essay

Note: This piece was written in collaboration with John Lantos, director of the Bioethics Center at Children’s Mercy Hospital.

“I just caution you that we don’t know what we don’t know.”

These words came from one of my senior faculty members at Children’s Mercy Hospital in Kansas City, Mo. The context and tone of her warning made me clench my teeth.  As a young neonatology fellow, I wanted to think that we did know.

But it turns out, the senior faculty member was right.  Her words may have been the most important lesson I’ve learned during my neonatology fellowship. When it comes to the most premature of babies, there is far more uncertainty than certainty. I have learned to recognize this, and believe that it is the key to being a good neonatologist.

In the October Health Affairs Narrative Matters Essay, Dr. Gautham Suresh recounts the tension that he experienced when resuscitating an infant at the borderline of viability. The essay raises the issues of parental decision making, the high rate of premature birth in the United States, and the always touchy issue of resource allocation.

In most health care centers in the United States, when an infant is born at the borderline of viability, typically 22-25 weeks of gestation, we ask the parents whether or not they want us to resuscitate the baby.  Theoretically, this approach makes sense.  In reality, however, parents are not really in a good position to make the decision.  They are emotionally stressed.  They don’t know the facts. They are dependent upon doctors to give them the facts, but these can be presented in ways that, intentionally or unintentionally, may lead the parents to a particular choice. 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.