Newly Born and Indeterminate

Abstract

What to do? How to define the child’s situation? The various treatment options are highly dependent on the child’s condition, if treatment is an option at all. This dilemma presents itself to all present in the delivery room of the Academic Medical Center. This hospital is one of the Dutch eight teaching hospitals. For four months I could be found nearly every day in this NICU. It offers space to 24 children, nine of which may be in its NICU. Most of them come from the same local region; only when there is a capacity problem in one of the other ten NICUs in the country, children from other regions are admitted.

Academic Medical Center

Sunday, in the delivery room, a woman who has been pregnant for six months of her first child suffers from a toxaemia of pregnancy*, a condition that is dangerous for both mother and child. The father, a gynaecologist, a neonatologist and a nurse, who are gathered around her bed, are all looking at the CTG* that displays the child’s heartbeat. Repeatedly the heart rate drops, which indicates that the child is in distress. A loud beep from the CTG is sounding. When the number of heart beat interruptions start to succeed each other ever more rapidly and it takes longer for the child’s heartbeat to recover, the moment may arrive that its heart will no longer be able to correct. This is why direct intervention is called for. The child needs to be delivered as soon as possible. The baby’s condition, however, is so feeble that the chances of a happy ending are slight at best.