Everything was moving along wonderfully for Yuting in her
pregnancy, and she and Tim were looking forward to their first child. They had a
new room almost ready for Lisa, and the baby showers had provided them plenty
of the accouterments they would need in the first year. All was going just as
they had hoped…until that Friday night that they will not soon forget.
Around 3 in the afternoon, Yuting began to experience a discomfort
in her abdomen that she couldn’t quite name, and, at first, she tried to ignore
it. An hour or so went by, and, having tried to take a nap, Yuting began to
notice that the discomfort started to turn to pain. She called Tim and told him
to come home, and then the real pain started. Something was definitely wrong. By
the time Tim arrived 20 minutes later, Yuting was in agony. She had another
month and a half at least until Lisa was due. As they drove as fast as they
could to the ER, thoughts of fear, incredible pain, and despair raced through
her head.
Even in their panic, Tim managed to call 911, and the
dispatcher alerted the hospital that the two were one their way. With Tim
mostly carrying her into the ER, Yuting was immediately taken back to be seen.
It quickly became clear that Lisa was going to be born.
* What is the “age of viability” for a fetus?
* What are some causes of premature birth? Does it seem that
Yuting was at risk for any of these?
* What usually happens when a baby is born prematurely?
Provide a rough outline of the medical considerations, what the doctors
typically need to ensure first, and then what kind of care occurs in the NICU.
How is it determined that the child is ready to go home? What later challenges
are associated with premature birth? Is being born prematurely a causal factor
in later difficulties, or is it correlational?
* Describe typical developmental milestones during the
newborn period and during the first year of life. How will babies born
prematurely meet or not meet those typical milestones? On what circumstances
does this depend?
* Find research that looks at parental stress associated
with the birth of a child and then with the premature birth of a child. Write a
narrative that tells of the kinds of thoughts and feelings that might be
present for Tim and Yuting as they experience the premature birth of Lisa and
come to realize the reality of the situation.
* Given the fees associated with a “normal” delivery in a
hospital, what fees are additionally associated with the NICU?
DECISION POINTS :::
Make a decision about how much of the cost Tim and Yuting will have to bear in terms of the financial aspects of Lisa’s delivery. Let us assume that Tim and Yuting had insurance. What kind of policy? What does it cover? Does it have a deductible? What do Tim and Yuting have to pay? You may also make a determination as to the nature of Lisa’s prematurity – how early was she born (there is some flexibility built into the narrative above), what does this have to do with her length of stay in the NICU, and what is the cost associated with all of this based on what kind of insurance coverage you decide Tim and Yuting have?
1. What is the “age of viability” for a fetus?
ReplyDeleteThe definition for “age of viability” should be given as the age that a fetus can survive if born prematurely. The age of viability for a fetus is something that has yet to be pinned down for certain. Some sources say that there is a limited possibility for survival of the fetus if born at 22 weeks, but usually the outcome of that pregnancy is still born, if the baby has fully developed. However, the age of viability that all definitions seem to be hovering around is between 22 and 24 weeks (“Management of premature infants born at the age of viability part I”, 2004). Anything after 24 weeks the fetus will have significant possibility of surviving.
2. What are some causes of premature birth? Does it seem that Yuting was at risk for any of these?
ReplyDeleteThere are many complications that can occur during a pregnancy, and several will cause the baby to be born prior to the expected date. Having a previous child that was born premature is a risk factor for another premature birth. Pregnancy with twin and triplets is another risk factor. Problems with the uterus, cervix or placenta, or conceiving through in-vitro fertilization may also cause a premature birth. More risk factors for a baby to be born preterm are poor nutrition, as well as smoking cigarettes, drinking alcohol, or using illegal drugs. If the fetus suffers from infections with the amniotic fluid or lower genital tract than the baby is likely to be born premature. Also, chronic conditions such as high blood pressure and diabetes will likely cause a baby to be born preterm. Stressful life events, multiple miscarriages or abortions, as well as physical injury or trauma are also risk factors for premature birth (Risk Factors). Lastly, less than six months between pregnancies will increase the risk of a premature birth. It does not appear that Yuting was at risk for any of these complications that increase the risk of a premature birth.
3. Given the fees associated with a “normal” delivery in a hospital, what fees are additionally associated with the NICU?
ReplyDeleteDepending on whether or not a woman has medical coverage, the fees associated with having a preterm baby is about 10 times greater than having a full-term, or “normal baby”. For both inpatient and outpatient services for the first year, a preterm baby costs around $32,325. This number is only associated with what is spent on the child once they are released from the hospital. For the NICU, specifically, it costs the hospital about 26 billion dollars per year to care for premature babies. This sum is about half of what it takes to care for all newborn babies. The cost that is paid by the family of the newborn and their insurance companies varies depending on how long they are in the NICU and if there are certain procedures that need to be done. On average, it is about $41,000 per child, that is paid by the individual and corporations.
4. Describe typical developmental milestones during the newborn period and during the first year of life. How will babies born prematurely meet or not meet those typical milestones? On what circumstances does this depend?
ReplyDeleteBefore the information on typical developmental milestones is given, it is important to know that every baby develops at a different rate, regardless of if they are carried to term or not. Having given that information, there are different stages of development that a baby goes through, starting at the end of their first month. By the end of their first month babies should be able to do things like keeping their hands in tight fists, hear very well, move their head from side to side while lying on their stomachs, as well as recognizing some sounds, including their parents’ voices and being able to focus on objects 8 to 12 inches from their face (American Academy of Pediatrics, 2005). By the end of their third month, babies should be able to raise their head and chest when lying on their stomach, open and shut hands, watch faces closely, follow a moving object with their eyes, as well as beginning to babble and imitate sounds (American Academy of Pediatrics, 2005). By the end of their seventh month, babies should be able to roll over both ways, sit up, reach for an object with their hands, support all of their weight on their legs when held upright, as well as distinguish emotions by tone of voice and struggle to get objects that are out of reach (American Academy of Pediatrics, 2005). By the time the baby is one, they should be able to sit without assistance, crawl, pull themselves up to a standing position, try to imitate words, say “dada” or “mama”, use pincer grasp, respond to “no” and simple verbal requests, as well as they begin to use objects correctly and they start to look at the correct picture when an object is named (American Academy of Pediatrics, 2005). Like mentioned earlier, babies develop at different paces, while some babies develop at this exact pace, some take a little longer to get to these developmental milestones. With a baby born before 37 weeks, which is considered being born prematurely, these guidelines are different. According to the American Academy of Pediatrics (2005), a baby will most likely achieve milestones two months later than the developmental guidelines predict. Developmental milestones are based on when the baby is due, not when they are born, so if they are born prematurely, then they will reach milestones later than a baby that is carried full term.
5. Find research that looks at parental stress associated with the birth of a child and then with the premature birth of a child. Write a narrative that tells of the kinds of thoughts and feelings that might be present for Tim and Yuting as they experience the premature birth of Lisa and come to realize the reality of the situation.
ReplyDeleteResearch shows that babies who are born premature are often more fragile and have under developed lungs, since this was the last organ to develop. This would cause parents to be more stressed with preterm babies because their children are more delicate and there is a greater chance for present and future health risks. Many new mothers often suffer from depression a few months after their pregnancy. Sometimes their child will remind them of the traumatic birth experience (Stobb). This can be even worse for mothers who gave birth to their baby too early. Their birth process was even more hectic because it was unplanned and unexpected. They did not have as much time to prepare and plan. Hopefully the mother will have a supporting partner and family to help them through this stressful time. Yuting is lucky to have her husband Tim to support her and Lisa in her first few months ahead.
Narrative: Our baby was born premature and we are worried for her health and future development. We want to do everything in our power to ensure that she will continue to grow into a healthy and happy child. We understand that the doctors and nurses are working with us to make sure that Lisa leaves the hospital healthy, even if that means staying in the neonatal unit for a few months before returning home. We recognize that new parents are often stressed upon the first few months of being parents, however we feel that we are slightly more scared for our daughter’s future than other parents since our baby Lisa was born so early. Our biggest concern is that Lisa will develop complications from being born too early that will make her life more difficult. We are staying positive and hopeful that all will be well, for at the time being it is all that we can do until we are presented with more updates and choices (Stobb).
6. What usually happens when a baby is born prematurely? Provide a rough outline of the medical considerations, what the doctors typically need to ensure first, and then what kind of care occurs in the NICU. How is it determined that the child is ready to go home? What later challenges are associated with premature birth? Is being born prematurely a causal factor in later difficulties, or is it correlational?
ReplyDeleteFor a baby to be prematurely born, the birth has to take place 3 weeks prior to the due date (prior to 37 weeks). If a premature birth does occur, the child will most likely be placed in the NICU (neonatal intensive care unit). The doctor must decide right away whether or not the child needs to be admitted into the NICU so that the child can get the proper support it needs to survive. Each child is usually admitted within 24 hours of their birth time. Once the child is in the NICU, the length of their stay will depend on the severity of illness/complication. There is a lot that must go into the care of the child. There are many different professionals that may assist in the care of a baby in the NICU, but there are mainly nurses in the facility. The babies are placed into incubators which help to regulate their breathing and their temperature. For those babies that have more difficulty breathing, doctors will often administer proteins called surfactants. If surfactants are not keeping the babies breathing at a normal rate, some babies may be placed on a ventilator, which will completely control the infant’s breathing. Many of the premature babies will require feeding assistance. Problems with intestines will be assisted by using a feeding tube that is inserted into the baby’s stomach to help with their digestion problems. IVs may be used to help with feeding, but it is rare that these are used on babies born before 28 weeks. Depending on what else is going on with the child, blood transfusions, medications, or even surgeries may have to be done while they are in the NICU. Most premature babies are on quite a few of pharmaceutical drugs and antibiotics. The nurses spend a lot of time with the babies in the NICU to provide the care and comfort that the infants need that they are not receiving from their mothers.
It is determined by the doctors and nurses when the baby is allowed to go home. Most of the time, the decision is based off of whether or not the baby can breathe on its own and can receive proper nutrition without being on any feeding tubes.The baby needs to be at a healthy weight and needs to have very minor complications that can be dealt with at home in order for them to be released.
There are many challenges that are associated with premature birth that can occur at a later time, once the baby is home, it could experience any of the following complications: cerebral palsy, impaired cognition, vision problem, hearing problems, dental problems, behavioral and psychological problems, and/or chronic health issues (some of which that could require hospitalization). These long-term complications revolve around how early the child was born and could occur at any point in the child’s life. Other than these complications, being a premature baby increases your risk for certain health risks as well. This includes an increased risk of sudden infant death syndrome, and an increased risk for type 2 diabetes and cardiovascular disease in adulthood. The challenges that a baby and their family may encounter after the release from the NICU can be both causal and correlational.
DECISION POINTS :::
ReplyDeleteMake a decision about how much of the cost Tim and Yuting will have to bear in terms of the financial aspects of Lisa’s delivery. Let us assume that Tim and Yuting had insurance. What kind of policy? What does it cover? Does it have a deductible? What do Tim and Yuting have to pay? You may also make a determination as to the nature of Lisa’s prematurity – how early was she born (there is some flexibility built into the narrative above), what does this have to do with her length of stay in the NICU, and what is the cost associated with all of this based on what kind of insurance coverage you decide Tim and Yuting have?
Tim and Yuting will have to bear a heavy financial burden when their baby Lisa is born prematurely. Deliveries are expensive on their own, so the fact that Lisa has been born prematurely adds a whole additional expense with her time spent in the NICU. Given their situation, we will explore what costs Tim and Yuting will have to pay out of pocket based on their specific insurance provider.
We are going to assume that Lisa was born at 32 weeks of pregnancy, making her a moderate preterm baby (Morrissette 2012). It is also suspected that Yuting is given a cesarean section by the doctors in order to get Lisa out as soon as possible. Overall, cesarean sections cost more than vaginal births due to the more in depth procedure it requires (How Much Does Baby Delivery Cost? 2008). Yuting and Tim currently have the Premier Anthem Blue Cross and Blue Shield health insurance plan. The Premier plan under Blue Cross and Blue Shield is one of their newest and most comprehensive, including fixed copayment deductibles (Individual and Family Health Care Plans for Virginia 2011). The maternity coverage under this plan helps pay for childbirth, prenatal and postnatal care, use of delivery room, hospital bed and board for the mother, routine nursery care, routine newborn circumcision, cesarean section deliveries, and diagnostic x-rays and lab charges. The maternity coverage is not provided for deductibles under $2,500 (Individual and Family Health Care Plans for Virginia 2011). For primary physicians the copay is $30 and for specialists the copay will be $40 (Individual and Family Health Care Plans for Virginia 2011).
An estimate of the some of the costs associated with Yuting and the baby’s stay in hospital before the insurance company covers it comes out as follows: hospital stay: 22,557.75, doctor fee: 2,612.00, and epidural: 1,562.42 (How Much Does Baby Delivery Cost? 2008). Because Lisa was born at 32 weeks, it is likely that she will spend several weeks in the NICU in order for the doctors to make sure she is healthy to go home (Morrissette 2012). Unfortunately, the cost of a baby in the NICU for as little as one day can be as much as $2,000 or more before insurance coverage (March of Dimes Study Unveils New Data on the Cost of Having a Baby 2012). This outrageous cost comes from neonatologists, nurses, and medical supplies (March of Dimes Study Unveils New Data on the Cost of Having a Baby 2012).
In conclusion, the total charge before insurance could add up to almost $50,000 (Individual and Family Health Care Plans for Virginia 2011). The Anthem insurance should pay approximately $40,000 of this, leaving Tim and Yuting to pay about $10,000 out of pocket (Individual and Family Health Care Plans for Virginia 2011). The Yoo’s may also have to continue to pay for care after Lisa comes home from the hospital due to her fragile state. It is important for both Tim and Yuting to meet with the hospital’s financial department if they don’t understand parts of the their bill (How Plans Can Improve Outcomes And Cut Costs for Preterm Infant Care 2010).