Mixed Blessings. Intensive Care for Newborns

Newborn intensive care, a relatively new medical specialty, has recently become a very controversial one. It involves extremely complicated and expensive technology applied to cases of often uncertain benefit and considerable emotional investment. Many difficult issues remain unresolved, including whether newborn intensive care is an appropriate allocation of increasingly limited medical resources, which neonates are amenable to treatment through intensive care, what the long-term consequences of these intensive care interventions are, when treatment should be withheld, and who ultimately should make these decisions. Guillemin and Holmstrom, both sociologists at Boston University, examine newborn intensive care from a sociologist's perspective and formulate policy recommendations to address some of these issues. The authors' research was quite extensive, involving numerous interviews with physicians, parents, nurses, social workers, and others involved in newborn intensive care as well as visits to newborn intensive care units in England, the Netherlands, Brazil, many facilities within the United States, and an entire year spent in one anonymous Level-III (highest degree of intensive care) nursery. As sociologists, one important focus was on examining the interrelationships between the many people involved in neonatal special care and how these relationships affected clinical decisions. The results of their research are presented in several sections: professional roles and responsibilities of the involved physicians, nurses, and social workers; the typical patient's care; the role of the family; and comparisons of newborn intensive care both between different facilities in this country and with units in other countries. Their observations are based on their many interviews, as well as an interesting, illustrative case study. One of the book's strengths is the effectiveness with which they outline and document the difficulties they found with newborn special care as currently implemented. The book concludes with their policy recommendations. These recommendations are very reasonable solutions to the problems they clearly documented. These are not the only possible solutions and are not themselves without inherent problems. The authors appreciate the great difficulties involved in implementing new health policy and are careful not only to describe their recommendations but also to include careful discussion of the benefits and barriers to their implementation. They realize that not all of the problems are addressable at this time or by sociological means and incorporate this understanding into their recommendations. For example, they suggest that all 500-to 1,000-gram newborns be designated experimental cases, thus not changing their treatment, but acknowledging the uncertainty involved in their …