key: cord-0787569-52gxdyni
authors: Kaempf, Joseph W.; Dirksen, Kevin M.; Kockler, Nicholas J.
title: Extremely premature infants, scarcity and the COVID‐19 pandemic
date: 2020-11-18
journal: Acta Paediatr
DOI: 10.1111/apa.15651
sha: fa399329e6815c3e25b6a9ed7d673b3e46349ba1
doc_id: 787569
cord_uid: 52gxdyni

Scarcity is Nature's creative provenance, the wellspring of human conflict and subsequent adaptation. Deficiencies of food, shelter, and basic safety are primary, but secondary privations real or imagined (material comforts, money, power, sex), are often perceived insufficient by humankind and drive history's discord (1). The COVID-19 pandemic spotlights scarcity and resource allocation, and we hope rational scrutiny of value in healthcare (benefits accrued/resources consumed). Physicians are more aware of this historic opportunity to thoughtfully study value considerations as objective metrics that can facilitate reasoned analysis, innovation, and justice (2).

Scarcity is Nature's creative provenance, the wellspring of human conflict and subsequent adaptation. Deficiencies of food, shelter and basic safety are primary, but secondary privations real or imagined (material comforts, money, power and sex), are often perceived insufficient by humankind and drive history's discord. 1 The COVID-19 pandemic spotlights scarcity and resource allocation, and we hope rational scrutiny of value in healthcare (benefits accrued/resources consumed). Physicians are more aware of this historic opportunity to thoughtfully study value considerations as objective metrics that can facilitate reasoned analysis, innovation and justice. 2 Considerable time, equipment and energy have been diverted to subdue COVID-19, and for generally sound reasons. But concerns of resultant deficiencies providing basic health services, for example cardiovascular, prenatal and preventive care, are worrisome.

Because >80% of COVID-19 deaths are in senior citizens, legitimate questions arise regarding scarcity and quality-of-life-years. 3 We can anticipate medical specialties and interest groups to claim the primacy of their target population should any care-rationing loom.

Neonatology should not be immune to scrutiny; we have an opportunity to improve our ability to serve whole families best. A recent large European collaboration documented that one-quarter of the deaths were after 3 months of age (Franz , Table 1 ).

Third, we are not aware of a single report from higher in- 

Services Foundation (Portland, OR USA). The sponsor had no role in the conduct of this analysis and commentary.

The authors declare no conflict of interest related to this manuscript.

Joseph W. Kaempf https://orcid.org/0000-0002-2160-8352

History of Philosophy

Costs, benefits, and sacred values -why health care reform is so fraught

Challenges estimating total lives lost in COVID-19 decisions

Estimates of healthcare spending for preterm and low-birthweight infants in a commercially insured population

Between-hospital variation in treatment and outcomes in extremely premature infants

Should extremely premature babies get ventilators during the COVID-19 Crisis?

Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Health and Human Development, Society for Maternal-Fetal Medicine

Committee on Fetus and Newborn. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation

Extremely premature birth, informed written consent, and the Greek ideal of sophrosyne

Physicians' attitudes on resuscitation of extremely premature infants: a systematic review