Dr. Mark Underwood
Dr. Mark Underwood. MD. 9/22/2017 ARC AMSA
Professor of Pediatrics, Chief of Neonatology
Started off not sure of what I wanted to do.
Took basic courses in science for med school
Plan b took lots of classes in Spanish
Got certified as a Nurses Aid
Take care of people
Went to med school
Pediatrics: Children and babies
Couldn't decide which one I liked
Became a general prediction
20 beds in ICU for 12 years
1 year possition in New Zealand
3 more years of training in US for Neonatoloy
Babies that are in the NICU and can’t go home for various reasons
Do clinical care at the hospital in the NICU 18 weeks out of the year
The other time: research. NEC (necrotizing enterocolitis) (~500 papers per year written on this topic)
Medicine: Saving the lives of people
Help people live easier:
discovery/ cause of death; new diseases,; diagnosis,
Quality of life.
Challenges to medicine:
Money: insurance is risk vs benefit
Burnout/Exhaustion, Compassion fatigue
Technechology Whats next?/ How do I keep up?
Ethics: Euthanasia, Genetic Engineering,
Regulation challenges: FDA, Pharmaceuticals
Powerpoint presentation: Diagnosis of diseases, There are links between risks and diseases that are related to gut bacteria.
It is clear that since the beginning of the century is that there are diseases that are on the decrease, and that there are other that are on the rise.
Hygiene hypothesis: If you are exposed to more germs/microbes in your childhood then your risk to later diseases if less for certain diseases is less when your are an adult.
Too much hygiene is causing disease.
Highest risk of NEC is in the under 2 pound range of babies. Just a disease of preemie babies.
A link between gut and the disease.
Preemies are put on mom's milk, or donor milk until 34 weeks of age.
Probiotics: not well regulated. In the premises there is a good way to monitor what is happening when probiotics are given.
Giving human milk and giving probiotics have both been proven to reduce the risk of NEC.
Human Milk Oligosaccharides: sugars that are made by the mom. Not able to be digested by the baby, but the good bacteria can, and the bad bacteria can’t.
Last September 2016, had the first American conferences wholly focused on NEC.
What sparked your interest in research.
The first baby I say die was in 1988.
The babies that develop NEC get opened up and the doctors see that part or all the digestive tract has died. If all the baby gets sewn up and the doctor tells the parent Im sorry your baby is going to die. If it’s only part, the dead portion is removed. Ostiums are made, and after time if the baby survives the ends are reconnected.
In New Zealand. If babies were born before 24 weeks the doctors would tell the parents i'm sorry your baby is going to die. After 24 weeks more care was offered.
In the US money and the healthcare industry is different. The chance of survival is 1 in 4 if born before 24 weeks.
In New Zealand the doctors decide, In the US the parents decide.
22week 1 in 10 survival
25weeks brains are still very fragile.
The dilemma: withdrawing support
Doctors and parents are on different sides.
Each parent is on different sides.
Parents will have to live with the decision for the rest of their lives. The baby can not make decisions for themselves. “I believe that it really should be the parents that make the final decision.”
Who decides what a meaningful or high quality life is?
Who decides the life worth living?
I have never once had a parent or child later come to me and say “I wish we had stopped. I wish we had withdrawn support."