Over the course of my career in litigating catastrophic newborn injury cases, a rather common ’defense tactic’ involves trying to prove a limited life expectancy for these catastrophically injured children. Essentially, defense lawyers attempt to convince a jury that such children have a very limited chance of survival for more than 8 to 15 years of life. The reason for this approach is quite simple – the shorter the period of time that such children survive, the lower the potential damage award for future care needs and future pain and suffering.
Lawyers for the inured child and family, on the other hand, contend that with appropriate medical care, such children will live a relatively normal life expectancy – therefore, there is an absolute need for a substantial amount of money for future care needs.
The issue often becomes: given a certain type of injury, what is the ‘probable’ life expectancy for such children?
A recent study published in the British medical journal, The Lancet, and reported in MedPage Today on January 19, 2010, provides some further insight into this issue. Medical News: Survival Rates Vary with Congenital Anomalies – in Pediatrics, General Pediatrics from MedPage Today.
It has long been suspected that if a child is unable to protect his/her airway because of an inability to roll-over and clear secretions, that child is at increased risk for breathing complications – potentially leading to early death. A number of limited studies are cited for other ‘factors’ leading to limited life expectancy.
This new study offers some interesting insights into various types of anomalies and the probability of survival for children suffering from them.
Just a sampling of the data (see the article for more details) gives a sense of the ‘predictability’ of survival based on specific defects:
The investigators analyzed survival among specific subtypes of anomalies and found rates of 20-year survival exceeding 95% for the following:
- Ventricular septal defects, 98.3% (95% CI 96.6 to 99.1)
- Pulmonary valve stenosis, 98.1% (95% CI 96.1 to 99.1)
- Cleft lip and palate, 97.7% (95% CI 94.6 to 99.1)
- Atrial septal defects, 96.3% (95% CI 93.3 to 98)
- Cleft palate, 96.3% (95% CI 92.8 to 98.1)
In contrast, subtypes with less than 50% one-year survival included arhinencephaly/holoprosencephaly, common arterial trunk, and hypoplastic left heart.
What the study also goes on to say, however, is that certain conditions, survivability is contingent on the quality of care being provided to these children.
What is obvious and beyond any argument is that funding is desperately needed for further long-term studies to clarify this issue for not only the physicians rendering care to these children, but also for the parents seeking a clearer picture of what the future holds for their families in terms of financial needs and planning.