Neonatal Care (neonatal + care)

Distribution by Scientific Domains

Terms modified by Neonatal Care

  • neonatal care unit

  • Selected Abstracts

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    PRESCRIBER, Issue 8 2008
    Article first published online: 12 MAY 200
    Glargine preferred to lispro as type 2 add-on Basal insulin glargine (Lantus) and insulin lispro (Humalog) at mealtimes improved glycaemic control equally well in patients with type 2 diabetes poorly controlled by oral agents, but patient satisfaction was greater with basal insulin (Lancet 2008;371:1073-84). The 44-week APOLLO trial, funded by Sanofi Aventis, was a nonblinded randomised comparison of basal and prandial insulin regimens added to oral treatment in 418 patients. It found similar reductions in HbA1C (,1.7 vs ,1.9 per cent respectively). Fasting and nocturnal glucose levels were lower with insulin glargine and postprandial levels were lower with insulin lispro. The basal regimen was associated with fewer hypoglycaemic events (5.2 vs 24 per patient per year), less weight gain (3.01 vs 3.54kg) and greater improvement in patient satisfaction scores. Treating hypertension cuts mortality in over-80s Treating hypertension in the over-80s reduces all-cause mortality by 21 per cent, the HYVET study has shown (N Engl J Med online: 31 March 2008; doi: 10.1056/NEJMoa 0801369). Compared with placebo, treatment with indapamide alone or with perindopril for an average of 1.8 years also reduced the incidence of fatal stroke by 39 per cent, cardiovascular death by 23 per cent and heart failure by 64 per cent. The incidence of stroke was reduced by 30 per cent but this was of borderline statistical significance. Fewer serious adverse events were reported with treatment than with placebo. New work for NICE The DoH has announced the 18th work programme for NICE. Seven public health interventions include preventing skin cancer, smoking by children and excess weight gain during pregnancy. Public health guidance will include the provision of contraceptive services for socially disadvantaged young people. Two new clinical guidelines are sedation in young people and management of fractured neck of femur. New technology appraisals may include eight therapies for cancer, two new monoclonal antibodies for psoriasis and rheumatoid arthritis, an oral retinoid for severe chronic hand eczema and methylnaltrexone for opioid-induced bowel dysfunction. Combinations no better against CV disease Taking ezetimibe and simvastatin (Inegy) does not appear to slow the progression of atherosclerosis more than high-dose simvastatin alone, say researchers from The Netherlands (N Engl J Med 2008;358: 1431-43). In patients with hypercholesterolaemia, there was no difference in regression or progression of atherosclerosis after two years' treatment with simvastatin 80mg per day alone or combined with ezetimibe 10mg per day. Adverse event rates were similar. In patients with vascular disease or high-risk diabetes, there was no difference between the ACE inhibitor ramipril 10mg per day or the ARB telmisartan (Micardis) 80mg per day as monotherapy, or their combination, in the risk of a composite outcome of cardiovascular death, MI, stroke and admission for heart failure (N Engl J Med 2008;358:1547-59). Combined treatment was associated with higher risks of hypotensive symptoms, syncope and renal dysfunction. Twice-daily celecoxib increases CV risk Taking celecoxib (Celebrex) twice daily carries a higher risk of cardiovascular events than the same total dose taken once daily, a metaanalysis suggests (Circulation 2008; doi: 10.1161/ CIRCULATIONAHA.108. 764530). The analysis of six placebo-controlled trials involving a total of 7950 patients taking celecoxib for indications other than rheumatoid arthritis found that the combined risk of cardiovascular death, myocardial infarction, stroke, heart failure or thromboembolic event increased with dose over the range 400-800mg per day. The risk was significantly greater with 200mg twice daily (HR 1.8) than 400mg once daily (HR 1.1). Patients at greatest baseline risk were at disproportionately increased risk from celecoxib. Long-term etanercept effective in AS An open-label study suggests that etanercept (Enbrel) remains effective in the treatment of ankylosing spondylitis in the long term (Ann Rheum Dis 2008;67:346-52). Of 257 patients who completed six months' treatment with etanercept and who entered the nonblinded extension study, 126 completed a total of 168-192 weeks' treatment. The commonest adverse events were injection-site reactions (22 per cent), headache (20 per cent) and diarrhoea (17.5 per cent). The annual rate of serious infections was 0.02 per person. Response and partial remission rates after 192 weeks were similar to those reported after 96 weeks. Metformin reduces risk Metformin reduces the risk of developing diabetes in individuals at increased risk, a meta-analysis suggests (Am J Med 2008;121:149-57.e2). The study included 31 mostly small, randomised, controlled trials involving a total of 4570 participants and lasting at least eight weeks (8267 patient-years of treatment). Metformin was associated with reductions in body mass (,5.3 per cent), fasting glucose (,4.5 per cent) and insulin resistance (,22.6 per cent); lipid profiles also improved. The odds of developing diabetes were reduced by 40 per cent,an absolute risk reduction of 6 per cent over 1.8 years. MHRA clarifies cough and colds advice Press reports mistakenly suggested that the MHRA had banned some cough and cold remedies when it issued new guidance on treating young children, the MHRA says. The Agency's advice followed a review of over-thecounter cough and cold medicines for children by the Commission on Human Medicines. Children under two are at increased risk of adverse reactions and should no longer be treated with products containing antihistamine (chlorphenamine, brompheniramine, diphenhydramine), antitussives (dextromethorphan, pholcodine), expectorants (guaifenesin, ipecacuanha) and decongestants (phenylephrine, pseudoephedrine, ephedrine, oxymetazoline and xylometazoline). The MHRA said these products, which are classified as general sale medicines, should be removed from open shelves until available in new packaging that complies with the advice. They may still be supplied by a pharmacist for the treatment of older children. Coughs and colds should be treated with paracetamol or ibuprofen for fever, a simple glycerol, honey or lemon syrup for cough, and vapour rubs and inhalant decongestants for stuffy nose. Saline drops can be used to thin and clear nasal secretions in young babies. Parents are being urged not to use more than one product at a time to avoid inadvertently administering the same constituent drug twice. Perindopril brand switch Servier Laboratories is replacing its current formulations of perindopril (Coversyl, Coversyl Plus) with a new product that is not bioequivalent. The current Coversyl brand contains perindopril erbumine (also known as tert -butylamine). The new formulation contains perindopril arginine; it will be distinguished by new brand names (Coversyl Arginine, Coversyl Arginine Plus) and new packaging. Coversyl 2, 4 and 8mg tablets are equivalent to Coversyl Arginine 2.5, 5 and 10mg. Servier says the change is part of the simplification and harmonisation of global manufacturing; the arginine salt is already used in other countries and offers greater stability and a longer shelf-life. Both Coversyl and Coversyl Arginine will be in the supply chain for the next few weeks. Generic perindopril will continue to be the erbumine salt and prescriptions for generic perindopril are not affected. New from NICE Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Clinical Guidance No. 63, March 2008 This clinical guideline focuses on additional aspects of care for women with gestational diabetes (88 per cent of cases) or pre-existing diabetes (of which about 40 per cent is type 2 diabetes) and their babies. To date, insulin aspart (NovoRapid) is the only drug in the guideline specifically licensed for use in pregnancy and NICE advises obtaining informed consent to implement its recommendations for using other insulins and oral hypoglycaemic agents. As with other guidelines, NICE begins by stressing the importance of patient-centred care and involving women in decisions about their treatment. The guideline is divided into six sections, dealing with consecutive periods of pregnancy. Preconceptual planning should include empowering women to help them reduce risks, optimising glycaemic control (after retinal assessment) and increasing monitoring intensity, and providing information about the effects of pregnancy on diabetes. Metformin may be recommended as an adjunct or alternative to insulin, but other oral hypoglycaemic agents should be replaced with insulin, although glibenclamide is an option during pregnancy. Isophane insulin is the preferred long-acting insulin; lispro (Humalog) and aspart are considered safe to use. ACE inhibitors and angiotensin-II receptor blockers should be replaced with other antihypertensive agents and statins should be discontinued. Recommendations for screening and treatment of gestational diabetes build on previous guidance (CG62). Drug treatment will be needed by 10-20 per cent , this includes insulin (soluble, aspart or lispro) and/or metformin or glibenclamide, tailored to individual need. Antenatal care includes optimising glycaemic control. Insulin lispro or aspart should be considered in preference to soluble insulin. If glycaemic control cannot be achieved with insulin injections, an insulin pump may be indicated. The guideline includes a timetable for appointments and the care that should offered after each interval. Recommendations for intrapartum care, which supplement those in CG55, include frequent monitoring of blood glucose. Neonatal care includes recommendations for monitoring and screening the infant and the management of hypoglycaemia. Postnatal care (supplementing CG37) involves adjusting maternal treatment to avoid hypoglycaemia and recommendations for returning to community care. Metformin and glibenclamide are the only oral agents suitable for breastfeeding women. Women with gestational diabetes need advice about glycaemic control and planning for future pregnancies. Lifestyle advice and measurement of annual fasting plasma glucose should be offered. Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. Technology Appraisal No. 138, March 2008 The latest technology appraisal of asthma treatments covers inhaled steroids for adults and children over 12 with chronic asthma. It makes only two recommendations. First, the cheapest appropriate option is recommended. Second, when a steroid and a long-acting beta2-agonist are indicated, the decision to prescribe a combined inhaler or separate devices should take into account therapeutic need and likely adherence. Combined inhalers are currently less expensive than separate devices, though they may not remain so. When a combined inhaler is chosen it should be the cheapest. NICE concludes that, at equivalent doses, there is little difference in the effectiveness or adverse event profile of the available steroids or the fixed-dose combinations. According to specialist advice, choosing the best device for an individual remains the overriding concern. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. Technology Appraisal No. 139, March 2008 NICE recommends continuous positive airway pressure (CPAP) for adults with moderate or severe obstructive sleep apnoea, and for those with a milder disorder if quality of life and functioning are impaired and alternative strategies such as lifestyle change have failed. Diagnosis and treatment is the responsibility of a specialist team. A CPAP device costs £250-£550 and lasts for seven years. Copyright © 2008 Wiley Interface Ltd [source]

    Diabetic mothers and their newborn infants , rooming-in and neonatal morbidity

    ACTA PAEDIATRICA, Issue 7 2010
    E Stage
    Abstract Aim:, As a result of increased neonatal morbidity, the infants of diabetic mothers have routinely been admitted to a neonatal special care unit (NSCU). We therefore investigated whether the offer of rooming-in diabetic mothers and their newborn infants has an effect on neonatal morbidity. Methods:, The records of an old cohort of 103 infants routinely admitted to the NSCU, and a new cohort (N = 102), offered rooming-in were assessed for neonatal morbidity. Results:, Eighty-four (82%) of the new cohort infants followed their mothers to the maternity ward; whereas 19 (18%) were transferred to the NSCU chiefly because of prematurity. Ten infants were later transferred to the NSCU for minor problems. Neonatal morbidity and neonatal hypoglycaemia were significantly less common in the new cohort than in the old cohort [27 (26%) vs. 55 (54%), p < 0.001 and 42 (41%) vs. 64 (63%), p = 0.0027 respectively]. Maternal HbA1c in late pregnancy was significantly lower in the new cohort, but the only independent predictors of neonatal morbidity were belonging to the old cohort and preterm delivery. Conclusion:, Neonatal care with rooming-in mothers with type 1 diabetes and their newborn infants seems safe and is associated with reduced neonatal morbidity, when compared with routine separation of infants from their mothers. [source]

    In-hospital mortality of newborn infants born before 33 weeks of gestation depends on the initial level of neonatal care: the EPIPAGE study

    ACTA PAEDIATRICA, Issue 3 2003
    JP Empana
    Aim: To determine the relation between the level of initial neonatal care and in-hospital mortality of infants born before 33 wk of gestation in the era of surfactant therapy. Methods: A 1 y prospective population-based survey was conducted in the north of France, as part of the EPIPAGE (Epidemiologie des Petits Ages Gestationnels) survey. Perinatal data were recorded for 585 very premature newborns transferred to a neonatal intensive care unit in 1997. The relation between the level of the neonatal unit that provided care for the first consecutive 48 h and in-hospital mortality was assessed by multivariate logistic regression, and adjusted for perinatal data and initial disease severity, estimated by the Clinical Risk Index for Babies (CRIB). Results: The average gestational age (mean ± SD) was 31.6 ± 0.62 wk in level I, 30.7 ± 0.21 in level II, 29.9 ± 0.13 in non-teaching level III, and 29.0 ± 0.15 in the level III teaching unit (p < 0.0001). The mean in-hospital mortality rate was 8.4% and did not differ by level of care (ptrend= 0.17). After adjustment for perinatal data and CRIB, however, with the teaching unit as the reference, the risk of death was significantly higher in level I,II units [adjusted odds ratio (ORa) = 7.9, 95% confidence interval (95% CI) 2.2,29.1], but not in the non-teaching level III units (ORa = 0.8, 95% CI 0.3,2.1). Conclusion: In-hospital mortality in non-teaching level III units was similar to that in a teaching unit, but significantly higher in level I-level II units. Neonatal care of newborns delivered before 33 wk of gestation should initially occur in level III units. [source]

    Photoplethysmography: a futuristic view for neonatal care

    ACTA PAEDIATRICA, Issue 7 2000
    Y Wickramasinghe
    No abstract is available for this article. [source]

    Life expectancy among people with cerebral palsy in Western Australia

    E Blair PhD
    This report describes trends, predictors, and causes of mortality in persons with cerebral palsy (CP)using individuals identified by the Western Australian Cerebral Palsy Register and born between 1958 and 1994. Two thousand and fourteen people were identified (1154 males, 860 females), of whom 225 had died by 1 June 1997. Using date-of-death data, crude and standardized mortality rates were estimated and predictors of mortality sought using survival analysis stratified by decade of birth, description of impairments, and demographic and perinatal variables. For those born after 1967, the cause of death profile was examined over time. Mortality exceeded 1% per annum in the first 5 years and declined to age 15 years after which it remained steady at about 0.35% for the next 20 years. The strongest single predictor was intellectual disability, but all forms of disability contributed to decreased life expectancy. Half of those with IQ/DQ score <20 survived to adulthood, increasing to 76% with IQ/DQ score 20,34, and exceeding 92% for higher scores. Severe motor impairment primarily increased the risk of early mortality. Despite there being 72 persons aged from 25 to 41 years with severe motor impairment in our data set, none had died after the age of 25 years. Infants born after more than 32 weeks'gestation were at significantly higher risk of mortality than very preterm infants, accounted for by their higher rates of intellectual disability. No improvements in survival of persons with CP were seen over the study period despite advances in medical care, improved community awareness, and the increasing proportion of very preterm births among people with CP. This may be the result of improved neonatal care enabling the survival of infants with increasingly severe disabilities. [source]

    Nursing and midwifery management of hypoglycaemia in healthy term neonates

    Vivien Hewitt BSc(Hons) GradDipLib
    Executive summary Objectives The primary objective of this review was to determine the best available evidence for maintenance of euglycaemia, in healthy term neonates, and the management of asymptomatic hypoglycaemia in otherwise healthy term neonates. Inclusion criteria Types of studies The review included any relevant published or unpublished studies undertaken between 1995 and 2004. Studies that focus on the diagnostic accuracy of point-of-care devices for blood glucose screening and/or monitoring in the neonate were initially included as a subgroup of this review. However, the technical nature and complexity of the statistical information published in diagnostic studies retrieved during the literature search stage, as well as the considerable volume of published research in this area, suggested that it would be more feasible to analyse diagnostic studies in a separate systematic review. Types of participants The review focused on studies that included healthy term (37- to 42-week gestation) appropriate size for gestational age neonates in the first 72 h after birth. Exclusions ,,preterm or small for gestational age newborns; ,,term neonates with a diagnosed medical or surgical condition, congenital or otherwise; ,,babies of diabetic mothers; ,,neonates with symptomatic hypoglycaemia; ,,large for gestational age neonates (as significant proportion are of diabetic mothers). Types of intervention All interventions that fell within the scope of practice of a midwife/nurse were included: ,,type (breast or breast milk substitutes), amount and/or timing of feeds, for example, initiation of feeding, and frequency; ,,regulation of body temperature; ,,monitoring (including screening) of neonates, including blood or plasma glucose levels and signs and symptoms of hypoglycaemia. Interventions that required initiation by a medical practitioner were excluded from the review. Types of outcome measures Outcomes that were of interest included: ,,occurrence of hypoglycaemia; ,,re-establishment and maintenance of blood or plasma glucose levels at or above set threshold (as defined by the particular study); ,,successful breast-feeding; ,,developmental outcomes. Types of research designs The review initially focused on randomised controlled trials reported from 1995 to 2004. Insufficient randomised controlled trials were identified and the review was expanded to include additional cohort and cross-sectional studies for possible inclusion in a narrative summary. Search strategy The major electronic databases, including MEDLINE/PubMed, CINAHL, EMBASE, LILACS, Cochrane Library, etc., were searched using accepted search techniques to identify relevant published and unpublished studies undertaken between 1995 and 2004. Efforts were made to locate any relevant unpublished materials, such as conference papers, research reports and dissertations. Printed journals were hand-searched and reference lists checked for potentially useful research. The year 1995 was selected as the starting point in order to identify any research that had not been included in the World Health Organisation review, which covered literature published up to 1996. The search was not limited to English language studies. Assessment of quality Three primary reviewers conducted the review assisted by a review panel. The review panel was comprised of nine nurses with expertise in neonatal care drawn from senior staff in several metropolitan neonatal units and education programs. Authorship of journal articles was not concealed from the reviewers. Methodological quality of each study that met the inclusion criteria was assessed by two reviewers, using a quality assessment checklist developed for the review. Disagreements between reviewers were resolved through discussion or with the assistance of a third reviewer. Data extraction and analysis Two reviewers used a data extraction form to independently extract data relating to the study design, setting and participants; study focus and intervention(s); and measurements and outcomes. As only one relevant randomised controlled trial was found, a meta-analysis could not be conducted nor tables constructed to illustrate comparisons between studies. Instead, the findings were summarised by a narrative identifying any relevant findings that emerged from the data. Results Seven studies met the inclusion criteria for the objective of this systematic review. The review provided information on the effectiveness of three categories of intervention , type of feeds, timing of feeds and thermoregulation on two of the outcome measures identified in the review protocol , prevention of hypoglycaemia, and re-establishment and maintenance of blood or plasma glucose levels above the set threshold (as determined by the particular study). There was no evidence available on which to base conclusions for effectiveness of monitoring or developmental outcomes, and insufficient evidence for breast-feeding success. Given that only a narrative review was possible, the findings of this review should be interpreted with caution. The findings suggest that the incidence of hypoglycaemia in healthy, breast-fed term infants of appropriate size for gestational age is uncommon and routine screening of these infants is not indicated. The method and timing of early feeding has little or no influence on the neonatal blood glucose measurement at 1 h in normal term babies. In healthy, breast-fed term infants the initiation and timing of feeds in the first 6 h of life has no significant influence on plasma glucose levels. The colostrum of primiparous mothers provides sufficient nutrition for the infant in the first 24 h after birth, and supplemental feeds or extra water is unnecessary. Skin-to-skin contact appears to provide an optimal environment for fetal to neonatal adaptation after birth and can help to maintain body temperature and adequate blood glucose levels in healthy term newborn infants, as well as providing an ideal opportunity to establish early bonding behaviours. Implications for practice The seven studies analysed in this review confirm the World Health Organisation's first three recommendations for prevention and management of asymptomatic hypoglycaemia, namely: 1Early and exclusive breast-feeding is safe to meet the nutritional needs of healthy term newborns worldwide. 2Healthy term newborns that are breast-fed on demand need not have their blood glucose routinely checked and need no supplementary foods or fluids. 3Healthy term newborns do not develop ,symptomatic' hypoglycaemia as a result of simple underfeeding. If an infant develops signs suggesting hypoglycaemia, look for an underlying condition. Detection and treatment of the cause are as important as correction of the blood glucose level. If there are any concerns that the newborn infant might be hypoglycaemic it should be given another feed. Given the importance of thermoregulation, skin-to-skin contact should be promoted and ,kangaroo care' encouraged in the first 24 h after birth. While it is important to main the infant's body temperature care should be taken to ensure that the child does not become overheated. [source]

    Developing Clinical Terms for Health Visiting in the United Kingdom

    June Clark
    BACKGROUND The UK health visiting service provides a universalist preventive health service that focuses mainly on families with young children and the elderly or vulnerable, but anyone who wishes can access the services. The principles of health visiting have been formally defined as the search for health needs, the stimulation of awareness of health needs, influencing policies that affect health, and the facilitation of health-enhancing activities. The project is currently in its fourth phase. In phase 1, 17 health visitors recorded their encounters with families with new babies over a period of 3 months; in phase 2, 27 health visitors recorded their encounters with a wider range of clients (769 encounters with 205 families) over a period of 9 months; in phase 3, the system is being used by a variety of healthcare professionals in a specialist program that provides intensive parenting support; phase 4 is developing a prototype of an automated version for point-of-contact recording. UK nursing has no tradition of standardized language and the concept of nursing diagnosis is almost unknown. Over the past decade, however, the government has initiated the development of a standardized terminology (Read codes) to cover all disciplines and all aspects of health care, and it is likely that the emerging SNOMED-CT terminology (a merger of the Read codes with the SNOMED terminology) will be mandated for use throughout the National Health Service (NHS). MAIN CONTENT POINTS The structure and key elements of the Omaha System were retained but the terminology was modified to take account of the particular field of practice and emerging UK needs. Modifications made were carefully tracked. The Problem Classification Scheme was modified as follows: ,All terms were anglicized. ,Some areas , notably relating to antepartum/postpartum, neonatal care, child protection, and growth and development,were expanded. ,The qualifiers "actual,""potential," and "health promotion" were changed to "problem,""risk," and "no problem." ,Risk factors were included as modifiers of "risk" alongside the "signs and symptoms" that qualify problems. The Intervention Classification was modified by substituting synonymous terms for "case management" and "surveillance" and dividing "health teaching, guidance, and counseling" into two categories. The Omaha System "targets" were renamed "focus" and a new axis of "recipient" was introduced in line with SNOMED-CT. The revised terminologies were tested in use and also sent for review to 3 nursing language experts and 12 practitioners, who were asked to review them for domain completeness, appropriate granularity, parsimony, synonymy, nonambiguity, nonredundancy, context independence, and compatibility with emerging multiaxial and combinatorial nomenclatures. Review comments were generally very favourable and modifications suggested are being incorporated. CONCLUSIONS The newly published government strategy for information management and technology in the NHS in Wales requires the rapid development of an electronic patient record, for which the two prerequisites are structured documentation and the use of standardized language. The terminology developed in this project will enable nursing concepts to be incorporated into the new systems. The experiences of the project team also offer many lessons that will be useful for developing the necessary educational infrastructure. [source]

    A Review of Psychometric Properties of Feeding Assessment Tools Used in Neonates

    Tsu-Hsin Howe
    ABSTRACT Objective:, To appraise the psychometric properties of clinical feeding assessment tools used in a neonatal population. Data sources:, PubMed, OvidMedline, CINHAL, and PsycINFO databases from 1980 to 2007. Reference lists of all identified articles were also reviewed. Study selection:, Research reports written in English that utilized or validated clinical feeding assessment tools. Data extraction:, In total, 941 articles were reviewed. Seven neonatal clinical feeding assessment tools were identified and categorized into three groups: tools used for assessing either bottle-feeding or breastfeeding behaviors, tools used only for assessing bottle-feeding behaviors, and tools used only for assessing breastfeeding behaviors. Results:, The psychometric properties of none of the seven assessment tools identified were satisfactory, and the limited representativeness of the samples of the psychometric research was noted in all assessment tools identified. The Neonatal Oral-Motor Assessment Scale appeared to have been examined more thoroughly and showed more consistent results in psychometric properties than the others, despite its own limitations. Conclusions:, A psychometrically sound neonate feeding assessment tool has not yet been empirically validated. Clinicians who use these tools for clinical and research purposes should take into account this lack of evidence of psychometric soundness and interpret results of assessment with precautions. Well-designed research is needed to study the scientific integrity of these instruments for program evaluations in neonatal care. [source]

    Screening, Diagnosis, and Clinical Care for Depression

    ANP-C, Mary Jo Goolsby EdD
    Depression is an extremely common condition, which usually responds well to prescribed treatment. Many patients have undiagnosed depression or related illnesses. There are a variety of screening tools that can be applied in practice settings. It is recommended that adult patients be screened for depression in practice sites able to coordinate the actual diagnosis and treatment of depression. This column reviews two sets of recommendations specific to the screening, diagnosis, and treatment of depression. Readers are invited to submit suggestions for future CPG columns and manuscripts reviewing CPGs. NPs interested in contributing to the column are invited to contact the column editor, Dr. Goolsby, to discuss their ideas. JAANP's readership is broad, covering all NP specialties. CPGs applicable to any areas of care can be submitted (from acute care to long term care, from neonatal care to geriatric care). [source]

    Repair of a large congenital diaphragmatic defect with a reverse latissimus dorsi muscle flap

    MICROSURGERY, Issue 2 2008
    Rui F. Barbosa M.D.
    Advances in neonatal care have led to an increase in the survival rate of children with large congenital diaphragmatic defects. Reconstruction by direct closure is not usually possible and surgical correction in the newborn consists of synthetic patch closure. Recurrence and complications are high with this technique and a latter reconstruction with living tissue is now advocated. We report a case of congenital diaphragmatic hernia treated initially by synthetic patch closure and 10 months latter, after a recurrence, with a reinnervated reverse latissimus dorsi (RLD) flap. We used an end-to-side neural coaptation of the thoracodorsal nerve to the phrenic nerve. The result was satisfactory, with remission of symptoms and improvement in growth and development, with permanent pleuro-peritoneal separation, normal lung growth, and apparent neodiaphragmatic function. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source]

    Primary predictors of preterm labour

    François Goffinet
    Spontaneous preterm birth accounts for 60% of all preterm births in developed countries. With the increase in multiple pregnancies, induced preterm birth and the progress in neonatal care for extremely preterm neonates, spontaneous preterm birth for singleton pregnancies in developed countries has probably decreased over the past 30 years. This decrease is likely to be related to better prenatal care for all pregnant women because the recognition of primary risk factors in early or late pregnancy remains a basic part of prenatal care. The failure to distinguish between induced and spontaneous preterm labour in most population-based studies makes it difficult to interpret results with respect to the primary predictors of preterm labour. Many such primary predictors of preterm labour have been used over the past 20,30 years. These include individual factors, socio-economic factors, working conditions and obstetric and gynaecological history. Risk scores have been proposed in order to produce these data. Unfortunately, the predictive value of these scores, especially their specificity, is poor, mainly because all of these factors are indirect. We still cannot identify the mechanisms that lead to preterm labour and birth. New markers more directly related to preterm labour have recently been proposed, some of which relate to direct causes of preterm labour such as cervical ultrasound measurement, fetal fibronectin (FFN), salivary estriol, serum CRH and bacterial vaginosis. Several of these have predictive values, which are potentially useful for clinical practice. Nonetheless, pregnant women in developed countries are already closely monitored throughout pregnancy. Before proposing new screening tests to be applied systematically to all pregnant women, their advantages and drawbacks must be fully evaluated. [source]

    Expectant management of early onset, severe pre-eclampsia: perinatal outcome

    D. R. Hall Consultant
    Objective To evaluate the perinatal outcome of expectant management of early onset, severe pre-eclampsia. Design Prospective case series extending over a five-year period. Setting Tertiary referral centre. Population All women (n= 340) presenting with early onset, severe pre-eclampsia, where both mother and the fetus were otherwise stable. Methods Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six-hourly heart rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward. Main outcome measures Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications. Results A mean of 11 days were gained by expectant management. The perinatal mortality rate was 24/1000 (, 1000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care. Conclusion Expectant management of early onset, severe pre-eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern. [source]

    Retinopathy of prematurity in a Copenhagen high-risk sample 1997,98

    The allover surveillance for ROP appears more, more complete
    ABSTRACT. Purpose: From two recent materials to describe the present clinical status regarding retinopathy of prematurity in Denmark, and to outline trends over time. Methods: A) Results of regular ophthalmic surveillance of 201 clinically selected (higher risk of ROP than average) pre-term infants of birth year 1997,98 taken care of in the two greater Copenhagen tertiary neonatal units, in an intended prospective design. Gestational age range was 24,32 weeks at delivery; birth weights 490,2200 g. Median values 28 weeks and 1090 g. B) A brief account of the latest ROP-associated registrations of visual impairment in Danish children aged 0,17 years (n=138). Results: A) ROP was observed in 31.3% (n=201). Retinal cryotherapy was given to eleven ,own' cases and to two from elsewhere (n=13, gestational age at delivery 25,31 weeks). Five had cryotherapy twice. Four of the 13 were later registered for visual impairment. B) Comparing the first and the latest third of the registrations, visual impairment has dropped in frequency and severity over the period from 1981 till now. Conclusions: Compared to previous data the present clinical profile of ROP in Denmark indicates a relatively lower overall frequency of ROP and a decrease in eventual severe visual impairment. Undoubtedly, the continued refinement of neonatal care has been of relevance, but the definite decline in visual impairment further reflects a more complete ophthalmic surveillance, on a national basis. The advanced cases are generally detected in time and retinal ablation therapy offered. [source]

    Neonatal intensive care utilization and neonatal outcome of infants born to women aged 40 years and over in New Zealand

    ACTA PAEDIATRICA, Issue 2 2010
    M Battin
    Abstract Background:, Increased maternal age is associated with pregnancy complications and there are few data available on neonatal outcome and utilization of neonatal resources. Our first aim was to use national New Zealand data to determine if the outcomes following admission to NICU are different for infants born to women aged 40 years and over, compared with those born to women under 40 years of age. The second aim was to document trends in the requirement of neonatal intensive care in infants born to women aged 40 years and older. Method:, Eligible infants were identified from registration with the Australian and New Zealand Neonatal Network for 1995,2004 inclusive. The relationship between maternal age and neonatal outcome was tested using univariate and multivariate analysis, and trends in the number of infants in maternal age groups below 35 years, 35,39 years and over 40 years were determined. Results:, On multivariate analysis using logistic regression, maternal age over 40 years was not found to be associated with a significant increase in the odds ratio for the composite poor outcome. However, over the 10-year period, there was an increase in the number of admissions and the percentage of admissions of infants born to women over 40 years of age. Conclusion:, Although the number of infants admitted for neonatal care following birth to women over 40 years of age has increased, these infants do not appear to have an increased risk of severe abnormal outcome. [source]

    A prospective study on the persistence of infant crying, sleeping and feeding problems and preschool behaviour

    ACTA PAEDIATRICA, Issue 2 2010
    G Schmid
    Abstract Aim:, To determine the persistence of regulatory problems (RP), i.e. excessive crying (>3 months of age), feeding and sleeping difficulties from infancy to preschool age, and to evaluate whether RP at 5 months are predictive of preschool adaptive behaviour and social skills. Method:, A prospective population study of newborns admitted to neonatal care. RP at 5, 20 and 56 months of age were obtained via parent interviews and neurological examination and preschool adaptive behaviour and social skills by parent ratings. Logistic and linear regression analyses were conducted and controlled for psychosocial and neurological factors. Results:, More than half of the sample had RP at least at one measurement point. In about 8% of infants, RP persisted across the preschool years. Multiple RP and feeding problems increased the odds of eating problems at 20 and 56 months. Persistent RP and feeding problems were predictive of deficits in preschool adaptive behaviour and social skills. In addition, sex differences were found. Conclusions:, Multiple RP and feeding problems had the highest stability. Persistent RP were predictive of adverse social and adaptive behaviour. Understanding of the aetiology may help to prevent persistent RP [source]

    Resuscitation at the limits of viability , an Irish perspective

    ACTA PAEDIATRICA, Issue 9 2009
    RA Khan
    Abstract Background:, Advances in neonatal care continue to lower the limit of viability. Decision making in this grey zone remains a challenging process. Objective:, To explore the opinions of healthcare providers on resuscitation and outcome in the less than 28-week preterm newborn. Design/Methods:, An anonymous postal questionnaire was sent to health care providers working in maternity units in the Republic of Ireland. Questions related to neonatal management of the extreme preterm infant, and estimated survival and long-term outcome. Results:, The response rate was 55% (74% obstetricians and 70% neonatologists). Less than 1% would advocate resuscitation at 22 weeks, 10% of health care providers advocate resuscitation at 23 weeks gestation, 80% of all health care providers would resuscitate at 24 weeks gestation. 20% of all health care providers would advocate cessation of resuscitation efforts on 22,25 weeks gestation at 5 min of age. 65% of Neonatologists and 54% trainees in Paediatrics would cease resuscitation at 10 min of age. Obstetricians were more pessimistic about survival and long term outcome in newborns delivered between 23 and 27 weeks when compared with neonatologists. This difference was also observed in trainees in paediatrics and obstetrics. Conclusion:, Neonatologists, trainees in paediatrics and neonatal nurses are generally more optimistic about outcome than their counterparts in obstetrical care and this is reflected in a greater willingness to provide resuscitation efforts at the limits of viability. [source]

    Costs of neonatal care for low-birthweight babies in English hospitals

    ACTA PAEDIATRICA, Issue 7 2009
    Hema Mistry
    Abstract Aim:, To estimate mean costs of neonatal care for babies with birthweights ,1800 g in a regional Level 3 unit and three Level 2 units providing short-term intensive care. Method:, Babies ,1800 g admitted to units in four hospitals in England over 15 months in 2001,2002 were audited until discharge. Unit costs (2005,2006 prices) were attributed to their resource items, including neonatal cot occupancy, pharmaceuticals, blood products and ambulance transfers. Bootstrapped mean costs were derived for the Level 3 unit and the Level 2 units combined. Results:, The mean gestation period for 199 Level 3 babies was 29.5 weeks compared with 30.4 weeks for 192 Level 2 babies (p = 0.003). Mean costs excluding ambulance journeys were £17 861 per Level 3 baby and £12 344 per Level 2 baby. Level 3 babies <1000 g averaged £26 815, whereas Level 2 babies <1000 g were generally less costly than babies 1000,1499 g. Ambulances transported 76 Level 3 babies and 62 Level 2 babies; their adjusted mean costs were £18 495 and £12 881, respectively. Conclusion:, By comprehensively costing resource components, the magnitude of total costs for low-birthweight babies has been revealed, thus demonstrating the importance of budgets for neonatal units being realistically determined by commissioners of neonatal services. [source]

    Motor performance in very preterm infants before and after implementation of the newborn individualized developmental care and assessment programme in a neonatal intensive care unit

    ACTA PAEDIATRICA, Issue 6 2009
    Anna Ullenhag
    Abstract Aim: To compare motor performance in supine position at the age of 4-months corrected age (CA) in very preterm (VPT) infants cared for in a neonatal intensive care unit (NICU) before and after the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Methods: Assessments of motor performance in supine position according to level of motor development and quality of motor performance were made, using the Structured Observation of Motor Performance in Infants (SOMP-I). Subjects: VPT infants cared for in a NICU at a Swedish university hospital before, Group A (n = 68), and after, Group B (n = 58), the implementation of developmentally supportive care based on NIDCAP. Results: The infants who were treated after the introduction of NIDCAP showed higher level of motor development in the arms/hands and trunk. No significant group differences were noted in total deviation score for the respective limbs, but lower frequency of lateral flexion in head movements, extension,external rotation,abduction, extension,internal rotation,adduction and varus and valgus position in the feet was found in the NIDCAP group, compared with those treated before the introduction. Conclusion: The infants who were treated after NIDCAP care had been implemented showed a higher level of motor development in arms/hand and trunk and fewer deviations in head, legs and feet at 4-months CA than infants treated before NIDCAP implementation. The observed changes may be due to NIDCAP and/or improved perinatal and neonatal care during the studied time period. [source]

    Cerebral MRI findings in a cohort of ex-preterm and control adolescents

    ACTA PAEDIATRICA, Issue 6 2009
    Zoltan Nagy
    Abstract Aim: Newborn infants were entered between 1988 and 1993 into a prospective, long-term, follow-up study. We aimed to investigate how the outcome of preterm-born individuals on cerebral magnetic resonance imaging (MRI) compared to that reported on similar cohorts internationally. Methods: The 74 ex-preterm (12.38,17.7 years, 51% girls) and 69 control participants (12.18,16.47 years, 53% girls) underwent a MRI examination on a 1.5T scanner. Two experienced neuroradiologists examined the T1- and T2-weigthed images first independently and then in consensus without knowledge of group adherence. Results: Only 21 (4 controls) of the 143 sets of scans showed any abnormalities. All but one of these were of mild extent. Among the ex-preterm adolescents two showed only incidental findings while the other 15 had either gliosis or white matter loss. Eleven subjects had white matter loss, seven of which had no other abnormalities. Four subjects had gliosis, three of which had no other abnormalities. The extent, severity or frequency of injury was not related to being born small for gestational age. Conclusion: Although the rate of structural abnormalities was higher in the group of adolescents born preterm, this rate was well below that reported from other centres around the world. We attribute this to the minimally invasive neonatal care and to different social structures in Sweden compared to that of other reports on similar cohorts. [source]

    Trends in the prevalence of low birth weight in Okinawa, Japan: a public health perspective

    ACTA PAEDIATRICA, Issue 2 2009
    T Hokama
    Abstract Aim: To review the trends in low birth weight (LBW) in Japan and Okinawa and to discuss the public health implications of the trend. Methods: The statistical records of Japan and the Okinawa prefecture were reviewed to observe secular trends of LBW incidence rate and other health indicators. Literature researches were undertaken of English and Japanese language publications to complete the review. Results: The LBW rate in Japan declined until the 1970s, reaching a low point for the whole country in 1978,1979 when it was 5.2% (7.2% in Okinawa). In Okinawa the proportion of LBW declined from 8.1% in 1973 to 7.2 in 1978. Since 1980 the LBW rate has steadily increased to its current level of 9.3% in Japan and 10.9% in Okinawa. During this period, the prematurity rate has not increased and other indicators of child health have continued to improve. Conclusion: Japan is unique among developed countries in that the LBW rate has almost doubled in the past three decades and the rate in Okinawa is 20% greater than the mainland. The health costs of this trend include the neonatal care of LBW infants and the increased risk of chronic disease in later life. [source]

    Correlations between welfare initiatives and breastfeeding rates: a 10-year follow-up study

    ACTA PAEDIATRICA, Issue 1 2009
    Bruno Mordini
    Abstract Aim: To evaluate the prevalence of full breastfeeding during the first 6 months of age and to discover if training programs for health caregivers and welfare initiatives at the community level could improve breastfeeding rates. Methods: Newborn babies with gestational age ,36 weeks and birth weight ,2500 g, discharged from the hospital within the first week of life, without any underlying pathologies, were enrolled in 3-month long sample periods between 1997 and 2006. A questionnaire was distributed to the mothers, to be completed and submitted before hospital discharge. Data were collected from phone interviews at 1, 3 and 6 months. Results: Full breastfeeding rates at hospital discharge showed an oscillation between 69.9% and 87%. The rate decreased in the following months and reached very low levels at 6 months of age (<24%), with the exception of the last sample period in 2006 (44.9%). Conclusion: A simple questionnaire, combined with standardized phone interviews, can be easily reproduced and may be used as an indicator for quality of neonatal care at hospital nurseries. A social and cultural change of the whole community towards breastfeeding promotion will result in increasing breastfeeding rates. [source]

    Rehospitalization of very preterm infants

    ACTA PAEDIATRICA, Issue 10 2004
    LAA Kollée
    Rehospitalization rates of very preterm infants because of reasons that are related to neonatal morbidity states can be decreased with further improvement of neonatal intensive care provided. Conclusion: Analysis of rehospitalization data should be included in follow-up programmes as a contribution to the development of strategies to improve neonatal care and the ultimate outcome for very-low-birthweight infants. [source]

    In-hospital mortality of newborn infants born before 33 weeks of gestation depends on the initial level of neonatal care: the EPIPAGE study

    ACTA PAEDIATRICA, Issue 3 2003
    JP Empana
    Aim: To determine the relation between the level of initial neonatal care and in-hospital mortality of infants born before 33 wk of gestation in the era of surfactant therapy. Methods: A 1 y prospective population-based survey was conducted in the north of France, as part of the EPIPAGE (Epidemiologie des Petits Ages Gestationnels) survey. Perinatal data were recorded for 585 very premature newborns transferred to a neonatal intensive care unit in 1997. The relation between the level of the neonatal unit that provided care for the first consecutive 48 h and in-hospital mortality was assessed by multivariate logistic regression, and adjusted for perinatal data and initial disease severity, estimated by the Clinical Risk Index for Babies (CRIB). Results: The average gestational age (mean ± SD) was 31.6 ± 0.62 wk in level I, 30.7 ± 0.21 in level II, 29.9 ± 0.13 in non-teaching level III, and 29.0 ± 0.15 in the level III teaching unit (p < 0.0001). The mean in-hospital mortality rate was 8.4% and did not differ by level of care (ptrend= 0.17). After adjustment for perinatal data and CRIB, however, with the teaching unit as the reference, the risk of death was significantly higher in level I,II units [adjusted odds ratio (ORa) = 7.9, 95% confidence interval (95% CI) 2.2,29.1], but not in the non-teaching level III units (ORa = 0.8, 95% CI 0.3,2.1). Conclusion: In-hospital mortality in non-teaching level III units was similar to that in a teaching unit, but significantly higher in level I-level II units. Neonatal care of newborns delivered before 33 wk of gestation should initially occur in level III units. [source]

    How clinicians in neonatal care see the introduction of neonatal nurse practitioners

    ACTA PAEDIATRICA, Issue 2 2002
    ME Redshaw
    The aim of this study was to investigate the views of UK clinicians in neonatal care who were working with nurses trained as neonatal nurse practitioners (NNPs). A questionnaire survey was used with a total sample of senior clinicians in the 66 neonatal units with one or more qualified NNPs. The main outcome measures were type and frequency of response, and similar data from NNPs were used to make comparisons. Data were returned from 57 of the 66 clinicians contacted (86%). NNP clinical practice as perceived by them was largely similar to that recorded by NNPs, though the clinicians expected more NNP involvement in some procedures (inserting central venous lines, umbilical arterial catheters, chest drains and peripheral arterial cannulae) than was actually found. Perceptions of the NNP role were similar, though the clinicians were significantly less likely to see taking a case-load, conducting a ward round, accepting outside referrals and taking charge of emergency transfers as integral elements. Reflections on the utilization of NNPs in neonatal care and the impact on junior medical staff education referred to NNPs filling gaps, a reduction in the intensity of work, improvements in training and in the quality of care. Conclusion: The introduction of NNPs is seen positively from the perspective of clinicians working alongside them in neonatal care. The development of similar models of care in countries where the introduction of NNPs is being considered is likely to be similarly supported. [source]