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Special Care Nursery (special + care_nursery)
Selected AbstractsThe drug epidemic: Effects on newborn infants and health resource consumption at a tertiary perinatal centreJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2000J J Kelly Objectives: Illicit drug taking in Australia, with its attendant social and medical consequences, is increasing and the effects extend to maternity hospitals where infants born to addicted mothers have more health problems in the neonatal period. The aims of this study were to evaluate (1) the patterns of illness of such infants and (2) the burden imposed on the neonatal department of a large tertiary maternity centre. Methodology: An audit was conducted of all Chemical Dependency Unit (CDU) mothers and babies delivered at the Royal Women's Hospital, Melbourne, Australia during 1997. Data were compared with those from a concurrent control group of mothers and babies randomly generated from the hospital's obstetric database. Results: Ninety-six infants born to CDU mothers were compared with a control group of 200 infant/mother pairs. The majority of women in the CDU clinic were treated for narcotic addiction with methadone (90%) but most continued to use heroin during pregnancy (68%). Infants born to CDU mothers were significantly less mature and lighter than control infants. Fifty-three (55%) CDU infants required admission to the Special Care Nursery either because of neonatal abstinence syndrome (n = 29) or other medical reasons (n = 24). The median length of hospital stay was significantly longer in CDU compared with control infants (8 vs 3 days, P < 0.01). Conclusions: Infants born to drug dependent mothers have more neonatal problems requiring specialized medical and nursing expertise, compared with control infants. These infants are large consumers of scarce health resources. [source] A randomised controlled trial of two instruments for vacuum-assisted delivery (Vacca Re-Usable OmniCup and the Bird anterior and posterior cups) to compare failure rates, safety and use effectivenessAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010Glen D.L. MOLA Background:, Most previous trials of vacuum-assisted delivery have been in settings with high rates of instrumental vaginal delivery (8,12%) and high rates of failure to deliver with the intended instrument (20,30%). Over the past 20 years, vacuum-assisted delivery rates at the Port Moresby General Hospital have been 3,4% with failure rates of <3%. Objective:, The objective is to compare the failure rates of two vacuum extractor instruments, the Vacca Re-Usable Omnicup and the Bird Vacuum delivery system (anterior and posterior cups). Setting:, Port Moresby General national referral and teaching Hospital (PMGH), Papua New Guinea. Population:, Two hundred consecutive women requiring assisted delivery, June,December, 2007. Methods:, When a woman required an assisted delivery, she was randomised into either the Vacca Re-Usable Omnicup (Clinical Innovations Inc.) or Bird anterior or posterior metal cup (depending upon the position of the vertex). One hundred women were randomised to each vacuum device. Statistical analysis was on ,an intention-to-treat' basis. Main outcome measures:, The main outcome measure was the successful completion of the delivery with the allocated instrument. Secondary outcomes were maternal trauma (episiotomy and trauma to the maternal genital tract), significant scalp trauma (sub-galeal haemorrhage or serious abrasion) and fetal and neonatal outcomes (Apgar score less than seven at 5 minutes, days spent in the Special Care Nursery and neonatal death). Results:, Failure rates for both Omnicup (2/100) and Bird metal cups (6/100) were not statistically different (RR 1.05, 95% CI 0.99,1.12; P = 0.17). Rates of maternal trauma and fetal scalp trauma were similar in both groups. Conclusion:, Both the Vacca re-useable Omnicup and the Bird metal cups are very effective instruments to achieve successful assisted delivery and equally so. Failures and problems were associated with not applying the vacuum cup to the flexion point on the fetal scalp and the mechanical faults with vacuum equipment devices. [source] Team Midwifery Care in a Tertiary Level Obstetric Service: A Randomized Controlled TrialBIRTH, Issue 3 2000Mary Anne Biró RN Background:In 1996 a new model of maternity care characterized by continuity of midwifery care from early pregnancy through to the postpartum period was implemented for women attending Monash Medical Centre, a tertiary level obstetric service, in Melbourne, Australia. The objective of this study was to compare the new model of care with standard maternity care.Methods:In a randomized controlled trial, 1000 women who booked at the antenatal clinic and met the eligibility criteria were randomly allocated to receive continuity of midwifery care (team care) from a group of seven midwives in collaboration with obstetric staff, or care from a variety of midwives and obstetric staff (standard care). The primary outcome measures were procedures in labor, maternal outcomes, neonatal outcomes, and length of hospital stay.Results:Women assigned to the team care group experienced less augmentation of labor, less electronic fetal monitoring, less use of narcotic and epidural analgesia, and fewer episiotomies but more unsutured tears. Team care women stayed in hospital 7 hours less than women in standard care. More babies of standard care mothers were admitted to the special care nurseries for more than 5 days because of preterm birth, and more babies of team care mothers were admitted to the nurseries for more than 5 days with intrauterine growth retardation. No differences occurred in perinatal mortality between the two groups.Conclusions:Continuity of midwifery care was associated with a reduction in medical procedures in labor and a shorter length of stay without compromising maternal and perinatal safety. Continuity of midwifery care is realistically achievable in a tertiary obstetric referral service. [source] Methadone in pregnancy: treatment retention and neonatal outcomesADDICTION, Issue 2 2007Lucy Burns ABSTRACT Aim To examine the association between retention in methadone treatment during pregnancy and key neonatal outcomes. Design Client data from the New South Wales Pharmaceutical Drugs of Addiction System was linked to birth information from the NSW Midwives Data Collection and the NSW Inpatient Statistics Collection from 1992 to 2002. Measurements Obstetric and perinatal characteristics of women who were retained continuously on methadone maintenance throughout their pregnancy were compared to those who entered late in their pregnancies (less than 6 months prior to birth) and those whose last treatment episode ended at least 1 year prior to birth. Findings There were 2993 births to women recorded as being on methadone at delivery, increasing from 62 in 1992 to 459 births in 2002. Compared to mothers who were maintained continuously on methadone throughout their pregnancy, those who entered treatment late also presented later to antenatal services, were more likely to arrive at hospital for delivery unbooked, were more often unmarried, indigenous and smoked more heavily. A higher proportion of neonates born to late entrants were born at less than 37 weeks gestation and were admitted to special care nursery more often. Conclusion Continuous methadone treatment during pregnancy is associated with earlier antenatal care and improved neonatal outcomes. Innovative techniques for early engagement in methadone treatment by pregnant heroin using women or those planning to become pregnant should be identified and implemented. [source] Use of Record Linkage to Examine Alcohol Use in PregnancyALCOHOLISM, Issue 4 2006Lucy Burns Background: To date, no population-level data have been published examining the obstetric and neonatal outcomes for women with an alcohol-related hospital admission during pregnancy compared with the general obstetric population. This information is critical to planning and implementing appropriate services. Methods: Antenatal and delivery admissions to New South Wales (NSW) hospitals from the NSW Inpatient Statistics Collection were linked to birth information from the NSW Midwives Data Collection over a 5-year period (1998,2002). Birth admissions were flagged as positive for maternal alcohol use where a birth admission or any pregnancy admission for that birth involved an alcohol-related International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) code. Key demographic, obstetric, and neonatal variables were compared for births to mothers in the alcohol group with births where no alcohol-related ICD10-AM was recorded. Results: A total of 416,834 birth records were analyzed over a 5-year period (1998,2002). In this time, 342 of these were coded as positive for at least 1 alcohol-related ICD-10-AM diagnosis. Mothers in the alcohol group had a higher number of previous pregnancies, smoked more heavily, were not privately insured, and were more often indigenous. They also presented later on in their pregnancy to antenatal services and were more likely to arrive at hospital unbooked for delivery. Deliveries involved less epidural and local and more general anesthesia. Cesarean sections were more common to women in the alcohol group and were performed more often for intrauterine growth retardation. Neonates born to women in the alcohol group were smaller for gestational age, had lower Apgar scores at 5 minutes, and were admitted to special care nursery more often. Conclusions: This study shows that linked population-level administrative data provide a powerful new source of information for examining the maternal and neonatal outcomes associated with alcohol use in pregnancy. [source] Original Article: Amniotic fluid lamellar body concentration as a marker of fetal lung maturity at term elective caesarean deliveryAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010Susan P. WALKER Background:, Caesarean birth, without prior labour, is associated with an increased risk of neonatal respiratory morbidity among term infants. The concentration of lamellar bodies in amniotic fluid reflects pulmonary surfactant production and release, and is thus used in preterm populations as a marker of fetal lung maturity. Whether amniotic fluid lamellar body concentration (AFLBC) may correlate with risk factors for term respiratory distress has not previously been evaluated. Aims:, To determine the relationship between AFLBC and risk factors for respiratory distress following term caesarean birth. Methods:, The AFLBC of 249 women at the time of term caesarean birth was examined for an association with gestational age, gender, presentation and neonatal respiratory distress requiring special care nursery (SCN) admission. Results:, There was a significant increase in AFLBC with gestation. When compared with caesarean deliveries performed during the 37th week of gestation, there was a 50%, 54% and 56% increase in lamellar body concentrations (LBCs) taken during the 38th, 39th and 40th week of gestation respectively (P < 0.05 for all). Female fetuses had a 16% higher LBC than males (P < 0.05). An LBC <100 × 109 mL,1 was associated with increased risk of admission to the SCN with respiratory distress (RR = 5.6; 1.2,26.5, P < 0.05). Conclusion:, Known risk factors for term respiratory distress are reflected in the AFLBC. A significant relationship exists between AFLBC and respiratory morbidity following term caesarean birth. However, the low prevalence of this condition limits the clinical role of AFLBC as a predictive test for term respiratory morbidity. [source] Characteristics and practices of birth centres in AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009Paula J. LAWS Background: Around 2% of women who give birth in Australia each year give birth in a birth centre. There is currently no standard definition of a birth centre in Australia. Aims: This study aimed to locate all birth centres nationally, describe their characteristics and procedures, and develop a definition. Methods: Surveys were sent to 23 birth centres. Questions included: types of procedures, equipment and pain relief available, staffing, funding, philosophies, physical characteristics and transfer procedures. Of the birth centres, 19 satisfied the inclusion criteria and 16 completed surveys. Results: Three constructs of a birth centre were identified. A ,commitment to normality of pregnancy and birth' was most commonly reported as the most important philosophy (44%). The predominant model of care was group practice/caseload midwifery (63%). Thirteen birth centres were located within/attached to a hospital, two were on a hospital campus and one was freestanding. The distance to the nearest labour ward ranged from 2 m to 15 km. Reported intrapartum transfer rates ranged from 7% to 29%. Thirteen centres had a special care nursery or neonatal intensive care unit onsite, or both. Eight centres undertook artificial rupture of membranes for induction of labour, while two administered oxytocin or prostaglandins. All centres offered nitrous oxide and local anaesthetic. Twelve centres had systemic opioids available and one offered pudendal analgesia. Fetal monitoring was used in all birth centres. Only three centres conducted instrumental deliveries, while 15 performed episiotomies. Conclusion: Birth centres vary in their philosophies, characteristics and service delivery. [source] | ||||||||||