Laundry Service, Hospital
Incubators, Infant
Intensive Care Units, Neonatal
Intensive Care, Neonatal
Infant, Newborn, Diseases
The neonatologist as primary care physician. (1/124)
Although trained first as pediatricians, neonatologists are not typically viewed as primary care physicians. However, given their particular training and expertise, patient population, and interaction with families as the newborn's first physician in many settings, neonatologists may rightly be viewed as the most appropriate primary care physician for newborns with medical or surgical problems. We review the fundamental underpinnings of primary care medicine with particular attention to how the neonatologist functions in such capacities. Neonatologist can contribute greatly to ensuring continuity of care for the sick newborn, the comprehensive nature of that care, and the coordination of care. Neonatologists' interactions with elements of the community to which the newborn will be discharged are an asset, as is their ability to work as part of a team. Given recent changes in practice management, the availability of neonatologists in the United States, and the desire for full-service mother and infant care capabilities in community hospitals, the primary care role of neonatologists bears recognition and support in today's changing healthcare marketplace. (+info)Non-ophthalmologist screening for retinopathy of prematurity. (2/124)
AIM: To determine if a non-ophthalmologist can accurately screen for retinopathy of prematurity (ROP) by evaluating the posterior pole blood vessels of the retina. ROP is a common ocular disorder of premature infants and may require multiple screening examinations by an ophthalmologist to allow for timely intervention. Since there is a strong correlation between posterior pole vascular abnormalities and vision threatening ROP, screening examinations performed by non-ophthalmologist may yield useful clinical information in high risk infants. METHODS: Infants born at the Medical University of South Carolina who met screening criteria (n = 142) were examined by a single non-ophthalmologist using a direct ophthalmoscope to evaluate the posterior pole blood vessels for abnormalities of the venules and/or arterioles. To determine the accuracy of the non-ophthalmologist's clinical observations, infants were also examined by an ophthalmologist, using an indirect ophthalmoscope, who graded the posterior pole vessels as normal, dilated venules, or dilated and tortuous venules and arterioles (including "plus disease"). RESULTS: There was significant correlation (p <0.001) between the non-ophthalmologist's and ophthalmologist's diagnoses of posterior pole vascular abnormalities. 47 infants had normal posterior pole blood vessels by the non-ophthalmologist examination. Of these, 31 (66%) were considered to have normal vessels and 16 (34%) to have dilated venules by the ophthalmologist. The non-ophthalmologist correctly identified abnormal posterior pole vessels in all 21 infants diagnosed with abnormal arterioles and venules by the ophthalmologist. No infants with clinically important ROP ("prethreshold" or worse) would have failed detection by this screening method. CONCLUSION: Using a direct ophthalmoscope, a non-ophthalmologist can screen premature infants at risk for ROP by evaluating the posterior pole blood vessels of the retina. While not necessarily recommended for routine clinical practice, this technique may nevertheless be of value to those situations where ophthalmological consultation is unavailable or difficult to obtain. (+info)Variation in the use of alternative levels of hospital care for newborns in a managed care organization. (3/124)
OBJECTIVE(S): To assess the extent to which variation in the use of neonatal intensive care resources in a managed care organization is a consequence of variation in neonatal health risks and/or variation in the organization and delivery of medical care to newborns. STUDY DESIGN: Data were collected on a cohort of all births from four sites in Kaiser Permanente by retrospective medical chart abstraction of the birth admission. Likelihood of admission into a neonatal intensive care unit (NICU) is estimated by logistic regression. Durations of NICU stays and of hospital stay following birth are estimated by Cox proportional hazards regression. RESULTS: The likelihood of admission into NICU and the duration of both NICU care and hospital stay are proportional to the degree of illness and complexity of diagnosis. Adjusting for variation in health risks across sites, however, does not fully account for observed variation in NICU admission rates or for length of hospital stay. One site has a distinct pattern of high rates of NICU admissions; another site has a distinct pattern of low rates of NICU admission but long durations of hospital stay for full-term newborns following NICU admission as well as for all newborns managed in normal care nurseries. CONCLUSIONS: Substantial variations exist among sites in the risk-adjusted likelihood of NICU admission and in durations of NICU stay and hospital stay. Hospital and NICU affiliation (Kaiser Permanente versus contract) or affiliation of the neonatologists (Kaiser Permanente versus contract) could not explain the variation in use of alternative levels of hospital care. The best explanation for these variations in neonatal resource use appears to be the extent to which neonatology and pediatric practices differ in their policies with respect to the management of newborns of minimal to moderate illness. (+info)Graphical user interface for a neonatal parenteral nutrition decision support system. (4/124)
We developed and implemented a decision support system for prescribing parenteral nutrition (PN) solutions for infants in our neonatal intensive care unit. We employed a graphical user interface to provide clinical guidelines and aid the understanding of the interaction among the various ingredients that make up a PN solution. In particular, by displaying the interaction between the PN total solution volume, protein, calcium and phosphorus, we have eliminated PN orders that previously would have resulted in calcium-phosphorus precipitation errors. (+info)The uneven landscape of newborn intensive care services: variation in the neonatology workforce. (5/124)
CONTEXT: In the past 30 years, the number of neonatologists has increased while total births have remained nearly constant. It is not known how equitably this expanded workforce is distributed. OBJECTIVE: To determine the geographic distribution of neonatologists in the United States. DATA SOURCES: 1996 American Medical Association physician masterfiles; 1999 survey of all U.S. neonatal intensive care units; 1995 American Hospital Association hospital survey; and 1995 U.S. vital records. MEASURES: The number of neonatologists and neonatal mid-level providers per live birth within 246 market-based regions. RESULTS: The neonatology workforce varied substantially across neonatal intensive care regions. The number of neonatologists per 10,000 live births ranged from 1.2 to 25.6 with an interquintile range of 3.5 to 8.5. The weakly positive correlation between neonatologists and neonatal mid-level providers per live birth is not consistent with substitution of neonatal mid-level providers for neonatologists (Spearman rank-correlation coefficient, 0.17; P < 0.01). There was no difference in the percentage of neonatal fellows in the lowest and highest workforce quintile (14% vs. 16%) or in the percentage of neonatologists engaged predominantly in research, teaching, or administration (14% in lowest and highest quintiles). CONCLUSIONS: The regional supply of neonatologists varies dramatically and cannot be explained by the substitution of neonatal mid-level providers or by the presence of academic medical centers. Further research is warranted to understand whether neonatal intensive care resources are located in accordance with risk and whether more resources improve newborn outcomes. (+info)Sir Leonard Parsons of Birmingham (1879-1950) and antenatal paediatrics. (6/124)
Born and educated in the Midlands, Sir Leonard Parsons made major contributions to the field of paediatrics in that area and played a leading role in the regional organisation of this specialty throughout the United Kingdom in the later years of his life. He was a founder member and later President of the British Paediatric Association, and later became Vice-President of the International Pediatric Congress and the President of the paediatric section of the Royal Society of Medicine. (+info)Parents' perceptions of research with newborns. (7/124)
OBJECTIVE: To examine beliefs and attitudes of parents about research with babies. STUDY DESIGN: Survey of 72 parents of newborn babies in the neonatal intensive care unit (NICU), and 159 parents of normal newborns using instrument designed for the study. The instrument included questions with graded responses and five research scenarios with varied risks and benefits. Statistical analysis included chi(2) analysis and Fisher's exact test. RESULTS: Parents showed generally favorable attitudes toward research with babies. There were few differences between the two groups of parents, but there was a trend toward more trust in doctors by "NICU parents." Couples with newborns in NICU were significantly more likely to enroll their newborn in a study involving moderate risk and possible major direct benefit. Almost a third of the sample in both groups was willing to enroll their newborn in a study with moderate risk and no direct benefit. CONCLUSION: Parents believe research is necessary and want to be asked for consent, but many feel they have limited knowledge and would depend on their physician's advice. The fact, that some might enroll their newborn in a study involving a risky procedure that would not benefit the newborn, supports the notion of vulnerability and emphasizes the fact that physicians must be alert to the possibility of coercion and undue influence. (+info)Creation of a neonatal end-of-life palliative care protocol. (8/124)
OBJECTIVE: To create a protocol delineating the needs of patients, families, and staff necessary to provide a pain-free, dignified, family-, and staff-supported death for newborns who cannot benefit from intensive, life-extending, technological support. STUDY DESIGN: Using Internet e-mail, a Delphi study with sequential questionnaires soliciting participant response, investigator analysis, and follow-up responses from participants was conducted to build a consensus document. Institutional review was granted and respondents gave consent. Recruitment was conducted at medical, ethics, nursing, and multidisciplinary organization meetings. Synthesis of 16 palliative care/end-of-life protocols developed by regional, institutional, and parent organizations was included. Participants from 93 locations in the US and 4 abroad gave feedback to 13 questions derived from clinical experience and the literature. The data underwent four rounds of analysis with 95% retention of the 101 participants over an 18-month period. RESULTS/CONCLUSION: Specific consensus-based recommendations are presented with a description of palliative care; categories of candidates; planning and education needed to begin palliative care services; relationships between community and tertiary centers; components of optimally supported neonatal death; family care, including cultural, spiritual, and practical needs; ventilator withdrawal, including pain and symptom management; recommendations when death does not occur after cessation of life-extending interventions; family follow-up care; and necessary ongoing staff support. (+info)Neonatology is a subspecialty of pediatrics that focuses on the medical care of newborn infants, particularly those who are born prematurely or with critical illnesses. Neonatologists are physicians who have additional training and expertise in managing complex neonatal conditions such as respiratory distress syndrome, birth defects, infection, and other issues that can affect newborns. They typically work in neonatal intensive care units (NICUs) and collaborate with a multidisciplinary team of healthcare professionals to provide comprehensive care for these vulnerable patients.
A hospital laundry service is a department or external service that is responsible for the cleaning, disinfection, and maintenance of textiles used within a healthcare facility. This includes items such as bed sheets, patient gowns, scrubs, towels, and other linens. The service ensures that these items are processed and returned in a hygienic and timely manner to maintain a clean and safe environment for both patients and staff. Hospital laundry services must adhere to strict infection control guidelines and use specialized equipment to ensure the removal of potential pathogens and prevent cross-contamination.
An infant incubator is a specialized piece of medical equipment used in the care of premature or critically ill newborns. It provides a controlled environment for the baby, allowing healthcare professionals to regulate temperature, humidity, and oxygen levels to meet the specific needs of the infant. The incubator also helps to protect the vulnerable newborn from infection and injury.
The primary goal of using an infant incubator is to create a stable internal environment that supports the baby's growth and development while minimizing potential complications associated with prematurity or critical illness. This may include supporting cardiovascular function, promoting respiratory health, and aiding in thermal regulation.
Some key features of infant incubators include:
1. Temperature control: Incubators allow healthcare providers to maintain a stable temperature between 36°C and 37.5°C (96.8°F and 99.5°F) to help the baby conserve energy and focus on growth.
2. Humidity control: Adjustable humidity levels ensure that the infant's delicate skin remains moist, preventing dehydration and promoting healthy skin development.
3. Oxygen regulation: Incubators can be equipped with oxygen sensors and supplemental oxygen supplies to help babies with respiratory distress or immature lungs receive the appropriate amount of oxygen.
4. Monitoring capabilities: Modern incubators often include built-in monitors that track vital signs such as heart rate, respiratory rate, and oxygen saturation, allowing healthcare professionals to closely monitor the infant's progress and respond quickly to any changes in condition.
5. Isolation: The enclosed design of an incubator helps protect the baby from infection by limiting exposure to external pathogens and providing a barrier against accidental injury or disturbance.
6. Accessibility: Clear sides and top openings allow healthcare providers easy access to the infant for examinations, treatments, and procedures while minimizing disruptions to the baby's environment.
7. Portability: Some incubators are designed to be mobile, allowing for safe transport of the infant within the hospital or between healthcare facilities.
Incubator care is a critical component of neonatal intensive care unit (NICU) services, and the use of advanced incubation technology has contributed significantly to improved outcomes for premature and critically ill newborns.
A "Nursery, Hospital" is a specialized unit within a hospital that provides care for newborn infants, particularly those who are born prematurely or sick. Also known as a neonatal intensive care unit (NICU), it is equipped with advanced medical technology and staffed by healthcare professionals trained in the care of newborns, including neonatologists, neonatal nurses, and respiratory therapists.
The nursery provides a range of services, such as monitoring vital signs, providing nutrition and hydration, administering medications, and performing medical procedures as needed. It may also offer developmental care to promote the growth and development of premature infants. The level of care provided in a hospital nursery can vary, with some units offering more intensive care for critically ill newborns and others providing less intensive care for those who are stable but require monitoring and support.
Diapers for infants are absorbent garments worn by babies and young children who are not yet fully potty-trained. They are typically made of cloth or disposable materials and feature fasteners to keep them securely in place around the baby's waist. Diapers serve to protect the child's clothing and the surrounding environment from accidents, such as urination and bowel movements. Infant diapers come in various sizes to accommodate growing babies, and some are designed with features like wetness indicators or adjustable leg cuffs for added convenience and protection.
A Neonatal Intensive Care Unit (NICU) is a specialized hospital unit that provides advanced, intensive care for newborn babies who are born prematurely, critically ill, or have complex medical conditions. The NICU staff includes neonatologists, neonatal nurses, respiratory therapists, and other healthcare professionals trained to provide specialized care for these vulnerable infants.
The NICU is equipped with advanced technology and monitoring systems to support the babies' breathing, heart function, temperature regulation, and nutrition. The unit may include incubators or radiant warmers to maintain the baby's body temperature, ventilators to assist with breathing, and intravenous lines to provide fluids and medications.
NICUs are typically classified into levels based on the complexity of care provided, ranging from Level I (basic care for healthy newborns) to Level IV (the highest level of care for critically ill newborns). The specific services and level of care provided in a NICU may vary depending on the hospital and geographic location.
A newborn infant is a baby who is within the first 28 days of life. This period is also referred to as the neonatal period. Newborns require specialized care and attention due to their immature bodily systems and increased vulnerability to various health issues. They are closely monitored for signs of well-being, growth, and development during this critical time.
Neonatal Intensive Care (NIC) is a specialized medical care for newborn babies who are born prematurely, have low birth weight, or have medical conditions that require advanced medical intervention. This can include monitoring and support for breathing, heart function, temperature regulation, and nutrition. NICUs are staffed with healthcare professionals trained in neonatology, nursing, respiratory therapy, and other specialized areas to provide the highest level of care for these vulnerable infants.
The goal of NICU is to stabilize the newborn's condition, treat medical problems, promote growth and development, and support the family throughout the hospitalization and transition to home. The level of care provided in a NICU can vary depending on the severity of the infant's condition, ranging from basic monitoring and support to complex treatments such as mechanical ventilation, surgery, and medication therapy.
In general, NICUs are classified into different levels based on the complexity of care they can provide. Level I NICUs provide basic care for infants born at or near term who require minimal medical intervention. Level II NICUs provide more advanced care for premature or sick newborns who require specialized monitoring and treatment but do not need surgery or complex therapies. Level III NICUs provide the highest level of care, including advanced respiratory support, surgical services, and critical care for critically ill infants with complex medical conditions.
A "newborn infant" refers to a baby in the first 28 days of life outside of the womb. This period is crucial for growth and development, but also poses unique challenges as the infant's immune system is not fully developed, making them more susceptible to various diseases.
"Newborn diseases" are health conditions that specifically affect newborn infants. These can be categorized into three main types:
1. Congenital disorders: These are conditions that are present at birth and may be inherited or caused by factors such as infection, exposure to harmful substances during pregnancy, or chromosomal abnormalities. Examples include Down syndrome, congenital heart defects, and spina bifida.
2. Infectious diseases: Newborn infants are particularly vulnerable to infections due to their immature immune systems. Common infectious diseases in newborns include sepsis (bloodstream infection), pneumonia, and meningitis. These can be acquired from the mother during pregnancy or childbirth, or from the environment after birth.
3. Developmental disorders: These are conditions that affect the normal growth and development of the newborn infant. Examples include cerebral palsy, intellectual disabilities, and vision or hearing impairments.
It is important to note that many newborn diseases can be prevented or treated with appropriate medical care, including prenatal care, proper hygiene practices, and timely vaccinations. Regular check-ups and monitoring of the newborn's health by a healthcare provider are essential for early detection and management of any potential health issues.
A premature infant is a baby born before 37 weeks of gestation. They may face various health challenges because their organs are not fully developed. The earlier a baby is born, the higher the risk of complications. Prematurity can lead to short-term and long-term health issues, such as respiratory distress syndrome, jaundice, anemia, infections, hearing problems, vision problems, developmental delays, and cerebral palsy. Intensive medical care and support are often necessary for premature infants to ensure their survival and optimal growth and development.
A "premature infant" is a newborn delivered before 37 weeks of gestation. They are at greater risk for various health complications and medical conditions compared to full-term infants, due to their immature organ systems and lower birth weight. Some common diseases and health issues that premature infants may face include:
1. Respiratory Distress Syndrome (RDS): A lung disorder caused by the lack of surfactant, a substance that helps keep the lungs inflated. Premature infants, especially those born before 34 weeks, are at higher risk for RDS.
2. Intraventricular Hemorrhage (IVH): Bleeding in the brain's ventricles, which can lead to developmental delays or neurological issues. The risk of IVH is inversely proportional to gestational age, meaning that the earlier the infant is born, the higher the risk.
3. Necrotizing Enterocolitis (NEC): A gastrointestinal disease where the intestinal tissue becomes inflamed and can die. Premature infants are at greater risk for NEC due to their immature digestive systems.
4. Jaundice: A yellowing of the skin and eyes caused by an accumulation of bilirubin, a waste product from broken-down red blood cells. Premature infants may have higher rates of jaundice due to their liver's immaturity.
5. Infections: Premature infants are more susceptible to infections because of their underdeveloped immune systems. Common sources of infection include the mother's genital tract, bloodstream, or hospital environment.
6. Anemia: A condition characterized by a low red blood cell count or insufficient hemoglobin. Premature infants may develop anemia due to frequent blood sampling, rapid growth, or inadequate erythropoietin production.
7. Retinopathy of Prematurity (ROP): An eye disorder affecting premature infants, where abnormal blood vessel growth occurs in the retina. Severe ROP can lead to vision loss or blindness if not treated promptly.
8. Developmental Delays: Premature infants are at risk for developmental delays due to their immature nervous systems and environmental factors such as sensory deprivation or separation from parents.
9. Patent Ductus Arteriosus (PDA): A congenital heart defect where the ductus arteriosus, a blood vessel that connects two major arteries in the fetal heart, fails to close after birth. Premature infants are at higher risk for PDA due to their immature cardiovascular systems.
10. Hypothermia: Premature infants have difficulty maintaining body temperature and are at risk for hypothermia, which can lead to increased metabolic demands, poor feeding, and infection.