The relation between the availability of neonatal intensive care and neonatal mortality. (9/124)

BACKGROUND: There is marked regional variation in the availability of neonatal intensive care in the United States. We conducted a study to determine whether a greater supply of neonatologists or neonatal intensive care beds is associated with lower neonatal mortality. METHODS: We used the 1996 master files of the American Medical Association and the American Osteopathic Association and 1998 and 1999 surveys of neonatal intensive care units to calculate the supply of neonatologists and neonatal intensive care beds in 246 neonatal intensive care regions. We used linked birth and death records from the 1995 U.S. birth cohort to assess associations between the supply of both neonatologists and neonatal intensive care beds per capita (in quintiles) and the risk of death within the first 27 days of life. RESULTS: Among 3,892,208 newborns with a birth weight of 500 g or greater, the mortality rate was 3.4 per 1000 births. After adjustment for neonatal and maternal characteristics associated with an increased risk of neonatal death, the rate was lower in the regions with 4.3 neonatologists per 10,000 births than in those with 2.7 neonatologists per 10,000 births (odds ratio for death, 0.93; 95 percent confidence interval, 0.88 to 0.99). Further increases in the number of neonatologists were not associated with greater reductions in the risk of death. There was no consistent relation between the number of neonatal intensive care beds and neonatal mortality. CONCLUSIONS: A minority of regions in the United States may have inadequate neonatal intensive care resources, whereas many others may have more resources than are needed to prevent the death of high-risk newborns. The effect of the availability of neonatologists on other health outcomes is not known.  (+info)

Using mnemonics and visual imagery to teach the new neonatal resuscitation program. (10/124)

Mnemonics have long been used to help learners remember facts in various disciplines of medicine. With the introduction of the revised Neonatal Resuscitation Program (NRP), it is vital for learners to know and remember important changes to the NRP curricula. While teaching the new curricula, we found that learners appeared confused, being unable to provide the correct sequence of answers to the questions posed during the assessment phase of the course. Mnemonics were developed to aid memory recall and optimize resuscitation skills.  (+info)

Congenital scoliosis in a neonate: can a neonatologist ignore it? (11/124)

The frequency of diagnosis of congenital scoliosis in the neonatal period is expected to rise given the increasing survival of high risk neonates in the surfactant era and their frequent exposure to x rays. Considering its significant long term implications a neonatologist cannot afford to ignore the diagnosis of congenital scoliosis in a neonate as close surveillance, early detection, and treatment may prevent/minimise the wide spectrum of potentially serious deformities that can affect the developing spine. The review provides general guidelines to help the neonatologists in counselling the parents and in planning the multidisciplinary follow up for management of congenital scoliosis.  (+info)

Reflections on errors in neonatology: I. The "Hands-Off" years, 1920 to 1950. (12/124)

This series discusses errors in neonatology since the 1920s. Three historical periods are defined: the "Hands-Off" years, 1920 to 1950; the "Heroic" years, 1950 to 1970; and the "Experienced" years, 1970 to 2000. In this article, the "Hands-Off" years, we discuss lowered thermal environment, supplemental oxygen, initial thirsting and starving, synthetic vitamin K, SMA formula, and diaper markings.  (+info)

Reflections on errors in neonatology: II. The "Heroic" years, 1950 to 1970. (13/124)

This series errors in neonatology since the 1920s. Three historical periods are defined: the "Hands-Off" years from 1920 to 1950, the "Heroic" years from 1950 to 1970, and the "Experienced" years from 1970 on. In this article, the "Heroic" years, we discuss the Blossom air lock, sulfisoxazole, chloramphenicol, novobiocin, hexachlorophene, Epsom salts enemas, feeding gastrostomy, diaper laundering, and equipment cleaning.  (+info)

Evaluation of echocardiography on the neonatal unit. (14/124)

BACKGROUND: Echocardiography is an investigation that is being used increasingly on the neonatal unit. There is some controversy as to whether this service can be provided safely and effectively by neonatologists or whether it should only be performed by paediatric cardiologists. AIMS: To describe (a) the indications for an echocardiogram, (b) the yield and range of positive findings, (c) the resulting changes in clinical management, and (d) the reliability of echocardiography in the hands of neonatologists when it is performed on the neonatal unit. METHODS: Information about all echocardiograms performed on the neonatal unit was collected prospectively. Indications for performing echocardiography, echocardiographic findings, and any resulting changes in clinical management were determined. The concordance of findings in infants who underwent echocardiograms performed by both a neonatologist and a paediatric cardiologist was described. RESULTS: A total of 157 echocardiograms were performed in 82 infants. Echocardiography identified 44 infants with a structural cardiac abnormality and a further 17 infants with a trivial abnormality. In addition, 13 babies were found to have an important functional abnormality. Echocardiography prompted a specific change in clinical management in 64 (78%) babies. In 31 of the 38 infants who had paired scans performed, there was complete concordance between the two examinations. No infants had scans that were completely different. Some discrepancy was identified in seven infants, but this did not prevent appropriate immediate clinical management. CONCLUSIONS: Echocardiography on the neonatal unit has a high yield for the diagnosis of structural and functional cardiac abnormalities, often results in a change in clinical management, and can be a reliable tool in the hands of neonatologists.  (+info)

Are primary health workers skilled enough to assess the severity of illness among young infants? (15/124)

OBJECTIVE: To evaluate the skills of health workers in assessing the severity of illness among young infants. DESIGN: Cross sectional. SETTING: Five different health institutions viz, subcenter, primary health center, community health center, sub-divisional hospital, district hospital. METHODS: 110 young infants aged <2 months who attended the selected health institutions on specific week days were assessed by a physician. Subsequently 10 female health workers assessed these babies. Physician and health workers used same symptom and sign based guidelines for classification of the illness. Level of agreement between the physician and the health workers were assessed using kappa statistics. RESULTS: Physician classified 37.3% infants as not sick or mildly sick, 42.7% as moderately sick and 20% as severely sick. In comparison to the physician, the sensitivity and specificity of the health workers' assessment of severe illness was 77% and 76% respectively. Of 22 babies classified as severely sick by the physician, female health workers classified 5 as not sick or mildly sick, 8 as moderately sick and 9 as severely sick. On the other hand health workers classified one not sick or mildly sick and 9 moderately sick infants as severely sick. Level of agreement between the physician and health workers was poor (Kappa value = 0.39, 95% CI = 0.26, 0.52). Health workers misclassified illness mainly due to 'not counting the respiratory rate and 'not looking for chest retractions, purulent discharge and jaundice'. CONCLUSION: Trained health workers' skills were not satisfactory for assessment of illness severity among young infants. During training, importance of these signs needs to be emphasized.  (+info)

Staphylococcal exanthematous disease in a newborn due to a virulent methicillin-resistant Staphylococcus aureus strain containing the TSST-1 gene in Europe: an alert for neonatologists. (16/124)

We report a case of staphylococcal exanthematous disease in a newborn due to a toxic shock syndrome toxin 1- and SEC-producing methicillin-resistant Staphylococcus aureus strain and alert neonatologists to the probable emergence in France of the neonatal toxic shock syndrome-like exanthematous disease in newborns previously described in Japan. We advise neonatologists to pay careful attention to clinical parameters and to prescribe appropriate tests: platelet count, serum C-reactive protein concentration, and Vbeta2-positive T-cell counts.  (+info)