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PubMed1993

A multicenter randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome. National Institute of Child Health and Human Development Neonatal Research Network.

OBJECTIVE: To compare the efficacy of two surfactants, Exosurf Neonatal (Burroughs Wellcome Co.) and Survanta (Ross Laboratories), for the treatment of neonatal respiratory distress syndrome. DESIGN: Multicenter randomized trial. SETTING: Eleven tertiary care university neonatal intensive care units participating in the National Institute of Child Health and Human Development Neonatal Research Network. PATIENTS: Newborn infants (n = 617) weighing 501 to 1500 gm with respiratory distress syndrome who were receiving assisted ventilation with 30% oxygen or more within 6 hours of birth were enrolled between January 1991 and January 1992. INTERVENTIONS: Infants were randomly assigned to receive up to four intratracheal doses of either Exosurf Neonatal (n = 309) or Survanta (n = 308). MAIN OUTCOME MEASURES: The occurrence of death or bronchopulmonary dysplasia 28 days after birth and the average fraction of inspired oxygen (FIO2) and mean airway pressure (MAP) during the first 72 hours after treatment. RESULTS: Death or bronchopulmonary dysplasia occurred in 67% of the infants in the Exosurf group and 62% of those in the Survanta group (adjusted relative risk, 1.07; 95% confidence interval, 0.96 to 1.20). During the 72 hours after the first surfactant dose, the average FIO2 (+/- SEM) was 0.50 +/- 0.01 for Exosurf and 0.42 +/- 0.01 for Survanta (difference, 0.08; 95% confidence interval, 0.05 to 0.11); the average MAP (+/- SEM) was 7.64 +/- 0.21 cm H2O for Exosurf and 6.93 +/- 0.21 cm H2O for Survanta (difference, 0.71 cm H2O; 95% confidence interval, 0.13 to 1.29 cm H2O). There was no difference between the groups in the incidence of other neonatal morbidities or in the duration of hospitalization, assisted ventilation, or supplemental oxygen administration. CONCLUSION: We found no difference between treatment groups in the incidence of death or bronchopulmonary dysplasia, although we did observe a difference in the initial response to treatment as measured by FIO2 and MAP.

Biological Products↗
PubMed1996

Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network.

OBJECTIVE: Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993). METHODS: The NICHD Neonatal Research Network maintains a prospectively collected registry of all VLBW neonates cared for at participating centers. Data from this registry were analyzed retrospectively. RESULTS: Of 6911 infants who survived beyond 3 days, 1696 (25%) had one or more episodes of blood culture-proven sepsis. The vast majority of infection (73%) were caused by gram-positive organisms, with coagulase-negative staphylococci accounting for 55% of all infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of infection included intubation, respiratory distress syndrome, prolonged ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, severe intraventricular hemorrhage, and necrotizing enterocolitis. Among infants with bronchopulmonary dysplasia, those with late-onset sepsis had a significantly longer duration of mechanical ventilation (45 vs 33 days; p <0.01). Late-onset sepsis prolonged hospital stay: the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days, respectively (p <0.001). Even after adjustment for other complications of prematurity, including intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia, infants with late-onset sepsis had a significantly longer hospitalization (p <0.001). Moreover, neonates in whom late-onset sepsis developed were significantly more likely to die than those who were uninfected (17% vs 7%; p <0.000 1), especially if they were infected with gram-negative organisms (40%) or fungi (28%). Deaths attributed to infection increased with increasing chronologic age. Whereas only 4% of deaths in the first 3 days of life were attributed to infection, 45% of deaths after 2 weeks were related to infection. CONCLUSIONS: Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs.

Age of Onset↗
PubMed2003

Functional MRI in neonates using neonatal head coil and MR compatible incubator.

Structural and functional magnetic resonance imaging of the newborn brain is a complex and challenging task. Term and preterm neonates require a controlled microenvironment and close monitoring during the MRI study to maintain respiratory and cardiovascular functions, body temperature, and fluid and electrolyte homeostasis. In addition, to minimize motion artifacts, most neonates also need to be sedated, which carries the risk of respiratory depression compromising the neonate's ability to maintain appropriate ventilation and oxygenation during the procedure. Finally, because of their small head size, the use of the standard MR head coils results in suboptimal picture quality in the neonate. Thus, these limitations affect our ability to obtain both high quality structural and functional MRI studies. To overcome these difficulties, we have utilized an MR compatible incubator with a built-in radiofrequency head coil optimized for the neonatal brain volume. In this study we demonstrate that functional MRI and high-resolution structural MRI of the newborn brain can be achieved with this novel design. The use of this equipment offers potential for studying the development of the preterm and term neonatal brain and obtaining state-of-the-art, high-resolution structural and functional imaging in this most vulnerable patient population.

Chloral Hydrate↗
PubMed2004

Neonatal microscopic polyangiitis secondary to transfer of maternal myeloperoxidase-antineutrophil cytoplasmic antibody resulting in neonatal pulmonary hemorrhage and renal involvement.

BACKGROUND: Microscopic polyangiitis is a systemic vasculitis characterized by small vessel involvement. Studies suggest myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) is involved in its pathogenesis, and the titer may reflect disease activity. OBJECTIVE: To report a case of transplacental transfer of MPO-ANCA from a mother to a 33-week gestational age neonate that resulted in neonatal pulmonary hemorrhage and renal involvement that was successfully treated with high-dose steroid therapy and exchange transfusion. METHODS: MPO-ANCA titers from the cord blood and the neonate on the 8th, 15th, and 25th days of life (DOLs) were obtained. Metabolic panels and chest x-ray examinations were performed for the neonate and mother and the following values were measured: ANCA, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, serial urinalysis, and complete blood cell count. Anti-glomerular basement membrane, quantitative immunoglobulins, anticardiolipin antibody, and rheumatoid factor were also measured for the neonate. RESULTS: The neonate had elevated MPO-ANCA titers at birth. Pulmonary hemorrhage and renal involvement were seen on DOL 2. High-dose steroid therapy decreased symptoms within 1.5 hours of initiation. Exchange transfusion performed on DOL 5 removed all of the remaining MPO-ANCA by DOL 25. The child remains asymptomatic to date. CONCLUSIONS: To our knowledge, this is the first reported case of transplacental transfer of MPO-ANCA resulting in pulmonary-renal syndrome that was successfully treated with high-dose steroid therapy and exchange transfusion.

Adrenal Cortex Hormones↗
PubMed1999

Mononuclear cell subpopulations in preterm and full-term neonates: independent effects of gestational age, neonatal infection, maternal pre-eclampsia, maternal betamethason therapy, and mode of delivery.

Blood samples from 29 preterm (24-32 weeks of gestation) and 21 full-term (37-42 weeks of gestation) neonates were analysed for surface markers of lymphocyte subtypes and macrophages, and the effects of gestational age, neonatal infection, maternal pre-eclampsia, maternal betamethason therapy and mode of delivery were assessed with multiple regression analysis. Gestational age alone had few independent effects (increase in CD3+, CD8+CD45RA+, and CD11alpha+ cells, and decrease in CD14+, HLA-DR- cells) during the third trimester on the proportions of the immune cell subtypes studied. Neonatal infection and mother's pre-eclampsia had the broadest and very opposite kinds of effects on the profile of immune cells in the blood. Infection of the neonate increased the proportions of several 'immature' cells (CD11alpha-CD20+, CD40+CD19-, and CD14+HLA-DR-), whereas mother's pre-eclampsia decreased the proportions of naive cell types (CD4+CD8+, CD5+CD19+). In addition, neonatal infection increased the proportion of T cells (CD3+, CD3+CD25+, and CD4+/CD8+ ratio, and CD45RA+ cells), while maternal pre-eclampsia had a decreasing effect on the proportion of CD4+ cells, CD4+/CD8+ ratio, and proportions of CD11alpha+, CD14+ and CD14+HLA-DR+ cells. Maternal betamethason therapy increased the proportion of T cells (CD3+) and macrophages (CD14+, CD14+HLA-DR+), but decreased the proportion of natural killer (NK) cells. Caesarean section was associated with a decrease in the proportion of CD14+ cells. We conclude that the 'normal range' of proportions of different mononuclear cells is wide during the last trimester; further, the effect of gestational age on these proportions is more limited than the effects of other neonatal and even maternal factors.

Antigens, CD↗
PubMedDate not supplied

[Measures for the assessment of pain in neonates as well as a comparison between the Bernese Pain Scale for Neonates (BPSN) with the Premature Infant Pain Profile (PIPP)].

BACKGROUND: Neonate's expression of pain lacks the ability to report pain. Several pain measures exist to assess acute pain in term and preterm neonates. The aim of the present study is to compare them with respect to their validity and reliability. METHOD: Review of the literature and a description of the measures most often cited. Additionally, the validity of the Bernese Pain Scale for Neonates (BPSN) was assessed in a department of neonatology of a university hospital. PATIENTS: Assessments of pain (n = 48) in term and preterm neonates with and without respiratory support. RESULTS: Existing pain measures are using behavioural indicators of pain (eg, facial expression, body posture, movements, and vigilance) as well as physiological indicators of pain (eg, changes in heart rate, respiratory rate, blood pressure, oxygen saturation). The used measures and their feasibility in everyday practice, the study population and the method of validation were presented. The BPSN differentiates pain from nonpain (F = 41.27, p < 0.0001) and the interrater- as well as the intrarater-reliability was high (r = 0.87 - 0.98 and r = 0.98 - 0.99, respectively). CONCLUSIONS: Assessment of acute pain in neonates should take into account the way of validation that has been performed especially with respect to the study population. The BSN is a pain measure with good validity and reliability for the assessment of pain in term and preterm neonates.

Arousal↗
PubMedDate not supplied

Development of rodent macrovibrissae: effects of neonatal whisker denervation and bilateral neonatal enucleation.

In this paper we describe the effects of manipulating two kinds of sensory input in neonatal rats upon the development of the macrovibrissae--that movable subset of the rodent mystacial vibrissae. In an initial study of normal whisker development, data on whisker size were obtained from neonatal, perinatal, and adult rats. Data on whisker size were also obtained from rats sustaining either neonatal sensory or motor denervation of the whiskers and from both rats and mice bilaterally enucleated as neonates (BEN). In normally reared rats, most whiskers attain their final size over the first three postnatal weeks but development of rows 6 and 7 are not completed until after the first month. In normal animals we found a significant correlation both between body weight and whisker size and between the size of a whisker and the size of its corresponding cortical barrel. Rats sustaining neonatal denervation of the whiskers have shorter and thinner whiskers as adults than normally reared animals. In both rats and mice bilaterally enucleated as neonates a subset of the macrovibrissae are significantly larger than those of normal controls but no such effect is seen if the enucleation is carried out in adults. Moreover, BEN rats exposed to a novel stimulus environment whisk at a significantly higher frequency than normally reared animals. Mechanisms which might mediate these effects are discussed.

Animals↗
PubMed2001

Neonatal electroencephalogram does not predict cognitive and academic achievement scores at early school age in survivors of neonatal extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation is an effective rescue treatment for severe cardiorespiratory failure in term or near-term neonates, although a wide range of neurologic sequelae have been noted in a substantial minority of survivors. The objective of the present study was to determine the value of the neonatal electroencephalogram (EEG) for predicting Wechler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), Wide Range Achievement Test, and Wide Range Assessment of Memory and Language scores at early school age in 66 testable survivors of extracorporeal membrane oxygenation who were not severely brain damaged. Technically satisfactory EEG recordings were obtained at least twice following admission to our nursery and prior to discharge. The EEGs were classified and graded according to standard criteria. The developmental test results of those who had only normal or mildly abnormal neonatal EEGs (group 1, n = 9) were compared with those who had at least one moderately or markedly abnormal recording (group 2, n = 57). School-age test and subtest scores were not statistically significantly worse in group 2 versus group 1 infants. No child in group 1 and five children in group 2 had WPPSI-R Full-Scale IQ scores of less than 70. Of the nine children in group 2 who had at least one markedly abnormal neonatal EEG recording (graded as burst suppression or as electrographic seizure), only two had abnormally low WPPSI-R Full-Scale IQ scores. We conclude that EEG recordings obtained during the neonatal course of neonates treated with extracorporeal membrane oxygenation do not predict cognitive and academic achievement test results in survivors at early school age who were testable and not severely brain damaged.

Brain Damage, Chronic↗
PubMed1988

Formation of intracellular vesicles in neonatal and adult erythrocytes: evidence against the concept of neonatal hyposplenism.

Intraerythrocytic vesicles accumulate in the peripheral blood as a result of impaired clearance of these intracellular inclusions by the spleen. The observation that neonates demonstrate an increased percentage of erythrocytes containing these vesicles constitutes the primary evidence supporting the concept that the newborn is functionally hyposplenic. Neonatal erythrocytes also demonstrate an increased propensity to undergo a variety of endocytic processes. We therefore questioned whether the increase in red cell vesicles in the neonate might be the result of increased vesicle formation as opposed to impaired splenic clearance. Newborn and adult erythrocytes were incubated in vitro in synthetic medium at 37 degrees C. Several parameters confirmed the maintenance of physiologic conditions, including levels of erythrocyte phosphate metabolites monitored by nuclear magnetic resonance. The acquisition of intraerythrocytic vesicles during the course of these incubations was compared. Over a period of 144 h, 19.2% of neonatal erythrocytes acquired vesicles compared to 3.7% of the adult cells (p less than 0.001). The increase in vesicles was greater in younger density-separated erythrocytes in both the neonate (37.6%, p less than 0.0005) and the adult (10.3%, p less than 0.002), but persisted even in the oldest erythrocytes (12.2% and 2.4%, respectively). We conclude that the increase in erythrocytic vesicles in the neonate may not simply be an indication of hyposplenism, but a reflection of increased vesicle formation which overwhelms the clearance capability of the spleen.

Adult↗
PubMed1983

[Neonatal mass-screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency. II. A pilot neonatal mass-screening study in the west of Shizuoka Prefecture, Japan].

Using a simplified radioimmunoassay method for "Disc-17 alpha-hydroxyprogesterone (Disc-17-OHP)", a pilot neonatal mass-screening study for 21-hydroxylase deficiency was performed in the West of Shizuoka Prefecture for a period of 19 months. During this period, 20,975 neonates were studied, and the mean value and S.D. of "Disc-17-OHP" values were 21.1 and 9.65 pg/disc, respectively. We tentatively decided the 99th-percentile value as a recalling point, and 219 neonates (1.04%) were the candidates for recall by this criteria. One hundred thirty-six neonates out of these 219 candidates who responded to recall were evaluated by physical examination, family history and measurements of plasma electrolytes, 17-OHP and 21-deoxycortisol values as well as concentrations of pregnanetriol and pregnanetriolone in spot urine specimens. As a result, 2 infants were proved to have the salt-losing type of 21-hydroxylase deficiency (21-OHD). Approximately one half of the candidates were premature or low birth-weight infants, and at least 80% had a history of some kind of problem at delivery or in the early neonatal period. Despite the problems remaining to be solved, the present study demonstrates the feasibility and importance of neonatal mass-screening programs for 21-OHD, and suggests that the incidence of 21-OHD is probably greater than previously expected.

17-alpha-Hydroxyprogesterone↗
PubMed2005

Neonatal pneumothorax: comparison between neonatal transfers and inborn infants.

OBJECTIVE: To assess the differences in clinical characteristics, management and outcome between the neonatal transfers and inborn neonates with pneumothorax. METHODS: The records of 36 neonatal transfers (Group A) and 25 inborn (Group B) neonates with symptomatic pneumothorax were retrospectively analyzed. RESULTS: In Group A, gestational age (36+/-2 vs. 31+/-4 weeks; P<0.01), birth weight (2720+/-537 vs. 1736+/-1028 g; P<0.01), exclusive oxygen-therapy before the event (47% vs. 20%; P<0.05) and tube thoracostomy (78% vs. 44%; P<0.05) were significantly higher than in Group B. The need of resuscitation at birth (19% vs. 44%; P<0.05), conventional mechanical ventilation (20% vs. 56%; P<0.05), presence of associated major congenital malformations (0% vs. 20%; P<0.01), length of hospital stay (9+/-6 vs. 32+/-32 days; P=0.01) and mortality (0% vs. 16%; P=0.01) were significantly lower in Group A than in Group B. CONCLUSIONS: Neonatal transfers and inborn neonates with pneumothorax have different clinical characteristics and outcome. This information could be useful for all persons involved in the interhospital care of perinatal patients.

Birth Weight↗
PubMed2006

Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmes.

OBJECTIVE: To assess the rates, timing and causes of neonatal deaths and the burden of stillbirths in rural Uttar Pradesh, India. We discuss the implications of our findings for neonatal interventions. METHODS: We used verbal autopsy interviews to investigate 1048 neonatal deaths and stillbirths. FINDINGS: There were 430 stillbirths reported, comprising 41% of all deaths in the sample. Of the 618 live births, 32% deaths were on the day of birth, 50% occurred during the first 3 days of life and 71% were during the first week. The primary causes of death on the first day of life (i.e. day 0) were birth asphyxia or injury (31%) and preterm birth (26%). During days 1-6, the most frequent causes of death were preterm birth (30%) and sepsis or pneumonia (25%). Half of all deaths caused by sepsis or pneumonia occurred during the first week of life. The proportion of deaths attributed to sepsis or pneumonia increased to 45% and 36% during days 7-13 and 14-27, respectively. CONCLUSION: Stillbirths and deaths on the day of birth represent a large proportion of perinatal and neonatal deaths, highlighting an urgent need to improve coverage with skilled birth attendants and to ensure access to emergency obstetric care. Health interventions to improve essential neonatal care and care-seeking behavior are also needed, particularly for preterm neonates in the early postnatal period.

Adolescent↗
PubMed2000

Antenatal, neonatal and post neonatal deaths evaluated by medical audit. A population-based study in northern Norway - 1976 to 1997.

BACKGROUND: Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997. SUBJECTS AND METHODS: Antenatal, neonatal and post neonatal deaths (n=472) at > or = 20 weeks of gestation have been evaluated. Data were collected from the Medical Birth Registry of Norway and from medical records. Pregnancy risk factors, mortality rates, causes of deaths, non-optimal care and avoidable deaths were recorded. RESULTS: The death rate (all deaths per thousand total births) declined from 13.8 (1976-80) to 7.7 (1992-97), (p<0.001), due to a reduced death rate in preterms > or = 24 weeks (p<0.001) and in those between 500 and 1995 g (p<0.001). Antenatal deaths decreased (p<0.001) due to reduced intrapartum deaths (p<0.001). Prelabor deaths, unexpected intrauterine pre-hospitalization deaths included, did not change. Postnatal deaths declined (p=0.01) due to reduced early neonatal mortality (p=0.002). Deaths from malformations (p<0.001), fetal and neonatal infections (p=0.03) and placental disorders (p<0.001) declined. Non-optimal care (22.5% of deaths, 2.3%o of total births), avoidable deaths (13.1% of deaths, 1.3% of total births), and maternal neglect (7.5% of cases with non-optimal care, 0.6% of total births) did not change. Death during transport was rare (n=5), and no deaths occurred at maternity homes. Non-cohabitance, smoking and undiagnosed SGA new borns declined, and the level of education increased in the study population. CONCLUSION: The improvement is due to a reduction in intrapartum deaths and early neonatal mortality in preterms. A constant high rate of unexpected intrauterine deaths in non-hospitalized patients is a challenge for antenatal health care providers.

Adult↗
PubMed1992

Influence of admission weight on neonatal mortality amongst hospitalised neonates in Calcutta.

The study was conducted on 785 neonates aged up to 28 days to evaluate the influence of admission weight on mortality. It was observed that there were 200 (25.5%) cases of septicaemia, 134(17.1%) of diarrhoea, 120(15.3%) each of prematurity related conditions and neonatal jaundice, 117(14.9%) of respiratory diseases and 94 (11.9%) cases of convulsion. There were total 182(23.18%) deaths comprising 70(38.5%) from prematurity related conditions, 40(22%) from diarrhoea, 35(19.2%) from respiratory diseases, 26(14.3%) from septicaemia, 8(4.4%) from neonatal jaundice and 3(1.6%) deaths from convulsion. The incidence of deaths among neonates weighing less than 2500 g on admission was 59.2% in diarrhoeal diseases, 53.4% in respiratory diseases and 44.6% in other conditions compared to those of 10%, 8.2% and 7.1% respectively in neonates having admission weight more than 2500 g. The findings are statistically significant. The results of the study indicate that low admission weight should be considered as a predictor of mortality among neonates.

Body Weight↗
PubMedDate not supplied

Neonatal mortality clusters: a new tool for classifying neonatal outcomes.

BACKGROUND: A method for assessing general hospital neonatal care performance is needed that is simple, is easy to use, and requires minimal data. METHODS: All neonatal deaths in Washington State obstetric hospitals from 1980 to 1983 were assigned to 10 mutually exclusive neonatal mortality clusters, a new classification method derived from information available on the death certificate. RESULTS: More than one-third (35.3 percent) of all neonatal deaths fell within one of the seven clusters considered to represent potentially preventable causes of death. The rate of possibly preventable deaths was much higher in level III hospitals than in level II or level I hospitals, a finding similar to that observed in other states using different analytic approaches. CONCLUSIONS: Neonatal mortality clusters offer a less complex method of classifying neonatal deaths and assessing hospital performance than other currently used techniques.

Birth Weight↗
PubMed1995

Neonatal disease profile in Larkana before and after establishment of neonatal ward.

This is a study of 2050 neonatal admissions excluding neonatal tetanus in children hospital CMC Larkana from December, 1988 to July, 1993. Six hundred and eighty-nine cases were admitted in General Paediatrics Ward before establishment of neonatal unit and 1361 cases were admitted in neonatal ward. The aime of study was to compare the disease pattern and mortality rates before and after establishment of a neonatal unit in the same hospital. Number of admissions significantly increased after the establishment of neonatal unit but there was no decline in the mortality. Changes in disease pattern were observed particularly for Gastroenteritis and miscellaneous (undetermined) category. Seventy percent of admissions were males in Ist week of their life. Commonest cause of admission and mortality was birth anoxia.

Asphyxia Neonatorum↗
PubMed2001

Role of score for neonatal acute physiology (SNAP) in predicting neonatal mortality.

OBJECTIVES: To assess the validity of SNAP in predicting the outcome in terms of mortality and duration of hospital stay. The study was also undertaken to evolve the best cut-off SNAP scores for predicting mortality in different individual neonatal conditions. METHODS: 295 consecutive newborn admitted to NICU during an eleven month period were evaluated with the investigations required as per the specifications of SNAP. Neonates who succumbed within 24 hours of admission and those who were shifted to the NICU for observation purposes were excluded. RESULTS: In general, SNAP correlated well with mortality; the sensitivity and specificity of SNAP score > 15 in predicting mortality were 63% and 95% respectively. The positive and negative predictive values were 72% and 92.5% respectively. Very low birth weight babies and ventilated preterm neonates had higher mortality and the best cut-off SNAP score for predicting mortality in these groups was 10. In all the other groups, SNAP score > 15 correlated well with higher mortality. By using multiple regression analysis on three variables including birth weight, gestational age and SNAP, SNAP was found to show the best correlation with mortality. On correlating SNAP with duration of hospital stay, 76.8% of the surviving neonates with SNAP < 16 stayed for < 15 days, whereas the rest stayed longer despite low SNAP. All the 9 babies with SNAP > 15 who survived stayed for > 15 days. CONCLUSIONS: SNAP is a measure of illness severity and correlates well with neonatal mortality. SNAP may assist the clinician in explaining the probable outcome and therapeutic intervention needed and the cost of treatment to the parents. SNAP scores > 10 in VLBW babies and > 15 in others are associated with higher mortality.

Female↗
PubMed2002

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

UNLABELLED: 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.

Attitude of Health Personnel↗