[Summary of the 3rd Bi-coastal symposium on neonatology and the 6th national symposium of neonatology].
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China↗
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[Ibero-American Society of Neonatology. Collaborative group for the improvement of clinical practice and research in neonatology].
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Biomedical Research↗
[Recommendations for the prevention of respiratory syncytial virus infections. Standards Committee of the Spanish Society of Neonatology. Board of Directors of the Spanish Society of Neonatology].
Premature babies < = 35 weeks gestation, with or without chronic lung disease (CLD), should be considered high risk population for RSV infection and rehospitalization. RSV monoclonal antibodies (palivizumab) have been found useful in decreasing rates of RSV hospitalization in this patients. Guidelines for their administration include: 1. Recommend their use in premature born between 29-32 weeks gestation without CLD and less than 6 months at entry of RSV station. 2. Strongly recommend their use in premature babies < = 28 weeks gestation or affected with CLD in treatment during last 6 months. These patients should be prophylaxed for two RSV seasons. 3. Prophylaxis among premature babies between 32-35 weeks gestation is not recommended on routine bases. Each case has to be individually analyzed considering risk factors.
Antibodies, Monoclonal↗
United States neonatology practice survey: personnel, practice, hospital, and neonatal intensive care unit characteristics.
BACKGROUND: The efficiency and access to existing perinatal resources has become a focus of debate. Despite inconsistent references to the number of neonatologists and unsubstantiated personnel requirement recommendations, recent commentaries have suggested a current 30% to 50% excess in workforce. OBJECTIVE: To describe the current neonatology workforce and its practice patterns. DESIGN: Using a questionnaire developed by the Committee on Practice of the Section on Perinatal Pediatrics of the American Academy of Pediatrics and distributed to 675 neonatology practices identified in the United States Neonatologists Directory 1996, a survey was conducted from July 1, 1995 to June 30, 1996 requesting specific information relating to personnel, type and size of practice, and clinical services provided at practice hospitals. RESULTS: Respondents included 420 neonatology practices (62.2% response rate) representing 2006 neonatologists providing clinical care in 695 hospitals, 652 with delivery services that accounted for 1 646 881 live births in 1994. More than 95% of practices and neonatologists identified themselves as based in university, private, or hospital settings. Eighty percent of neonatologists were <50 years old. There was an overall 2:1 male to female gender distribution. Sixty percent of practices consisted of 4 or fewer neonatologists, 25% of practices 5 to 7 neonatologists, and 15% of practices 8 or more neonatologists. Sixty percent of practices provided clinical care in only 1 hospital and 1 neonatal intensive care unit (NICU) as compared with 15% of practices in 3 or more hospitals and <5% of practices in 3 or more NICUs. Of the total 478 NICUs (22 in children's hospitals), 67% had <501 annual admissions and 33% had more then 500 admissions. Of the 456 NICUs in 652 practice hospitals with delivery services, 61% of hospitals had <2501 annual deliveries (57% with NICUs) and 39% of hospitals had more than 2500 annual deliveries (90% with NICUs). The average inborn admission rate for these practice hospitals was 11.7%. University, private, and hospital practices had consistent rates of admissions for inborn and outborn NICU and special care nursery admissions. More than 60% of neonatology practices were involved in normal newborn care on a routine basis, in addition to staffing developmental clinics and providing inpatient and outpatient pediatric care. Additional information was analyzed for utilization of residents and neonatal nurse practitioners. By 1999, 50% of practices anticipated hiring 279 neonatologists and 575 neonatal nurse practitioners. CONCLUSION: Significant discrepancies between earlier projected neonatologist requirements and current neonatology workforce and service responsibilities are discussed in relation to demands of reallocation of subspecialty resources within an evolving health care system.
Adult↗
[Drug use in neonatology units of 6 Spanish hospitals].
OBJECTIVE: To determine the status of drug use in Neonatology units regarding: 1. Frequency of use for drugs unauthorised by DirecciA(3)n General de Farmacia y Productos Sanitarios. 2. Suitability of commercial presentations regarding actual needs of patients. METHOD: Two cut-off points were established for 100% of patients admitted to Neonatology Units in 6 Spanish hospitals. Data on demography and therapeutic drug profile were collected, as well as on whether doses were or not prepared by Pharmacy departments. Approval for each drug regarding indication, age range, dosage and administration route was assessed. RESULTS: The number of patients included was 346. In all, 17.6% of patients were under treatment with unauthorised drugs, the reason being age in 78.7% and indication in 21.3%. Master formula preparation was needed for 22% of patients because of a lack of commercial preparations suited for paediatric age. Pharmacy departments prepared 25% of prescribed drugs. CONCLUSIONS: The use of unauthorised drugs in Neonatology is a common fact. Pharmacy departments are actively involved in Neonatology-related drug therapies: counselling and/or processing for compassionate unauthorised drug use, master formula preparation, intravenous mixtures, etc. Therapeutics in Neonatology benefits from specialised pharmaceutical involvement.
Drug Therapy↗
[Bibliometric analysis of systematic reviews in the Neonatal Cochrane Collaboration. Its role in evidence-based decision making in neonatology].
INTRODUCTION: The Cochrane Neonatal Collaborative Review Group (CNRG) is one of the most important collaborative review groups registered in the Cochrane Collaboration (CC) and provides a growing and readily accessible source of information to help neonatologists base their care on detailed, critical, and up-to-date reviews of the best available evidence. The objective of this article was to perform a bibliometric analysis (quantitative and qualitative) of the systematic reviews (SR) published in the Neonatal Cochrane Collaboration (NCC) and to identify the subject areas studied by the CNRG in which decision-making in clinical practice is based on the best available evidence. METHODS: We performed a bibliometric analysis of the Cochrane Database of Systematic Reviews in Neonatology, Issue 2, 2003 (n = 147 SR). The following variables were registered in each SR: subject area of the study, authors (number and country), dates (last review and update), characteristics of the clinical trials included (number and type), characteristics of included newborns (number and gestational age), reviewers' conclusions and potential conflicts of interest. RESULTS: The main subject areas of studies in the NCC were respiratory diseases (69 SR) and gastroenterology-nutrition (23 SR). Reviews were relatively scarce on some subjects that are very important in clinical practice in neonatology, such as cardiovascular diseases (10 SR), neurology (10 SR) and infectious diseases (6 SR). All the SR dealt with interventions for the treatment or prevention of diseases of the newborn infant (mainly preterm) and we found no reviews on diagnostic tests. Eighty-two per cent of the SR were signed by 2 or 3 authors, and we found four Bradford's zones of productivity. Ninety-two percent of the authors of SR were from four countries (Australia, United States, United Kingdom and Canada). Seventy-nine percent of all SR were published between 2000 and 2002, and 48 % have been updated. The median number of clinical trials per SR was 5 (range 0-30) and the median number of newborns included per SR was 559 (range 0-5448). Sixty percent of SR also included quasi-randomized clinical trials, and 67 % of SR included only preterm infants. In 54 % of the SR, the reviewers' conclusion was sufficient to infer probable effects (favorable or unfavorable) in clinical practice, and potential conflicts of interest were registered in 22 %. DISCUSSION: Although CC reviews are based on specific guidelines, errors and biases occur, suggesting the need to "review the reviews". The bibliometric analysis of the NCC shows that the quality of published SR varies, and the main conclusion is that almost half of the reviewers' conclusions are insufficient to infer probable effects in clinical practice. There is a lack of scientific evidence on many therapies in neonatology and, at the moment, the SR published in the NCC enable evidence-based decision making mainly in the subject area of respiratory diseases and gastroenterology-nutrition. Challenges for the future include the need for bigger and better clinical trials in this field (with long-term outcomes among surviving children), the preparation of systematic reviews on topics not yet covered, and keeping an increasing number of reviews up-to-date. Every decision in neonatology should be based on a systematic appraisal of the best evidence available in the context of the prevailing values and resources at our disposal.
Bibliometrics↗
Neonatology in Europe. Training, accreditation, and research.
OBJECTIVE AND DESIGN: In order to assess training, accreditation, and scientific status of neonatology in the European countries, a structured questionnaire on availability, duration, and accreditation of neonatology training programs was mailed to the pediatric and neonatal societies. A medline search was performed on the item 'infant, newborn' and the data were related to the population number, total fertility, and infant mortality. RESULTS: In most European countries, two year training programs in neonatology exist in addition to 4 or 5 years pediatric training. Numbers of certified neonatologists ranged from 2 to 10 per million inhabitants. An inverse correlation of infant mortality and medline entry rate was found (R(s) -0.91, P < 0.001). CONCLUSIONS: Conforming training and accreditation in Europe may help to compensate delays in infant mortality and scientific productivity and would facilitate subspecialist mobility.
Accreditation↗
Evidence of nosocomial Stenotrophomonas maltophilia cross-infection in a neonatology unit analyzed by three molecular typing methods.
OBJECTIVE: To characterize the epidemiological relationships among Stenotrophomonas maltophilia isolates in the neonatology unit of our institution over a 4-month period in which an increased number of isolates was observed. SETTING: The neonatology ward in a 2,000-bed university hospital in Madrid, Spain. DESIGN: A retrospective molecular epidemiological analysis using three different typing methods, arbitrarily primed polymerase chain reaction (PCR), pulsed-field gel electrophoresis, and enterobacterial repetitive intergenic consensus-PCR, was performed with 11 isolates obtained from seven neonates over a 4-month period. Presumed unrelated isolates also were included as controls. A similarity dendrogram was obtained, to analyze the genetic relatedness among the isolates. RESULTS: All isolates from the neonates, except one, showed a remarkably high homology among their typing patterns for the three methods assayed and clustered in the relatedness dendrogram at 96% similarity. The unrelated strains selected as controls were unclustered. The index case was considered to be a newborn who had an S. maltophilia isolate from a culture drawn on the day of admission to the neonatology unit and which was included in the clustered similarity group. CONCLUSIONS: Such a high genetic similarity among the isolates, together with the presence of an index case who had been colonized or infected by S. maltophilia before arrival at our institution, constitutes the first evidence of nosocomial cross-transmission of this microorganism.
Bacterial Typing Techniques↗
The evolution of neonatology.
In 1960, the terms "neonatology" and "neonatologist" were introduced. Thereafter, an increasing number of pediatricians devoted themselves to full-time neonatology. In 1975, the first examination of the Sub-Board of Neonatal-Perinatal Medicine of the American Board of Pediatrics and the first meeting of the Perinatal Section of the American Academy of Pediatrics were held. One of the most important factors that improved the care of the neonate was the miniaturization of blood samples needed to determine blood gases, serum electrolytes, glucose, calcium, bilirubin, and other biochemical measurements. Another factor was the ability to provide nutrition intravenously, and the third was the maintenance of normal body temperature. The management of respiratory distress syndrome improved with i.v. glucose and correction of metabolic acidosis, followed by assisted ventilation, continuous positive airway pressure, antenatal corticosteroid administration, and the introduction of exogenous surfactant. Pharmacologic manipulation of the ductus arteriosus, support of blood pressure, echocardiography, and changes in the management of persistent pulmonary hypertension, including the use of nitric oxide and extracorporeal membrane oxygenation, all have influenced the cardiopulmonary management of the neonate. Regionalization of neonatal care; changes in parent-infant interaction; and technological changes such as phototherapy, oxygen saturation monitors, and brain imaging techniques are among the important advances reviewed in this report. Most remarkable, a 1-kg infant who was born in 1960 had a mortality risk of 95% but had a 95% probability of survival by 2000. However, errors in neonatology are acknowledged, and potential directions for the future are explored.
Female↗
Research in neonatology: need for introspection.
This study was conducted to evaluate the quality of neonatal research published in major Indian journals. Four indexed Indian journals were scanned for topics pertaining to neonatology and the manuscripts were evaluated for the most important morbidity studied and its relevance to the national need. The analytical studies were evaluated for their quality of research methodology. Approximately 12% studies were pertaining to neonates and only one third of them were investigative in nature. Less than 20% studies were of national interest and only 5% of the total studies were community based. Although aims of the studies were clearly defined in 81%, sample size estimation was done in only 11%, blinding in 15% and one or more category of bias was seen in 84% of the studies. We conclude that there is an urgent need for interventional and community based studies in neonatology, on issues of national interest. A need was felt for improvement in the quality of research in neonatology with special emphasis on training in clinical epidemiology.
Forecasting↗
[Acquired--accepted--adopted? On the status of neonatology in West Germany].
The worldwide reduction in infant mortality and low birthweight lethality has also been observed in the Federal Republic of Germany during the past two decades. In many countries, neonatology has emerged as a scientifically active subspecialty of pediatrics. Its main characteristic is an understanding of partially mature function and perinatal adaptation. In West Germany, however, education programs for neonatologists have not been inaugurated and neonatology has been identified with pediatric intensive care. Sophisticated neonatal transport systems, expensive special care units, and highly aggressive therapeutic approaches have resulted. Neither perinatal centers for high-risk deliveries nor regionalization programs for intrauterine transport to the neonatal special care unit have been created. Neonatology may drift towards obstetrics if established pediatrics continues to ignore educational, organizational and manpower needs of neonatal care.
Ethics, Medical↗
[Nosocomial infections in a neonatology department, 1995-2002].
Nosocomial infections in newborns department are common due to number of invasive diagnostic and therapeutic procedures, prolonged hospitalization and development antibiotic resistance culture. Sepsis achieved 1 to 8 newborn infants for 1000 live births. This is still unresolved very important medical, organization, ethical and medical problem. The aim of this study was the estimation on the number, etiology and clinical form of nosocomial infection in Neonatology Department as well as the way of spread. We analyzed nosocomial infection in 8770 newborn infants in Neonatology Department with Intensive Therapy Chair and Clinic Obstetric and Perinatology Pomeranian University of Medicine from 1995 to 2002. For this retrospective study we used data from Commission for Nosocomial Infection. In analyzed period total percentage of newborn infants with nosocomial infection was under 1%, but in NICU was over 11%. Inborn vertical infection was 26.8% and horizontal strictly nosocomial infection was diagnosed in 73.2%. Etiology was mainly due to Gram negative bacterial infection. Clinically sepsis, pneumonia and meningitis was diagnosed. Clinical manifestation and laboratory tests like CRP, PCT, blood count, leukocyte index and microbiological culture was used for diagnosis. The most often positive bacterial culture was obtained from cock, washstand, bath and medical staff. Nosocomial infections in neonatology department are significant medical problem which need continuous monitoring, systemic prevention and in case of infection early intervention.
Bacteremia↗
[Recent advances in neonatology--new tasks for the radiologist].
Modern neonatology comprises care for a growing number of infants with congenital abnormalities and an increasing number of premature born infants. The survival rates of premature infants have increased dramatically during the past decade. This increase in survival rates can be attributed to improved prenatal and obstetric management and to advances in neonatal intensive care medicine. RADIOLOGICAL SUPPORT: Neonatology has become a pediatric subspecialty of its own resulting in the demand for an equally specialised radiological support. Therefore the availability of a children's radiologist for radiological and sonographic examinations is mandatory (24 hours a day) for optimal patient care on a neonatal intensive care unit. A good cooperation between radiologist and neonatologist in neonatal intensive care medicine is therefore warranted.
Austria↗
[Medical informatics (hospital information systems) in neonatology: reality and insufficiencies].
The generalized implementation in France of hospital information systems (HIS) is often considered by the medical practitioners as a useless constraint. Nevertheless, they are now largely used by the administrative authorities for their economical evaluation of medical care. In neonatology HIS is applied to the hospitalized sick neonates as well as to the healthy newborn infants during their maternity hospital stay with their mother following birth. This paper focuses on the practical aspects and difficulties of the current French HIS in neonatology.
Diagnosis-Related Groups↗
The impact of a new educational strategy on acquiring neonatology skills.
OVERVIEW: A shortage of staff for teaching neonatology skills to large numbers of students, in small groups and following a new curriculum, necessitated an innovative educational strategy. This entailed the development and implementation of an interactive multimedia program (CD-ROM) to deliver information about skills and to demonstrate them. METHODS: Students had to study a specific skill using the CD-ROM and then practise in the Skills Laboratory, supported by lecturers who provided formative evaluation. OBJECTIVES: The aims of this study were to assess the students' perspectives on the new strategy, and to compare the skills of students following the new curriculum to those of students following the traditional curriculum, who do not follow structured programmes on practical skills but experience a practical neonatology rotation. RESULTS: The evaluation of the CD-ROM program was very favourable. The majority of students still preferred live demonstrations but found the CD-ROM useful for revision purposes. With the exception of one skill, endotracheal intubation, the new curriculum students were found to be as competent as the students following the traditional curriculum and performed mask ventilation and cardiac massage significantly better than them.
CD-ROM↗
Neonatology research for the 21st century: executive summary of the National Institute of Child Health and Human Development-American Academy of Pediatrics workshop. Part II: training issues.
This is the second part of the executive summary based on the presentations and discussions at a workshop on research in neonatology sponsored by the National Institute of Child Health and Human Development and the American Academy of Pediatrics held in January 2004. In this article, neonatology fellowship training requirements and workforce issues are addressed, and the reasons for the shortage of physician-scientists, particularly of the underrepresented minority ethnic groups, are highlighted. Full-length articles from the presented topics are yet to be published.
Biomedical Research↗
An HMO neonatology service. Providing care to high-risk newborns.
Clinical and technological advances in the treatment of premature infants and other acutely ill newborns have resulted in widespread use of neonatal intensive care units (NICUs). Along with this trend is concern over the high cost of NICU services. This paper describes how an HMO established a neonatology service in order to participate more directly in the care of its member infants and control the escalating costs of NICU therapy. Two years of NICU utilization data are presented. It is concluded that establishing a neonatology service within a managed care system can improve the clinical care of member neonates and decrease NICU costs.
Boston↗
Neonatology in Singapore: the way we were, the way forward.
Singapore has a maternity hospital since 1924, but for many decades the newborns could only receive basic care. Neonatal and perinatal mortality rates were high. Marked improvement in neonatal care began from the 1980s when many neonatal departments were set up to provide intensive care. Improved socioeconomic status, better healthcare facilities, effective infection control, immunisation programmes and availability of potent antibiotics contributed to the decline of perinatal and neonatal mortality. Following the implementation of the glucose-6-phosphate dehydrogenase (G6PD) deficiency screening programme, severe neonatal jaundice and kernicterus were largely reduced. Exchange blood transfusions initiated in the 1960s and phototherapy in the 1970s had saved many babies. Kernicterus is almost not seen now. With more neonatal-trained staff, organised resuscitation teams, advances in respiratory management and better monitoring equipment, more babies have survived. Closer cooperation between obstetricians and neonatologists was a great leap forward towards perinatal medicine. Physicians should endeavour to reduce the incidence and prevalence of birth defects and metabolic errors. Perinatal asphyxia should be promptly detected and managed effectively, including neuroprotective strategies. There should be markers to predict the outcome of asphyxiated babies for decision-making. Neonatologists should be mindful of safe introduction of new technologies and rapid diagnostic techniques for infections, including group B streptococcal screening and chemoprophylaxis when required. Other current issues include prevention of major morbidities, preservation of brain function, improved neurodevelopmental outcome of premature babies, use of blood substitutes, optimal nutrition, fetal surgery, evidence-based medicine, better information systems, avoidance of medication errors, adequate sedation and pain relief of the baby, and the use of nitric oxide. One should bear in mind the need to enhance the neonatal intensive care environment, improve non-invasive monitoring and minimise invasive procedures. Physicians should prioritise neonatal care for their country and utilise less costly neonatal care. Ethical issues in neonatology that arise following advancement in neonatal care deserve attention. Advances in life sciences, such as the completion of the human genome project, cloning of tissues and organs, human stem cell research and technology, gene therapy, deoxyribonucleic acid vaccines and nanomedicine, should benefit neonatology.
History, 20th Century↗