Improving health care provisions to neonates in the United States

Article Abstract:

Improving the health care of neonates (infants within the first six weeks of life) requires improvements in maternal health care and the entire health care delivery system. The United States spends the largest portion of the gross national product on health care, yet quality of life does not reflect that expenditure; the US ranks 19th in infant mortality, 7th in female life expectancy, and 15th in male life expectancy. Health resources are inequitably distributed, finances are inappropriately applied, and costs are excessively high. Changes must be implemented, and preventive health care must be given high priority. Good health practices and attitudes begin with pregnant mothers, infants and children. The necessary improvements in health care can not be achieved without addressing social issues related to teenage pregnancies and infants with low birth weights. Effective birth control and contraception have not been encouraged. The use of extreme procedures to maintain the viable, but obviously borderline, high-risk infant must be carefully evaluated. The adoption of regionalization of intensive care and technology in the 1970s was an important milestone in providing high quality neonatal care. The tendency now appears to be in the other direction, deregionalization. The potential of high profits from operating neonatal intensive care units (NICU) has induced many hospitals to leave regional networks and set up their own facilities. Quality and efficient care have taken a second place to economic gain for physicians, hospitals, and third parties. These practices may lead to a two-tier system of health care; minimal and basic care for the poor and uninsured, but all the advantages of modern medicine for those with insurance and the ability to pay. Attitudinal changes are in order to reverse these trends and recall that the patient, no matter how young, must come first. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Economic aspects, Prevention, Neonatal intensive care, Pregnancy, Complications of, Pregnancy complications, Infant health services, Maternal health services

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Factors associated with umbilical catheter-related sepsis in neonates

Article Abstract:

Catheters to the umbilical cord artery or vein are useful in treating sick newborns. However, use of these umbilical catheters can lead to complications such as systemic infection (sepsis) in up to 16 percent of cases. To determine the elements influencing catheter-related sepsis (CRS), 225 infants for whom 357 umbilical catheters in place at least three days were evaluated. The infants were treated in a neonatal intensive care unit; the average infant weight was 3.4 pounds, and the average gestational age was 31 weeks. Fourteen newborns developed CRS, 10 of whom had an arterial catheter (UAC) and 4 of whom had venous catheters (UVC). Bacteria could be isolated from catheters of 87 newborns. Staphylococcus bacteria were the most common type found in catheters and in cases of CRS. Very low birth weight (VLBW) infants, with birth weights of less than 3.3 pounds, were at highest risk for CRS among infants with UACs. Use of antibiotic therapy during catheter removal and the duration of antibiotic therapy were also related to a significantly higher risk for CRS. Use of hyperalimentation (feeding) fluid infused through UACS was associated with a higher risk for CRS, but this was dependent on other risk factors such as infantile birth weight and duration of UAC use. Larger infants tended to have hyperalimentation fluid given through UVCs, and so UVC-related CRS was significantly associated with larger birthweight, catheter duration, and hyperalimentation fluid infusion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Causes of, Complications and side effects, Risk factors, Catheterization, Bacteremia

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Hyperbaric oxygen use in neonates: a report of four patients

Article Abstract:

Hyperbaric oxygen therapy employs a specialized pressure device called a hyperbaric chamber, which contains oxygen, to treat carbon monoxide poisoning, gas gangrene, burns, smoke inhalation, radiation injury, and other conditions. In addition, this treatment has been effectively used in adults with delayed wound healing. Increased oxygen supply to tissue activates the replication or production of fibroblasts, cells that develop into connective tissue; increases the production of collagen, a structural protein in connective tissue; and enhances the killing of bacteria. However, there is limited knowledge about the effectiveness of hyperbaric oxygen therapy in newborns. Cases are described of four newborns, who were treated with hyperbaric oxygen therapy for delayed wound healing. Three infants had congenital heart disease, associated with cyanosis or decreased oxygen supply. Their wounds resulted from surgery. A fourth child developed a nonhealing wound after the insertion of a catheter or tube-like device into the umbilical artery. The newborns were treated in a hyperbaric chamber with 100 percent oxygen at two atmospheres absolute of pressure. Hyperbaric oxygen therapy healed the wounds and caused no serious side effects. These findings suggest that hyperbaric oxygen therapy is effective in treating newborns with delayed wound healing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Injuries, Wounds and injuries, Wound care, Hyperbaric oxygenation

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