Persistent perceptions of vulnerability following neonatal jaundice

Article Abstract:

Vulnerable child syndrome refers to a condition that arises when a family considers their child to have had a 'close call' and thus believes him to be prone to serious injury. This condition is well known to occur following problems relating to newborns. Neonatal jaundice is a common condition in newborns and results from excess bilirubin in the blood; it is treated with phototherapy (exposure to sunlight or artificial blue light). A previously reported portion of this study reported that most mothers of babies with neonatal jaundice considered it a serious condition. They were more likely to have their breastfeeding interrupted in the hospital and to stop breastfeeding completely after one month. They were also less willing to leave their babies with another person, and sought medical attention more frequently than did mothers of babies without jaundice. These maternal actions were consistent with the signs of vulnerable child syndrome. The study was continued for an additional six months to determine if these maternal behaviors continued. At six months of age it was found that the jaundiced babies experienced more feeding problems than did nonjaundiced babies. Although a similar number of health problems existed among both jaundiced and nonjaundiced babies, the jaundiced babies were brought for medical attention more frequently. Surprisingly, the mothers of jaundiced babies dramatically changed their attitudes about separation from their babies. When the jaundiced babies reached about one month old, their mothers were less likely than other mothers to leave them with someone else, yet at 6 months old they were more likely to do so. The authors suggest that the benefits derived from treating mild neonatal jaundice in otherwise healthy babies be weighed against the risk of developing vulnerable child syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Behavior, Parent and child, Parent-child relations, Mothers

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Improving the use of early follow-up care after emergency department visits: a randomized trial

Article Abstract:

Many parents do not comply with instructions for necessary follow-up care after bringing their children to the emergency department (ED) for medical attention. Inadequate follow-up care includes missed appointments, failure to follow specific instructions, failure to call to find out about test results, and revisits to the ED for nonurgent problems. This may be harmful to the child and can result in elevated health care costs. In a review of one hospital ED, inappropriate follow-up care was noted in 20 to 25 percent of the cases in the week following a visit to the ED. In an attempt to improve follow-up care, this ED arranged to have a pediatric nurse practitioner (NP) contact the child's parents within one day of a visit to the ED. The parents of 190 children seeking medical attention at this urban university hospital ED were randomly chosen to participate in the study. The day after the ED visit 91 parents were contacted by an NP who provided individualized guidance for follow-up care. The NP also offered to be available to the family if they had further questions. The remaining 93 families received the usual follow-up advice during their child's visit to the ED. During the week following the ED visit, parents who were contacted by an NP were less likely to miss a follow-up appointment; 15 percent missed appointments, compared with 31 percent for those who were not contacted. Similarly, the contacted parents were more likely to follow instructions (79 percent compliance versus 61 percent). In addition, the NP's assistance resulted in less inappropriate use of follow-up care (10 percent compared with 20 percent). These results demonstrate that the parents' use of follow-up care improved when they received counselling from a nurse practitioner within a day of their child's visit to the ED. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Usage, Services, Statistics, Nurse practitioners, Patient compliance, Emergency medical services, Pediatric emergencies

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Metalloporphyrin-enhanced photodegradation of bilirubin in vitro

Article Abstract:

The primary treatment for jaundice in newborns is phototherapy. A therapeutic effect is achieved by the photo-oxidation (break down) of bilirubin, a bile pigment which produces the characteristic yellowish tint associated with jaundice. An alternative therapeutic approach using metalloporphyrins to enhance phototherapy has been proposed. These compounds are known to be effective in inhibiting heme oxygenase, an enzyme which is essential in the production of bilirubin. Blood solutions containing bilirubin were treated with metalloporphyrin in conjunction with phototherapy and the results were evaluated. Both zinc and tin metalloporphyrin analogues were used; trials were conducted with light and in the absence of light. Reductions in bilirubin were evident with all treatments, but the tin compounds demonstrated a greater effect than the zinc compounds. In conclusion, the use of metalloporphyrins enhanced the bilirubin degradation effects of phototherapy. However, the side effects of this treatment are still not known, and need to be determined before this approach is considered for therapeutic use in infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Porphyrins, Bilirubin

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