Teaching intubation skills using newly deceased infants

Article Abstract:

Intubation (the process of inserting a tube into the airway) is a technique that can be taught using newly dead patients as models; one study found that 20 percent of 185 hospitals surveyed used patients in this manner without informing their families. To evaluate the possibility that families would, in fact, consent to such practices if asked, a study was carried out in a neonatal intensive care unit (NICU) that is a major referral center for 25 hospitals in Ohio. Additional questions concerned the effects on hospital staff of intubating the body of a newly dead infant. Fifty-five infants died in the unit during the 10-month study period, all but one of whom received respiratory assistance. After each infant's death, the neonatologist requested consent for an autopsy and, when appropriate, for the infant's body to be used to help medical residents and respiratory therapists learn intubation. If consent was granted, and after the family had left the newly dead infant, the body was moved to a treatment room where intubation techniques were demonstrated and practiced. Trainees completed questionnaires concerning their reactions to the procedure. Results showed that 32 of 44 requests for using the infant's corpse for teaching intubation techniques were granted; more white than black families consented, which was also related to permission for an autopsy. Families tended to grant consent in hopes that other infants could be helped; when they refused, it was often because their child ''had been through enough.'' For 22 of the 71 trainees, the experience was the first intubation of an infant; for 10, the first time ever to intubate a human body. All 53 who completed the questionnaires considered the experience helpful, while also reporting mixed feelings about intubating dead infants. These included doubt, apprehension, and respect for the body. The trainees also expressed increased comfort at knowing the families had granted consent. A discussion is presented of the issues for both families and staff surrounding intubation of newly dead infants and family consent. The trainees kept their reactions to themselves until they were elicited by the questionnaire, indicating the importance of sensitivity on the part of medical teaching staff. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Methods, Training, Ethical aspects, Graduate medical education, Parental consent, Postgraduate medical education, Respiratory therapists

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Excess infant mortality in an American Indian population, 1940 to 1990

Article Abstract:

Infant mortality statistics indicate that the health of American Indians has improved significantly, from 62.7 deaths per 1,000 live births during the 1950s, to 9.8 deaths per 1,000 live births in the 1980s. However, these figures may be inaccurate because of misclassification of race and other factors. Undercounting leads to funding cuts in programs for maternal and infant health care, and lower priority for infant health issues. A significant change has occurred in self-reported race among American Indians, in part accounting for the 70 percent growth in their population between 1970 and 1980. An additional complication for statistical analysis is that American Indians are diverse, with over 300 tribes and widely divergent life styles. There is also a large difference between Indians who live on reservations and those who do not. Infant mortality was assessed among the Warm Springs Confederated Tribes of central Oregon, an economically well-off group with high employment. The tribe maintains accurate census figures and vital statistics. Despite economic success, the median age of death was 44 years, compared with a state average of 75 years. Infant mortality in Warm Springs has decreased, but was still 2.6 times the national rate in the 1980s. Almost all the excess mortality is caused by sudden infant death syndrome (SIDS). Among the risk factors for SIDS are low socioeconomic status, young or single mother, maternal substance abuse, cold weather, male sex, premature birth and low birth weight for gestational age. When the Warm Springs community became aware of this situation, a comprehensive program of youth services, prenatal care, drug screening, and a review of all out-of-hospital was undertaken. This effort can serve as a model for other Indian communities. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Native Americans, Native North Americans, Oregon, Sudden infant death syndrome

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Birth weight and perinatal mortality: a comparison of the United States and Norway

Article Abstract:

The higher perinatal mortality rate in the US compared with Norway may be due to a higher rate of preterm births in the US rather than to lower birth weights in general. Perinatal mortality refers to stillbirth or infant death within four weeks of birth. Preterm birth is a delivery before 37 weeks' gestation. Researchers analyzed US and Norwegian birth and perinatal death data for 1986 and 1987, and calculated that the US perinatal mortality rate was 10% higher in the US after adjusting for some reporting discrepancies. Although Norwegian birth weights are heavier than US birth weights, the predominant distribution curves are similar. The difference appears to lie in the residual distribution, consisting of low birth weights, mostly due to preterm birth. The US rate of infants in the residual distribution was 2.9%, versus 2.1% in Norway. Since almost 60% of perinatal deaths occurred among this group, the disparity in overall perinatal mortality may be explained by the difference in preterm births.

Health aspects, Norway, Birth weight

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