摘要:

The progress in information and communication technology, together with the search for the most effective and efficient ways to use the limited resources for health care, are opening new areas for research and development in perinatal care. Information systems and practice oriented by evidence-based medicine are modifying the operation of health services, and the quality of their management is being monitored by the success of their outcomes. As a study case, a Perinatal Information System widely used in Latin America and the Caribbean is discussed in some detail. Future challenges in the compatibility of information systems and databanks, the need for longer follow-up periods and measurement of healthrelated quality of life as outcomes for perinatal care, and the strategies to integrate all these concepts for the improvement of daily practice are discussed.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Necrotizing enterocolitis is a relatively common disorder of unknown etiology that primarily affects premature newborns. The majority of babies with necrotizing enterocolitis respond to nonsurgical management, and, despite an increase in the number of premature infants, the surgical mortality rate has improved. This review provides an overview of the current literature covering new developments in etiology, risk factors, pathogenesis, diagnosis, therapy, outcome, and preventable measures related to necrotizing enterocolitis.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article reviews clinical and experimental evidence as to whether magnesium sulfate, administered soon before premature birth, can reduce the high rate of cerebral palsy in tiny infants. Three observational studies have reported an association of magnesium sulfate with lower rate of cerebral palsy, whether treatment was for maternal preeclampsia or for tocolysis. One of these studies also noted a significant reduction in cognitive disability. In another study, no significant protective effect was seen except in a small subset of infants. Magnesium was neuroprotective in many but not all of a variety of experimental studies and has a variety of biologic effects that might account for benefit. All existing clinical studies had relatively small numbers of very premature infants. Although all attempted to control for possible confounders, such studies cannot provide definitive answers as to possible benefits or risks of magnesium therapy. Only randomized clinical trials are likely to resolve the question of whether a brief exposure to an agent which, in the American experience, is considered safe if administered with appropriate supervision, can reduce longterm neurologic disability in premature infants.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Developmental care is a framework that encompasses all care procedures as well as social and physical aspects in the newborn intensive care unit. Its goal is to support each individual infant to be as stable, well-organized, and competent as possible. The infant's physiologic and behavioral expression of current functioning is seen as the reliably available guide for caregivers to estimate the infant's current strengths, vulnerabilities, and thresholds to disorganization; to identify the infant's own strategies and efforts in collaborating toward best progress; and to implement care in a way that enhances the infant's stability and competence. The family is understood to be the infant's primary coregulator. It is the caregivers' responsibility to maximize opportunities to enhance each infant's and family's strengths and reduce apparent stressors. Studies of the effectiveness of developmental care also identify implications for staff education and challenges for nursery-wide implementation.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The first children with HIV-1 infection were described in 1983. As of 1998, the global HIV epidemic is having a profound impact on the health and survival of children. Almost all HIV infections among young children are due to vertical transmission, and the intrapartum period appears to provide us with a crucial window of opportunity for prevention. Postnatal transmission through breastfeeding also contributes an estimated one third to one half of vertical transmission worldwide. Carefully conducted epidemiologic studies are elucidating the immunologic, virologic, and behavioral factors affecting the risk of HIV-1 transmission from mother to infant and the natural history of HIV disease in perinatally infected children. Transmission of HIV-1 is influenced by many factors, and a high maternal viral load is insufficient to fully explain vertical transmission of HIV-1. Pediatricians and other providers should counsel HIV-infected women about the means available to decrease the risk of HIV transmission to the infant. However, the majority of HIV-infected children are born in the developing world, and a crucial challenge is to identify safe and effective interventions that are feasible in those countries with the most significant HIV burden.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Neonatal nurse practitioners have been introduced into tertiary level neonatal intensive care units in the United States, Canada, and the United Kingdom in response to the increased survival rates of extremely low birth weight infants, the shortage of physicians, and the nursing profession's emphasis on development of advanced nursing practice roles. This brief review summarizes the recent research related to the facilitating and constraining factors that influence the role; the safety, effectiveness, and cost of the role; the impact of this role on other members of the health care team; and the satisfaction of those in the role.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The topic of renal trauma has offered many substantial and poignant issues of debate over the years, such as classification schemes, management techniques, imaging and diagnostic preferences, and post-traumatic sequelae. This overview presents the most recent and applicable arguments and data surrounding the treatment of renal trauma. Various classification structures have been proposed and utilized for over a century, yet they do not all focus on the different features of trauma presentation (pathogenesis, morphologic implications, symptoms, predisposing conditions) in an equal manner. The traditional controversy between observation and invasive surgery with trauma patients still exists, yet new methods of treatment protocol have been proposed for patients in traumatic shock. Concerning the state of the patient, it has been recognized that children with pretraumatic renal abnormalities are more prone to serious injury, but it is still undecided whether renal trauma will predispose a child to later pathologies such as arterial hypertension. Modern advances in imaging and diagnostic procedures have dramatically shifted the reliance on intravenous pyelograms to computed tomography, yet the question remains of how much imaging actually is needed in the average patient presenting with renal trauma. Pertinent issues such as these are presented, with main emphasis on literature published within the past 18 months.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Nocturnal enuresis (NE) can result from an interaction of unstable detrusor contractions, delayed arousal from sleep, and nocturnal polyuria. Some children with NE can hold urine well for several hours during the day and have isolated nocturnal enuresis, while others manifest diurnal voiding symptoms (DVS) as well, including urinary frequency, urgency, urge incontinence, and pelvic withholding. The pathogenesis of NE in patients with isolated NE may be different than in those with NE and DVS. In children with NE and DVS, detrusor instability may play a major role in the causation of their voiding problems, whereas delayed arousal from sleep in response to a full bladder may be a major contributor to NE in patients with isolated NE. The treatment should address the underlying pathogenic factors. The commonly used treatment regimens are described. Motivation and efforts of the child in training the bladder are vital to achieving cure of enuresis.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID