ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01534.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01535.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

ABSTRACT:The group of babies at lowest risk for neonatal problems have experienced a significant drop in morbidity and mortality since neonatology began in the 1960's. Up to 50% of such low‐risk babies develop jaundice which requires treatment. ABO hemolytic disease and polycythemia affect 5% and 3% of full‐term babies, respectively. Congenital malformations occur in about 1–2% of term newborns, and infection will be found in 2–5 babies per thousand. Because infections can be life‐threatening and the symptoms are vague in newborns, we do from 25 to 40 septic work‐ups for every one infection confirmed.Handling the high risk mother whose infant needs diagnostic or treatment procedures is easier than handling the shocked mother who expected a normal outcome according to Dr. Phibbs. It is better to give a simple statement of what is being done, and why, than to give technical explanations. Because of the adaptability of human mothers and infants, we find that separation of mothers and infants for common procedures does not interfere w

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01536.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

ABSTRACT:The effect on the number of tests and procedures on full‐term newborns of medical teaching, quality of medical care, research, malpractice, third party reimbursements, and metabolic screening are discussed. Aspects of informed consent are described in relation to common procedures, especially sepsis, meningitis, jaundice and circumcision. These three are selected as representing a spectrum of newborn procedures from one with much benefit and little risk, to one with little benefit and much risk. Before we can decide a risk/benefit ratio for any procedure, we must know the incidence of the disease, the severity, the effectiveness of the diagnostic procedure, and the benefits and risks of the treatmen

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01537.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

ABSTRACT:Among the health regions of Britain, admissions to special care baby units (SCBUs) vary from 15% to 27% of live born children. These variations in admission rates do not correlate with the percentage of low birth‐weight babies born in each region, nor with the perinatal mortality rate. However, they correlate positively with the provision of cots for special newborn care and with how close the baby was to such a facility when born. A large number of full‐term babies are admitted with no disease, but simply for observation. These babies come predominately from deliveries in consultant obstetric units which also have SCBUs, so that admissions for observation are most probable for the group of babies receiving the highest standards of care and therefore are least in need of it. Some of the disadvantages of unnecessary admissions are described.A change in admission policy at one SCBU resulted in the number of full‐term babies admitted to SCBU dropping from 928 in 1972 to 163 in 1975. The effects of pressures to fill the cots in such units, of competition between units, and of other factors influencing admission are disc

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01538.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

ABSTRACT:The nursery and labor/delivery unit have long been loss leaders in hospital accounting. However, Medicaid, Crippled (or Handicapped) Children's Services, Blue Cross and Blue Shield will make very high payments for intensive fetal and neonatal care. As a result, there was an increase of 18% in the number of neonatal intensive care units (NICUs) between 1977 and 1978, and a concomitant reduction in newborn nursery space.Because a large number of NICU beds, and a 75% occupancy rate, are required by local and professional standards, in order to fill NICU beds normal or very mildly sick full‐term newborns are being admitted. The number of tests and treatments were found to be lowest after rotation of residents in August, and to increase monthly until they rotated out in June. Of full‐term newborns, 18% were treated for jaundice and/or given septic work‐ups at one Level II hospital. At another, the same percent of babies was admitted to the NICU from the alternative birth center (ABC) as from the labor/delivery unit, despite figures indicating that the ABC babies had better outcomes on all param

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01539.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

ABSTRACT:Since 1967 neonatal intensive care units have incorporated Yale's “large room concept” of design. Many environmental problems of NICUs result, including the reducing of parents to occasional observers and overwhelming them with the sight of many sick babies, machinery and staff. The large room concept also plays a role in the risks of 24‐hour intense fluorescent lighting, noise, electromagnetic hazards, ionizing radiation, and outgassing of surface materials. An alcove design is suggested, which would reduce these risks, and provide graded exposure of parents to the sick infants. As the infants recover, an alcove design would allow for parents to assume full care of their baby and even roomi

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01540.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

ABSTRACT:The recumbent positions for labor and lithotomy position for birth serve the needs of the attendant rather than the needs of the woman and fetus. Various upright positions have been chosen for birth in most cultures. The advantages of upright and ambulant positions, with full mobility during labor, include avoidance of supine hypotension, aortic and uterine artery compression, cord compression FHR patterns, and inefficient contractions which are more painful. A birth stool or chair allows mothers to push more effectively and to use the great elasticity of the pelvis during delivery.

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01541.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

ABSTRACT:The Alternative Birth Center (ABC) practice and outcomes at Mount Zion Hospital are described and compared to those in the regular labor and delivery area. In the ABC there were fewer cesareans, better Apgar scores at 1 and 5 minutes, less use of analgesia and anesthesia, but no significant difference in admissions of babies to the newborn intensive care nursery. The ABC has helped to make more flexible some of the newborn procedures. Several case histories are presented which illustrate ways that such care can be provided while responding appropriately to parents’concern

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01542.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

ABSTRACT:Those who work with new babies in neonatal intensive care often inure themselves to the pain they cause their tiny patients. In order to counter this turning away, neonatologists and nurses should talk to the baby while they do procedures, and try to develop an awareness—an affection. Neonatologists must become more involved in telling about what they do, and why, to parents. A dialogue should begin during pregnancy, before a crisis occur

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1980.tb01543.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY