Pediatrics
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Health care systems today are complex, technically proficient, competitive, and market-driven. One outcome of this environment is the recent phenomenon in the health care field of "consumerism." Strong emphasis is placed on customer service, with organized efforts to understand, measure, and meet the needs of customers served. The purpose of this article is to describe the current understanding and measurement of parent needs and expectations with neonatal intensive care services from the time the expectant parents enter the health care system for the birth through the discharge process and follow-up care. ⋯ Five parent satisfaction questionnaires-the Parent Feedback Questionnaire, Neonatal Index of Parent Satisfaction, Inpatient Parent Satisfaction-Children's Hospital Minneapolis, Picker Institute-Inpatient Neonatal Intensive Care Unit Survey, and the Neonatal Intensive Care Unit-Parent Satisfaction Form-are critically reviewed for their ability to measure parent satisfaction within the framework of the neonatal care delivery process. An immense gap was found in our understanding about what matters most and when to parents going through the neonatal intensive care experience. Additional research is required to develop comprehensive parent satisfaction surveys that measure parent perceptions of neonatal care within the framework of the care delivery process.
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Hydrops fetalis (HF) consists of an abnormal accumulation of fluid in two or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema. Almost all observed cases of HF are of the nonimmune type, the causes of which remain undetermined in 15% of patients. We report a newborn infant with nonimmune hydrops fetalis (NIHF) and congenital hypothyroidism. ⋯ These observations support our hypothesis that deficient adrenergic activity in congenital hypothyroidism might lead to chylothorax with NIHF in the fetus. We speculate that thyroid hormone may play a role in the regulation of adrenergic receptors in the lymphatic system and lungs, thus modulating both the lymphatic flow rate and lung liquid clearance, and facilitating the resolution of chylothorax. Examination of thyroid functions should be included in the investigation of fetuses and neonates with NIHF of an obscure origin.
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The Vermont Oxford Network is a voluntary collaborative group of health professionals committed to improving the effectiveness and efficiency of medical care for newborn infants and their families through a coordinated program of research, education, and quality-improvement projects. In support of these activities, the Network maintains a clinical database of information about very low birth weight infants that now has more than 300 participating neonatal intensive care units (NICUs). We anticipate that these NICUs will submit data for 25 000 infants with birth weights of 401 to 1500 g born in 1998. ⋯ During the collaborative, participants will contribute to a knowledge bank of clinical, organizational, and operational change ideas for improving neonatal care. The coordinated program of research, education, and quality improvement described in this article is only possible because of the voluntary efforts of the members. The Network will continue to support these efforts by developing and providing improved tools and resources for the practice of evidence-based neonatology.neonatology, very low birth weight, database, network, quality improvement, evidence-based medicine, randomization, trials, outcomes, mortality, length of stay.