Pediatrics
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The justification of neonatal intensive care for extremely premature infants is contentious and of considerable importance. The goal of this report is to describe our experience implementing consensus medical staff guidelines used for counseling pregnant women threatening extremely premature birth between 22 and 26 weeks' postmenstrual age and to give an account of family preferences and the immediate outcome of their infants. ⋯ Rational, consensus periviability guidelines are well accepted and can be used by all neonatologists, obstetricians, and nurses who provide care to pregnant women and infants at extremely early gestational ages. Pregnant women see these guidelines as highly understandable, useful, consistent, and respectful. When encouraged to participate with attending staff in discussions involving morbidity and mortality outcomes of premature infants and consensus medical practice recommendations, a substantial proportion of parents will choose palliative comfort care for their extremely premature infant up through 25 weeks' postmenstrual age. We believe the choice of neonatal intensive care versus palliative comfort care in extremely premature infants rightfully belongs to medically informed parents. More research is needed to examine how these decisions are made under diverse conditions of culture, religion, and technology.
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Comparative Study
Evaluation of the accuracy of different methods used to estimate weights in the pediatric population.
The purpose of this study was to compare the predictive accuracy of 3 methods (Broselow tape, Leffler formula, and Theron formula) for pediatric weight estimation to identify factors that can influence weight estimation, and to derive alternative models for such estimation if indicated. ⋯ The Broselow tape is accurate for weight estimation in children < or =25 kg, but the Theron formula performs better with patients weighing >40 kg. The Broselow tape was not statistically superior to the Leffler formula in subjects weighing 25.1 to 40 kg. A separate cohort is needed to evaluate the validity of the alternative predictive formulae.
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The purpose of this work was to assess a quality improvement initiative to implement a potentially better practice, bubble continuous positive airway pressure, to reduce bronchopulmonary dysplasia and improve other pulmonary outcomes among very low birth weight infants with respiratory distress syndrome. ⋯ Among very low birth weight infants with respiratory distress syndrome, the use of bubble continuous positive airway pressure is a potentially better practice that may reduce the use of mechanical ventilation. Although an increase in retinopathy of prematurity was observed in our population, carefully designed randomized, controlled trials will be required to more accurately address the potential risks and benefits of this therapy.
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To assess (1) the differences in attitudes toward disabilities of 3 groups of subjects involved in neonatal care decision-making: health care workers, mothers of term infants, and parents of preterm infants, and (2) the impact of subject characteristics on these attitudes including parental education level, religion, and severity of disability. ⋯ Our findings suggest that parents of preterm infants as a group were most likely to save the infant at all costs and prepared to tolerate more severe disability health states. However, personal characteristics, in particular religious belief and severity of neonatal complications, have overriding influence on these attitudes. We suggest inclusion of experienced parents of preterm infants for more effective counseling of parents in making life-and-death decisions.
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Carbon monoxide (CO) poisoning is common after major storms because of loss of electrical power and use of alternate fuel sources for heat and electricity. In past epidemics of hurricane-related CO poisoning, the source has typically been gasoline-powered electrical generators. Although it is typically believed that generators were used to power air conditioning and refrigeration, this report demonstrates an unsuspected reason for their use. ⋯ Generator-related CO poisoning is indeed common during power outages after hurricanes. However, generators are commonly being used to provide electricity to power entertainment devices for children, such as video games. Additional public education about CO risk is needed, perhaps directed at older children and teenagers through the schools in regions susceptible to hurricanes.