Outside looking in: the lived experience of adults with prematurely born siblings.

Siblings have unique relationships; however, not all sibling relationships are typical. In North America, the preterm birth rate ranks second only to Africa in a global climate of rising preterm birth rates. A paucity of literature exists for sibling relationships when one sibling is born prematurely. In this hermeneutic phenomenological study, we explored the lived experience of adult siblings with prematurely born, young adult brothers and sisters who subsequently developed disabilities. The 28 siblings, interviewed with open-ended questions, represented 47 families with extremely-low-birth-weight young adults with neurodevelopmental disabilities born between 1977 and 1982. Existential reflection guided by van Manen's human science approach assisted the analysis of tape-recorded conversations. A structure of meaning entitled "outside looking in" emerged to illustrate the extraordinary relationships forged by the adult siblings with their brothers and sisters throughout their years together.

One-and-a-half syndrome--two cases.

One-and-a-half syndrome is characterized by combination of the clinical features of unilateral horizontal gaze palsy and internuclear ophthalmoplegia. The common symptoms are double vision and oscillopsia. The lesion is located in the paramedian pontine reticular formation, involving the centre of horizontal gaze and medial longitudinal fasciculus. More extensive brainstem damage may result in additional neurological signs. The most frequent underlying diseases are vascular insults, multiple sclerosis, and brainstem tumor. We present two cases of one-and-a-half syndrome. Both patients had lacunar infarction in the paramedian pontine tegmentum, revealed by MRI. The first patient had isolated eye movement disorder, while the second had additional nuclear-type facial paresis. In the first case brainstem evoked potentials indicated brainstem damage, in the second patient it was normal. Ocular symptoms improved within some days in both patients.

Simultaneous central and peripheral nervous system involvement in systemic lupus erythematosus.

Systemic lupus erythematosus is a frequent autoimmune disease, affecting several organs, including the brain, spinal cord and nerves. Cerebral vasculitis, transverse myelitis and polyneuropathy are the most common neurological manifestations. We report a case of a 46 years old woman who suffered incomplete transverse myelitis at the age of 44. After 2 years the second relapse presented with arthralgias, painful paraesthesias and weakness of the lower limbs. Neurological signs suggested involvement of the central and the peripheral nervous system. Based upon clinical and laboratory findings systemic lupus erythematosus was diagnosed. Magnetic resonance imaging revealed two hyperintense lesions on T2 weighted scans within the cervical spinal cord. The brain scan was normal. Protein content was slightly elevated in the cerebrospinal fluid, with normal cell count. Electrophysiological examinations diagnosed a subacute sensory-motor axonal polyneuropathy. On methylprednisolone treatment her condition improved. Simultaneous development of central and peripheral lesions of the nervous system in cases with systemic lupus erythematosus may lead to a challenge to establish the diagnosis.

Guidelines for feeding very low birth weight infants.

Despite the fact that feeding a very low birth weight (VLBW) neonate is a fundamental and inevitable part of its management, this is a field which is beset with controversies. Optimal nutrition improves growth and neurological outcomes, and reduces the incidence of sepsis and possibly even retinopathy of prematurity. There is a great deal of heterogeneity of practice among neonatologists and pediatricians regarding feeding VLBW infants. A working group on feeding guidelines for VLBW infants was constituted in McMaster University, Canada. The group listed a number of important questions that had to be answered with respect to feeding VLBW infants, systematically reviewed the literature, critically appraised the level of evidence, and generated a comprehensive set of guidelines. These guidelines form the basis of this state-of-art review. The review touches upon trophic feeding, nutritional feeding, fortification, feeding in special circumstances, assessment of feed tolerance, and management of gastric residuals, gastro-esophageal reflux, and glycerin enemas.

Discharge planning utilizing the discharge train: improved communication with families.

In Ontario, publicly funded, regionalized healthcare enables transfer of convalescing infants from level III neonatal intensive care units (NICUs) to regional level II nurseries prior to discharge home. To facilitate a timely transfer and allow time for preparation of families and regional hospital nurseries, NICU staff must recognize infant readiness early. This article describes the implementation process of a 4-part, multidisciplinary, discharge planning instrument that assists staff in early identification of infant readiness for transfer or discharge home. Titled the Discharge Planning Train, this interactive instrument encourages communication and collaboration between all levels of the multidisciplinary staff and with families and decreases confusion at the time of transfer. Barriers to and strategies for successful implementation are included. Evaluation methods and results are presented. The success of the instrument in improving communication and collaboration with the families is well described by the RNs.