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1.
; UNICEF.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-46938

RESUMEN

O UNICEF estima que 392.078 bebês vão nascer em todo o mundo no Dia de Ano Novo.


Asunto(s)
Recién Nacido , Parto , Personal de Salud
2.
Adv Exp Med Biol ; 1232: 3-9, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893387

RESUMEN

Neonates with hypoxic-ischaemic (HI) brain injury were monitored using a broadband near-infrared spectroscopy (NIRS) system in the neonatal intensive care unit. The aim of this work is to use the NIRS cerebral oxygenation data (HbD = oxygenated-haemoglobin - deoxygenated-haemoglobin) combined with arterial saturation (SaO2) from pulse oximetry to calculate cerebral blood flow (CBF) based on the oxygen swing method, during spontaneous desaturation episodes. The method is based on Fick's principle and uses HbD as a tracer; when a sudden change in SaO2 occurs, the change in HbD represents a change in tracer concentration, and thus it is possible to estimate CBF. CBF was successfully calculated with broadband NIRS in 11 HIE infants (3 with severe injury) for 70 oxygenation events on the day of birth. The average CBF was 18.0 ± 12.7 ml 100 g-1 min-1 with a range of 4 ml 100 g-1 min-1 to 60 ml 100 g-1 min-1. For infants with severe HIE (as determined by magnetic resonance spectroscopy) CBF was significantly lower (p = 0.038, d = 1.35) than those with moderate HIE on the day of birth.


Asunto(s)
Lesiones Encefálicas , Encéfalo , Circulación Cerebrovascular , Oximetría , Oxígeno , Espectroscopía Infrarroja Corta , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Lesiones Encefálicas/diagnóstico por imagen , Humanos , Recién Nacido , Oximetría/instrumentación , Oximetría/métodos , Oxígeno/metabolismo
3.
Adv Exp Med Biol ; 1232: 11-17, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893388

RESUMEN

In the adult brain, it is well known that increases in local neural activity trigger changes in regional blood flow and, thus, changes in cerebral energy metabolism. This regulation mechanism is called neurovascular coupling (NVC). It is not yet clear to what extent this mechanism is present in the premature brain. In this study, we explore the use of transfer entropy (TE) in order to compute the nonlinear coupling between changes in brain function, assessed by means of EEG, and changes in brain oxygenation, assessed by means of near-infrared spectroscopy (NIRS). In a previous study, we measured the coupling between both variables using a linear model to compute TE. The results indicated that changes in brain oxygenation were likely to precede changes in EEG activity. However, using a nonlinear and nonparametric approach to compute TE, the results indicate an opposite directionality of this coupling. The source of the different results provided by the linear and nonlinear TE is unclear and needs further research. In this study, we present the results from a cohort of 21 premature neonates. Results indicate that TE values computed using the nonlinear approach are able to discriminate between neonates with brain abnormalities and healthy neonates, indicating a less functional NVC in neonates with brain abnormalities.


Asunto(s)
Encéfalo , Acoplamiento Neurovascular , Espectroscopía Infrarroja Corta , Adulto , Encéfalo/fisiopatología , Encefalopatías/diagnóstico , Encefalopatías/fisiopatología , Electroencefalografía , Entropía , Humanos , Recién Nacido , Acoplamiento Neurovascular/fisiología
4.
Adv Exp Med Biol ; 1232: 19-24, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893389

RESUMEN

The Consensus on Resuscitation Science and Treatment Recommendations indicate the target SpO2 values during the first 10 min of life. There are a few studies of values of brain regional saturation of oxygen (rSO2) in newborns, conventional instruments are large and not suitable for measuring in the delivery room. The purpose of this study was to develop reference values for brain rSO2 up to 10 min after birth and to review the changes in cerebral oxygenation in late preterm and term newborn infants immediately after birth. METHOD: We evaluated both brain rSO2 and SpO2 at 1, 3, 5 and 10 min after birth in 100 neonates. rSO2, was measured at the forehead using a finger-mounted oximeter. This is 1/100 the size of conventional NIRS and can be carried. To measure SpO2, a Radical-7 was used. This study was approved by the institutional review board at our hospital. RESULTS: The gestational age and birth weight were 37.9 ± 1.2 weeks and 2825 ± 429 g, respectively. Eighty-seven infants and 13 infants were term and late preterm infants, respectively, and there were 21 vaginal deliveries and 79 cesarean sections. In all cases, rSO2 levels were measured at 1, 3, 5, and 10 min after birth. For the SpO2 measurements, nine cases at 1 min, 40 cases at 3 min, 81 cases at 5 min and 93 cases at 10 min were available. The median rSO2 level was 43% at 1 min after birth, 48% at 3 min, 52% at 5 min and 57% at 10 min. CONCLUSION: We used a finger-mounted oximeter to observe changes in brain rSO2 values of 100 normal transition infants. It was easier to detect rSO2 in comparison to the peripheral oxygen saturation monitored by our pulse oximeter. Brain rSO2 values might be useful to evaluate oxygenation immediately after birth.


Asunto(s)
Encéfalo , Oximetría , Encéfalo/fisiología , Humanos , Recién Nacido , Recien Nacido Prematuro , Oximetría/instrumentación , Oximetría/métodos , Oxígeno/análisis , Valores de Referencia
5.
Adv Exp Med Biol ; 1232: 25-31, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893390

RESUMEN

Hypoxic ischemic encephalopathy (HIE) leads to significant mortality and morbidity, and therapeutic hypothermia (TH) has become a standard of care following HIE. After TH, the body temperature is brought back to 37 °C. Early electroencephalography (EEG) is a reliable outcome biomarker following HIE. We hypothesized that changes in cerebral oxidative metabolism, measured as Δ[oxCCO], in relation to changes in brain tissue oxygenation (measured as Δ[HbD]) during rewarming will correlate with injury severity as evidenced on amplitude integrated EEG/EEG at initial presentation. Broadband near-infrared spectroscopy (NIRS) and systemic data were collected during rewarming from 14 infants following HIE over a mean period of 12.5 h. All infants were monitored with video EEG telemetry using a standard neonatal montage. aEEG and EEG background was classified into mild, moderate and severely abnormal groups based on the background pattern. Two infants had mild, 6 infants had moderate and another 6 infants had severe abnormality at presentation. The relationship between [oxCCO] and [HbD] was evaluated between two groups of infants with abnormal electrical activity (mild vs moderate to severe). A significant difference was noted between the groups in the relationship between [oxCCO] and [HbD] (as r2) (p = 0.02). This result indicates that the mitochondrial injury and deranged oxidative metabolism persists in the moderate to severely abnormal group during rewarming.


Asunto(s)
Electroencefalografía , Hipotermia Inducida , Hipoxia-Isquemia Encefálica , Biomarcadores/análisis , Encéfalo/metabolismo , Humanos , Hipoxia-Isquemia Encefálica/diagnóstico , Lactante , Recién Nacido , Recalentamiento
6.
Adv Exp Med Biol ; 1232: 33-38, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893391

RESUMEN

Monitoring of cerebral tissue oxygen saturation (StO2) by near-infrared spectroscopy (NIRS oximetry) has great potential to reduce the incidence of hypoxic and hyperoxic events and thus prevent long-term disabilities in preterm neonates. Since the light has to penetrate superficial layers (bone, skin and cerebrospinal fluid) before it reaches the brain, the question arises whether these layers influence cerebral StO2 measurement. We assessed this influence on the accuracy of cerebral StO2 values. For that purpose, we simulated light propagation with 'N-layered medium' software. It was found that with a superficial layer thickness of ≤6 mm, typical for term and preterm neonates, StO2 accurately reflects cerebral tissue oxygenation.


Asunto(s)
Oximetría , Oxígeno , Cráneo , Encéfalo/metabolismo , Humanos , Hipoxia/diagnóstico , Recién Nacido , Oximetría/normas , Cráneo/anatomía & histología , Espectroscopía Infrarroja Corta
7.
Adv Exp Med Biol ; 1232: 285-290, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893422

RESUMEN

In neonatal intensive care units (NICUs), 87.5% of alarms by the monitoring system are false alarms, often caused by the movements of the neonates. Such false alarms are not only stressful for the neonates as well as for their parents and caregivers, but may also lead to longer response times in real critical situations. The aim of this project was to reduce the rates of false alarms by employing machine learning algorithms (MLA), which intelligently analyze data stemming from standard physiological monitoring in combination with cerebral oximetry data (in-house built, OxyPrem). MATERIALS & METHODS: Four popular MLAs were selected to categorize the alarms as false or real: (i) decision tree (DT), (ii) 5-nearest neighbors (5-NN), (iii) naïve Bayes (NB) and (iv) support vector machine (SVM). We acquired and processed monitoring data (median duration (SD): 54.6 (± 6.9) min) of 14 preterm infants (gestational age: 26 6/7 (± 2 5/7) weeks). A hybrid method of filter and wrapper feature selection generated the candidate subset for training these four MLAs. RESULTS: A high specificity of >99% was achieved by all four approaches. DT showed the highest sensitivity (87%). The cerebral oximetry data improved the classification accuracy. DISCUSSION & CONCLUSION: Despite a (as yet) low amount of data for training, the four MLAs achieved an excellent specificity and a promising sensitivity. Presently, the current sensitivity is insufficient since, in the NICU, it is crucial that no real alarms are missed. This will most likely be improved by including more subjects and data in the training of the MLAs, which makes pursuing this approach worthwhile.


Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Cuidado Intensivo Neonatal , Aprendizaje Automático , Monitoreo Fisiológico , Oximetría , Teorema de Bayes , Circulación Cerebrovascular , Humanos , Recién Nacido , Recien Nacido Prematuro , Cuidado Intensivo Neonatal/métodos , Monitoreo Fisiológico/métodos , Oximetría/métodos , Oximetría/normas
8.
Adv Exp Med Biol ; 1232: 347-354, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893430

RESUMEN

In preterm infants, there is a risk of long-term cognitive, motor and behavioral impairments due to hemorrhagic and/or ischemic lesions. If detected early, lesions can be prevented. A bedside imaging modality, capable of early detection of both disorders, is necessary. We present the state of development of a tomographic imager (named Pioneer), that will be capable of determining the oxygenation of the preterm-infant brain with high spatial resolution. Pioneer is a time-resolved near-infrared optical tomography (TR NIROT) instrument. It employs multiple wavelength laser light in short pulses on 11 distinct locations and measures the re-emerging light in a contactless fashion by means of a time-correlated single-photon counting (TCSPC) camera (named Piccolo) covering ~4.9 cm2 with 300 detectors. Timing response of the entire system is 116 ps. An in-house designed biocompatible source ring ensures fixed relative positions of sources and detectors and provides a secure interface between the patient and the probe. At the present state, the NIROT Pioneer system successfully detected a 6x6x50 mm3 inclusion 3 cm deep inside a phantom. These results confirm that the Pioneer imager is working as expected and is on a solid path towards full 3D tissue oxygenation imaging.


Asunto(s)
Encéfalo , Recien Nacido Prematuro , Oximetría , Oxígeno , Encéfalo/diagnóstico por imagen , Humanos , Recién Nacido , Oximetría/instrumentación , Oximetría/métodos , Oximetría/normas , Oxígeno/metabolismo , Fantasmas de Imagen
9.
FP Essent ; 488: 11-15, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31894950

RESUMEN

Circumcision is the surgical removal of some or all of the foreskin (ie, prepuce) of the penis. Among high-resource countries, the United States is the only country in which the majority of newborns are circumcised for nonreligious reasons. The rate of circumcision in the United States has been decreasing. Circumcised males have a lower risk of urinary tract infections, penile cancer, and several sexually transmitted infections. The benefit of circumcision is greater for males with certain urologic conditions, such as isolated hydronephrosis, vesicoureteral reflux, and ureteropelvic junction obstruction. Complications develop in approximately 1 of every 200 procedures. The American Academy of Pediatrics and the American Academy of Family Physicians recommend continued access to circumcision on an elective basis and conclude that the benefits outweigh the risks. However, they do not endorse routine neonatal circumcision. Local anesthesia should be used to decrease pain during the procedure. Three devices commonly are used. Each has risks and benefits, and no one device has been proven to be superior to another.


Asunto(s)
Circuncisión Masculina , Neoplasias del Pene , Enfermedades de Transmisión Sexual , Infecciones Urinarias , Niño , Humanos , Lactante , Recién Nacido , Masculino , Neoplasias del Pene/prevención & control , Enfermedades de Transmisión Sexual/prevención & control , Estados Unidos , Obstrucción Ureteral , Infecciones Urinarias/prevención & control
10.
FP Essent ; 488: 16-20, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31894951

RESUMEN

In children, inguinal hernias, hydroceles, and cryptorchidism typically are associated with a patent processus vaginalis. Inguinal hernias occur in 3.5%-5% of full-term newborns and 9%-11% of premature newborns. Inguinal hernias are characterized by an intermittent mass in the groin that may be reducible or incarcerated. Incarcerated hernias usually are painful, can cause vomiting, and require prompt intervention. The definitive treatment is surgery, and urgency depends on symptoms and ability to reduce the hernia. Hydrocele is an accumulation of serous fluid in the tunica vaginalis around the testicle that presents as a painless, fluctuant mass. Most hydroceles resolve spontaneously by age 1 year. Cryptorchidism occurs when one or both testes do not migrate to the scrotum. The diagnosis is made via history and physical examination. Spontaneous descent of the testis may occur before age 6 months but referral to a surgical subspecialist is indicated if descent does not occur.


Asunto(s)
Criptorquidismo , Hernia Inguinal , Hidrocele Testicular , Niño , Humanos , Lactante , Recién Nacido , Masculino
11.
MMWR Morb Mortal Wkly Rep ; 69(1): 1-5, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31917782

RESUMEN

In May 2018, a study of birth defects in infants born to women with diagnosed human immunodeficiency virus (HIV) infection in Botswana reported an eightfold increased risk for neural tube defects (NTDs) among births with periconceptional exposure to antiretroviral therapy (ART) that included the integrase inhibitor dolutegravir (DTG) compared with other ART regimens (1). The World Health Organization* (WHO) and the U.S. Department of Health and Human Services† (HHS) promptly issued interim guidance limiting the initiation of DTG during early pregnancy and in women of childbearing age with HIV who desire pregnancy or are sexually active and not using effective contraception. On the basis of additional data, WHO now recommends DTG as a preferred treatment option for all populations, including women of childbearing age and pregnant women. Similarly, the U.S. recommendations currently state that DTG is a preferred antiretroviral drug throughout pregnancy (with provider-patient counseling) and as an alternative antiretroviral drug in women who are trying to conceive.§ Since 1981 and 1994, CDC has supported separate surveillance programs for HIV/acquired immunodeficiency syndrome (AIDS) (2) and birth defects (3) in state health departments. These two surveillance programs can inform public health programs and policy, linkage to care, and research activities. Because birth defects surveillance programs do not collect HIV status, and HIV surveillance programs do not routinely collect data on occurrence of birth defects, the related data have not been used by CDC to characterize birth defects in births to women with HIV. Data from these two programs were linked to estimate overall prevalence of NTDs and prevalence of NTDs in HIV-exposed pregnancies during 2013-2017 for 15 participating jurisdictions. Prevalence of NTDs in pregnancies among women with diagnosed HIV infection was 7.0 per 10,000 live births, similar to that among the general population in these 15 jurisdictions, and the U.S. estimate based on data from 24 states. Successful linking of data from birth defects and HIV/AIDS surveillance programs for pregnancies among women with diagnosed HIV infection suggests that similar data linkages might be used to characterize possible associations between maternal diseases or maternal use of medications, such as integrase strand transfer inhibitors used to manage HIV, and pregnancy outcomes. Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy.


Asunto(s)
Infecciones por VIH/diagnóstico , Defectos del Tubo Neural/epidemiología , Complicaciones Infecciosas del Embarazo/diagnóstico , Adolescente , Adulto , Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estados Unidos/epidemiología , Adulto Joven
12.
Urology ; 135: 137-138, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31895676
14.
Isr Med Assoc J ; 22(1): 43-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927805

RESUMEN

BACKGROUND: Temporary abdominal closure (TAC) surgical technique relates to a procedure in which the post-surgical abdominal wall remains open in certain indications. The Bogota bag (BB) technique is a tension-free TAC method that covers the abdominal contents with a sterilized fluid bag. There are very few reports of pediatric patients treated with this technique. OBJECTIVES: To describe our institution's 15 years of experience using the BB technique on pediatric patients. METHODS: A retrospective cohort study describing our experience treating patients with BB was conducted. The medical files of 17 pediatric patients aged 0-18 years were reviewed. RESULTS: Between January 2000 and December 2014, 17 patients were treated with BB at our medical center (6 females, median age 12 years). Indications for BB were a need for a surgical site re-exploration, mechanical inability for primary abdominal closure, and high risk for ACS development. Median BB duration was 5 days and median bag replacement was 2 days. Median ICU length of stay (LOS) was 10 days and hospital LOS was 27 days. The ICU admission and BB procedure was tolerated well by 6 patients who were discharged home without complications. Of the remaining 11 patients, 6 patients died during the admission (35%) and the others presented with major complications not related to the BB but to the patient's primary disease. CONCLUSIONS: This report represents the largest series of children treated with BB. The technique is simple to perform, inexpensive, and has very few complications.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Abdomen/cirugía , Pared Abdominal/cirugía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos
15.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945037

RESUMEN

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Asunto(s)
Anomalías Congénitas/mortalidad , Mortalidad Infantil/tendencias , Afroamericanos/estadística & datos numéricos , Anomalías Congénitas/etnología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Disparidades en el Estado de Salud , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Mortalidad Infantil/etnología , Recien Nacido Extremadamente Prematuro , Recién Nacido , Posmaduro , Recien Nacido Prematuro , Masculino , Estados Unidos/epidemiología
16.
N C Med J ; 81(1): 5-13, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908325

RESUMEN

BACKGROUND In 2016, the North Carolina Division of Public Health (DPH) launched the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program to provide 5 local health departments (LHDs) with financial resources and technical assistance to address 3 aims: improve birth outcomes, reduce infant mortality, and improve health for children from birth to 5 years.METHOD: State legislation established an academic-practice partnership between NCDPH and the University of North Carolina at Chapel Hill (UNC) to provide program evaluation and implementation coaching to LHDs. ICO4MCH used a collective impact framework, principles of implementation science, and a health equity approach to implement evidence-based strategies to address the program's aims.RESULTS: A shared measurement system was developed by an evaluation stakeholders group led by the NCDPH and UNC in which LHDs reported data on a quarterly basis and the evaluators returned reports to drive improvements. Structured assessments and technical assistance provided by implementation coaches helped grantees address barriers to implementation including cultivating and sustaining a diverse community action team, addressing staff turnover, and using data to drive improvements.LIMITATIONS: It was challenging for grantees to balance community needs and build partnerships in the first year while integrating data from multiple assessments into action plans to meet the performance measures. It was necessary to streamline assessments and reduce indicators to make data more actionable.CONCLUSION: An academic-practice partnership was integral to successful implementation of the ICO4MCH program and may serve as a model for moving evidence-based maternal child health programs to practice in LHDs.


Asunto(s)
Salud del Niño , Promoción de la Salud/organización & administración , Relaciones Interinstitucionales , Salud Materna , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , North Carolina , Embarazo , Evaluación de Programas y Proyectos de Salud
17.
N C Med J ; 81(1): 24-27, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908328

RESUMEN

In working to improve the health of North Carolinians, a critical focus starts with our mothers and infants and their surrounding communities. North Carolina's perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context of lifelong physical and mental health of our citizens, offer areas for improvement and policy implications. In addition, the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This issue of the NCMJ highlights the state of perinatal health in North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our parents, children, and families; and how we as a state and as a community can come together to improve the safety and experience of giving birth in North Carolina and beyond.


Asunto(s)
Salud del Lactante/estadística & datos numéricos , Salud Materna/estadística & datos numéricos , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Mortalidad Materna/tendencias , North Carolina/epidemiología , Embarazo , Nacimiento Prematuro/epidemiología
18.
N C Med J ; 81(1): 28-31, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908329

RESUMEN

This commentary evaluates access and barriers to perinatal care in North Carolina utilizing key goals the state has identified in its strategic plans, such as expanding health care access for North Carolinians, increasing access to preconception care for women and men, improving access to prenatal care, and undoing racism.


Asunto(s)
Accesibilidad a los Servicios de Salud , Mortalidad Infantil/tendencias , Atención Perinatal , Calidad de la Atención de Salud , Femenino , Humanos , Lactante , Recién Nacido , Masculino , North Carolina/epidemiología , Embarazo
19.
N C Med J ; 81(1): 32-35, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908330

RESUMEN

Since its inception in the 1970s, the stratification of perinatal health care into complexity-based levels has resulted in improved outcomes. Recent trends toward de-regionalization based on financial incentives, however, threaten to undermine these gains and should be addressed.


Asunto(s)
Atención Perinatal/organización & administración , Femenino , Humanos , Recién Nacido , North Carolina , Embarazo
20.
N C Med J ; 81(1): 41-44, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908333

RESUMEN

Navigating perinatal specialty care requires access for both patients and their clinicians. Convenience and availability of regional resources, especially in predominantly rural areas, impact the ability to provide care in the ideal setting for each patient's individualized medical needs.


Asunto(s)
Accesibilidad a los Servicios de Salud , Atención Perinatal/organización & administración , Femenino , Humanos , Recién Nacido , North Carolina , Embarazo
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