Lessons from the past.

This article considers errors of care in neonatology. In the 19th century errors that resulted in high infant mortality were shaped by the social environment, and in this setting the development of the incubator failed. In the early 20th century, with the emergence of the modern hospital as a technological, science-driven system, physicians had more control of patients' environments, and thus medical errors could occur from systematic care and affected larger numbers. Later in the 20th century, the development of randomized controlled trials and systematic reviews began to improve care and to decrease the risks associated with new treatment methods. Large variations in practice still exist between physicians as individuals and institutions. Considering these variations as risks has led to the use of institutional databases, benchmarking and clinical care guidelines. The efficacy and safety of these methods is unproven. Risks will never disappear from medicine. The question of what risks are 'acceptable' is, in general, unanswerable.

Reflections on errors in neonatology: II. The "Heroic" years, 1950 to 1970.

This series errors in neonatology since the 1920s. Three historical periods are defined: the "Hands-Off" years from 1920 to 1950, the "Heroic" years from 1950 to 1970, and the "Experienced" years from 1970 on. In this article, the "Heroic" years, we discuss the Blossom air lock, sulfisoxazole, chloramphenicol, novobiocin, hexachlorophene, Epsom salts enemas, feeding gastrostomy, diaper laundering, and equipment cleaning.

Reflections on errors in neonatology: I. The "Hands-Off" years, 1920 to 1950.

This series discusses errors in neonatology since the 1920s. Three historical periods are defined: the "Hands-Off" years, 1920 to 1950; the "Heroic" years, 1950 to 1970; and the "Experienced" years, 1970 to 2000. In this article, the "Hands-Off" years, we discuss lowered thermal environment, supplemental oxygen, initial thirsting and starving, synthetic vitamin K, SMA formula, and diaper markings.

Comparison of hemolysis in blood samples collected using an automatic incision device and a manual lance.

OBJECTIVE: To evaluate the magnitude of hemolysis in blood specimens collected from the heels of newborns using an automated blood collection device that uses a spring-loaded lance with blood collected using a manual lance. DESIGN: A randomized controlled trial involving 134 newborns assigned to have blood collected using either an automated blood collection device or a manual lance. A single experienced individual performed all blood collections. Serum hemoglobin concentrations were measured in all samples to gauge the extent of hemolysis. SETTING: A neonatology unit in a 740-bed tertiary care teaching hospital. PATIENTS: Healthy newborns with gestational ages ranging from 33 weeks to 41 weeks. Blood samples were collected from study participants at between 7 and 126 hours postpartum. Group 1 consisted of 66 individuals who had blood collected using the manual lance. Group 2 contained 68 individuals with blood collected using a spring-loaded automatic lance. MAIN OUTCOME MEASURE: Plasma hemoglobin content as an indicator of the extent of hemolysis. RESULTS: There were no significant differences between newborns in groups 1 and 2 with respect to gestational age, birth weight, or time interval between birth and time of blood collection. We found a highly significant difference with respect to plasma hemoglobin concentrations in specimens collected with an automated lance (hemoglobin, 2.35 g/L) vs that collected using the hand-held lance (hemoglobin, 4.85 g/L). CONCLUSION: Use of an automated spring-loaded lance allows for the collection of blood specimens with smaller levels of plasma hemoglobin.