Probable neonatal propoxyphene withdrawal: a case report.

A baby with neonatal withdrawal from propoxyphene as evidenced by severe diarrhea, flapping tremors, shrill cry, diaphoresis, hypertonicity, and seizures is presented. Propoxyphene and its metabolites were identified in the patient's serum and urine. We express concern about the wide use of propoxyphene and its proposed use in substitution programs for detoxifying and maintaining heroin addicts in view of the possibility of neonatal complications.

Vasopressin and pneumothorax in the neonate.

The release of vasopressin (AVP) was assessed by measuring urinary excretion of the hormone in ten neonates who had an acute and symptomatic pneumothorax in the first three days after birth. AVP excretion rose significantly (paired t analysis) after the pneumothorax occurred. When apparent re-expansion of the lungs occurred after treatment, excretion of AVP returned to prepneumothorax levels within eight to 16 hours. If the pneumothorax persisted or worsened. AVP excretion remained elevated. Urine osmolality rose significantly (paired t analysis) after pneumothorax, presumably in response to the increased AVP levels. Two of the ten infants had hyponatremia in the period studied, while in a state of sodium balance. It was concluded that AVP release is increased after a pneumothorax occurs. This increase is apparently not due to osmoregulatory requirements. Fluid intake in these infants may need adjustment to prevent an inappropriate positive water balance.

Personnel in neonatal pediatrics: assessment of numbers and distribution.

There has not been an accurate assessment made of the number of practicing neonatologists, attrition rate of neonatologists, or geographic distribution of neonatologists; therefore, a telephone survey was conducted to assess these issues. The basic conclusion of this study is that numbers and distribution of neonatologists, as well as ratio to patient population, are not deficient or disproportionate when analyzed on a nationwide basis.

The scope of nursing practice in level III neonatal intensive care units.

A structured, timed, telephone survey to determine the scope of nursing practice in level III neonatal intensive care units revealed that the staff/head nurse and neonatal nurse clinician/specialist now are responsible for a wide variety of sophisticated skills and procedures, which were heretofore usually performed by a physician. This study has broad implications for educational as well as service activities and indicates a need to change physician and nurse expectations and education accordingly.

Neonatal mortality risk for the eighties: the importance of birth weight/gestational age groups.

Since 1976 a computerized data base has been used to store information on babies admitted to two intensive care nurseries serving the Vermont/New Hampshire region. The data base now allows reporting "neonatal" mortality by birth weight/gestational age (BW/GA) groupings for 1976--1979. For all BW/GA groups, except the most immature infants, there has been marked improvement compared to data gathered in the sixties (ie, mortality has decreased). These data are probably applicable to most other centers providing neonatal intensive care. The use of BW/GA categories provides the most reliable way of objectively comparing statistics from one center to another. Differences between two centers were observed when birth weight specific rates were used, but were largely abolished by using BW/GA groups. Data gathered in this way will be increasingly important for comparisons between centers and across years and when evaluating the effectiveness of new therapeutic interventions.

Parental dreams, dilemmas, and decision-making in cinéma vérité.

Our film Dreams and Dilemmas: Parents and the Practice of Neonatal Care is on its way to meeting its goal of furthering the "Principles for Family Centered Neonatal Care" (Harrison H. Pediatrics 1993;92:643-50) through cinéma vérité depiction of parental involvement in decision-making. Reality-based filmmaking can provide valuable and successful educational material that advances care and understanding. However, there are real practical and ethical concerns such as privacy, consent, and uncertain or unknown future impact on participants. Successful reality-based filmmaking in a complex medical environment such as a neonatal intensive care unit requires careful attention to ways of ensuring full communication between all those involved and efforts to allay participants' anxiety about being portrayed unfavorably. The most important ingredient, however, is the skill and ability of the filmmaker to engender trust.

The New Hampshire Perinatal Program: twenty years of perinatal outreach education.

OBJECTIVE: To describe 20 years of regional outreach education by the New Hampshire Perinatal Program, its interaction with all 26 community hospitals in the state with maternity services and an additional four in adjoining Vermont. STUDY DESIGN: This paper describes educational initiatives responsive to the needs of perinatal physicians and nurses. The core of the program is the transport conference held annually at each referring hospital in which maternal-fetal and infant referrals are discussed. There are additional community hospital-based programs, programs at convenient locations in the region and medical center conferences and skills programs. RESULTS: The program annually awards 10,000 continuing medical education credits (CME) and nursing contact hours. Evaluation and feedback from all participants is encouraged. New Hampshire has one of the lowest perinatal mortality rates in the county, which reflects in part the accomplishments of the program. CONCLUSION: Perinatal outreach education is a shared responsibility of providers in both the academic center and community hospitals and is necessary to ensure optimal care for mothers and infants.

Caring for parents of sick newborns.

This paper is concerned with the care needed by parents who give birth to a "high risk" infant. Interviews with eight families demonstrate the diversity of responses to this anxiety-producing situation.

Neonatal and infant care and outcomes.

A major advance in neonatal care, surfactant replacement therapy, has received wide endorsement and approval after being subject to over 30 clinical trials. Details of clinical application and full impact on outcomes are in the process of being determined. Neonatal outcome data indicate that the focus of improvement in survival now rests primarily on the extremely low birth weight (less than 750 g) infant. There is additional need for clarity of actual survival by gestational age in the less-than-28-week cohort. The differences and limitations of neonatal and obstetric methods of gestational age assessment are important. Significant contributions to our knowledge of problems such as retinopathy of prematurity, syphilis, and infants of diabetic mothers have recently appeared.