Clinics in perinatology
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In the debate over medical malpractice reform, the dimension of fairness often is invoked but is poorly understood. This article describes the factors that promote fairness in public policy and then examines whether proposed or enacted tort reforms would be fair. It finds that many of the reforms that are being promoted by perinatologists would be unfair; however, some reforms, including one broad-ranging proposal that was put forward by the Institute of Medicine, could satisfy fairness criteria depending on how they were implemented.
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Clinics in perinatology · Mar 2005
A defense attorney's perspective on medical negligence litigation.
Being named as a defendant in a lawsuit is an unnerving development. Proceeding through the discovery stage of a case can be a daunting prospect. ⋯ In this day and age, many physicians, including extremely well qualified specialists, often must deal with these realities. To cope best with these events, this article is an attempt to summarize certain legal principles that are relevant to these cases and to emphasize the practical realities that are attendant to medical negligence litigation.
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An Rh-negative woman is at risk for developing Rh isoimmunization upon exposure to RhD antigens from her Rh-positive baby through fetal-maternal hemorrhage. The incidence of Rh isoimmunization and fetal hemolytic disease has decreased substantially since Rh immune globulin was introduced in 1968. When RhD sensitization does occur, careful follow-up of these mothers and judicious intervention can result in good outcomes for most pregnancies. Both Doppler assessment of middle cerebral artery peak systolic velocity and spectral analysis of amniotic fluid at 450 nm (DeltaOD 450) are useful in the diagnosis and management of fetal anemia.
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Clinics in perinatology · Sep 2004
ReviewUnderstanding and preventing severe neonatal hyperbilirubinemia: is bilirubin neurotoxity really a concern in the developed world?
Although rare, extreme neonatal hyperbilirubinemia and its dreaded complication, kernicterus, continue to occur. Hyperbilirubinemia develops when bilirubin production exceeds the body's capacity to excrete it, primarily by conjugation. ⋯ Adjuncts to the interpretation of the serum total bilirubin concentration are suggested. Prevention and management of severe hyperbilirubinemia should be based on American Academy of Pediatrics guidelines, with individualization including earlier institution of treatment and delayed discharge from the hospital for neonates with risk factors for kernicterus.
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There are relatively few studies of albumin use in neonates and children, with most showing no consistent benefit compared with the use of crystalloid solutions. Certainly, albumin treatment is not indicated for treatment of hypoalbuminemia alone. Studies also show that albumin is not indicated in neonates for the initial treatment of hypotension, respiratory distress, or partial exchange transfusions. ⋯ In patients with hypoalbuminemia and increased capillary permeability, albumin supplementation often leads to greater albumin leakage across the capillary membrane, contributing to edema formation without improvement in outcome. As the disease process improves and capillary permeability normalizes, albumin supplementation may accelerate recovery, but long-term benefits of albumin treatment usually cannot be demonstrated. These patients will recover whether or not albumin is administered.