Clinics in perinatology
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Clinics in perinatology · Jun 2000
Family factors and social support in the developmental outcomes of very low-birth weight children.
This study used data that were representative of the normative population of all infants born in 1988 and were followed during the first 3 years of life. Large developmental delays and limitations in function were common among children weighing less than 1500 g at birth. Among very low-birth weight infants, minority status and living in a household headed by a single mother further worsen the disadvantages associated with a very low birth weight. ⋯ Single-parent family structure, race and ethnic minority status, and poverty status also are known to impact on kindergarten readiness, so that we expect a delayed impact of these variables on the child. The strength of this article is the use of normative population data to assess the role of birth weight in child outcome. We examined prenatal risk factors for a baby of very low birth weight, traced the manner by which these selective risks are reflected in the composition of very low-birth weight babies, demonstrated how a very low birth weight was fundamental to delays in development, and identified risk factors and potential buffers in this process. (ABSTRACT TRUNCATED)
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Clinics in perinatology · Sep 1999
Historical ArticleHistory of neonatal resuscitation. Tales of heroism and desperation.
Although the history of neonatal resuscitation is as old as medicine itself, today's standards of practice evolved over the past 40 years. Most ancient physicians and midwives did know that stimulation and expansion of lungs was needed to revive the "apparently dead" newborn, but the means of providing these 'therapies' varied from brutal shaking, hitting, swinging, electrocuting, hanging upside-down to applying gentle pressures or squeezing of the chest. ⋯ Even after great advances in medical science in the 19th century, cardiopulmonary resuscitation techniques remained primitive until the mid-1950s. In this article the author has traced some elements of cardiopulmonary resuscitation techniques and developed an outline of the history of neonatal resuscitation.
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Expertise in neonatal resuscitation is essential for all hospital personnel involved in the care of newborn infants. The guidelines to resuscitation reviewed here have been established by the American Academy of Pediatrics and the American Heart Association and have resulted in significantly improved training and expertise of delivery room personnel. Although widely accepted, many of these guidelines are only now being rigorously studied in controlled trials. This lack of rigorous testing has raised some questions regarding routine resuscitative practices and indicates that present-day standard therapies must always be under constant review.
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The American Heart Association has published guidelines for medication use in neonatal resuscitation. These recommendations should not, however, be regarded as standards or as the final word on resuscitation in neonates. Little work has been performed to justify these recommendations directly; therefore, it was necessary to make recommendations by extrapolating from studies not specifically designed to answer questions concerning the neonate. ⋯ The American Heart Association guidelines were made with reasoning based on the information available, even though the information is tangential. Similarly, since no data exist to document the benefit of NaHCO3 and some data would suggest harmful effects, its routine use is discouraged. Fertile areas for research exist to define better the optimum doses of epinephrine required in newborn resuscitation and to further delineate the importance and safety of rapid reversal of acidosis in newborn resuscitation.
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Clinics in perinatology · Mar 1999
ReviewDemographic and psychosocial characteristics of substance-abusing pregnant women.
Women who abuse drugs and alcohol during pregnancy are an elusive population who often remain unidentified to practitioners and researchers and hence have not been well studied. In trying to understand better the characteristics of women who use drugs during pregnancy, the present article relies extensively on information gathered in studies of women in substance abuse treatment who, as epidemiologic studies show, may be more severely impaired than other substance-abusing women and, therefore, may not be typical of substance-abusing women identified in the course of obstetric practice. Yet, those pregnant women who are actually identified by medical providers as substance users are often those whose behavior raises concerns with health providers (such as presenting for labor having had no prenatal care) and thus also may represent only a relatively impaired group of substance-abusing women. ⋯ They are commonly involved with men who are also users of drugs, they are often the victims of domestic violence, and they suffer from a variety of psychiatric disorders. Studies of epidemiologic and treatment populations indicate that the majority of substance-abusing women have one or more types of comorbid mental disorders, with depression being the most common and the most elevated compared with substance-abusing men, but antisocial personality being extremely high compared with samples of non-substance-abusing women. These findings are of great concern given a growing body of research with non-substance-abusing women, suggesting that family violence and maternal psychopathology can have a profound effect on women's parenting and development o