Seminars in perinatology
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Seminars in perinatology · Apr 2011
ReviewThe case for OBLS: a simulation-based obstetric life support program.
Errors by health care professionals result in significant patient morbidity and mortality, and the labor and delivery ward is one of the highest risk areas in the hospital. Parturients today are of higher acuity than anytime previously, and maternal mortality is increasing. ⋯ We describe the evolution of immersive learning and simulation in the Neonatal Resuscitation Program, and suggest the development of a multidisciplinary team, simulation-enhanced obstetric crisis training program (OBLS) may likewise benefit obstetrical health care professionals. OBLS would emphasize high quality basic life support, uterine displacement, use of an automatic external defibrillator, and delivery of the fetus within 5 minutes of maternal arrest should resuscitative efforts prove ineffective.
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The trend toward single-room neonatal intensive care units (NICUs) is increasing; however scientific evidence is, at this point, mostly anecdotal. This is a critical time to assess the impact of the single-room NICU on improving medical and neurobehavioral outcomes of the preterm infant. We have developed a theoretical model that may be useful in studying how the change from an open-bay NICU to a single-room NICU could affect infant medical and neurobehavioral outcome. ⋯ The single-room NICU has the potential to improve the neurobehavioral status of the infant at discharge. Neurobehavioral assessment can assist with early detection and therefore preventative intervention to maximize developmental outcome. We also present an epigenetic model of the potential effects of maternal care on improving infant neurobehavioral status.
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Seminars in perinatology · Dec 2010
ReviewReducing intrapartum-related neonatal deaths in low- and middle-income countries-what works?
Each year, 814,000 neonatal deaths and 1.02 million stillbirths result from intrapartum-related causes, such as intrauterine hypoxia. Almost all of these deaths are in low- and middle-income countries, where women frequently lack access to quality perinatal care and may delay care-seeking. Approximately 60 million annual births occur outside of health facilities, and most of these childbirths are without a skilled birth attendant. ⋯ For example, providing neonatal resuscitation for 90% of deliveries currently taking place in health facilities would save more than 93,000 newborn lives each year. Longer-term strategies must address the gaps in coverage of institutional delivery, skilled birth attendance, and quality by strengthening health systems, increasing demand for care, and improving community-based services. Both short- and long-term strategies to reduce intrapartum-related mortality should focus on reducing inequities in coverage and quality of obstetrical and perinatal care.
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Seminars in perinatology · Dec 2010
ReviewCommunity-based intervention packages for improving perinatal health in developing countries: a review of the evidence.
The Lancet Neonatal Survival Series categorized neonatal health interventions into 3 service delivery modes: "Outreach," "Family-Community Care," and "Facility-based Clinical Care." Family-Community Care services generally have a greater potential impact on neonatal health than Outreach services, with similar costs. Combining interventions from all 3 service delivery modes is ideal for achievement of high impact. However, access to clinical care is limited in resource-poor settings with weak health systems. ⋯ Several conclusions can be reached. (1) Family-Community Care interventions can have a substantial effect on neonatal and perinatal mortality. (2) Several important common strategies were used across the studies, including community mobilization, health education, behavior change communication sessions, care seeking modalities, and home visits during pregnancy and after birth. However, implementation of these interventions varied widely across the studies. (3) There is a need for additional, large-scale studies to test evidence-based CBIPs in developing countries, particularly in Africa, where no large-scale studies were identified. (4) We need to establish consistent, clearly defined terminology and protocols for designing trials and reporting outcomes so that we are able to compare results across different settings. (5) There is an urgent need to invest in research and program development focusing on neonatal health in urban areas. (6) It is crucial to integrate CBIPs in rural and urban settings into the already existing health care system to facilitate sustainability of the program and for scaling up. It is also important to evaluate the packages and to demonstrate the health impact of large-scale implementation. (7) Finally, there is a need for improving the continuum of care between home and facility-based care.