Journal of perinatology : official journal of the California Perinatal Association
-
This report describes the physiologic alterations that predispose pregnant women to diabetic ketoacidosis and the experience in a tertiary center after adoption of aggressive management of diabetics. ⋯ Diabetic ketoacidosis and fetal morbidity/mortality can be reduced by aggressive management during pregnancy.
-
Comparative Study
Is a twelve-percent cesarean section rate at a perinatal center safe?
Our purpose was to examine the pregnancy and neonatal outcomes at a perinatal center with a consistent cesarean section rate approximately half the national average. ⋯ The lowest safe cesarean section rate is not known; it will undoubtedly vary with location and patient mix. We believe that we have been able to establish a rate of cesarean section one half of the national average with good maternal and fetal outcomes. This has been accomplished through a vigorous prenatal care program, excellent perinatal and infertility services, a vigorous program of vaginal birth after cesarean section, and a competent nurse-midwifery service.
-
Our purpose was to evaluate the cost and benefit of noise reduction after replacement of acoustic ceiling tile in an open ward neonatal intensive care unit (NICU). ⋯ The renovation resulted in a small decrease in the decibel level in the NICU, although this measured decrease was not perceived by observers. With a formal prerenovation noise evaluation, a more efficient ceiling tile might have been selected or the project may have been aborted or modified because of the low levels of noise already present.
-
The objective of this study was to analyze the clinical course and neurodevelopmental outcome of infants with total anomalous pulmonary venous drainage (TAPVD) who were treated with venoarterial extracorporeal life support (ECLS). ⋯ The diagnosis of TAPVD was often known before the initiation of ECLS. Neonates were more likely to survive if the repair could be done before or after ECLS rather than during ECLS. The lower survival of infants who underwent repair during ECLS reflects the degree of illness in many of these infants who were placed on ECLS on an emergency basis because their condition was too unstable to permit detailed cardiac evaluation. The survival rate of infants with TAPVD requiring ECLS is poor, with approximately one half of the survivors having mental and motor deficiencies; however, these infants represent a subset of patients with TAPVD who probably would have died without ECLS. We recommend that infants who are not starting to wean from ECLS at 7 days undergo reevaluation with color-flow Doppler echocardiography with consideration for cardiac catheterization if the diagnosis is in doubt. We also recommend that before infants with known TAPVD are placed on ECLS parents should be informed that survival with the use of ECLS is no different from survival with operation alone and that many of the survivors are impaired. Each active ECLS center should periodically review its accuracy in making this definitive diagnosis.
-
Prolonged intravenous access is an important consideration in the treatment of premature neonates. Because peripheral intravenous catheters have short dwell times, centrally positioned percutaneous catheters have been used increasingly in neonatal intensive care. Midline catheters are peripherally inserted long catheters advanced only to the proximal portion of a limb or to the neck, with the tip remaining outside the thoracic and abdominal cavities. ⋯ Dwell time was found to be 9.0 +/- 1.4 days for the midline catheters versus 3.1 +/- 0.5 days for peripheral intravenous catheters placed in the same patients (p < 0.05). No significant complications occurred with the use of midline catheters. These data suggest that midline catheters may be useful in neonates who require a limited duration of intravenous therapy.