Journal of perinatology : official journal of the California Perinatal Association
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Randomized Controlled Trial Clinical Trial
Early hospital discharge of preterm very low birth weight infants.
The objective of this study was to investigate whether early discharge from the hospital was feasible for selected very low birth weight (VLBW) infants. ⋯ Early discharge from the hospital at weights as low as 1300 to 1350 gm is safe for the VLBW infant when properly selected on the basis of behavioral criteria and environmental approval. The potential savings in hospital costs should be considered when resources are allocated for continued support for these infants.
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India has an excellent infrastructural layout for the delivery of MCH services in the community through a network of subcenters, primary health centers, community health centers, district hospitals, state medical college hospitals, and other hospitals in the public and private sectors. However, the health pyramid does not function effectively because of limited resources, communication delays, a lack of commitment on the part of health professionals, and, above all, a lack of managerial skills, supervision, and political will. The allocation of financial resources for the delivery of health care continues to be meager. ⋯ The RCH program, to be launched shortly, aims at effective utilization of these facilities to ensure delivery of integrated services of assured quality through decentralized planning. Simultaneously, as a result of the ongoing economic liberalization, the MCH care in the private sector will also expand rapidly. Indeed, India is on the threshold of an extraordinary improvement in the status of its neonatal-perinatal health.
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Pakistan, one of the most populous countries in the world, has an estimated perinatal mortality rate of 60 to 90 per thousand births, of which almost half are stillbirths. Although infant mortality rates have declined in recent years, nearly 60% of all deaths occur in the neonatal period and have shown comparatively little change over several decades. This is attributed mainly to inadequate attention to programs of maternal and newborn care. ⋯ The primary health care services network is also being revamped in an effort to improve timely recognition of high-risk pregnancies and to facilitate prompt referral. The importance of the newborn period is also being emphasized in pediatric undergraduate and postgraduate training programs, as well as through continuing medical education. However, the most important long-term solution would be improvement in the educational and social status of women, as well as a greater political support for diversion of limited resources to appropriate primary and secondary health care.
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The need for cardiopulmonary resuscitation and repeated correction of persistent acidosis identifies extracorporeal membrane oxygenation patients more likely to develop an intracranial hemorrhage. The objective of this study was to identify risk factors for an intracranial hemorrhage (ICH) in infants on extracorporeal membrane oxygenation (ECMO). This study was a retrospective-matched, case-controlled study of infants with ICH on ECMO compared with infants without ICH on ECMO. ⋯ The need for CPR and repeated correction of persistent acidosis before or during cannulation identifies ECMO patients more likely to develop an ICH. We found that elevated ACTs and low platelet counts requiring transfusion showed a statistical association with the development of an ICH. Daily head ultrasounds and frequent neurologic checks are thus valuable tools in assessing the ECMO patient who demonstrates difficulty in maintaining coagulation values in the normal range or who requires frequent platelet transfusions.