human milk blood sampling anesthesia bone disease - nicmag.ca

60 Pages·2009·3.28 MB·English

neonatal
Vol. 22 No. 7
November/December 2009
INTENSIVE CARE
Human milk
Blood Sampling
aneStHeSia
Bone diSeaSe
StillBirtHS
reSearcH
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neonatal November/OVcotol.b 2e2r N2o00. 79 Editorial
INTENSIVE CARE
Perspective
A recent article posted on e-medicine by Brian Carter of Vanderbilt University reminds
neonatal healthcare practitioners not to lose sight of their goals. Dr Carter raises the
following questions: Who deserves access to neonatal specialty care? Who pays for
it? Are the costs acceptable? Is the distribution of care equitable? Are some babies
too small or sick for care? What outcomes are too burdensome? Who decides about
who gets care? How are these decisions made? But Carter points out that many of
these questions are often vaguely posed, if at all, and typically in reverse order. He
says neonatal caregivers may also wonder, Why are we doing this? Did we make a
Vol. 22 No. 7 difference? What were we trying to accomplish with our efforts? Failing to approach
and try to answer these questions, he says, leads to moral uncertainty and distress.
November-December 2009
Another way to put the picture in perspective, he notes, is to posit the following
questions before proceeding: what are the goals of neonatal intensive care? What place
do guidelines have in ethical practice, and how should they be developed? What’s good
for the infant, and who says so? Neonatal caregivers, he says, can’t simply say their
job is to “save all babies,” or “reduce infant mortality.” The physical constraints of the
Table of Contents
NICU need to be considered, he says, and the ends to which care is provided should
be kept in mind: Goals need to include more than the simple application of critical
care technology, such as ventilators, monitors, medications, invasive devices, and a
multiplicity of laboratory measurements, to sick and premature newborn patients.
They should include stabilization of the newborn and, ultimately, facilitation of the
DEPARTMENTS
transition to normal, extrauterine, neonatal physiology. This transition takes longer
4 for some infants and may require significant intervention and support. The reversal of
Editorial: Perspective
acute disease processes, such as infection and respiratory distress, is one recognized
15 News end to aim for. Care should be provided, he says, with a reasonable expectation of
steady improvement, and shouldn’t cause needless pain. When apportioning care,
20
Monitoring the “capacity for the newborn to enjoy and participate in the human experience
over a life prolonged beyond infancy” must be considered. Carter also reminds us
21
Products that “parents are considered to be the spokespersons [for infants], and thus their
input must be considered, and that decisions should be shared and communicated
among all parties.” Finally, he says, data about outcomes can’t rely solely on national,
generalized information, because it may not apply to the local situation. Carter
ARTICLES
notes, “Perhaps the final consideration in answering these questions is that each day,
13 healthcare professionals must work within the realities of the cases before them.
Commentary: WIC vs Breastfeeding
Each patient has a unique set of problems that prompt action, moral reflection,
22 and reevaluation. Each healthcare dilemma reminds caregivers of their limitations,
Human Milk in the NICU
including uncertainty, the human predicament, lack of knowledge, and decision-
27 Umbilical Blood Sampling making abilities. All of these are tempered by the moral constraints under which they
act. Healthcare professionals must, at times, accept the reality that tragic cases have
29
Anesthesia for C-Sections tragic outcomes… [The practitioner is] asked to not only inquire, ‘What good are we
doing here?’ but also to move toward defining goals for the individual patient.”
33
Bone Disease and Nutrition
39
Stillbirth Intervention
44
Vaginal vs Cesarean
47 Les Plesko, Editor
Maternal Health
56 Prioritizing Research From E-medicine, Ethical Issues in Neonatal Care, Brian S. Carter, MD, FAAP,
Professor of Pediatrics (Neonatology), Vanderbilt University School of Medicine; Co-
58
ASV Mode for Ventilation director, Pediatric Advance Comfort Team, Monroe Carell Jr Children’s Hospital at
Vanderbilt. http://emedicine.medscape.com. From WebMD. All material on the website
is protected by copyright, Copyright© 1994-2009 by Medscape.
4 neonatal INTENSIVE CARE Vol. 22 No. 7 n November-December 2009
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Editorial Advisory Board
Arie L. Alkalay, MD Ivan Frantz, III, MD Ataturk School of Medicine
Clinical Professor of Pediatrics Professor of Pediatrics Erzurum, Turkey
UCLA School of Medicine Chief, Division of Newborn Medicine
Published seven times each year by Los Angeles, CA Tufts University School of Medicine Michael O’Shea
Boston, MA Wake Forest University School of Medicine
Goldstein and Associates, M. A. Arif, MD Winston-Salem, NC
Professor of Pediatrics & Head, Philippe S. Friedlich, MD
Inc. Neonatology Assistant Professor of Pediatrics G. Battisita Parigi, MD
National Institutes of Child Health Keck School of Medicine Associate Professor of Pediatric Surgery
10940 Wilshire Blvd., Suite 600 Karachi, Pakistan University of Southern California University of Pavia
Los Angeles CA 90024 Los Angeles, CA Italy
Muhammad Aslam, MD
Phone: [phone] Clinical Fellow in Newborn Medicine G. Paolo Gancia, MD Richard Paul, MD
Harvard Neonatal-Perinatal Fellowship Neonatologist, Terapia Intensiva Chief, Maternal & Fetal Medicine
Fax: [phone] Program Neonatale-Neonatologia Department of Obstetrics & Gynecology
E-mail: [email protected] Children’s Hospital Boston Cuneo, Italy University of Southern California
Harvard Medical School/ Harvard Los Angeles, CA
Web: www.nicmag.ca University, Boston, MA. GPreoofersgsoer Aof. PGerdeiagtoricrsy ,a nMdD A nesthesia Max Perlman, MD
Publisher Edward Austin, MD University of California Professor of Pediatrics
Steve Goldstein APesdsiisattarinct SCulringiecrayl Professor San Francisco, CA TThoero Hntoos,p Oitnatl aforiro ,S Cicakn Cahdialdren
ELdesit Porlesko USanniv Ferrasnitcyi socfo C, CalAifornia-San Francisco WNDeeipollaniraattmmale RnRte. soHpf iarRaleltisobpryiur arCttaoorreny ,CC RoaorRerT d,i nRaCtoPr BProorfeiss sPoer torf iOkbosvtestkriyc,s ManDd Gynecology
Richard L. Auten, MD Hillcrest Baptist Medical Center Nassau Health Care Corporation
Senior Editor Assistant Professor of Pediatrics Waco, TX East Meadow, NY
Carol Brass DDuukrhea Umn, ivNeCrsity Medical Center MAsasorcyi aCtea tPhroefreisnsoer Hofa Prerdisia, tMricDs APrroufens sPorra omf Paendiiakt,r iMcsD
Associate Editor Bruce G. Bateman, MD Division of Neonatology Section of Neonatology
Department of Obstetrics & Gynecology University of Pennsylvania School of Louisiana State University
Laszlo Sandor University of Virginia Medicine Health Sciences Center
Charlottesville, VA The Children’s Hospital of Medicine Shreveport, LA
Design, Typography, Prepress
and Production Management DWaakvei dF oDre. sBt eUrnriyve, rMsitDy School of Medicine PDhailvaidde lJp.h Hiao, fPfAman, MD BCheinefa omf aNneoanhaatolllio Kgy. Rajegowda, MD
http://accugraphics.net Winston-Salem, NC Clinical Associate Professor of Pediatrics Lincoln Medical and Mental Health Center
Penn State College of Medicine Professor of Clinical Pediatrics
Circulation, Coverage, Advertising D. Spencer Brudno, MD Staff Neonatologist Weill Medical College of Cornell University,
Rates: Complete details regarding Associate Professor of Pediatrics The Reading Hospital and Medical Center NY
Medical Director, Pediatric Therapy
circulation, coverage, advertising Medical College of Georgia West Reading, PA Koravangattu Sankaran, FRCP(C),
rates, space sizes, and similar Augusta, GA Michael R. Jackson, RRT FAAP, FCCM
CWN 6 Neonatal Respiratory Care Professor of Pediatrics and Director of
information are available to Curtis D. Caldwell, NNP Brigham & Women’s Hospital Neonatology and Neonatal Research
prospective advertisers. Closing date UNM School of Medicine Boston, MA Department of Pediatrics
Department of Pediatrics Royal University Hospital
is 45 days preceding date of issue.
Albuquerque, NM Chang-Ryul Kim, MD University of Saskatchewan
Associate Professor of Pediatrics Saskatoon, Saskatchewan, Canada
Change of Address notices should Ed Coombs, MA, RRT College of Medicine
be sent promptly to Circulation Sr. Marketing Manager - Ventilation Hanyang University Kuri Hospital Istvan Seri, MD, PhD
Department: provide old mailing DTerlafeogrde,r PMAedical Seoul, South Korea PHreoafde,s sUoSrC o fD Piveidsiioantr iocsf Neonatal Medicine
label as well as new address: include David M. Kissin BS, RRT University of Southern California
Jonathan Cronin, MD
Perinatal/Pediatric Specialist Los Angeles, CA
zip code or postal code. Allow two Associate Chief of Neonatology
Maine Medical Center
months for change. Massachusetts General Hospital for Portiand, ME Otwell D. Timmons, MD
Children Assistant Professor of Pediatrics
Editorial Contributions may be Harvard Medical School Sheldon Korones, MD University of Utah Medical Center
Cambridge, MA Director of Newborn Center Salt Lake City, UT
sent by e-mail and will be handled
College of Medicine
with reasonable care: however, Michael P. Czervinske, RRT Memphis, TN Maya Vazirani, MD, FAAP
Neonatal and Pediatric Critical Care Board Certified Neonatology and
publishers assume no responsibility University of Kansas Medical Center Raymond Malloy, BS, RRT Pediatrics
for safety of art work, photographs, Kansas City, KS Director of Pulmonary Care Lancaster, CA
or manuscripts. Every precaution Professor Adekunle H. Dawodu TPhhoilmadaesl pJehfiafe, rPsAon University Hospital Max Vento, MD
is taken to ensure accuracy, but Chairman of Pediatrics Associate Professor of Pediatrics
Faculty of Medicine and Health Sciences Paul J. Mathews, PhD, RRT, Chief, Pediatric Services
the publishers cannot accept
United Arab Emirates University FCCM, FCCP, FAARC Neonatologia Hospital Virgin del Consuelo
responsibility for the correctness Al Anin, UAE Associate Professor of Respiratory Care Valencia, Spain
or accuracy of informa tion supplied University of Kansas Medical Center
Jayant Deodhar, MD Kansas City, KS Dharmapuri Vidyasagar, MD
herein or for any opinion expressed. Associate Professor of Clinical Pediatrics Professor of Pediatrics
Editorial closing date is the first day Children’s Hospital Center William Meadow, MD Department of Pediatrics
Cincinnati, OH Associate Professor University of Illinois
of the month preceding month of
Department of Pediatrics Chicago, IL
issue. Leonard Eisenfeld, MD The University of Chicago
Associate Professor of Pediatrics
Chicago, IL
University of Connecticut School of
©2009 by Goldstein & Associates,
Medicine David G. Oelberg, MD
Inc. All rights reserved. Reproduction Division of Neonatology Center for Pediatric Research
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permission is strictly prohibited.
Norfolk, VA
Sami Elhassani, MD
Neonatologist Rahmi Ors, MD
Spartanburg, SC Chief, Division of Neonatology
6 neonatal INTENSIVE CARE Vol. 22 No. 7 n November-December 2009
INL-006 NIC-RT.eps 8/9/07 9:10:19 AM
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NEW_NICMagAdQuiet5.qxd:NIC Mag Ad Quiet 5.qxd 9/3/09 11:42 AM Page 1
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patients > 2.5 kg
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o < 2.5 kg: trend monitoring
(cid:116)(cid:1) (cid:47)(cid:80)(cid:79)(cid:74)(cid:79)(cid:87)(cid:66)(cid:84)(cid:74)(cid:87)(cid:70)(cid:1)(cid:74)(cid:79)(cid:69)(cid:74)(cid:68)(cid:66)(cid:85)(cid:74)(cid:80)(cid:79)(cid:1)(cid:80)(cid:71)(cid:1)(cid:48) changes in the cerebral and
2
(cid:81)(cid:70)(cid:83)(cid:74)(cid:81)(cid:73)(cid:70)(cid:83)(cid:66)(cid:77)(cid:1)(cid:68)(cid:74)(cid:83)(cid:68)(cid:86)(cid:77)(cid:66)(cid:85)(cid:80)(cid:83)(cid:90)(cid:1)(cid:84)(cid:90)(cid:84)(cid:85)(cid:70)(cid:78)(cid:84)
o Often providing an early warning of O defi cits associated
2
with impending shock and anaerobiosis
Labeling claims not applicable to other devices as data was derived using the INVOS System and its
proprietary algorithm.
© Somanetics Corporation. Somanetics, INVOS and “Refl ecting the color of life” are registered trademarks of Somanetics
Corporation. US federal regulations restrict the sale of this device to, or on the order of, licensed medical practitioners.
Learn more at www.somanetics.com | 800.359.7662
Somanetics_NeonatalIntensiveCare_Jun09_SMS1084.indd 1 5/7/09 9:25:32 PM