Is Neonatal Medicine in the United States Out of Step?

PEDIATRICS ◽  
1993 ◽  
Vol 92 (4) ◽  
pp. 612-613
Author(s):  
WILLIAM A. SILVERMAN
Keyword(s):  
United States ◽  
Intensive Care ◽  
High Risk ◽  
Neonatal Intensive Care ◽  
Ethical Issues ◽  
The United States ◽  
Medical System ◽  
The World ◽  
Market Driven ◽  
Disproportionate Number

Here are the results of an informal survey which suggest that the number of neonatologists is disproportionately high in the United States: the ratio of neonatologists to liveborn infants may be two to six times higher than in six other countries examined (Table). The rough estimates raise some disturbing questions that can only be answered by formal surveys in each country which include the annual cost of neonatal intensive care (as percent of gross domestic product) and the compensation of neonatologists. In recent years, most of the discussion about the limits of neonatal intensive care has been focused on ethical issues. As costs of medical care have soared throughout the world, questions are now raised about the economic limits of this activity. For example, compared with the United States, has the rest of the world set more realistic financial limits on neonatal intensive care by controlling the number of neonatologists and their compensation? Is the relative surfeit of neonatologists explained by a disproportionate number of high-risk neonates in the United States, or is the number of practitioners market-driven in our laissez-faire medical system? These and other unsettling questions may be ignored, but they will not go away.

Shiva’s Babies

2019 ◽  
pp. 124-141
Author(s):  
Swasti Bhattacharyya
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Neonatal Intensive Care ◽  
Newborn Infants ◽  
Nationwide Survey ◽  
The United States ◽  
Cultural Humility ◽  
Religious Perspectives

Discussing religious views from within any tradition is challenging because they are not monolithic. However, it is worth exploring religious perspectives because they are often the foundation, whether conscious or not, of the reasoning underlying people’s decisions. Following a brief discussion on the importance of cultural humility and understanding the worldview of patients, the author focuses on Hindu perspectives regarding the care of infants in the neonatal intensive care unit. Along with applying six elements of Hindu thought (underlying unity of all life, multivalent nature of Hindu traditions, dharma, emphasis on societal good, karma, and ahimsa), the author incorporates perspectives of Hindu adults, living in the United States, who responded to a nationwide survey regarding the care of high-risk newborn infants in the hospital.

Limitation of Private Attending Pediatricians' Neonatal Intensive Care Privileges in Level III Institutions Throughout the United States

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 190-193
Author(s):  
Rita G. Harper ◽  
Concepcion G. Sia ◽  
Regina Spinazzola ◽  
Raul A. Wapnir ◽  
Shahnaz Orner ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Health Care Providers ◽  
Curriculum Design ◽  
Neonatal Intensive Care ◽  
District Of Columbia ◽  
The United States ◽  
Geographic Region ◽  
Neonatal Intensive Care Units ◽  
Care Providers

Objective. To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States. Design. A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States. Results. Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and >9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (≤10) as well as large (≥60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged. Conclusions. The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.

Variation in Performance of Neonatal Intensive Care Units in the United States

2017 ◽  
Vol 171 (3) ◽  
pp. e164396 ◽  
Author(s):  
Jeffrey D. Horbar ◽  
Erika M. Edwards ◽  
Lucy T. Greenberg ◽  
Kate A. Morrow ◽  
Roger F. Soll ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
The United States ◽  
Neonatal Intensive Care Units

scholarly journals Exploring Innovations in Human Milk Analysis in the Neonatal Intensive Care Unit: A Survey of the United States

2021 ◽  
Vol 8 ◽  
Author(s):  
Stacey R. Ramey ◽  
Stephanie Merlino Barr ◽  
Katie A. Moore ◽  
Sharon Groh-Wargo
Keyword(s):  
United States ◽  
Intensive Care ◽  
Human Milk ◽  
Clinical Setting ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
The United States ◽  
Future Research ◽  
Milk Analysis ◽  
The Us

Introduction: Human milk (HM) is the ideal enteral feeding for nearly all infants and offers unique benefits to the very low birthweight (VLBW) infant population. It is a challenge to meet the high nutrient requirements of VLBW infants due to the known variability of HM composition. Human milk analysis (HMA) assesses the composition of HM and allows for individualized fortification. Due to recent U.S. Food and Drug Administration (FDA) approval, it has relatively recent availability for clinical use in the US.Aim: To identify current practices of HMA and individualized fortification in neonatal intensive care units (NICUs) across the United States (US) and to inform future translational research efforts implementing this nutrition management method.Methods: An institutional review board (IRB) approved survey was created and collected data on the following subjects such as NICU demographics, feeding practices, HM usage, HM fortification practices, and HMA practices. It was distributed from 10/30–12/21/2020 via online pediatric nutrition groups and listservs selected to reach the intended audience of NICU dietitians and other clinical staff. Each response was assessed prior to inclusion, and descriptive analysis was performed.Results: About 225 survey responses were recorded during the survey period with 119 entries included in the analysis. This represented 36 states and Washington D.C., primarily from level III and IV NICUs. HMA was reported in 11.8% of responding NICUs. The most commonly owned technology for HMA is the Creamatocrit Plus TM (EKF Diagnostics), followed by the HM Analyzer by Miris (Uppsala, Sweden). In NICUs practicing HMA, 84.6% are doing so clinically.Discussion: Feeding guidelines and fortification of HM remain standard of care, and interest in HMA was common in this survey. Despite the interest, very few NICUs are performing HMA and individualized fortification. Barriers identified include determining who should receive individualized fortification and how often, collecting a representative sample, and the cost and personnel required.Conclusions: Human milk analysis and individualized fortification are emerging practices within NICUs in the US. Few are using it in the clinical setting with large variation in execution among respondents and many logistical concerns regarding implementation. Future research may be beneficial to evaluate how practices change as HMA and individualized fortification gain popularity and become more commonly used in the clinical setting.

What Is the Legal `Standard of Medical Care' When There Is No Standard Medical Care? A Survey of the Use of Home Apnea Monitoring by Neonatology Fellowship Training Programs in the United States

PEDIATRICS ◽  
1992 ◽  
Vol 89 (6) ◽  
pp. 1083-1088
Author(s):  
William Meadow ◽  
David Mendez ◽  
John Lantos ◽  
Robert Hipps ◽  
Michele Ostrowski
Keyword(s):  
United States ◽  
Intensive Care ◽  
Medical Care ◽  
Neonatal Intensive Care ◽  
Training Programs ◽  
The United States ◽  
Supplemental Oxygen ◽  
Expert Opinions ◽  
Legal Standard ◽  
Apnea Monitoring

In treating a patient, a doctor is obliged to use the skill and care that is ordinarily used by reasonably well-qualified doctors in similar cases. In addition, the only way in which a juror may decide whether the defendant used the skill and care which the law required of him or her is from evidence presented by doctors called as expert witnesses (cf Illinois Pattern Jury Instructions). However, what should be done if expert opinions differ concerning the care that is "ordinarily used"? Home apnea monitoring (HAM) is prescribed at times for graduates of neonatal intensive care units despite the fact that indications for its use are not well established and efficacy is completely unknown. The authors attempted to determine standards for HAM as it is currently practiced in neonatology training programs. The primary teaching hospital for each of the 99 neonatology training programs in the United States was identified. Both the medical director (MD) and a neonatal intensive care unit nurse manager (RN) were asked about the use of HAM in their own nursery for four clinical vignettes. Each vignette depicted a 1000-g birth weight infant, currently 7 weeks old and ready for discharge. In three vignettes, the infant had demonstrated no apnea, mild apnea (resolved by 2 weeks of age), or moderate apnea (requiring theophylline therapy at discharge) during the hospital course. In the fourth vignette, the infant had no apnea but was to be discharged home with supplemental oxygen. For 67 of 99 training programs, paired responses of RN managers and MD directors were obtained. For infants with no apnea or mild apnea, approximately 85% of RN/MD pairs agreed that HAM would not be used at their institution, 2% would use HAM, and 12% responded that they might use HAM depending on individual circumstances. In contrast, for the premature infant with moderate apnea, there was much less agreement. Sixteen percent of RN/MD pairs responded that HAM would not be used, 39% would use HAM, and 19% might. Remarkably, for this vignette 25% of the RN/MD responses disagreed on the practice of HAM at their own center. Similarly, for the infant with home oxygen, 15% of RN/MD responses agreed that HAM would not be used, 49% answered that HAM would be used, 10% were uncertain, and 25% disagreed on the use of HAM at their own center. It is concluded that (1) for premature infants with no or mild apnea, HAM is currently prescribed by a minority of fellowship-associated neonatology programs, and (2) no obvious consensus exists for HAM in the context of moderate apnea or home oxygen therapy. For many infants, there is no "standard care" for HAM in the neonatology community at this time. "Expert" opinions of the legal "standard of care" for HAM should reflect this fact.

Accreditation in advanced critical care echocardiography

2020 ◽  
pp. 365-368
Author(s):  
Anthony Mclean
Keyword(s):  
United States ◽  
Critical Care ◽  
Intensive Care ◽  
Quality Care ◽  
Training Programme ◽  
The United States ◽  
Critical Care Echocardiography ◽  
The World ◽  
Training Standards ◽  
Over Time

The development of smaller, mobile, sophisticated ultrasound machines has been central to echocardiography becoming an everyday tool in the intensive care setting. However, the parallel process of ensuring quality studies are obtained from these machines places a focus on training standards for the doctors operating them. In response, credentialing and certification programmes in advanced critical care echocardiography have come into existence around the world, and although they are not identical, the programmes share many of the same features whether it is run in France, Scotland, Australia, the United States, or elsewhere. The challenge of determining the optimum training programme is an ongoing process and will no doubt evolve further over time. Yet the development of the programmes to date demonstrate how far critical care physicians have come over the past two decades in achieving quality care in the use of echocardiography.

scholarly journals Nurse Staffing in Neonatal Intensive Care Units in the United States

2015 ◽  
Vol 38 (5) ◽  
pp. 333-341 ◽  
Author(s):  
Jeannette A. Rogowski ◽  
Douglas O. Staiger ◽  
Thelma E. Patrick ◽  
Jeffrey D. Horbar ◽  
Michael J. Kenny ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Nurse Staffing ◽  
The United States ◽  
Neonatal Intensive Care Units

Screening for Retinopathy of Prematurity—A Problem Solved?

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 755-757
Author(s):  
John T. Flynn ◽  
Augusto Sola ◽  
William V. Good ◽  
Roderic H. Phibbs
Keyword(s):  
United States ◽  
Intensive Care ◽  
Birth Weight ◽  
Intensive Care Units ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
The United States ◽  
Neonatal Intensive Care Units ◽  
Premature Births ◽  
Indirect Ophthalmoscopy

In the United States there are about 4 million births annually,1 of which about 10% are premature. The percentage of premature births has increased over the last decade2 and every year there are >20 000 infants whose birth weight is 1250 g or under who survive beyond 28 days of life.3 An additional 32 000 surviving infants weigh between 1251 and 1500 g at birth. Both birth weight strata contain, by all that we know about the disease, infants at the highest risk for the development of retinopathy of prematurity (ROP). If infants of these birth weights are to be examined by ophthalmologists competent to perform indirect ophthalmoscopy on these tiny prematures, an average of 6 times during the period of highest susceptibility for the development of threshold ROP4 disease—32 to 40 weeks postconceptional age5,6—then we are talking about ±300 000 such examinations per year in the neonatal intensive care units across this country.

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