Neonatal intensive care unit

Each infant participated in two series of tests at 34 and 36 weeks PCA. Tests were conducted in the neonatal intensive care unit, with the baby laying face up with the head held in place by rolled cotton towels. During each of these test series,... 

Menon PA, Thach BT, Smith CH, et al. Benzyl alcohol toxicity in a neonatal intensive care unit. Incidence, symptomatology, and mortality. Am J Perinatal 1984 1(4) 288-292. 

Calafat AM, Needham EL, Silva MJ, Lambert G (2004) Exposure to di-(2-ethyUiexyl) phthalate among premature neonates in a neonatal intensive care unit. Pediatrics 113 e429-e434... 

Weuve J, Sanchez BN, Calafat AM, Schettler T, Green RA, Hu H, HauserR (2006) Exposure to phthalates in neonatal intensive care unit infants urinary concentrations of monoesters and oxidative metabolites. Environ Health Perspect 114 1424—1431... 

Spillover costs on other sectors (e.g. additional educational costs related to the proportion of children who survive neonatal intensive care units with learning disabilities)... 

LaPointe DR, Arnold AD, Eichelberger WJ, 2002. Quality improvement projects to enhance safety and efficacy of gentamicin in a neonatal intensive care unit. ASHP Midyear Clinical Meeting, Adanta, GA. 

One needs to keep in mind that the use of drugs by the mother will sometimes lead to impairment of the activity of bilirubin-UDP-glucuronyltransferase. Phenothiazines are an example of this kind of interaction. The use of drugs in the neonatal intensive care unit also can contribute to hyperbilirubinemia. Usually, the medications that compete for binding sites on albumin are the culprits in this case (see section on Bilburin Transport). An example of this type of interaction is the use of furosimide, which is a diuretic used to decrease fluid retention and improve cardiac function and renal output. 

S. C., Pinsky, P.P., Jarvis, W.R., Ott, C.E., Mai olis, H.S. Hepatitis A outbreak in a neonatal intensive care unit risk factors for transmission and evidence of prolonged viral excretion among preterm infants. J. Infect. Dis. 1991 164 476 - 482... 

Brown, W.J. Buist, N.R.M. Gipson, H.T.C. Huston, R.K. Kennaway, N.G. Fatal benzyl alcohol poisoning in a neonatal intensive care unit. Lancet 1982, 1, 1250, Letter... 

In a prospective study on the prevalence of hearing impairment in a neonatal intensive care unit population (a total of 942 neonates were screened), aminoglycoside administration did not seem to be an important risk factor for communication-related hearing impairment (148). In almost all cases, another factor was the more probable cause of the hearing loss (dysmorphism, prenatal rubella or cytomegaly, a positive family history of hearing loss, and severe perinatal and postnatal complications). 

Coudray S, Janoly A, Belkacem-Kahlouli A, Bourhis Y, Bleyzac N, Bourgeois J, Putet G, Aulagner G. Erythromycin-induced digoxin toxicity in a neonatal intensive care unit. J Pharm Chn 2001 20 129-31. 

Case Conclusion Because of her reaction to the terbutaline, PC is placed on IV MgS04. Her contractions abate and she continues on the medication for the next 48 hours. At that time, the medication is discontinued and she remains acon-tractile. She is discharged to home, but presents 2 weeks later with stronger contractions. On her second admission, the MgSO is unable to stop her labor and she delivers a 32-week infant weighing 1400 g. She is quite concerned about her infant, but he does well in the neonatal intensive care unit and is discharged home on day of life 23. 

E510 Conrad, P.D., Sparks, J.W., Osberg, L, Abrams, L. and Hay, W.W. (1989). Clinical application of a new glucose analyzer in the neonatal intensive care unit Comparison with other methods. J. Pediatr. 114, 281-287. 

Once one knows the problem and has devised a solution, then the real job begins. National Center for Health Statistics data show a decline in total US infant mortality from 1982 to 1992, but marked geographic and racial differences remain. The 1992 overall US rate of infant death was 8.5 per 1000 live births (California, 6.9 Texas, 7.7 New York, 8.5 New Jersey, 8.5 Pennsylvania, 8.6 Ohio, 8.7 Florida, 9.1 Illinois, 10.0 Georgia, 10.4 Michigan, 10.5) - a decline attributed not to reductions in the numbers of birth defects or premature births but to improved neonatal intensive care units and the introduction of synthetic pulmonary surfactants and consequent reductions in death from acute neonatal respiratory distress syndrome. Still, the years of potential life lost due to birth defects ranks fifth, just behind that of homicide and suicide (1, unintentional injury 2, cancer 3, cardiovascular disease) prematurity/low birth weight ranks sixth and sudden infant death syndrome seventh. Ethnic discrepancy remains pronounced rates of White (5.8 per 1000 live births) and Cuban Hispanic (3.7 per 1000 live births) infant death are similar, but the 2002 rate for Blacks (13.9 per 1000 live births) increased compared to the previous year. 

The study enrolled 97 infants of gestational ages of 24-33 weeks admitted to the neonatal intensive care unit of Connecticut Children s Medical Center (Hartford, CT) (3). Twenty-eight infants were studied prospectively, 69 retrospectively. The neonates were studied from birth up to a maximum of 18.286 postnatal weeks. Data on daily apneic episodes were obtained on approximately 5000 patient-days for 95 of the neonates. Figure 27.1 shows a distribution of the number of apneic episodes per day across all neonates and postnatal days studied. The mean (SD) number of spells per day was 1.93 (2.91). TTie range was 0-30 episodes per day. Figure 27.2 depicts the time course of the mean daily episode count with respect to postnatal age. The frequency increases up to approximately 1.5 weeks and declines gradually as the infants mature. 

RDS, historically known as hyaline membrane disease (HMD), is more appropriately termed surfactant-deficiency RDS. RDS is associated with considerable morbidity and mortality. Before 35 weeks gestation, the risk of RDS and the severity of disease increase with greater degree of prematurity and, in the absence of appropriate antenatal interventions, occurs in over 50% of newborns of 30 weeks or less gestation. The Vermont Oxford Network experience for 1999 describes over 27,000 neonates below 1500 g from 325 neonatal intensive care unit (NICU) sites. The annual report noted that RDS occurred in over 80% of premature infants below 1000 g and that there was a gradual decline to about 42% of neonates with birth weights between 1400 and 1500 g. 

Rangel-Frausto MS, Wibhn T, Blumberg HM, et al. National Epidemiology of Mycoses Survey (NEMIS) Variations in rates of blood stream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Chn Infect Dis 1999 29 ... 

Lair CS, Kennedy KA. Monitoring postnatal growth in the neonatal intensive care unit. Nutt Clin Pract 1997 12 124-129. 

Clark RH, Wagner CL, Merritt RJ, et al. Nutrihon in the neonatal intensive care unit How do we reduce the incidence of extrauterine growth restriction J Perinatol 2003 23 337-344. 

Jew R, Owen D, Kaufman D, et al. Osmolality of commonly used medications and formulas in the neonatal intensive care unit. Nutr Qin Pract 1997 12 158-163. 

Chang HR, Lian JD, Shu KH, Cheng CH, Wu MJ, Chen CH, Lau YJ, Hu BS (2000) Use of pulsed-field gel electrophoresis in the analysis of recurrent Staphylococcus aureus infections in patients on continuous ambulatory peritoneal dialysis. Am J Nephrol 20 463 67 Chaves F, Garcia-Alvarez M, Sanz F, Alba C, Otero JR (2005) Nosocomial spread of a Staphylococcus hominis subsp. novobiosepticus strain causing sepsis in a neonatal intensive care unit. J Clin Microbiol 43 4877 879... 

The Institute of Medicine (lOM) estimates that between 44,000 and 98,000 deaths annually in the U.S. result from medical errors. While there is some debate about this estimate, it is clear that medication errors are common and result in significant adverse effects, including death. Databases of anonymously reported errors are maintained jointly by the Institute for Safe Medication Practices (ISMP), the U.S. Pharmacopeia Medication Errors Reporting Program (USP MERP), and the FDA s MedWatch program. Adverse drug events occm in 3% of hospitalizations, and this number is larger for special populations such as those in pediatric and neonatal intensive care units. 

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