635 e-Letters

  • Current UK practice: Infant Car Seat Challenges
    Rebecca C H Towler

    This paper highlights some limitations in the use of infant car-seat challenges (ICSCs) to monitor for abnormal cardiorespiratory events prior to hospital discharge[1]. Current practice is non-standardised and unlikely to replicate actual infant experience.

    In the USA it is recommended that all infants born <37 weeks gestation or birth-weight <2500g should have a period of observation in a car-seat prior t...

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  • Response to the article by Zanardo et al
    Stefano Ghirardello

    We read with interest the article by Zanardo et al (1). The authors found a lower pre-ductal SpO2, a higher hearth rate (HR) and hematocrit in term infants born by cesarean delivery (CD) compared to those born by vaginal delivery (VD), similarly to the findings by Dawson et al (2) but not confirmed by others (3). The authors did not mentioned if a different management of cord clamping was performed between vaginal and ce...

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  • How a Belgian daily paper informed its readers about the contents of the review on waterbirth
    Sophie Alexander

    Le Soir, one of Belgium's leading French language newspapers (1), headlined the front page of its 23 May 2016 edition with "Birth in water: a dangerous new fashion." Page 6 was devoted to the review by Taylor et al; the subtitle said "New study underlines the dangers of drowning and pulmonary infection for babies; no benefit from this fashionable birthing technique". I was asked that afternoon, in my capacity of advise...

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  • Re: Handheld Doppler use for measuring newborn HR has been described in the literature
    Amanda Dyson

    We thank Dr Hutchon for his interest in our article and acknowledge his contribution to developing this technique of measuring heart rate rapidly and efficiently in newborns. We were particularly interested to hear of his experience with a Doppler that displays an averaged heart rate. We can see that having a displayed rather than counted Doppler heart rate would be highly practical in the delivery room providing that...

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  • Re:End of Life Decisions - Do we make them wisely?
    Praeksh S Shah

    Reply to End of Life Decisions - Do we make them wisely?: End of life decisions: How do we improve process? We thank Dr Cohn for his response to our paper and for voicing the issues it raised for him. Certainly one of the objectives of the study was to explore whether there were differences in approach to similar medical disorders in NICUs across Canada. We hoped that our finding of differences in what appear to be medical...

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  • Handheld Doppler use for measuring newborn HR has been described in the literature
    David J Hutchon

    We read this article with considerable interest as it confirms that Precordial Doppler Ultrasound (PDU) can detect the neonatal heart rate within seconds of birth, much earlier than is possible with oximetry and much more reliably than with auscultation. As the authors state "Handheld Doppler use for measuring newborn HR has been described in the literature" (by Goenka et al and by Hutchon) "but needs further investigat...

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  • Re: Water births: adverse events for the baby are rare but devastating
    Alastair Sutcliffe

    We are grateful for the interest in our paper and the opportunity to refute the suggestion that it is falsely reassuring. Our paper provides a fair and accurate representation of the best available data; it concludes that "this systematic review and meta-analysis did not identify definitive evidence that waterbirth causes harm to neonates ... However, there is currently insufficient evidence to conclude that there are no...

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  • Re: Current debate about the limit of viability: the neglected majority
    John Lantos

    Neonatal mortality in poor countries

    We appreciate Dr. Berger's astute observation that most of the babies in the world do not have access to neonatal intensive care. His statistics underestimate the extent of the problem. Around the world, 7 million infants die each year. Most die of diseases that are preventable or treatable. Their deaths are due to lack of access to the most basic medical care. This is no...

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  • Current debate about the limit of viability: the neglected majority
    Thomas M. Berger

    It is with great interest that I read the editorial entitled "Delivery room practices for extremely preterm infants: the harms of the gestational age label" by Janvier and Lantos (1) analysing the results of the EPIPAGE-2 study (2). The two authors question the appropriateness of the French non-intervention approach towards infants born at 22, 23 and 24 weeks for whom NICU admission was withheld in 96%, 91% and 38% of cas...

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  • Water births: adverse events for the baby are rare but devastating
    Mark W Davies

    The overall tone of this systematic review is to reassure the reader that waterbirths are safe; this is not justified by the results which rely almost exclusively on extremely poor quality retrospective cohort studies. Different study designs have significant differences in their susceptibility to bias and the authors have largely ignored this issue. Larger, non-randomised studies, more prone to bias, carry more weight ; n...

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