640 e-Letters

  • 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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  • Staffing in NICUs is more that a 1:1 nurse to patient ratio
    Kaye Spence

    I read the article by Watson et al and the accompanying Editorial. While it is an interesting concept to link nurse patient ratios with mortality this does not take into account the individual nurses and their experiences. I would challenge the authors to demonstrate how retrospective data measures acuity and nursing experience. The authors presented the 1:1 ratio as measured by the percentage of ICU days where there wa...

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  • The Dr Isaac 'Harry' Gosset Collection
    Andrew N Williams

    The 'Dr Isaac 'Harry' Gosset Collection' a repository of UK General Paediatric and Premature Baby Care 1947-1965 is now on line.

    http://www.northamptongeneral.nhs.uk/AboutUs/Ourhistory/Dr-Gosset/The -Dr-Isaac-Harry-Gosset-Collection.aspx

    Conflict of Interest:

    I am the author of the paper I am replying to

  • End of Life Decisions - Do we make them wisely?
    anthony cohn

    Hellman, Knigthon et Al and Carter in the accompanying editorial raise many issues dealing with the end of life care of sick newborn babies. Although consensus within multidisciplinary teams in each centre is recorded as being achieved relatively easily, the wide variation between centres in how each deals with the issue of withholding life saving treatments, particularly where there are 'quality of life issues' und...

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  • Incostintencies in defining "Work of breathing"
    Paola Papoff

    We read with great interest the recent article by Shetty et al (Arch Dis Child Fetal Neonatal Ed 2016;0:F1-F4) who showed that continuous positive airway pressure (CPAP) and humidified high-flow nasal cannula (HHFNC) in infants with evolving or established bronchopulmonary dysplasia (BPD) have similar effects on work of breathing (WOB).1 Like many other articles in this field, Shetty's paper unfortunately suffers from in...

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  • Re: The reliability and safety of self-inflating bags for PIP/ PEEP delivery to neonates is all but clear
    Mark Tracy

    Title: Reliance on manikin and bench studies of manual infant resuscitators: the devil is in the detail

    Dear Sirs

    Thank you for the opportunity to respond to Dr Roehr and colleagues' comments on our paper1. Our results in contrast to those of Morley2 and Kelm3 show consistent measured levels of PEEP close to the set values1.

    We feel an important detail has been overlooked in ignoring the manu...

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  • The reliability and safety of self-inflating bags for PIP/ PEEP delivery to neonates is all but clear
    Charles C Roehr

    Dear Sirs, We read with interest the recent work by Dr Tracy and colleagues: "The effectiveness of Ambu neonatal self-inflating bag to provide consistent positive end-expiratory pressure", doi:10.1136/ archdischild-2015-308649 ADC FN&N Ed. 2016.

    We would like to comment on the statement and findings by Tracy et al. Firstly, a strong point of the paper is that the authors have systematically investigated t...

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