eLetters

71 e-Letters

published between 2011 and 2014

  • Cardiac assessment using echocardiography in the sick neonate - An unmet need for a training syllabus for aspiring neonatologists
    John Madar

    In the UK speciality training through the grid scheme has been in existence for about a decade with a well-defined syllabus of knowledge and skills deemed necessary for the qualified neonatologist. Although much emphasis is laid on various aspects of neonatal care and the acquisition of procedural skills including cranial ultrasound, cardiac assessment using echocardiography is still considered to be an optional skill (1)...

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  • Decision-making during preterm birth in Italy
    Carlo Dani

    Dear Dr. Gallagher,

    We read with great interest your paper "European variation in decision-making and parental involvement during preterm birth". We would like to point out that in Italy there are not national guidelines for the resuscitation of infants at 22 to 25 weeks of gestation as reported in table 1. In 2008 the Italian National Committee of Bioethics published, with the endorsement of our Government, a docum...

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  • Response to the two letters regarding tongue-tie, from Dr Essex and Mr Mercer
    Alan Emond

    Dr Essex and Mr Mercer highlight many of the reasons why we undertook the Bristol Tongue Tie trial. Ankloglossia is a spectrum condition, which overlaps with 'normal' variation in anatomy, and milder forms do not result in feeding impairment. There is very limited evidence of the need for frenotomy in mild-moderate degrees of tongue tie. However, it is also true that at the severe end of the spectrum infants can be limi...

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  • Banked donor human milk: more research is needed
    Gopi Menon

    We thank Dr. Verd and colleagues for their comments [1] on our review of the use of human milk for preterm infants. Our aim was certainly not to discourage the use of donor human milk, but rather to look objectively at the evidence base that currently exists for its use.

    The authors of the letter refer to a 1984 study by Narayanan et al [2] which appeared to show a reduction in the risk of infection in infants fe...

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  • The child has rights!
    Nigel S G Mercer

    Sirs

    The tongue remains with in the boundaries of the mandible during suckling and so it is difficult to see the anatomical or the physiological basis for how a frenulectomy works in reducing breast and nipple discomfort during feeding. This randomised trial does not seem to assess the potential, positive psychological impact of the mother being told their child has had a frenulectomy. That is the question that...

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  • Most tongue tie is the medicalisation of childhood
    Charles Essex

    Lawson's editorial and Emond and colleagues' article exposes potentially bad medicine: lack of knowledge of normal and variations of normal; lack of knowledge of the natural history of a condition; a desire to do something - Ulysses syndrome (1); medicalising the child by giving the condition a name; and then ascribing any improvement to the intervention, forgetting that association does not mean causation.

    Th...

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  • Re: Strengthening the evidence base on frenulotomy
    Alan Emond

    Dear Editors:

    We read Val Finigan's letter with interest, and agree with her experience that most mothers do report an improvement in the comfort and efficacy of breastfeeding after their baby has had a frenotomy. The difficulty is in showing objective improvement in breastfeeding after division of less severe degrees of tongue tie.

    In the Bristol Tongue Tie Trial, the median age of the babies at...

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  • Concerns regarding statistical presentation and interpretation
    Jane M Hawdon

    I am writing to express my concern regarding the discordance between the results and conclusions of this paper. The paper compares a point of care glucose measurement with a laboratory "gold standard". The results are presented in a number of forms (and with no consistency regarding units of measurement). The error-grid analysis is unhelpful as high levels will be high and low levels will be low for both methods and the scale...

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  • Strengthening the evidence base on frenulotomy
    Val Finigan

    Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie. Edmond et al (2014)

    Dear Editor, I read this report on frenotomy to support breastfeeding with great interest as currently there is limited evidence to support this procedure. The outcomes contrast considerably with my own experience and audit data, particularly with regard to persistence of breastfeeding for more...

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  • Neonatal rotavirus immunisation, and breast feeding friendly hospitals
    John C Dearlove

    Sirs, we were surprised to read that11 out of 56 units in the resource rich UK did not administer Rotavirus vaccine to their babies. (1) Thirty years ago, one of us described a neonatal rotavirus outbreak that had a considerable morbidity (2). Although these outbreaks continue(3.), some low resource units like ours (Birth rate 3000/year) are accredited as Breast Feeding Friendly and have adopted a very enthusiastic breast...

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