We read with great interest the paper of Dimitrou et al. on the
impact of antenatal steroids and fluid balance in very low birth weight
infants. The authors nicely documented the impact of prenatal steroids on
insensible water loss and on urine output. However, one should be aware
that diuresis, glomerular filtration rate and tubular function all are
different aspects of renal function. While the au...
We read with great interest the paper of Dimitrou et al. on the
impact of antenatal steroids and fluid balance in very low birth weight
infants. The authors nicely documented the impact of prenatal steroids on
insensible water loss and on urine output. However, one should be aware
that diuresis, glomerular filtration rate and tubular function all are
different aspects of renal function. While the authors nicely documented a significant increase in diuresis, they were not able to report on other aspects of renal function.
We recently reported on the interindividual variability of amikacin
clearance at birth in a large cohort of preterm neonates (n=205, <24
-30 weeks) on respiratory support and hereby illustrated the impact of
gestational age, of birth weight and (negative) of the co-administration
of a non-selective cyclo-oxygenase inhibitor while prenatal betamethason
administration had no effect on amikacin clearance[1] hereby confirming an
earlier report in a more limited cohort of preterm neonates (n=159) with
the same clinical characteristics.[2]
As stated by the authors, aminoglycoside clearance reflects
glomerular filtration rate. By consequence - at least in our cohort -
prenatal betamethasone had no effect on glomerular filtration rate.
Unfortunately, we had to use a retrospective approach in our group of
preterm neonates. If the authors by chance collected aminoglycoside
samples for therapeutic drug monitoring, they might have the unique
opportunity to simultaneously study diuresis and GFR in the same cohort of
neonates.
We read with
interest the report by Cataldi et al of the case control study on acute renal
failure in preterm infants in 7 Italian NICUs.1We have recently completed a on...
We read with
interest the report by Cataldi et al of the case control study on acute renal
failure in preterm infants in 7 Italian NICUs.1We have recently completed a one year study
of acute renal failure (ARF) in 467 consecutive admissions to a tertiary
neonatal referral unit.There were 5661
live births in the adjoining maternity unit over the year and 47 admissions
were from out-born patients (1 surgical, 46 medical).We defined ARF as a plasma creatinine >100µmol/l at 48 hrs of age based on
published data of declining creatinine levels in infants of various gestational
ages.241 infants (8.8%
ofNICU admissions) fulfilled this
criteria with renal impairment occurring in 23 of 63 (37%) admissions <28
weeks gestations, 10 of 123 (8.1%) 28 – 32 weeks gestation, 4 of 93 (4.3%) 33 –
36 weeks gestation and 4 of 188 (2.1%) of term infants.Cataldi et al noted that 79% of cases of ARF
occurred in very low birth weight infants <1500g who were all <37 weeks
gestation compared to 63% in our series, which included infants of any
gestation.
We also found
the causes of ARF to be
multifactorial in origin with sepsis the predominant insult in 16/41 (39%),
perinatal asphyxia in 7/41 (17%) and hypotension not associated with sepsis in
4/41 (10%).59% of infants had a pH
<7.3 at the time of onset of the ARF and 39% received inotropic
support.In 13/41 (32%) infants we
found no specific cause other than prematurity.We agree that drug administration may be an important factor with
Indomethacin being used prophylactically on our unit in all ventilated patients
with a birth weight less than 1000g or <28 weeks gestation.
The clinical
management for ARF was conservative in all cases with no infant requiring
dialysis.310/41 patients
(24%) died and in only one was renal failure felt to be a contributing
cause.Cataldi et al reported an 11%
mortality in their 71 patients but these were gathered over 3 years in 7
different units and our series represents a one year survey in one tertiary
unit. The mortality rate will depend upon the proportion of external admissions
to the unit and the treatment of extreme pre-term infants.The patients who died in our series (Table
1) were more premature with a lower birth weight and had a more profound
acidosis.All but 2 of the survivors
in our study had a plasma creatinine < 100µmol prior to discharge.One term infant with perinatal asphyxia had persistent renal impairment
and one child had surgical treatment for posterior urethral valves with
associated renal dysplasia.
We would concur
with Cataldi et al that renal impairment is common in low birth weight infants
and careful attention to fluid and electrolyte management, along with drug
dosing, is essential.However, there is
still a paucity of information on the long-term outcomes of neonates with
ARF.Assessment of renal function
should be part of the long-term follow-up of preterm cohorts as acute renal
impairment combined with potential oligonephronia could lead to hypertension
and renal impairment in later life.2,4
References
1.Cataldi L,
Leone R, Moretti U, et al.Potential
risk factors for the development of acute renal failure in preterm newborn
infants: a case-control study.Arch
Dis Child Fetal Neonatal Ed 2005;90:F514-519
2.Drukker A,
Guignard J-P.Renal Aspects of the Term
and Preterm Infant: A Selective Update. Current Opinion in Pediatrics 2002,
14:175-182
3.Strazdins
V, Watson AR, Harvey B on behalf of the European Pediatric Peritoneal Dialysis
Working Group.Renal replacement
therapy for acute renal failure in children: European guidelines.Pediatr
Nephrol 2004;19:199-207
4.Rostand SG.Oligonephronia, primary hypertension and renal disease: ‘is the child
father to the man?’.Nephrol Dial Transplant 2003;18(8):1434-1438
Table
1:The gestation (mean), weight (mean),
peak creatinine (median) and pH (mean) in infants who died compared to all
preterm infants and all patients in our study.
Isaacs et al. provide no data on gender and circumcision status of the methicillin-resistant Staphylococcus aureus (MRSA) patients.1 This is a significant lapse in view of previous reports that put newborn boys and particularly newly-circumcised boys newborn boys at substantially heightened risk of staphylococcal disease....
Isaacs et al. provide no data on gender and circumcision status of the methicillin-resistant Staphylococcus aureus (MRSA) patients.1 This is a significant lapse in view of previous reports that put newborn boys and particularly newly-circumcised boys newborn boys at substantially heightened risk of staphylococcal disease.2-7
Although male neonatal circumcision is rare in the U.K. because the NHS does not provide this non-therapeutic operation, it remains common in Australia, Canada, and the United States. Doctors circumcised about 13 percent of Australian and Canadian newborn boys in 2003, and in the U.S. the incidence was about 55 percent.
Provision of data on gender and circumcision status would be helpful in identifying and quantifying the MRSA risk to which those medical doctors who perform circumcisions may expose newborn boys.
George Hill Vice-President for Bioethics and Medical Science
Doctors Opposing Circumcision
Suite 42, 2442 NW Market Street
Seattle, Washington 98107-4137
USA
Web: http://www.doctorsopposingcircumcision.org
I thank Dr Maisels for his comments. I agree that pre-discharge
serum bilirubin measurement in newborn infants can predict with reasonable
sensitivity the risk of later significant hyperbilirubinaemia. Given the
rarity of extreme hyperbilirubinaemia and associated encephalopathy,
however, the numbers of infants studied in the papers cited by Dr Maisels
are too small to determine whether universal pre-d...
I thank Dr Maisels for his comments. I agree that pre-discharge
serum bilirubin measurement in newborn infants can predict with reasonable
sensitivity the risk of later significant hyperbilirubinaemia. Given the
rarity of extreme hyperbilirubinaemia and associated encephalopathy,
however, the numbers of infants studied in the papers cited by Dr Maisels
are too small to determine whether universal pre-discharge bilirubin
measurement reduces the frequency of these adverse outcomes. The findings
of Newman et al, that combining this measurement with clinical risk
factors enhances its predictive value, lend support to the notion that
bilirubin measurement alone is insufficient, and must be considered in the
clinical context. [1]
Apart from the difficulties in obtaining evidence of clinical
benefit, I have concerns with the suggestion to incorporate universal pre-
discharge bilirubin measurement into the UK system of surveillance for two
reasons; first, this would increase the complexity of the system and
second, it could lend a false sense of security to surveillance of infants
who are considered to be at low risk for later significant
hyperbilirubinaemia.
The current UK system of universal clinical surveillance, while
labour intensive, is conceptually simple. Undoubtedly, however, it
sometimes fails and this may lead, as Dr Maisels suggests, to some infants
suffering severe hyperbilirubinaemia. Maintaining compliance would become
more difficult as the system becomes more complex, and professionals
making individual risk assessments 'in the field' based on timed serum
bilirubin measurements may not perform as effectively as might be assumed
from the findings of the studies cited by Dr Maisels.
When population-derived risk assessments are applied to individuals,
both health professionals and lay persons may misinterpret, and draw
unduly optimistic conclusions from, low risk assignment. While the
Bhutani nomogram has strong positive predictive value,[2] about in in 200
infants with a pre-discharge serum bilirubin mesasurement imparting low
risk will later have a measurement above the 95th centile. [1,3] If
professionals reduce their vigilance for infants assigned low risk status,
these infants may be put at risk for significant hyperbilirubinaemia. A
low early serum bilirubin concentration, furthermore, cannot reassure
against the possibility of lactation failure, or systemic illness,
contributing to later severe jaundice. More evidence of clinical benefit,
and safety, is needed to justify the introduction of universal pre-
discharge serum bilirubin measurement in the UK.
References
1. Newman TB, Liljestrand P, Escobar GJ. Combining clinical risk factors
with bilirubin levels to predict hyperbilirubinaemia in newborns. Arch
Pediatr Adolesc Med 2005; 159: 113-119.
2. Bhutani VK, Johnson L, Sivieri EM. predictive value of a pre-
discharge hour-specific serum bilirubin for subsequent significant
hyperbilirubinaemia in healthy term and near-term infants. Pediatrics
1999; 103: 6-14.
3. Stevenson DK, Fanaroff AA, Maisels MJ et al. Prediction of
hyperbilirubinaemia in near-term and term infants. Pediatrics 2001; 108:
3
1-39.
I read this paper with interest. This putative association is another
example of a "factoid" that has been handed down as fact from one
generation of clinicans to the next. It would be interesting to know the
origin.
We reviewed the evidence in our journal club some years ago( below) and
came to the same conclusion: urinary tract abnormalities and preauricular skin tags
The presence of preauricular skin t...
I read this paper with interest. This putative association is another
example of a "factoid" that has been handed down as fact from one
generation of clinicans to the next. It would be interesting to know the
origin.
We reviewed the evidence in our journal club some years ago( below) and
came to the same conclusion: urinary tract abnormalities and preauricular skin tags
The presence of preauricular skin tags is a poor predictor of structural
renal abnormalities
Renal ultrasound is not routinely indicated in these babies
Citation/s:
Kohelet D, Arbel E . Pediatrics vol 105 No5 May 2000.
A prospective search for urinary tract abnormalities in infants with
isolated preauricular tags.
Lead Author's name and fax: David Kohelet: kdavid@post.tau.ac.il
Three-part Clinical Question: in new-born babies with isolated
preauricular skin tag are renal tract abnormalities more common?
Search Terms: preauricular skin tag The Study:
The Study Patients: well new-born babies with isolated preauricular
skin tag
Independent, partly blind comparison with a reference (gold) standard.
There was an appropriate spectrum of patients. The gold standard was not
applied regardless of the test result (i.e. babies without skin tags did
not all have a renal ultrasound scan).
Target disorder and Gold Standard: renal USS
Diagnostic test: presence or absence of skin tag (clinical exam)
The Evidence:
Target Disorder: Renal tract abnormal
Test: presence of skin tag
Present
Absent
Test Result
Num
Prop
Num
Prop
Likelihood Ratios
Positive
6
a
64
b
44.58
20.60 to 96.50
Negative
31
c
17531
d
0.84
0.73 to 0.97
Sensitivity:
16%
4 to 28
Specificiity:
100%
100 to 100
Prevalence:
0%
0 to 0
Positive Predictive Value:
9%
2 to 15
Negative Predictive Value:
100%
100 to 100
Comments:
Blinding was not explicitly stated. “Control” group were babies being
investigated for vomiting + cyanosis (i.e. not healthy controls). Study
babies had ultrasound on day 3 or 4. Age at which the “controls” were
scanned was not stated, but likely to be some weeks later, when many
milder cases of hydronephrosis would be expected to have resolved.6 of 70
babies with skin tags had a renal abnormality detected on ultrasound.
However, the importance of the findings is debatable (5 had grade 2-3
hydronephrosis and one had horseshoe kidney), most or all could be
expected to resolve spontaneously.
Interrogation of the data with 2x2 table (above) suggests to us that the
authors’ conclusions (renal ultrasound routinely for babies with
preauricular skin tags) is not justified.
The second paper was a retrospective case note review of babies with
ear abnormalities who had been referred to 2 genetics centres and who had
undergone renal ultrasound. Therefore felt not to be relevant to our
patient population.
Appraised by: Richard Nicholl Neonatal Unit Northick Park ; 18 April
2002
Email: richard.nicholl@nwlh.nhs.uk
Three important data are missing from this article:
(1) The seniority of doctors who assess the cranial ultrasound
interpretation not mentioned in the ANZNN Data, this could account for the
discrepancy in diagnosis.
(2) 2D images (Still pictures) are not substitute for 2 D Real time
Video images , this should be the gold standard for Cranial ultrasound
interpretation
Three important data are missing from this article:
(1) The seniority of doctors who assess the cranial ultrasound
interpretation not mentioned in the ANZNN Data, this could account for the
discrepancy in diagnosis.
(2) 2D images (Still pictures) are not substitute for 2 D Real time
Video images , this should be the gold standard for Cranial ultrasound
interpretation
(3) It is easy to diagnose Parenchymal Haemorrhages in 2 D (still pictures).
Hassan and Shah(1) do not mention recently published national
policies and standards for newborn blood spot screening (formerly known as
the Guthrie test) produced by the Department of Health-funded UK Newborn
Screening Programme Centre(2). These include clear guidance on best
practices for taking blood spot samples and state that it is not essential
for the heel to be warmed prior to the heel puncture. A...
Hassan and Shah(1) do not mention recently published national
policies and standards for newborn blood spot screening (formerly known as
the Guthrie test) produced by the Department of Health-funded UK Newborn
Screening Programme Centre(2). These include clear guidance on best
practices for taking blood spot samples and state that it is not essential
for the heel to be warmed prior to the heel puncture. A systematic review
found that warming the heel had no impact on pain responses or need for
repeat samples(3). More research is needed with only two studies of heel
warming ever published. In both studies assessment of the outcomes was not
blind(4,5).
In our regional survey prior to the publication of the new national
guidance, we found 97% of midwives reported warming the heel prior to heel
puncture(6). However, as clearly illustrated by Hassan and Shah, hot water
in the nappy is a potentially unsafe method of warming the heel. If
clinicians feel compelled to warm the heel, heel warmers that provide a
safe and consistent temperature are commercially available and should be
used.
Interestingly, like the senior midwives referred to in this case
report, parents of babies with phneylketonuria, who regularly perform heel
pricks, have told us that keeping the baby warm with clothing is helpful.
We would welcome research on the effectiveness of heel warming and of
warming the whole baby for obtaining blood samples from newborn infants.
N.B. The UKNSPC is funded by the Department of Health for England. The
opinions expressed here are those of the authors.
References
1. Hassan Z, Shah M. Scald injury from the Guthrie test: should the
heel be warmed? Arch. Dis. Child. Fetal Neonatal Ed. 2005;90;533-534.
2. UK Newborn Screening Programme Centre. Newborn blood spot
screening in the UK: Health Professional Handbook. 2005;1-52.
www.newbornscreening-bloodspot.org.uk.
3. Franck LS, Gilbert R. Reducing pain during blood sampling in
infants. In: Barton S (ed.). Clinical Evidence. London: BMJ Publishers,
2003;9; 419-435.
4. Barker DB, Willets B, Cappendijk VC, et al. Capillary blood
sampling: should the heel be warmed? Arch.Dis.Child. Fetal Neonatal Ed.
1996:74;F139-140.
5. Janes M, Pinelli J. Comparison of blood sampling using an
automated incision device with and without warming the heel. J. Perinatol.
2002;22;154-158
6. Cavanagh CM, Coppinger C, Franck LS. How midwives obtain samples
for the newborn blood spot screening: a survey of current practice.
Br.J.Midwifery 2005;3;160-164.
In his commentary on the recent American Academy of Pediatrics
Guidelines for the management of neonatal hyperbilirubinemia [1] Dr Manning
notes that the "British system of midwifery based universal surveillance
of recently discharged infants should not be abandoned" and I
enthusiastically endorse this view. The AAP recommendations for follow-up
are quite specific – any infant who is discharged before a...
In his commentary on the recent American Academy of Pediatrics
Guidelines for the management of neonatal hyperbilirubinemia [1] Dr Manning
notes that the "British system of midwifery based universal surveillance
of recently discharged infants should not be abandoned" and I
enthusiastically endorse this view. The AAP recommendations for follow-up
are quite specific – any infant who is discharged before age 72 hours
should be seen within 2 days of discharge. This recommendation applies to
all infants although it is noted that even earlier follow-up might be
necessary for infants who have several risk factors whereas those
discharged with few or no risk factors might be seen after a longer
interval. There is no suggestion that predischarge bilirubin levels
should be the sole determinant of follow up.
It is true, as noted by Dr Manning, that the actual values provided
in the AAP (Bhutani) nomogram [2] might not apply to every population and it
would be helpful if nomograms could be devised for different populations.
This would also take into account the variability encountered in the
laboratory measurement of bilirubin. On the other hand, there is little
doubt that the principle of risk assessment using a transcutaneous or
serum bilirubin level before discharge has universal application. The
Bhutani nomogram was used in an international study of infants in the USA,
Japan, Hong Kong and Israel and its predictive power was fully confirmed.[3]
A more recent US study has also validated this methodology [4] as have
similar, if not identical, studies in Turkey, [5] Spain [6] and Israel.[7] It
would be surprising if this approach was not similarly effective in
Britain. The clinical risk factors listed in the AAP guideline are also
not unique to the North American population.
Unfortunately, in the USA, we do not enjoy the superb public health
service provided in the United Kingdom where all mothers and infants
receive at least one and often more postnatal home visits from a midwife
in the first week after hospital discharge. But it is hard to imagine
that knowing whether or not a baby is at high or low risk for developing
severe hyperbilirubinemia would not be of some value to a midwife when she
assesses a newborn and makes a decision about the need for obtaining a
bilirubin level. Dr Manning notes that kernicterus is also occurring in
the UK and I wonder if some form of predischarge risk assessment, by
drawing attention to certain infants, might have helped to prevent some of
these unfortunate outcomes.
Universal post-discharge surveillance is one of the principles
enunciated in the AAP guideline. Unfortunately, we have a long way to go
before we can be satisfied that this recommendation is being followed by
physicians throughout the USA. A home visit by a midwife on the day after
discharge followed by additional visits in the first week provides
marvelous support for the mother and baby and is a tribute to the British
health care system. Please don’t give this up but do help your physicians
and midwives by also assessing the risk of subsequent severe
hyperbilirubinemia before the baby leaves the hospital.
References
(1) Manning D. American Academy of Pediatrics guidelines for
detecting neonatal hyperbilirubinaemia and preventing kernicterus. Arch
Dis Child Neonatal Ed 2005; 90:F450-F451.
(2) Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a
predischarge hour-specific serum bilirubin for subsequent significant
hyperbilirubinemia in healthy-term and near-term newborns. Pediatrics
1999; 103:6-14.
(3) Stevenson DK, Fanaroff AA, Maisels MJ, Young BWY, Wong RJ, Vreman
HJ et al. Prediction of hyperbilirubinemia in near-term and term infants.
Pediatrics 2001; 108:31-39.
(4) Newman TB, Liljestrand P, Escobar GJ. Combining clinical risk
factors with bilirubin levels to predict hyperbilirubinemia in newborns.
Arch Pediatr Adolesc Med 2005; 159:113-119.
(5) Alpay F, Sarici S, Tosuncuk HD, Serdar MA, Inanc N, Gokcay E. The
value of first-day bilirubin measurement in predicting the development of
significant hyperbilirubinemia in healthy term newborns. Pediatrics 2000;
106:E16.
(6) Carbonell X, Botet F, Figueras J, Riu-Godo A. Prediction of
hyperbilirubinaemia in the healthy term newborn. Acta Paediatr 2001;
90:166-170.
(7) Kaplan M, Hammerman C, Feldman R, Brisk R. Predischarge bilirubin
screening in glucose-6-phosphate dehydrogenase-deficient neonates.
Pediatrics 2000; 105:533-537.
i was taking seroxat(20mg) per day in 2001.i became pregnant
and decided that i should stop taking seroxat,as doctors were unable to
provide any data to say that it was safe to take during pregnancy.
several weeks later,after terrible withdrawl(which my doctor refused
to put down to withdrawl,just sickness in pregnancy)my daughter was born
prematurely at 28 weeks gestation.she was 2lb 4oz and very poorly.we had...
i was taking seroxat(20mg) per day in 2001.i became pregnant
and decided that i should stop taking seroxat,as doctors were unable to
provide any data to say that it was safe to take during pregnancy.
several weeks later,after terrible withdrawl(which my doctor refused
to put down to withdrawl,just sickness in pregnancy)my daughter was born
prematurely at 28 weeks gestation.she was 2lb 4oz and very poorly.we had
months of agony as she was in the neonatal unit,doctors had no reason for
the prem rupture of membranes.
i was convinced then that it was due to the seroxat and still am.
obviously,i became very depressed while our baby daughter was
fighting for her life in hospital,so doctors recommended that i start
seroxat treatment again.
i did,and in the summer of 2002 i became pregnant again with another girl.
at the 20 week routine scan,it was confirmed that her arms were
considerably shorter than normal and we were referred to a specialist.the
scans showed that there were 2 missing radius bones,therfore,the hands
turned inwards.
an agonising decision for us to make,but,no-one could confirm a
diagnosis of a syndrome,and we were told we would have to wait until the
baby was born for a diagnosis.
after the recent problems with our daughter,we could not not have
coped with a child in hospital who could have died,so we made a decision
that the pregnancy would be terminated.
on 26th september i gave birth to abigail grace,at 22weeks gestation.an
autopsy showed many problems-missing radius bones,a slight facial
abnormality,a ductal liver plate malformation,a sandal gap on both
feet.(this is from memory,so not correct medical terms).
no syndrome could be matched to these problems,so genetic advice was
advised.
one day i hope that someone will be able to say that what happened to
us,was a result of my taking seroxat in pregnancy.i know in my heart that
it was,we have a healthy 9 year old son,and we are both healthy people.our
beautiful daughter made a full recovery and is now nearly 4 years old.
i later came off seroxat which took months and was a horrible
experience.i am prone to bouts of depression-and no doctor in the world
could ever convince me to take those tablets again-so i muddle through the
best i can.
i dont think that seroxat is safe to take during pregnancy,and i wish
that data was available to people to show them that.
We read with interest the paper by Bramwell et al.[1] and we would like to add
our experience on this issue.
Unrestricted visiting policy has been prectised at our NICU since early
80s. Even now, our Unit is the only one practising unrestricted visiting
among the 15 NICUs in Greece. Initially parents were present during ward
rounds. However several things became apparent.
We read with interest the paper by Bramwell et al.[1] and we would like to add
our experience on this issue.
Unrestricted visiting policy has been prectised at our NICU since early
80s. Even now, our Unit is the only one practising unrestricted visiting
among the 15 NICUs in Greece. Initially parents were present during ward
rounds. However several things became apparent.
1. During ward rounds
parents present were trying to overhear what was discussed about their
baby. It was also evident that they could neither understand medical
jargon frequently used or fully appreciate what had been discussed. These
had fairly frequently led to misunderstanding regarding their baby's true
condition. These erroneous perceptions had to be explained and reverted by
the medical staff. Also parents seemed to fixate on numbers of laboratory
results mentioned during the ward round which again had led to erroneous
perceptions regarding their baby's true condition.
2. Parents had been
overhearing medical discussions regarding other babies and sometimes had
contacted and informed the parents of the relevant baby. This on some
occasions had created problems with the particular parents receiving
information in such a way and further explaining had to be undertaken by
the medical staff. Also some parents complained that they did not wish
other parents to overhear information regarding their baby.
3. Medical and
nursing staff had felt that the presence of parents had a restrictive
effect on how a baby could or should be discussed. Concluding parents are
not any more present during ward rounds. However, we have not formally
evaluated this approach. Parents are now formally informed on major issues
after the main ward round by the consultant(s) in the presnce of the
doctor on duty. On minor issues doctors and nurses inform the parents
while the visit their baby.
Reference
1. R Bramwell, M Weindling for the FVWR Research Team. Families’ views on ward rounds in neonatal units
Arch. Dis. Child. Fetal Neonatal Ed. 2005; 90: F429-F431.
Dear Editor,
We read with great interest the paper of Dimitrou et al. on the impact of antenatal steroids and fluid balance in very low birth weight infants. The authors nicely documented the impact of prenatal steroids on insensible water loss and on urine output. However, one should be aware that diuresis, glomerular filtration rate and tubular function all are different aspects of renal function. While the au...
Dear Editor
We read with interest the report by Cataldi et al of the case control study on acute renal failure in preterm infants in 7 Italian NICUs.1We have recently completed a on...
Dear Editor
I thank Dr Maisels for his comments. I agree that pre-discharge serum bilirubin measurement in newborn infants can predict with reasonable sensitivity the risk of later significant hyperbilirubinaemia. Given the rarity of extreme hyperbilirubinaemia and associated encephalopathy, however, the numbers of infants studied in the papers cited by Dr Maisels are too small to determine whether universal pre-d...
Dear Editor
I read this paper with interest. This putative association is another example of a "factoid" that has been handed down as fact from one generation of clinicans to the next. It would be interesting to know the origin. We reviewed the evidence in our journal club some years ago( below) and came to the same conclusion: urinary tract abnormalities and preauricular skin tags The presence of preauricular skin t...
Dear Editor
Three important data are missing from this article:
(1) The seniority of doctors who assess the cranial ultrasound interpretation not mentioned in the ANZNN Data, this could account for the discrepancy in diagnosis.
(2) 2D images (Still pictures) are not substitute for 2 D Real time Video images , this should be the gold standard for Cranial ultrasound interpretation
(3) It is...
Dear Editor
Hassan and Shah(1) do not mention recently published national policies and standards for newborn blood spot screening (formerly known as the Guthrie test) produced by the Department of Health-funded UK Newborn Screening Programme Centre(2). These include clear guidance on best practices for taking blood spot samples and state that it is not essential for the heel to be warmed prior to the heel puncture. A...
Dear Editor
In his commentary on the recent American Academy of Pediatrics Guidelines for the management of neonatal hyperbilirubinemia [1] Dr Manning notes that the "British system of midwifery based universal surveillance of recently discharged infants should not be abandoned" and I enthusiastically endorse this view. The AAP recommendations for follow-up are quite specific – any infant who is discharged before a...
i was taking seroxat(20mg) per day in 2001.i became pregnant and decided that i should stop taking seroxat,as doctors were unable to provide any data to say that it was safe to take during pregnancy.
several weeks later,after terrible withdrawl(which my doctor refused to put down to withdrawl,just sickness in pregnancy)my daughter was born prematurely at 28 weeks gestation.she was 2lb 4oz and very poorly.we had...
Dear Editor
We read with interest the paper by Bramwell et al.[1] and we would like to add our experience on this issue. Unrestricted visiting policy has been prectised at our NICU since early 80s. Even now, our Unit is the only one practising unrestricted visiting among the 15 NICUs in Greece. Initially parents were present during ward rounds. However several things became apparent.
1. During wa...
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