Heliox Rso2 Oximetry Mortality Regional Care Maternal Study
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Vol. 22 No. 5 neonatal September 2009 INTENSIVE CARE HELIOX rSO2 OXIMETRY MORTALITY REGIONAL CARE MATERNAL STUDY YOU LIVE AND BREATHE PATIENT SAFETY IN THE NICU. So do we. As the industry leader in pulse oximetry, we’ve been tailoring products for neonatal Nellcor™ patients for more than two decades. Today you can choose from several Nellcor™ OxiMax™ Puritan Bennett™ ™ Airox™ sensors designed for neonates, including sterile adhesive sensors with LoSat expanded accuracy. Mallinckrodt™ LoSat helps you better manage patients in the challenging lower saturation ranges. Plus, our latest DAR™ signal processing technology lets you effectively monitor wiggling infants with weak pulses. Shiley™ Sandman™ For free continuing education courses on topics such as neonatal skin integrity, check out our Center for Clinical Excellence website at www.nellcor.com/ccexcellence. www.covidien.com | 1-800-635-5267 COVIDIEN, COVIDIEN with logo, Covidien logo and positive results for life are U.S. and/or internationally registered trademarks of Covidien AG. All other brands are trademarks of a Covidien company. © 2009 COVIDIEN. All rights reserved. 09-PM-6376v1 Trusted in NICU 07-13-09 Neo Natal Intensive Care job number: ad name: date sent: publication: Sept 8.125 x 10.875 run date: size [email protected] Andre Naval email/FTP: contact Vol. 22 No. 5 neonatal September 2009 INTENSIVE CARE Editorial Trials and Tribulations HELIOX A recent article in BioMed Central discussed parental attitudes toward enrolling rSO2 OXIMETRY children in randomized trials. I thought you might be interested in the discussion. Here MORTALITY REGIONAL CARE are the highlights from the article pertaining specifically to neonatology. MATERNAL STUDY For parents the diagnosis of serious illness in a child can be a shattering experience. When consent is sought soon after diagnosis, parents will be making decisions when they are distressed and vulnerable. Being approached about a trial confronts parents with a volume and complexity of information well beyond their everyday experience Vol. 22 No. 5 and they can never be certain about what is the “right” decision. However, while they may be vulnerable, protecting their child is fundamental to the parental role September 2009 and this will shape how they think about trials. Parents who participated in a survey investigating different types of consent to hypothetical neonatal resuscitation trials were more comfortable with prospective consent than with consent which was deferred, waived or required the parent to “opt-out.” They wanted to be informed about the trial and make the decision themselves. Other surveys provide further evidence that parents value their role in decisions about trial entry—over 90% say they Table of Contents do not want the doctor or nurse to decide on their behalf. Parents upheld these views even when they realized that the quality of their consent was limited or experienced the informed consent process as an additional burden, indicating that consent could indeed serve important symbolic functions. DEPARTMENTS In one neonatal study three-quarters of parents believed their doctors would not ask Editorial: Randomized Trials 4 to do research if it might put babies in real danger and half indicated that they trusted their doctor, and if he or she suggested their baby should enter a trial, they would 1 4 News agree. Though they have authority for their child, parents lack expertise in matters 20 Products related to the child’s illness, and as a consequence, are likely to rely heavily upon the expertise of medical practitioners. 24 Spotlight on Ventilation Parents considering neonatal trials report particularly high levels of distress during 2 4 Case Study/Executive Profile trial discussions and a sense that this impairs their ability to ask questions or seek additional information, occasionally leading them to later doubt their decisions. Some parents will see trials as a threat to their child or fear regretting their decision, while others see trials as offering hope of better treatments for their child. Almost all parents ARTICLES cherish their role in protecting children and want to secure the best outcome for them, but many are aware of complexities of the medical and research context and how this Heliox Therapy for Neonates 25 constrains their fulfillment of this role. 26 Maternal Care Case Study Interactions at the time of trial recruitment offer scope for negotiating these 32 History of Humidifiers complexities if practitioners have the flexibility to tailor discussions to the needs and situation of individual parents. In this way, parents may be helped to retain a sense 34 High Pressure Hydrocephalus that they have acted as good parents to their child whatever decision they make. 38 Absolute Cerebral Oximetry 42 SARS and Neonatal Mortality 47 Norovirus in an NICU Les Plesko 51 Regional Care and Mortality From the article, How do parents experience being asked to enter a child in a 57 Hemodynamic Management of rSO2 randomised controlled trial? by Valerie Shilling and Bridget Young, Division of Clinical Psychology, School of Population, Community and Behavioural Sciences, University of 6 1 Evidence-Based Practice Liverpool, UK, BMC Medical Ethics 2009, © 2009 Shilling and Young; licensee BioMed Central Ltd. The article is open access, distributed under the terms of the Creative Commons Attribution License. 4 neonatal INTENSIVE CARE Vol. 22 No. 5 n September 2009 BLACK YELLOW MAGENTA INL-006 NIC-RT.eps8/9/079:10:19AM CYAN INL-006_NIC-RT_1-Page 1.pgs08.09.200709:17 Cyan Magenta Yellow Black R GB 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 5 25 50 75 95 100 Editorial Advisory Board Arie L. Alkalay, MD Ivan Frantz, III, MD Ataturk School of Medicine Clinical Professor of Pediatrics Professor of Pediatrics Erzurum, Turkey UCLA School of Medicine Chief, Division of Newborn Medicine Michael O’Shea Published seven times each year by Los Angeles, CA Tufts University School of Medicine Boston, MA Wake Forest University School of Medicine M. A. Arif, MD Winston-Salem, NC Goldstein and Associates, Professor of Pediatrics & Head, Philippe S. Friedlich, MD Inc. Neonatology Assistant Professor of Pediatrics G. Battisita Parigi, MD National Institutes of Child Health Keck School of Medicine Associate Professor of Pediatric Surgery 10940 Wilshire Blvd., Suite 600 Karachi, Pakistan University of Southern California University of Pavia Los Angeles, CA Italy Los Angeles CA 90024 Muhammad Aslam, MD Phone: 310-443-4109 Clinical Fellow in Newborn Medicine G. Paolo Gancia, MD Richard Paul, MD Harvard Neonatal-Perinatal Fellowship Neonatologist, Terapia Intensiva Chief, Maternal & Fetal Medicine Fax: 310-443-4110 Program Neonatale-Neonatologia Department of Obstetrics & Gynecology E-mail: [email protected] Children’s Hospital Boston Cuneo, Italy University of Southern California Harvard Medical School/ Harvard Los Angeles, CA Web: www.nicmag.ca University, Boston, MA. George A. Gregory, MD Professor of Pediatrics and Anesthesia Max Perlman, MD Publisher Edward Austin, MD University of California Professor of Pediatrics Assistant Clinical Professor San Francisco, CA The Hospital for Sick Children Steve Goldstein Pediatric Surgery Toronto, Ontario, Canada University of California-San Francisco William R. Halliburton, RRT, RCP Editor Neonatal Respiratory Care Coordinator Boris Petrikovsky, MD San Francisco, CA Professor of Obstetrics and Gynecology Les Plesko Department of Respiratory Care Richard L. Auten, MD Hillcrest Baptist Medical Center Nassau Health Care Corporation East Meadow, NY Senior Editor Assistant Professor of Pediatrics Waco, TX Duke University Medical Center Arun Pramanik, MD Carol Brass Durham, NC Mary Catherine Harris, MD Associate Professor of Pediatrics Professor of Pediatrics Section of Neonatology Associate Editor Bruce G. Bateman, MD Division of Neonatology Department of Obstetrics & Gynecology University of Pennsylvania School of Louisiana State University Laszlo Sandor University of Virginia Medicine Health Sciences Center Charlottesville, VA The Children’s Hospital of Medicine Shreveport, LA Design, Typography, Prepress Philadelphia, PA Benamanahalli K. Rajegowda, MD and Production Management David D. Berry, MD Wake Forest University School of Medicine David J. Hoffman, MD Chief of Neonatology http://accugraphics.net Winston-Salem, NC Clinical Associate Professor of Pediatrics Lincoln Medical and Mental Health Center Penn State College of Medicine Professor of Clinical Pediatrics Circulation, Coverage, Advertising D. Spencer Brudno, MD Staff Neonatologist Weill Medical College of Cornell University, Associate Professor of Pediatrics NY Rates: Complete details regarding The Reading Hospital and Medical Center Medical Director, Pediatric Therapy West Reading, PA circulation, coverage, advertising Medical College of Georgia Koravangattu Sankaran, FRCP(C), FAAP, FCCM rates, space sizes, and similar Augusta, GA Michael R. Jackson, RRT CWN 6 Neonatal Respiratory Care Professor of Pediatrics and Director of information are available to Curtis D. Caldwell, NNP Brigham & Women’s Hospital Neonatology and Neonatal Research prospective advertisers. Closing date UNM School of Medicine Boston, MA Department of Pediatrics Department of Pediatrics Royal University Hospital is 45 days preceding date of issue. Albuquerque, NM Chang-Ryul Kim, MD University of Saskatchewan Associate Professor of Pediatrics Saskatoon, Saskatchewan, Canada Change of Address notices should Ed Coombs, MA, RRT College of Medicine