Abstract：
:Babies of extremely low birthweight and elderly adults both require expensive and scarce resources, and both have a relatively poor prognosis for survival if they require intensive care. Thus, proposals for rationing often target one or both of these groups. We suspected that although mortality rates might be higher in the neonatal intensive care unit (NICU) than in the adult intensive care unit (ICU), NICU care might nevertheless be more cost effective, where cost efficiency is measured along the dimension of resources targeted to survivors. We examined mortality patterns in our NICU and for adults admitted to our medical intensive care units. We found that adult ICU patients who died consumed many times more ICU resources before their death than did their NICU confreres, independent of the severity of illness or likelihood of dying. Although there may be many legitimate concerns about justice and ethics in the NICU, undue expenditure of society's resources prolonging the dying of extremely low birthweight infants is not among them. To the extent that concerns about distributive justice drive allocation decisions in ICU care, it would seem more justifiable to ration intensive care for the very old, not the very young.
journal_name
Clin Perinatoljournal_title
Clinics in perinatologyauthors
Meadow W,Lantos JD,Mokalla M,Reimshisel Tsubject
Has Abstractpub_date
1996-09-01 00:00:00pages
597-608issue
3eissn
0095-5108issn
1557-9840pii
S0095-5108(18)30231-8journal_volume
23pub_type
杂志文章abstract：:This article discusses the management of short bowel syndrome during the neonatal period. It includes information regarding etiology and pathophysiology and parenteral and enteral nutrition therapy. Finally, a discussion of the role of intestinal transplantation in the treatment of short bowel syndrome is included. ...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1996-06-01 00:00:00
abstract：:Prematurity is the leading cause of perinatal morbidity and mortality in the industrial world, occurring in 4% to 9% of all deliveries, a rate that has remained unchanged during the past decades. Despite the relative minority of obstetric patients affected by this problem, prematurity is responsible for approximately ...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1998-09-01 00:00:00
abstract：:We emphasize again that the prevalence of maternal infections may vary in different populations, and others might arrive at different estimates about the percentage of infants colonized and, concerning those infants colonized, about the percentage with adverse outcomes. Additionally, many women are colonized or infect...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1997-03-01 00:00:00
abstract：:The fetal environment is thus well suited for normal growth and development with oxygen availability exceeding oxidative needs. With impairments in blood gas exchange this excess oxygen acts as a "margin of safety," providing for the maintenance of oxidative metabolism through increases in fractional O2 extraction, al...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1989-09-01 00:00:00
abstract：:Although it has been customary to treat neonatal jaundice at lower serum bilirubin levels in low-birth weight infants than in term infants, the threshold bilirubin levels and long-term benefits for early treatment of preterm infants have not been validated. This article summarizes and evaluates existing evidence and s...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/s0095-5108(05)70012-9
更新日期：2000-03-01 00:00:00
abstract：:Congenital lobar emphysema is an uncommon but potentially life-threatening cause of respiratory distress in the newborn. The clinical picture and radiologic findings are diagnostic. Lobectomy in the distressed neonate is curative. In infants with onset of symptoms between one and four months of age surgery may not be ...
journal_title：Clinics in perinatology
pub_type： 杂志文章
doi：
更新日期：1978-03-01 00:00:00
abstract：:There are various causes for frequent desaturations in infants. Frequent hypoxemia is a significant change in clinical status and must be investigated carefully for possible etiology. When common extra-airway causes for desaturation are ruled out, one should attempt to distinguish between central apnea and obstructive...
journal_title：Clinics in perinatology
pub_type： 历史文章,杂志文章,评审
doi：10.1016/j.clp.2006.12.013
更新日期：2007-03-01 00:00:00
abstract：:This article discusses the background, methodology, previous clinical studies, and the clinical role and limitations of the noninvasive Doppler technique in the assessment of the cerebral circulation of the newborn infant. ...
journal_title：Clinics in perinatology
pub_type： 杂志文章
doi：
更新日期：1985-02-01 00:00:00
abstract：:Although therapies in addition to whole-body cooling are being developed to treat the neonate at risk for hypoxic-ischemic encephalopathy, we have no quickly measured serum inflammatory or neuronal biomarkers to acutely and accurately identify brain injury or to follow the efficacy of therapy. This review covers infla...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/j.clp.2016.04.008
更新日期：2016-09-01 00:00:00
abstract：:Visual evoked potentials (VEPs) are easily recorded in the neonatal intensive care setting using light-emitting diode goggles as the flash stimulus. They are sensitive measures of CNS integrity and are altered or abolished by hypoxia. Prognosis in newborns with birth asphyxia or hypoxia is difficult to predict; howeve...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1993-06-01 00:00:00
abstract：:The increased vulnerability of late preterm infants is no longer a novel concept in neonatology, with many studies documenting excess morbidity and mortality in these infants during the birth hospitalization. Because outcomes related to gestational age constitute a continuum, it is important to analyze data from the g...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/j.clp.2013.07.008
更新日期：2013-12-01 00:00:00
abstract：:Emphasis has been placed on engaging parents in processes of shared decision making for delivery room management decisions of critically ill neonates whose outcomes are uncertain and unpredictable. The goal of antenatal consultation should rather be to adapt to parental needs and empower them through a personalized de...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/j.clp.2017.01.006
更新日期：2017-06-01 00:00:00
abstract：:This article reviews the significance of hypoxic-ischemic encephalopathy and the associated patterns of cerebral injury in the context of the most probable timing of the insult and prognosis. The evolution of the clinical features of significant hypoxic-ischemic encephalopathy, and the diagnostic value of imaging and ...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1989-06-01 00:00:00
abstract：:When cystic hygroma is detected antenatally, the prognosis is usually poor, and intrauterine or neonatal death are common. This seems especially true for Turner syndrome (the largest etiologic group associated with cystic hygroma) and the lethal multiple pterygium syndromes. However, some fetuses with Turner syndrome,...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1990-09-01 00:00:00
abstract：:Several microangiopathic disorders that are encountered during pregnancy provide physicians with a formidable diagnostic challenge. Severe pre-eclampsia with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and many other obstetric and medical or surgical conditions produce similar clinical presen...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/j.clp.2004.06.007
更新日期：2004-12-01 00:00:00
abstract：:The nature of perinatal education has been transformed, reflecting the changes in health care and health care consumers. Because of short maternity stays, the venue of most perinatal education, especially postpartum education, has moved from hospitals to other areas, including the home. In light of conflicting finding...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1998-06-01 00:00:00
abstract：:The evaluation of the craniofacial region is a multistep process. First, sonographic skill and expertise are required to ascertain these often subtle abnormalities. Next, precise measurements must be obtained in appropriate and reproducible planes. Finally, a thorough search for other related fetal anomalies is essent...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/s0095-5108(05)70054-3
更新日期：2000-12-01 00:00:00
abstract：:Neonatology has optimized medical outcomes for high-risk newborns yet neurodevelopmental outcomes continue to be a concern. Basic science, clinical research, and environmental design perspectives have shown the impact of the caregiving environment on the developing brain and the role of professional caregivers in prov...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/j.clp.2011.08.003
更新日期：2011-12-01 00:00:00
abstract：:Human milk provided by healthy and well-nourished mothers is believed to cover the infant's nutrient requirements during the first half year of life. It is composed of a mixture of nutritive components as well as other bioactive factors with relevant physiologic effects in the neonate infant. Human milk composition ha...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1999-06-01 00:00:00
abstract：:Outcomes of neonatal intensive care unit (NICU) graduates have been categorized by rates of neurodevelopmental impairment at 2 years old. Although useful as metrics for research, these early childhood assessments may underestimate or overestimate later functional capabilities. Often overlooked are less severe but more...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/j.clp.2018.05.008
更新日期：2018-09-01 00:00:00
abstract：:The LBW infant with congenital heart defects is likely to be at a higher risk for postoperative death and complications than their normal-sized counterparts because of the effects of prematurity and other organ system dysfunction. Current experience, however, does not suggest that waiting to obtain an arbitrary weight...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/s0095-5108(05)70078-6
更新日期：2001-03-01 00:00:00
abstract：:Neonatal sepsis continues to take a devastating toll globally. Although adequate to protect against invasive infection in most newborns, the distinct function of neonatal innate host defense coupled with impairments in adaptive immune responses increases the likelihood of acquiring infection early in life, with subseq...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/j.clp.2010.04.001
更新日期：2010-06-01 00:00:00
abstract：:Although hyperbilirubinemia is extremely common among neonates and is usually mild and transient, it sometimes leads to bilirubin-induced neurologic damage (BIND). The auditory pathway is highly sensitive to the effects of elevated total serum/plasma bilirubin (TB) levels, with damage manifesting clinically as auditor...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/j.clp.2016.01.006
更新日期：2016-06-01 00:00:00
abstract：:There is now clear evidence that dietary supplementation of omega-3 fatty acid is essential for normal eye and brain development. Corn oil-based diets induce omega-3 deficiency in preterm infants, affecting retinal responses to light, cortical visual evoked potentials, and behavioral measures of visual acuity. Preterm...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1995-03-01 00:00:00
abstract：:The epitome of FAS and ARBD has been documented substantially in the medical literature. There appears to be little question that alcohol is a teratogen. The precise nature for the mechanism of causing congenital defects, whether it be direct or indirect, is still unknown. There is no unequivocal information that can ...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1991-03-01 00:00:00
abstract：:Our current ability to predict neurologic outcome based on intrapartum information is very limited. Adding information on neurologic state during the first days of life adds powerfully to the ability to predict long-term outcome. Further enhancement of predictive abilities will require putting together into single stu...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1989-12-01 00:00:00
abstract：:Antimicrobial-resistant pathogens are of increasing concern in the neonatal intensive care unit population. A myriad of resistance mechanisms exist in microorganisms, and management can be complex because broad-spectrum antibiotics are increasingly needed. Control and prevention of antibiotic-resistant organisms (AROs...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：10.1016/j.clp.2010.06.004
更新日期：2010-09-01 00:00:00
abstract：:Decades of research have led to the understanding of neonatal pulmonary physiology and have influenced the clinical care that neonatologists provide to the sick newborn. Advances in microprocessor technology have allowed for clinical access of the research-based measurements of neonatal pulmonary functions. These eval...
journal_title：Clinics in perinatology
pub_type： 杂志文章
doi：10.1016/s0095-5108(05)70102-0
更新日期：2001-09-01 00:00:00
abstract：:Pulse oximetry, a noninvasive technique of measuring oxygen saturation continuously, is being used increasingly in the intensive care setting. This article provides information regarding physiologic basis and practical aspects of clinical usage of pulse oximetry in the neonate, both in medical and surgical units. ...
journal_title：Clinics in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1989-03-01 00:00:00
abstract：:A scheme of regionalization is proposed in which a regional perinatal system within a defined geographic area permits access of the high risk mother-fetus and infant to the appropriate level of technology for improved perinatal outcome. ...
journal_title：Clinics in perinatology
pub_type： 杂志文章
doi：
更新日期：1976-09-01 00:00:00
