{"title":"Relationship between respiratory control and feeding in the developing infant","authors":"Martha J Miller , Pakaphan Kiatchoosakun","doi":"10.1016/j.siny.2003.11.006","DOIUrl":"10.1016/j.siny.2003.11.006","url":null,"abstract":"<div><p>Simultaneous breathing and nursing from a bottle or breast requires intricate coordination of the muscles that serve both respiration and feeding. During the buccopharyngeal phase of feeding reflex input to the brainstem from the oropharynx and larynx, as well as suprabulbar and chemoreceptor areas controls the sequential activity of the muscles of deglutition. Coordinated development of buccopharyngeal functions generally occurs by 35 weeks post-conceptional age in infants, but can be disrupted by respiratory disease or neuropathology. During the oesophageal phase of feeding, the bolus of food traverses the oesophagus and lower oesophageal sphincter, whose tone is also regulated by nuclei in the brainstem and modulated by respiratory drive. Control of the lower oesophageal sphincter gradually develops postnatally in premature infants. Although symptomatic gastro-oesophageal reflux can be problematic for the term or preterm infant, it does not appear that reflux is a common stimulus for apnoea of prematurity.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"9 3","pages":"Pages 221-227"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.siny.2003.11.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24439687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Development of regionalized perinatal care","authors":"Victor Y.H Yu , Peter M Dunn","doi":"10.1016/j.siny.2003.08.011","DOIUrl":"10.1016/j.siny.2003.08.011","url":null,"abstract":"<div><p>Regionalized perinatal care was first advocated in Canada 35 years ago. Its development in the United States of America (from 1971), United Kingdom (from 1972) and Australia (from 1978), has been described. In all instances, the efforts and perseverance of visionary individuals were crucial in introducing the concepts to the medical profession, and in bringing the principles to national consciousness at a governmental level. Official endorsement of regionalized perinatal care by both the national professional bodies and the central and regional governments was necessary. An important milestone along the path of regionalized perinatal care was the establishment of national training programmes, and the recognition of maternal–fetal medicine and neonatal–perinatal medicine as respective subspecialties for obstetricians and paediatricians. The developmental process requires close collaboration among all three groups (individuals, professional bodies and government) to improve both the quality and availability of perinatal services to a geographically defined region.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"9 2","pages":"Pages 89-97"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.siny.2003.08.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25684361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regionalized long-term follow-up","authors":"Victor Y.H Yu , Lex W Doyle","doi":"10.1016/j.siny.2003.08.008","DOIUrl":"10.1016/j.siny.2003.08.008","url":null,"abstract":"<div><p>The importance of population-based long-term follow-up studies of geographically determined cohorts to evaluate the effectiveness, efficiency and availability of a regionalized perinatal–neonatal care programme is demonstrated by the Victorian Infant Collaborative Study Group. The survival and quality of survival of consecutively born extremely-low-birthweight infants below 1000<!--> <!-->g or extremely preterm infants below 28 weeks' gestation in the state of Victoria were assessed up to 14 years of age over four distinctive eras: 1979–1989, 1985–1987, 1991–1992 and 1997. Both survival and quality-adjusted survival rates rose progressively in all birth weight and gestation subgroups, associated with progressively more such infants being born in level III perinatal centres. Cost–effectiveness and cost–utility ratios remained stable overall, with efficiency gains in the smaller infants over time. Regionalized long-term follow-up provides unique information that is not available from institution-based studies, which is vital to the regional organization of perinatal–neonatal care.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"9 2","pages":"Pages 135-144"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.siny.2003.08.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25675763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer Zeitlin , Emile Papiernik , Gérard Bréart , The EUROPET Group
{"title":"Regionalization of perinatal care in Europe","authors":"Jennifer Zeitlin , Emile Papiernik , Gérard Bréart , The EUROPET Group","doi":"10.1016/j.siny.2003.08.004","DOIUrl":"10.1016/j.siny.2003.08.004","url":null,"abstract":"<div><p>This review describes European health policies related to the place of birth of very preterm babies, and the organizational context in which these policies were enacted using data from two European studies. It also compiles available information on the place of birth of very preterm babies from the published literature. In Europe, there is significant diversity in approaches to the provision of intensive care services for the small proportion of pregnant women and babies that need it, both in terms of health policies and the supply and characteristics of maternity and neonatal units. These diverse models in countries with similar levels of development and medical technology could offer an opportunity to understand how different organizational characteristics affect access to care, health outcomes and resource use.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"9 2","pages":"Pages 99-110"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.siny.2003.08.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25684362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Kattwinkel , Lynn J Cook , George Nowacek , Carey Bailey , Warren M Crosby , Hallam Hurt , Jerry Short
{"title":"Regionalized perinatal education","authors":"John Kattwinkel , Lynn J Cook , George Nowacek , Carey Bailey , Warren M Crosby , Hallam Hurt , Jerry Short","doi":"10.1016/j.siny.2003.08.005","DOIUrl":"10.1016/j.siny.2003.08.005","url":null,"abstract":"<div><p>Despite changes in the organization and financing of healthcare delivery, and dramatic increases in the number and distribution of perinatal facilities and professionals over the past three decades, there remains a continuing need for effective and efficient regionalized perinatal outreach education programmes. Both the organizers and the participants should be multidisciplinary and include both inpatient and outpatient providers. Content should be restricted to issues relevant to participants' practice, and include topics ranging from preconception to postpartum and early infant care. There are various effective formats, but consideration should be given to reaching as many providers as possible simultaneously within a given facility, minimizing expense and economizing on participants' time. Evaluation strategies range from assessment of immediate outcomes, which generally examine programme process, to ultimate outcomes, which measure changes in patient care and patient health.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"9 2","pages":"Pages 155-165"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.siny.2003.08.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25675765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regional quality assessment in perinatal care","authors":"Gunilla Lindmark , Jens Langhoff-Roos","doi":"10.1016/j.siny.2003.08.013","DOIUrl":"10.1016/j.siny.2003.08.013","url":null,"abstract":"<div><p>Quality assessment is essential in every sector of health care and, in modern regionalized perinatal care, continuous data should be collected at all levels to give a stable basis for this activity. The discussion of definitions and choice of indicators is in itself an activity that will increase awareness of quality. Modern computer facilities will simplify data storage and analysis, but do not change the need to use a limited number of well-validated and appropriate variables.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"9 2","pages":"Pages 145-153"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.siny.2003.08.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25675764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regionalized neonatal emergency transport","authors":"Brian A. Lupton, Margaret R. Pendray","doi":"10.1016/j.siny.2003.08.007","DOIUrl":"10.1016/j.siny.2003.08.007","url":null,"abstract":"<div><p>This article reviews the components that facilitate an effective neonatal emergency transport network, and discusses the human resources required for safe transport, including a section focused on the option of an expanded role for the paramedic. In addition, the topics of transport equipment, communications, quality assurance, data management, family support and education are addressed in the context of a neonatal transport programme. Finally, elements involved in the organization of neonatal transport and transport issues pertaining to networking of neonatal medical care are highlighted and illustrated with reference to local experience in British Columbia.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"9 2","pages":"Pages 125-133"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.siny.2003.08.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25675762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regionalized perinatal care in North America","authors":"Herman A Hein","doi":"10.1016/j.siny.2003.08.009","DOIUrl":"10.1016/j.siny.2003.08.009","url":null,"abstract":"<div><p>The aim of this article is to familiarize the reader with the status of regionalized perinatal health care in North America, and specifically in the United States of America, using the Iowa regionalization model. The evolution of the regionalization movement in the late 1960s and early 1970s is reviewed. It is noted that the movement was largely without federal government intervention. The role of the March of Dimes in developing the first set of so-called national guidelines is chronicled.</p><p>The Iowa model, utilizing some non-tertiary referral centres, is discussed in depth. This model included extensive outreach education for the entire state, and worked well largely because of the lack of competition to the major university teaching hospital located at the University of Iowa in Iowa City. This was not true for many other states and regions because competition did exist between tertiary centres.</p><p>The impact of managed care systems on the overall role of regionalization is discussed. Suggestions are offered for controlling the impact of third-party payers (managed care) on the quality of perinatal health care. An idealized system of monitoring the impact of regionalization and monitoring the effect of managed care is detailed. Finally, the future of regionalization is discussed in the face of deregionalization in populous areas. The need for the best possible care as close to patients' homes as possible (regionalization) still seems apparent.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"9 2","pages":"Pages 111-116"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.siny.2003.08.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25684363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regionalized perinatal care in developing countries","authors":"Vinod K Paul , Meharban Singh","doi":"10.1016/j.siny.2003.08.010","DOIUrl":"10.1016/j.siny.2003.08.010","url":null,"abstract":"<div><p>Neonatal–perinatal ill health and mortality are overwhelmingly a burden of the developing world. As many as 90% of births, 98% of fetal deaths and 98% of neonatal deaths occur in less developed countries. Regionalized perinatal services were introduced in developed countries when most neonatal mortality was confined to very-low-birthweight babies who required intensive perinatal care to survive. A large proportion of newborn morbidity and mortality in developing countries, however, continues to occur among full-term and moderate-sized low-birthweight neonates who can be managed well in the community and at small hospitals. The model of regionalized perinatal care as practiced in developed countries is, at present, neither affordable nor relevant to the needs of many developing countries. It is possible to achieve considerably lower neonatal mortality rates in resource-poor settings by implementing home-based newborn care delivered by community health workers, and by promoting institutional perinatal care at simple facilities provided by trained midwives.</p></div>","PeriodicalId":74783,"journal":{"name":"Seminars in neonatology : SN","volume":"9 2","pages":"Pages 117-124"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.siny.2003.08.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25684364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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