No abstract

Computer generated and dictated discharge summaries were compared for all 133 babies admitted for intensive and special care during a six month period. Whereas 130/133 (98%) had a computer generated summary, only 94/ 133 (71%) had a dictated summary. In addition, computerised summares were completed at discharge, but there was a delay up to 26 weeks for dictated summaries. Dictated summaries had more items of basic data missing but were more readable. A main diagnosis was missing in only 5/95 (5%) of dictated and 1/130 (1%) computerised summar- We have conducted an initial evaluation of the computer generated summaries by comparing them with dictated summaries. We noted the number of summaries and the time it took to complete them, and compared a number of basic data items and the diagnoses for each baby. We also looked at their readability. As we planned to give a copy of the summary to the parents, we also assessed whether or not we considered the summaries suitable for them. Materials and methods DATA COLLECTIONClinical data about any infant requiring intensive or special care are entered into the computer by paediatric staff who select relevant systems from a menu (table 1). To minimise the need to enter negative answers, a branching method of data entry is used so that further information is only requested when relevant, only systems with abnormalities are selected, and only important problems are entered.For short stays in the baby unit all the clinical information can be entered when the baby leaves the unit. For complicated patients who stay a long time information is entered at least weekly to ensure its accuracy.At discharge a list of diagnoses linked to ICD codes is generated by the computer. This is checked, amended as necessary, and the diagnoses ranked in order of importance by the paediatrician. In addition, advice on pertussis immunisation is entered and a statement is made about the baby's neurological and ophthalmological status at discharge. Free text can be added to the discharge letter; this is particularly useful for expanding social problems and discussing prognoses that do not lend themselves to computerisation, but it is discouraged for medical problems.When data entry is complete the discharge summary is generated. Copies are printed for the neonatal notes, general practitioner, midwife or health visitor, or both, and the obstetric notes. A copy may also be printed for Lissauer, Paterson, Simons, Beard the mother. The data are also available for audit, and monthly and annual activity reports have been designed. The computer is also used by nursing staff to generate the daily bed state, which includes details of the level of care each baby is receiving. METHODSDuring the six month period from August 1988 to January 1989 when the computer system was being piloted, discharge summaries were dictated by the senior registrar using information from the clinical notes. These were then typed by a secretary who kept a record of the date the summary was typed, and filed a copy for the stud...

The case highlights the importance of having a clear policy for skin cleansing in every neonatal unit and measures to avoid errors by vigilant checking of all medications including topical solutions.

Objective To measure the incidence of syphilis detected in pregnancy and congenital syphilis in the United Kingdom.

ABSTRACT. A number of studies have indicated that the emphasis on low shear rate viscosity and rouleaux-related pherheologic properties of neonatal blood are different from nomena. those of the adult. The frequent administration of blood components to the neonate during intensive care make it important that these differences be established and their MATERIALS AND METHODS causes understood. The purpose of this study was to make a detailed comparison of the rheologic properties of nee-Blood was obtained from healthy adults by venesection, natal and adult blood, with particular emphasis on low and from the umbilical vein of neonates immediately after shear rate viscosity and rouleaux-related phenomena. The clamping of the cord at delivery. In each case, it was anticoaguviscometric data was obtained from seven preterm (PT) lated with 12.5 U/mL of heparin. The babies were all born and l8 term (NT) babies and with those vaginally and did not require resuscitation. They were of normal l8 (A)-In the present study, "iscometry was wt for gestation age. There were too few preterm babies to group performed Over a wide range Of shear rates, O a 3 them according to gestational age, which ranged from 24 to 35 130 s-', and the low shear rate data were with wk, thus all babies of less than 37 wk were classified as preterm. direct measurement of rouleaux formation using the MY-he adults had an age range of 24 to 50 y with a median age of renne Erythrocyte Aggregometer. A major factor leading 30. to the viscometric differences observed was the high hem-1, a pilot survey, the rheologically important variables-hematOcrit in the newborn (46.8 + 2.1% PT, 52.8 + atocrit, plasma viscosity, and plasma fibrinogen concentration-6-1% NT, 44-1 * 2.5% A 40.5 + A females)-were compared between pre-and normal term babies and adults.ow ever, this tended to be compensated for by the lower This was followed by a more comprehensive hemorheologic plasma (Iso5 * 0.07 mPas PT, * 0-14 mPas study that included the measurement of blood viscosity over a NT,* O e o 8 mPas A-n0 sex difference) and reduced wide range of shear rates. These viscometric studies were made rOuleaux in the and more according to the ICSH Guidelines (7) on blood at native hemamarked in the preterm baby. The lowered levels red tocrit and, after adjustment by adding or subtracting autologous aggregation were found not to be due to cellular differences plasma, at 45%. The hematocrit was measured by microcentribetween the adults and the babies but rather to differing fugation without correction for trapped plasma, plasmaThe presence the fetal variant In some experiments, washed cells were used. The cells were fibrinogen and low levels of immunoglobulins, especially washed, by alternate centrifugation and aspiration of supernaIgM and IgA, are likely be particular imp0rtance. tant, using isotonic PBS. The cells were finally suspended at a (Pediatv Res 25457-460, 1989) hematocrit of 45% in PBS or PBS containing adult human fibrinogen (Kabi Pharmaceuticals, Stockholm, Sweden). Fibrinog...