A History of Neonatal Medicine—Past Accomplishments, Lessons Learned, and Future Challenges. Part 1—The First Century

Lussky, Richard C.; Cifuentes, Raul F.; Siddappa, Ashajyothi M.

doi:10.5863/1551-6776-10.2.76

Cited by 6 publications

(6 citation statements)

References 70 publications

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“…During the 1970s and 1980s significant advances occurred in neonatal care. 62,63 Contraception and pregnancy termination became increasingly available, and there was a reduction in preterm birth which is known to be a strong determinant of perinatal mortality. 64 These changes occurred contemporaneously with the introduction and expansion of CTG use and may well explain the apparent benefit from 60 Oxytocin infusion 50%, epidural 36%.…”

Section: Discussionmentioning

confidence: 99%

Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review

et al. 2020

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Problem: Caesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring. Background: Intrapartum cardiotocograph monitoring is considered to be indicated for women at risk for poor perinatal outcome. Aim: This systematic literature review with meta-analysis examined randomised controlled trials and non-experimental research to determine whether cardiotocograph monitoring rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates for high-risk women. Methods: A systematic search for research published up to 2019 was conducted using PubMed, CINAHL, Cochrane, and Web of Science databases. Non-experimental and randomised controlled trial research in populations of women at risk which compared intrapartum cardiotocography with intermittent auscultation and reported on stillbirth, neonatal mortality, perinatal mortality and/or cerebral palsy were included. Relative risks were calculated from extracted data, and meta-analysis of randomised controlled trials was undertaken. Findings: Nine randomised controlled trials and 26 non-experimental studies were included. Metaanalysis of pooled data from RCTs in mixed-and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy. Discussion: Research evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome. Conclusion: There is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.

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Section: Discussionmentioning

confidence: 99%

Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review

et al. 2020

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“…from use of benzyl alcohol as a bacteriostatic agent, intravenous injections of vitamin E leading to deaths, and long-term side effects of dexamethasone used to treat chronic lung disease. 3 The International Neonatal Consortium (INC) is a multi-stakeholder consortium (nurses, neonatologists, parents, regulators, and industry representatives) that addresses barriers to the development of drugs and therapies for neonates. 4 The National Association of Neonatal Nurses (NANN) and the Council of International Neonatal Nurses, Inc (COINN), are the 2 nursing organizations actively participating in INC since its inception in 2015.…”

Section: Background and Significancementioning

confidence: 99%

“…Bucci-Rechtweg and Ward 11 Lussky et al 3 Outlines factors influencing the current predicament where >90% of neonates in the NICU are exposed to medications that are off-label.…”

Section: Neonatal Researchmentioning

confidence: 99%

Nurses' Knowledge, Communication Needs, and Future Directions in Neonatal Research

Beauman

Eklund²,

Short³

et al. 2023

Advances in Neonatal Care

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Background: Preterm birth is a significant contributor to neonatal morbidity and mortality. Despite legislative efforts to increase pediatric drug development, neonatal clinical trials continue to be infrequent. The International Neonatal Consortium (INC) includes nurses as key stakeholders in their mission to accelerate safe and effective therapies for neonates. Purpose: INC developed a survey for nurses, physicians, and parents to explore communication practices and stakeholders' perceptions and knowledge regarding clinical trials in neonatal intensive care units (NICUs). Methods: A stepwise consensus approach was used to solicit responses to an online survey. The convenience sample was drawn from INC organizations representing the stakeholder groups. Representatives from the National Association of Neonatal Nurses and the Council of International Neonatal Nurses, Inc, participated in all stages of the survey development process, results analysis, and publication of results. Results: Participants included 188 nurses or nurse practitioners, mainly from the United States, Canada, the European Union, and Japan; 68% indicated some level of research involvement. Nurses expressed a lack of effective education to prepare them for participation in research. Results indicated a lack of a central information source for staff and systematic approaches to inform families of studies. The majority of nurses indicated they were not asked to provide input into clinical trials. Nurses were uncertain about research consent and result disclosure processes. Implications for Practice and Research: This study indicates the need to educate nurses in research, improve NICU research communication through standardized, systematic pathways, and leverage nurse involvement to enhance research communication.

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“…What assists them in their decisions and what constrains them? First, we place these questions within the existing scholarship on the history and sociology of neonatology (Anspach 1993, Guillemin and Holmstrom 1986, Heimer and Staffen 1998, Lantos and Meadow 2008, Lussky et al 2005, Mesman 2008, Placencia and McCullough 2011. We then explore the changing professional autonomy of neonatologists as it is emerges in interviews between 1978 and 2017.…”

Section: Introductionmentioning

confidence: 99%

“…Public attention to the plight of imperiled newborns in the United States increased in 1963 after the death of President John F. Kennedy’s infant son, born at about 37 weeks, 39 hours after his birth (Lussky et al . 2005, Placencia and McCullough 2011). Yet the increase in resources devoted to neonatal care over the following decade, including the expansion of NICUs, was accompanied by concern for insufficient expertise to properly care for such unique, complex patients.…”

Section: Introductionmentioning

confidence: 99%

Paradoxes of professional autonomy: a qualitative study of U.S. neonatologists from 1978‐2017

Rozier

Willison

Anspach

et al. 2020

Sociology Health & Illness

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The professional autonomy of physicians often requires they take responsibility for life and death decisions, but they must also find ways to avoid bearing the full weight of such decisions. We conducted in‐person, semi‐structured interviews with neonatologists (n = 20) in four waves between 1978 and 2017 in a single Midwestern U.S. city. Using open coding analysis, we found over time that neonatologists described changes in their sense of professional autonomy and responsibility for decisions with life and death consequences. Through the early 1990s, as neonatology consolidated as a profession, physicians simultaneously enjoyed high levels of professional discretion and responsibility and were often constrained by bioethics and the law. By 2010s, high involvement of parents and collaboration with multiple subspecialties diffused the burden felt by individual practitioners, but neonatology’s professional autonomy was correlatively diminished. Decision‐making in the NICU over four decades reveal a complex relationship between the professional autonomy of neonatologist and the burden they bear, with some instances of ceding autonomy as a protective measure and other situations of unwelcomed erosion of professional autonomy that neonatologists see as complicating provision of care.

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A History of Neonatal Medicine—Past Accomplishments, Lessons Learned, and Future Challenges. Part 1—The First Century

Abstract: This is the first of two articles that will review the history of neonatal medicine. This article will describe the beginnings of the modern era of newborn medicine, review pharmacological misadventures, and describe recent advances in the fields of neonatal and perinatal medicine.

Cited by 6 publications

References 70 publications

Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review

Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review

Nurses' Knowledge, Communication Needs, and Future Directions in Neonatal Research

Paradoxes of professional autonomy: a qualitative study of U.S. neonatologists from 1978‐2017

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