Reflections on Errors in Neonatology: I. The “Hands-Off” Years, 1920 to 1950

Robertson, Alex

doi:10.1038/sj.jp.7210842

Cited by 50 publications

(36 citation statements)

References 48 publications

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“…The most important group of enzymes involved in phase I metabolism are cytochrome (CYP) P450 enzymes [7]. A lack of activity of these enzymes can be responsible for the extreme toxicity syndromes that have been seen in premature infants, such as grey sickness or grey baby syndrome with chloramphenicol and gasping syndrome with benzyl alcohol [18,30,31].…”

Section: Metabolismmentioning

confidence: 99%

Pharmacokinetics in neonatal prescribing: evidence base, paradigms and the future

O’Hara

Wright

Schneider

et al. 2015

Brit J Clinical Pharma

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Paediatric patients, particularly preterm neonates, present many pharmacological challenges. Due to the difficulty in conducting clinical trials in these populations dosing information is often extrapolated from adult populations. As the processes of absorption, distribution, metabolism and excretion of drugs change throughout growth and development extrapolation presents risk of over or underestimating the doses required. Information about the development these processes, particularly drug metabolism pathways, is still limited with weight based dose adjustment presenting the best method of estimating pharmacokinetic changes due to growth and development. New innovations in pharmacokinetic research, such as population pharmacokinetic modelling, present unique opportunities to conduct clinical trials in these populations improving the safety and effectiveness of the drugs used. More research is required into this area to ensure the best outcomes for our most vulnerable patients.

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Section: Metabolismmentioning

confidence: 99%

Pharmacokinetics in neonatal prescribing: evidence base, paradigms and the future

O’Hara

Wright

Schneider

et al. 2015

Brit J Clinical Pharma

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“…Many of these were outlined by Dr. William Silverman in his book Retrolental Fibroplasia (18). In addition, Dr. Alex Robertson recently published three papers detailing some major mistakes that have occurred in neonatology (195)(196)(197). The second and third papers are concerned with errors that occurred since 1950.…”

Section: Errors In Neonatologymentioning

confidence: 99%

The Evolution of Neonatology

Philip

2005

Pediatr Res

544

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In 1960, the terms "neonatology" and "neonatologist" were introduced. Thereafter, an increasing number of pediatricians devoted themselves to full-time neonatology. In 1975, the first examination of the Sub-Board of Neonatal-Perinatal Medicine of the American Board of Pediatrics and the first meeting of the Perinatal Section of the American Academy of Pediatrics were held. One of the most important factors that improved the care of the neonate was the miniaturization of blood samples needed to determine blood gases, serum electrolytes, glucose, calcium, bilirubin, and other biochemical measurements. Another factor was the ability to provide nutrition intravenously, and the third was the maintenance of normal body temperature. The management of respiratory distress syndrome improved with i.v. glucose and correction of metabolic acidosis, followed by assisted ventilation, continuous positive airway pressure, antenatal corticosteroid administration, and the introduction of exogenous surfactant. Pharmacologic manipulation of the ductus arteriosus, support of blood pressure, echocardiography, and changes in the management of persistent pulmonary hypertension, including the use of nitric oxide and extracorporeal membrane oxygenation, all have influenced the cardiopulmonary management of the neonate. Regionalization of neonatal care; changes in parent-infant interaction; and technological changes such as phototherapy, oxygen saturation monitors, and brain imaging techniques are among the important advances reviewed in this report. Most remarkable, a 1-kg infant who was born in 1960 had a mortality risk of 95% but had a 95% probability of survival by 2000. However, errors in neonatology are acknowledged, and potential directions for the future are explored. Abbreviations AAP, American Academy of Pediatrics BPD, bronchopulmonary dysplasia CPAP, continuous positive airway pressure ECMO, extracorporeal membrane oxygenation ELBW, extremely low birth weight HMD, hyaline membrane disease iNO, inhaled nitric oxide IUGR, intrauterine growth restriction IVH, intraventricular hemorrhage L/S, ratio of lecithin, phosphatidyl choline, to sphingomyelin NICU, neonatal intensive care unit PDA, patent ductus arteriosus PEEP, positive end expiratory pressure PPHN, persistent pulmonary hypertension of the newborn PVH, periventricular hemorrhage RDS, respiratory distress syndrome ROP, retinopathy of prematurity SIDS, sudden infant death syndrome VLBW, very low birth weight VON, Vermont-Oxford Network "There is need for specialization in neonatal medicine. This applies to doctors and nurses as well as teaching and construction of hospitals. The specialist in neonatal diseases and the nurse intensively trained and expert in the management of delicate newborns will be commonplace ere long." J.W. Ballantyne, 1923 (1) "In previous times the problems of the newborn child have been the province of the obstetrician, a field in which he has taken comparatively little interest and to which he has contributed little. As pediatricians we have but s...

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“…There have been periods of "therapeutic exuberance" 82 where physicians entered into clinical care with a "great spirit of innovation, somewhat lacking discipline". 83 These misguided efforts were always with the best of intentions, unfortunately sometimes with devastating results. The following is a review of this topic in newborn medicine as it pertains to the field of pharmacology.…”

Section: Pharmacological Misadventures In Newborn Medicinementioning

confidence: 99%