Neonatal intensive care. When and where is it justified?

Changing trend in perinatal management and outcome of extremely low birthweight (ELBW) infants

Perinatal care of the extremely preterm and low birthweight (ELBW) infant is founded on basic principles of physiology and knowledge about the prevailing pathophysiological mechanisms. New therapies in clinical care are usually introduced non-uniformly, so more often there is a gradual rather than a sudden change in the development of perinatal care, conceivably involving also an important learning process. This was confirmed in an evaluation of respiratory care for ELBW infants (n = 325) over a 9-year period (1986-1994). Although birthweight (mean 815 g) and degree of immaturity at birth (mean 26.7 weeks of gestation) did not change over the years, our trend analysis showed that the survival rate increased from 47% to 70% (p < 0.04) and the percentage of survivors without bronchopulmonary dysplasia and/or major intracranial haemorrhages (ICH grades 3 and 4) increased from 67% to 87% (p < 0.006). We suggest that besides medical treatment per se, refinement and tuning of nursing and medical care procedures will also affect the total outcome of ELBW infants.

Advanced neonatal nurse practitioners in the United Kingdom: where are they and what do they do?

The former Wessex region was the first in England to institute an advanced neonatal nurse practitioner (ANNP) course within the United Kingdom (UK), and at the time of this survey three cohorts had completed the course. The role has been developed over several years in the North American health care system, where it has been shown that ANNPs have the ability to perform as competently and efficiently as junior doctors. It is a major development both in neonatal care and nursing. Following a review of the literature on ANNPs, this paper details the distribution of ANNPs in the UK, and reports on a survey undertaken by the authors, which examined the function, clinical grading and source of funding of ANNPs, as well as examining the ANNPs' view of their role and challenges they have encountered.

Health care technology as a policy issue

Health care technology has become an increasingly visible issue in many countries, primarily because of the rising costs of health care. In addition, many questions concerning quality of care are being raised. Health care technology assessment has been seen as an aid in addressing questions concerning technology, including benefits and costs. A number of industrialized countries have developed active programs of health care technology assessment during the past two decades. Eight countries at similar levels of socio-economic and health development--Australia, Canada, France, Germany, the Netherlands, Sweden, the United Kingdom and the United States--have been examined to gain insights into how they manage health care technology and what place technology assessment has in such management. In addition to seeking general information, specific cases--treatment for coronary artery disease, medical imaging, laparoscopic surgery, treatment of end-stage renal disease, neonatal intensive care, and breast cancer screening--were examined in each country.