The effect of a neonatal telecardiology system on respiratory therapy in very low birthweight infants

Factors in the U.S. healthcare system have shifted the site of care of many newborns to hospitals where subspecialty services are unavailable. This study examines whether a more rapid turn-around of echocardiogram interpretations and availability of interactive video during neonatal consultations reduces the morbidity of very low birthweight (VLBW) infants. The two groups (n = 21 and n = 28) were similar on the basis of known risk factors. A composite index of respiratory therapy intensivity and duration was used to measure the utilization of respiratory therapies. The index was similar in both groups, 89.6 +/- 12.6 before versus 89.5 +/- 13.0 with telemedicine. These results show little evidence of a reduction in RT utilization.

Comprehensive computerized neonatal intensive care unit data system including real-time, computer-generated daily progress notes

A neonatal intensive care unit patient data system, NeoData, which was developed using microcomputers connected by a local area network, is described. The system allows for real-time generation of daily progress notes, as well as admission and discharge summaries. It includes two databases: one for daily patient data and one for admission/discharge summary data. Both sets of data are easily accessible for later analysis and report generation. The daily patient data are entered directly into a computer by the neonatal intensive care unit medical and nurse practitioner staff; a progress note is printed immediately thereafter for inclusion in the patient's chart. Data from the previous day are selectively carried forward into the current day's note, minimizing data entry. Several benefits are derived from this progress note system, including legibility, tracking of laboratory and other data, tracking of management plans and procedures due at a later date, and significant time savings. The system has proved to be easy to learn, and the neonatal intensive care unit staff have found it to contribute to the efficient delivery of patient care.

Mean airway pressure--significance during mechanical ventilation in neonates

Variations in PEEP with concomitant changes of DPP while MAP, PIP, flow, FIO2, and ventilator rate remained constant were investigated in nine neonates with RDS during the first and second days of life. After stabilization on baseline ventilator settings, PEEP was increased by 3 cm of H2O and DPP decreased in order to maintain balance MAP. Following a return to baseline settings, the PEEP was decreased by 3 cm of H2O and DPP increased sufficiently to maintain constant MAP. Arterial PaO2, PaCO2, pH, blood pressure, heart rate and a/APO2 ratios were measured before, during, between, and after the experimental conditions. Analysis revealed no significant changes in PaO2, a/APO2, blood pressure, or heart rate during baseline or experimental conditions. PaCO2 decreased significantly when PEEP was decreased and DPP increased, both on day 1 (37.2 +/- 2.4 vs 41.4 +/- 2.3 torr; P less than 0.025) and day 2 (42.1 +/- 2.6 vs 46.8 +/- 2.0 torr; P less than 0.05). Changes in pH were inversely related to PaCO2 changes. This study confirms the importance of MAP in determining oxygenation in newborn infants with RDS. However, ventilation was significantly affected by variation in PEEP and DPP despite a constant MAP.