Ann L. Wilson

The parent-infant relationship. Promoting a positive beginning through perinatal coaching.

A program that provides a practical and efficient way of helping parents learn to communicate with their newborn infant is described, and guidelines for setting up the program are offered.

Perinatal Nurturance: The Beginnings of a Human Relationship

The period of time from the twentieth week of pregnancy to the twenty-eighth day of an infant’s life comprises what has been identified as the perinatal epoch. Perinatal medicine reflects a unique merging of subspecialists in obstetrics and pediatrics, as well as a concept of collaborative care for the mother, developing fetus, and newborn. However, this period encompasses much more than the cooperation of medical specialists who care for the pregnant woman and her baby. It includes all of the factors surrounding the baby’s entry and early days in the world.

Development of the U.S. Federal Role in Children’s Health Care: A Critical Appraisal

In this paper I will examine the history of one way in which the federal government of the United States attempts “to promote the general Welfare” and “secure the Blessings of Liberty to ourselves and our Posterity”, namely, through the provision of health care for children. My account will begin at the turn of the century when the idea of a Children’s Bureau to gather data on the status of the nation’s children was; first conceived. I will argue that, since that time, three themes are dominant in Congressional and public debate about federal responsibility for children’s health care. They are: what is the authority of government to create legislation and policy affecting children’s health; what are the economics of supporting health care for children; and whether health care for children should be a basic human right compelling its provision as a humane act of government. These are issues elected officials have faced and attempted to resolve as they have debated, voted on, and funded legislation for children’s health care.1

HOME UTILIZATION OF INFANT APNEA MONITORS

To investigate the home utilization of apnea monitors, 44 mothers of monitored infants were interviewed by telephone 6 to 8 weeks following discharge from a Level III NICU. Monitoring was prescribed for clinical apnea and bradycardia in 57%, for pneumogram abnormalities in 27%, and for other reasons in 16% of the sample. The infants had a mean gest. age of 32.4 ± 4.1 weeks (± 1 SD) .The mothers were asked if they “always”, “sometimes”, or “never” used the monitor in three situations: (1) at night, (2) during naps, (3) when the infant was out of sight. Ninety-five percent of the mothers reported “always” using the monitor at least at night. Among this group, 34% “always” use the monitor at night only, 25% “always” use it at night plus one other situation and 36% “always” use it in all three situations. Five percent reported that they do not consistently use the monitor in any situation. Chi-square analyses show no significant relationships between use of the monitor and the infants gest. age, sex, length of hospital stay, maternal age, marital status, number of siblings, farm or city residence, reason for monitoring or socioeconomic status. Compliance with a monitor prescription is difficult to establish due to probable variation in counseling given to parents by physicians, nurses and monitor companies. However, it is clear that many parents do not maintain consistent use of home monitors at times when apnea is possible.

601 STATE REPORTING OF LIVE NEWBORNS WEIGHING LESS THAN 500 GRAMS AT BIRTH

In 1981 there was large variation in state reported incidence of live births of newborns weighing less than 500 grams at birth (.3 to 2.4 per 1,000 live births). The states with the lowest neonatal mortality rate (NMR) have the lowest incidence of birth weights less than 500 grams (rho=.70). Assuming that mortality for this weight category is 100%, there is marked variation (5 to 24%) in the contribution of this weight cohort to a states total NMR. Major deficiencies in reporting may exist. For example, Alaska, Arizona and North Dakota report no Native American live births with weights less than 500 grams. Reporting may also depend on the definition of live birth. The American Academy of Pediatrics and American College of Obstetricians and Gynecologists Guidelines for Perinatal Care uses the World Health Organization (WHO) definition of live birth as a baby with signs of life “irrespective of duration of pregnancy”. Standard obstetric and pediatric textbooks offer guidance on this issue varying from adherence to the WHO definition to describing a live birth as greater than 500 grams. Thirty-six states officially use the WHO definition of live birth and nine states have definitions without gestational criteria. Four states have no definition of live birth including Vermont which has the nations lowest NMR. There is evidence to suggest inconsistency in reporting the births of previable newborns which potentially affects national neonatal mortality statistics.