Guest Editorial
Article Outline
Advances and new possibilities in neonatal care continue to astound us. Only decades ago, the arrival of surfactant revolutionized management and increased survival of the tiniest babies. Proper delivery of care has become more complex as different agencies provide new standards to reframe neonatal practices. The Joint Commission on Accreditation of Healthcare Organizations' National Patient Safety Goal #3 specifically focuses on improving the safety of using medications.1 Hefting even greater fiscal impact, on October 1, 2008, the Centers for Medicare and Medicaid Services implemented a new provision within the Deficit Reduction Act 2005 which prevents payment for certain preventable errors in care.2 Its repercussions provide that hospital-acquired injuries due to preventable medication errors would not be reimbursed. Although the neonatal intensive care unit (NICU) is not usually a habitat for Medicare patients, a number of our patients are Medicaid beneficiaries, and other insurers have historically been known to use their reimbursement guidelines as a benchmark. Clearly, this will eventually impact the NICU, our practice environment. As health care providers, maintaining currency in our knowledge base has now been elevated to an even greater level of responsibility. To support that end, this issue is dedicated to new pharmacologic strategies and considerations.
An emerging strategy for ameliorating the effects of hypoxic ischemic encephalopathy is hypothermia therapy. As many centers seek to adopt and implement various cooling protocols, much remains to be discovered about the effects of hypothermia on the neonatal metabolism and the pharmacology of commonly administered medications to these critically ill patients. Santina Zanelli and Karen Fairchild present a comprehensive substantive review of the literature as well as their clinical perspectives and recommendations from the University of Virginia, one of the first centers to adopt and implement the protocols from the initial cooling trials.
Congenital heart defects have been reported to occur in as many as 4 in 1000 to 50 in 1000 live births.3 From one of the nation's leading pediatric cardiovascular surgery programs, JoAnn Nieves and Marilyn Torres of Miami Children's Hospital present a fascinating discussion of new pharmacologic agents on the horizon for use in the smallest complex cardiac patients.
Skin, the largest organ in the body, has been referred to as the “first battlefield” and barrier to infection.4 From Cincinnati Children's Hospital, Marty Visscher presents an update on topical agents in use in the neonatal population, including a review of skin physiology and specific profiles of the active ingredients in many commonly used preparations.
Infection in the NICU continues to present a menacing challenge, even more so as management of newly resistant organisms becomes more elusive. Marie Ambroise takes an in-depth look at the problem of antibiotic resistance and describes specific agents, including those that target extended spectrum β lactamase–producing organisms.
The Joint Commission on Accreditation of Healthcare Organizations' National Patient Safety Goal 03.05.01 specifically addresses diminishing patient harm associated with the use of anticoagulant therapy. No other single medication has merited more attention in the press of late than heparin. Melissa Otoya presents a critical review of the literature related to the common utilization of heparin as a strategy for achieving line longevity and as a flush solution. She raises some thought-provoking questions to consider as institutions are challenged to develop or redesign medication safety systems to evolve toward the goal of being completely error free.
The problem of maternal drug use continues, and we see the unfortunate results as neonatal abstinence syndrome all too often. Karen D'Apolito profiles the current pharmacologic strategies for management including a new therapeutic agent that is achieving noteworthy results.
The current reactive architecture of the health care landscape mandates that maintaining up-to-date knowledge regarding medications is no longer an option. For the safety of our tiny patients, it is our only choice.
References
- Joint Commission on Accreditation of Healthcare Organizations. Available at: http://www.jcaho.org. [Accessed 11/30/08].
- Centers for Medicare & Medicaid Services. Available at: http://www.cms.hhs.gov. [Accessed 11/30/08].
- . The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890–1900
- . Skin: the first battlefield. Anesth Analg. 2003;97:933–935
PII: S1527-3369(08)00163-3
doi:10.1053/j.nainr.2008.12.001
© 2009 Elsevier Inc. All rights reserved.
