Sleeping position: change in practice, advice, and opinion in the newborn nursery

OBJECTIVE

Sudden infant death syndrome (SIDS) is a major cause of infant mortality and is associated with the prone sleeping position. The goal of this study was to determine changes in newborn nursery policies and practices regarding infant sleeping position between 1992 and 1999.

STUDY DESIGN

The researchers conducted telephone interviews with the head nurses in all of the newborn nurseries in Missouri.

POPULATION

In 1992 there were 79 hospitals in Missouri with newborn nurseries; in 1999 that number had decreased to 75.

OUTCOMES MEASURED

During the interviews, the researchers solicited nursery infant sleep position policy and practice, head nurses' opinions about the supine sleep recommendation, and nurses' advice to parents regarding sleep position.

RESULTS

In 1992, 32% of the nurseries used the prone position for sleep, and 58% of the head nurses interviewed disagreed with the recommendations of the American Academy of Pediatrics (AAP). By 1999, all newborn nurseries in Missouri placed infants on their backs or sides for sleep. The rate of disagreement with the AAP recommendation had decreased, with 25% of respondents indicating that they disagreed.

CONCLUSIONS

From 1992 to 1999 nurseries in Missouri have changed from predominantly using prone and lateral positioning to lateral and supine positioning for newborns. Some nurses continue to voice concern about placing infants on their backs and expressed a willingness to place babies prone. Since there is agreement between nurses' usual infant positioning and the advice given to parents, and because both are important influences on infant positioning by parents, future campaigns to decrease SIDS should emphasize correcting nurses' positioning behavior and advising parents to increase infant supine positioning.

Urinary tract infections during pregnancy

Urinary tract infections are common during pregnancy, and the most common causative organism is Escherichia coli. Asymptomatic bacteriuria can lead to the development of cystitis or pyelonephritis. All pregnant women should be screened for bacteriuria and subsequently treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin. Ampicillin should no longer be used in the treatment of asymptomatic bacteriuria because of high rates of resistance. Pyelonephritis can be a life-threatening illness, with increased risk of perinatal and neonatal morbidity. Recurrent infections are common during pregnancy and require prophylactic treatment. Pregnant women with urinary group B streptococcal infection should be treated and should receive intrapartum prophylactic therapy.

Trigeminal neuralgia. New treatment options for a well-known cause of facial pain

Trigeminal neuralgia is an idiopathic disorder of unilateral facial pain that is characterized by lancinating paroxysms of pain in the lips, gums, cheek, or chin. Pain in trigeminal neuralgia is associated with physical triggers. Much of the treatment has been unchanged for more than 10 years, with cabamazepine being the standard first-line treatment. There are several promising new medications available, such as pimozide, tizanidine hydrochloride, and topical capsaicin. Surgical management is also effective.

Resident partnerships: an effective strategy for training in primary care

BACKGROUND AND OBJECTIVES

To facilitate resident training in the ambulatory setting, a few family practice residency programs use a partnership system to train residents. Partnerships are pairs of residents from the same year that rotate together on inpatient services. We identified and characterized the advantages and disadvantages of partnership programs in family practice residencies.

METHODS

We conducted a national survey of family practice residencies, followed by phone interviews with residency directors of programs with partnerships.

RESULTS

A total of 305 of 407 (75%) residencies responded; 10 programs fit our definition of partnership. Program directors were positive about resident partnerships. Benefits included improved outpatient continuity, enhanced medical communication skills, and emotional and intellectual support. Disadvantages were decreased inpatient exposure and difficulty coordinating residents' schedules.

CONCLUSIONS

Directors were favorable about partnerships, which seem to be an underutilized technique to improve residency training.