Too much neonatal care?

[black small square] Many places may have too many neonatologists and devote too many resources to caring for sickly infants, according to a new study. Researchers found almost no difference in newborn death rates across the Unites States, regardless of how many specialized care providers a region has. Only sickly newborns in areas with 2.7 or fewer neonatologists for every 10,000 births had a higher death rate (about 7% higher) than elsewhere.

Researchers used data from the American Medical Association and the American Osteopathic Association to evaluate the supply of neonatologists and neonatal intensive care unit (NICU) beds in 246 neonatal intensive care regions. They compared this data to an infant's risk of death within the first 27 days of life.

In more than 3 million births of infants weighing 500 g or greater, the average death rate is 3.4 per 1,000 births. Less deaths occurred in areas with 4.3 neonatologists per 10,000 births. But a higher saturation of neonatologists in a region didn't translate into greater reductions in mortality rates. Critics argue that mortality rates are too crude of an outcome measure-researchers should also have looked at morbidity.

Source:"The Relation between the Availability of Neonatal Intensive Care and Neonatal Mortality," The New England Journal of Medicine, D. Goodman, et al., May 16, 2002.

Drug-coated stents give sub-par performance

[black small square] Coronary artery stents coated with a drug that inhibits cell growth may not prevent restenosis as well as hoped, according to results of a small study. Researchers examined 15 patients 6 and 12 months after they'd received drug-coated stents to open blocked arteries. At 6 months, two patients had experienced restenosis and one had died. At 12 months, eight patients had restenosis and one patient had experienced a myocardial infarction.

Although the stent appeared to work well at first, the benefits vanished in a year's time. Researchers speculate that the stent's plastic sleeve, not the drug, may explain the stent's disappointing performance.

Source:"First Clinical Experience with a Paclitaxel Derivate-Eluting Polymer Stent System Implantation for In-Stent Restenosis. Immediate and Long-Term Clinical and Angiographic Outcome," Circulation : F. Liistro, et al., April 1, 2002.