RESUMEN
Very little is known about the alcohol elimination rates of newborns who have had chronic alcohol exposure in utero. In these case reports, blood alcohol levels were taken immediately before delivery, at delivery, and postdelivery for 2 mothers who drank alcohol during their pregnancies and 3 single-birth newborns. Newborn A1 of Mother A had no physical characteristics of fetal alcohol syndrome (FAS). The initial blood alcohol level for this newborn was 38.4 mg/dL 129 minutes after birth, with a subsequent blood alcohol level of 5.5 mg/dL 304 minutes after delivery, resulting in an alcohol elimination rate of 11.3 mg/dL per hour. The blood alcohol level for Mother A was 87.4 mg/dL 66 minutes before delivery. Newborn A2 of mother A had FAS. Sixty minutes after delivery, the blood alcohol level for this newborn was 39.5 mg/dL, and the alcohol level of the mother was 42.1 mg/dL. Newborn B1 of mother B had FAS. At 67 minutes after birth, newborn B1 had a blood alcohol level of 246.5 mg/dL, which dropped to 178.7 mg/dL 302 minutes after birth, resulting in an alcohol elimination rate of 17.3 mg/dL per hour. This alcohol elimination rate is within the metabolism range (15-49 mg/dL per hour) of adults with alcoholism. The maternal blood alcohol level was 265.9 mg/dL 27 minutes before delivery. Blood alcohol levels drawn on both the mother and newborn at delivery and 2 or 3 hourly follow-up levels can provide evidence that fetal alcohol dehydrogenase activity is induced by chronic maternal alcohol use.
Asunto(s)
Trastornos Relacionados con Alcohol/sangre , Etanol/farmacocinética , Complicaciones del Embarazo/sangre , Adulto , Trastornos Relacionados con Alcohol/etnología , Etanol/sangre , Femenino , Trastornos del Espectro Alcohólico Fetal/sangre , Trastornos del Espectro Alcohólico Fetal/etnología , Humanos , Indígenas Norteamericanos , Recién Nacido , Masculino , Tasa de Depuración Metabólica , Embarazo , Complicaciones del Embarazo/etnología , South DakotaRESUMEN
Most American Indian and Alaska Native Children (AIAN) receive health care that is based on the unique historical legacy of tribal treaty obligations and a trust relationship of sovereign nation to sovereign nation. From colonial America to the early 21st century, the wellbeing of AIAN children has been impacted as federal laws were crafted for the health, education and wellbeing of its AIAN citizens. Important public laws are addressed in this article, highlighting the development of the Indian Health Service (IHS), a federal agency designed to provide comprehensive clinical and public health services to citizens of federally recognized tribes. The context during which various acts were made into law are described to note the times during which the policy making process took place. Policies internal and external to the IHS are summarized, widening the lens spanning the past 200 years and into the future of these first nations' youngest members.
Asunto(s)
Atención a la Salud , Política de Salud , Indígenas Norteamericanos , Formulación de Políticas , United States Indian Health Service , Alaska , Consumo de Bebidas Alcohólicas/efectos adversos , Niño , Características Culturales , Atención a la Salud/historia , Atención a la Salud/legislación & jurisprudencia , Atención a la Salud/normas , Atención a la Salud/tendencias , Brotes de Enfermedades/prevención & control , Educación/historia , Educación/legislación & jurisprudencia , Educación/normas , Educación/tendencias , Política de Salud/historia , Política de Salud/legislación & jurisprudencia , Promoción de la Salud , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Indígenas Norteamericanos/historia , Indígenas Norteamericanos/legislación & jurisprudencia , Inuk , Legislación como Asunto/historia , Estados Unidos , United States Indian Health Service/historia , United States Indian Health Service/legislación & jurisprudenciaRESUMEN
American Indian and Alaska Native (AI/AN) people have suffered disproportionately from infectious diseases compared with the general US population. As recently as 25 years ago, rates of hepatitis A and B virus, Haemophilus influenzae type b, and Streptococcus pneumoniae infections were as much as 10 times higher among AI/AN children compared with the general US child population. In the past quarter century, routine use of childhood immunizations for hepatitis A and B viruses has eliminated disease disparities for these pathogens in AI/AN children, and significant decreases have been demonstrated for H influenzae type b, S pneumoniae, and pertussis. Nevertheless, certain infectious diseases continue to occur at higher rates in AI/AN children. The reason for continued disparities is most likely related to adverse living conditions such as household crowding, lack of indoor plumbing, poverty, and poor indoor air quality. Although tremendous strides have been made in eliminating disparities in infectious disease among AI/AN children, further gains will require addressing disparities in adverse living conditions.
Asunto(s)
Costo de Enfermedad , Inmunización , Indígenas Norteamericanos , Infecciones/epidemiología , Inuk , Niño , Difteria/epidemiología , Infecciones por Haemophilus/epidemiología , Haemophilus influenzae tipo b , Hepatitis A/epidemiología , Hepatitis B/epidemiología , Humanos , Sarampión/epidemiología , Infecciones Neumocócicas/epidemiología , Infecciones por Rotavirus/epidemiología , Factores SocioeconómicosAsunto(s)
Protección a la Infancia/estadística & datos numéricos , Indígenas Norteamericanos/estadística & datos numéricos , Inuk/estadística & datos numéricos , Bienestar Materno/estadística & datos numéricos , Alaska , Niño , Preescolar , Femenino , Estado de Salud , Humanos , Lactante , Recién Nacido , Masculino , Embarazo , Resultado del Embarazo , Estados UnidosRESUMEN
Fifty years ago, American Indian and Alaska Native children faced an overwhelming burden of disease, especially infectious diseases such as pneumonia, meningitis, tuberculosis, hepatitis A and B, and gastrointestinal disease. Death rates of American Indian/Alaska Native infants between 1 month and 1 year were much higher than in the US population as a whole, largely because of these infectious diseases. The health care of American Indian/Alaska Native patients was transferred to the Department of Health, Education, and Welfare in 1955 and placed under the administration of an agency soon to be known as the Indian Health Service. The few early pediatricians in the Indian Health Service recognized the severity of the challenges facing American Indian/Alaska Native children and asked for help. The American Academy of Pediatrics responded by creating the Committee on Indian Health in 1965. In 1986 the Committee on Native American Child Health replaced the Committee on Indian Health. Through the involved activity of these committees, the American Academy of Pediatrics participated in and influenced Indian Health Service policies and services and, combined with improved transportation, sanitation, and access to vaccines and direct services, led to vast improvements in the health of American Indian/Alaska Native children. In 1965, American Indian/Alaska Native postneonatal mortality was more than 3 times that of the general population of the United States. It is still more than twice as high as in other races but has decreased 89% since 1965. Infectious diseases, which caused almost one fourth of all American Indian/Alaska Native child deaths in 1965, now cause <1%. The Indian Health Service and tribal health programs, authorized by the Indian Self-Determination and Education Assistance Act of 1976 (Pub L. 93-638), continue to seek American Academy of Pediatrics review and assistance through the Committee on Native American Child Health to find and implement interventions for emerging child health problems related to pervasive poverty of many American Indian/Alaska Native communities. Acute infectious diseases that once were responsible for excess morbidity and mortality now are replaced by excess rates resulting from harmful behaviors, substance use, obesity, and injuries (unintentional and intentional). Through strong working partnerships such as that of the American Academy of Pediatrics and the Indian Health Service, progress hopefully will occur to address this "new morbidity." In this article we document the history of the Indian Health Service and the American Academy of Pediatrics committees that have worked with it and present certain statistics related to American Indian/Alaska Native child health that show the severity of the health-status disparities challenging American Indian/Alaska Native children and youth.
Asunto(s)
Indígenas Norteamericanos , Relaciones Interinstitucionales , Pediatría/organización & administración , Sociedades Médicas/historia , Sociedades Médicas/organización & administración , United States Indian Health Service/historia , United States Indian Health Service/organización & administración , Alaska , Niño , Protección a la Infancia , Estado de Salud , Historia del Siglo XX , Humanos , Mortalidad Infantil/tendencias , Recién Nacido , Pediatría/historia , Estados UnidosRESUMEN
OBJECTIVES: Prenatal exposure to alcohol interferes with fetal development and is the leading preventable cause of birth defects and developmental disabilities. The purpose of this study was to identify current knowledge, diagnosis, prevention, and intervention practices related to fetal alcohol syndrome and related conditions by members of the American Academy of Pediatrics. METHODS: This study was developed collaboratively by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Questionnaires were mailed to a 3% random sample (n = 1600) of American Academy of Pediatrics members in the United States. General pediatricians, pediatric subspecialists, and pediatric residents were included. RESULTS: Participation rate was 55% (n = 879). Respondents almost universally knew the teratology and clinical presentation of fetal alcohol spectrum disorders. However, they were less likely to report comfort with routine pediatric care of these children. Whereas 62% felt prepared to identify and 50% felt prepared to diagnose, only 34% felt prepared to manage and coordinate the treatment of children with fetal alcohol spectrum disorders. Even fewer (n = 114 [13%]) reported that they routinely counsel adolescent patients about the risks of drinking and pregnancy. CONCLUSIONS: The survey confirms that pediatricians are knowledgeable about fetal alcohol syndrome but do not feel adequately trained to integrate the management of this diagnosis or prevention efforts into everyday practice. Furthermore, the respondents were not active in routine anticipatory guidance with adolescents for prevention of alcohol-affected pregnancies. The development, dissemination, and implementation of best practice tools for prevention, diagnosis, and referral of fetal alcohol syndrome that are specific for general and subspecialist pediatricians are recommended.