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Adverse medical events and adverse drug events are not uncommon in NICUs, and research has been directed at determining the causes of such events as well as potential methods of reducing their occurrence. Both human fallibility and the complex adaptive system that comprises the NICU present opportunities for errors. Human factors engineering and systems can improve reliability, as can computer systems for ordering, dispensing, administering, and monitoring drugs. Barcode scanning medication dispensing and administration systems and smart pumps also have been investigated. Human factors that have contributed to errors include fatigue, communication failure, poor handoffs, problems with cross-coverage, workload, and staffing patterns. Addressing these factors can aid in reducing medical errors.

Human milk pH was measured in 309 samples obtained from 52 women who had delivered at term and lactated for as long as 10 months thereafter. The mean pH decreased from 7.45 for colostrum to a nadir of 7.04 during the second week of lactation. Thereafter, the pH of milk remained between 7.0 and 7.1 until 3 months postpartum and then increased gradually to 7.4 by 10 months. The change in hydrogen ion concentration in milk was associated with corresponding changes throughout lactation in the concentration of citrate but not with the concentration of lactose. Lactose concentration increased gradually for 3 weeks; the concentration of saturated medium-chain fatty acids increased more rapidly. One interpretation of these findings is that the hydrogen ions and citrate generated by mammary secretory cell metabolism are used after the second week of lactation for de novo synthesis of fatty acids more rapidly than they are synthesized. Milk samples from ruminants were found to have concentrations of hydrogen ions and citrate that are greater than and pH that is less than the respective measurements in human milk. The significance for the recipient infant of the predictable changes in human milk pH during lactation and of the higher pH of human milk throughout lactation relative to bovine milk is unknown. However, drug excretion into milk, milk enzyme activity, milk leukocyte function, and neonatal gastroin-testinal function are affected by ambient pH and may be influenced by the pH of milk.

Duodenal motility was studied by intraluminal manometry in 27 healthy infants of 26 to 42 weeks, gestational age. The frequency of contractions, the number of contractions per burst, and the intraluminal peak pressure during contractions all increased during a narrow postconceptual period, 29 to 32 weeks, regardless of length of gestation before birth. Antenatal β-methasone administration to the mothers of 11 additional infants of 26 to 32 weeks gestational age was associated with creased duodenal contraction rate, number of contracintions per burst, and intraluminal peak pressure compared with infants of similar gestational age whose mothers did not receive β-methasone. The maturational effect of β-methasone on duodenal motility was most pronounced in infants whose gestational age at birth was 26 to 29 weeks. Seven infants of 31 weeks' or longer gestational duration who had a CNS abnormality or insult had fasting duodenal contraction rates that were less than one half of the rate for normal infants of similar gestational age. These observations suggest that neonatal duodenal motility undergoes marked maturational changes between 29 and 32 weeks after conception and that these changes may be inducible before 29 weeks by corticosteroid administration. An intact CNS appears to be required for full expression of the maturational changes.

As participants in the clinical field trials in the United States for the Roche 5301 transcutaneous oxygen monitor, we report here the results of our experience for comparison with that reported by Meith and colleagues in an earlier Letter (Pediatrics 58: 299, August 1976). The Roche model 5301 differs from the previously tested model 5300 in that the oxygen sensor has been modified and the electrode operates at 44 C instead of 42 C. Thirty-two newborn infants of 28 to 39 weeks' gestational age and 560 to 3,700 gm birth weight were monitored while they experienced respiratory illness caused by idiopathic respiratory distress syndrome, pneumonia, or apnea.