Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1259 (doi:10.1542/peds.2007-0845)

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LETTER TO THE EDITOR

Give Synagis Via Home Care: A Reply: In Reply

John Goldenring, MD, MPH, JD, FAAP, FSAM, FCLM
San Diego, CA 92131

I thank Dr Schipper for his supportive comments. I am not surprised to find that the Netherlands, a country with a well-designed national health system, would encourage administration of Synagis in children's homes.

Again, I call on the American Academy of Pediatrics Committee on Infectious Diseases to consider this issue and change its guideline to specify home administration of Synagis during respiratory syncytial virus season.

I also believe it is time that we consider administering all immunizations to these most vulnerable newborns at the same home visits. These visits will also offer, if we wish, an opportunity to assess the home environment of these maximally stressed families with very small, and sometimes very ill, infants, with a view to preventing child abuse, among other possible positive spin-offs.¹

It has been postulated that the automobile was a huge factor in changing how we provide medical care in the United States.² People could visit us easily. Hence, office-based practices developed. However, now we must return full-circle to realize that we can go back out to homes, if not by ourselves then at least through the services of our highly trained nursing colleagues.

As a medical director, I have participated in ongoing trials of physician- and nurse practitioner–based home care for the most vulnerable elderly patients. None of the busy physicians who cared for these very ill patients raised any objection to the care rendered as long as communication was good. Therefore, like Dr Schipper, I see no reason why busy pediatricians would feel differently. I suggest that home nursing programs for vulnerable newborns and infants do not diminish or interfere with the concept of the medical home; they merely extend it.

REFERENCES

1. Duggan A, Windham A, McFarlane E, et al. Hawaii's Healthy Start Program of home visiting for at-risk families: evaluation of family identification, family engagement, and service delivery. Pediatrics. 2000;105 :250 –259[Abstract/Free Full Text]
2. Starr P. The Social Transformation of American Medicine. New York, NY: Basic Books; 1984

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Goldenring, J. Search for Related Content PubMed Articles by Goldenring, J. Related Collections Office Practice Social Bookmarking                         What's this?