Infant health is tied to the health of birthing people, they wrote. North Carolina’s infant mortality rate largely plateaued between 20, and the disparity ratio between Black and white infant death rate of 2.67 was wider in 2020 than it was in 1990, when it was 2.01. The state did not meet its 2020 goal of 6.3. The target was a 7.4 infant mortality rate while the state reached 7. Jones-Vessey and Cobb write that the state has had reducing infant mortality in all of its Healthy North Carolina plans and met it once, in 2010. The goal for infant mortality is to lower the overall rate to 6 – it was 6.8 in 2020 – and the Black/white disparity ratio to 1.5. The 2030 goals include decreasing the poverty rate, increasing the primary care workforce, and increasing life expectancy. Infant mortality is considered an indicator of overall community health.Įvery 10 years, health policy experts adopt a set of goals for the state called Healthy North Carolina. The infant death rate, measured in deaths per 1,000 birth, is higher in the United States than it is in most other industrialized countries. Both work at the state Department of Health and Human Services. The latest issue of the North Carolina Medical Journal focuses on life expectancy and includes the commentary “Back to the Future: Reflecting on Three Decades of Healthy North Carolina Infant Mortality Goals,” by Kathleen Jones-Vessey and Sarah McCracken Cobb. The chances that a Black baby will live long enough to see that first birthday candle is significantly lower than it is for a white infant. But in the years the state’s plan for healthy communities targeted the racial gap between Black and white babies’ death rates, that gap has just gotten wider.Įven with the overall decline, the state still has one of the highest infant mortality rates in the nation – seventh from the bottom according to the latest CDC data. Hence, understanding how vasopressors such as phenylephrine change PPV and the PPV threshold is very important and represents an important knowledge gap in the practice of anesthesia.The state’s infant mortality rate has dropped significantly in the three decades since getting babies to their first birthdays became an official goal for the state back in the early 1990s. a PPV of 13% without vasopressors likely represents different physiologic conditions compared to a PPV of 13% with vasopressors in the same operation). Furthermore, it is unclear how effective the current threshold is at predicting fluid responsiveness when vasopressors are added during the same operation (i.e.
However, this cut-off was based on studies that used a wide variety of vasopressor agents with different mechanisms. In a patient under general anesthesia, a PPV cut-off of 13% indicates a positive response to fluid administration. Hence the proposed study seeks to characterize the PPV response during simulated hypovolemia with and without infusion of phenylephrine, which acts on alpha-1 receptors to increase systemic vascular resistance, and hence blood pressure. For example it is commonly accepted in the perioperative community that PPV is interpretable in patients without vasopressor infusion since there is little consensus to the effects of vasopressor therapy on PPV. However, there are many commonly encountered intraoperative conditions that may make these interpretations of PPV problematic.
Increasing PPV indicates hypovolemia, and a decreasing PPV indicates progression towards euvolemia. Pulse pressure variation (PPV), which quantifies the respiratory variation in beat-to-beat arterial blood pressure, is viewed as a reliable method to assess volume status. It has been demonstrated that over 50% of perioperative complications are tied to intraoperative fluid administration and that changing intraoperative fluid management alone has significant positive benefit. Overzealous intraoperative administration of fluids can lead to cardiac overload thus potentially causing significant morbidity. Perioperative fluid administration is a very important issue in modern anesthesia practice.
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