RESUMEN
BACKGROUND: The increased survival chances of extremely low-birthweight (ELBW) infants (weighing <1000 g at birth) has led to concern about their behavioural outcome in childhood. In reports from several countries with different assessments at various ages, investigators have noted a higher frequency of behavioural problems in such infants, but cross-cultural comparisons are lacking. Our aim was to compare behavioural problems in ELBW children of similar ages from four countries. METHODS: We prospectively studied 408 ELBW children aged 8-10 years, whose parents completed the child behaviour checklist. The children came from the Netherlands, Germany, Canada, and USA. The checklist provides a total problem score consisting of eight narrow-band scales. Of these, two (aggressive and delinquent behaviour) give a broad-band externalising score, three (anxious, somatic, and withdrawn behaviour) give a broad-band internalising score, and three (social, thought, and attention problems) indicate difficulties fitting neither broad-band dimension. For each cohort we analysed scores in ELBW children and those in normal- birthweight controls (two cohorts) or national normative controls (two cohorts). Across countries, we assessed deviations of the ELBW children from normative or control groups. FINDINGS: ELBW children had higher total problem scores than normative or control children, but this increase was only significant in European countries. Narrow-band scores were raised only for the social, thought, and attention difficulty scales, which were 0.5-1.2 SD higher in ELBW children than in others. Except for the increase in internalising scores recorded for one cohort, ELBW children did not differ from normative or control children on internalising or externalising scales. INTERPRETATION: Despite cultural differences, types of behavioural problems seen in ELBW children were very similar in the four countries. This finding suggests that biological mechanisms contribute to behavioural problems of ELBW children.
Asunto(s)
Trastornos de la Conducta Infantil/epidemiología , Comparación Transcultural , Recién Nacido de muy Bajo Peso/psicología , Canadá/epidemiología , Niño , Trastornos de la Conducta Infantil/diagnóstico , Trastornos de la Conducta Infantil/psicología , Preescolar , Femenino , Alemania/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Países Bajos/epidemiología , Estudios Prospectivos , Estados Unidos/epidemiologíaRESUMEN
This study sought to determine whether neonatal cranial ultrasound abnormalities are related to motor and cognitive outcomes in low-birthweight (LBW, <2000 g) children without major motor or cognitive disability. The relation of neonatal cranial ultrasound abnormalities to motor performance and general cognitive ability at ages 2, 6, and 9 years was examined in a prospectively followed regional cohort of LBW children, excluding those with major disability, and controlling for other risk factors. Compared with children without ultrasound abnormalities, children with abnormalities indicative of ischemic white-matter injury had poorer motor performance at all three ages and, at age 2, lower general cognitive ability. The latter finding was not seen when motor performance was also controlled for. It was concluded that in LBW children without major motor or cognitive disability, ischemic white-matter injury indicated by neonatal cranial ultrasound abnormalities adversely affected motor performance at ages 2, 6, and 9 years, but not general cognitive ability.
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Isquemia Encefálica/diagnóstico por imagen , Encéfalo/irrigación sanguínea , Trastornos del Conocimiento/diagnóstico , Ecoencefalografía/métodos , Trastornos de la Destreza Motora/diagnóstico , Factores de Edad , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Masculino , Pruebas NeuropsicológicasRESUMEN
OBJECTIVE: The objective of this study was to investigate the relation of short interpregnancy interval and cerebral palsy (CP) in a low birth weight population in whom neonatal brain injury was systematically ascertained in the newborn period. STUDY DESIGN: We used data from a prospective cohort study of 1105 infants born < or = 2000 gm, designed to study the cause and consequences of neonatal brain injury. Of the 777 children with data on brain injury and CP, 382 were born to multiparous women, and 375 had information available to calculate interpregnancy interval, defined as the number of days from the end of the last pregnancy to conception of the index pregnancy. RESULTS: In the presence of the strong explanatory power of neonatal brain injury, short interpregnancy interval maintains an independent risk for disabling CP. CONCLUSION: In this cohort of low birth weight infants, short interpregnancy interval appears to represent a significant risk for the development of disabling CP.
Asunto(s)
Intervalo entre Nacimientos , Lesiones Encefálicas/complicaciones , Parálisis Cerebral/etiología , Recién Nacido de Bajo Peso , Lesiones Encefálicas/diagnóstico por imagen , Estudios de Cohortes , Escolaridad , Femenino , Edad Gestacional , Humanos , Recién Nacido , Modelos Logísticos , Valor Predictivo de las Pruebas , Embarazo , Factores de Riesgo , UltrasonografíaRESUMEN
BACKGROUND: Children with asthma may be at increased risk for low immunization rates given that they have recurrent illnesses that often result in acute care visits to their pediatrician, visits to the emergency room, admissions to the hospital, and visits to subspecialists, where immunizations are not routinely administered. OBJECTIVES: To assess immunization rates for routine and influenza vaccines in children with asthma and assess factors that may contribute to delay. METHODS: We conducted a cross-sectional survey of 117 children aged 6 to 48 months with onset of asthma within the first 15 months of life. Subjects were recruited from an allergy and immunology clinic at an urban, tertiary care center. Those judged to have immunization delay did not have the required 4 DTP, 3 OPV, and 1 MMR vaccine by age 24 months (4:3:1 series). Receipt of influenza vaccine was determined for eligible children with moderate to severe asthma. RESULTS: Seventy-four (80%) children had up-to-date immunizations at age 24 months. Those with delay had fewer visits to a subspecialist than those who were up-to-date (1 versus 2 visits P = .010). Twenty-two (25%) of 87 eligible subjects received influenza vaccine. Recipients were more likely to have been hospitalized than nonrecipients (77% versus 49%, P = .022). CONCLUSIONS: Though the majority of young children with asthma were up-to-date for routine immunizations, only 25% of children with moderate to severe asthma received influenza vaccine. Greater efforts must be made by pediatricians and asthma subspecialists to ensure that children with moderate to severe asthma are immunized against influenza virus.
Asunto(s)
Asma/complicaciones , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Vacunación/estadística & datos numéricos , Preescolar , Femenino , Humanos , Lactante , Masculino , New Jersey , PennsylvaniaAsunto(s)
Parálisis Cerebral/diagnóstico , Recién Nacido de Bajo Peso , Examen Neurológico/métodos , Enfermeras Practicantes , Evaluación en Enfermería/métodos , Enfermería Pediátrica , Articulación del Tobillo/fisiopatología , Parálisis Cerebral/fisiopatología , Humanos , Recién Nacido , Articulación de la Rodilla/fisiopatología , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: This study examined the relation of neonatal cranial ultrasound abnormalities to psychiatric disorder at age 6 years in a regional birth cohort of low-birth-weight children. METHODS: Neonatal cranial ultrasound abnormalities were classified as (1) isolated germinal matrix and/or intraventricular hemorrhage (suggestive of injury to glial precursors) or (2) parenchymal lesions and/or ventricular enlargement (suggestive of white matter injury) with or without germinal matrix-intraventricular hemorrhage. Psychiatric disorders by DSM-III-R at age 6 years were assessed by means of a structured parent interview. Children with severe mental retardation were excluded. Analyses were conducted first in the entire sample and then in children with normal intelligence. RESULTS: Twenty-two percent of the cohort had at least 1 psychiatric disorder, the most common being attention deficit hyperactivity disorder (15.6%). In the entire sample, parenchymal lesions and/or ventricular enlargement increased risk relative to no abnormality, independently of other biological and social predictors, for any disorder (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.8-10.3; P < .001), attention deficit hyperactivity disorder (OR, 3.4; CI, 1.3-8.7; P = .02), and tic disorders (OR, 8.7; CI, 1.3-57.7; P = .02). In children of normal intelligence, parenchymal lesions/ventricular enlargement independently increased risk for any disorder (OR, 4.8; CI, 1.6-12.0; P < .01), attention deficit hyperactivity disorder (OR, 4.5; CI, 1.3-16.0; P = .02), and separation anxiety (OR, 5.3; CI, 1.1-24.8; P = .03). These effects were not ameliorated by female sex or social advantage. Isolated germinal matrix/intraventricular hemorrhage was not related to psychiatric disorder at age 6 years. CONCLUSION: Neonatal cranial ultrasound abnormalities suggestive of white matter injury significantly increased risk for some psychiatric disorders at age 6 years in low-birth-weight children.
Asunto(s)
Lesiones Encefálicas/diagnóstico , Encéfalo/patología , Recién Nacido de Bajo Peso , Trastornos Mentales/epidemiología , Ultrasonografía , Factores de Edad , Puntaje de Apgar , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/etiología , Traumatismos del Nacimiento/diagnóstico , Traumatismos del Nacimiento/epidemiología , Lesiones Encefálicas/epidemiología , Lesiones Encefálicas/patología , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/etiología , Niño , Trastornos de la Conducta Infantil/epidemiología , Trastornos de la Conducta Infantil/etiología , Preescolar , Comorbilidad , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Lactante , Recién Nacido , Masculino , Trastornos Mentales/etiología , Prevalencia , Factores de Riesgo , Factores Sexuales , Trastornos de Tic/epidemiología , Trastornos de Tic/etiologíaRESUMEN
OBJECTIVES: To explore adolescent fatherhood from the perspectives of teen fathers, teen mothers, paternal grandmothers (PGMs), and maternal grandmothers (MGMs). To identify perceived barriers to and recommendations for the enhancement of teen father participation in child rearing. METHODS: A total of 61 teen parents participated in the design of a structured interview. A community-based sample of 173 teen fathers, 167 teen mothers, 76 PGMs, and 79 MGMs were interviewed by teenage assistants. Multiple logistic regression analysis using maximum likelihood estimation and the best subset algorithm identified barriers most predictive of paternal uninvolvement in child rearing. RESULTS: Fifty-four percent of teen fathers and 70% of partners of teen mothers' met the definition of involvement in child rearing. Disinterest in child rearing most consistently predicted uninvolvement. Fathers were less likely than mothers to report paternal disinterest as a barrier and more likely to attribute their lack of involvement to resistance from mothers and MGMs (p < 0.05). The best model predicting paternal involvement from the fathers' perspective included paternal disinterest [odds ration (OR) = 0.42, confidence interval (CI) = 0.19-0.92] and age (OR = 0.74, CI = 0.56-0.97). The best model from the mothers' perspective included paternal disinterest (OR = 0.16, CI = 0.07-0.36) and lack of time (OR = 0.31, CI = 0.15-0.91). Of those fathers who cited disinterest, there was an association with lack of money (p = 0.002) and lack of knowledge of child care (p = 0.069. While fathers and mothers disagreed on several interventions, they agreed (82% and 95%, respectively) that availability of jobs would promote paternal involvement. CONCLUSIONS: Most teen fathers in this study were involved and interested in child rearing. A young father's financial insecurity or confusion about child care was most likely to lead to a stated disinterest, and that disinterest predicted uninvolvement.
PIP: A community-based sample of 173 teen fathers, 167 teen mothers, 76 paternal grandmothers, and 79 maternal grandmothers was interviewed by teenage assistants to explore adolescent fatherhood from a range of differing perspectives. 54% of teen fathers and 70% of partners of teen mothers met the definition of involvement in child rearing. Disinterest in child rearing most consistently predicted uninvolvement. Fathers were less likely than mothers to report paternal disinterest as a barrier and more likely to attribute their lack of involvement to resistance from mothers and maternal grandmothers. The best model predicting paternal involvement from the fathers' perspective included paternal disinterest and age, while the best model from the mothers' perspective included paternal disinterest and lack of time. Of those fathers who cited disinterest, there was an association with lack of money and lack of knowledge of child care. While fathers and mothers disagreed upon several interventions, they agreed that an availability of jobs would promote paternal involvement.
Asunto(s)
Conducta del Adolescente , Crianza del Niño , Relaciones Padre-Hijo , Embarazo en Adolescencia/psicología , Adolescente , Actitud , Relaciones Familiares , Femenino , Humanos , Lactante , Masculino , Embarazo , Apoyo SocialRESUMEN
OBJECTIVE: Children who live in violent households are at risk for emotional and physical injury. Although recent research has addressed the emotional impact of witnessing family violence, no study has addressed the inadvertent physical injuries that result to children who witness family violence. The objective of this study was to describe the causes, types, and patterns of pediatric injuries resulting from family violence. METHODS: We reviewed the medical records of 139 children who presented to the emergency department with injuries resulting from domestic violence for demographic information, mechanism of injury, type, location, and severity of injury, treatment, and disposition. RESULTS: Children who were injured during domestic violence ranged in age from 2 weeks to 17 years. Although the mean age of the children identified was 5 years, 48% of the children were younger than 2 years. Although the most common dyad involved in the fight was the mother and father (57% of cases), extended family members and nonrelated adults were involved in almost one third of the cases. The most common mechanism of injury was a direct hit (36%). Of the injured children who were younger than 2 years, 59% were injured while being held by parents. Thirty-nine percent of the children were injured during attempts to intervene in fights. The majority of injuries were to the head (25%), face (19%), and eyes (18%). Young children sustained more head and facial injuries than older children, who had disproportionately more extremity trauma. Medical intervention was indicated in 43% of patients, of which 9% required hospital admission and 2% required surgical or intensive care intervention. Of the 91% of children discharged from the emergency department, 73% returned home, and 27% went to alternative homes. CONCLUSIONS: Children sustain a wide range of physical injuries from family violence. Because the majority of injuries are minor, specific inquiry into the causes of all pediatric injuries may help further identify children living among family violence.
Asunto(s)
Violencia Doméstica/estadística & datos numéricos , Heridas y Lesiones/etiología , Adolescente , Niño , Protección a la Infancia , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Philadelphia , Estudios Retrospectivos , Índices de Gravedad del Trauma , Heridas y Lesiones/clasificación , Heridas y Lesiones/epidemiologíaRESUMEN
OBJECTIVE: To assess the independent relation of neonatal cranial ultrasound (US) abnormalities in low birth weight (LBW) infants to cognitive outcomes at 6 years of age. DESIGN: Prospective cohort study. SAMPLE AND METHODS: Six-year follow-up data were obtained on a regional birth cohort of LBW infants (< 2 kg) systematically screened as neonates with serial US. US abnormalities were dichotomized into isolated germinal matrix/intraventricular hemorrhage (GM/IVH) and parenchymal lesions/ventricular enlargement (PL/VE). Global cognitive outcomes (mental retardation, borderline intelligence, and normal intelligence) and selected specific cognitive abilities were assessed at 6 years of age with standardized instruments. Multivariate techniques were used to assess the effects of US independent of maternal social disadvantage at birth and other perinatal and neonatal risk factors. RESULTS: The sample as a whole had a significantly elevated rate of mental retardation (MR; 5%), almost all moderate to profound in severity. PL/VE was independently related to MR (odds ratio [OR], 65.8; confidence interval [CI], 19.1 to 22.4) and borderline intelligence (OR, 3.7; CI, 1.3 to 10.8); isolated GM/IVH was more modestly related to MR (OR, 4.6; CI, 1.2 to 18.6) but not related to borderline intelligence. Approximately half of the cases of MR were attributable to PL/VE independent of other factors. Of non-US factors, the number of days receiving mechanical ventilation increased the risk for MR. Maternal social disadvantage increased the risk for borderline intelligence but not MR. Among children of normal intelligence, those with PL/VE, but not isolated GM/IVH, performed more poorly than those without US abnormalities on tests of visual perceptual organization but not on tests of language, memory, or quantitative skills. CONCLUSION: Prevention of white matter injury would substantially improve cognitive outcomes for LBW infants.
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Envejecimiento/psicología , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/psicología , Cognición , Ultrasonografía Doppler Transcraneal , Hemorragia Cerebral/complicaciones , Niño , Desarrollo Infantil , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Discapacidad Intelectual/diagnóstico por imagen , Discapacidad Intelectual/etiología , Discapacidad Intelectual/psicología , Masculino , Análisis Multivariante , Pronóstico , Estudios Prospectivos , Factores de RiesgoRESUMEN
We assess the prevalence of vision problems in a cohort of low birth weight infants at age 2 years and the relationship of these problems to neonatal brain injury. Data on prenatal and neonatal history and brain injury status were prospectively collected on 721 children weighing 500-2,000 gm at birth enrolled in a multi-center, population-based longitudinal study. Visual acuity was evaluated using the Teller Acuity Card Procedure. Abnormalities of the eye were assessed by a specially trained pediatric nurse practitioner. Failure of the acuity screen occurred in 62 of 699 tested (8.9%). Multiple logistic regression analysis revealed that the only significant independent predictors of failure included presence of disabling cerebral palsy (DCP) (odds ratio [OR] = 14.8) or nondisabling cerebral palsy (NDCP) (OR = 4.0) and Apgar score of less than 5 at 5 minutes (OR = 2.4). Parenchymal brain injury (PEL) was of borderline significance. Strabismus was present in 123 of 702 children (17.5%). Multiple logistic regression analysis disclosed that the joint predictors of strabismus were presence of DCP (OR = 7.2) and length of hospital stay (OR = 1.6). We conclude that low birth weight infants with parenchymal brain lesions leading to cerebral palsy are at particular risk for vision problems early in life and should be carefully evaluated.
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Lesiones Encefálicas/complicaciones , Recién Nacido de Bajo Peso , Efectos Tardíos de la Exposición Prenatal , Trastornos de la Visión/epidemiología , Preescolar , Factores de Confusión Epidemiológicos , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Modelos Logísticos , Embarazo , Prevalencia , Estudios Prospectivos , Trastornos de la Visión/etiología , Selección Visual , Agudeza VisualRESUMEN
BACKGROUND: Transient hypothyroxinemia, a common finding in premature infants, is not thought to have long-term sequelae or to require treatment. We investigated whether hypothyroxinemia in premature infants is a cause of subsequent motor and cognitive abnormalities. METHODS: In this historical cohort study, we retrieved blood thyroxine values, obtained on routine screening in the first week of life, from state screening records on children who weighted 2000 g or less at birth, who were born at 33 weeks' gestation or earlier, and who were enrolled in a population-based study of the late sequelae of neonatal brain hemorrhage. We investigated the relation of these values to the odds for disabling cerebral palsy among 463 subjects for whom data were available and to the mental-development score on the Bayley Scales of Infant Development or the Stanford-Binet Intelligence Scales for Children at the age of two years in 400 subjects. The effects of severe hypothyroxinemia, defined as a blood thyroxine value more than 2.6 SD below the mean for New Jersey newborns, were assessed before and after adjustment for gestational age and potentially confounding variables. RESULTS: In analyses adjusted for gestational age, infants with severe hypothyroxinemia had a risk of disabling cerebral palsy that was nearly 11 times that of infants without hypothyroxinemia (odds ratio, 10.8; 95 percent confidence interval, 3.0 to 39.3) and a mean mental-development score at the age of two that was 15.4 points lower (95 percent confidence interval, 8.1 to 22.6 points) than the mean score of children with normal neonatal blood thyroxine concentrations. After adjustment for gestational age and multiple prenatal, perinatal, and early and last neonatal variables, severe hypothyroxinemia was still associated with an increased risk of disabling cerebral palsy (odds ratio, 4.4; 95 percent confidence interval, 1.0 to 18.6) and a reduction of nearly 7 points (95 percent confidence interval, 0.3 to 13.2 points) in the mental-development score. CONCLUSIONS: Severe hypothyroxinemia in preterm infants may be an important cause of problems in neurologic and mental development detected at the age of two years.
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Parálisis Cerebral/etiología , Recien Nacido Prematuro/sangre , Discapacidad Intelectual/etiología , Tiroxina/sangre , Desarrollo Infantil/fisiología , Preescolar , Estudios de Cohortes , Humanos , Recién Nacido , Pruebas de Inteligencia , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Tiroxina/deficienciaRESUMEN
OBJECTIVE: To determine the percentage of term newborns discharged by 24 hours of life and the actions taken by physicians and institutions to avoid false-negative phenylketonuria (PKU) screens in these infants. DESIGN: Descriptive cross-sectional survey. PARTICIPANTS: One hundred forty term nurseries and 157 pediatricians. SELECTION PROCEDURE: Stratified sampling techniques were used to sample nurseries from the 1992 American Hospital Association guide to provide equal representation of each region of the country. Pediatricians were systematically sampled from a national list of practicing pediatricians supplied by Ross Laboratories to provide equal sampling from each state. RESULTS: The response rates were 95% (n = 133) for term nurseries and 83% (n = 131) for pediatricians. Twenty-four percent of healthy newborns are discharged by 24 hours of life. Ninety-three percent of nurseries screen all infants for PKU before discharge. In states without laws mandating rescreening, only 48% of institutions that discharge the majority of their infants (> 50%) by 24 hours of life rescreen. Also, in states without rescreening laws, 64% of pediatricians rescreen. The timing of this repeat screen ranges from less than 72 hours of life to 4 weeks. Determining which infants to rescreen varies by practitioner; some rescreen all infants, whereas others rescreen those discharged early. Just more than half of all pediatricians, whether practicing in a state requiring repeat PKU screening, claim to be familiar with the American Academy of Pediatrics recommendations regarding repeated PKU screening of infants discharged by 24 hours of life. CONCLUSION: Twenty-four percent of term newborns in the United States are discharged by 24 hours of life. Most hospitals screen all infants for PKU before discharge regardless of age. The majority of states do not mandate rescreening; rescreening policies among pediatricians and institutions in those states vary widely. A significant number of infants do not receive repeated screening and are therefore at risk for delayed or missed diagnosis of PKU because of insensitive initial screens. Pediatrician awareness of the need to perform repeated PKU screens on infants discharged by 24 hours is poor.
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Tiempo de Internación , Tamizaje Neonatal , Alta del Paciente , Fenilcetonurias/prevención & control , Factores de Edad , Estudios Transversales , Humanos , Recién Nacido , Legislación Médica , Tamizaje Neonatal/legislación & jurisprudencia , Sensibilidad y Especificidad , Factores de Tiempo , Estados UnidosRESUMEN
To determine whether test-of-cure cultures are necessary for prepubertal children diagnosed with Neisseria gonorrhoeae, we examined the records of all 66 patients < 10 years old seen at Children's Hospital of Philadelphia over a 7.5-year period (1987-1994) diagnosed with gonorrhea. Ninety-eight percent had genital discharge on examination. All children with genital gonorrhea were symptomatic, but only 10% of children with rectal gonorrhea and 20% with pharyngeal infection were symptomatic. Seventy-seven percent of children were treated with ceftriaxone. Of these, 72% returned for test-of-cure cultures. Ninety-three percent of children had complete resolution of physical symptoms at test-of-cure, and all follow-up cultures were negative for N. gonorrhoeae. Our data suggest that most prepubertal children with gonorrhea are symptomatic at initial presentation and are cured after recommended treatment with ceftriaxone. The Centers for Disease Control and Prevention recommendations for obtaining test-of-cure cultures in young children with gonorrhea are unnecessary, potentially harmful, and should be revised.
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Ceftriaxona/uso terapéutico , Cefalosporinas/uso terapéutico , Gonorrea/tratamiento farmacológico , Niño , Femenino , Humanos , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the practices of US nurseries, neonatal intensive care units (NICUs), and pediatricians regarding universal hepatitis B vaccination. DESIGN: Descriptive cross-sectional survey. PARTICIPANTS: One hundred forty term nurseries, 152 NICUs, and 157 pediatricians. Selection procedure. Nurseries and NICUs were systematically sampled from the 1992 American Hospital Association Guide to provide equal sampling from each region of the country. Pediatricians were systematically sampled from a national list of practicing pediatricians supplied by Ross Laboratories to provide equal sampling from each state. RESULTS: The response rates were 95% (n = 133) for term nurseries, 95% (n = 144) for NICUs, and 83% (n = 131) for pediatricians. Sixty-two nurseries (47%) provide routine hepatitis B vaccine (HBV) to their infants. Eighty-five NICUs (59%) routinely vaccinate their preterm infants; 62 (73%) initiate the series just before discharge; and 11 (13%) do so at birth. Principal reasons for not vaccinating include cost and a preference to allow the primary-care physician to initiate the series. One hundred ten (85%) pediatricians provide universal hepatitis B vaccination. Principal reasons for not vaccinating include cost and parents opting against vaccination. CONCLUSIONS: More than half of NICUs provide HBV routinely to their preterm infants, predominantly just before hospital discharge. A minority of NICUs are initiating vaccination at birth, which may provide suboptimal seroconversion. Although less than half of participating term nurseries are routinely vaccinating before discharge, 85% of pediatricians do initiate HBV by two months of age. The principal reasons for not providing vaccine are financial.
Asunto(s)
Vacunas contra Hepatitis B/uso terapéutico , Hepatitis B/prevención & control , Recién Nacido , Pediatría/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Transversales , Recolección de Datos , Vacunas contra Hepatitis B/administración & dosificación , Humanos , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Estados UnidosRESUMEN
OBJECTIVE: To employ multivariate analytic techniques to assess the association between neonatal cranial ultrasound (US) abnormalities and subsequent cerebral palsy (CP), defined as disabling CP (DCP) or nondisabling CP (NDCP) depending on the level of motor dysfunction. DESIGN: Prospective cohort study. SUBJECTS AND METHODS: The Neonatal Brain Hemorrhage Study enrolled a geographically representative sample of 1105 newborns 501 to 2000 g and obtained follow-up data on 777 (86%) of the 901 survivors at age two. One hundred thirteen children (14.6%) had motor findings severe enough to classify them as having CP. The 61 (7.9%) of these children who were disabled by their motor impairment we classified as having DCP. The remaining 52 (6.7%) who had definite neurologic findings (usually mild spastic diplegia) but without evidence of interference with daily living, we classified as having NDCP. RESULTS: In a multivariate logistic regression model of perinatal and postnatal variables, the following factors were found to be significant risk factors for DCP: parenchymal echodensities/lucencies or ventricular enlargement (PEL/VE) on cranial US (OR = 15.4; 7.6, 31.1), germinal matrix/intraventricular hemorrhage (GM/IVH) (OR = 3.5; 1.7, 6.9) and mechanical ventilation (OR = 2.9; 1.2, 7.1). Fully 93.4% of infants were correctly classified as to presence or absence of DCP on the basis of this model. Birth weight, gestational age, length of hospital stay, gender, race, plurality, presence of labor and Apgar score were not significant independent predictors of DCP. For NDCP, the only risk factor significant in the multivariate model was PEL/VE (OR = 5.3; 2.2, 12.6). CONCLUSIONS: Among perinatal and postnatal factors, cranial US abnormalities are by far the most powerful predictors of disabling CP in low birth weight infants. Although PEL/VE was the strongest predictor, GM/IVH also appeared to independently contribute to the risk of DCP. NDCP in low birth weight infants appears to have a different risk profile than DCP. In particular, it is less closely related to US evidence of perinatal brain injury.
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Encefalopatías/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Parálisis Cerebral/epidemiología , Recién Nacido de Bajo Peso/crecimiento & desarrollo , Ultrasonografía Doppler Transcraneal , Encefalopatías/complicaciones , Hemorragia Cerebral/complicaciones , Parálisis Cerebral/etiología , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Modelos Logísticos , Masculino , Análisis Multivariante , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To compare actual and ideal time commitments of pediatric chief residents between 1972 and 1992 and to determine if actual time commitments have changed. DESIGN: Descriptive, cross-sectional survey. PARTICIPANTS: One thousand two hundred eighty-four former pediatric chief residents. RESULTS: Chief residents between 1972 and 1982 spent a greater percentage of time teaching and providing patient care than chief residents between 1983 and 1992. Chief residents between 1983 and 1992 spent a greater percentage of time scheduling and performing other administrative tasks. In general, chief residents desired more time to teach, to conduct research, and to provide outpatient care and desired less time for scheduling and for performing other administrative duties. CONCLUSIONS: Although chief residents desire to spend more time teaching and less time performing administrative tasks, administrative duties have increased at the expense of teaching and patient care responsibilities over the past 20 years.