RESUMEN
We performed a multicenter, historical-cohort analysis to identify factors associated with chronic lung disease (CLD) in extremely low birth weight infants. The 235 infants who were born in 1984 with birth weights of 751 to 1000 gm and admitted to any of 10 participating neonatal intensive care units comprised the study population. We analyzed demographic characteristics, status at birth, severity of acute atelectasis, and early respiratory treatment in relation to CLD, which we defined as having received oxygen at age 30 days. By univariate analysis, CLD was associated with lower gestational age (p less than 0.001), male sex (p = 0.004), more severe acute atelectasis as indicated by a higher roentgenographic score (p less than 0.001), a higher ventilation rate at 96 hours (p = 0.012), and lower PaCO2 at 48 hours (p = 0.04). Infants receiving mechanical ventilation whose highest PaCO2 levels at 48 or 96 hour were less than 40 mm Hg were 1.45 times as likely to develop CLD as those whose highest PaCO2 levels were greater than 50 mm Hg (95% confidence interval 1.04 to 2.01). CLD rates by center were inversely related to mean PaCO2 levels in infants receiving mechanical ventilation at 48 and 96 hours (Spearman rank correlations 0.60 and 0.55; p less than 0.001). A logistic risk model that included sex, PaCO2 at 48 hours, roentgenographic score, gestational age, and race showed only male sex (p = 0.009) and lower PaCO2 at 48 hours (p = 0.04) to be independent predictors of CLD. We conclude that mechanical ventilation that results in PaCO2 levels above the physiologic range may decrease the risk of CLD in extremely low birth weight infants.
Asunto(s)
Recién Nacido de Bajo Peso , Enfermedades Pulmonares/etiología , Dióxido de Carbono/análisis , Enfermedad Crónica , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Atelectasia Pulmonar/complicaciones , Respiración Artificial , Factores de RiesgoRESUMEN
OBJECTIVE: Examining the psychologic risks of court and related interventions on child sexual abuse victims. DESIGN: A prospective cohort study with follow-up at 5 months. SETTING: Eleven county social service departments in central North Carolina. SUBJECTS: 100 sexually abused children, ages 6 to 17 years, were recruited from consecutive referrals by social service departments; 75 completed the study. MEASUREMENTS AND RESULTS: Using a structured psychiatric inventory, the Child Assessment Schedule, we found a high degree of distress at referral. The level of distress fell by 26% over the next 5 months (p less than 0.001). The 33 children not involved in criminal proceedings improved 30%, in comparison with a 17% improvement in the 22 children waiting for the proceedings (p = 0.042). The 12 children who had testified in juvenile court improved 42% on the Anxiety subscale, in comparison with a 17% improvement in all other subjects (p less than 0.01). With mathematical modeling that controlled for the factors of vaginal or anal penetration, the relationship to the perpetrator, an estimate of verbal IQ, duration of abuse, and whether counseling was received, it was estimated that children waiting for court proceedings at the follow-up examination were only one twelfth as likely to have improved by one standard deviation on the Depression subscale (p less than 0.05). A second model revealed that children who testified in juvenile court were 20.11 times more likely to improve by one standard deviation on the CAS Anxiety subscale (p less than 0.05). CONCLUSIONS: Testimony in juvenile court may be beneficial for the child, whereas protracted criminal proceedings may have an adverse effect on the mental health of the victim.