RESUMO
OBJECTIVE: To investigate the costs and referral rates of 3 universal newborn hearing screening programs: transient evoked otoacoustic emissions (TEOAE), automated auditory brainstem response (AABR), and a combination, two-step protocol in which TEOAE and AABR are used. STUDY DESIGN: Clinical outcomes (referral rates) from 12,081 newborns at 5 sites were obtained by retrospective analysis. Prospective activity-based costing techniques (n = 1056) in conjunction with cost assumptions were used to analyze the costs based on an assumed annual birth rate of 1500 births. RESULTS: Referral rates differed significantly among the 3 screening protocols (AABR, 3.21%; two-step, 4.67%; TEOAE, 6.49%; P <.01), with AABR achieving the best referral rate at discharge. Although AABR had the lowest referral rate at discharge and the highest pre-discharge costs, the total pre- and post-discharge costs per infant screened (AABR, $32.81; two-step, $33.05; TEOAE, $28.69) and costs per identified child (AABR, $16,405; two-step, $16,527; TEOAE, $14,347) were similar among programs. CONCLUSION: Although AABR incurs higher costs during pre-discharge screening, it has lower referral rates than either the TEOAE or two-step program. As a result, the total costs of newborn hearing screening and diagnosis are similar among the 3 methods studied.
Assuntos
Custos e Análise de Custo , Potenciais Evocados Auditivos do Tronco Encefálico , Testes Auditivos/economia , Programas de Rastreamento/economia , Testes Auditivos/métodos , Humanos , Recém-Nascido , Estudos Multicêntricos como Assunto , Encaminhamento e Consulta/economia , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: We determined neonatal survival and morbidity rates based on both fetal (stillborn) and neonatal deaths for infants delivered at 22 to 25 weeks' gestation. STUDY DESIGN: Two hundred seventy-eight deliveries at 22 to 25 weeks' completed gestation were analyzed by gestational age groups between January 1993 and December 1997. Logistic regression models were used to identify maternal and neonatal factors associated with survival. RESULTS: The rate of fetal death was 24%; 76% of infants were born alive and 46% survived to discharge. Survival rates including fetal death at 22, 23, 24, and 25 weeks were 1.8%, 34%, 49%, and 76%; and survival rates excluding fetal death were 4.6%, 46%, 59%, and 82%, respectively. Logistic regression analyses showed that higher gestational age (P<.0002), higher birth weight (P<.001), female sex (P<.005), and surfactant (P<.003) were associated with neonatal survival. Cesarean section was associated with decreased survival (P <.006). CONCLUSION: Hospital neonatal survival rates of infants at the limits of viability are significantly lower with the inclusion of fetal deaths. This information should be considered when providing prognostic advice to families when mothers are in labor at 22 to 25 weeks' gestation.
Assuntos
Doenças do Prematuro/mortalidade , Terapia Intensiva Neonatal , Trabalho de Parto Prematuro , Assistência Perinatal , Ressuscitação , Feminino , Morte Fetal/epidemiologia , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Morbidade , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
OBJECTIVE: The objective of this study was to evaluate key outcomes of a universal hearing screen/rescreen program for all births with transient evoked otoacoustic emissions in all 8 maternity hospitals in the state of Rhode Island over a 4-year period. STUDY DESIGN: This was a retrospective analysis of the hearing screen/rescreen refer data collected prospectively for 53,121 survivors born in Rhode Island between January 1, 1993, and December 31, 1996. Primary outcomes included the first-stage refer rates, rescreen compliance, diagnostic referral rates, identification rates, and the age of amplification. RESULTS: During this 4-year time period 11 infants were identified with permanent hearing loss, resulting in an impairment rate of 2 per 1000. The mean age of hearing loss confirmation decreased from 8.7 months to 3.5 months, and the age at amplification declined from 13.3 months to 5.7 months. CONCLUSION: We conclude that time and experience are important factors in the development and refinement of a universal hearing screen program. Hearing screen outcome data collected over a 4-year period in Rhode Island reveal a steady improvement in the percent of infants completing the 2-stage screen process, the stage 1 and stage 2 refer rates, compliance with rescreen and diagnostic testing, and significant improvement in the age of identification and age of amplification.
Assuntos
Transtornos da Audição/prevenção & controle , Audição/fisiologia , Triagem Neonatal , Fatores Etários , Análise de Variância , Percepção Auditiva/fisiologia , Cóclea/fisiologia , Estudos de Avaliação como Assunto , Potenciais Evocados Auditivos/fisiologia , Seguimentos , Auxiliares de Audição , Transtornos da Audição/diagnóstico , Transtornos da Audição/terapia , Humanos , Lactente , Recém-Nascido , Avaliação de Resultados em Cuidados de Saúde , Cooperação do Paciente , Valor Preditivo dos Testes , Estudos Prospectivos , Encaminhamento e Consulta , Estudos Retrospectivos , Rhode Island , Fatores de RiscoRESUMO
OBJECTIVE: The purpose of this case-control study was to examine the maternal and neonatal morbidities associated with in vitro fertilization (IVF) in a single large teaching hospital. It was hypothesized that IVF mothers would have more perinatal complications and IVF infants would have higher mortality and morbidity rates than non-IVF control subjects. METHODS: One hundred forty-three gestations resulting from 101 IVF pregnancies, which included singletons (n = 62), twins (n = 72), and triplets (n = 9), were compared with equal numbers of non-IVF control subjects. Each pregnancy was matched by maternal age, race, insurance type, neonatal gender, order of gestation, order in delivery, and date of delivery (+/- 6 months). Among the 143 matched gestations, six IVF and seven control infants died, leaving 137 IVF and 136 control neonates for comparison. RESULTS: The IVF mothers had more pregnancy-induced hypertension (21% vs 4%), premature labor (44% vs 22%), labor induction (25% vs 1%), and preterm delivery (37% vs 21%). The IVF infant survivors had a lower mean (+/- SD) birth weight (2623 +/- 857 gm vs 3006 +/- 797 gm), more frequent occurrence of low birth weight (42% vs 27%), and shorter gestations (37 +/- 4 vs 38 +/- 3 weeks). The IVF infants had longer hospitalizations, more days of oxygen therapy, more days of continuous positive airway pressure, and increased prevalence of respiratory distress syndrome, patent ductus arteriosus, and sepsis. CONCLUSIONS: Couples who undergo IVF appear to be at increased risk of having low birth weight and preterm infants, and multiple gestations account for most of the neonatal morbidities. Both the mothers who conceive multiple gestations by means of IVF and their neonates are at an increased risk of having multiple morbidities.
Assuntos
Fertilização in vitro/efeitos adversos , Doenças do Recém-Nascido/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Fertilização in vitro/estatística & dados numéricos , Humanos , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Mortalidade Materna , Complicações do Trabalho de Parto/etiologia , Gravidez , Complicações na Gravidez/etiologia , Gravidez Múltipla , Rhode Island/epidemiologia , Fatores de Risco , Sobreviventes/estatística & dados numéricos , Trigêmeos , GêmeosRESUMO
OBJECTIVE: Because stress in utero may enhance neuromotor maturation, we hypothesized that infants born to mothers with preeclampsia would have a shorter absolute latency V and interpeak latency I-V period (brain-stem conduction time) of brain-stem auditory evoked response (BAER) than infants born to normotensive mothers. STUDY DESIGN: A retrospective cohort study was performed to assess the effects of maternal preeclampsia on BAER of very low birth weight infants. The cohort consisted of 24 infants with a birth weight less than 1251 gm born to mothers with preeclampsia, and 48 infants born to normotensive mothers, matched for birth date within 2 months, gestational age, and chronologic age at the time of the BAER test. The BAER test was completed before discharge, with the infant in a quiet state and the use of a 30 dB stimulus. RESULTS: The mean latencies of wave V were shortened bilaterally (left 8.60 +/- 0.6 msec vs 9.02 +/- 0.6 msec, p < 0.008; right 8.61 +/- 0.6 msec vs 8.96 +/- 0.6 msec, p < 0.033, and the interpeak latency of I-V was significantly shortened compared with the control subjects on the left (left 4.91 +/- 0.5 msec vs 5.38 +/- 0.6 msec, p < 0.003; right 5.17 +/- 0.5 msec vs 5.37 +/- 0.6 msec, not significant). CONCLUSION: These results suggest that the intrauterine stress of maternal preeclampsia accelerates the maturation of the auditory nerve and brain-stem auditory pathway in very low birth weight infants.
Assuntos
Potenciais Evocados Auditivos do Tronco Encefálico , Retardo do Crescimento Fetal/etiologia , Recém-Nascido de Baixo Peso , Bem-Estar Materno , Mães , Pré-Eclâmpsia/complicações , Adulto , Vias Auditivas/fisiologia , Estudos de Coortes , Desenvolvimento Embrionário e Fetal , Feminino , Maturidade dos Órgãos Fetais , Humanos , Lactente , Recém-Nascido , Masculino , Troca Materno-Fetal , Gravidez , Estudos Retrospectivos , Nervo Vestibulococlear/fisiologiaRESUMO
We enrolled 61 neonates of 600 to 1250 gm birth weight with evidence of low-grade intraventricular hemorrhage at 6 to 11 hours of age in a prospective, randomized, placebo-controlled trial to test the hypothesis that indomethacin (0.1 mg/kg given intravenously at 6 to 12 postnatal hours and every 24 hours for two more doses) would prevent extension of intraventricular hemorrhage. Twenty-seven infants were assigned to receive indomethacin; 34 infants received saline placebo. There were no significant differences between the two groups in birth weight, gestational age, sex, Apgar scores, percentage of infants treated with surfactant, or distribution of hemorrhages at the time of the first cranial sonogram (echo-encephalogram). Within the first 5 days, 9 of 27 indomethacin-treated and 12 of 34 saline solution-treated infants had extension of their initial intraventricular hemorrhage (p = 1.00). Four indomethacin-treated and three saline solution-treated infants had parenchymal extension of the hemorrhage. Indomethacin was associated with closure of a patent ductus arteriosus by the fifth day of life (p = 0.003). There were no differences in adverse events attributed to indomethacin. We conclude that in very low birth weight infants with low grade intraventricular hemorrhage within the first 6 postnatal hours, prophylactic indomethacin therapy promotes closure of the patent ductus arteriosus and is not associated with adverse events, but does not affect the cascade of events leading to parenchymal involvement of intracranial hemorrhage.
Assuntos
Hemorragia Cerebral/tratamento farmacológico , Indometacina/uso terapêutico , Doenças do Prematuro/tratamento farmacológico , Esquema de Medicação , Permeabilidade do Canal Arterial/tratamento farmacológico , Feminino , Humanos , Indometacina/administração & dosagem , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Prospectivos , Resultado do TratamentoRESUMO
Twenty very low birth weight infants (birth weight < 1500 gm) were assessed to compare the clinical effects of breast and bottle feedings. The infants started breast-feeding during the same week that they started bottle feedings. Five breast-feedings and five bottle feedings for each infant were observed. Axillary temperature and weight before and after feedings were measured, and oxygen saturation, respiratory rate, and heart rate were monitored and recorded every 2 minutes during the feeding periods. The results showed no difference in oxygen saturation during breast-feeding (p = 0.056) but a lower incidence of oxygen desaturation (< 90%) (21% vs 38% in breast-feeding vs bottle feeding, respectively; p < 0.025). Infants with bronchopulmonary dysplasia had higher oxygen saturation during breast-feeding than during bottle feeding (p < 0.025), but weight gain during breast-feeding sessions was less (median, no gain vs 31 gm, p < 0.001). We conclude that (1) very low birth weight infants can tolerate both breast and bottle feedings at the same postnatal age; (2) very low birth weight infants are less likely to have oxygen desaturation to less than 90% during breast-feeding; and (3) weight gain is less during breast-feeding, probably because of lower intake, and may require more lactation counseling or supplementation of the feedings.
Assuntos
Aleitamento Materno , Recém-Nascido de Baixo Peso , Peso Corporal , Alimentação com Mamadeira , Feminino , Frequência Cardíaca , Humanos , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Masculino , Estudos Prospectivos , RespiraçãoRESUMO
Eighty-one very low birth weight (VLBW) infants were followed for 3 years to assess the relative impact of intrauterine growth retardation on growth and development; 27 small for gestational age (SGA) infants were compared with 27 gestation-matched infants with appropriate size for gestational age (AGA) and 27 birth weight-matched AGA infants. It was hypothesized that growth and neurodevelopmental outcomes in SGA VLBW infants are poorer than those of AGA gestation-matched (AGA-GA) infants but do not differ from those of birth weight-matched (AGA-BW) control infants. Gestational ages of the SGA, AGA-GA, and AGA-BW infants were 29 +/- 2, 29 +/- 1, 26 +/- 2 weeks, and birth weights were 821 +/- 178, 1124 +/- 85, and 848 +/- 141 gm, respectively. The SGA infants did not differ from the AGA infants in neonatal course, but AGA weight-matched infants had lower Apgar scores and more days of assisted ventilation, and an increased incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, and seizures. At 3 years of age the SGA VLBW infants had lower weight and height than both comparison groups (p < 0.05). Neurologic outcome in SGA infants did not differ from that in AGA-GA infants. The AGA-BW infants had an increased incidence of suspect or abnormal neurologic findings at 2 and 3 years of age (p < 0.05). The SGA infants scored lower on developmental tests at 1, 2, and 3 years than AGA-GA infants but had scores similar to those of the AGA-BW group. We conclude that intrauterine growth retardation in VLBW infants has a significant long-term impact on growth. Although 3-year development of SGA infants is significantly lower than that of gestation-matched control infants, it does not differ from that of weight-matched control infants.
Assuntos
Deficiências do Desenvolvimento/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Doenças do Prematuro/epidemiologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Doenças do Sistema Nervoso/epidemiologia , Peso ao Nascer , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Fatores de Risco , Fatores de TempoRESUMO
We hypothesized that gender and intrauterine growth retardation (IUGR) have greater effects than birth order on mortality and morbidity rates of very low birth weight (< 1501 gm) twins. Neonatal data were collected on 44 pairs of twins born alive between January 1984 and December 1987. Birth weight was 1018 +/- 289 gm and gestational age was 28.1 +/- 2.5 weeks. The male/female ratio was 46:42; 24 infants had IUGR, and 64 were appropriate in size for gestational age. Of the 88 infants, 61 (69%) survived. Birth order had no effect on outcome. Female twin pairs had a longer gestation than either male twin pairs or twins with discordant sex (29.2 +/- 2.5 weeks vs 27.4 +/- 2.0 weeks and 27 +/- 3 weeks, respectively; p < 0.002). They also had a lower mortality rate (14% vs 47% and 25%; p < 0.001) and a lower incidence of bronchopulmonary dysplasia (22% vs 57% and 50%; p < 0.02). Infants with IUGR had an increased mortality rate (50% vs 23%; p < 0.02) and an increased sepsis rate (61% vs 25%; p < 0.02) compared with infants with appropriate size for gestational age who were matched for gestational age. Multiple logistic regression analysis to assess the independent effects of gestational age, gender, and IUGR on mortality rate, bronchopulmonary dysplasia, and intraventricular hemorrhage revealed that gestational age was the most significant contributor to all three outcome variables; IUGR contributed to an increased mortality rate, and male gender contributed to the occurrence of bronchopulmonary dysplasia.
Assuntos
Ordem de Nascimento , Retardo do Crescimento Fetal/epidemiologia , Recém-Nascido de Baixo Peso , Resultado da Gravidez/epidemiologia , Gêmeos , Índice de Apgar , Distribuição de Qui-Quadrado , Feminino , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Modelos Logísticos , Masculino , Gravidez , Rhode Island/epidemiologia , Fatores de Risco , Fatores Sexuais , Gêmeos/estatística & dados numéricosRESUMO
A prospective longitudinal study assessed the effects of intraventricular hemorrhage (IVH) and socioeconomic status on the perceptual, cognitive, and neurologic status of preterm infants at 5 years of age. The preterm group consisted of infants with no IVH, grade I to II IVH, and grade III to IV IVH; a control group of normal term infants was also studied. Outcome was evaluated at 3, 4, and 5 years of age. Twenty-four percent of infants with grade III to IV IVH had abnormal neurologic diagnoses at 5 years of age. Correlations of predictor variables including IVH status, latency of visual evoked response, days of hospitalization, and socioeconomic status with 5-year neurologic outcome indicated that IVH status and visual evoked response at 1, 2, and 3 years continued to have an effect on neurologic outcome, but socioeconomic status and days of hospitalization did not; socioeconomic status did have a significant effect on the McCarthy cognitive scores but not on the perceptual scores at 5 years. Multiple regression analyses revealed that duration of hospitalization (reflecting neonatal morbidity), visual evoked response, and socioeconomic status all have independent effects on the cognitive index, whereas only duration of hospitalization has an independent effect on the perceptual index. These data support the concept that a complex interaction of biologic and environmental risk factors determines the degree of recovery from IVH by high-risk preterm infants.
Assuntos
Hemorragia Cerebral/complicações , Cognição , Recém-Nascido de Baixo Peso , Doenças do Sistema Nervoso/etiologia , Percepção , Fatores Socioeconômicos , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/psicologia , Desenvolvimento Infantil , Pré-Escolar , Potenciais Evocados Visuais , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Exame Neurológico , Testes Psicológicos , Desempenho PsicomotorRESUMO
The purpose of this study was to test the hypotheses that newborn infants with moderate serum bilirubin concentrations have depressed Brazelton scores and increased brain-stem conduction time and that serum bilirubin levels correlate with Brazelton behavior scores and brain-stem auditory evoked response changes. Fifty term infants who were enrolled into either a low serum bilirubin group (less than 8 mg/dl) or a moderate serum bilirubin group (10 to 20 mg/dl) were tested with the Brazelton Neonatal Behavioral Assessment Scale and a brain-stem auditory evoked response test. Partial correlation analysis controlling for phototherapy revealed that increased bilirubin concentration correlated negatively with the Brazelton orientation and with state range clusters and individual Brazelton test items that involve auditory processing. Increased bilirubin concentration correlated with an increased latency of brain-stem auditory evoked response wave 4, 5. An increased interpeak 1-5 (brain-stem conduction time) correlated with the decreased animate visual and auditory item. We conclude that moderate hyperbilirubinemia in term infants affects both infant behavior, as measured by specific components of the Brazelton test, and brain-stem conduction time, as measured by the brain-stem auditory evoked response test.
Assuntos
Tronco Encefálico/fisiologia , Potenciais Evocados Auditivos/fisiologia , Recém-Nascido/psicologia , Icterícia Neonatal/psicologia , Nível de Alerta/fisiologia , Humanos , Orientação/fisiologia , Tempo de Reação/fisiologiaRESUMO
We hypothesized that changes in brain-stem auditory evoked responses related to bilirubin would be associated with changes in cry because of the anatomic proximity in the brain stem of cranial nerves 8 (auditory) and 9 to 12 (vagal complex, which controls cry). Brain-stem auditory evoked responses and computerized cry analysis were used to study the concurrent effects of moderate hyperbilirubinemia on auditory function and cry. Fifty term infants were divided equally into two groups on the basis of serum bilirubin concentrations: low (less than 8 mg/dl; 136) mumol/L and moderate (10 to 20 mg/dl, 170 to 342 mumol/L). Forty-three infants had successful tracings of brain-stem auditory evoked responses recorded with a Cadwell model 5200A evoked response unit during two successive trials, and a cry recording of each infant was analyzed by computer. The moderate serum bilirubin group had an increase in percent cry phonation (p less than 0.02) and an increase in the variability of the first formant (p less than 0.04) in comparison with the low serum bilirubin group. Serum bilirubin values correlated positively with brain-stem conduction time (r = 0.36, p less than 0.01), percent phonation (r = 0.42, p less than 0.004), and variability of the first formant (r = 0.39, p less than 0.02). Percent phonation, the voiced component produced by increased neural control, correlated with the interpeak of waves latencies I to III (r = 0.32, p less than 0.03) and brain-stem conduction time (wave I to V) (r = 0.35, p less than 0.01). We conclude that hyperbilirubinemia affects adjoining areas of the brain stem that control hearing and cry production.
Assuntos
Tronco Encefálico/fisiopatologia , Choro/fisiologia , Icterícia Neonatal/fisiopatologia , Potenciais Evocados Auditivos , Feminino , Humanos , Recém-Nascido , Masculino , FonaçãoRESUMO
We prospectively and longitudinally evaluated neurologic status, cognitive status, and visual-evoked responses in 63 premature infants with cerebral intraventricular hemorrhage, 27 premature infants without hemorrhage, and 22 full-term normal infants. We hypothesized that severe intraventricular hemorrhage (grades III and IV) is associated with impaired visual-motor function, in part because of compression-related injury of the periventricular white matter by ventricular dilation. Infants with grade III or IV hemorrhage had significantly more neurologic sequelae at term and at 3, 7, 12, and 24 months; lower Bayley mental and motor scores at 3, 7, and 12 months; more abnormality on Kohen-Raz subscales for eye-hand coordination, object manipulation, and object relations at 3, 7, and 12 months; and lower Mullen vision-receptive and vision-expressive coordination scores at 24 months. The 12-month visual-evoked response correlated with the 24-month vision-receptive and vision-expressive organization scores for infants with grade III or IV intraventricular hemorrhage (r = -0.49, p less than 0.01, and r = -0.40, p less than 0.05, respectively). The data confirm our hypotheses of increased cognitive and neurologic sequelae, and increased abnormality of visual-motor coordination, during the first 2 years of life in infants with severe (grade III or IV) intraventricular hemorrhage.
Assuntos
Hemorragia Cerebral/fisiopatologia , Deficiências do Desenvolvimento/etiologia , Doenças do Prematuro/fisiopatologia , Doenças do Sistema Nervoso/etiologia , Transtornos Psicomotores/etiologia , Hemorragia Cerebral/complicações , Cognição , Potenciais Evocados Visuais , Humanos , Recém-Nascido , Estudos Longitudinais , Exame Neurológico , Estudos Prospectivos , Fatores Socioeconômicos , UltrassonografiaRESUMO
Maternal and infant behavior during feeding was assessed in 30 mother-infant dyads: 15 small-for-gestational-age (SGA) infants (birth weights below the 10th percentile) and 15 appropriate-for-gestational-age (AGA) infants (birth weights between the 25th and 90th percentiles). The groups were balanced for gestational age, sex, neonatal risk factors, and maternal age, parity, socioeconomic status, and race. Behaviors indicative of infant feeding difficulties were coded for mother and infant. The SGA mothers had higher frequencies of these behaviors than did their AGA counterparts. Qualitative ratings of interactive behavior were recorded for mother and infant: SGA infants had ratings indicative of less optimal interactions than those of the AGA group. Infant caloric intake (calories per kilogram per feeding) was calculated by first dividing the change in infant weight in grams before feeding and immediately after feeding by the infant's weight before feeding and then converting it to calories. Although no difference in caloric intake was observed between the two groups, infant behaviors and ratings were associated with caloric intake. These data suggest the importance of including neonatal behavior during feeding in the risk assessment of potential growth failure in SGA infants.
Assuntos
Alimentação com Mamadeira , Recém-Nascido de Baixo Peso/psicologia , Relações Pais-Filho , Ingestão de Energia , Feminino , Humanos , Recém-Nascido , Comportamento MaternoRESUMO
Fourteen (2.2%) of 645 survivors with birth weight less than or equal to 1500 gm cared for in the Special Care Nursery between 1975 and 1981 were identified as having stage III-IV retrolental fibroplasia (RLF) in one or both eyes. These 14 survivors and 14 controls matched for birth weight have been observed for 2 to 7 years. There were no differences between survivors with RLF and controls in birth weight, gestation, multiple neonatal risk factors, or Hollingshead socioeconomic status. The only significant difference was in prolonged O2 requirements (greater than 2 weeks) (13 of 14 patients vs 7 of 14 control infants (P less than 0.025) and prolonged assisted ventilation requirements (21 +/- 15 for RLF vs 6 +/- 10 days for control infants, P less than 0.05). Follow-up assessments showed that the RLF survivors had a significantly higher incidence of neurologic abnormality, lower developmental quotients, increased requirements for special education, increased number of hospitalizations for illness, and more maternal stress as observed in the mother's adapted Life Experience Survey. We conclude that low-birth-weight infants with stage III-IV RLF are at a higher risk for neurodevelopmental problems and that their families are in need of comprehensive support services.
Assuntos
Recém-Nascido de Baixo Peso , Retinopatia da Prematuridade/epidemiologia , Desenvolvimento Infantil , Suscetibilidade a Doenças/epidemiologia , Família , Feminino , Seguimentos , Humanos , Recém-Nascido , Acontecimentos que Mudam a Vida , Masculino , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/psicologia , Apoio Social , Fatores Socioeconômicos , Estresse Psicológico/epidemiologiaRESUMO
The growth pattern and neurologic and developmental performance of 21 preterm infants small for gestational age and 20 preterm infants appropriate for gestational age (birth weight less than 1500 gm) were prospectively studied. The two groups had comparable birth weight, sex, perinatal morbidities, and socioeconomic status. All infants with congenital anomalies or genetic defects were excluded. Nineteen of 21 SGA (90%) and 16 of 20 AGA (80%) infants born in 1975 or 1976 were evaluated in our follow-up program until 5 years of age. At 1 year of age, the weights and lengths of the SGA infants were comparable to those of their AGA counterparts; AGA infants were significantly heavier, however, at 2, 3, 4, and 5 years of age. In addition, AGA infants were significantly taller at 2, 3, and 5 years. Neurologic evaluation of 5 years showed a comparable rate of major abnormalities between the SGA (15%) and AGA (12%) children. Minor neurologic abnormalities were present in 26% of SGA and 12% of AGA children. Linear-regression analysis demonstrated a positive relationship between socioeconomic status and developmental outcome for both SGA and AGA children at 5 years of age. Although SGA infants scored significantly lower in developmental performance at 9 months through 3 years of age, at 4 to 5 years of age this difference was no longer observed. These observations indicate the importance of long-term follow-up.
Assuntos
Desenvolvimento Infantil , Crescimento , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Estatura , Peso Corporal , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
In this study of the effects of maternal diabetes on the growth of offspring, 52 diabetic mothers were enrolled prenatally in the Providence cohort of the Perinatal Collaborative Study during 1960-1963. Among the offspring, there were 12 perinatal deaths. We were able to enroll 34 survivors and 34 matched controls in an adolescent follow-up study. Of the 34 diabetic mothers, six were insulin dependent, six had chemical diabetes, 13 had gestational diabetes, and nine were suspects. As part of the Collaborative Project, sequential follow-up evaluations had been done at four months, one year, four years, and seven years. A positive relationship was found between maternal pre-pregnant weight, weight gain during pregnancy, and the neonatal weight/height index in both diabetic and control subjects. At 7 years of age, eight of 19 offspring of diabetic mothers who were large for gestation at birth were obese, whereas only one of 14 infants who were appropriate for gestation at birth were obese (P < 0.05). Adolescent obesity (weight/height index greater than or equal to 1.2) was more likely in infants who had been LGA at birth. These data suggest that macrosomia in infants of diabetic mothers may be a predisposing factor for later obesity.