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D K Richardson

Publications and source records attributed to D K Richardson.

At least 37 records · Page 2Linked to original sources
PubMed1998

Variation among neonatal intensive care units in narcotic administration.

OBJECTIVES: To compare rates of narcotic administration for medically treated neonates in different neonatal intensive care units (NICUs) and to compare treated and untreated neonates to assess whether narcotics provided advantages or disadvantages for short-term outcomes, such as cardiovascular stability (ie, blood pressure and heart rate), hyperbilirubinemia, duration of respiratory support, growth, and the incidence of intraventricular hemorrhage. STUDY DESIGN: The medical charts of neonates weighing less than 1500 g, admitted to 6 NICUs (A-F), were abstracted. Neonates who had a chest tube or who had undergone surgery were excluded from the study, leaving the records of 1171 neonates. We modeled outcomes by linear or logistic regression, controlling for birth weight (<750, 750-999, and 1000-1499 g) and illness severity (low, 0-9; medium, 10-19; high, > or =20) using the Score for Neonatal Acute Physiology (SNAP), and adjusted for NICU. RESULTS: Narcotic use varied by birth weight (<750 g, 21%; 750-999 g, 13%; and 1000-1499 g, 8%), illness severity (low, 9%; medium, 19%; and high, 37%), day (1, 11%; 3, 6%; and 14, 2%), and NICU. We restricted analyses to the 1018 neonates who received mechanical ventilation on day 1. Logistic regression, adjusting for birth weight and SNAP, confirmed a 28.6-fold variation in narcotic administration (odds ratios, 4.1-28.6 vs NICU A). Several short-term outcomes also were associated with narcotic use, including more than 33 g of fluid retention on day 3 and a higher direct bilirubin level (6.8 micromol/L higher [0.4 mg/dL higher], P = .03). There were no differences in weight gain at 14 and 28 days or mechanical ventilatory support on days 14 and 28. Narcotic use was not associated with differences in worst blood pressure or heart rate or with increased length of hospital stay. CONCLUSIONS: Our study found a 28.6-fold variation among NICUs in narcotic administration in very low-birth-weight neonates. We were unable to detect any major advantages or disadvantages of narcotic use. We did not assess iatrogenic abstinence syndrome or long-term outcomes. These results indicate the need for randomized trials to rationalize these widely differing practices.

Birth Weight↗
PubMed1998

Variations in blood transfusions among newborn intensive care units. SNAP II Study Group.

OBJECTIVES: Very low birth weight (< 1500 g) infants frequently require packed red blood cell transfusions, and transfusion rates vary among neonatal intensive care units (NICUs). We analyzed transfusions and compared outcomes among NICUs. STUDY DESIGN: In a 6-site prospective study, we abstracted all newborns weighing < 1500 g (total = 825) born between October 1994 and September 1995. Transfusion frequency and volume and phlebotomy number were analyzed by site and adjusted for birth weight and illness severity. We compared rates of intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, growth, and length of stay between the high and low transfuser NICUs. RESULTS: Sites differed significantly in mean birth weight, illness severity, number of transfusions, pretransfusion hematocrit, blood draws, and donor number. Multivariate adjustment for these risks showed that the highest transfusing NICU transfused an additional 24 cc/kg per baby during the first 14 days and 47 cc/kg per baby after 15 days, relative to the lowest transfusing NICU. The presence of arterial catheters increased the frequency of blood transfusions. The rates of intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia were not higher in the 2 lowest transfusing NICUs, nor were there differences in 28-day weight gain or length of stay. CONCLUSIONS: Major differences in transfusion practices for very low birth weight infants exist among NICUs. Because clinical outcomes were no different in lower transfuser NICUs, it is likely that transfusion and phlebotomy guidelines could result in fewer transfusions, fewer complications, and reduced cost.

Anemia, Neonatal↗
PubMed1998

Intravenous lipid emulsions are the major determinant of coagulase-negative staphylococcal bacteremia in very low birth weight newborns.

BACKGROUND: Intravenous lipid emulsions and the i.v. catheters through which they were administered were the major risk factors for nosocomial coagulase-negative staphylococcal (CONS) bacteremia among newborns in our neonatal intensive care units a decade ago. However, medical practice is changing, and these and other interventions may have different effects in the current setting. OBJECTIVES: We determined the independent risk factors for CONS bacteremia in current very low birth weight newborns after adjusting for severity of underlying illness. METHODS: We surveyed 590 consecutively admitted newborns with birth weights < 1500 g hospitalized in 2 neonatal intensive care units and conducted a case-control study in a sample of 74 cases of CONS bacteremia and 74 pairs of matched controls. Adjusted relative odds of bacteremia were estimated for a number of attributes and therapeutic interventions in 2 time intervals before CONS bacteremia: any time before bacteremia and the week before bacteremia. RESULTS: Using conditional logistic regression to adjust for indicators of severity of illness, two procedures were independently associated with subsequent risk of CONS bacteremia at any time during hospitalization: i.v. lipids, odds ratio (OR) = 9.4 [95% confidence interval (CI) 1.2 to 74.2]; and any surgical or percutaneously placed central venous catheter, OR = 2.0 (95% CI 1.1 to 3.9). Considering only the week immediately preceding bacteremia, the independent risk factors were: mechanical ventilation, OR = 3.2 (95% CI 1.3 to 7.6); and short peripheral venous catheters, OR = 2.6 (95% CI 1.0 to 6.5). CONCLUSIONS: During the last decade exposure to i.v. lipids any time during hospitalization has become an even more important risk factor for CONS bacteremia (OR = 9.4). Of these bacteremias 85% are now attributable to lipid therapy. In contrast the relative importance of intravenous catheters as independent risk factors has declined. Mechanical ventilation in the week before bacteremia has emerged as a risk factor for bacteremia.

Bacteremia↗
PubMed1998

Variations in transfusion practice in neonatal intensive care.

OBJECTIVE: To compare the transfusion practices between two neonatal intensive care units (NICUs) to assess the impact of local practice styles on the timing, number, and total volume of packed red cell transfusions in very low birth weight infants. To derive multivariate models to describe practice and to identify potential areas for improvement in the future. METHODOLOGY: We reviewed phlebotomy losses and transfusion rates between two NICUs (A and B) for 270 consecutive admissions of birth weight < 1500 g. We stratified for birth weight and for illness severity by the Score for Neonatal Acute Physiology (SNAP). Measures of short-term outcome were compared. We derived multivariate models to describe and compare the practices in the two NICUs. RESULTS: Patients in NICU A had smaller phlebotomy losses than those in NICU B. A lower percentage of the patients in NICU A (65% vs 87%) received transfusions, but they tended to receive a greater total volume per kg per patient (67 mL/kg vs 54.8 mL/kg). Transfusion timing differed between the NICUs; in NICU A only approximately one-half of their transfusions occurred in the first 2 weeks, whereas in NICU B almost 70% of the transfusions were given in this time period. Multivariate models showed that phlebotomy losses were significantly related to lower gestational age (GA) and higher SNAP. Hospitalization in NICU B resulted in 10.7 cc of additional losses relative to NICU A for a comparable GA and illness severity score. The volume of blood transfused per kilogram of body weight was a function of GA, SNAP, and hospital. Care practices in NICU A added an additional 19 cc of transfused volume in the first 14 days of life, and an additional 26 cc thereafter when adjusted for GA and SNAP. These differences in phlebotomy and transfusion were not associated with differences in the days of oxygen therapy or mechanical ventilation, the oxygen requirement at 28 days, the incidence of chronic lung disease, or the rate of growth by day 28. CONCLUSIONS: We identified significant differences in phlebotomy and transfusion practices between two NICUs. We found no differences in short-term outcome, suggesting that the additional use of blood in one of the NICUs was discretionary rather than necessary. Our multivariate models can be used to characterize and quantify transfusion and phlebotomy practices. By predicting which patients are likely to require multiple transfusions, clinicians can target patients for erythropoietin therapy and identify those patients for whom donor exposure can be reduced by a unit of blood for multiple use. The models may help in monitoring changes in practice as they occur.

Blood Transfusion↗
PubMed1998

Outcome prediction in Greek neonatal intensive care units using a score for neonatal acute physiology (SNAP)

OBJECTIVES: This study was undertaken to evaluate the performance of the score for neonatal acute physiology (SNAP) in Greece, to examine the predictive power of SNAP calculated during the 12 hours after admission in comparison with customarily calculated SNAP during the first 24 hours, and to assess SNAP during the second 12 hours from admission as a measure of response to treatment. METHODOLOGY: A total of 579 newborns admitted to three neonatal intensive care units (NICUs) from two cities in Greece were enrolled in the study; SNAP was determined during the first 12 hours, the second 12 hours, and the first 24 hours from admission to the NICU and calculated using an algorithm based on deviations from normal values of 26 physiologic parameters. RESULTS: All three variants of SNAP were powerful predictors of vital status at discharge, as well as of duration of stay among survivors. A five-point increase in SNAP in the first 12 hours corresponds to a more than twofold ratio in the odds for death, whereas a five-unit difference in SNAP from the second 12 hours corresponds to a more than threefold ratio. The combined 24-hour score was similar to that for the first 12 hours. A considerable advantage of SNAP was its independence from more traditional predictors of neonatal death, notably gestational age, birth weight, and Apgar score. The combination of all of these predictors improved further the overall predictive potential. CONCLUSIONS: SNAP is a useful tool in medical research and can be applied in different population groups. Its independence from birth weight underlines its added value to predict fatality ratios. Moreover, the results of the present study indicate that SNAP can be estimated without loss of predictive efficiency during the first 12 hours from admission to the NICU, whereas SNAP during the second 12 hours adequately reflects the effectiveness of early medical interventions.

Apgar Score↗
PubMed1998

Declining severity adjusted mortality: evidence of improving neonatal intensive care.

OBJECTIVES: Declines in neonatal mortality have been attributed to neonatal intensive care. An alternative to the "better care" hypothesis is the "better babies" hypothesis; ie, very low birth weight infants are delivered less ill and therefore have better survival. DESIGN: We ascertained outcomes of all live births <1500 g in two prospective inception cohorts. We estimated mortality risk from birth weight and illness severity on admission and measured therapeutic intensity. We calculated logistic regression models to estimate the changing odds of mortality between cohorts. PATIENTS AND SETTING: Two cohorts in the same two hospitals, 5 years apart (1989-1990 and 1994-1995) (total n = 739). RESULTS: Neonatal intensive care unit mortality declined from 17.1% to 9.5%, and total mortality declined from 31.6% to 18.4%. Cohort 2 had lower risk (higher birth weight, gestational age, and Apgar scores and lower admission illness severity for newborns >/=750 g). Risk-adjusted mortality declined (odds ratio, 0.52; confidence interval, 0.29-0. 96). One third of the decline was attributable to "better babies" and two thirds to "better care." Use of surfactant, mechanical ventilation, and pressors became more aggressive, but decreases in monitoring, procedures, and transfusions resulted in little change in therapeutic intensity. CONCLUSIONS: Mortality decreased nearly 50% for infants <1500 g in 5 years. One third of this decline is attributable to improved condition on admission that reflects improving obstetric and delivery room care. Two thirds of the decline is attributable to more effective newborn intensive care, which was associated with greater aggressiveness of respiratory and cardiovascular treatments. Attribution of improved birth weight specific mortality solely to neonatal intensive care may underestimate the contribution of high-risk obstetric care in providing "better babies."

Hospital Mortality↗
PubMed1998

Characterization of the triage process in neonatal intensive care.

OBJECTIVE: Despite intense interest in allocation of resources to neonatal intensive care, no description exists of resource use by the large numbers of newborns admitted for triage, the process of short-term evaluation and management of infants after delivery. This study characterized the triage phase of neonatal care with respect to infant demographics, risk factors for illness, and the course of the hospital admission. We hypothesized that triage infants were responsible for a significant fraction of total intensive care resource utilization, and that patterns of use were predictable. DESIGN: Cross-sectional cost analysis of prospectively collected data. PARTICIPANTS: Data were collected prospectively on 2486 inborn infants admitted to two neonatal intensive care units (NICUs) for <24 hours and subsequently discharged to routine care. Over the 11-month study period, these two hospitals delivered 15 097 live births and admitted a further 1837 infants for nontriage NICU care. INTERVENTIONS: On a 50% random subsample, we calculated severity of illness using the Score for Neonatal Acute Physiology (SNAP) and applied a NICU resource checklist. Daily NICU workload was estimated according to the number and labor intensity of NICU admissions using Medicus and SNAP. Charges were obtained from patient-level item charge records and converted to costs using Medicare ratios of costs to charges. Length of stay (LOS) and costs for triage were correlated with diagnoses, perinatal descriptors, severity of illness, and markers of concurrent NICU workload using stepwise regression. RESULTS: Mean birth weight for triage infants was 3367 g (standard deviation, 600 g) and mean gestational age 39.1 weeks (standard deviation, 1.8 weeks). The predominant reasons for evaluation were exclusion of sepsis (34%), birth complications including meconium aspiration, perinatal depression and trauma (24%), and transitional respiratory distress (23%). Severity illness, as measured by SNAP, was minimal, with 70% having scores of 0, indicating no derangement. Only 6% experienced depressed 5-minute Apgar scores (<7), and 80% required no delivery room resuscitation. The most frequent forms of resource use were antibiotic administration (34%), placement of a peripheral intravenous line (40%), cardiac monitoring (53%) and external warming (26%). Median LOS was 102 minutes, corresponding over the study period to 2% of total NICU hours but 7% of NICU days charged. Median cost was $870, with aggregate costs accounting for a total of 9.5% of total NICU costs. In the multivariate model, LOS was increased by respiratory diagnosis or hypoglycemia, severity of illness, lower gestational age, the need for intravenous placement, daytime shift, hospital, and lower acuity of concurrent NICU admissions (R2 = 0.24). CONCLUSIONS: Neonatal triage is a low-acuity but time-intensive process that contributes significantly to total resource use by newborns because of the large numbers of infants involved. Both LOS and costs are affected not only by infant medical characteristics but also by nonmedical markers of unit structure, which may be amenable to change. This source of resource consumption should be recognized in future assessments of costs associated with neonatal intensive care.

Academic Medical Centers↗
PubMed1998

Neonatal risk scoring systems. Can they predict mortality and morbidity?

Physiology-based illness severity scores are proving their value through a wide variety of practical applications. The theoretical disadvantages noted in Table 1 have not turned out to be major problems, whereas the advantages have been quite real. Numerous studies have reported insightful comparisons between treatment groups, between NICUs, between countries, between eras, and over the course of care. Many institutions have implemented routine collection of physiology-based newborn scores. The answer to the question posed in the title is yes; neonatal risk scoring systems can predict some mortality and some morbidity. However, it is clear that this function is much less important than their application as a means of improving quality and cost. Future development will depend on commercially viable applications.

Birth Weight↗
PubMed1997

Cost-effectiveness of fetal lung maturity testing in preterm labor.

OBJECTIVE: To determine the marginal cost-effectiveness of two strategies for preventing respiratory distress syndrome (RDS) resulting from preterm birth: 1) tocolysis with beta-mimetic agonists and treatment with corticosteroids (TREATALL), and 2) amniocentesis and testing for fetal lung maturity, with treatment based on test results (TESTALL), compared with no treatment. METHODS: We used a Markov decision analytic model to estimate the outcomes of each strategy, from a hospital-based perspective. Probability variables were obtained from the literature, whereas cost variables came from the Beth Israel-Deaconess Medical Center. Sensitivity analysis was performed on all variables. RESULTS: The most cost-effective strategy varied with the probability of RDS. TREATALL was the most cost-effective strategy above a probability of 17% (before 34 weeks' gestation), TESTALL was most cost-effective from 17% to 2% (34-36 weeks), and it was most cost-effective to use no treatment at probabilities less than 2% (after 36 weeks). TREATALL and TESTALL were both cost-saving compared with no treatment at probabilities of RDS above 2%. TREATALL was more highly favored as the costs of RDS and preterm birth increased, whereas TESTALL was more favored as the specificity of the test and the cost of maternal hospitalization increased. CONCLUSION: Although testing for fetal lung maturity is useful in many clinical situations, the cost-effectiveness of such testing in the setting of idiopathic preterm labor from a tertiary medical center perspective depends primarily on the probability and costs of RDS and the costs of non-RDS-related morbidity. At our institution, such testing is cost-effective between 34 and 36 weeks' gestation.

Amniocentesis↗
PubMed1997

Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation.

OBJECTIVE: Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature. This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics. METHODS: We studied 1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission for delivery. The rates of maternal intrapartum fever >100.4 degrees F, neonatal sepsis evaluation, and neonatal antibiotic treatment according to use of epidural analgesia during labor were determined. Rate ratios and 95% confidence intervals (CI) were calculated. Multiple logistic regression was used to examine associations while controlling for confounding factors. RESULTS: Intrapartum fever >100.4 degrees F occurred in 14.5% of women receiving an epidural but only 1.0% of women not receiving an epidural (adjusted odds ratio (OR) = 14.5, 95% CI = 6.3, 33.2). Without epidural, the rate of fever remained low regardless of length of labor; with epidural, the rate of fever increased from 7% for labors < or = 6 hours to 36% for labors >18 hours. Neonates whose mothers received epidurals were more often evaluated for sepsis (34.0% vs 9.8%; adjusted OR = 4.3, 95% CI = 3.2, 5.9) and treated with antibiotics (15.4% vs 3.8%; adjusted OR = 3.9, 95% CI = 2.1, 6.1). Although 63% of women received epidurals, 96.2% of intrapartum fevers, 85.6% of neonatal sepsis evaluations, and 87.5% of neonatal antibiotic treatment occurred in the epidural group. CONCLUSIONS: Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment.

Analgesia, Epidural↗
PubMed1997

Physician variations and the ancillary costs of neonatal intensive care.

OBJECTIVE: To determine to what degree attending physicians contribute to cost variations in the care of ventilator-dependent newborns. DATA SOURCES: Clinical data were merged with hospital financial data describing daily ancillary care costs during the first two weeks of life for 132 extremely low-birthweight newborns. In addition, each patient's chart was reviewed and illness severity graded using both SNAP and CRIB scores. STUDY DESIGN: This was a retrospective cohort of infants with birth weights of less than 1,001 grams and respiratory distress syndrome requiring mechanical ventilation in the first day of life. From birth up to two weeks of life, each received care directed by only one of 11 faculty neonatologists in a single university hospital. Data were analyzed stratified by these physicians. t-Test, ANOVA, and chi-square were used to assess bivariate data. For continuous data, log linear regressions were used. PRINCIPAL FINDINGS: After controlling for illness severity, when stratified by physicians, there were significant variances in the costs of ancillary resources for the study infants (p < .0001). Twenty-nine percent of the variance was attributable to whether or not the hospital day included the use of a ventilator. Physician identity explained only 5.6 percent (p < .0001). CONCLUSIONS: Physician identity was significant but explained less than 6 percent of the total variance in ancillary costs. Whether or not a ventilator was used during care was far more important. We conclude that for very sick babies during the first two weeks of care, reducing variations in ancillary services utilization among neonatologists will yield only modest savings.

Analysis of Variance↗
PubMed1996

Outcomes of severely abnormal umbilical artery doppler velocimetry in structurally normal singleton fetuses.

OBJECTIVE: To construct a management guide for preterm pregnancies complicated by severely abnormal umbilical artery Doppler velocimetry. METHODS: A retrospective chart review was conducted on all cases of absent or reversed end-diastolic flow umbilical artery Doppler velocimetry identified through an ultrasound data base. Maternal and perinatal outcome variables were retrospectively reviewed and analyzed using both parametric and nonparametric statistical techniques. Seventy-one cases were identified over a 5-year period. After excluding multiple gestations, anomalous fetuses, and two cases that were terminated before 24 weeks' gestation, 56 singleton gestations remained for analysis. RESULTS: Among the 56 subjects, there were 45 survivors and 11 deaths (five fetal and six neonatal deaths). Nonsurvivors had a significantly lower gestational age at diagnosis and delivery. Nonsurviving live-born neonates had lower Apgar scores and were significantly smaller; however, there were no differences in proportion or severity of fetal growth restriction in survivors and nonsurvivors. There were no differences in last biophysical profile before delivery or interval from diagnosis of reversed end-diastolic flow to delivery. Predictors of nonsurvival were the presence of reversed end-diastolic flow and oligohydramnios. Perinatal mortality for reversed end-diastolic flow was 333/1000 and 94/1000 for absent end-diastolic flow. Risk for perinatal death was highly gestational age dependent. For delivery at less than 26 weeks, survival was one of four; at 26-27.9 weeks, survival was seven of 12; and at 28 weeks or greater, survival was 37 of 40. CONCLUSION: Whereas severely abnormal umbilical artery blood flow poses significant risk for pregnancy, perinatal mortality is dominated by gestational age at diagnosis and delivery. This may reflect the severity of the disease or the low survival of very immature gestations. Interventions on behalf of the fetus at very early gestational ages should be undertaken with caution.

Female↗
PubMed1996

Prediction of respiratory distress syndrome by the novel dipalmitoyl phosphatidylcholine test.

OBJECTIVE: To determine the accuracy of a new test that measures the concentration in amniotic fluid (AF) of dipalmitoyl phosphatidylcholine (DPPC) in predicting respiratory distress syndrome (RDS). METHODS: The neonatal respiratory status of 176 newborns delivered within 72 hours of sampling was correlated with the concentration of DPPC, fluorescence polarization (TDx-FLM), lecithin-sphingomyelin ratio (L/S), and phosphatidyl-glycerol (Amniostat-FLM) in AF. RESULTS: Thirty infants developed RDS (17%), all correctly predicted with DPPC values less than 12 micrograms/mL (sensitivity 100%). Only six of the 146 cases with no RDS had DPPC values less than 12 micrograms/mL (specificity 96%). The overall accuracy of the DPPC test was 98% compared with 70% for TDx-FLM, 71% for the L/S, and 67% for Amniostat-FLM. Receiver operating characteristic analysis area was 0.98 +/- 0.01, indicating that the DPPC test is superior to both the TDx-FLM and L/S tests. CONCLUSION: The DPPC test is an accurate predictor of RDS and fetal lung maturity.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1996

Racial differences in the predictive value of the TDx fetal lung maturity assay.

OBJECTIVE: Black newborns have lower rates of neonatal respiratory distress syndrome compared with nonblack newborns. This has been attributed to accelerated lung maturation. Previous studies have demonstrated a difference in the predictive value of the lecithin/sphingomyelin ratio, a test for lung maturity, between races. Our study examines the predictive value of the newer TDx Fetal Lung Maturity Surfactant-to-Albumin assay. STUDY DESIGN: We reviewed the records of 393 nonblack and 87 black infants delivered within 72 hours of the TDx FLM S/A assay testing. We compared the rates of neonatal respiratory distress syndrome by race, stratified by results. RESULTS: In our study population black newborns had less than one half the rate of respiratory distress syndrome compared with nonblack newborns (4.6% vs 10.4%). To adjust for possible differences in the timing of lung maturation, the results were stratified by the TDx FLM S/A assay result. Black race had a protective effect (Mantel-Haenszel weighted odds ratio 0.30, 95% confidence interval 0.06 to 0.93, p < 0.05). This significant racial difference remained when both TDx FLM S/A assay result and gestational age were controlled in a multiple logistic regression analysis. CONCLUSIONS: There are differences in the predictive value of the TDx FLM S/A assay among races. Black fetuses are less likely to have respiratory distress syndrome. The difference in rates of respiratory distress syndrome between races must be due to either a qualitative difference in the surfactant or to an anatomic difference in fetal lungs. Consideration should be given to a lower cutoff value for a mature test result in black women.

Black People↗
PubMed1996

Prediction of fetal lung maturity in infants of diabetic mothers using the FLM S/A and disaturated phosphatidylcholine tests.

The authors evaluated the performance of the amniotic fluid surfactant to albumin ratio (FLM S/A), and disaturated phosphatidylcholine (DSPC) tests in assessing fetal lung maturity in infants of mothers with insulin-dependent diabetes mellitus antedating pregnancy. The distribution of the study population (n = 180) by class of diabetes was class B (27%); class C (28%); class D (29%); class F, FR and T (8%); and class R patients (8%). The diagnosis of respiratory distress syndrome (RDS) was the standard for evaluating the performance of FLM S/A and DSPC. The mean estimated gestational age was 37.4 weeks. Three infants (1.7%) were diagnosed with RDS. All three were delivered before 36 weeks. FLM S/A at the cut-off for "maturity" of > or = 70 mg/g, had a sensitivity of 66.6%, specificity of 94.9%, positive predictive value (PPV) of 18.2%, and negative predictive value (NPV) of 99.4%. DSPC at the cut-off for "maturity" of 1,000 micrograms/dL, had identical sensitivity and NPV, but lower specificity (89.2%) and PPV (9.5%) than FLM S/A. Both tests mispredicted maturity in the same case of RDS. The false "mature" rate of FLM S/A was 0.6% (95% confidence interval 0.0%-3.2%). The FLM S/A result of > or = 70 mg/g, obtained at or near-term, is a reliable predictor of the absence of RDS in infants of mothers with diabetes mellitus antedating pregnancy.

Albumins↗
PubMed1996

Normal birth weight intensive care unit survivors: outcome assessment.

UNLABELLED: RATIONALE/OBJECTIVE: Although the short- and long-term outcome of low birth weight neonatal intensive care unit (NICU) survivors has been extensively studied, much less information is available for normal birth weight (NBW) infants (greater than or equal to 2500 g) who require NICU care. METHODS: To address this issue, we retrospectively examined the neonatal hospitalizations and 6-month health status of 521 consecutive NBW admissions to a single NICU. Information on the neonatal hospitalization was obtained from a review of medical records. Postdischarge health status was collected by using telephone survey techniques. RESULTS: NBW infants comprised 88.1% of births in this hospital and 35.4% of NICU admissions during the study period. The in-hospital mortality rate for this group was 2%. The median length of stay was 7.7 days (range 1 to 110 days) with median hospital charges of $5222 (range $565 to $317,820). Only 59% of infants required active intensive care therapy; the remainder received only intensive monitoring. The need for intensive therapy on admission day along with the presence of prematurity and congenital anomalies were significant predictors of hospital charges (R2 = 0.31, P < .01). After initial discharge, 10.1% of these infants required rehospitalization in the first 6 to 8 months of life. The rate of readmission among infants with congenital anomalies was over 30%. In addition to its association with neonatal resource consumption, the presence of congenital anomalies along with low 5-minute Apgar scores was associated with higher postdischarge resource use, as measured by frequency of physician visits, need for special medical items, and rate of rehospitalization (P < .05). CONCLUSIONS: NBW infants represent a significant percentage of NICU admissions, but for many of these patients NICU admission could be avoided if alternative care settings that provided intensive monitoring were available. In addition, these infants also incur higher rates of postdischarge use of medical care.

Birth Weight↗