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Biomedical subjects

J M Oehler

Publications and source records attributed to J M Oehler.

At least 19 recordsLinked to original sources
PubMed1997

Developmental outcome of very low birth weight infants at four years of age as a function of biological risk and psychosocial risk.

The continuing contribution of early biological and psychosocial risk factors to developmental outcome of 55 very low birth weight infants (< or = 1500 g) was assessed at 4 years of age. Biological risk, assessed by the Neurobiologic Risk Score, accounted for significant portions of the variance in the perceptual-performance (17%) and motor (35%) dimensions of the McCarthy Scales of Children's Abilities. Psychosocial risk, reflected in maternal appraisals of daily stress during the newborn period, did not account for a significant portion of variance in any of the McCarthy Scales. Maternal education level, however, another measure of psychosocial risk, accounted for significant portions of variance (from 6% to 34%) on each of the McCarthy Scales. Movement from low neurobiologic risk status to poor outcome status at 4 years of age was associated with a number of psychosocial variables, including maternal education and early levels of maternal daily stress. The findings are discussed in terms of early markers for very low birth weight infants who require careful follow-up and of potential intervention targets to promote developmental outcome.

Brain Damage, Chronic↗
PubMed1995

Influence of acidosis, hypoxemia, and hypotension on neurodevelopmental outcome in very low birth weight infants.

OBJECTIVE: We previously demonstrated that acidosis (pH < 7.15) predicts poor motor outcome in very low birth weight (VLBW) infants. The present study was undertaken to examine the association between acidosis and developmental outcome in more detail and to better understand the interrelationship of acidosis with related factors such as hypoxemia and hypotension. METHODS: The nursery records of 191 infants enrolled in our VLBW follow-up study were reviewed to identify the type of acidosis (metabolic or respiratory) present, measure the duration of single and cumulative episodes, and examine the interaction of acidosis with hypoxemia and hypotension. The Bayley Scales of Infant Development and a detailed neurologic examination were performed at 6 (n = 158) and 24 (n = 106) months corrected age. RESULTS: At 6 months, both respiratory and metabolic acidosis as well as the total duration and longest single episode of acidosis were significantly correlated with cognitive, motor, and neurologic outcome (P < .0001). By 24 months, only the association of the metabolic component of acidosis with all three outcome measures remained significant. Duration of hypotension independently correlated with outcome at both testing periods (P < .002) but isolated hypoxemia did not. The metabolic component of acidosis and isolated hypotension contributed significantly to the variance in all three outcome measures (P < .05). Duration of hypoxemia, but not hypotension, contributed significantly (53%) to the variance in the metabolic component of acidosis. CONCLUSION: We conclude that it is the metabolic component of acidosis that is important in predicting poor developmental outcome in VLBW infants. The detrimental effect of hypoxemia appears to be closely related to the occurrence of metabolic acidosis while hypotension has an independent effect on outcome.

Acidosis↗
PubMed1994

Developmental outcome of very low birth weight infants as a function of biological risk and psychosocial risk.

The relative contribution of biological and psychosocial risk factors to developmental outcome of 102 very low birth weight infants (< 1500 g) was delineated through 24 months corrected age. Biological risk, assessed by the Neurobiologic Risk Score (NBRS), accounted for significant amounts of variance in Bayley Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at the 6-, 15-, and 24-month assessment points. Psychosocial risk, reflected in maternal appraisals of daily stress, accounted for a significant increment in cognitive outcome (MDI), over and above that accounted for by the NBRS, at each assessment point. Cognitive functioning at each assessment point differed as a function of biological risk and psychosocial risk status. The findings are discussed in terms of maternal stress as a marker of, and salient intervention target for, caregiving environments that can maximize or minimize the effects of biological vulnerability.

Brain Damage, Chronic↗
PubMed1994

Instrumentation in neonatal research: commonly used statistics.

Nurse researchers share one common characteristic: They all use statistical tests to provide the answers they are seeking. For others to correctly interpret research, it is important to understand what choices of tests are available and why a test was used. As nursing becomes more sophisticated in the research arena, the ability to read, interpret, and critique reported research findings becomes an important component of professional practice. This month's column contains a description of commonly used statistical tests. Researchers are often interested in differences between groups and relationships between variables. Examples of these two types of research are provided to illustrate use of the various tests. One common part of statistical tests examining differences between groups is the number of degrees of freedom. Degrees of freedom are usually defined as the number of observations (number of subjects or categories) minus the number of limitations placed on those observations. Examples of this concept are provided throughout the pertinent tests.

Humans↗
PubMed1993

Nursery neurobiologic risk score: levels of risk and relationships with nonmedical factors.

This study compares the Neurobiologic Risk Score (NBRS) with developmental outcome in 199 infants < or = 1500 g birth weight to determine levels of risk and to investigate the relative contributions of the NBRS and nonmedical factors to developmental outcome. The NBRS correlated significantly (p < .0001) with the Bayley Mental (MDI) and Psychomotor (PDI) Indexes, and neurologic examination score (NS) at 6, 15, and 24 months. Three risk groups were identified: low, NBRS < or = 4; intermediate, NBRS 5 to 7; and high, NBRS > or = 8 with an incidence of major handicaps at 24 months of 7%, 32%, and 50%, respectively. Of eight factors considered, the NBRS accounted for the greatest variance: MDI, 14 to 27%; PDI, 25 to 29%; NS, 34 to 42%. Additional increments of variance were contributed by gender (MDI, PDI, NS), maternal intelligence and race (MDI), and maternal education (PDI). The NBRS is a useful tool for identifying risk for developmental abnormalities due to neonatal medical events.

Birth Weight↗
PubMed1993

Maternal views of preterm infants' responsiveness to social interaction.

Mothers of 47 very low birth weight ( < 1,500 gram) infants were interviewed concerning their feelings and views about interactions with them. Interviews were conducted within the first ten days and again three to five weeks after birth. Over the first month of the baby's hospitalization, mothers significantly increased their pleasure in interacting, knowledge of infant cues, and perception that their infants were responding. The most frequently mentioned behaviors were maternal talking and touching and infant eye opening and body activity. Many mothers appeared to be utilizing their infants' behaviors as a guide for their own behaviors and reported that their infants' behaviors had specific meanings. However, an equal number of mothers were not ascribing meaning to their infants' behaviors and did not appear to be using behavioral cues. These findings have implications for interventions by neonatal nurses.

Adult↗
PubMed1993

Developmental care of low birth weight infants.

Nurses are the key to the implementation of developmentally focused care for LBW infants. There seems to be a sufficient research base to support reduced lighting in the hospital setting and consideration of cycled lighting. Face-to-face visual stimulation would seem sufficient for infants less than 40 weeks old until further research is done. In regard to sound, it seems clear that failure to reduce noise created by personnel, faculty equipment, radios, and so on represents negligence. Talking to infants who are in states other than sleep is to be encouraged, and planned interventions such as taped music and vocal selections need continued exploration. There seems to be a sufficient research base to support handling and caretaking that considers the state of the infant and aims to disrupt sleep as little as possible. Similarly, there appears to be ample support for placing infants in ways that promote a balance of flexion and extension or in the prone position whenever possible. NNS should be used during feeding and to reduce stress. Attention to reducing pain should be as much a part of the care of LBW infants as it is for adults. The potential negative effects of drugs on the developing brain must be considered and studied. Finally, the family, including siblings, should be encouraged to participate in the infant's plan of care as much as possible and prepared for discharge well in advance of the actual date. A note of caution should be entertained for stimulation programs not based on sufficient research. It is possible, perhaps even probable, that excessive sensory input at critical times can do harm. Interventions may be recommended with great enthusiasm but without research support. Thus, until the relative merits and possible adverse effects of various interventions are known, they should be approached with caution. Perhaps remembering that the first consideration in giving care is to "Do not harm" should facilitate our care of LBW infants.

Child Development↗
PubMed1992

Job stress and burnout in acute and nonacute pediatric nurses.

OBJECTIVE: To identify predictors of burnout in pediatric nurses and to compare the incidence of burnout, job stress, anxiety and perceived social support in acute and nonacute care pediatric nurses. DESIGN: Prospective correlational-descriptive methodology was used to predict high, moderate or low burnout from length of work experience, perceived work stress and social support and anxiety. SUBJECTS AND SETTING: Registered nurses (n = 121) employed full-time in neonatal and pediatric intensive care units and pediatric intermediate care units. MEASUREMENTS AND RESULTS: Measures of job stress, anxiety, experience, social support and burnout were compared in acute and nonacute care pediatric nurses. The overall mean incidence of burnout was in a moderate range for both acute and nonacute care pediatric nurses for the emotional exhaustion and depersonalization subscales and in the high range of personal accomplishment subscales of the Maslach Burnout Inventory. Analysis of variance revealed no differences between groups. However, when nurses were grouped by high, moderate and low burnout scores, chi-square analysis revealed significant differences. More acute care nurses reported high burnout and more nonacute care nurses reported low burnout. Discriminant function analysis revealed that job stress was the strongest significant predictor of burnout, followed by state anxiety, coworker support, trait anxiety and experience on the unit. CONCLUSIONS: Even though high burnout levels are more frequent in acute care pediatric nurses, burnout is a problem in both acute and nonacute care pediatric nurses. The pattern of results suggests that efforts directed toward reducing anxiety and job stress and increasing coworker support, particularly for less experienced nurses, might reduce burnout.

Adult↗
PubMed1991

Nursery Neurobiologic Risk Score: important factor in predicting outcome in very low birth weight infants.

We developed a nursery Neurobiologic Risk Score (NBRS) based on potential mechanisms of brain cell injury in preterm infants and correlated it with developmental outcome at the corrected ages of 6, 15, and 24 months. The NBRS was determined at 2 weeks of age and at the time of discharge from intensive care in 58 preterm infants with birth weights less than or equal to 1500 gm. The NBRS correlated significantly with the Bayley Scales of Infant Development, Mental Development Index (MDI) (r = -0.61 to -0.40) and Psychomotor Development Index (PDI) (r = -0.59 to -0.46), and with abnormal neurologic examination findings (r = 0.59 to 0.73) at the three testing periods. Although 12 of the 13 items composing the NBRS individually correlated with one or more outcome variables, seven items (infection, blood pH, seizures, intraventricular hemorrhage, assisted ventilation, periventricular leukomalacia, and hypoglycemia) accounted for almost all of the explained variance. Logistic regression of individual items demonstrated intraventricular hemorrhage to be the most important item for predicting the MDI at 24 months; pH was the most influential item for predicting the PDI at every testing period. A shorter, revised NBRS that included only the seven significant items demonstrated as strong a correlation with developmental outcome as the original NBRS. A revised 2-week score of greater than or equal to 5 or a discharge score of greater than or equal to 6 demonstrated 100% specificity and had a 100% positive predictive value for an abnormal outcome at 24 months of age in this group of infants. We conclude that the NBRS identifies during the intensive care nursery stay those infants at highest risk for an abnormal outcome related to nursery events. In addition, analysis of NBRS items provides insight into the relative importance of individual factors for influencing mental, motor, and neurologic outcome.

Brain Damage, Chronic↗
PubMed1991

Burnout, job stress, anxiety, and perceived social support in neonatal nurses.

Forty-nine nurses working in neonatal intensive care were surveyed by using measures of job stress, burnout, anxiety, and perceived social support. On the Maslach Burnout Inventory, they scored in a moderate range of burnout for emotional exhaustion and depersonalization and in a high range of burnout for sense of personal accomplishment. Stepwise regression analyses revealed that higher job stress scores, higher anxiety scores, perception of less supervisor (head nurse) support, and less experience were associated with higher burnout subscale scores.

Adult↗
PubMed1990

Effect of early sibling visitation in an intensive care nursery.

In an attempt to assess the effects of early sibling visitation in a neonatal intensive care unit, 31 siblings (ages 3-12) of the hospitalized infant were randomly assigned to either a visit group (during first week of neonatal life) or a comparison group who visited only after the study was completed 3 weeks after birth of the neonate. Parents of both groups of siblings completed the Missouri Behavioral Checklist (MBCL) and Family Environment Scale (FES) in the first few days after birth and, again, 3 weeks after birth. All siblings were interviewed 3 weeks after birth of the neonate. Neither group experienced any increase in negative behaviors following the new sibling's birth. In fact, both groups showed some decrease in negative behaviors. In addition, the visitor group showed a significant decrease in negative behaviors on a specific subset of MBCL items. In addition, the visitor group was significantly more well informed about their sibling than the comparison group.

Child↗