Can we improve the return rate for tuberculin skin test readings?
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Adolescent↗
Biomedical subjects
Lydia Furman
Publications and source records attributed to Lydia Furman.
Evaluation of breastfeeding of very low birth weight infants: can we use the infant breastfeeding assessment tool?
The objective of this study was to evaluate the use of the Infant Breastfeeding Assessment Tool (IBFAT, Matthews, 1993) to assess breastfeeding in very low birth weight (VLBW, < 1.5 kg) infants. Thirty-four mothers of singleton VLBW infants completed the IBFAT and underwent a standardized feeding observation at 35 weeks corrected age. Median feeding duration was 14.5 minutes (range, 1-20), intake per feed was 6.0 mL (range, 0-60), and intake rate was 0.5 mL/minute (range, 0-3). IBFAT scores were correlated with feeding observation measures. The IBFAT summary score was significantly correlated with milk intake volume (r = 0.651, P < .001) and intake rate (r = 0.559, P = .001). The IBFAT sucking quality score was significantly associated with percent time sucking (r = 0.559, P = .001) and sucking bursts (r = 0.632, P< .001 on the feeding observation. The authors conclude that although IBFAT scores correlated with objective feeding measures, these data do not support use of the IBFAT to identify infants with adequate as compared to inadequate intakes. Further study is needed.
Breast Feeding↗
What is attention-deficit hyperactivity disorder (ADHD)?
Attention-deficit hyperactivity disorder (ADHD) is described as the most common neurobehavioral condition of childhood. We raise the concern that ADHD is not a disease per se but rather a group of symptoms representing a final common behavioral pathway for a gamut of emotional, psychological, and/or learning problems. Increasing numbers of children, especially boys, are diagnosed with ADHD and treated with stimulant medications according to a simplified approach. Methodical review of the literature, however, raised concerning issues. "Core" ADHD symptoms of inattentiveness, hyperactivity and impulsivity are not unique to ADHD. Rates of "comorbid" psychiatric and learning problems, including depression and anxiety, range from 12 to 60%, with significant symptom overlap with ADHD, difficulties in diagnosis, and evidence-based treatment methods that do not include stimulant medications. No neuropsychologic test result is pathognomic for ADHD, and structural and functional neuroimaging studies have not identified a unique etiology for ADHD. No genetic marker has been consistently identified, and heritability studies are confounded by familial environmental factors. The validity of the Conners' Rating Scale-Revised has been seriously questioned, and parent and teacher "ratings" of school children are frequently discrepant, suggesting that use of subjective informant data via scale or interview does not form an objective basis for diagnosis of ADHD. Empiric diagnostic trials of stimulant medication that produce a behavioral response have been shown not to distinguish between children with and without "ADHD." In summary, the working dogma that ADHD is a disease or neurobehavioral condition does not at this time hold up to scrutiny of evidence. Thorough evaluation of symptomatic children should be individualized, and include assessment of educational, psychologic, psychiatric, and family needs.
Affective Symptoms↗
Efficiency of breastfeeding as compared to bottle-feeding in very low birth weight (VLBW, <1.5 kg) infants.
OBJECTIVES: To examine feeding efficiency and correlates of feeding behaviors in breastfeeding as compared with bottle-feeding VLBW infants at 35 weeks corrected age (CA, postmenstrual plus chronologic age). STUDY DESIGN: In all, 105 singleton VLBW infants underwent a standardized feeding observation, of whom 35 were observed breastfeeding and 70 bottle-feeding. Intake, efficiency, and feeding behaviors were compared, and effects of infant and maternal factors were examined. RESULTS: Breastfeeding as compared with bottle-feeding infants took in smaller volumes (median 6.5 vs 30.5 ml, p<0.001), fed less efficiently (median 0.6 vs 2.2 ml/min, p<0.001), and spent less time with sucking bursts (mean 33 vs 55%, p<0.001). For breastfed infants, birth and neonatal factors and prior maternal breastfeeding experience were not associated with feeding efficiency or behaviors. CONCLUSION: Feeding performance of breastfeeding compared with bottle-feeding VLBW infants at 35 weeks CA is worrisome, and lactation intervention is needed for discharge planning.
Bottle Feeding↗
The effect of neonatal maternal milk feeding on the neurodevelopmental outcome of very low birth weight infants.
The effect of maternal milk feeding during the first 4 weeks of life on neurodevelopmental outcomes at 20 months corrected age (CA) of singleton very low birth weight (VLBW) (< 1.5 kg) infants was examined. Ninety-eight VLBW infants born from January 1997 to February 1999 were followed to 20 months CA (mean birth weight, 1012 g; gestational age, 27 weeks). Maternal milk intake was calculated as both mean milliliters per kilogram per day and graded doses. Outcomes included the Bayley Mental Development Index (MDI) and Psychomotor Development Index (PDI), and rates of cerebral palsy (CP) and of overall neurodevelopmental impairment. After adjusting for neonatal and social risk, results revealed no effect of maternal milk on outcomes. MDI was predicted by both social and neonatal risk, and PDI, CP, and neurodevelopmental impairment were predicted by neonatal risk. In this small, high-risk group of VLBW infants, the effects of social and neonatal risk appear to outweigh any possible benefits of maternal milk on neurodevelopmental outcome.
Breast Feeding↗
Rethinking the AAP attention deficit/hyperactivity disorder guidelines.
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Attention Deficit Disorder with Hyperactivity↗
The effect of maternal milk on neonatal morbidity of very low-birth-weight infants.
OBJECTIVE: To examine the dose effect of maternal milk on neonatal morbidity of very low-birth-weight (<1.5 kg) infants. DESIGN: Prospective observational study. SETTING: An urban tertiary care neonatal intensive care unit and follow-up clinic. POPULATION: One hundred nineteen singleton very low-birth-weight infants admitted from January 1, 1997, to February 14, 1999 (mean birth weight, 1056 g; mean gestational age, 28 weeks; 57% male; and 43% white). METHODS: A comparison of the effect on neonatal outcomes of daily graded doses (1-24, 25-49, and > or = 50 mL/kg of body weight) of maternal milk through week 4 of life vs a reference group receiving no maternal milk. MAIN OUTCOME MEASURES: Neonatal outcomes examined included rates of sepsis after age 5 days, retinopathy of prematurity, chronic lung disease, necrotizing enterocolitis, jaundice, duration of ventilator dependence, and length of hospital stay. RESULTS: Seventy-nine infants (66%) received maternal milk, of whom 32 received at least 50 mL/kg per day through week 4 of life. Poisson regression analysis adjusting for birth weight, sex, and ethnicity revealed that the mean number of episodes of sepsis for infants receiving at least 50 mL/kg per day was lower by a factor of 0.27 (95% confidence interval, 0.08-0.95) compared with infants receiving no maternal milk. There was no effect of maternal milk on other neonatal outcomes. CONCLUSIONS: A daily threshold amount of at least 50 mL/kg of maternal milk through week 4 of life is needed to decrease the rate of sepsis in very low-birth-weight infants, but maternal milk does not affect other neonatal morbidities.
Female↗
Accelerated intravenous rehydration.
This study was undertaken to determine whether accelerated intravenous (i.v.) rehydration using a new Isotonic Dehydration Worksheet results in: (1) complications in serum sodium or volume status; and (2) decreased duration of i.v. fluid therapy or length of hospital stay. A retrospective cohort study utilizing chart review method was used. An intervention group of 98 children ages 1 month to 12 years treated with the Isotonic Dehydration Worksheet from December 2000 to March 2001 was compared to a control group of 61 children treated from December 1999 to March 2000 before introduction of the worksheet. Complication rates were low and did not differ between the 2 groups. Mean unadjusted lengths of i.v. therapy (35.3 vs. 33.7 hours) and of hospital stay (47.0 vs. 49.3 hours) were not significantly different between the 2 groups. Introduction of an accelerated rehydration protocol was well tolerated by patients, but did not result in a significant decrease in the outcome variables examined. Other factors may have a greater impact on the outcome variables, and a prospective study to address these questions is planned.
Case-Control Studies↗
Accelerated intravenous rehydration.
To determine whether accelerated intravenous (i.v.) rehydration using a new Isotonic Dehydration Worksheet results in: (1) complications in serum sodium or volume status, and (2) decreased duration of i.v. fluid therapy or length of hospital stay, we conducted a retrospective cohort study utilizing chart review. An intervention group of 98 children, ages 1 month to 12 years, treated with the Isotonic Dehydration Worksheet from December 2000 through March 2001 was compared to a control group of 61 children treated from December 1999 through March 2000 before introduction of the Worksheet. Complication rates were low and did not differ between the 2 groups. Mean unadjusted lengths of i.v. therapy (35.3 vs. 33.7 hours) and of hospital stay (47.0 vs. 49.3 hours) were not significantly different between the 2 groups. Introduction of an accelerated rehydration protocol was well-tolerated by patients but did not result in a significant decrease in the outcome variables examined. Other factors may have a greater impact on the outcome variables, and a prospective study to address these questions is planned.
Administration, Oral↗
Attention-deficit/hyperactivity disorder treatment and later drug use.
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Attention Deficit Disorder with Hyperactivity↗
Correlates of lactation in mothers of very low birth weight infants.
OBJECTIVE: We sought to determine the correlates of intent to breastfeed and of successful lactation and nursing at the breast in mothers of very low birth weight (VLBW; <1.5 kg) infants. METHODS: We conducted a prospective observational study of 119 mothers of singleton VLBW infants (mean birth weight: 1056 g; mean gestational age: 28 weeks), 87 (73%) of whom intended to breastfeed. Mothers completed questionnaires at 3 weeks' postnatal age and at 35 and 40 weeks' (term) and 4 months' corrected ages (CAs). RESULTS: Of the 87 mothers who intended to breastfeed, 30 mothers (34%) continued lactation beyond 40 weeks' CA (postmenstrual plus postnatal age). Compared with mothers who discontinued lactation before this time, those who continued were older (31 vs 26 years), more were married (80% vs 39%), they had more than a high school education (70% vs 42%), and they were white (63% vs 35%). There were no significant differences in their infants' birth data or rates of neonatal morbidity. Significant correlates of lactation beyond 40 weeks' CA included beginning milk expression before 6 hours postdelivery, expressing milk > or =5 times per day, and kangaroo care. These correlates remained significant after controlling for maternal age, race, marital status, and education beyond high school. At 4 months' CA, 14 mothers (16%) were still lactating, 12 of whom were nursing at the breast. CONCLUSIONS: Increased maternal support specifically directed toward behavioral factors, including early and more frequent milk expression and kangaroo care, may improve the rates of successful lactation among mothers of VLBW infants who choose to breastfeed.
Adult↗