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Biomedical subjects

M B Resnick

Publications and source records attributed to M B Resnick.

50 records · Page 3Linked to original sources
PubMed1988

Developmental intervention program for high-risk premature infants: effects on development and parent-infant interactions.

Developmental follow-up studies have documented that low birth weight infants are at high risk for mental and physical disabilities, despite recent advances in neonatal intensive care. Moreover, parent-infant bonding is hampered by the barriers created by technical equipment. This study evaluated a program of hospital and home-based developmental interventions designed to enhance the development of high-risk, preterm infants and the quality of communication between infants and their caregivers. Treatment and contrast groups consisted of 41 premature infants weighing less than 1800 g at birth. Treatment took a preventive approach, consisting of daily multimodal interventions in-hospital and twice-monthly interventions by child development specialists in the child's home, through 12 months adjusted age. Infants in the contrast group received traditional, remedially oriented care. The Bayley Scales of Infant Development were used to measure mental and psychomotor development, and the Greenspan-Lieberman Observations System (GLOS) was used to analyze the behavioral characteristics of infant-caregiver interactions. Developmental interventions had positive, significant effects on mental development and on the quality of caregiver-infant interactions. Changes in mental development were not independent of changes in the GLOS.

Cognition↗
PubMed1988

Prospective pricing model for neonatologists and obstetricians in tertiary care centers.

According to the new federal diagnosis-related group (DRG) system, hospitals are reimbursed fixed sums based on discharge diagnoses, rather than variable sums that depend on specific goods and services consumed and number of days hospitalized. The government is now exploring DRGs as a potential mechanism for reimbursing physicians. In Florida, two DRG-type reimbursement systems were developed for neonatal and obstetrical hospitalizations in tertiary care settings, as departures from the federal DRG system. Called neonatal care groups (NCGs) and obstetrical care groups (OBCGs), both classification systems predicted hospital charges in these settings more accurately than did federal DRGs. The feasibility of a prospective pricing system for neonatologists and obstetricians based on NCGs and OBCGs was investigated. The data showed that neonatologists' charges had a high correlation with hospital charges (r = .90) and that increasing levels of intensity of care as defined by the NCGs were reflected by consistent increases in reimbursement to neonatologists. If the NCG system were to be applied, neonatologists would receive compensation equivalent to that which they currently earn according to the fee-for-service system. In contrast, obstetricians' charges bore almost no relationship to hospital charges. However, modest differences in obstetrician's charges did emerge as a reflection of number of complications, which are incorporated into the OBCG categories; this suggests that a reimbursement system based on hospital OBCG categories might be applied to obstetricians.

Diagnosis-Related Groups↗
PubMed1987

Prospective pricing system by diagnosis-related groups: comparison of federal diagnosis-related groups with high-risk obstetric care groups.

Of 468 diagnosis-related groups identified by the federal government for Medicaid reimbursement, 15 are related to obstetric hospital care. Each diagnosis-related group is considered a distinct group in which cases are homogeneous with respect to resource consumption. Because the diagnosis-related group system is based primarily on data from community and secondary care hospitals, it does not differentiate sufficiently among high-risk obstetric patients seen at tertiary care institutions, such as Florida's Regional Perinatal Intensive Care Centers. We developed an alternative scheme for diagnosis-related groups, called obstetric care groups, using the federal diagnosis-related groups as the model from which to depart. Data collected for 4192 women during a 2 1/2-year period indicate that obstetric care groups provide more homogeneous groups than diagnosis-related groups for our population of high-risk patients. The obstetric care groups differentiate between no complications, one complication, and two or more complications, while the diagnosis-related groups differentiate only between no complications and one or more complications. Also, complications for obstetric care groups are based on only 19 diagnoses that contribute significantly to resource consumption, while the list of possible complications exceeds 200 for diagnosis-related groups. Although the obstetric care group classification system is simpler than that for diagnosis-related groups, it results in a more accurate reimbursement of hospitalization charges for high-risk obstetric care.

Diagnosis-Related Groups↗
PubMed1987

The relationship of Apgar scores, gestational age, and birthweight to survival of low-birthweight infants.

While Apgar scores provide a valid prediction of mortality in term infants (primarily reflecting asphyxia), intervening variables in premature newborns complicate interpretation. Physiologic states normal to preterm infants (such as, decreased muscle tone) can depress scores but may not influence survival significantly. Therefore the relationship between Apgar scores and survival in term and preterm infants differs. Because of the paucity of studies on preterm infants, we tested Apgar scores, as well as birthweight and gestational age, as outcome predictors in 748 low-birthweight infants (500-1800 gm). Our purpose was to assess the relationship between 1- and 5-minute Apgar scores and survival, and to evaluate all combinations of the four variables as outcome predictors. Univariate analysis showed a significant relationship between each of the four variables and survival; however, no single variable accounted for more than 32% of the variance in outcome, thus no single factor could be invoked as the major determinant of survival. Logistic regression analyses demonstrated the interrelationships of the four variables to survival. While both Apgar scores were related to survival, independent of the effects of birthweight and gestational age, they were slightly less predictive than either of these variables alone. However, when 1- and 5-minute Apgar scores were combined with gestational age, the predictive value was slightly better than any of the four variables alone or in other possible combinations.

Apgar Score↗
PubMed1987

Developmental intervention for low birth weight infants: improved early development outcome.

This prospective longitudinal study was designed to evaluate the effects of a multidisciplinary infant development program (IDP) on the mental and physical development of low birth weight infants (less than 1,800 g). Infants in the neonatal intensive care were randomly assigned to the IDP or to traditional care (control group). IDP infants received developmental interventions in the hospital and at home through the first 2 years of life. Counseling and parenting education were provided to their parents during this same period. The control group received all the postnatal care and referrals customarily given in traditional care. Both IDP and control infants were enrolled in an independent follow-up program, which used the Bayley Scales of Infant Development in a blind evaluation design. The IDP group had a significantly lower incidence of developmental delay (P less than .05) and scored significantly higher than the control group (P less than .05) on mean mental and physical indices at 12 and 24 months of adjusted age.

Counseling↗
PubMed1986

Prospective pricing system for tertiary neonatal intensive care.

This study assessed the potential impact of the federal neonatal diagnosis-related group (DRG) pricing system upon reimbursement to a state neonatal intensive care program. Data for length of intensive care unit stay, procedures, hospital charges, and audited cost reports from the state of Florida's ten regional neonatal intensive care centers were analyzed for 8,492 neonates whose charges totaled $118 million. Mean lengths of stay in these tertiary care centers were substantially longer than those reported for the federal DRGs, which were based on community hospital data. If federal DRG-based reimbursement to hospitals were implemented in Florida's perinatal intensive care program, compensation would range from 9% to 56% of actual hospital care charges. Federal DRG price rates were not predictive of hospital charges. Only 16% of the total variation in hospital charges was explained by differences among federal DRG rates (R2 = .16). Analysis of data by major determinants of resource consumption provided groups more homogeneous with respect to hospital charges and, hence, cost. Therefore, we developed a prospective pricing system that used modifications of federal newborn DRG system. These modifications resulted in a threefold increase in R2 (.52). Our proposed system permits prediction of cost and reimbursement for infants by three criteria: birth weight, need for mechanical ventilation and/or major surgery, and survival status and length of survival for those who die.

Analysis of Variance↗
PubMed1984

Characteristics, mortality, and outcome of higher-birth weight infants who require intensive care.

The improved outcome of small infants who have received intensive care is well documented; however, the mortality and morbidity of infants weighing greater than or equal to 2500 gm who require intensive care have not been emphasized. During a 2-year period these infants accounted for 41% of admissions and 34% of all deaths in our nursery. The most common diagnoses were pulmonary disease (32%), asphyxia (22%), congenital anomalies (18%), infant of diabetic mother (10%), hematologic disease (9%), and infection (4%). Mortality was 11% with 50% of the deaths from lethal malformations, 26% from asphyxia, 13% from infection, and 11% from miscellaneous causes. One half of the deaths were potentially preventable. According to developmental follow-up, over 90% of the survivors were developing normally. Thus, while outcome for survivors is usually good, mortality remains excessively high. This large and understudied group of infants requires increased investigative emphasis.

Birth Weight↗
PubMed1980

Developmental outcome of premature infants treated with theophylline.

The methylated xanthines are known to have multiple metabolic effects. This study was performed to examine the development of premature infants treated with theophylline in the neonatal period for apnea. The theophylline-treated infants had lower Apgar scores and gestational ages when compared to those who did not receive theophylline. There were no significant differences in the developmental indices, and both groups had similar incidences of severe neurologic sequelae and retrolental fibroplasia. Similarly, there were no differences in the somatic growth. The data suggest that theophylline does not adversely affect development of premature infants when examined at 9--27 months of age.

Apnea↗
PubMedDate not supplied

Intra-abdominal desmoplastic small round cell tumor with extensive extra-abdominal involvement.

Intra-abdominal desmoplastic small round cell tumor (DSRCT) is a recently described, rare neoplasm that usually occurs in male adolescents, has a poor prognosis, and displays a typical clinicopathological profile. This aggressive neoplasm exhibits a predominantly intra-abdominal serosal pattern, with frequent pelvic extension, less frequent retroperitoneal involvement, and rare pulmonary and mediastinal spread. We report on the autopsy findings of a 9-year-old male who presented with a biopsy-proven DSRCT involving the abdomen, retroperitoneum, and scrotum and additional radiologic studies suggesting vertebral, hepatic, and mediastinal involvement. Postmortem examination performed 10 months after presentation confirmed the initial radiologic findings and demonstrated extensive pleural and pulmonary metastases and, for the first time, direct evidence of bone marrow involvement. This tumor exhibited the typical immunophenotype previously reported for DSRCT, namely multidirectional expression of epithelial, neural, and muscular markers.

Abdominal Neoplasms↗