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At least 19 recordsLinked to original sources
PubMed1990

Effects of birth weight and sociodemographic variables on mental development of neonatal intensive care unit survivors.

Neonatal intensive care unit survivors (N = 494) from 10 tertiary care centers were evaluated over the first 4 to 5 years of life to determine the relative contributions of birth weight and sociodemographic factors to mental development. Six sociodemographic factors were studied: sex, race, family income, and mother's marital status, age, and educational level; the last five factors also are known to be associated with premature birth. Mental development was measured with the Bayley Scales of Infant Development (12 to 24 months) and the Stanford Binet Intelligence Test (4 to 5 years). Each factor's influence was assessed by multivariate analysis. Birth weight had limited long-term implications; at 4 to 5 years, only infants with birth weights less than 1000 gm had significantly lower scores than those in other birth weight categories. Sociodemographic variables had a greater impact on mental development, with age-dependent differences found between nonwhite and white children and between children with mothers of low, medium, and high educational levels.

Adult↗
PubMed1979

Osteomyelitis in a neonatal intensive care unit.

Neonatal osteomyelitis presents with few clinical signs despite multiple sites of involvement. Four cases of osteomyelitis due to Staphylococcus aureus or Candida albicans were encountered in a neonatal intensive care unit. Three were unsuspected clinically and were detected as incidental radiologic findings. The fourth presented with soft-tissue abscesses. Long bone metaphyses were most frequently affected. Other sites included iliac bones, clavicles, and spine. On follow-up the bones healed, but one patient was left with hip deformity secondary to destruction of the cartilaginous femoral heads and another patient developed obstructive hydrocephalus due to Candida ventriculitis. Complete skeletal survey is indicated in any infant with osteomyelitis at one site to seek additional silent areas of involvement.

Abscess↗
PubMed1991

Drug utilization in very premature infants in neonatal intensive care units.

Neonatal drug utilization in very premature infants (gestational age (GA) 24-29 weeks), requiring intubation and mechanical ventilation at birth was registered as part of a multicenter controlled clinical trial of high-dose versus low-dose bovine surfactant (initial doses 100 mg/kg birth weight (b.w.) versus 50 mg/kg b.w.). Drug utilization during 4 weeks after birth was analyzed in 164 infants (mean GA 27.2 +/- 1.2 (SD) weeks, b.w. 970 +/- 145 g (SD)). More than half of the study infants received antibiotics (98.8%), sedatives and analgesics (91.5%), sodium bicarbonate (78%), solutions for volume replacement (62.8%), methylxanthines (56.7%) and catecholamines (52.4%). It may be concluded that the pattern of drug usage indicates a high incidence of proven or suspected infections and circulatory and respiratory disorders reflecting the high-risk state of study infants.

Dose-Response Relationship, Drug↗
PubMedDate not supplied

Mortality in infants discharged from neonatal intensive care units in Georgia.

Although neonatal intensive care units (NICUs) have contributed to advances in neonatal survival, little is known about the epidemiology of deaths that occur after NICU discharge. To determine mortality rates following NICU discharge, we used linked birth, death, and NICU records for infants born to Georgia residents from 1980 through 1982 and who were admitted to NICUs participating in the state's perinatal care network. Infants who died after discharge (n = 120) had a median duration of NICU hospitalization of 20 days (range, 1 to 148 days) and a median birth weight of 1983 g (range, 793 to 5159 g). The postdischarge mortality rate was 22.7 per 1000 NICU discharges. This rate is more than five times the overall postneonatal mortality rate for Georgia from 1980 to 1982. The most common causes of death were congenital heart disease (23%), sudden infant death syndrome (21%), and infection (13%). Demographic characteristics commonly associated with infant mortality were not strongly associated with the mortality following NICU discharge.

Black or African American↗
PubMed1991

Predicting outcome of care in the neonatal intensive care unit.

The accuracy of a neonatal intensive care unit (NICU) staff in predicting the outcome and length of stay of infants admitted to the NICU, and the factors they felt were important in making these predictions, were evaluated. This prospective study used a questionnaire to survey 44 nurses, residents, and attending neonatologists working in the NICU about the predicted outcomes of 52 infants admitted to the NICU at the University of Nebraska Medical Center over a 1-month period. Factors previously identified by the staff as important indicators of infant outcome were assigned points of importance by the respondents, and specific values for these factors were recorded for each infant. The NICU staff indicated that gestational age was the most important indicator of infant outcome. The attending neonatologists placed more value on gestational age (analysis of variance [ANOVA] P less than .0001) than did the nurses or residents. Among the staff groups, there were significant differences in the weight or points assigned to a given factor for pulmonary function, renal function, number of resuscitations, and the "other" category (ANOVA P less than .05). The nurses ranked pulmonary function criteria lower than the residents did (P less than .04), but considered renal function more important than either the residents (P = .005) or the attending neonatologists considered it to be (P = .01). The number of resuscitations was ranked higher by the nursing staff than by other groups, whereas the attending neonatologists assigned less importance to the "other" category.(ABSTRACT TRUNCATED AT 250 WORDS)

Forecasting↗
PubMed1991

Managing the future: an examination of the neonatal intensive care unit.

The successes in neonatal intensive care have recently encountered the economic reality of the health care marketplace. Competition and cost constraints from new reimbursement formulas have affected the spirit of altruism that guided the early organization of perinatal regional care. Since high-risk neonatal care is so costly, it is more likely to be adversely affected by competition and cost containment than other inpatient services. The author proposes an examination of the concept of managed competition. Facing the reality of competition, the managers of neonatal units must strive to be cost competitive while maintaining quality of care. Hospitals with a disproportionate share of medically indigent patients must receive public support. To retain the concept of perinatal regional care, hospitals must form partnerships that assure appropriate high-risk care for the patient populations they serve. The public sector must monitor their arrangements to assure quality and access to the appropriate services by all patients in need of high-risk perinatal care. In this manner, the intent of the original perinatal regionalization concept can be preserved in an otherwise hostile competitive health care marketplace.

Economics, Hospital↗
PubMed1989

Nosocomial infection in neonatal intensive care units.

Nosocomial infection rates in neonatal intensive care units range from 5% to 25%. Both endemic and epidemic infections have been documented, with causative agents including gram-positive cocci, gram-negative bacilli, and viruses. This paper reviews the host, maternal, and environmental factors that influence susceptibility of neonates. Usual preventive measures, such as nursery design, staff apparel, handwashing, employee health, and neonatal care, as well as epidemic control measures to minimize infection risks and limit transmission of infectious organisms, are discussed.

Cross Infection↗
PubMed1990

Imaging procedures and developmental outcomes in the neonatal intensive care unit.

Behavioural and environmental modification techniques in the neonatal intensive care unit for oxygen-dependent premature infants with chronic lung disease have been shown to result in a decrease in the number of days of respirator support and number of days of supplemental oxygen therapy. Long-term neurodevelopment outcome was significantly better for infants in the experimental therapy group who received specialized environmental modification to decrease stressful stimuli. We present results of cranial ultrasound and chest radiograph studies in this very high-risk population and suggest that such studies represent additional stressful stimuli that should be scheduled with consideration of an overall behavioral infant care plan.

Bronchopulmonary Dysplasia↗
PubMed1986

Patterns of medical services utilization by infants discharged from a neonatal intensive care unit.

A decreasing neonatal mortality rate has increased the number of infants who survive their stay in a neonatal intensive care unit only to need continued medical care. Medical services utilization by families with high-risk infants has been widely studied, but research is sparse on high-risk infants who do not receive follow-up care through medical specialists' services or speciality clinics. After dividing medical services utilization into four patterns, ranging from use of only primary care to use of three kinds of medical services, the authors analyzed a set of predictors of utilization. The factors most likely to affect pattern of utilization significantly are related to health need and illness level. The infants with more serious medical conditions diagnosed at birth were found to use the most follow-up services. No effects of location of residence or social class were found, which suggests that families had no significant problems of access to medical care services for their infants in the defined region of the study.

Child Health Services↗
PubMed1992

[Rashkind atrio-septostomy in incubators and neonatal intensive care units].

In 7 neonates with cyanotic heart disease, balloon atrial septostomy was performed in the neonatal intensive care unit under two-dimensional echocardiographic control. Trans-umbilical route was used with success in 6 neonates and percutaneous femoral vein in 1 neonate after failure of the trans-umbilical route. The mean transcutaneous oxygen saturation increase was 22%. No complications were observed. The average duration of the procedure was 25 minutes. Thus this technique is efficient, quick and easy to perform, allowing the procedure to be done under optimal environmental conditions in critically ill neonates.

Catheterization↗
PubMed1992

Back transporting infants from neonatal intensive care units to community hospitals for recovery care: effect on total hospital charges.

Many neonates are referred to neonatal intensive care units (NICUs) for specialized care far from their parents' residence. This distance can add to the stress of the parents and reduce the contact of the parents with their newborn. Small studies have found that back transporting these neonates to hospitals closer to their homes is safe and cost-effective. Despite these findings, the reluctance of many insurers to pay for back transports prevents or delays many back transports. Insurers may not consider the findings of the previous studies to be conclusive, given that the comparisons were between small numbers of neonates back transported and neonates who remained in tertiary care, and the potential for differences in severity of illness between the groups is significant. In this study the effect on hospital charges of back transports was examined by comparing the charges for care in community hospitals with what these charges would have been in a tertiary care center. The advantage of this method is that it avoids case-mix differences between the groups and thus minimizes the potential for small-sample bias. Data were collected for all back transports from a NICU to non-tertiary care centers (n = 90) for a 9-month period. We were able to obtain the itemized bills for the care at community hospitals for 42 of these patients. Each bill was recalculated using the charges for the NICU to determine potential for savings. The average charges for recovery care were about $6200 lower at the community hospital than they would have been at the NICU.(ABSTRACT TRUNCATED AT 250 WORDS)

Convalescence↗
PubMedDate not supplied

Ethical problems in neonatal intensive care unit--medical decision making on the neonate with poor prognosis.

In current NICU (neonatal intensive care units), it is inevitable that ethical decisions on neonates with a poor prognosis will have to be made. At Tokyo Women's Medical College, we have been applying our own policy of medical decision making, which is somewhat different to those of most western countries. Most families are not asked to make final decisions, and the ethical committee is not actively involved. Staff in the NICU make the decision after plenary discussions. The position after decision making is not to discontinue the life supporting system but to observe, with no additional treatments and with routine care (class C). From October 1984 to September 1989, 58 out of 1589 neonates admitted to the NICU at Tokyo Women's Medical College died and 32 (55%) of them were classified as class C. The main causes of medical decision making were; non-viable (4/4, 100%), lethal malformations (13/20, 65%) and birth asphyxia (15/19, 79%).

Decision Making↗
PubMed1992

Development of a program for neonatal intensive care units managed by neonatal nurse practitioners.

Because of reduced medical coverage and changing educational experiences of the pediatric residents, the Department of Nursing Practice at the University of Utah Hospital in collaboration with the Department of Patient Care Services at Primary Children's Medical Center seized the opportunity to develop a nurse-managed patient care service within two tertiary-level nurseries in the State of Utah. Collaboration with nursing administrators and practitioners in both sites yielded joint plans for a successful NNP program. Initial efforts were to fund jointly and support the College of Nursing to develop an educational program, whereas the clinical program was developed before the reduction in medical coverage. Many issues were addressed because of the multidisciplinary and multi-institutional nature of the program. Work is ongoing in the recruitment of students and NNPs, development and review of clinical practice, and endorsement and privileging considerations.

Hospitals, Pediatric↗
PubMed1989

Comparison of neonatal mortality rates between transports to tertiary and intermediate neonatal intensive care units.

The differential of neonatal mortality rates between infant transports to tertiary and to intermediate neonatal intensive care units (NICUs) was examined based on 8,391 one-time infant transports from community hospitals to tertiary or intermediate NICUs in Southern California in the three-year period 1981-1983. Among the demographic, birth and delivery, and diagnostic characteristics studied, nine were identified to be related significantly to the higher neonatal mortality rate among transports to tertiary NICUs: birthweight, gestational age, necessity of intubation, multiple clinical conditions, presence of cardiac, neurologic, and genitourinary problems, anomalies, and syndromes. Adjusting for differences in the number of cases with necessity of intubation and the presence of the five clinical problems reduced the neonatal mortality ratio of tertiary to intermediate NICUs from 1:56 to 1:01, while adjustment for birthweight and gestational age differences reduced the ratio from 1.56 to 1.54. This analysis indicates that the difference of neonatal mortality between the two levels of NICUs can be explained to a larger extent by the higher proportion of infants requiring intubation with serious clinical problems. Birthweight and gestational age played only a minor role in this respect.

Apgar Score↗
PubMed1989

Audit of drug usage in a regional neonatal intensive care unit.

Drug utilization has been audited prospectively for all infants cared for in a regional neonatal intensive care unit for a 3-month period. Twenty-five infants had a birthweight less than 1500 g and 54 had a birthweight greater than 1500 g. The total number of different drugs used was 76 and the mean number received was 8.6 with a range of 0-30. Infants with birthweights less than 1500 g received a mean of 14.5 drugs and infants with birthweights greater than 1500 g received a mean of 4.8 drugs. Almost two-thirds (63%) of doses were given orally, 20% intravenously and 10% via an umbilical artery catheter. Three drugs, one of which was received by 13% of infants, carried manufacturers' inserts advising against use in premature infants or the newborn.

Drug Utilization↗
PubMed1977

Outcome of infants of very low birthweight treated in neonatal intensive care unit.

The neonatal survival rate of 500 VLBW (less than or equal to 1 500 g) treated in the neonatal unit of the Departement of Paediatrics in Lausanne (C.H.U.V.) was studied according to changing patterns of nursing and medical care occurring in four successive periods (1961 IX-1963, X-1963 - 1965, 1966-1968, IV-1971-1973). The survival rate at 28 days increased from 35.5% to 47.7% between 1961 and 1965. Earlier start of feeding, intravenous fluid therapy, better control of ambient temperature and better oxygenotherapy are the main changes during this period. Further improvement in neonatal care did not affect the 28-day survival rate. 213 VLBW out of 500 (42.6%) survived at 28 days, 13 (6.1%) out of these died within the first two years of life, 36 (16.9%) were lost for the follow-up. The remaining 164 VLBW were followed until ages between 18 months and 8 years. The improvement in neonatal care was associated with a decrease in the incidence of major neurological sequels from 21.1% to 12.2% between 1961 and 1973. Cerebral palsy and epilepsy are responsible for this decrease. The incidence of mental retardation (DQ or IQ less than 80) also decreased from 17.5% to 4.9% during the same period. However, the incidence of retrolental fibroplasia remained stable. The outlook for VLBW infants is now much more encouraging. Further improvement in perinatal care is likely to further reduce the incidence of major handicaps. but it is not clear whether they will affect the incidence of minor problems such as learning difficulties or poor school performances. More prospective studies are necessary to clarify these points and to ensure early detection of these developmental problems.

Central Nervous System Diseases↗
PubMed1988

Correlates of parenting on a neonatal intensive care unit: maternal characteristics and family resources.

The association of maternal characteristics, family resources, and receipt of prenatal care with parenting behaviors observed in a neonatal intensive care unit (NICU; n = 383) was assessed. The parenting behavior of mothers not receiving prenatal care (n = 128) was compared to that of mothers of the preceding and subsequent admissions (n = 256) by retrospective chart review. Parenting variables included frequency of visits to the NICU and evaluative ratings of parents' involvement with their infant. Parenting of the no-prenatal-care group was significantly less favorable than the control on all comparisons. Factor analysis supported a priori grouping of parenting variables. A stepwise multiple regression of maternal and family characteristics to the factor-derived variable, parenting, showed significant contributions for prenatal drug use and father involvement. Pediatric interventions assessing maternal social and behavioral characteristics are proposed.

Female↗