Neonatal Abstinence Syndrome: Influence of a Combined Inpatient/Outpatient Methadone Treatment Regimen on the Average Length of Stay of a Medicaid NICU Population.

Prescription opioid and heroin abuse have been increasing steadily year after year, and continue to be a serious national problem. A sequela of the increase in opioid abuse has been an increase in the number of infants born with opioid dependence. These infants often require costly, prolonged stays in the neonatal intensive care unit (NICU) for drug withdrawal treatment.

Birth weight and risk of type 2 diabetes: a systematic review.

Context: Low birth weight is implicated as a risk factor for type 2 diabetes. However, the strength, consistency, independence, and shape of the association have not been systematically examined.

Objective: To conduct a quantitative systematic review examining published evidence on the association of birth weight and type 2 diabetes in adults.

A standardized method for assigning gestational age: a tool for measuring gestational age based newborn intensive care outcomes.

We developed a computer-generated algorithm for standardizing the assignment of a best gestational age. Our database collected information on maternal last menstrual period (LMP), prenatal ultrasonography, obstetrical estimated date of confinement (EDC), use of assisted reproductive technology (ART), and newborn assessment based on the Ballard examination. The algorithm for determining best gestational age was developed based on the literature on the accuracy of prenatal and neonatal dating.

Clinical outcomes for newborn intensive care in Alaska.

Recent clinical outcomes for the Newborn Intensive Care Unit (NICU) at Providence Alaska Medical Center based on Alaska Neonatology's Clinical Outcomes Database are presented. There has been a decrease in overall mortality, with much of the improvement occurring in babies from 22 to 25 weeks gestation in the years 1998--2002. There has also been a decrease in the incidence of severe intraventricular hemorrhage / periventricular leukomalacia.

Effect of birth weight on blood pressure and body size in early adolescence.

The fetal programming theory that birth weight contributes to blood pressure or body size in later life is examined in this study. A prospective longitudinal study was conducted on subjects who were examined as newborns and prospectively interviewed and re-examined at 11 to 14 years old. Low birth weight (<2500 g) was present in 36% of the sample.

Racial differences in birthweight-specific neonatal mortality in Alaska: 1987-1996.

Objectives: This study compared the neonatal mortality in the Alaska Native and non-native (primarily white) population in Alaska for a 10-year period (1987-1996).

Methods: Natality, mortality, and cause of death data were obtained from the State of Alaska's Bureau of Vital Statistics (BVS). Birthweight-specific and preventable birthweight-specific mortality were analyzed for babies < 1500 grams, 1500-2499 grams, and > or = 2500 grams birthweight.

Racial differences in newborn intensive care morbidity in Alaska.

Birthweight-specific neonatal mortality for Alaska Natives is higher than for non-natives for the years 1987-1996. We investigated the reasons for this based on Level III Neonatal Intensive Care Unit information available from 1991-1996. We also investigated whether differences in mortality extended to measures of morbidity.

The next challenge for newborn intensive care in Alaska: improving the survival of the larger neonate.

Using information from our database, a review of mortality for the Newborn Intensive Care Unit at Providence Alaska Medical Center was conducted for 1987-1996. There has been a significant decline in mortality over the last decade (p = 0.003).

Can cardiovascular risk be predicted by newborn, childhood, and adolescent body size? An examination of longitudinal data in urban African Americans.

Objective: Recent retrospective studies of older adults have demonstrated a correlation between lower birth weight and hypertension and insulin resistance. We tested this finding in our sample of urban African Americans with prospective data on growth and blood pressure and also tested other variables (in addition to birth weight) for their relationship to adult cardiovascular risk.

Study Design: A prospective study of birth weight, growth, and blood pressure (Philadelphia Perinatal Collaborative Project) followed a sample of 137 African Americans, with nine examinations from birth through 28.

Birth weight versus childhood growth as determinants of adult blood pressure.

In older white American adults, recent retrospective studies have demonstrated a relationship between lower birth weight and hypertension. Black Americans have a higher occurrence of both lower birth weight and hypertension than do white Americans. To test the low birth weight-high blood pressure hypothesis, data from a prospective study (Perinatal Collaborative Project) were examined.

Effect of estrogen withdrawal on blood pressure and insulin resistance in sucrose-fed juvenile rats.

We have previously shown that juvenile Sprague-Dawley rats, fed a diet in which complex carbohydrates are replaced by sucrose, develop insulin resistance and hypertension. These conditions develop despite the absence of genetic predisposition to either. When studied with the euglycemic hyperinsulinemic clamp technique, these rats have reduced insulin-stimulated glucose utilization, but normal suppression of hepatic glucose output.

Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group.

There are few blood pressure (BP) data reported for premature and term newborn infants after 24 hours of age. To determine BP levels and BP trends in a representative population of infants admitted to neonatal intensive care units (NICUs), this study was conducted in 14 NICUs in the greater Philadelphia area. All infants admitted to the 14 NICUs during a 3-month period were entered into the study.

Gender differences in insulin-stimulated glucose utilization among African-Americans.

The purpose of this study was to determine whether there are gender differences in plasma insulin levels or insulin resistance in young adult African-Americans. Male (n = 53) and female (n = 45) subjects (age 23 to 28 years) included normotensives (N, blood pressure [BP] < 135/85 mm Hg) and borderline hypertensives (BH, BP > 135/85 mm Hg). Plasma insulin concentration was measured during an oral glucose tolerance test (OGTT) in all subjects.

The effect of excess dietary sucrose on growth, blood pressure, and metabolism in developing Sprague-Dawley rats.

To determine the effects of sucrose-enriched feeds on somatic growth, blood pressure development, and insulin-stimulated glucose metabolism, Sprague-Dawley rat pups (n = 94) were randomly assigned at weaning (3 wk) to a control diet (15% sucrose, by calories, n = 48) or an isocaloric diet in which starch is replaced by sucrose (66% sucrose, by calories, n = 46). Weight and blood pressure were followed until 13 wk. Chronic catheters were placed in a subset of male animals (n = 13), fasting glucose production was measured, and euglycemic hyperinsulinemic clamps were performed while the rats were in the conscious, nonstressed state.

Red blood cell sodium-proton exchange in hypertensive blacks with insulin-resistant glucose disposal.

To define the potential pathogenic role of hyperinsulinemia as a mediator of alterations in sodium transport, we have examined red blood cell Na(+)-H+ and Na(+)-Li+ exchanges in a young adult black population characterized for blood pressure and insulin-mediated glucose disposal. Normotensive and mildly hypertensive blacks (blood pressure, 120 +/- 2/76 +/- 2 and 139 +/- 3/94 +/- 2 mm Hg, respectively) with a mean age of 26.1 years were studied for insulin sensitivity with the euglycemic hyperinsulinemic clamp (molar index of insulin sensitivity, M/I = moles glucose metabolized/insulin in milliliters of plasma).

Insulin-stimulated glucose utilization and borderline hypertension in young adult blacks.

The purpose of this investigation was to determine whether there is a relation between impaired insulin-stimulated glucose utilization, or insulin resistance, and blood pressure (BP) in a young adult black population. Clinically well, young black men and women, including normotensive (BP < 135/85 mm Hg, n = 23) and borderline hypertensive (BP > or = 135/85 mm Hg, n = 27) individuals, were studied. Each subject had an oral glucose tolerance test (OGTT) and underwent a euglycemic hyperinsulinemic clamp procedure.

Insulin resistance in the conscious spontaneously hypertensive rat: euglycemic hyperinsulinemic clamp study.

To determine whether spontaneously hypertensive rats (SHR) are insulin resistant when compared with their genetic control, Wistar-Kyoto rats (WKY), insulin-stimulated glucose utilization was studied in both strains with the euglycemic hyperinsulinemic clamp technique. This methodology can determine if insulin resistance is present and whether it is due to ineffective stimulation of peripheral glucose utilization, or to incomplete suppression of (hepatic) endogenous glucose production (EGP) by insulin, or both. Twelve WKY and 15 SHR (all male) had long-term catheters surgically placed.

Hyperinsulinemia and blood pressure sensitivity to sodium in young blacks.

The relationship of blood pressure sensitivity to sodium with plasma insulin concentration was examined in young adult (22 to 28 yr) blacks (N = 45). The study included normotensive and borderline hypertensive subjects. Blood pressure sensitivity to sodium was determined by the change in mean blood pressure after 14 days of sodium loading (10 g of NaCl daily plus usual diet).

Blood pressure patterns in the first three days of life.

Current blood pressure data for healthy newborn infants consist primarily of single measurements of systolic and diastolic pressure in the first 48 hours of life. The purpose of this study was to determine if blood pressure levels are stable or are changing during the first few days of life. To determine blood pressure level and trend, indirect blood pressure was measured on day 1 through day 3 of life in all infants admitted to the well newborn nursery at Hahnemann University Hospital in Philadelphia.

Insulin resistance in the spontaneously hypertensive rat.

To determine experimentally if insulin resistance is associated with spontaneously occurring hypertension, insulin-stimulated glucose metabolism was studied in an animal model of genetic hypertension. The spontaneously hypertensive rat (SHR) and its genetic control, the Wistar-Kyoto strain (WKY) were studied with the euglycemic hyperinsulinemic clamp technique. Clamp studies demonstrated reduced insulin-stimulated glucose uptake in SHR (P less than .

Insulin resistance and blood pressure in young black men.

Insulin resistance, independent of obesity or non-insulin-dependent diabetes mellitus, has been demonstrated to be associated with high blood pressure. To determine if insulin resistance could be an antecedent to hypertension in a high-risk population, we studied normotensive (112 +/- 12/70 +/- 10 mm Hg) and borderline hypertensive (135 +/- 8/85 +/- 5 mm Hg) lean young black men (22-26 years old) with the euglycemic hyperinsulinemic clamp technique. All subjects had clinically normal oral glucose tolerance.

Multicenter HIV and hepatitis B seroprevalence study.

Prior single institutional investigations have found unrecognized HIV seroprevalence in emergency department (ED) patients to range from 0.38% to 4%. A prospective, anonymous study of HIV and hepatitis B (HB) seroprevalence was performed on excess serum of all ED patients over two 48-hour periods in May and August, 1988, from 7 hospitals in the Portland metropolitan area.

Evaluation of active versus passive AIDS surveillance in Oregon.

We searched for unreported AIDS cases in Oregon through death certificate and medical record review, and enhanced infection control practitioner and physician surveillance. Fifty-six AIDS cases diagnosed between February 1, 1986 and January 31, 1987 were reported passively. Twenty-nine additional cases diagnosed during this time were retrospectively identified by active methods.

Relationship between plasma renin concentration and atrial natriuretic peptide in the human newborn.

To test the hypothesis that atrial natriuretic peptide (ANP) concentration in the newborn is negatively related to plasma renin concentration (PRC), as it is in the adult, we measured the concentration of both substances in the same plasma sample. We studied 24 well term newborns and 20 samples of umbilical venous blood from normal deliveries. Both ANP and PRC are elevated in newborn plasma, but not in umbilical venous plasma.

Assessment of insulin resistance in newborn beagles with the euglycemic hyperinsulinemic clamp.

The developmental response to the euglycemic hyperinsulinemic clamp was assessed among newborn and adult beagles to investigate neonatal insulin resistance. Both neonatal dogs and adults were clamped at euglycemic blood glucose concentrations while receiving insulin at a rate of 3.75, 15, 30, 60, 75 or 100 mU/kg/min to generate a dose-response curve.