An intervention to decrease time to parents' first hold of infants in the Neonatal Intensive Care Unit requiring respiratory support.

Background: There are many barriers to parental skin-to-skin contact for critically ill neonates. Our aims were to decrease median time to first parental hold of neonates requiring respiratory support from 6.4 to 3 days, and to increase the percentage of neonates held within the first 24 h after birth from 6 to 75%.

The influence of family characteristics on perinatal decision making.

Objective: To determine whether parental characteristics affect estimates of best interests and intervention decisions for preterm infants.

Design And Methods: The study consisted of an anonymous questionnaire given to nurses, physicians, and students. The study included scenarios of 3 sets of parents, including a 16-year-old teenager, a couple who were lawyers, and a couple with a history of in vitro fertilization, about to deliver at 22 5/7 weeks, 24 weeks, or 27 5/7 weeks.

State infant mortality: an ecologic study to determine modifiable risks and adjusted infant mortality rates.

Objective: To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002.

Design/methods: Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics.

Increasing illness severity in very low birth weight infants over a 9-year period.

Background: Recent reports have documented a leveling-off of survival rates in preterm infants through the 1990's. The objective of this study was to determine temporal changes in illness severity in very low birth weight (VLBW) infants in relationship to the outcomes of death and/or severe IVH.

Methods: Cohort study of 1414 VLBW infants cared for in a single level III neonatal intensive care unit in Delaware from 1993-2002.

Racial differences in prenatal care of mothers delivering very low birth weight infants.

Objectives: To determine whether there are any racial differences in the prenatal care of mothers delivering very low birth weight infants (VLBW).

Study Design: Retrospective cohort study of infants cared for at a single regional level III neonatal intensive care unit over a 9-year period, July 1993-June 2002, N = 1234. The main outcome variables investigated included antenatal administration of steroids, delivery by cesarean section, and use of tocolytic medications.

Is infant mortality in Delaware truly increasing? Evidence for increasing illness severity and shift to fetal deaths and previable births.

The infant mortality rate, considered an important proxy for societal health, has been recently rising in Delaware. In fact, in 2001, Delaware's infant mortality rate (10.1/1,000 births) was the highest in the country.

Effect of inhaled corticosteroids on markers of pulmonary inflammation and lung maturation in preterm infants with evolving chronic lung disease.

Background: Chronic lung disease (CLD) is one of the most severely disabling conditions of extremely low-birth-weight infants. Systemic corticosteroids are effective but cause many adverse effects. Targeted therapy with inhaled corticosteroids may be an effective and less toxic alternative.

Factors influencing levels of 17-hydroxyprogesterone in very low birth weight infants and the relationship to death and IVH.

Objectives: 17-Hydroxyprogesterone, an intermediary hormone in cortisol synthesis, has been shown to be elevated in premature infants. However, the relationship between levels of 17-hydroxyprogesterone with death and intraventricular hemorrhage has not been extensively explored. The objective of this study was to determine the factors influencing 17-hydroxyprogesterone and determine if there is an association between intraventricular hemorrhage, mortality, and levels of 17-hydroxyprogesterone in a population of very low birth weight infants.

Are perinatal risk factors helpful in predicting and optimizing treatment strategies for transient hypothyroxinemia in very-low-birth-weight infants?

Transient hypothyroxinemia is common in premature infants and has been associated with intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), poor neurodevelopmental outcomes, and mortality. Recent trials have failed to show that supplemental thyroid hormone improves overall neurodevelopmental outcome. The objective of this article is too determine perinatal risk factors for transient hypothyroxinemia (TH).

Maternal antibiotics and decreased periventricular leukomalacia in very low-birth-weight infants.

Objective: To investigate the effect of maternal antibiotics, given in the predelivery period, on neonatal outcomes.

Design: Retrospective cohort study.

Setting: A single level 3 neonatal intensive care unit.

Caesarean delivery and outcome in very low birthweight infants.

Objective: To determine the relationship between mode of delivery, intraventricular haemorrhage (IVH), and mortality in very low birthweight (VLBW) infants.

Study Design: A historical cohort study of infants admitted to a single level III neonatal intensive care unit during a five-year period. Infants < 1500 g born by caesarean delivery (n = 400) were compared to those born by vaginal delivery (n = 305).

Transfusion volume in infants with very low birth weight: a randomized trial of 10 versus 20 ml/kg.

Background: Although preterm infants often require transfusions of red blood cells for anemia of prematurity, the optimal volume of blood to be transfused has not been established.

Observations: Infants with birth weights between 500 and 1,500 g were randomly assigned to receive 10 or 20 mL/kg red blood cells. Infants with transfusions of 20 mL/kg had a greater hemoglobin (14.

Prenatal consultation with a neonatologist prior to preterm delivery.

Objective: Evaluate the usefulness of prenatal consultation with a neonatologist before preterm birth.

Study Design: A questionnaire was administered to mothers 1 week before home discharge of their preterm infant in a single regional level III neonatal intensive care unit.

Results: Sixty-seven mothers completed the questionnaire; 84% indicated the consult was useful and 71% were comforted by the consult.

Home delivery of palivizumab: outcomes and compliance in regional preterm infants.

Palivizumab, a monoclonal antibody against respiratory syncytial virus (RSV), has been shown to be effective in preventing RSV-related hospitalization in preterm infants; however, ensuring infants receive the desired monthly injections remains a challenge. We studied two cohorts of preterm infants and the rate of documented RSV illness in infants receiving palivizumab at home between 1998 and 2000. Medical records were reviewed for the number of doses received, hospitalization for RSV illness, and other demographic data.

Thyroxine and illness severity in very low-birth-weight infants.

The objective of this study was to determine the relationship between thyroxine (T4) and illness severity in a population of preterm infants. We investigated a cohort of infants with birth weights 1,500 g or less from a single level III neonatal intensive care unit who received a minimum of one cranial sonogram to screen for intraventricular hemorrhage (IVH) and one newborn screen for T4 during a 2-year period, (n = 284). The Score for Neonatal Acute Physiology (SNAP) was used to measure illness severity.

Thyroid function in very-low-birth-weight infants with intraventricular hemorrhage.

The objective of this investigation was to study the natural course of thyroid function in infants with intraventricular hemorrhage (IVH). A cohort of infants < 1,500 grams birth weight, n=247, were included in the analysis. Total T4 and thyrotropin from newborn screening during the 1st week of life (Test 1) and from repeat screening at 2-4 weeks postnatal age (Test 2) were compared in infants with IVH (n=43) and a group of infants without IVH.

Heliox improves pulmonary mechanics in a pediatric porcine model of induced severe bronchospasm and independent lung mechanical ventilation.

BACKGROUND: A helium-oxygen gas mixture (heliox) has low gas density and low turbulence and resistance through narrowed airways. The effects of heliox on pulmonary mechanics following severe methacholine-induced bronchospasm were investigated and compared to those of a nitrogen-oxygen gas mixture (nitrox) in an innovative pediatric porcine, independent lung, mechanical ventilation model. RESULTS: All of the lungs showed evidence of severe bronchospasm after methacholine challenge.

Increased leukocytes in infants with intraventricular hemorrhage.

The objective of this study was to investigate the relationship between intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL) with changes in the peripheral blood count. Total peripheral leukocytes, absolute neutrophils, platelets, and nucleated erythrocytes from the first 3 days after birth were compared in very-low-birth-weight infants with (n = 100) and without (n = 388) IVH and cystic PVL (n = 16). After controlling for potential confounding variables, infants with IVH had an increase in total leukocytes and absolute neutrophils and a reduction in nucleated erythrocytes compared with infants without IVH.

Preeclampsia does not increase the risk for culture proven sepsis in very low birth weight infants.

The risk of sepsis associated with neutropenia in infants born to mothers with preeclampsia remains controversial. The objective of this study is to investigate the incidence of culture-proven sepsis along with changes in the complete blood count in very-low-birth-weight infants born to mothers with preeclampsia. We conducted a retrospective cohort study of infants cared for at a single tertiary care neonatal intensive care unit during a 4-year period.

Cranial sonography in very-low-birth-weight infants: do all infants need to be screened?

The objective of the study was to develop clinical screening criteria to diagnose infants with intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL). We performed a case-control investigation of two cohorts of very-low-birth-weight infants (n = 505, combined cohorts). Univariate and multivariate analyses were performed from data obtained in cohort 1 to develop screening criteria for IVH and cystic PVL.

Effect of preeclampsia on mortality, intraventricular hemorrhage, and need for mechanical ventilation in very low-birth-weight infants.

Infants born to mothers with preeclampsia have been shown to have a reduction in intraventricular hemorrhage (IVH). The objective of this article is to investigate the relationship between preeclampsia, IVH, neonatal mortality, mechanical ventilation, and other potential confounding variables such as neutropenia and magnesium sulfate. Methods of research include review of infants <1500 g admitted to a single level III neonatal intensive care unit (NICU), n=356.

Low serum thyroxine on initial newborn screening is associated with intraventricular hemorrhage and death in very low birth weight infants.

Unlabelled: Transient hypothyroxinemia (TH) of prematurity has been correlated with poor neurodevelopmental outcome. However, the relationship between thyroid function and neonatal mortality and brain injury has not been described.

Objective: To investigate the relationship between thyroid function and neonatal outcome.

Predicting red blood cell transfusions in very low birth weight infants based on clinical risk factors.

Objective: To describe the clinical factors most predictive of red blood cell transfusion in very low birth weight (VLBW) infants.

Study Design: Retrospective review of VLBW infants cared for at a single level III NICU during a two year period, n = 199.

Results: Overall transfusion requirement was 4.

Routine use of fentanyl infusions for pain and stress reduction in infants with respiratory distress syndrome.

Objective: To determine whether fentanyl infusions given to premature infants with respiratory distress syndrome reduce stress and improve long- and short-term outcome.

Methods: Twenty premature infants undergoing mechanical ventilation for respiratory distress syndrome were randomly assigned, in a double-blind fashion, to receive fentanyl by continuous infusion or a volume-matched placebo infusion. A behavioral state score was used to assess the infants' behavior.