Maternal, Child Health and Neonatal Nursing Commons^™

Aggressive Vs Conservative Phototherapy For Infants With Extremely Low Birth Weight, Brenda H Morris, William Oh, Jon E Tyson, David K Stevenson, Dale L Phelps, T Michael O'Shea, Georgia E Mcdavid, Rebecca L Perritt, Krisa P Van Meurs, Betty R Vohr, Cathy Grisby, Qing Yao, Claudia Pedroza, Abhik Das, W Kenneth Poole, Waldemar A Carlo, Shahnaz Duara, Abbot R Laptook, Walid A Salhab, Seetha Shankaran, Brenda B Poindexter, Avroy A Fanaroff, Michele C Walsh, Maynard R Rasmussen, Barbara J Stoll, C Michael Cotten, Edward F Donovan, Richard A Ehrenkranz, Ronnie Guillet, Rosemary D Higgins

Faculty, Staff and Student Publications

BACKGROUND: It is unclear whether aggressive phototherapy to prevent neurotoxic effects of bilirubin benefits or harms infants with extremely low birth weight (1000 g or less).

METHODS: We randomly assigned 1974 infants with extremely low birth weight at 12 to 36 hours of age to undergo either aggressive or conservative phototherapy. The primary outcome was a composite of death or neurodevelopmental impairment determined for 91% of the infants by investigators who were unaware of the treatment assignments.

RESULTS: Aggressive phototherapy, as compared with conservative phototherapy, significantly reduced the mean peak serum bilirubin level (7.0 vs. 9.8 mg per deciliter [120 …

Characteristics Of A Spina Bifida Population Including North American Caucasian And Hispanic Individuals, Kit Sing Au, Phong X Tran, Chester C Tsai, Michelle R O'Byrne, Jone-Ing Lin, Alanna C Morrison, Amy W Hampson, Paul Cirino, Jack M Fletcher, Kathryn K Ostermaier, Gayle H Tyerman, Sabine Doebel, Hope Northrup

Faculty, Staff and Student Publications

BACKGROUND: Meningomyelocele (MM) is a common human birth defect. MM is a disorder of neural development caused by contributions from genes and environmental factors that result in the NTD and lead to a spectrum of physical and neurocognitive phenotypes.

METHODS: A multidisciplinary approach has been taken to develop a comprehensive understanding of MM through collaborative efforts from investigators specializing in genetics, development, brain imaging, and neurocognitive outcome. Patients have been recruited from five different sites: Houston and the Texas-Mexico border area; Toronto, Canada; Los Angeles, California; and Lexington, Kentucky. Genetic risk factors for MM have been assessed by genotyping and …

Outcomes Of Safety And Effectiveness In A Multicenter Randomized, Controlled Trial Of Whole-Body Hypothermia For Neonatal Hypoxic-Ischemic Encephalopathy, Seetha Shankaran, Athina Pappas, Abbott R Laptook, Scott A Mcdonald, Richard A Ehrenkranz, Jon E Tyson, Michelle Walsh, Ronald N Goldberg, Rosemary D Higgins, Abhik Das

Faculty, Staff and Student Publications

BACKGROUND: Whole-body hypothermia reduced the frequency of death or moderate/severe disabilities in neonates with hypoxic-ischemic encephalopathy in a randomized, controlled multicenter trial.

OBJECTIVE: Our goal was to evaluate outcomes of safety and effectiveness of hypothermia in infants up to 18 to 22 months of age.

DESIGN/METHODS: A priori outcomes were evaluated between hypothermia (n = 102) and control (n = 106) groups.

RESULTS: Encephalopathy attributable to causes other than hypoxia-ischemia at birth was not noted. Inotropic support (hypothermia, 59% of infants; control, 56% of infants) was similar during the 72-hour study intervention period in both groups. Need for blood transfusions …

Effects Of Hypoxic-Ischemic Encephalopathy And Whole-Body Hypothermia On Neonatal Auditory Function: A Pilot Study, Ulrike Mietzsch, Nehal A Parikh, Amber L Williams, Seetha Shankaran, Robert E Lasky

Faculty, Staff and Student Publications

We assessed the effects of hypoxic-ischemic encephalopathy (HIE) and whole-body hypothermia therapy on auditory brain stem evoked responses (ABRs) and distortion product otoacoustic emissions (DPOAEs). We performed serial assessments of ABRs and DPOAEs in newborns with moderate or severe HIE, randomized to hypothermia ( N = 4) or usual care ( N = 5). Participants were five boys and four girls with mean gestational age (standard deviation) of 38.9 (1.8) weeks. During the first week of life, peripheral auditory function, as measured by the DPOAEs, was disrupted in all nine subjects. ABRs were delayed but central transmission was intact, suggesting …

Intensive Care For Extreme Prematurity--Moving Beyond Gestational Age, Jon E Tyson, Nehal A Parikh, John Langer, Charles Green, Rosemary D Higgins

Faculty, Staff and Student Publications

BACKGROUND: Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients.

METHODS: We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks' gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to …

Ambulatory Care Adverse Events And Preventable Adverse Events Leading To A Hospital Admission, Donna M Woods, Eric J Thomas, Jane L Holl, Kevin B Weiss, Troyen A Brennan

Faculty, Staff and Student Publications

BACKGROUND: Most healthcare in the US is delivered in the ambulatory care setting, but the epidemiology of errors and adverse events in ambulatory care is understudied.

METHODS: Using the population-based data from the Colorado and Utah Medical Practices Study, we identified adverse events that occurred in an ambulatory care setting and led to hospital admission. Proportions with 95% CIs are reported.

RESULTS: We reviewed 14,700-hospital discharge records and found 587 adverse events of which 70 were ambulatory care adverse events (AAEs) and 31 were ambulatory care preventable adverse events (APAEs). When weighted to the general population, there were 2608 AAEs …

Treatment Evolution In High-Risk Congenital Diaphragmatic Hernia: Ten Years' Experience With Diaphragmatic Agenesis, Kevin P Lally, Pamela A Lally, Krisa P Van Meurs, Desmond J Bohn, Carl F Davis, Bradley Rodgers, Jatinder Bhatia, Golde Dudell

Faculty, Staff and Student Publications

OBJECTIVE: The objective of this study was to evaluate the impact of newer therapies on the highest risk patients with congenital diaphragmatic hernia (CDH), those with agenesis of the diaphragm.

SUMMARY BACKGROUND DATA: CDH remains a significant cause of neonatal mortality. Many novel therapeutic interventions have been used in these infants. Those children with large defects or agenesis of the diaphragm have the highest mortality and morbidity.

METHODS: Twenty centers from 5 countries collected data prospectively on all liveborn infants with CDH over a 10-year period. The treatment and outcomes in these patients were examined. Patients were followed until death …

Honduras: Marketing New Reproductive Health Services Is Cost-Effective, Frontiers In Reproductive Health

Reproductive Health

In 1999, the Honduran Ministry of Health (MOH) revised national guidelines on women’s health services delivery to allow nurse auxiliaries to insert IUDs, give DMPA injections, and take Pap smears. This policy change addresses low contraceptive use among rural women and reflects findings from a 1998 Population Council study that showed that nurse auxiliaries can safely and successfully provide these services. Under the previous guidelines, rural women had limited access to long-term family planning methods. In 2000, the Population Council and the MOH assessed the effectiveness and cost of using a simple leaflet, distributed by nurse auxiliaries, to market the …

Honduras: Promover Nuevos Servicios De Salud Reproductiva Es Costo-Efectivo, Frontiers In Reproductive Health

Reproductive Health

En 1999, la Secretaría de Salud de Honduras (SSH) modificó las Normas de Atención Integral a la Mujer a fin de autorizar a las auxiliares de enfermería a prestar los servicios de inserción de DIU, aplicación del inyectable DMPA y toma de Papanicolaou. Este cambio en las normas aborda el problema de la baja prevalencia en el uso de anticonceptivos en áreas rurales. El cambio también refleja los hallazgos de un estudio anterior, realizado por el Population Council, que mostró que las auxiliares de enfermería pueden proporcionar estos servicios de manera segura y con buena calidad. Anteriormente, las mujeres en …

Mother-To-Child Transmission Of Aids: A Problem Of International Psychology, Ibpp Editor

International Bulletin of Political Psychology

This article describes international psychological phenomena that may be implicated in the identification, prevention, and management of mother-to-child transmission of AIDS.

A Correlative Study Of An At-Risk Population And Low Birth Weight/Infant Mortality In A Northeast Oklahoma City Community, Estacia D. Thrower

McCabe Thesis Collection

Studies show that numerous and complex variables influence pregnancy outcomes and infant mortality rates. These variables include demographic, medical, physical, environmental, behavioral, and attitudinal factors and prenatal care. Improving the health of mothers and infants is a national challenge. In 1987, more than 3.8 million infants were born in the United States. Of these, 38,408 died before their first birthday. Although the infant mortality rate is at an all-time low, the pace of progress has slowed. According to Dr. Robert Deppen of the Oklahoma State Health Department, "In 1992, Oklahoma ranked 29th in the United States for infant mortality and …

Women’S-Perceived Quality In Postpartum Care, Maryland A. Hunter

Theses and Dissertations (ETD)

Increased competition among healthcare organizations for the obstetric consumer market has led to increased interest in women’s perceptions of their obstetric experience. This study explored women’s perceptions of quality and women’s perceptions of benefits for women who received family-centered postpartum care (FCPPC) and women who received traditional postpartum care (TPPC). The study also assessed the relationship between women’s-perceived quality (WPQ) and women’s-perceived benefit (WPB) for those receiving FCPPC and those receiving TPPC. Quality and beneficence are the two concepts of Larrabee’s (1992) model of quality operationalized in this study. The sample consisted of 60 postpartum women, 30 receiving care on …

The Effect Of Post-Hospital Nursing Intervention On Success In Breastfeeding, Melinda Hoskins

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to compare the proportion of women in the experimental group who had a successful breastfeeding experience following post-discharge nursing intervention with the proportion of women in the control group who had a successful breastfeeding experience without nursing intervention. Criteria defining success in breastfeeding were established before the study. Chi-square analysis was used to test for significance with the preset level of significance being α = 0.05. The sample comprised 25 mother-infant dyads with 12 in the experimental group and 13 in the control group. Both groups were similar in type of delivery (spontaneous or …

Identification Of Needs In High Risk Prematures Significant To Public Health Nursing Follow-Up, Vida Francis

Loma Linda University Electronic Theses, Dissertations & Projects

Experts in the field of prematurity have stressed the needs for an intensive follow-up program for premature infants after discharge from the hospital and cited the important role that public health nurses can play. It was hypothesized that there are needs of the high risk premature infant significant to public health nursing follow-up.

The descriptive survey method and an interview schedule was the selected manner for obtaining necessary data. The sample was chosen from high risk premature infants attending the Premature Clinic at the White Memorial Hospital. The selected infants had birth weights of 1,500 grams or less, were under …