Beverly L. Koops

Relationship of intravenous sodium bicarbonate infusions and cerebral intraventricular hemorrhage

The incidence of cerebral intraventricular hemorrhage was determined by computed tomography in 100 infants with birth weights less than or equal to 1,500 gm. A comparison of IVH with serum sodium concentrations and the amount of intravenous sodium bicarbonate administered did not reveal a significant relationship. Analysis of the method of infusion of sodium bicarbonate indicated that the rapid infusion of hyperosmolar (M to M/12) sodium bicarbonate is associated with a significantly increased incidence of IVH.

Experience with Home Oxygen in the Management of Infants with Bronchopulmonary Dysplasia

We followed the clinical course of 23 infants with bronchopulmonary dysplasia (BPD) on home oxygen therapy during the first year of life in order to monitor patterns of growth, need for hospital readmission, and improvement in oxygenation. Oxygenation was assessed by serial, resting, awake, and room air transcutaneous PO2 (tcPO2) measurements at clinic visits. Weight gain was poor, with boys growing below the fifth percentile and girls growing at the tenth percentile. Ten of the 23 infants (43%) required rehospitalizations. There were no deaths. Fourteen of the 23 infants (61%) were taken off supplemental oxygen by 12 months corrected age, at a mean age of 7.9 months. Mean rate of improvement in tcPO2 was 3 torr/month, but wide individual variation was found. Infants off of oxygen treatment at 12 months corrected age grew at a significantly greater rate than those still requiring oxygen supplementation (p < 0.02). Infants with right ventricular hypertrophy (RVH) by electrocardiogram tended to resolve their RVH while on home oxygen therapy. We conclude that infants with BPD on home oxygen therapy generally show steady improvement in oxygenation, but grow poorly and require frequent hospitalizations.

Who pays the bill for neonatal intensive care

The Childrens Hospital Newborn Emergency Service conducted 174 transports to the Newborn Center during a four-month period in 1976. The transport charge directly related to the distance between the referring hospital and the NBC. Two years after the NBC discharged the last study infant, 150 of 174 accounts have been paid in full. Insurance paid 85%, families paid 4%, and the hospital wrote off 11% of all hospital charges. The Childrens Hospital referred 2% of all hospital charges to a bill collection agency. One hundred-forty-four infants (84%) survived and 27 (16%) died. The mean charge per day for survivors was

1144 NON-SURGICAL TREATMENT OF ACQUIRED HYDROCEPHALUS: EVALUATION OF SERIAL LUMBAR PUNCTURE

338; the mean charge per day for nonsurvivors was

1363 OUTCOME OF INBORN VS. TRANSPORTED HIGH-RISK INFANTS

607.

Pulmonary Vascular Response to Oxygen in Infants with Severe Bronchopulmonary Dysplasia

Serial lumbar puncture (LP) as a method of treating hydrocephalus was evaluated in ten infants of birthweights ≤ 1500 grams, who had a cerebral intraventricular hemorrhage(CVH) and ventricular dilatation identified by computed tomography (CT).Each of the infants had an initial CT scan within the first ten days of life. Follow-up CT scans were done at weekly intervals. If progressive ventricular dilatation was observed, daily LP was attempted. Ventricular size remained stable or decreased throughout the tapping period and remained so after the cessation of tapping in eight of the ten infants. Follow-up CT scans at six months of age on eight of the ten infants showed no increase in ventricular size and an increase in the thickness of the cerebral mantle. The two infants from whom cerebrospinal fluid could not be obtained had progressive ventricular dilatation and required the placement of a ventriculo-peritoneal shunt.This approach to early intervention of progressive ventricular dilatation secondary to CVH by means of serial LP may arrest the development of hydrocephalus and eliminate the need for a shunt.

Role of Coagulopathy in Newborn Intracranial Hemorrhage

The outcome of 694 births of infants weighing <1500 grams from two sources was compared. 301 births occurred in 5 metro area hospitals (MH) with Level I nursery facilities; the high-risk infants were transported to Level III nurseries. 393 infants were born in University Hospital (UH) where Level III intrapartum and neonatal care are available. Fetal deaths were twice as frequent in the MH population as in the UH group, 25 vs. 12.5% (p <.01). Neonatal deaths were slightly increased in the MH, 37 vs. 30% but not to a significant degree. Infant deaths occurred in 3 and 4% respectively in MH and UH. Outcome at approximately 12-24 months was the same in both groups. Because 61% of the UH population in this weight group comes from in utero transport patients from the region, this population was reviewed. Fetal deaths occurred in 9.5% of total maternal transport births. Neonatal deaths were similarly reduced (27%) and outcome slightly improved 33%. When the in utero transport patients from the MH were credited back to these hospitals the fetal death rate was 22% compared to the UH rate of 17% (p=NS). Maternal transport patients constitute a population which differs from that of the MH and UH. Data on maternal complications, neonatal morbidity, birth weight, gestational age, socioeconomic status, type of transport and long-term outcome in relation to these factors is in preparation.