Herman Risemberg

Acoustic features of normal-hearing pre-term infant cry

Acoustic features of expiratory cry vocalizations were studied in 125 pre-term infants prior to being discharged from a level-3 neonatal intensive care unit. The purpose was to describe various phonatory behaviors in infants in whom significant hearing loss could be ruled out. We also compared these results with normal-hearing full-term infants, and evaluated whether linkage exists among acoustic cry features and various anthropometric, diagnostic and treatment variables obtained throughout the peri- and neonatal periods. Our analysis revealed that cry duration was significantly related to total days receiving respiratory assistance. The occurrence of other complex spectral and temporal aspects of acoustic cry vocalizations including harmonic doubling and vibrato also increased in infants receiving some form of respiratory assistance. The presence of harmonic doubling also depended on weight and conceptional age at test. The discussion focuses on the implication of these relationships and directions for future research.

Airway management in the premature infant.

Out of 262 premature newborn patients admitted with a diagnosis of respiratory distress, it was necessary to treat 70 with a ventilator. Of these 70, 25 eventually underwent tracheostomy. Indications for tracheostomy were that of an infant needing prolonged endotracheal intubation greater than one week. The procedure itself was easily performed and an overall complication rate of 7% was the result. Of the patients who underwent tracheostomy, 8% had significant complications. There was no death attributable to the treatment regime. We feel, therefore, that a combination approach starting with the endotracheal tube and progressing to tracheostomy when necessary, provided the best care for premature infants requiring intensive airway management.

A simple objective system for early recognition of overwhelming neonatal respiratory distress

The early recognition of severe respiratory distress in the newborn allows for optimal care. The prompt identification of overwhelming respiratory failure may assist in the selection of candidates for new therapeutic techniques. We have evaluated, both retrospectively and prospectively, a simple scoring system for neonatal respiratory insufficiency. During the first 24 hr of life, serial inspired oxygen values (FiO2) are plotted with serial pH measurements against time on a graph. With pulmonary insufficiency, the lines cross. The severity of the insufficiency is quantified by integrating the area between the crossed lines. The 25 infants in our Regional Intensive Care Unit Nursery who died with respiratory distress syndrome (RDS) during 1976 were compared with surviving infants matched for gestational age, birth weight, and admission date; all patients received similar conventional management. The difference in the mean 24-hr cumulative scores between the two groups was significant (p < 0.01). Only 1 infant with a score over 40 U ultimately survived (96% specificity). From January 1978 through June 1979, data were graphed at the bedside on 100 neonates who required respiratory support, and analyzed without knowledge of the eventual outcome. Overall, the scoring system predicted the final outcome in 95% of the cases. False positive determinations were minimal, the system accurately selecting 86/87 ultimate survivors (98.8% specificity). These data suggest that this simple scoring system may prove useful in identifying infants with overwhelming respiratory distress. Such infants may be considered for specialized care or innovative yet unproven treatment modalities.

A Problem‐Oriented Perinatal Database Concept: An Early View

The perinatal database system at Albany Medical Center is in an embryonic state in relation to its basic objectives. This paper describes the developmental steps in our approach to the handling of perinatal information, and is at risk of being repetitive to those who have gone through this process. In describing our approach to the problem of “where to begin”, it may be the first exposure to this process for some practitioners. Our principle goal is to accelerate the presentation and processing of medical information. The ultimate goal of this project is the improvement of maternalinfant care by enhancing the efficiency of the perinatal practitioner, establishing a centralized regional database and hospital clinical database, as well as facilitating perinatal research activities. The purpose for which this information is to be gathered must be clearly stated and understood. We believe that there is a need for a computerized perinatal database system that is directly responsive to the specific requirements of clinical and regional management. Furthermore, this unified perinatal information should encompass the continuum of patient care, not circumscribed to just diagnostic and statistical data manipulations. The objective(s), therefore, determines what measurements or classifications in question are used and which items or people will be the source of the information. Our main objectives are 1) to provide a system of informational exchange between all participant members, 2) to achieve a more efficient and accurate tabulation of pertinent information for both regional and local management, so as to a) support evaluation of obstetric and neonatal patient care (demographic data, statistics, etc.) and b) define and meet educational needs. Medical management decisions are made on the basis of data which are frequently scattered. Isolated determinations of multiple parameters usually compound this problem. The volume and dispersion of these data often hide significant trends. It is apparent that immediately accessible patient data are a requirement for timely care. These data must also be up-todate and available in a legible form, which both guides the management of known problems and assists in the recognition of new ones. We readily recognized that computer assisted processing organizes in a legible form the documentation and facilitates speedy retrieval. Centralization of objective data permits recognition of inappropriate values and trend prediction. We first asked ourselves (obstetricians and neonatologists) if we could define the ideal perinatal database What type of questions do we want answered, and in what formats are they to be presented to us? Working backwards we asked next What would we prefer to have in it and be able to do with it? What is available to us now that may provide us with reasonable, verified information? Nothing? Not really, for it was suggested that the N. Y. State Birth-Death Certificate information is at least available. The thought of mixing with “Big Apple” bureaucracy, and rumors of dubious reporting initially gave more credence to reinventing the ‘data-capture’ wheel ourselves. However, the former thought was not abandoned. Within six months of initiating our perinatal “Outreach” education series at hospitals throughout our region, we were able to compare information generated at the state level to that of the community. It was surprisingly good for the Northeastern N.Y.S./HSA 5 area. Of course, there were lots of holes for a complete database. We were also able to follow the flow and verification of data into the vital records in each participant hospifal. Thus evolved our concept of the expanded birth record (EBR), a nonrepetitive, sequentially linked perinatal information system based around the nucleus of the state record. This consists of the following components: 1. A maternal questionnaire form (a quick yes, no,