Judith Jones

Effect of pulse dexamethasone therapy on the incidence and severity of chronic lung disease in the very low birth weight infant

We conducted a prospective, randomized, double-blind trial to assess the efficacy and safety of pulse doses of dexamethasone on survival without supplemental oxygen in very low birth weight infants at high risk of having chronic lung disease. Seventy-eight infants with birth weights < or = 1500 gm who were ventilator dependent at 7 days of postnatal age were randomly assigned to receive pulse doses of dexamethasone, 0.5 mg/kg per day, divided twice daily (n = 39), or an equivalent volume of saline solution placebo (n = 39), for 3 days at 10-day intervals until they no longer required supplemental oxygen or assisted ventilation, or reached 36 weeks of postmenstrual age. At study entry, the groups did not differ by birth weight, gestational age, or severity of lung disease. At 36 weeks of postmenstrual age, there was both a significant increase in survival rates without oxygen supplementation (p = 0.03) and a significant decrease in the incidence of chronic lung disease (p = 0.047) in the group that received pulse therapy. Supplemental oxygen requirements were less throughout the study period in the group that received repeated pulse doses of dexamethasone (p = 0.013). The total numbers of deaths and the durations of supplemental oxygen, ventilator support, and hospital stay did not differ between groups. Recorded side effects in the pulse therapy group were minimal and included an increase in the use of insulin therapy for hyperglycemia (p < 0.05). We conclude that in this population of very low birth weight infants, treatment with pulse doses of dexamethasone resulted in improvement in pulmonary outcome without clinically significant side effects.

CDC/AAP Guidelines for Prevention of Early-onset Group B Streptococcal Sepsis(EOGBSS): Evaluation of an Infant Protocol † 1425

CDC/AAP Guidelines for Prevention of Early-onset Group B Streptococcal Sepsis(EOGBSS): Evaluation of an Infant Protocol † 1425

Prevention of Early-onset Group B Streptococcal Sepsis (EOGBSS): Implementation of the CDC Guidelines |[dagger]| 1424

Background: CDC guidelines for prevention of EOGBSS which recommended intrapartum antimicrobial prophylaxis (IAP) for GBS positive (+) or GBS unknown (unk) women with risk factors (RF=fever >38°C, PROM≥18hrs or <37wks GA) were instituted 10/1/95 at Magee-Womens Hospital(MWH). The purpose of this study was to document the effectiveness of these guidelines.

Early Discharge Program in a NICU Can be Cost Effective Without Compromising Quality. † 831

We hypothesized that an Early Discharge Program (EDP) using case management(CM) to facilitate earlier discharge (d/c) of preterm infants to home or transfer to level II hospital would be cost effective without compromising quality. The EDP was instituted on 1/1/96. Infants born 1/1/96-6/30/96 at<30wk GA were included in the analysis. Infants were excluded for transfer or death prior to 30wk postmenstrual age (PMA). CM included involvement of family, patient care coordinator, primary care physician, neonatologist and home nursing. D/C criteria were based on physiologic stability and included:3 34wks PMA, po feeds, thermostability in an open crib, infrequent apnea and FiO2 requirement <30%. Infants were considered for transfer to a level II facility when medically stable with FiO2 requirement <30% and on enteral feeds. Families were contacted within 4 wks of d/c to assess parent satisfaction and post-d/c healthcare utilization. CM infants were stratified into 2 categories based on GA at birth and compared with a retrospective control (CTL) group (7/1/94-6/30/95) for NICU length of stay (LOS) and d/c wt[mean (SD)]: Table Regression analysis, controlled for gender, BW, 5 min apgar, insurance and race showed that LOS was decreased in the CM group by 7d (p=0.02). Using a 4 point rating system, all of the parents contacted, indicated that they were highly satisfied with the discharge preparations. ER visits and readmission within 2 wks of d/c were infrequent and not related to early discharge. Given that the average charge for an NICU is

A REGIMEN OF FLUID RESTRICTION IS ASSOCIATED WITH A DECREASE IN CHRONIC LUNG DISEASE IN THE VERY LOW BIRTHWEIGHT INFANT. 1179

2,000/day, we conclude that the preliminary data suggests that this ED program will have a substantial effect on NICU expenditures with no demonstrable compromise to healthcare delivery or parent satisfaction.

Use of a Vaginal Ring Containing Dapivirine for HIV-1 Prevention in Women.

A REGIMEN OF FLUID RESTRICTION IS ASSOCIATED WITH A DECREASE IN CHRONIC LUNG DISEASE IN THE VERY LOW BIRTHWEIGHT INFANT. 1179