Paul H. Perlstein

Apnea in premature infants and incubator-air-temperature changes.

Abstract The thermal events associated with apneic spells-were recorded during the monitoring of selected premature infants housed in incubators controlled by servo mechanism to maintain skin temperature between 35.8 and 36.6°C. The temperature changes that occurred during the 120 seconds before the onset of apnea were compared to the changes measured exactly 15 minutes before each episode. Of the 126 apneic spells 70 occurred during a rise, 44 during a fall, and 12 during a plateau (no change) in air temperature. During the nonapneic control periods, there were 41 rises, 64 falls and 21 plateaus in temperature. The onsets of apnea, therefore, were preceded by rising air temperatures more commonly (p less than 0.001) than matched moments without apnea. This correlation, supported by dramatic examples of apnea with sudden increases in air temperature, adds to the evidence that present incubator thermal control may help trigger apnea.

Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit.

The effect of a cost-containment program focused on decreasing the lengths of hospital stay of high-risk neonates was assessed by comparison of discharge weights and lengths of stay for 257 study infants, discharged from a neonatal intensive care unit (NICU) after an early-discharge program began, with those of 477 control infants discharged during a prior 1-year period. Demographic data and costs, as well as data on emergency department use and hospital readmissions, were included in the comparisons. There was a significant decrease in mean discharge weight and length of stay for infants in the study group. During a 7-month period, an estimated 2073 days of hospital care and approximately

The transparent baby bag. A shield against heat loss.

2,700,000 in hospital charges were saved, or

Use of hospital-based services in the first three months of life: Impact of an early discharge program

10,609 per infant discharged. The cost of instituting and maintaining the program was

Prenatal care and infant emergency department use.

120,413, or

Acuity scores as predictors of cost-related outcomes of neonatal intensive care

468 per infant. Seven visits were made to the emergency department by the study infants during the first 14 days after discharge. One infant was readmitted for a 4-day hospital stay for suspected sepsis. Significantly earlier discharge of high-risk neonates produced a decrease in hospital charges without causing excessive morbidity. The success of the program was coincident and presumed related to the institution of multiple elements focused toward family support through early-discharge planning. The reduction in hospital charges was 30 times higher than program expenses.

EFFECT OF AN EARLY DISCHARGE PROGRAM ON THE RELATIONSHIP BETWEEN PRIMARY CARE VISIT (PCV) AND EMERGENCY ROOM (ER) USE. • 625

Abstract Swaddling of newborn infants in double-layered, clear-plastic bags with a head shield allowed less heat loss than a radiant heater alone. Protection against heat loss is increased if the plastic bag is combined with a radiant heater. This protection is accomplished without severe compromise of either visualization or handling of the infant.

A computer-generated blood gas display in a newborn intensive care unit.

OBJECTIVE To assess the effect of an early discharge program on the use of hospital-based health care services in the first 3 months of life. DESIGN Retrospective cohort study. SETTING Metropolitan university hospital and a childrens hospital. PATIENTS Term infants cared for in a single term nursery, before and after implementation of an early discharge program. INTERVENTION Early discharge program. METHODS Linking of the birth hospital and the childrens hospital records and chart review. OUTCOME MEASURES Pattern of emergency department visits and rehospitalizations in the first 3 months of life. RESULTS The early discharge group had a shorter stay, 32 +/- 21 hours (mean +/- SD) than the control group (48 +/- 22 hours). There was no effect of early discharge on mean age at rehospitalization, rehospitalization rate, or reason for rehospitalization. Twenty-eight percent of infants in both study and control groups had at least one emergency department visit by 3 months of age. There was no difference between study and control groups in mean age or frequency of emergency department visits. Maternal age and race had a significant effect on the odds of visiting the emergency department. For any maternal age, nonwhite mothers were more likely to visit the emergency department. CONCLUSIONS Early discharge of newborn infants to inner city parents can be accomplished without increasing hospital-based resource use in the first 3 months of life provided coordinated postdischarge care and home visiting services are available.

Thermal Patterns on the Backs of Cold Stressed Babies

Objective To determine the relationship between mothers’ use of prenatal care and pediatric emergency department (ED) use by their infants in the first 3 months of life. Methods This is a retrospective, cohort-control study of well, full-term infants who use a children’s hospital ED. Using logistic regression, the likelihood of an emergency visit in the first 3 months of life was compared between infants of women with fewer than two prenatal visits and infants of women with two or more prenatal visits. Covariates were maternal age, race, substance abuse history, parity, infant birth weight, insurance status, and distance from the ED. Results The odds of an ED visit before age 3 months by infants of mothers with less than two prenatal visits was 29% lower than the comparison group. ED use was increased by proximity, Medicaid or no health insurance and younger maternal age. Seventy percent (70%) of visits by both cohorts were classified as unjustified. The odds of making an unjustified ED visit were increased by younger maternal age and proximity to the emergency department. Conclusions Women with poor prenatal care are less likely to seek ED care for their young infants. Although suboptimal prenatal care is associated with negative health outcomes, it is not known whether fewer infant ED visits are similarly deleterious.

Changes Associated with the Introduction of an Evidence Based Clinical Practice Guideline (EBCPG) for Acute Gastroenteritis (AGE) in Children 2 Months to 5 Years of Age

OBJECTIVE The Medicus Patient Classification System (PCS) and the lameter Acuity Index Method (AIM) are two proprietary scoring systems in common use for stratifying patient populations before making comparisons of the medical care they receive. In this study the validities of these scores were tested when the scores were used to evaluate cost-related elements of high-risk neonatal intensive care. METHODS A total of 687 surviving inborn infants cared for in a university hospital newborn intensive care unit provided data for these analyses. The infants were stratified into the five diagnosis-related groups (DRGs) for surviving neonates (386, 387, 388, 389, and 390), as determined from their discharge diagnoses. Each infants summed total of daily PCS scores, a single AIM score, and birth weight were extracted from the hospitals decision-support data files and used as independent variables in regression analyses to determine correlations with lengths of hospital stay, ancillary resource utilizations, and hospital charges. RESULTS The Medicus scores, which are computed prospectively on a daily basis, when summed retrospectively, correlated highly with lengths of stay, ancillary resource utilization, and associated hospital charges. The lameter scores, which are assigned retrospectively, were far less predictive of these outcome variables and generally worse than birth weight in explaining outcome variances. CONCLUSIONS Although in common use, the lameter AIM could not be validated as an appropriate method for assessing cost-related outcomes after newborn intensive care. The Medicus PCS produced daily scores that, when summed after patient discharge, correlated highly with the same outcome variables. There is a need to test further these and other proprietary methods now used to compare the cost-related elements of care provided by different hospitals and physicians.