Savitri P Kumar

A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants

To determine the safety, efficacy, and cost savings of early hospital discharge of very-low-birth-weight infants (less than or equal to 1500 g), we randomly assigned infants to one of two groups. Infants in the control group (n = 40) were discharged according to routine nursery criteria, which included a weight of about 2200 g. Those in the early-discharge group (n = 39) were discharged before they reached this weight if they met a standard set of conditions. For families of infants in the early-discharge group, instruction, counseling, home visits, and daily on-call availability of a hospital-based nurse specialist for 18 months were provided. Infants in the early-discharge group were discharged a mean of 11 days earlier, weighed 200 g less, and were two weeks younger at discharge than control infants. The mean hospital charge for the early-discharge group was 27 percent less than that for the control group (

Anxiety, depression, and hostility in mothers of preterm infants.

47,520 vs.

Effect of Sympathetic Nerve Stimulation on Cerebral Blood Flow in Newborn Piglets

64,940; P less than 0.01), and the mean physicians charge was 22 percent less (

Human Fetal Weight and Placental Weight Growth Curves

5,933 vs.

Red Cell Metabolic Alterations in Postnatal Life in Term Infants: Glycolytic Intermediates and Adenosine Triphosphate

7,649; P less than 0.01). The mean cost of the home follow-up care in the early-discharge group was

Red cell glycolytic intermediates and adenosine triphosphate in preterm infants on the first day of life.

576, yielding a net saving of

Red Cell Metabolic Alterations in Postnatal Life in Term Infants: Possible Control Mechanisms

18,560 for each infant. The two groups did not differ in the numbers of rehospitalizations and acute care visits, or in measures of physical and mental growth. We conclude that early discharge of very-low-birth-weight infants, with follow-up care in the home by a nurse specialist, is safe and cost effective.

RHYTHMIC ORGANIZATION OF SPONTANEOUS MOVEMENTS IN PREMATURE INFANTS ≤ 34 WEEKS GESTATIONAL AGE (GA)

Anxiety, depression, and hostility in 47 mothers of high-risk preterm infants were tested at the time of infant discharge and when the infant was 9 months old. Mothers of these high-risk preterms were significantly more anxious and depressed before their infant was discharged than when the infant was 9 months old. Before infant discharge, multiparas were significantly more depressed than primiparas. Additionally, mothers whose infants remained in the hospital longer than the mean of 51 days were significantly less depressed at infant discharge than were mothers whose infants had shorter hospital stays. Maternal anxiety, depression, and hostility did not differ based on marital status, maternal education, socioeconomic status, or maternal age at the time of infant discharge or when the infant was 9 months old.

1404 IN-VIVO BRAIN OXIDATIVE METABOLISM IN THE VENTI LATOR AND NONVENTILATOR DEPENDENT LOW BIRTHWEIGHT INFANTS

ABSTRACT. The purpose of this study was to determine the effect of sympathetic nerve stimulation on regional cerebral blood flow during the first 3 wk of postnatal development in piglets. Forty-one piglets ranging in age from 2 to 24 days were studied while anesthetized with 30% N2O, paralyzed and mechanically ventilated (PaCO2 = 35-40 mm Hg). Regional cerebral blood flow was measured with tracer microspheres (15 ± 1 µm) during electrical stimulation (15 Hz, 15 V, 3 ms) of the right cervical sympathetic trunk. Sympathetic stimulation decreased blood flow to the ipsilateral cerebrum (gray and white matter) (-15 ± 2%), hippocampus (-9 ± 2%), choroid plexus (-50 ± 5%), and masseter muscle (-93 ± 2%) compared to the contralateral side where blood flow to these regions was 74 ± 4, 45 ± 2, 258 ± 26, and 24 ± 4 ml/min/100 g, respectively (mean ± SEM; p ≤ 0.05). The magnitude of the reduction in cerebral blood flow was not dependent on postnatal age as no significant differences were noted when the piglets were grouped according to age. Hypercapnia (PaCO2=64 ± 5 mm Hg) increased blood flow 2- to 4-fold above control in all brain regions except the choroid plexus. The effect of sympathetic nerve stimulation was augmented during hypercapnia where blood flow to the ipsilateral cerebrum, hippocampus, and caudate nucleus was decreased by -34 ± 4, -23 ± 5, and -6 ± 3 %, respectively. Activation of sympathetic nerves can reduce blood flow to specific brain regions during control conditions and these effects are larger in hyperemic conditions such as hypercapnia. These data demonstrate that sympathetic nerves are present and completely developed at birth and, when sufficiently activated, capable of influencing regional cerebrovascular resistance in the newborn piglet.

557 INFECTION IN NEWBORN INFANTS - A CHANGING PATTERN IN A SPECIAL CARE UNIT (SCU)

A mathematical analysis of human fetal and placental growth curves was made on data collected prospectively from a population at sea level. Both the fetal and placental growth curves can best be described by a form of the logistic equation inhibited growth model. The fetal growth rate reaches its maximum approximately 4 weeks after the placental growth rate has reached its maximum. Growth rate constants were calculated for several populations at various altitudes.