Sylvia W. Lang

Twelfth Grade Follow-Up of the Effectiveness of a Middle School-Based Substance Abuse Prevention Program.

A twelfth-grade follow-up afforded the opportunity to assess the long-term effects of substance abuse prevention delivered in sixth and seventh grades. A social pressures resistance skills curriculum implemented by classroom teachers had been evaluated with short-term positive results previously reported. Students completed self-administered questionnaires at sixth grade pre- and posttests, and at seventh and twelfth-grade posttests. Curriculum group students received lessons on alcohol, tobacco (cigarettes and smokeless), marijuana, and cocaine, which were later incorporated into the Michigan Model for Comprehensive School Health Education. This evaluation used data from 262 students who completed all four questionnaires and who received the complete two-year intervention or no intervention. Repeated measures analyses of variance demonstrated that significant effects evident at seventh grade for alcohol use and misuse, as well as cigarette, cocaine, and other drug use were generally not maintained through twelfth grade. Ongoing reinforcement of effective prevention is recommended.

Barriers to screening infants for retinopathy of prematurity after discharge or transfer from a neonatal intensive care unit.

OBJECTIVE:To assess neonatal intensive care unit (NICU) practices affecting screening and follow-up for retinopathy of prematurity (ROP).METHODS:Retrospective study of infants at risk for ROP, eligible for back transport, admitted to a regional NICU from January 1, 1999 until May 31, 2002. Patients failed to receive needed follow-up for ROP after discharge or transfer from a NICU, if we could not verify their ROP screening follow-up within 1 month.RESULTS:A total of 74 infants were identified to need follow-up eye care. Infants who did not receive the follow-up care had greater mean gestational age (mean SD; 30.7±2.3 vs 29.6±2.5 weeks, p=0.05) and birth weights (mean SD; 1581±366 vs 1360±508 g, p=0.007), compared to infants who received the recommended care. Infants transported back to the community hospital were significantly more likely to miss follow-up eye care compared to infants discharged from the regional center (relative risk 2.81, 95% confidence interval (CI) (1.09 to 7.20)). Infants not screened for ROP in the NICU had greater risk for missing follow-up care compared to infants who had their first retinal examination in the NICU (relative risk 4.25, 95% CI (1.42 to 12.73)).CONCLUSIONS:Infants transferred back or discharged from the NICU before ROP screening represent a high-risk group for not receiving follow-up eye care.

Pregnant mothers out of the perinatal regionalization's reach

Introduction:Birth of very low birth weight (VLBW) infants outside subspecialty perinatal centers increases risk for death and major morbidities.Objective:The purpose of this study is to evaluate barriers to utilizing a regional perinatal center for the birth of VLBW infants to mothers not living in the immediate vicinity of the center.Methods:We conducted a retrospective cohort study of VLBW infants residing in the catchment area of a community level II, Specialty Neonatal Unit (SN) admitted to a Regional Subspecialty Neonatal Intensive Care Unit (RC) between January 1999 and December 31, 2004. Maternal demographics and prenatal care as well as outcomes were compared by place of birth.Results:Out of 98 VLBW infants admitted to the RC, 49 (50%) were delivered outside the RC (out-born) and 49 (50%) were born at the RC (in-born). There was no statistical difference in insurance coverage, race, gestational age, severity of illness or maternal demographic factors between out-born and in-born infants. Less than adequate prenatal care rather than distance of maternal residence from the RC was associated with birth outside the RC. Adjusting for prenatal care, distance of residence from the RC increased the risk for delivering outside the center in the subset of mothers insured by Medicaid.Conclusions:Mothers of VLBW infants who received less than adequate prenatal care and did not live in the vicinity of a subspecialty center had an increased risk for delivery outside that center compared to those with adequate care. Appropriate place of birth for VLBW infants to low-income mothers may be influenced by the distance of their residence to an RC.

Back Transport of Neonates: Effect on Hospital Length of Stay

INTRODUCTION:In a regionalized perinatal system, recovering neonates may be back transported from a regional Neonatal Intensive Care Unit (NICU) to community hospitals closer to their residence to convalesce prior to hospital discharge.OBJECTIVE:This study evaluates the practice of neonatal back transport for growth and the duration of total hospitalization.METHODS:We conducted a retrospective study comparing length of stay (LOS) for infants back transported from a regional NICU to a level II nursery for convalescent care (BT), with LOS for infants eligible for back transport discharged home from the Regional Center (RC).RESULTS:A total of 221 infants were studied. BT infants (n=104) had lower birth weights (median; 1955 vs 2700 g, p=0.001), more frequently needed mechanical ventilation (84 vs 65%, p=0.002) and parenteral nutrition (71 vs 55%, p=0.013), less frequently were evaluated by subspecialists (20 vs 59% p=0.0001), and had longer total LOS (median; 20 vs 11 days, p<0.0001) compared to infants discharged home from the RC (n=117). However, in the subgroup with birth weights ≤1500 g (very low birth weight (VLBW)), BT (n=25) infants had similar birth weight (median; 1160 vs 1215 g, p=0.9) compared to those discharged home from the RC (n=24) and did not have a statistically different total LOS (median; 50 vs 56 days, p=0.1). Almost all infants who had major surgeries, treatment for retinopathy of prematurity, seizures, or had severe intra-ventricular hemorrhages were discharged home from the RC. The rates of hospital readmissions or emergency room visits acutely after their discharge to home from the RC or the community hospital were similar.CONCLUSIONS:BT Infants differed based on clinical features compared to premature infants discharged from the RC. VLBW infants, back transported for growth, had similar total LOS compared to similar weight infants discharged home from the RC.