Hospital readmission with feeding-related problems after early postpartum discharge of normal newborns.

CONTEXT: Increasingly short postpartum hospital stays in the United States precipitated a policy debate that culminated in passage of the Newborns' and Mothers' Health Protection Act of 1996. The debate occurred without population-based evidence for adverse health effects in newborns who are discharged early. OBJECTIVE: To determine whether early postpartum hospital discharge of normal newborns increases their risk for hospital readmission with feeding-related problems. DESIGN AND SETTING: Nested case-control analysis of 1991 to 1994 Wisconsin birth certificate and hospital discharge data. SUBJECTS: A total of 210 readmitted case patients and 630 control subjects selected from a cohort of 120 290 normal newborns who weighed at least 2500 g, were delivered vaginally of mothers with uncomplicated medical and obstetrical histories, and were discharged from the hospital either early (day of life 1 or 2) or conventionally (day 3). OUTCOME MEASURE: Readmission at age 4 to 28 days with discharge diagnoses indicating a primary feeding problem, secondary dehydration, or inadequate weight gain. RESULTS: Early discharges increased 3-fold (reaching 521/1000 discharges) during the study period, but feeding-related readmissions (1.7/1000) remained stable. Most readmitted newborns (53.8%) were 4 to 7 days old, many (34.3%) had concurrent dehydration and jaundice, and 29% were admitted through emergency departments. Readmitted newborns were significantly (P<.05) more likely to have been breast-fed, firstborn, or preterm or to have mothers who were poorly educated (<12th grade), unmarried, or receiving Medicaid. Readmission was not associated with early discharge (adjusted odds ratio, 1.05; 95% confidence interval, 0.71-1.53). CONCLUSION: Although several neonatal and maternal factors increase the risk that a normal newborn will be rehospitalized with a feeding-related problem, early discharge following an uncomplicated postpartum hospital stay appears to have little or no independent effect on this risk.

Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease.

OBJECTIVE: We examined whether the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease increase with increasing numbers of chlamydial infections. STUDY DESIGN: A retrospective cohort design was used to evaluate the risks of hospitalization for ectopic pregnancy or pelvic inflammatory among 11,000 Wisconsin women who had one or more chlamydial infections between 1985 and 1992. Logistic regression was used to evaluate the strength of association between recurrent infection and sequelae. RESULTS: After adjustment in multivariate analyses, we observed elevated risks of ectopic pregnancy among women who had two (odds ratio 2.1, 95% confidence interval 1.3 to 3.4) and three or more chlamydial infections (odds ratio 4.5, 95% confidence interval 1.8 to 5.3). These groups were also at increased risk for pelvic inflammatory (two infections: odds ratio 4.0, 95% confidence interval 1.6 to 9.9; three or more infections: odds ratio 6.4, 95% confidence interval 2.2 to 18.4). CONCLUSIONS: A unique prevention opportunity occurs at the diagnosis of any chlamydial infection because women with subsequent recurrences are at increased risk for reproductive sequelae.

Correlation of ischemia-induced extracellular and intracellular ion changes to cell-to-cell electrical uncoupling in isolated blood-perfused rabbit hearts. Experimental Working Group.

BACKGROUND: The relationships between the metabolic, ionic, and electrical changes of acute ischemia have not been determined precisely because they have been studied under different experimental conditions. We used ion-selective electrodes, nuclear magnetic resonance spectroscopy, and the four-electrode method to perform four series of experiments in the isolated blood-perfused rabbit heart loaded with 5F-BAPTA during 30 to 35 minutes of no-flow ischemia. We sought to determine the relationship between changes in phosphocreatine (PCr), adenosine triphosphate (ATP), intracellular calcium ([CA2+]i), intracellular pH (pHi) extracellular potassium ([K+]e), extracellular pH (pHe), and whole-tissue resistance (rt). METHODS AND RESULTS: In the first 8 minutes of ischemia, [K+]e rose from 4.9 to 10.8 mmol/L, PCr fell by 90%, ATP decreased by 25%, and pHi and pHe decreased by 0.5 U, while [Ca2+]i and rt changed only slightly. Between 8 and 23 minutes, [K+]e changed only slightly; pHi, pHe, and ATP continued to fall, and [Ca2+]i rose. rt did not increase until >20 minutes of ischemia, when pHi was <6.0 and [Ca2+]i had increased more than three-fold. The increase in rt, indicating electrical uncoupling, coincided with the third phase of the [K+]e change. CONCLUSIONS: Our study suggests that cellular uncoupling occurs only after a significant rise in [Ca2+]i and fall in pHi and that these ionic and electrical changes can be identified by the change in [K+]e. Our study underscores the importance of using a common model while attempting to formulate an integrated picture of the ionic, metabolic, and electrical events that occur during acute ischemia.

The impact of a comprehensive chlamydia prevention program in Wisconsin.

An analysis using case reports, laboratory records of tests for C. trachomatis, and Hospital Discharge Summary data shows that, following implementation of a chlamydia prevention program in Wisconsin in 1985, statewide declines were observed in prevalence, incidence and complications of infection. In 1990, prevalence rates among teenage women peaked at 2,794 infections per 100,000 15-19-year-old females. Between 1987 and 1991 (a period of stable testing volume), the proportion of positive tests decreased in all age-groups for females (by 29-41%) and males (by 10-14%), and the incidence of new infections in women decreased in clinic populations by 27%-50%. Between 1986 and 1991, hospitalization rates declined by 33% for pelvic inflammatory disease and by 20% for ectopic pregnancy.

A randomized trial of abdominal incision suture technique and wound strength in rats.

OBJECTIVE: To determine whether interrupted en bloc suture or continuous running mass suture technique for closure of abdominal incisions results in stronger wounds, and to determine the time required for each technique. DESIGN: Randomized trial. SETTING: Arthur C. Guyton Animal Facilities, University of Mississippi Medical Center, Jackson. SUBJECTS: Male Sprague-Dawley rats. INTERVENTION: A midline laparotomy was performed on 103 rats that were separated into two groups using computer-generated random numbers. In group 1, incisions were repaired using a continuous mass closure suture technique. In group 2, incisions were repaired using an en bloc interrupted suture technique. OUTCOME MEASURES: Wound bursting pressure was determined on postoperative day 7. The time required to repair each incision was recorded. RESULTS: Continuous mass closure suture technique resulted in significantly greater wound strength (P < .05) and required significantly less time (P < .000001). CONCLUSION: Continuous mass closure suture technique is superior to interrupted en bloc closure with respect to wound strength and closure time.

Characterization of chloramphenicol-resistant Haemophilus influenzae.

We examined nine chloramphenicol-resistant (minimal inhibitory concentration, greater than or equal to 15 micrograms/ml) Haemophilus influenzae strains isolated in various parts of the world to characterize the genetic and biochemical bases of the resistance; four were type b. All nine contained conjugative plasmids, ranging in molecular weight from 34 x 10(6) to 46 x 10(6), which encoded for resistance to chloramphenicol and tetracycline or chloramphenicol, tetracycline, and ampicillin. Deoxyribonucleic acid homology studies showed that these plasmids were closely related to a previously described ampicillin-resistant plasmid, RSF007, and to each other. All nine isolates and their chloramphenicol-resistant transconjugants produced chloramphenicol acetyltransferase. We conclude that chloramphenicol resistance in these strains of H. influenzae is via plasmid-mediated production of chloramphenicol acetyltransferase.