ABSTRACT
Infants born prematurely have a plethora of medical problems. Some have cerebral palsy, resulting in limited mobility, while others require oxygen, hearing aids, and/or glasses for medical problems. Most of these could have been prevented if preterm birth was avoided, but efforts to curb this have been slow. This article discusses how blindness can be prevented in infants born prematurely by accepting lower oxygen saturations when on oxygen in the intensive care nursery.
Subject(s)
Intensive Care, Neonatal/organization & administration , Oxygen Inhalation Therapy/adverse effects , Oxygen Inhalation Therapy/nursing , Retinopathy of Prematurity/prevention & control , Algorithms , Decision Trees , Education, Nursing, Continuing/organization & administration , Hospitals, Pediatric , Humans , Incidence , Infant, Newborn , Monitoring, Physiologic/nursing , Neonatal Nursing/education , Neonatal Nursing/organization & administration , North Carolina/epidemiology , Nursing Assessment/organization & administration , Nursing Evaluation Research , Nursing Staff, Hospital/education , Nursing Staff, Hospital/organization & administration , Organizational Culture , Organizational Innovation , Oxygen Inhalation Therapy/methods , Program Development , Program Evaluation , Retinopathy of Prematurity/epidemiology , Retinopathy of Prematurity/etiology , Risk Factors , Total Quality Management/organization & administration , Ventilator Weaning/nursingABSTRACT
CONTEXT: Early childhood development programs such as Head Start have proven benefits for impoverished children. However, few physicians assist families with enrollment. OBJECTIVE: To test if a primary care-based intervention is efficacious in increasing Head Start attendance. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of 246 Head Start-eligible children aged 0 through 4 years recruited in spring 2003 from 4 health clinics in Seattle, Wash. INTERVENTIONS: List of Head Start telephone contacts provided to families of all children and, for those in the intervention group, a computer-generated packet containing a physician referral letter (and a physical examination form and immunization record, if available) mailed directly to Head Start by study personnel. MAIN OUTCOME MEASURE: Head Start attendance by January 2004. RESULTS: The 123 children analyzed in each study group were similar at baseline. Overall, 72 children (29%) were successfully connected with Head Start (ie, actively attending or on a waiting list) by January 2004. Among the intervention group, 50 children (41%) were successfully connected with Head Start, contrasted with 22 (18%) in the control group (adjusted difference, 17%; 95% confidence interval [CI], 8%-27%). Among the intervention group, 31 children (25%) were actively attending Head Start, contrasted with 14 (11%) in the control group (adjusted difference, 12%; 95% CI, 3%-21%). Only 2 clinics contributed children to Head Start waiting lists. Among children from these clinics, 19 of 87 (22%) in the intervention group got onto a Head Start waiting list, vs 8 of 94 (9%) in the control group (adjusted difference, 13%; 95% CI, 5%-21%). To get 1 child either into Head Start or onto a waiting list, we needed to refer 4 children. CONCLUSION: Facilitating an initial connection to Head Start on families' behalf substantially increased Head Start attendance.
