Clinically significant cardiopulmonary events and the effect of definition standardization on apnea of prematurity management.

OBJECTIVE: To define the impact of care standardization on caffeine and cardiorespiratory monitoring at neonatal intensive care unit (NICU) discharge. STUDY DESIGN: Electronic records were abstracted for infants aged 24-36 weeks gestation with birth weights appropriate for gestational age. Infants who died, transferred prior to discharge, had major pulmonary anomalies, required a home monitor for mechanical ventilation or had a family history of sudden infant death syndrome were excluded. Data and records were used to indicate when the new definition of clinically significant cardiopulmonary events (CSCPEs) and concurrent education was implemented. Preimplementation and postimplementation cohorts were compared. RESULTS: Incidence fell from 74% diagnosed with apnea of prematurity at baseline to 49% diagnosed with CSCPE postimplementation (P<0.001). Infants discharged on caffeine reduced from 17% to 5% (P<0.001), and home monitor use also fell from 54% to 16% (P<0.001). CONCLUSION: Standardizing definitions and treatments reduced the use of caffeine and cardiorespiratory monitors upon NICU dismissal.

The absolute nucleated red blood cell (aNRBC) count at birth is not an indicator for retinopathy of prematurity (ROP).

OBJECTIVE: To establish the reproducibility of a published observation by Lubetzky et al. that infants affected by retinopathy of prematurity (ROP) had higher absolute nucleated red blood cell (aNRBC) counts than those unaffected. The authors suggested that infants exposed to intrauterine hypoxia are at higher risk for ROP. We attempted to verify this reported relationship of ROP with the aNRBCs at birth and hypothesized that infants with ROP ≥ stage 2 have higher aNRBCs at birth. STUDY DESIGN: We report a retrospective 1:1 case matched analysis where cases had a diagnosis of grade II ROP or worse and matching infants had confirmed stage I or no ROP. Eligible infants had birth weights of 501 to 1500 g and were discharged alive from 1st January 2000 to 31st December 2008. Wilcoxon's signed rank test was performed for continuous comparisons. This study was approved by two local Institutional Review Boards. RESULT: In all, 66 matched pairs were analyzed. When comparing aNRBCs there was no statistically significant relationship (w=-0.265, P=0.791) between the ROP affected group (M=4550, s.d.=7342) and the unaffected group (M=5287, s.d.=6524). CONCLUSION: We are unable to support the previously reported relationship of aNRBCs with ROP. Our population was three times larger, had higher aNRBCs and less retinopathy than previously reported. A biological principle of cause and effect or predisposition to ROP as reflected by aNRBCs should have been easier for us to demonstrate, if it existed.

School counselors' knowledge of eating disorders.

BACKGROUND: Twenty years ago, Price published a survey identifying knowledge deficits of school counselors regarding eating disorders. Our study surveys current school counselors to determine whether knowledge has increased and determine the availability of school-based prevention programming. METHODS: School counselors from a single metropolitan area were surveyed prior to a mandatory in-service on eating disorders. RESULTS: Of the 109 respondents, 55% felt eating disorders were a problem in their school. Very few felt "very competent" identifying (6%) or helping (2%) students with eating disorders. Today's school counselors were more likely to know a symptom of anorexia nervosa (AN) is missing at least three consecutive menstrual cycles and malnutrition is not a common cause of death for bulimia nervosa (BN). CONCLUSIONS: While knowledge of AN and BN appear to have increased, school counselors still lack some basic understanding and report very low confidence in identifying and helping students with eating disorders.