Common orthopedic problems of the newborn.

Newborn orthopedic problems are cause for major concern, both economically and emotionally, for the family. Dysplasia of the hip and abnormal feet can be successfully diagnosed and treated with proper assessment and early recognition. This article reviews the orthopedic examination for the newborn infant, discusses the major orthopedic problems encountered in the neonate, and provides guidelines that will impact the course of the condition for both the patient and family for those professionals working in orthopedics.

Postdischarge utilization of medical services by high-risk infants: experience in a large managed care organization.

BACKGROUND: Infants discharged from intensive care nurseries are a high-risk infant (HRI) population known to have increased utilization of medical services. Most studies tracking HRIs have been based on data obtained from individual chart review or direct patient contact. Given the high cost of such studies, it is desirable to develop less costly methods to track such infants. OBJECTIVES: Our goals were: (1) to identify an HRI cohort at two neonatal intensive care units; (2) to identify a control group of infants not meeting HRI criteria; and (3) to measure outpatient and inpatient utilization in both controls using computerized files in a managed care organization. METHODS: Using California Children's Services criteria as our starting point, we established an HRI definition. From a 1-year birth cohort of 7579 infants at two facilities, we identified 250 infants meeting the HRI definition at two neonatal intensive care units during 1990. We then matched the HRIs with a cohort of 896 randomly selected control newborns (those not meeting the HRI definition). Using organizational computer files and state of California death certificate tapes, we followed these infants until February 28, 1992. We measured the number of hospitalizations, total number of hospital days, and total number of outpatient visits and expressed these outcomes as rates per person-year. We also measured postdischarge mortality. RESULTS: The rate of hospitalization in the HRI group was 6.07 times (95% confidence interval [CI], 4.74-7.77) that in the control group. The utilization of hospital days by the HRI population (hospital days per 1000 person-months) was 13.24 times higher (95% CI, 11.00-16.04). The outpatient visit rate was 1.40 times higher (95% CI, 1.36-1.45) in the HRI population. CONCLUSION: Our findings in a large managed care organization corroborate previous studies showing that hospitalization rates are significantly higher among HRIs. In our study population, outpatient utilization was significantly higher as well. Our study also demonstrates the feasibility of using computerized files to study outcomes in selected pediatric populations. These methods can be used for epidemiologic studies, interventional trials, and planning for resource allocation.

Reducing crying and irritability in neonates using a continuously controlled early environment.

A mother's "holding" environment has been shown to be effective in reducing infant crying and irritability. When mothers hold or cuddle their infants they create a microenvironment with stimuli similar to those of the intrauterine environment. Several of these same stimuli were incorporated into a cradle designed to provide a similar "holding" environment for the infant when the mother was not there. Ninety healthy term newborn infants were randomized to an experimental (n = 45) or control group (n = 45). The experimental group used a cradle that produced motion, sound, tactile (containment), and reduced-light stimuli at stimulus levels that initially approximated intrauterine sensory stimulation levels and gradually decreased to the levels of the home environment over 16 weeks. The control group used an identical cradle with no stimulus modulation features. Infants were placed in their respective cradles from 2 hours after birth during the times they would normally be placed in an infant bed. The mother-infant interaction or parenting style was not changed or manipulated. Mothers' use of the cradles did not differ significantly. An electronic status monitor measured and recorded infant presence and crying in the cradles. The Brazelton Neonatal Behavioral Assessment Scale test was done at 1 to 2, 14, and 24 days of age by "blinded" examiners. Additionally, phone calls and home visits were conducted by a registered nurse.(ABSTRACT TRUNCATED AT 250 WORDS)

Metabolic studies of transient tyrosinemia in premature infants.

The recently developed technique of gas chromatography-mass spectrometry supported by computer has considerably improved the analysis of physiologic fluids. This study attempted to demonstrate the value of this system in the investigation of metabolite patterns in urine in two metabolic problems of prematurity, transient tyrosinemia and late metabolic acidosis. Serial 24-hr urine specimens were analyzed in 9 infants. Transient tyrosinemia, characterized by 5-10-fold increases over basal excretion of tyrosine, p-hydroxyphenyllactate, and p-hydroxyphenylpyruvate in urine, was noted in five of the infants. Several infants had fluctuating levels of tyrosine metabolites in urine although dietary protein intake remained constant at 3-4 g/kg/24 hr and ascorbic acid at 50 mg/24 hr. Late metabolic acidosis was seen in four infants, but bore no relation to transient tyrosinemia. The ratio of net acid to urea excretion in urine increased with increasing base deficit, implying a nonprotein origin of the metabolic acid. No unique metabolic patterns were characteristic of late metabolic acidosis.