Teaching pediatric residents about early intervention and special education.

We compared two educational interventions (didactic lecture with handouts vs guidelines placed in patient charts) and assessed their impact on knowledge of early developmental services and identification of children eligible for these services. Forty-nine pediatric residents participated in preintervention and postintervention tests of knowledge of such services. Mean scores for all residents were 54% (pre-test) and 60% (post-test). First-year residents scored significantly lower than 2nd- and 3rd-year residents on pre- (p = .0001) and post-tests (p < .02). From our convenience sample of 1204 patients, ages newborn to 6 years, seen in the resident continuity clinic during the study period, residents identified children eligible for early developmental services. The mean percentage of identifying eligible children was 13% (range, 0-40%). We did not detect a statistically significant impact of either educational strategy. We conclude, therefore, that more comprehensive strategies are needed to change physician knowledge of and behavior toward early developmental services.

Early interactions between drug-involved mothers and infants. Within-group differences.

OBJECTIVE: To explore differences in maternal characteristics, mother-infant interaction, and infant development within a group of women who used cocaine, alcohol, and tobacco during pregnancy and their infants. DESIGN: Prospective survey. SETTING: Countywide, voluntary, home-based clinical intervention program. PARTICIPANTS: Thirty-two mother-infant pairs identified through a risk-assessment screen who participated in the program for 1 year. VARIABLES: Maternal characteristics, neonatal characteristics, interactional measures (Nursing Child Assessment Feeding Scale and Home Observation for Measurement of the Environment scale), and developmental assessment (Bayley Scales of Infant Development at 1 year). RESULTS: The majority of women were black, single, and unemployed. Fifteen (47%) of the infants were born prematurely; four (13%) were small for gestational age. Mean Bayley Scales of Infant Development scores were as follows: the mental development index was 99.8, and the psychomotor development index was 102.4. Older mothers (r = .41, P = .04), mothers of higher parity (r = .42, P = .02), and mothers who were more actively involved in the program (r = .41, P = .04) had higher scores on the Nursing Child Assessment Satellite Training Feeding Scale. Mothers who were better educated (r = .49, P = .009) and mothers who were more active in the program (r = .44, P = .02) had higher scores on the Home Observation for Measurement of the Environment scale. Several of the subscales of the Home Observation for Measurement of the Environment scale were significantly associated with scores on the Bayley Scales of Infant Development. CONCLUSIONS: For this group of substance-exposed infants whose mothers were receiving support services, developmental skills at 1 year were age appropriate. Despite drug abuse and poverty, there was some variability in the ability of mothers to provide a developmentally supportive environment for their infants. Those who were better organized to support infant development had infants who performed better on global developmental assessments.

Developmental needs of infants and toddlers who require lengthy hospitalization.

OBJECTIVES: To describe demographic and medical characteristics of a sample of children younger than age 3 years who required lengthy hospitalization in a tertiary care hospital. To determine the proportion of children in the sample with biologic handicaps, developmental delays, or risk factors for developmental disorders who met eligibility criteria for early intervention services based on federal law PL 99-457 and state regulations. DESIGN: Survey of medical records. SETTING: Large, urban, tertiary care children's hospital. PATIENTS: All 135 children younger than age 3 years hospitalized for more than 30 days during 1990 and 1991. INTERVENTIONS: None. MAIN RESULTS: The most prevalent cause of lengthy hospitalization was congenital anomaly followed by chronic and perinatal conditions; 38 patients (28%) required technology assistance at the time of discharge. Seventy-three children (54%) were eligible for early intervention services based on the presence of a biologic handicap or developmental delay. An additional 48 patients (36%) were eligible for developmental screening and periodic developmental monitoring on the basis of medical and social risk factors. CONCLUSIONS: Because of the high prevalence of developmental disorders and risk factors in infants and toddlers requiring lengthy hospitalizations, hospital-wide systems for identification, developmental assessment, and early intervention services should be designed and implemented.

Ten years of extracorporeal membrane oxygenation: neurodevelopmental outcome.

Cf the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores greater than or equal to 85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores less than 70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 +/- 12 [SD], IQ controls = 107 +/- 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 +/- 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 +/- 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.

Prevalence of non-group-A beta-hemolytic streptococci in childhood pharyngitis.

We studied the prevalence of non-group-A beta-hemolytic streptococci (NGAS) in the pharyngeal cultures of symptomatic and asymptomatic children. Throat cultures were obtained by house officers in the Emergency Department at Children's Hospital of Pittsburgh to aid in the evaluation of children with symptoms or signs of pharyngitis, or both. A total of 929 throat cultures were read in four discrete periods between July 1982 and February 1984. A control group was composed of 414 asymptomatic children, recruited contemporaneously with study subjects. beta-Hemolytic colonies were evaluated for bacitracin susceptibility and grouped by the Streptex method. The prevalences of NGAS in symptomatic and control children were 6.5% (60/929) and 1.0% (4/414), respectively (P less than .01). Seasonal variation in the recovery of NGAS from symptomatic children was suggested by higher relative and absolute recovery rates of NGAS during warm weather. This study demonstrates an association between NGAS and sporadic pharyngitis in school children but does not establish causality.