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Objective The objective of this study was to implement a strategy for critical congenital heart disease (CCHD) newborn screening in the neonatal intensive care unit (NICU). Design A NICU-specific curriculum, screening algorithm, slide presentations, and templates of orders, policies, and procedures were developed into a toolkit for training NICU personnel. Screening was conducted on first and second screen pre- and postductal oxygen saturations (SpO2) on newborns admitted or transferred to the NICU. Results We trained 347 NICU personnel in 13 Texas hospitals, representing rural, suburban, and metropolitan settings. Key hospital staff submitted deidentified, case-based screening data. Of 4,621 NICU admissions, 80% received a first screen. Second screening rates were substantially lower in all gestational age groups. Screening rates on first and second screens were lowest among infants born Conclusion CCHD screening in the NICU is challenging, given the complexities of the NICU population. A modified screening protocol that recognizes special circumstances of neonatal intensive care could facilitate a more efficient system.

Purpose To compare infant and retinopathy of prematurity (ROP) characteristics from 3 clinical studies conducted over a 27-year period in the United States. Design Secondary analysis of results of 3 clinical studies. Participants Infants with birth weight (BW) Methods Analysis of data from the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) and Early Treatment for Retinopathy of Prematurity (ETROP) trials and the primary data from the Telemedicine Approaches for the Evaluation of Acute-Phase Retinopathy of Prematurity (e-ROP) study. Main Outcome Measures Infant characteristics and onset, severity, and time course of ROP. Results Across the 3 studies, mean (standard deviation) BW and mean gestational age (GA) decreased over time from CRYO-ROP (954 g [185 g], 27.9 weeks [2.2 weeks]) to ETROP (907 g [205 g], 27.4 weeks [2.2 weeks]) to e-ROP (864 g [212 g], 27.0 weeks [2.2 weeks]), with an increase in the percentage of infants enrolled weighing P P = 0.003). Moderately severe ROP (defined as prethreshold or referral warranted) varied (17.8% CRYO, 12.3% ETROP, 19.4% e-ROP; P Conclusions The BW and GA of infants enrolled in ROP studies in the United States have decreased over the past 27 years, whereas ROP prevalence and onset of disease are stable.

The aim of the study was to determine the acute and long-term outcomes of preterm infants treated with an intravenous fish oil-based lipid emulsion (FishLE) for parenteral nutrition-associated liver disease (PNALD).Preterm infants 14 days to 24 months of age with anatomic short gut or severe intestinal dysmotility, serum direct bilirubin ≥4 mg/dL, and requiring60% calories from parenteral nutrition were eligible. Enrolled infants received 1 g · kg · day of FishLE until resolution of direct hyperbilirubinemia or return of enteral nutrition. Acute clinical effects and biochemical markers of liver function were monitored. Growth and developmental scores at 6 and 12 months postmenstrual age (PMA) were assessed and compared with controls matched by gestational age (GA).Thirteen patients with mean GA of 28 ± 4 weeks were treated and compared with 119 GA-matched controls. Their mean direct bilirubin was 9.8 ± 6.4 mg/dL at enrollment. All infants had resolution of cholestasis after study completion. There were no acute adverse events, deaths, or liver/intestinal transplants. Weight and head circumference were similar between FishLE-treated patients and controls at 6- and 12-month PMA. Cognitive and motor scores were decreased at 6 and 12 months PMA in FishLE-treated infants. Logistic regression analysis showed that prolonged hospitalization was detrimental to cognitive and motor development, whereas treatment was not.The use of intravenous FishLEs in premature infants appears to be safe and reverses PNALD despite significant liver disease and intestinal failure. This therapy should be used in preterm infants with PNALD and followed long term to evaluate development.

Objective Critical congenital heart disease (CCHD) is a leading cause of death in infants. Newborn screening (NBS) by pulse oximetry allows early identification of CCHD in asymptomatic newborns. To improve readiness of hospital neonatal birthing facilities for mandatory screening in Texas, an educational and quality improvement (QI) project was piloted to identify an implementation strategy for CCHD NBS in a range of birthing hospitals. Study Design Thirteen Texas hospitals implemented standardized CCHD screening by pulse oximetry. An educational program was devised and a tool kit was created to facilitate education and implementation. Newborn nursery nurses' knowledge was assessed using a pre- and posttest instrument. Results The nurses' knowledge assessment improved from 71 to 92.5% (p Conclusion Our educational program, including a tool kit, QI processes, and standardized pulse oximetry CCHD NBS, is applicable for a range of hospital birthing facilities and may facilitate wide-scale implementation, thereby improving newborn health.

Importance Most premature infants will not develop retinopathy of prematurity (ROP) of clinical relevance, yet screening evaluations often continue beyond hospital discharge, even for those infants without ROP. Objectives To identify the characteristics of infants at low risk for ROP, for whom further postdischarge screening may be of limited value. Design, setting, and participants This study took place in North American neonatal intensive care units where clinicians had expertise in ROP. Infants with birth weight less than 1251 g who were born at or transferred into an Telemedicine Approaches to Evaluating Acute-Phase ROP (e-ROP) study center were enrolled. The study included post hoc analysis of prospectively collected in-hospital ROP examination results among infants enrolled in the e-ROP study. We characterized infants without ROP and performed logistic regression on the subset of infants who were 27 to 33 weeks' gestational age to determine characteristics associated with the absence of ROP during all in-hospital examinations. Main outcomes and measures The main measure was the absence of ROP prior to hospital discharge; the main outcome was treatment for ROP. Results A total of 1257 infants born at 22 to 35 weeks' gestation (median [interquartile range (IQR)], 26 [25-28] weeks) with birth weights less than 1251 g (median [IQR], 860 [690-1040] g) underwent 4113 ROP examinations between 31 and 47 weeks' postmenstrual age. Overall, 1153 examinations (38%) showed no ROP, and 456 infants (36%) did not have ROP prior to study center discharge or study end point. Among infants without ROP during examinations at 32 and 33 weeks' postmenstrual age, 16 (9.4%) and 14 (5.3%) subsequently underwent ROP treatment, respectively. At hospital discharge, there was no ROP in 59% of infants of 27 to 33 weeks' gestational age, compared with 15% of those who were less than 27 weeks' gestational age (difference, 44% [95% CI, 38.5%-48.1%]; P ≤ .001). With more than 85% follow-up among infants without ROP by 37 weeks' postmenstrual age, none (95% CI, 0%-0.98%) were treated for ROP. In multivariate analysis of infants born at 27 to 33 weeks' gestation, larger birth weight (OR, 4.1 [95% CI, 1.6-10.3]) and higher gestational age (OR, 4.0 [95% CI, 1.5-10.8]) were significantly associated with absence of ROP. Conclusions and relevance These findings suggest that, for infants of 27 weeks' gestational age or greater and birth weights larger than 750 g, if no ROP has been detected by discharge at near-term postmenstrual age, then further ROP surveillance has limited value. Studies of all infants at risk are needed to develop more specific, objective criteria for termination of ROP surveillance and focus resources on infants at higher risk of ROP. Trial registration ClinicalTrials.gov Identifier: NCT01264276.

Importance Measurable competence derived from comprehensive and advanced training in grading digital images is critical in studies using a reading center to evaluate retinal fundus images from infants at risk for retinopathy of prematurity (ROP). Details of certification for nonphysician trained readers (TRs) have not yet been described. Objective To describe a centralized system for grading ROP digital images by TRs in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study. Design, Setting, and Participants Multicenter observational cohort study conducted from July 1, 2010, to June 30, 2014. The TRs were trained by experienced ROP specialists and certified to detect ROP morphology in digital retinal images under supervision of an ophthalmologist reading center director. An ROP reading center was developed with standard hardware, secure Internet access, and customized image viewing software with an electronic grading form. A detailed protocol for grading was developed. Based on results of TR gradings, a computerized algorithm determined whether referral-warranted ROP (RW-ROP; defined as presence of plus disease, zone I ROP, and stage 3 or worse ROP) was present in digital images from infants with birth weight less than 1251 g enrolled from May 25, 2011, through October 31, 2013. Independent double grading was done by the TRs with adjudication of discrepant fields performed by the reading center director. Exposure Digital retinal images. Main Outcomes and Measures Intragrader and intergrader variability and monitoring for temporal drift. Results Four TRs underwent rigorous training and certification. A total of 5520 image sets were double graded, with 24.5% requiring adjudication for at least 1 component of RW-ROP. For individual RW-ROP components, the adjudication rate was 3.9% for plus disease, 12.4% for zone I ROP, and 16.9% for stage 3 or worse ROP. The weighted κ for intergrader agreement (n = 80 image sets) was 0.72 (95% CI, 0.52-0.93) for RW-ROP, 0.57 (95% CI, 0.37-0.77) for plus disease, 0.43 (95% CI, 0.24-0.63) for zone I ROP, and 0.67 (95% CI, 0.47-0.88) for stage 3 or worse ROP. The weighted κ for grade-regrade agreement was 0.77 (95% CI, 0.57-0.97) for RW-ROP, 0.87 (95% CI, 0.67-1.00) for plus disease, 0.70 (95% CI, 0.51-0.90) for zone I ROP, and 0.77 (95% CI, 0.57-0.97) for stage 3 or worse ROP. Conclusions and Relevance These data suggest that the e-ROP system for training and certifying nonphysicians to grade ROP images under the supervision of a reading center director reliably detects potentially serious ROP with good intragrader and intergrader consistency and minimal temporal drift.

This study describes the incidence, correlates and subsequent morbidities of hyperglycemia, a highly prevalent condition in extremely low birth weight (ELBW) infants. A retrospective chart review of 169 infants with birth weight (BW)

BACKGROUND: Conventional methods for measuring the total bilirubin concentration in blood require the use of serum or plasma, but physically separating red blood cells from plasma by centrifugation is a time-consuming and potentially dangerous process that does not lend itself to rapid, near-patient testing. Therefore, we have sought to determine whether spectrophotometric measurements of total bilirubin concentration are feasible in unaltered whole blood. METHODS: We modified an Hb-Quick hemoglobinometer (Avox Systems, Inc., San Antonio, TX), a relatively new, portable, battery-powered instrument that uses disposable cuvettes and a reagentless system to measure total hemoglobin in nonhemolyzed, whole blood. The prototype consisted of an Hb-Quick equipped with light-emitting diodes with emissions at five different wavelengths to measure total bilirubin and total hemoglobin. Using blood samples from neonates with suspected hyperbilirubinemia, we made measurements on plasma from centrifuged samples and on hemolyzed and nonhemolyzed aliquots of the same blood samples. RESULTS: In the first series of experiments, we compared the Unistat bilirubinometer's readings with the prototype's measurements of bilirubin in plasma. There was a close linear correlation between the prototype's measurements and those of the reference instrument (slope=1.01, r2=0.991). Subsequently, we used the prototype's measurements on plasma as the reference method and compared them with readings on hemolyzed and nonhemolyzed aliquots of each sample. Readings on hemolyzed and nonhemolyzed aliquots were significantly correlated with the measurements in plasma, but the regression lines did not have a slope of 1. However, when the measurements on hemolyzed and nonhemolyzed blood were scaled appropriately to compensate for the fact that red cells “dilute” the bilirubin in plasma, the correlation coefficients improved, and there was then a 1:1 relationship between the measurements in whole blood and plasma. CONCLUSIONS: These preliminary findings demonstrate the feasibility of developing a portable instrument to measure total bilirubin in unaltered whole blood. The advantages of this method are speed, elimination of centrifugation or other sample preparation, and instrument portability. The disadvantage is that the concentration units are unconventional, i.e., milligrams of bilirubin per volume of whole blood. However, the instrument can be programmed to display the total bilirubin concentration in traditional units, e.g., milligrams of bilirubin per volume of plasma.

During a recent comparison of two portable hemoglobinometers designed for near-patient testing, we noted disparate readings on a quality-control material derived from human hemoglobin (Level 1, Multi-4® CO-Oximeter Controls; Instrumentation Laboratory). The insert sheet listed an acceptable range of total hemoglobin readings of 159–185 g/L (15.9–18.5 g/dL) for the OSM3 co-oximeter (Radiometer A/S). Our results on the OSM3 were at the midpoint of this range, as were results with one of the hemoglobinometers, the Hb-Quick® hemoglobinometer from Avox Systems [mean (SD), 175 (0.5) g/L; n = 5]. By contrast, readings on a HemoCue hemoglobinometer (HemoCue AB) were 16 g/L higher than the mid-range value and averaged 188 ± 1.5 g/L. Both hemoglobinometers had recently been calibrated by factory-trained employees of the respective companies. Because Level 1 controls contained ∼60% carboxyhemoglobin, we made additional measurements on fresh whole blood from a nonsmoking donor and on …

Objective. The Hb-Quick® is a new portable hemoglobinometer that uses disposable cuvettes to measure the total hemoglobin concentration of capillary, venous, or arterial blood. Therefore, the objectives of this study were 1) to evaluate the performance of this compact, battery-powered hemoglobinometer by assessing its precision, accuracy, and linearity, 2) to determine whether its measurements suffer from interference by hemolysis, bilirubin, fetal hemoglobin, or hemodilution, and 3) to establish whether it can easily be used by clinical personnel with little or no laboratory training. Methods. The precision of the test instrument was assessed by making repeated measurements on blood samples. Its accuracy and linearity were evaluated by comparing its measurements with the internationally accepted cyanmethemoglobin method. Samples of whole blood with and without bilirubin, fetal hemoglobin, hemolysis, and hemodilution were also analyzed to determine if any interference occurred when these disturbances were present, and it was placed in physicians’ offices to evaluate its use by non-laboratory personnel. Results. Repeated measurements on blood samples with a wide range of hemoglobin concentrations were consistent with the precision specification (0.25 g/dl). The bias of the new hemoglobinometer was calculated as the mean difference between its readings and measurements with the cyanmethemoglobin method, and its accuracy as the standard deviation of the differences between the two methods. As assessed in this manner, the new hemoglobinometer had a bias of −0.04 g/dl and an accuracy of 0.40 g/dl. The linearity was checked over a hemoglobin concentration range from 0 to nearly 30 g/dl. There was a highly significant linear relationship between its readings and measurements with the cyanmethemoglobin method (slope = 0.997, y-intercept = 0.005, r = 0.999). Complete hemolysis of the sample increased the readings on average by only 0.22 g/dl. Bilirubin (17.5 mg/dl) increased the reading by an average of 0.29 g/dl, and fetal hemoglobin (76.5% HbF) reduced the readings by an average of only 0.035 g/dl. Diluting blood samples with saline also did not appreciably affect its accuracy. Conclusions. The new hemoglobinometer is fast and easy to operate. No sample preparation or pipetting is required. To operate the instrument, the user simply allows a drop of blood to fill the disposable cuvette by capillary action and inserts the cuvette into the instrument. The instrument analyzes the 10 µl sample and displays the results in less than 10 seconds. The interference caused by hemolysis, hemodilution with saline, fetal hemoglobin, and bilirubin were too small to be of any clinical importance. Tests in physician’s offices indicated that clinical personnel with little or no formal laboratory training could successfully use this device. The observed precision, accuracy, linearity, and freedom from interference indicate that this hemoglobinometer is suitable for near-patient testing in a wide range of clinical settings including physicians’ offices.

A multicenter, randomized, double-blind, placebo-controlled trial of synthetic surfactant therapy for premature infants with respiratory distress syndrome (RDS) and birth weights of 700 to 1350 gm demonstrated a reduction in severity of RDS, morbidity, and neonatal and 1-year mortality. Of the 419 infants who were entered in the study, 80% of the surviving infants in both the air placebo group (122) and the synthetic surfactant group (138) returned for the follow-up evaluation at 1-year adjusted age. The only significant difference observed at follow-up was a reduction in the incidence of mild cerebral palsy in the synthetic surfactant group (air placebo group, 8 of 122 (7%); synthetic surfactant group, 3 of 138 (2%); relative risk 0.306; 95% confidence interval 0.094, 0.999). No differences were observed between the air placebo and synthetic surfactant treatment groups with respect to health status of the infants, including the incidence of retinopathy of prematurity and neurodevelopmental delays. The difference in the overall incidence of impairment among the 1-year survivors in the air placebo group (43 of 122 (35%)) and in the synthetic surfactant group (40 of 138 (29%)) was not statistically significant. The results of this 1-year follow-up study show that rescue treatment with synthetic surfactant in infants weighing 700 to 1300 gm is not associated with adverse developmental consequences despite the improvement in survival.

OBJECTIVES a) To evaluate the performance of a compact, new instrument that uses disposable cuvettes to measure total hemoglobin concentration, oxygen content, and the relative concentrations of oxy- and methemoglobin in 50-microL blood samples; b) to determine whether the instrument can be used for near-patient assessment of methemoglobinemia; and c) to ascertain whether problems commonly encountered in neonatal blood samples affect the instrument's performance. DESIGN Prospective study, in which the test instrument was compared with a standard method. Samples of whole blood with and without bilirubin, fetal hemoglobin, and hemolysis were analyzed on the new (test) instrument and on a widely used cooximeter (OSM3 hemoximeter, Radiometer; reference instrument). SETTING In vitro analyses of blood samples in clinical and university laboratories. MEASUREMENTS AND MAIN RESULTS There was a close linear correlation between the methomoglobin measurements of the test instrument and those measurements of the reference instrument (slope = 0.989; r2 = .989). The average difference in mean assay values between the reference instrument and the test instrument was -0.59%, i.e., < 1% methemoglobin. Repeated measurements indicated the precision was 0.5% methemoglobin. Complete hemolysis of the sample reduced the methemoglobin reading by only 0.40%. Adding bilirubin (10 to 11 mg/dL [171 to 188.1 mumol/L]), increased the methemoglobin reading by 0.23%, increased the oxyhemoglobin reading by 0.45%, and increased total hemoglobin by 0.21 g/dL. Fetal hemoglobin also had minimal effects on the readings. CONCLUSIONS The test instrument is fast and easy to operate. No sample preparation or pipetting is required. To operate the instrument, the user simply connects a syringe containing the blood sample to one of the disposable cuvettes, injects 50 microL of blood into the cuvette, and inserts the cuvette into the instrument. The test instrument automatically detects the presence of the cuvette, analyzes the sample, and displays the results in < 10 secs. The findings in this study indicate that the test instrument has sufficient accuracy for near-patient testing in intensive care units. The errors introduced by hemolysis, fetal hemoglobin, and bilirubin were too small to be of clinical importance. Thus, the test instrument is essentially unaffected by complications commonly encountered in neonatal blood. The capacity of the test instrument to measure methemoglobin makes it particularly useful if inhaled nitric oxide therapy becomes a standard clinical practice.

The objectives of this study were to provide an economic assessment as well as a calculated projection of the costs that typical U.S. tertiary-care hospitals would incur through policy reconfiguration and implementation to achieve the UNICEF/World Health Organization Baby-Friendly® Hospital designation and to examine the associated challenges and benefits of becoming a Baby-Friendly Hospital. We analyzed hospital resource utilization, focusing on formula use and staffing profiles at one U.S. urban tertiary-care teaching hospital, as well as conducted an online survey and telephone interviews with a selection of Baby-Friendly Hospitals to obtain their perspective on costs, challenges, and benefits. Findings indicate that added costs for a new Baby-Friendly Hospital will approximate $148 per birth, but these costs sharply decrease over time as breastfeeding rates increase in a Baby-Friendly environment.

OBJECTIVE The aim of the present study was to examine the effects of early and high intravenous (IV) amino acid (AA) supplementation on growth, health, and neurodevelopment of extremely-low-birth-weight (ELBW) infants throughout their first 2 years of life. METHODS Infants were prospectively randomized in a double-masked fashion and treated for 7 days with either IV AA starting at 0.5 g · kg (-1) · day(-1) and increased by 0.5 g · kg(-1) every day to 3 g · kg(-1)· day(-) or starting at 2 g · kg (-1) · day(-1) of IV AA and advanced by 1 g · kg(-1) every day to 4 g · kg (-1) · day(-1). Plasma AA concentrations were determined by reverse-phase high-performance liquid chromatography. Survivors were longitudinally assessed with Bayley II Scales of Infant Development and physical, social, and global health. RESULTS Forty-three of 51 survivors were studied. Mental Developmental Index (MDI) and Psychomotor Developmental Index were similar between groups; however, the early and high AA group had a lower MDI at 18 months. This difference disappeared at 2 years of age. The early and high AA group z score means for weight, length, and head circumferences were significantly lower than the standard AA group at most visits. Cumulative and single plasma AA concentrations correlated negatively with MDI and postnatal growth. CONCLUSIONS ELBW infants who received early and high IV AA during the first week of life were associated with poor overall growth at 2 years.

In a multicenter, double-blind, placebo-controlled trial conducted at 23 hospitals in the United States, a single prophylactic 5 ml/kg dose of a synthetic surfactant (Exosurf Neonatal) or air placebo was administered shortly after birth to 215 infants with birth weights of 500 to 699 gm. Despite stratification at entry by birth weight and gender, by chance female infants predominated in the air placebo group and male infants predominated in the surfactant group. Among infants receiving synthetic surfactant, improvements in oxygen requirements were significant at 2 hours after birth ( p =0.014) and persisted for 3 days ( p =0.001); improvements in the alveolar-arterial partial pressure of oxygen gradient were significant at 6 hours after birth ( p =0.01) and persisted for 3 days ( p =0.008). Improvements in mean airway pressure were not significant at 2 or at 6 hours after birth ( p =0.622 and 0.083, respectively), but became significant thereafter and persisted for 3 days ( p =0.002). Pneumothorax was reduced by slightly more than half (25 vs 11; p =0.014); death from respiratory distress syndrome (RDS) was also reduced (26 vs 15; p =0.046). Overall neonatal mortality, however, was not significantly reduced (58 vs 46; p =0.102). Other complications of RDS and prematurity were not altered, except that pulmonary hemorrhage occurred significantly more frequently in infants receiving synthetic surfactant (2 vs 12; p =0.006). These findings indicate that a single prophylactic dose of synthetic surfactant in infants weighing 500 to 699 gm at birth improves lung function, incidence of air leak, and death from RDS but not overall mortality. The only safety problem identified was an increase in pulmonary hemorrhage.

We studied the hemodynamic effects of using natural surfactant in premature baboons with hyaline membrane disease (HMD). Study animals (n = 5) received a single dose of surfactant immediately after delivery and control animals (n = 8) did not. Using microspheres at 3, 8, and 23 h we found no significant differences in left ventricular output, effective systemic flow, systemic-to-pulmonary patent ductus arteriosus (PDA) shunting, or in cerebral or renal organ blood flow. However, both groups had large PDA shunts (fraction of LVO to lungs > 0.40–0.55 at 3 and 8 h) resulting in low systemic perfusion (< 80 ml/min/kg). Single dose surfactant did not improve the myocardial dysfunction and low cerebral and renal blood flow which occur during treatment for HMD.

Background Hyperglycemia (HG) has been reported in up to 70% of extremely low birth weight (ELBW) infants (birth weight Objective To describe the incidence of HG in ELBW infants, risk factors, and related morbidities. Design/Methods: Retrospective chart review of live-born ELBW infants admitted to University Hospital, San Antonio, Texas, from 1998-2001. 230 charts were reviewed; 45 were excluded due to previable status. HG was defined as serum glucose level $ 150 mg/dL during the first 2 weeks of life. Logistic regression, multivariate analysis, and Fisher exact test were performed using SPSS and SAS. Results 185 patients were eligible for the analysis. The mean gestational age (GA) and mean birth weight (BW) were 25.9 6 2.1 weeks and 760 6 138 g, respectively. Seventy-two percent of the infants were Hispanic and 55% were male. The incidence of HG was 88%. The mean serum glucose level for the HG group was 249 mg/dL 6 83 compared to 128 mg/dL 6 16 for the normoglycemic group; both groups peaked on day of life 6 (1-15 d). On average, the number of days with hyperglycemia was 3.7 days. There were no differences in race, gender, prenatal steroid use, sepsis, and chorioamnionitis between the groups. Using a multivariate analysis, higher GA had a protective effect for HG (OR 0.16, CI 0.04-0.53), whereas BW, small for gestational age (SGA), sepsis, and postnatal steroids had no effect. ROP was significantly associated with HG after adjusting for GA, BW, and postnatal steroid use (OR 4.6, CI 1.12-18.9). Laser treatment was required in 15/66 patients with ROP in the HG group, and 0/3 with ROP in the normoglycemic group (p .37). Bronchopulmonary dysplasia (BPD), IVH, length of stay, and death were not associated with HG. Conclusions In our predominantly Hispanic population, the incidence of HG is higher than previously reported. However, race was not identified as a risk factor. HG infants tend to be more immature by GA at birth, independent of BW and SGA status. HG was associated with the development of ROP even after correction for GA, BW, and postnatal steroid use. This association may be due to an expression of severity of illness, although no differences in death, length of stay, IVH, or BPD were demonstrated. Further studies need to be done to determine if this association is causal.

Clinical trials are underway that use pulmonary surfactant replacement therapy in an attempt to prevent respiratory distress syndrome (RDS) in premature infants. This study was undertaken to determine the relationship between the clinical course of infants receiving prophylactic "first-breath" endotracheal surfactant and their initial posttreatment radiographs. The study population consisted of 80 premature infants of 24-32 weeks gestational age. All received 3 ml of calf-lung surfactant extract via endotracheal tube at birth. Anteroposterior chest radiographs taken within 1 hr of treatment were reviewed and correlated with gestational age, birth weight, days of endotracheal intubation, mean airway pressure, and days of oxygen requirement greater than 30%. Three distinct patterns of radiographic abnormality were encountered: typical RDS with hypoinflation, diffuse granularity, and air bronchograms (30%); central clearing of RDS (14%); and disproportionate clearing of RDS in the right lung (8%). No significant differences in ventilator requirements or clinical course were seen among these three groups. A fourth group (49%), whose posttreatment radiographs showed no evidence of RDS, required significantly less ventilatory support. Prophylactic first-breath surfactant treatment of premature infants occasionally results in radiographic patterns that are atypical for RDS. Familiarity with these patterns and their clinical significance will be important if surfactant augmentation becomes prevalent.

Cord serum samples treated with staphylococcus protein A and an immune affinity column to remove immunoglobulin G were used to establish a seronegative range for herpes simplex virus and cytomegalovirus. No seroconversions or increased heterologous antibody levels to herpes simplex virus or cytomegalovirus were found in live varicella vaccine recipients.

Background Neonatal intensive care is a remarkable success story with dramatic improvements in survival rates for preterm newborns. Significant efforts and resources are invested to improve mortality and morbidity but much remains to be learned about the short and long-term effects of neonatal intensive care unit (NICU) interventions. Published guidelines recommend that infants discharged from the NICU be in an organized follow-up program that tracks medical and neurodevelopmental outcomes. Yet, there are no standardized guidelines for provision of follow-up services for high-risk infants. The National Institute of Child Health and Human Development Neonatal Research Network and the Vermont Oxford Network have made strides toward standardizing practices and conducting outcomes research, but only include a subset of developmental follow-up programs with a focus on extremely preterm infants. Several studies have been conducted to gain a better understanding of current practices in developmental follow-up. Some of the major themes in these studies are the lack of personnel and funding to provide comprehensive follow-up care; feeding difficulties as a primary issue for NICU survivors, families, and programs; wide variability in referral and follow-up care practices; and calls for standardized, systematic developmental surveillance to improve outcomes. Findings We convened a one-day summit to discuss developmental follow-up practices in Texas involving four academic and three nonacademic centers. All seven centers described variable age and weight criteria for follow-up of NICU patients and a unique set of developmental practices, including duration of follow-up, types and timing of developmental assessments administered, education and communication with families and other health care providers, and referrals for services. Needs identified by the centers focused on two main themes: resources and comprehensive care. Participants identified key challenges for developmental follow-up, generated recommendations to address these challenges, and outlined components of a quality program. Conclusions The long-term goal is to ensure that all children maximize their potential; a goal supported through quality, comprehensive developmental follow-up care and outcomes research to continuously improve evidence-based practices. We aim to contribute to this goal through a statewide working group collaborating on research to standardize practices and inform policies that truly benefit children and their families.

It has been shown that Herpes Simplex Virus (HSV) and Varicella-zoster Virus (VZV) share antigenic determinants and that the VZV genome contains homologous regions to HSV-1 and HSV-2 genomes. More recently Edson, et al, found that the envelope glycoproteins HSV gB and VZV gp63 share common antigens and that cross reactive anti-HSV polyclonal and monoclonal antibody can neutralize VZV infection. Because of these common antigens, we sought to determine if administration of LVV in children can cause cross-reactive immune responses which could confer partial immunity to the heterologous viruses. Blood was obtained from 43 children at the time of LVV vaccine and three months later. A control group of 36 age matched children were tested to determine seroconversion rates in the absence of vaccine. Antibody response was determined by enzyme-linked immunosorbent assay. A sero-negative range for HSV and for CMV was established by studying sera obtained from 200 individuals of varying ages including newborns, infants, and adults. Seroconversion rate for the immunized population was 0 of 43 infants for HSV and 1 of 40 for CMV; respective rates for the control population were 2 of 35 and 1 of 36. (NS) We conclude that immunization with LVV vaccine offers no heterologous antibody protection to HSV and CMV in children.

1393 COMPARISON OF POSTNATAL HORMONAL CONTROL OF GLUCOSE IN OFFSPRMGS OF DIABETIC MOTHERS (IDM) AND IN HEALTHY INFANTS