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Objective To evaluate bronchopulmonary dysplasia (BPD), serious brain injury, and severe retinopathy of prematurity (ROP) as predictors of poor long-term outcome in very low birth weight infants. Study design We examined the associations between counts of the 3 morbidities and long-term outcomes in 1514 of 1791 (85%) infants with birth weights of 500-1250 g who were enrolled in the Caffeine for Apnea of Prematurity trial from October 1999, to October 2004, had complete morbidity data, and were alive at 36 weeks postmenstrual age (PMA). BPD was defined as use of supplemental oxygen at 36 weeks PMA. Serious brain injury on cranial ultrasound included grade 3 and 4 hemorrhage, cystic periventricular leucomalacia, porencephalic cysts, or ventriculomegaly of any cause. Poor long-term outcome was death after 36 weeks PMA or survival to 5 years with 1 or more of the following disabilities: motor impairment, cognitive impairment, behavior problems, poor general health, deafness, and blindness. Results BPD, serious brain injury, and severe ROP occurred in 43%, 13%, and 6% of the infants, respectively. Each of the 3 morbidities was similarly and independently correlated with poor 5-year outcome. Rates of death or disability (95% CI) in children with none, any 1, any 2, and all 3 morbidities were 11.2% (9.0%-13.7%), 22.9% (19.6%-26.5%), 43.9% (35.5%-52.6%), and 61.5% (40.6%-79.8%), respectively. Conclusions In very low birth weight infants who survive to 36 weeks PMA, a count of BPD, serious brain injury, and severe ROP predicts the risk of a late death or survival with disability at 5 years.

OBJECTIVE: To determine the extent that social variables influence cognitive development of very low birth weight (VLBW) infants across the preschool years. STUDY DESIGN: Participants were VLBW (500-1250 g) children enrolled in the Caffeine for Apnea of Prematurity randomized trial between 1999 and 2004. We investigated the relationships between 4 potential social advantages: higher maternal education, higher paternal education, caregiver employment, and 2 biologic parents in the same home--and gain in cognitive scores. Cognitive assessments were performed at the corrected ages of 18 months (Mental Development Index score on the Bayley Scales of Infant Development II) and 5 years (Full Scale IQ on the Wechsler Preschool and Primary Scale of Intelligence III). Cognitive gain was computed by subtracting each individual 18-month Mental Development Index score from the corresponding Full Scale IQ at 5 years. RESULTS: Data were available for 1347 children. Mean (SD) cognitive scores were 90.8 (15.7) at 18 months and 98.9 (14.5) at 5 years. Multivariable regression showed that higher maternal education, higher paternal education, and caregiver employment had independent and additive effects of similar size on cognitive gain (P < .001); the mean cognitive gain between 18 months and 5 years increased by 3.6 points in the presence of each of these advantages. When all 3 were present, cognitive scores improved on average by 10.9 points compared with children without any of these advantages. CONCLUSION: In VLBW children, a count of 3 social advantages strongly predicts gains in cognitive scores across the preschool years.

This study examined the influences of birth order on behavior occurring in the initial, unstructured interactions of 40 mixed-sex dyads composed of a man and a woman who each had a sibling of the opposite sex. The design contrasted four different dyad types: (a) a firstborn man paired with a firstborn woman, (b) a firstborn man paired with a last born woman, (c) a last born man paired with a firstborn woman and (d) a last born man paired with a last born woman. Results indicated that individuals with an older, opposite-sex sibling were particularly likely to have rewarding interactions with strangers of the opposite sex. Relative to firstborn men, last born men talked nearly twice as long, asked more questions, and evoked more gazes, verbal reinforcers, and self-reported liking from their female partners. Relative to firstborn women, last bora women were more likely to initiate the interaction and to exceed the rate at which their male partners smiled. These findings are inconsistent with Toman's (1961, 1976) "family constellation" theory but are consistent with the results of various empirical studies that have also documented the greater social skills of later borns.

Subjects seem to react to a word faster than they react to a letter within a word. One interpretation is that words are processed holistically; another is that all visual stimuli are processed in terms of components, but that more stimulus information is available for use when the targets are words than when they are letters within words. The results of three experiments indicate that the word or pattern-level advantage occurs even when the stimulus information in the two situations is equated, but if the perceptual arrays cannot be unitized (e.g., consonant sequences), a pattern-level advantage does not occur. In addition, the experiments provide substantial evidence to indicate that if letter arrays cannot be unitized, then they are processed on a componentby-component basis, rather than holistically. Finally, the appropriate definition ofholistic processing is considered.

A radioimmoassay for digoxin is described which uses commercially available reagents. Two assay procedures are used, one for batch assays, and another, which needs a 5 minute incubation only, for ‘stat’ assays. The methods are shown to be simple, rapid, precise and inexpensive and the batch procedure compared well with the Amerlex digoxin method for 63 patient samples.

The effects of an extradural narcotic, diamorphine, and of an extradural local anesthetic, bupivacaine, on postoperative responses of plasma glucose and cortisol levels following surgery were investigated in 20 fit women undergoing major gynecologic operations. The operations were conducted with morphine premedication and extradural local anesthetic with nitrous oxide, oxygen, and halothane. After surgery the patients were given either further extradural local anesthetic or 5 mg of extradural diamorphine. After surgery plasma glucose and plasma cortisol concentrations decreased in patients given extradural diamorphine, but increased in those given extradural local anesthetic. The differences between the groups were statistically highly significant (p less than 0.05) for both glucose and cortisol. The effects on metabolic responses to surgery produced by a small (5 mg) dose of diamorphine injected into the extradural space suggest a local action of the narcotic at the level of the spinal cord. Only very large intravenous doses of narcotics have previously been shown to suppress these responses.