Biomedical subjects

J A Pinto-Martin

Publications and source records attributed to J A Pinto-Martin.

6 recordsLinked to original sources

PubMed1996

The relation of transient hypothyroxinemia in preterm infants to neurologic development at two years of age.

BACKGROUND: Transient hypothyroxinemia, a common finding in premature infants, is not thought to have long-term sequelae or to require treatment. We investigated whether hypothyroxinemia in premature infants is a cause of subsequent motor and cognitive abnormalities. METHODS: In this historical cohort study, we retrieved blood thyroxine values, obtained on routine screening in the first week of life, from state screening records on children who weighted 2000 g or less at birth, who were born at 33 weeks' gestation or earlier, and who were enrolled in a population-based study of the late sequelae of neonatal brain hemorrhage. We investigated the relation of these values to the odds for disabling cerebral palsy among 463 subjects for whom data were available and to the mental-development score on the Bayley Scales of Infant Development or the Stanford-Binet Intelligence Scales for Children at the age of two years in 400 subjects. The effects of severe hypothyroxinemia, defined as a blood thyroxine value more than 2.6 SD below the mean for New Jersey newborns, were assessed before and after adjustment for gestational age and potentially confounding variables. RESULTS: In analyses adjusted for gestational age, infants with severe hypothyroxinemia had a risk of disabling cerebral palsy that was nearly 11 times that of infants without hypothyroxinemia (odds ratio, 10.8; 95 percent confidence interval, 3.0 to 39.3) and a mean mental-development score at the age of two that was 15.4 points lower (95 percent confidence interval, 8.1 to 22.6 points) than the mean score of children with normal neonatal blood thyroxine concentrations. After adjustment for gestational age and multiple prenatal, perinatal, and early and last neonatal variables, severe hypothyroxinemia was still associated with an increased risk of disabling cerebral palsy (odds ratio, 4.4; 95 percent confidence interval, 1.0 to 18.6) and a reduction of nearly 7 points (95 percent confidence interval, 0.3 to 13.2 points) in the mental-development score. CONCLUSIONS: Severe hypothyroxinemia in preterm infants may be an important cause of problems in neurologic and mental development detected at the age of two years.

Cerebral Palsy↗

PubMed1995

The management of prepubertal children with gonorrhea.

To determine whether test-of-cure cultures are necessary for prepubertal children diagnosed with Neisseria gonorrhoeae, we examined the records of all 66 patients < 10 years old seen at Children's Hospital of Philadelphia over a 7.5-year period (1987-1994) diagnosed with gonorrhea. Ninety-eight percent had genital discharge on examination. All children with genital gonorrhea were symptomatic, but only 10% of children with rectal gonorrhea and 20% with pharyngeal infection were symptomatic. Seventy-seven percent of children were treated with ceftriaxone. Of these, 72% returned for test-of-cure cultures. Ninety-three percent of children had complete resolution of physical symptoms at test-of-cure, and all follow-up cultures were negative for N. gonorrhoeae. Our data suggest that most prepubertal children with gonorrhea are symptomatic at initial presentation and are cured after recommended treatment with ceftriaxone. The Centers for Disease Control and Prevention recommendations for obtaining test-of-cure cultures in young children with gonorrhea are unnecessary, potentially harmful, and should be revised.

Ceftriaxone↗

PubMed1995

Phenylketonuria screening: effect of early newborn discharge.

OBJECTIVE: To determine the percentage of term newborns discharged by 24 hours of life and the actions taken by physicians and institutions to avoid false-negative phenylketonuria (PKU) screens in these infants. DESIGN: Descriptive cross-sectional survey. PARTICIPANTS: One hundred forty term nurseries and 157 pediatricians. SELECTION PROCEDURE: Stratified sampling techniques were used to sample nurseries from the 1992 American Hospital Association guide to provide equal representation of each region of the country. Pediatricians were systematically sampled from a national list of practicing pediatricians supplied by Ross Laboratories to provide equal sampling from each state. RESULTS: The response rates were 95% (n = 133) for term nurseries and 83% (n = 131) for pediatricians. Twenty-four percent of healthy newborns are discharged by 24 hours of life. Ninety-three percent of nurseries screen all infants for PKU before discharge. In states without laws mandating rescreening, only 48% of institutions that discharge the majority of their infants (> 50%) by 24 hours of life rescreen. Also, in states without rescreening laws, 64% of pediatricians rescreen. The timing of this repeat screen ranges from less than 72 hours of life to 4 weeks. Determining which infants to rescreen varies by practitioner; some rescreen all infants, whereas others rescreen those discharged early. Just more than half of all pediatricians, whether practicing in a state requiring repeat PKU screening, claim to be familiar with the American Academy of Pediatrics recommendations regarding repeated PKU screening of infants discharged by 24 hours of life. CONCLUSION: Twenty-four percent of term newborns in the United States are discharged by 24 hours of life. Most hospitals screen all infants for PKU before discharge regardless of age. The majority of states do not mandate rescreening; rescreening policies among pediatricians and institutions in those states vary widely. A significant number of infants do not receive repeated screening and are therefore at risk for delayed or missed diagnosis of PKU because of insensitive initial screens. Pediatrician awareness of the need to perform repeated PKU screens on infants discharged by 24 hours is poor.

Age Factors↗

PubMed1995

Universal hepatitis B immunization.

OBJECTIVE: To determine the practices of US nurseries, neonatal intensive care units (NICUs), and pediatricians regarding universal hepatitis B vaccination. DESIGN: Descriptive cross-sectional survey. PARTICIPANTS: One hundred forty term nurseries, 152 NICUs, and 157 pediatricians. Selection procedure. Nurseries and NICUs were systematically sampled from the 1992 American Hospital Association Guide to provide equal sampling from each region of the country. Pediatricians were systematically sampled from a national list of practicing pediatricians supplied by Ross Laboratories to provide equal sampling from each state. RESULTS: The response rates were 95% (n = 133) for term nurseries, 95% (n = 144) for NICUs, and 83% (n = 131) for pediatricians. Sixty-two nurseries (47%) provide routine hepatitis B vaccine (HBV) to their infants. Eighty-five NICUs (59%) routinely vaccinate their preterm infants; 62 (73%) initiate the series just before discharge; and 11 (13%) do so at birth. Principal reasons for not vaccinating include cost and a preference to allow the primary-care physician to initiate the series. One hundred ten (85%) pediatricians provide universal hepatitis B vaccination. Principal reasons for not vaccinating include cost and parents opting against vaccination. CONCLUSIONS: More than half of NICUs provide HBV routinely to their preterm infants, predominantly just before hospital discharge. A minority of NICUs are initiating vaccination at birth, which may provide suboptimal seroconversion. Although less than half of participating term nurseries are routinely vaccinating before discharge, 85% of pediatricians do initiate HBV by two months of age. The principal reasons for not providing vaccine are financial.

Cross-Sectional Studies↗

PubMed1995

Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in a low birth weight population.

OBJECTIVE: To employ multivariate analytic techniques to assess the association between neonatal cranial ultrasound (US) abnormalities and subsequent cerebral palsy (CP), defined as disabling CP (DCP) or nondisabling CP (NDCP) depending on the level of motor dysfunction. DESIGN: Prospective cohort study. SUBJECTS AND METHODS: The Neonatal Brain Hemorrhage Study enrolled a geographically representative sample of 1105 newborns 501 to 2000 g and obtained follow-up data on 777 (86%) of the 901 survivors at age two. One hundred thirteen children (14.6%) had motor findings severe enough to classify them as having CP. The 61 (7.9%) of these children who were disabled by their motor impairment we classified as having DCP. The remaining 52 (6.7%) who had definite neurologic findings (usually mild spastic diplegia) but without evidence of interference with daily living, we classified as having NDCP. RESULTS: In a multivariate logistic regression model of perinatal and postnatal variables, the following factors were found to be significant risk factors for DCP: parenchymal echodensities/lucencies or ventricular enlargement (PEL/VE) on cranial US (OR = 15.4; 7.6, 31.1), germinal matrix/intraventricular hemorrhage (GM/IVH) (OR = 3.5; 1.7, 6.9) and mechanical ventilation (OR = 2.9; 1.2, 7.1). Fully 93.4% of infants were correctly classified as to presence or absence of DCP on the basis of this model. Birth weight, gestational age, length of hospital stay, gender, race, plurality, presence of labor and Apgar score were not significant independent predictors of DCP. For NDCP, the only risk factor significant in the multivariate model was PEL/VE (OR = 5.3; 2.2, 12.6). CONCLUSIONS: Among perinatal and postnatal factors, cranial US abnormalities are by far the most powerful predictors of disabling CP in low birth weight infants. Although PEL/VE was the strongest predictor, GM/IVH also appeared to independently contribute to the risk of DCP. NDCP in low birth weight infants appears to have a different risk profile than DCP. In particular, it is less closely related to US evidence of perinatal brain injury.

Brain Diseases↗

PubMed1994

Experiences and reflections of former pediatric chief residents.

OBJECTIVE: To compare actual and ideal time commitments of pediatric chief residents between 1972 and 1992 and to determine if actual time commitments have changed. DESIGN: Descriptive, cross-sectional survey. PARTICIPANTS: One thousand two hundred eighty-four former pediatric chief residents. RESULTS: Chief residents between 1972 and 1982 spent a greater percentage of time teaching and providing patient care than chief residents between 1983 and 1992. Chief residents between 1983 and 1992 spent a greater percentage of time scheduling and performing other administrative tasks. In general, chief residents desired more time to teach, to conduct research, and to provide outpatient care and desired less time for scheduling and for performing other administrative duties. CONCLUSIONS: Although chief residents desire to spend more time teaching and less time performing administrative tasks, administrative duties have increased at the expense of teaching and patient care responsibilities over the past 20 years.

Career Choice↗