Search PubMed⌕ Search

Biomedical subjects

M C McCormick

Publications and source records attributed to M C McCormick.

At least 55 records · Page 3Linked to original sources
PubMed1995

Access to neonatal intensive care.

The birth of a high-risk infant is still a relatively rare, not totally predictable event; and the management of high-risk newborns requires highly skilled personnel and sophisticated technology. In the early days of neonatal intensive care, scarce resources led to regionalized systems of neonatal and, later, perinatal services, generally based on voluntary agreements but sometimes reinforced by planning legislation. At present, a vastly increased pool of skilled professionals and technical resources is available in the context of a rapidly changing medical care system characterized by intense competition, coalescence of services under large managed care plans, and substantial cost pressures. The evidence suggests that, in many areas, these forces have led to the dismantling of regional networks; however, the full potential for these changes to hinder or facilitate access to neonatal intensive care remains to be assessed.

Female↗
PubMed1995

The effect of bronchopulmonary dysplasia on growth at school age.

OBJECTIVE: To determine the effect of bronchopulmonary dysplasia (BPD) on growth at school age. DESIGN: A prospective cohort study. METHODS: The sample included 406 children selected from a reconstructed cohort of infants of very low birth weight previously enrolled in a multisite, randomized, controlled clinical trial. The children were contacted at 8 to 10 years of age. Height, weight, and head circumference (HC) were measured. Possible confounders including sociodemographic data, and neonatal factors were also recorded. RESULTS: The children in the BPD group were significantly smaller in weight (z score, -0.50 +/- 1.19 SD vs -0.06 +/- 1.30 SD) and HC (z score, -1.41 +/- 1.32 SD vs -0.63 +/- 1.62 SD) than those without BPD. However, after controlling for cofounders (using analysis of covariance), no significant differences were demonstrated between the two groups. Power analyses showed that a difference of at least 0.43 z score units could have been detected. The previously documented associations between BPD and suspected confounders were reconfirmed. CONCLUSIONS: Significant differences were noted between children with and without BPD for weight and HC but not height. When possible confounders were taken into account, the differences were no longer appreciated. Thus, the previously reported poor growth in children with BPD may have been related to other factors and not necessarily to BPD.

Body Height↗
PubMed1995

Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome.

OBJECTIVE: To examine the impact of admission-day illness severity on nosocomial bacteremia risk after consideration of traditional risk determinants such as birth weight and length of stay. METHODS: The hospital courses for 302 consecutive very low birth weight (less than 1500 g) infants admitted to two neonatal intensive care units were examined for the occurrence of nosocomial coagulase-negative staphylococcal bacteremia. Using both cumulative incidence and incidence density as measures of bacteremia risk, we explored the relation between illness severity (as measured by the Score for Neonatal Acute Physiology [SNAP]) and bacteremia both before and after birth weight adjustment. In addition, the effect of bacteremia on hospital resource use was estimated. RESULTS: Coagulase-negative staphylococcus was the most common pathogen noted in blood cultures drawn at 48 hours after admission or later. It was isolated on at least one occasion in 53 patients (cumulative incidence of 17.5 first episodes per 100 patients). These episodes occurred during 7652 days at risk, giving an incidence density of 6.9 initial bacteremias per 1000 patient-days at risk. As expected, when compared with the nonbacteremic group, bacteremic patients were of lower birth weight (888 +/- 231 vs 1127 +/- 258 g; P < .01) and gestational age (26.4 +/- 2.1 vs 28.9 +/- 2.8 weeks; P < .01). In addition, these patients were more severely ill on admission (SNAP 17.3 +/- 6.5 vs 12.2 +/- 5.8; P < .01). Even after birth weight stratification, the risk of bacteremia by both measures increased with higher SNAP scores. For example, among infants with birth weights greater than 1 kg, 25% of the most severely ill patients (SNAP 20 and higher) experienced at least one bacteremic episode, whereas the rates seen in infants with intermediate (SNAP 10 to 19) and low illness severity (SNAP 0 to 9) were 8.6% and 3.0%, respectively (chi 2 for trend = 7.25; P < .01). Multivariate linear regression showed that bacteremia was associated with a prolongation of neonatal intensive care unit stay of 14.0 +/- 4.0 days (P < .01) and an increase in hospital charges of $25,090 +/- 12,051 (P < .05), even after adjustment for birth weight and admission-day SNAP. CONCLUSIONS: Nosocomial coagulase-negative bacteremia is an important complication among very low birth weight infants. Assessment of illness severity with SNAP provides information regarding nosocomial infection risk beyond that available from birth weight alone.

Bacteremia↗
PubMed1994

Early intervention in low-birth-weight premature infants. Results through age 5 years from the Infant Health and Development Program.

OBJECTIVE: To evaluate the persistence of effects on health and development at age 5 years of the Infant Health and Development Program, an early childhood intervention that was provided to low-birth-weight (LBW) premature infants from neonatal discharge through age 3 years. DESIGN: Randomized, controlled, multicenter trial, stratified by two LBW groups: lighter (< or = 2000 g) and heavier (2001 to 2500 g). SETTING: Eight socioeconomically heterogeneous clinical sites. PARTICIPANTS: Of 985 eligible infants weighing 2500 g or less and at 37 weeks' or less gestational age, 377 infants were randomly assigned to the intervention group and 608 to the follow-up only group. About two thirds of the infants in each group were in the lighter LBW stratum, and one third were in the heavier LBW stratum. INTERVENTION: The intervention group received home visits (from neonatal discharge through age 3 years) as well as center-based schooling (from 1 to 3 years of age). Children in both groups received pediatric surveillance. MAIN OUTCOME MEASURES: Cognitive development, behavioral competence, and health status. RESULTS: At age 5 years, the intervention group had full-scale IQ scores similar to children in the follow-up only group. However, in the heavier LBW stratum, children in the intervention group had higher full-scale IQ scores (3.7 points higher; P = .03) and higher verbal IQ scores (4.2 points higher; P = .02). No significant differences between intervention and follow-up only groups in cognitive measures at age 5 years were noted in the lighter LBW infants. The intervention and follow-up groups were similar in behavior and health measures regardless of LBW stratum. CONCLUSION: The early childhood intervention provided in the first 3 years of life had effects on heavier LBW premature infants' IQ and verbal performance at age 5 years that were not observed for lighter LBW premature infants. The intervention did not affect health or behavior at age 5 years in either LBW stratum.

Child Behavior↗
PubMed1994

CRIB and SNAP.

Explore the source record for details and available documents.

Humans↗
PubMed1994

The effects of early education intervention on maternal employment, public assistance, and health insurance: the infant health and development program.

OBJECTIVES: The purpose of this study was to test whether early education intervention influences maternal employment, education, fertility, and receipt of public assistance and health insurance. METHODS: The Infant Health and Development Program is a randomized trial of the efficacy of early education on the outcomes of 985 low-birthweight, premature children. Families in eight sites received either pediatric follow-up and referral (follow-up only group) or pediatric services plus early intervention services (intervention group) for the first 3 years of the child's life. RESULTS: Mothers in the intervention group were employed more months and returned to the work force earlier than those in the follow-up only group. Fertility and education were not associated with treatment. Mothers who had some college education received more months of public assistance in the intervention group compared with the follow-up only group. Mothers who were employed received more public assistance and public health insurance in the intervention group compared with the follow-up only group, when maternal employment was controlled. CONCLUSIONS: Findings are discussed in terms of the recent emphasis on two-generational programs directed to providing health, welfare, and child care services to young children and their families.

Adult↗
PubMed1994

School achievement and failure in very low birth weight children.

The extent to which low birth weight confers a risk for poor school function remains an important question. Children (N = 1868) in four birth weight categories [extremely low birth weight (ELBW; children weighed < or = 1000 g at birth, n = 247), other very low birth weight (1001 through 1500 g, n = 364), heavier low birth weight (1501 through 2500 g, n = 724), and normal birth weight (NBW > 2500 g, n = 533)] were compared on indicators of school achievement which included grade failure, placement in special classes, classification as handicapped, and math and reading achievement scores (Woodcock-Johnson Battery). Our results indicate that as birth weight decreases, the prevalence of grade failure, placement in special classes, and classification as handicapped increases, even when controlling for maternal education and neonatal stay. Moreover, ELBW children score lower than all other birth weight groups on math and reading achievement tests. Even among children with IQ scores above 85, ELBW children still obtain lower math scores than NBW children, suggesting the potential for future educational needs.

Brain Damage, Chronic↗
PubMed1994

Classroom behavior of very low birth weight elementary school children.

OBJECTIVE: To examine the effect of birth weight on the classroom behavior of children during elementary school (N = 1120; mean age = 9.16 years). DESIGN: The study used an inception cohort. SETTING/PARTICIPANTS: Participants were from two previously studied multi-site cohorts: very low birth weight (VLBW) children referred to participating intensive care units and heavier low birth weight (HLBW) children from a stratified random sample of births in geographically defined regions. Teacher reports of children's behavior were obtained for 80% of those eligible. Information was obtained for 137 children who were extremely low birth weight (ELBW, < or = 1000 g at birth), 223 who were other very low birth weight (OVLBW, 1001 to 1500 g), 434 who were HLBW (1501 to 2500 g), and 326 who were normal birth weight (NBW, > 2500 g). MAIN OUTCOME MEASURES: The child's teacher provided reports of language and attention in the classroom, behavior problems, and social competence. RESULTS: Comparisons were made among the four birth weight groups: ELBW, OVLBW, HLBW, and NBW. The ELBW children had lower attention and language skills, overall social competence, scholastic competence, and athletic ability than all other birth weight groups as measured by classroom teachers, even when controlling for neonatal stay, child's gender and ethnicity, and maternal education. All low birth weight (LBW) children had lower attention and language skills and scholastic competence and higher daydreaming and hyperactivity scores than NBW children. White children and children with more educated mothers generally had greater language and attention and social competence scores and fewer behavior problems; girls had fewer behavior problems than boys. Neonatal health was generally not associated with outcomes, except that healthier children had lower anxiety scores. The classroom behavior of LBW (< 2500 g) children was rated by teachers as poor, even for children who had not failed a grade; LBW children who are on grade level still may be at risk for school problems. Differences between ELBW and NBW children persisted for overall language and attention and social competence scores even when additional controls were added for sociodemographic and familial variables. Of these variables, maternal depression and home environment were significantly associated with social competence scores.

Attention↗
PubMed1994

Estimating neonatal mortality risk: an analysis of clinicians' judgments.

BACKGROUND: Clinicians' estimates of mortality risk in the neonatal intensive care unit (NICU) have implications for patient triage, transfer, initiation and termination of life support, and allocation of medical resources. The accuracy of these judgments has not been studied, nor the differences between nurses and attending physicians. OBJECTIVES: 1) evaluate the accuracy of subjective judgments of NICU unit mortality risk, 2) identify the key components of clinician judgments, 3) compare accuracy between attending physicians and nurses, and 4) examine the utility of combining an objectively computed risk and clinician judgments to improve predictions. METHODS: We obtained estimates of mortality risk on 544 admissions to two NICUs on the day of admission from the attending physician and primary nurse. These were compared with an objective computed mortality risk based on birth weight and the Score for Neonatal Acute Physiology (SNAP) using a linear judgment analysis model, as well as with actual outcomes. RESULTS: Physicians and nurses had good discriminating power with actual mortality rates ranging from 0% among low risk patients to 67% among those with the highest mortality estimates. Physicians had a tendency to overestimate mortality risk. Clinicians base their estimates on the same factors and similar judgment weights as the empiric mortality risk model (22% birth weight, 62% illness severity (SNAP), 13% low Apgar, and 3% for intrauterine growth restriction). Clinicians place additional emphasis on therapeutic as well as physiologic factors. When the computed risk and physician judgment were combined, both made significant contributions in a logistic mortality risk model. CONCLUSIONS: Clinician judgments of mortality risk are fairly accurate and similar to an objective illness severity index. This simple method provides insight into clinical decision making and has important applications in improving direct patient care, appropriate allocation of medical resources, and medical training.

Clinical Competence↗
PubMed1993

Early educational intervention for very low birth weight infants: results from the Infant Health and Development Program.

OBJECTIVE: To examine the effect of early educational intervention after discharge from the hospital on the health and developmental status of very low birth weight (< or = 1500 gm) infants. DESIGN: Randomized, controlled trial, with post hoc analysis. SETTING: Eight sites, heterogeneous for sociodemographic and health care use. PARTICIPANTS: Infants (N = 280) born weighing < or = 1500 gm and selected for the Infant Health and Development Program. Eligibility was limited primarily by geographic distance from the day care center. One third were randomly assigned to the intervention (INT) group and two thirds to follow-up only. INTERVENTIONS: All children received intensive pediatric and developmental surveillance. The INT group received home visits and center-based educational interventions until 36 months of age (corrected for gestational age when final assessments were completed). OUTCOMES: Cognitive development (Stanford-Binet Intelligence Scale), behavioral competence (Achebach Child Behavior Checklist), and health status (indexes summarizing reported morbidity, the Functional Status II (R) Scale, and General Health Ratings Index). RESULTS: Cognitive development scores were 7.2 points higher (p = 0.002) in the INT group, after adjustment for baseline differences in site, sociodemographic characteristics, and neonatal morbidity, and were 9.4 points higher (p < 0.0003) when the 29 children with significant cerebral palsy were removed. No differences in behavior, serious morbidity, functional status, or health rating were found overall. The infants in the INT group who weighted < or = 1000 gm at birth had significantly lower behavior problem scores but no differences on other outcomes. All children in the INT group had slightly higher rates of less serious morbidity. CONCLUSION: The advantage conferred by being in the INT group, as previously reported for heavier infants, extends to very low birth weight children, supporting the use of early intervention in this group.

Cerebral Palsy↗
PubMed1993

Hospitalization of very low birth weight children at school age.

OBJECTIVE: To assess whether very low birth weight (VLBW) increases the risk of hospitalization at school age. DESIGN: Prospective, multisite cohort study. PARTICIPANTS: Selected from a previous multisite, hospital-based trial, 611 VLBW children, and, from a prior representative sample, 724 children who weighed 1501 to 2500 gm and 533 who weighed > 2500 gm. All the children were re-contacted at 8 to 10 years of age for this study. METHODS: Maternal interview with the use of standardized questions. MAIN OUTCOME: Hospitalization in year before interview. RESULTS: The VLBW children were three or four times more likely to be rehospitalized than children of normal birth weight, both in the year before the interview (7% vs 2%) and since birth (50% to 60% vs 22%). Morbidity and Medicaid coverage increased the risk of hospitalization in the year before the interview; non-white race decreased it. After control for other factors, however, lower birth weight remained a significant risk factor for hospitalization. CONCLUSIONS: The VLBW children continue to have an increased risk of hospitalization; the risk is similar in magnitude to that seen in infancy.

Birth Order↗
PubMed1993

Infant mortality.

Infant mortality continues to be a major public health issue in the United States. Although some preventive strategies for neonatal mortality are emerging for congenital malformations, notably neural tube defects, the prevention of preterm deliveries among disadvantaged populations remains elusive, suggesting the need for different approaches to women's health needs. Despite the lack of success in preventing preterm birth, neonatal mortality rates continued to decline substantially, a decline attributed to improvements in neonatal intensive care associated with surfactant use. The increasing survival of very preterm infants continues to raise questions about their longer term outcomes especially with several recent studies on difficulties in school, and about the need for postdischarge developmental interventions. Attempts to decrease postneonatal mortality received marked attention with the recommendations for specific positioning to prevent sudden infant death syndrome and heightened attention to increased immunization completion rates. The dismal ranking of the United States in infant mortality rates among industrialized countries, however, continues to present a social policy challenge.

Humans↗
PubMed1993

When you're only a phone call away: a comparison of the information in telephone and face-to-face interviews.

Telephone interviews offer an economical method of obtaining information, but little published experience addresses the use of telephone interviews for the sometimes lengthy questionnaires composed of scales with multiple-category items often required in developmental and behavioral research. In a study of the outcomes of very low birth weight infants, circumstances required that we administer a questionnaire, including seven scales composed of several Likert-type items each, to a substantial portion of the study population. Those contacted by telephone (n = 1067) differed from those responding face-to-face (n = 822) in being less likely to have a very low birth weight child and more likely to be white and of higher maternal education. The length of the interview was only slightly shorter by telephone (60.7 +/- 27.9 vs 66.4 +/- 21.0 minutes, p < .001), but respondent fatigue, as indicated by lower completion rates for scales at the end of the interview (92.5%) compared with those near the beginning (99.5%) did not differ by mode. Internal consistency of parental response (Cronbach's alpha) was high for most scales and did not differ by mode. Because assignment to mode was not random, other factors may influence our findings. However, high completion rates and comparable consistency of response supports the use of telephone interviews.

Adaptation, Psychological↗
PubMed1993

Maternal rating of child health at school age: does the vulnerable child syndrome persist?

OBJECTIVES: To assess the extent to which parental ratings of child health, including perceived vulnerability to illness, are associated with current and past health events and sociodemographic characteristics of the family and the child. DESIGN: Prospective cohort study of children aged 8 to 10 years previously assessed in infancy in two multi-site studies. SETTING: Thirteen sites largely in eastern United States. PARTICIPANTS: 1877 children representing 65% of those originally selected for follow-up from the two previous studies. Participants were specifically selected on the basis of birth weight so that more than two-thirds were low birth weight. MEASUREMENT: Parental interviews at school age including measures of several dimensions of child health and sociodemographic characteristics of the family. The former included a six-item scale assessing parental perceptions of child health overall, and on subscales assessing child current health, previous health, and resistance or susceptibility to illness. Data on health problems at birth were derived from previously collected birth certificates, medical records, and interviews. MAIN RESULTS: Although overall parental perceptions of child health reflected both current and past health events, a clear distinction emerged. Parental rating of current child health and resistance or susceptibility were associated with current child health problems, not events in infancy including very low birth weight. Nonwhite race and maternal rating of her own health also influenced maternal rating of child health. CONCLUSION: The results do not support the persistence of a vulnerable child syndrome, as health in infancy does not affect maternal rating of current child health at school-age in the absence of current health problems.

Adult↗
PubMed1993

Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care.

The substantial variation in birth weight-adjusted mortality among neonatal intensive care units (NICUs) may reflect differences in population illness severity. Development of an illness severity measure is essential for comparisons of outcomes. The Score for Neonatal Acute Physiology (SNAP) was developed and validated prospectively on 1643 admissions (114 deaths) in three NICUs. SNAP scores the worst physiologic derangements in each organ system in the first 24 hours. SNAP showed little correlation with birth weight and was highly predictive of neonatal mortality even within narrow birth weight strata. It was capable of separating patients into groups with 2 to 20 times higher mortality risk. It also correlated highly with other indicators of severity including nursing workload (r = .59), therapeutic intensity (r = .78), physician estimates of mortality risk (r = .65), and length of stay (R2 = .59). SNAP is an important new tool for NICU research.

Birth Weight↗
PubMed1993

Has the prevalence of handicapped infants increased with improved survival of the very low birth weight infant?

Several methodologic issues affect the literature on the outcomes of very low birth weight children, making assessing trends difficult. A conservative estimate is that the proportion of handicapped survivors has remained stable, and with increasing survival, the absolute numbers will increase, but many studies suggest decreasing proportions with handicap. Suggestions for improving responses to the questions are proposed.

Persons with Disabilities↗