Search PubMed⌕ Search

Biomedical subjects

N Paneth

Publications and source records attributed to N Paneth.

At least 91 records · Page 5Linked to original sources
PubMed1988

Determinants of interhospital transfer of low-birth-weight newborns.

In a single year in New York City, we identified 1413 neonates who were transferred for medical care from their hospitals of birth; 83% of transferred infants were sent from Level 1 hospitals (no special facilities for sick infants) to Level 3 hospitals (newborn intensive care units). Level 2 hospitals (those with an intermediate level of care) participated little in the transfer process as either senders or receivers. Infants weighing more than 2250 g were rarely transferred. Among low-birth-weight infants born at Level 1 hospitals, the major determinants of transfer were birth weight, gestational age, and Apgar score. Peak transfer rates were for infants weighing 1000-1750 g (84% transferred), those with gestational ages of 28-31 weeks (79% transferred), and those with Apgar scores of 4-6 (68% transferred). Infants with values either above or below these modes were transferred less frequently. Transfer from Level 2 hospitals was also significantly related to birth weight and Apgar score. Socioeconomic indicators such as race, maternal education, ward/private status, and financial coverage for the delivery had no effect on transfer rates. Transferred low-birth-weight infants were a highly selected sample of low-birth-weight infants. Infants transferred from Level 1 hospitals were those in better condition (higher Apgar scores) when weighing less than 1750 g, and those in worse condition (lower Apgar scores) when weighing more than 1750 g.

Adult↗
PubMed1988

Interobserver variability in neonatal cranial ultrasonography.

The reliability of cranial ultrasound diagnosis in the premature neonate was examined using data from an ongoing multicentre study of the epidemiology and long-term consequences of neonatal brain haemorrhage. First week ultrasound films (obtained at 4 hours, 24 hours and 7 days) from 60 study subjects were randomly selected for independent review by two groups of experienced interpreters, and results were recorded separately for observations (i.e. presence or absence of an abnormal echodense area on a film) and interpretations (i.e. presence or absence of haemorrhage or ventricular dilatation) in each hemisphere. Because of deaths in the first week of life, the total number of films examined was 138. Concordance on the presence or absence of an abnormal echodensity was examined for each individual film for three areas of interest: the germinal matrix, the ventricles and the parenchyma. Concordance on the presence or absence of haemorrhage or ventricular dilatation was examined only for the seventh-day film, or the final film prior to death. Finally, concordance was analysed with the diagnostic interpretations grouped into categories thought to differ prognostically for long-term outcome. In general, concordance was poorest for germinal matrix lesions and best for parenchymal lesions. Concordance was lower for observations made on each individual film than it was for interpretation of the final film in each case. Fifty-five of 60 cases (92%) were assigned to the same major prognostic category by both readers. Ultrasound review conferences were held periodically and there was evidence that concordance in ultrasound reading and interpretation improved during the course of the study.

Cerebral Hemorrhage↗
PubMed1987

The choice of place of delivery. Effect of hospital level on mortality in all singleton births in New York City.

In an analysis of all singleton births and neonatal deaths with known birth weights and gestational ages in New York City maternity services during a three-year period (1976 to 1978), intensive care services at the hospital of birth were found to influence mortality only in preterm (less than 37 weeks' gestation) or low-birth-weight infants (less than 2251 g). By contrast, for infants who were born at term and of normal birth weight, mortality rates did not differ by level of perinatal care available at the hospital of birth. On the average, preterm and low-birth-weight infants were at a 24% higher risk of death if birth occurred outside of a level 3 center, regardless of whether birth occurred at a level 1 or level 2 hospital. Preterm and low-birth-weight infants, though constituting only 12% of births, accounted for 70% of neonatal deaths in New York City. The remaining infants, ie, those born at term and of normal birth weight, who experienced no measurable mortality advantage when born in a level 3 hospital, accounted for 88% of all births.

Birth Weight↗
PubMed1986

An assessment of the effects of maternal age and parity in different components of perinatal mortality.

Perinatal mortality has several components which may have distinct epidemiologic features. In an investigation of the total singleton birth population of New York City in 1976-1978 (n = 320,726), the authors divided perinatal mortality into four components: late fetal deaths that occurred before labor (late antepartum fetal deaths), fetal deaths during labor (intrapartum fetal deaths), neonatal deaths, and perinatal deaths attributed to congenital anomalies, and they assessed the relation of each of these to maternal age and parity, controlling for relevant confounding factors. In analyses which controlled for prior fetal loss, type of service (public vs. private), race, marital status, and mother's educational attainment in a multiple logistic regression model, the authors found that: 1) increasing maternal age was strongly associated with antepartum fetal deaths but not with intrapartum fetal deaths, while older maternal age was also associated with perinatal deaths attributed to congenital anomalies; 2) high parity bore a strong relationship to intrapartum fetal deaths, but none to antepartum fetal deaths, neonatal deaths, or congenital anomaly deaths; and 3) for neonatal death, there was a statistically significant (p less than 0.001) interaction between parity and age such that mothers over 34 years old having their first birth were at especially high risk.

Adult↗
PubMed1986

Etiologic factors in cerebral palsy.

A variety of insults can cause cerebral palsy, but the dominant mechanism of damage is ischemic and/or asphyxial. Table 2 provides a rough estimate of the relative contribution of each of the several risk factor groups to the total burden of cerebral palsy. This table is only approximate both because of our lack of knowledge, and because risk factors often interact with one another. Cerebral palsy is frequently multifactorial in nature. For example the small-for-gestational age infant is both more likely to experience labor asphyxia, and is also more susceptible to its effects. The numerically largest etiologic grouping in cerebral palsy consists of pre-term/low birthweight infants, many of whom have experienced ischemic damage perinatally. The second largest grouping is infants born at term experiencing severe perinatal asphyxia. Congenital infections, and metabolic conditions such as hyperbilirubinemia certainly play some role in the genesis of cerebral palsy but genetic conditions as such rarely cause cerebral palsy. Some infants, if carefully studied, will prove to have a congenital brain malformation. The role of intrauterine ischemic events is at present not well understood, but is probably significant.

Adolescent↗
PubMed1986

Medical care and preterm infants of normal birth weight.

Preterm infants of normal birth weight (born before 37 completed weeks of gestation and weighing more than 2,250 g) experience a neonatal mortality risk almost four times higher than do term infants in the same weight range. In an analysis of the effect of hospital level of birth on neonatal mortality, such preterm normal weight infants were found to experience higher mortality if born outside of a Level 3 (tertiary care) center. For all singleton infants in this weight-gestation category born in New York City maternity services during a 3-year period (N = 23,257), the relative mortality risk for Level 1 births (compared with Level 3) was 1.72 (P less than .01) and for Level 2 births 1.47 (P less than .05). The excess mortality at Level 1 and Level 2 units was almost entirely due to a more than twofold higher death rate in black infants born in these units. Several potentially confounding socioeconomic, demographic, and biologic variables entered into a logistic regression model could not account for the higher mortality rates for black infants born in Level 1 and Level 2 units. Among black infants born at Level 1 units, deaths in preterm normal birth weight infants were less likely to occur in a receiving tertiary care center than were either deaths in low birth weight infants or deaths in term normal weight infants, suggesting that the need for special care of preterm normal birth weight infants is underestimated in some hospitals without newborn intensive care units.

Analysis of Variance↗
PubMed1985

Fetal death during labor: an epidemiologic indicator of level of obstetric care.

The effect of level of perinatal care on rates of intrapartum fetal death was studied in births of infants weighing greater than 1000 gm in New York City in 1976 to 1978. With potential confounding by birth weight, gestational age, and several other variables controlled, intrapartum fetal death rates decreased as intensiveness of care increased. Compared with births in Level 3 maternity units (perinatal intensive care), births in Level 1 units (community hospitals) had a 61% excess risk of intrapartum fetal death (p less than 0.01) and births in Level 2 units (intermediate level of care) had a 35% excess risk (p = 0.06). The effect of hospital level on intrapartum fetal death rates could not be attributed to differences in the classification of fetal deaths during labor across hospital levels, since no compensatory differences in late antepartum fetal death rates were found. Our findings in a total population are compatible with several studies carried out in single hospitals that have reported declines in intrapartum fetal death rates, especially in births more closely attended during labor. Fetal deaths that occur in labor, as contrasted with fetal deaths occurring before labor, constitute a perinatal outcome that is especially sensitive to level of obstetric care.

Birth Weight↗
PubMed1984

Investigation of a temporal cluster of left sided congenital heart disease.

During October and November 1977, eight newborns with critical congenital heart disease, six of these with left sided lesions, were admitted to a New Jersey newborn unit serving two predominantly rural counties with 9700 annual live births. The six left heart lesions (three cases of hypoplastic left heart, two of interrupted aortic arch, and one of aortic coarctation) represented 30% of all neonatal left sided lesions seen at the unit in the three year period 1976-8. The scan statistic for temporal clustering was significant (p less than 0.05). A case-control study was performed in which an average of four controls were matched to each case. A questionnaire was administered to the mothers of cases and controls concerning occupation, periconceptional and prenatal nutrition, radiation and chemical exposure, use of alcohol and tobacco, medications, immunisations, infections, and other exposures. No statistically significant differences between cases and controls were found on any of these items. Although no aetiology for this cluster of congenital heart anomalies could be found, it is of interest that three temporal clusters of fetuses or newborns with chromosomal trisomies have been reported in the medical literature whose conceptions were roughly contemporaneous with those of the infants in our series. These occurred in Rhode Island/Massachusetts, Maryland, and New York City. A speculative possibility is that these four point epidemics represented exposure to a common teratogenic agent, perhaps influenza B, in the winter of 1976/77 in the northeastern United States.

Aorta, Thoracic↗
PubMed1984

Age at death used to assess the effect of interhospital transfer of newborns.

In New York City, newborn units classified as level 1 (no intensive care) frequently transfer low-birth-weight infants to units classified as level 3 (complete intensive care), but level 2 units (those with intermediate levels of care) transfer rarely. As deaths occurring in the first hours of life are unlikely to be affected by infant transport services, early (first four hours), late (four hours to 28 days), and overall neonatal death rates were separately examined at each of the three levels of care for singleton live-births weighing 501 to 2,250 g. As previously reported, overall neonatal mortality (adjusted for birth weight, gestational age, sex, and race) for births at level 1 units (163.0/1,000) and level 2 units (168.1/1,000) was similar, and rates for births at level 3 (128.0/1,000) were significantly lower. Mortality up to four hours, and from four hours to 28 days, however, differed between level 1 and level 2 units. Among early deaths, the mortality for level 1 births was 68.0/1,000, significantly higher than both the rate for level 2 births (46.0/1,000) and for level 3 births (40.6/1,000). Between four hours and 28 days, mortality relative to level 3 improved for level 1 births, but worsened for level 2 births. For infants with birth weight less than 1,251 g, for whom transport rates from level 1 units are highest, mortality in level 1 births was higher than in level 2 births only until 18 hours of life; thereafter, level 2 mortality was higher.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1983

Cerebral palsy and mental retardation in relation to indicators of perinatal asphyxia. An epidemiologic overview.

Although intrapartum asphyxia is established as an important cause of perinatal loss, there is little consensus as to how much of the burden of neurologic handicap in the community is attributable to intrapartum and neonatal asphyxia, as measured clinically. A review of the available epidemiologic information suggests that the role of perinatal events in the genesis of severe mental retardation and cerebral palsy is not as large as popularly thought. Of all neurologic handicaps, cerebral palsy bears the closest relationship to adverse perinatal events, but at least 50% of all cases have no documented depression at the time of birth. No more than 15% of severe mental retardation can be attributed to perinatal events. Severe mental retardation without cerebral palsy does not appear to be attributable to birth asphyxia. The majority of even quite severely asphyxiated babies suffer no detectable neurologic or intellectual sequelae. These epidemiologic observations suggest that resuscitative efforts in mature newborn infants ought not to be too quickly abandoned for fear of late sequelae. At the same time, obstetric intervention based solely on concern for later neurologic development cannot be justified. The most appropriate justification for antenatal and intrapartum monitoring of fetal condition are the established associations of indicators of fetal asphyxia with fetal and neonatal death, and with morbidity in the neonatal period.

Apgar Score↗
PubMed1982

Newborn intensive care and neonatal mortality in low-birth-weight infants: a population study.

We examined the neonatal mortality rates of low-birth-weight infants (501 to 2250 g) born between 1976 and 1978 in three kinds of hospitals in New York City: those with newborn-intensive-care units (Level 3), those with capabilities for the care of most premature infants (Level 2), and those without any special facilities for premature newborns (Level 1). Among 13,560 singleton low-birth-weight infants, the adjusted neonatal mortality rate for Level 3 hospitals was 128.5 per thousand live births - significantly lower (P less than 0.001) than the rates for both level 2 (168.1) and Level 1 units (163.0). The association of level of care with mortality could not be accounted for by differences between groups in social or demographic status, in prenatal care, or in medical complication of pregnancy. We infer that birth at a Level 3 center lowers neonatal mortality in low-birth-weight infants. However, only 34 per cent of the patients in this study were born in such units.

Critical Care↗
PubMed1982

Recent trends in neonatal mortality: the Canadian experience.

In Canada between 1958 and 1977 the neonatal mortality dropped by more than 50%. the decline was most prominent from 1963 and was almost entirely due to an improvement in neonatal birthweight-specific mortality, which suggests an improvement in perinatal medical care. The timing and pattern of the decline are similar to those reported for the United States. There was a transient increase in the incidence of low and very low birthweight in both countries in the late 1960s. The cause of this increase remains unexplained.

Adult↗