No abstract

SUMMARY Energy expenditure indices (EEI) based on oxygen uptake and heart rate were used to compare the economy of walking at various speeds by normal and cerebral‐palsied children. At low walking speeds, EEI values were high, indicating poor economy. At higher speeds the EEI values decreased until a range of maximum economy was reached. For normal children who were capable of walking beyond this range at higher speeds, the EEI increased again. This pattern was noted for both oxygen‐uptake and heart‐rate indices. Mean EEI values based on oxygen uptake and heart rate for normal children were significantly lower and occurred at faster walking speeds than values for children with cerebral palsy. EEI based on either oxygen uptake or heart rate can be used clinically to provide objective information to help evaluate the influence on gait function of surgical intervention, ambulatory aids or orthotics. RÉSUMÉ Index d'économie énergétique de la marche chez les enfants normaux et IMC Les indices de l'économie énergétique (EEI) basés sur la consommation d'oxygène et le rythme cardiaque ont été utilisés pour comparer l'économie de marche à vitesses variées chez l'enfant normal et IMC. A faible vitesse, les valeurs EEI étaient élevées, indiquant une économie médiocre. A vitesses plus élevées, les valeurs EEI décroissaient jusqu'à un niveau d'économie optimale. Pour les enfants normaux capables de vitesses de marche au delà de cet optimum, l'EEI s'accroissait. Cette distribution était observée aussi bien pour la consommation d'oxygène que le rythme cardiaque. Les valeurs moyennes EEI de consommation d'oxygène et de rythme cardiaque étaient significativement plus basses et apparaissaient à des vitesses plus élevées chez les enfants normaux par rapport aux valeurs des enfants IMC. L'EEI basée sur la consommation d'oxygène ou le rythme cardiaque est bien adaptée à la clinique et peut être utilisée pour fournir des informations objectives aidant à évaluer l'influence des interventions chirurgicales, des aides de marche ou des appareillages sur la fonction de marche. ZUSAMMENFASSUNG Energieumsatzindex beim Laufen bei gesunden Kindern und Kindern mit Cerebralparese Der Energieumsatzindex (EEI), basierend auf Sauerstoffverbrauch und Herzfrequenz, wurde herangezogen, um die Energieausnutzung beim Laufen mit verschiedenen Geschwindigkeiten bei gesunden und cerebralparetischen Kindern zu vergleichen. Bei niedrigen Geschwindigkeiten waren die EEI‐Werte hoch, was für eine schlechte Energieausnutzung sprach. Bei höheren Geschwindigkeiten fielen die EEI‐Werte ab, bis ein Bereich der maximalen Ausnutzung erreicht war. Bei den gesunden Kindern, die in der Lage waren, diesen Bereich mit höheren Geschwindigkeiten zu überschreiten, stieg der EEI an. Dieser Verlauf wurde sowohl für den Sauerstoffverbrauch als auch für die Herzfrequenz festgestellt. Die mittleren EEI‐Werte, basierend auf Sauerstoffverbrauch und Herzfrequenz waren für gesunde Kinder signifikant niedriger und traten bei höheren Geschwindigkeiten auf, als die Werte für die cerebral...

There is a low utilization of the ACR appropriateness criteria by clinicians when ordering imaging studies for their patients. The ACR has invested a great deal of resources in these criteria and should therefore be aware of information regarding utilization. Our findings may have implications about how the ACR appropriateness criteria are reviewed, revised, and disseminated.

OBJECTIVE: To characterize discrepancies between transcutaneous bilirubin (TcB) measurements and total serum bilirubin (TSB) levels among newborns receiving care at multiple nursery sites across the United States.METHODS: Medical records were reviewed to obtain data on all TcB measurements collected during two 2-week periods on neonates admitted to participating newborn nurseries. Data on TSB levels obtained within 2 hours of a TcB measurement were also abstracted. TcB -TSB differences and correlations between the values were determined. Data on demographic information for individual newborns and TcB screening practices for each nursery were also collected. Multivariate regression analysis was used to identify characteristics independently associated with the TcB -TSB difference.RESULTS: Data on 8319 TcB measurements were collected at 27 nursery sites; 925 TSB levels were matched to a TcB value. The mean TcB -TSB difference was 0.84 6 1.78 mg/dL, and the correlation between paired measurements was 0.78. In the multivariate analysis, TcB -TSB differences were 0.67 mg/dL higher in African-American newborns than in neonates of other races (P , .001). The TcB -TSB difference also varied significantly based on brand of TcB meter used and hour of age of the infant. For 2.2% of paired measurements, the TcB measurement underestimated the TSB level by $3 mg/dL. CONCLUSIONS: During routine clinical care, TcB measurement provided a reasonable estimate of TSB levels in healthy newborns. Discrepancies between TcB and TSB levels were increased in African-American newborns and varied based on brand of meter used. WHAT'S KNOWN ON THIS SUBJECT:In most previous studies, transcutaneous bilirubin measurement has been found to provide an accurate estimate of total serum bilirubin levels. However, most of these studies were conducted in settings that optimized accuracy. WHAT THIS STUDY ADDS:This study provides a "real-world" assessment of the accuracy of transcutaneous bilirubin measurements in multiple clinical settings and identification of sources of discrepancy between transcutaneous and total serum bilirubin measurements.

IMPORTANCE There are few population-based studies addressing trends in neonatal intensive care unit (NICU) admission and NICU patient-days, especially in the subpopulation that, by gestational age (GA) and birth weight (BW), might otherwise be able to stay in the room with their mothers. OBJECTIVE To describe population-based trends in NICU admissions, NICU patient-days, readmissions, and mortality in the birth population of a large integrated health care system. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data extracted from electronic medical records at Kaiser Permanente Southern California (KPSC) health care system. Participants included all women who gave birth at KPSC hospitals and their newborns from January 1, 2010, through December 31, 2018. Data extraction was limited to data entry fields whose contents were either numbers or fixed categorical choices. Rates of NICU admission, NICU patient-days, readmission rates, and mortality rates were measured in the total population, in newborns with GA 35 weeks or greater and BW 2000 g or more (high GA and BW group), and in the remaining newborns (low GA and BW group). Admissions to the NICU and NICU patient-days were risk adjusted with a machine learning model based on demographic and clinical characteristics before NICU admission. Changes in the trends were assessed with 2-sided correlated seasonal Mann-Kendall test. Data analysis was performed in August 2019. EXPOSURES Admission to the NICU and NICU patient-days among the birth cohort. MAIN OUTCOMES AND MEASURES The primary outcomes were NICU admission and NICU patient-days in the total neonatal population and GA and BW subgroups. The secondary outcomes were readmission and mortality rates. RESULTS Over the study period there were 320 340 births (mean [SD] age of mothers, 30.1 [5.7] years; mean [SD] gestational age, 38.6 [1.97] weeks; mean [SD] birth weight, 3302 [573] g). The riskadjusted NICU admission rate decreased from a mean of 14.5% (95% CI, 14.2%-14.7%) to 10.9% (95% CI, 10.7%-11.7%) (P for trend = .002); 92% of the change was associated with changes in the care of newborns in the high GA and BW group. The number of risk-adjusted NICU patient-days per birth decreased from a mean of 1.50 patient-days (95% CI, 1.43-1.54 patient-days) to 1.40 patientdays (95% CI, 1.36-1.48 patient-days) (P for trend = .03); 70% of the change was associated with newborns in the high GA and BW group. The unadjusted 30-day readmission rates and mortality rates did not change. CONCLUSIONS AND RELEVANCE Admission rates to the NICU and numbers of NICU patient-days decreased over the study period without an increase in readmissions or mortality. The observed decrease was associated with the high GA and BW newborn population. How much of this decrease (continued) Key Points Question How are neonatal intensive care unit (NICU) admission rates and NICU patient-days changing over time for various birth weight, gestational age, and acuity subgroups? Findings In this cohort study of neonates in a large integr...

Risk-adjusted readmission rates for jaundice rose following the 1994 hyperbilirubinemia guidelines and declined after postpartum length-of-stay legislation in 1998. In 2000, the readmission rate remained 6% higher than in 1991. These findings highlight the complex relationship among newborn physiology, socioeconomics, race or ethnicity, public policy, clinical guidelines, and physician practice. These trend data provide the necessary baseline to study whether revised guidelines will change practice patterns or improve outcomes. Cost data also provide a break-even point for prevention strategies.

When using the PSC, a new cutoff score of 12 for clinical significance should be considered if screening low-income, Mexican American children for behavioral problems. Additional study is indicated to determine the causes of the PSC's apparently lower sensitivity in Mexican American populations.

BACKGROUND AND OBJECTIVES: Recent public health efforts focus on reducing formula use for breastfed infants during the birth hospitalization. No previous randomized trials report the effects of brief early formula use. The objective of the study was to determine if small formula volumes before the onset of mature milk production might reduce formula use at 1 week and improve breastfeeding at 3 months for newborns at risk for breastfeeding problems. METHODS: We randomly assigned 40 exclusively breastfeeding term infants, 24 to 48 hours old, who had lost ≥5% birth weight to early limited formula (ELF) intervention (10 mL formula by syringe after each breastfeeding and discontinued when mature milk production began) or control (continued exclusive breastfeeding). Our outcomes were breastfeeding and formula use at 1 week and 1, 2, and 3 months. RESULTS: Among infants randomly assigned to ELF during the birth hospitalization, 2 (10%) of 20 used formula at 1 week of age, compared with 9 (47%) of 19 control infants assigned during the birth hospitalization to continue exclusive breastfeeding (P = .01). At 3 months, 15 (79%) of 19 infants assigned to ELF during the birth hospitalization were breastfeeding exclusively, compared with 8 (42%) of 19 controls (P = .02). CONCLUSIONS: Early limited formula may reduce longer-term formula use at 1 week and increase breastfeeding at 3 months for some infants. ELF may be a successful temporary coping strategy for mothers to support breastfeeding newborns with early weight loss. ELF has the potential for increasing rates of longer-term breastfeeding without supplementation based on findings from this RCT.