Objective To estimate risk of NEC for ELBW infants as a function of preterm formula and maternal milk (MM) intake and calculate the impact of suboptimal feeding on NEC incidence and costs. Design We used adjusted odds ratios (aORs) derived from the Glutamine Trial to perform Monte Carlo simulation of a cohort of ELBW infants under current suboptimal feeding practices, compared to a theoretical cohort in which 90% of infants received at least 98% MM. Results NEC incidence among infants receiving ≥98% MM was 1.3%; 11.1% among infants fed only preterm formula; and 8.2% among infants fed a mixed diet (p=0.002). In adjusted models, compared with infants fed predominantly MM, we found an increased risk of NEC associated with exclusive preterm formula (aOR=12.1, 95% CI 1.5, 94.2), or a mixed diet (aOR 8.7, 95% CI 1.2-65.2). In Monte Carlo simulation, current feeding of ELBW infants was associated with 928 excess NEC cases and 121 excess deaths annually, compared with a model in which 90% of infants received ≥ 98% MM. These models estimated an annual cost of suboptimal feeding of ELBW infants of $27.1 million (CI $24million, $30.4 million) in direct medical costs, $563,655 (CI $476,191, $599,069) in indirect nonmedical costs, and $1.5 billion (CI $1.3 billion, $1.6 billion) in cost attributable to premature death. Conclusions Among ELBW infants, not being fed predominantly MM is associated with an increased risk of NEC. Efforts to support milk production by mothers of ELBW infants may prevent infant deaths and reduce costs.

SUMMARY Current information was obtained from I 17 respondents, including 71 who completed interviews, of a population of 810 individuals who had been diagnosed with cerebral palsy between 1951 and 1974. Original chart reviews constituted the basis for predicting employment capabilities of the interviwed cohort. A comparison of predictions with actual functional outcomes demonstrated a tendency to pessimistic underestimation of'long‐term functional outcome, sounding a note of caution to paediatric developmentalists. RÉSUMÉ Ce qu'il advicni des enfants IMC ‐Prédiction à long terme des devenirs fonctionncls Sur une population de 810 individus, chez qui un diagnostic ayant répondu, dont 71 recontrés dans une entrevue. Les dossiers d'origine ont fourni une base de prédiction sur Is capacités d'insertion professionanelle dans le groupe étudié. Une comparaison des prédictions avec le devenir fonetionncl effectif a révelé une sous‐estimation pessimiste du devenir fonetionncl à long terme, soulignant une note de prudence chez les développementalistes pédiatres. ZUSAMMENFASSUNG Was wird aus Kindern mil Cerebralparese –Langzeitprognose der funktionellen fähigkeiten Die vorlicgcnden Informationen stammen von 117 Patienten, darunter 71 mit vollständigen Intervies, aus einer Population von 810 Patientcn, bei dencn in den Jahren /.wischen 1951–1974 die Diagnose einer Carebralparese gestellt worden war. Die Befunde aus den Krankenakten bildeten die Grundlage fUur die Prognose von Berufschancen bei den interviewten Patienten und ein Vergleich unserer Prognosen mit den aktuellcn funktionellen Befunden zeigte die Tendenz einer pessimisiischen Unterschätzung des funktionellen Outcomes, was den pädiatrischen Kntwicklungsneurologen zu denken geben sollte. RESUMEN Cued es el futuro de los niños con paráisis cerebral–Predicción a largo plazo del éxito funcional Se obutvo informatión de 117 casos. incluyendo 71 que completaron entrevistas, de una población de 810 individuos que habían sido diagnosticados de parálisis cerebral entre 1951 y 1974. La revisión de targetas originates constituyó la base para la predicción de las capacidades de empleo de la cohorte entrevistada, asi como la comparación de nuestras predicciones con el éxito functional real, demostrándose una tendencia a la subestimación pesimista del éxito a largo plazo, lo que reprcsenta una nota de atención para los evolutivistas prediátricos.

Objective-To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision. Study design-For infants born at <27 weeks of gestation between 2006 and 2013, prospectively collected maternal and neonatal characteristics and 18-to 26-month corrected age follow-up data were analyzed. Bayley-III cognitive and language scores of infants with discharge CPS supervision were compared with infants without CPS supervision using regression analysis while adjusting for potentially confounding variables, including entering CPS after discharge from the hospital. Results-Of the 4517 preterm infants discharged between 2006 and 2013, 255 (5.6%) were discharged with a need for CPS supervision. Mothers of infants with CPS supervision were significantly more likely to be younger, single, and gravida ≥3; to have less than a high school education; and to have a singleton pregnancy and less likely to have received prenatal care or

Objective To test whether infants randomized to a lower oxygen saturation (SpO2) target range while on supplemental oxygen from birth will have better growth velocity from birth to 36 weeks postmenstrual age (PMA), and less growth failure at 36 weeks PMA and 18–22 months corrected age. Study design We evaluated a subgroup of 810 preterm infants from the Surfactant, Positive Pressure, and Oxygenation Randomized Trial, randomized at birth to lower (85–89%, n=402, GA 26 ± 1wk, BW 839 ± 186 g) or higher (91–95%, n=408, GA 26 ± 1wk, BW 840 ± 191 g) SpO2 target ranges. Anthropometric measures were obtained at birth, postnatal days 7, 14, 21, and 28; then at 32 and 36 weeks PMA, and 18–22 months corrected age. Growth velocities were estimated using the exponential method and analyzed using linear mixed models. Poor growth outcome, defined as weight < 10th percentile at 36 weeks PMA and 18–22 months corrected age, was compared across the two treatment groups using robust Poisson regression. Results Growth outcomes including growth at 36 weeks PMA and 18–22 months corrected age, as well as growth velocity were similar in the lower and higher SpO2 target groups. Conclusion Targeting different oxygen saturation ranges between 85% and 95% from birth did not impact growth velocity or reduce growth failure in preterm infants.

Clinical trials and quality control measures are characterized by evaluation of assistive technology by users, and feedback to providers for the purpose of improving devices or service delivery. These processes recognize that consumer satisfaction is an important measure of device and service delivery effectiveness. In this article, types of clinical trials are reviewed, and both prospective and retrospective methods of quality control are presented. The authors take the position that rehabilitation engineering centers providing customized devices and adapted technology should implement quality control measures in order to improve services to their clients.