Impact of Infants Born at the Threshold of Viability on the Neonatal Mortality Rate in Colorado

Hernandez, Jacinto A.; Hall, Daniel M.; Goldson, Edward; Chase, Mary K.; Garrett, Carol

doi:10.1038/sj.jp.7200300

Cited by 18 publications

(5 citation statements)

References 5 publications

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“…The sorts of sound that reach prenatal human ears differ from those conducted through air: high-frequency sounds are strongly attenuated, so prenatal stimulation is dominated by low-frequency energy. A fetus can thus detect vowels and musical pitches, but can perceive little of the auditory characteristics that will identify consonants or overtones (Gerhardt and Abrams, 2000). …”

Section: Music and Early Language Acquisitionmentioning

confidence: 99%

Music and Early Language Acquisition

Brandt¹,

Gebrian²,

Slevc³

2012

Front. Psychology

178

121

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Language is typically viewed as fundamental to human intelligence. Music, while recognized as a human universal, is often treated as an ancillary ability – one dependent on or derivative of language. In contrast, we argue that it is more productive from a developmental perspective to describe spoken language as a special type of music. A review of existing studies presents a compelling case that musical hearing and ability is essential to language acquisition. In addition, we challenge the prevailing view that music cognition matures more slowly than language and is more difficult; instead, we argue that music learning matches the speed and effort of language acquisition. We conclude that music merits a central place in our understanding of human development.

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Section: Music and Early Language Acquisitionmentioning

confidence: 99%

Music and Early Language Acquisition

Brandt¹,

Gebrian²,

Slevc³

2012

Front. Psychology

178

121

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“…The main subsample of infants we used to test our hypotheses were infants born at the 'threshold of viability,' defined as birth weight <750 g. This definition complies with the adopted position of the Committee on the Fetus and Newborn of the AAP, and enabled us to compare more recent data to the findings of Hernández, et al, who used the same cutoff. 5,13 The study periods 1991 to 1996 and 1997 to 2003 were used in order to make comparisons to the findings of Hernández, et al…”

Section: Primary Outcomesmentioning

confidence: 99%

“…2 Due in part to these advances, more studies have examined survivability of infants of lower birth weights, with the corollary that the threshold of viability, the birth weight at which infants are expected to have a reasonable chance of survival, continues to trend lower. 3,4 In 2000, Hernández, et al 5 examined the impact of infants born at the threshold of viability on the Colorado NMR. The study reviewed neonatal deaths of all liveborn infants <750 g from January 1991 to December 1996, and noted that while these extremely low birth weight infants accounted for 0.31% of all live births, they accounted for 46.3% of the neonatal deaths.…”

Section: Introductionmentioning

confidence: 99%

Infants born at the threshold of viability in relation to neonatal mortality: Colorado, 1991 to 2003

Kamath¹,

Box

Simpson

et al. 2008

J Perinatol

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Objective-To determine the contribution of infants born at the threshold of viability (defined as <750 g birth weight) and the role of regionalization of perinatal care on the neonatal mortality rate (NMR) in Colorado. Result-The overall unadjusted NMR of the two time periods was 4.3 and 4.4 per 1000 live births, respectively (P=0.42). The contribution of infants with birth weights <750 g to the overall NMR increased from 45.0 to 54.5% (P<0.01). The odds of death for infants <750 g increased between time periods (Odd ratio 1.3, 95% Confidence interval 1.11, 1.61). However, NMR decreased between time periods for all birth weight categories, until infants <600 g. With respect to regionalization, the number of infants <750 g born in a level III care center increased slightly between the two time periods (69.6 versus 73.3%; P=0.04); however, adjusted analysis showed no difference in the practice of regionalization between time periods. Regardless of time period, infants who weighed <750 g born in a level III center had 60% lower mortality risk when compared to <750 g infants born in a non-level III center (P<0.01; 95% CI 0.30, 0.52).Conclusion-Despite advances in neonatal medicine, the overall NMR in the state of Colorado remained unchanged between the time periods of 1991 to 1996 and 1997 to 2003. Infants at the threshold of viability continue to have a large impact on the Colorado NMR, making up a larger proportion of overall neonatal deaths. While the results demonstrate that the risk of mortality is significantly reduced for <750 g infants born in a level III center, the practice of regionalization has not changed between the two time periods. Improved efforts to standardize the referral practices to ensure delivery of <750 g infants in level III centers could potentially reduce the impact of these infants on the NMR. While the overall NMR in Colorado has not changed between the two time periods, the NMR for infants >600 g has significantly decreased, suggesting that the

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“…[28][29][30] What appears to hold true across published studies is that survival for infants born at Ͻ23 weeks of gestation is more an exception than the rule. [31][32][33][34][35][36] Survival rates for extremely low birth weight infants have increased substantially in the past decades, [37][38][39][40][41] but major neurologic impairments have remained practically unchanged. [42][43][44][45][46][47] However, compared with normal birth weight infants, extremely low birth weight survivors without major impairments are still at greater risk of learning disabilities during the school years, [48][49][50][51] which persist into early adulthood.…”

Section: E484mentioning

confidence: 99%

Ensuring Accurate Knowledge of Prematurity Outcomes for Prenatal Counseling

et al. 2005

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ABSTRACT. Objectives. To determine the accuracy of knowledge of different health care providers regarding survival and long-term morbidity rates for very premature infants and to examine whether a focused educational intervention improves the accuracy of this knowledge and influences health care decisions.Methods. Using hypothetical case scenarios with infants at <28 weeks of gestation, we surveyed a variety of caregivers involved in perinatal communication and decision-making processes at a tertiary center that provides intensive care for neonates. We asked physicians from the pediatrics and obstetrics services and nurses and nurse practitioners from the NICU and obstetrics ward for their best estimates of survival and major long-term disability rates and for their opinions regarding the appropriateness of resuscitation and life support at each week of gestation of <29 weeks. After the survey, we educated all providers about current data on survival and long-term disability rates for preterm infants and gave them pocket-sized cards summarizing this information for reference during prenatal counseling. One month after the educational intervention and complete dissemination of the cards, a questionnaire with questions identical to those in the first survey was mailed to the same individuals.Results. Fifty-one health care providers were involved in the baseline survey. The response rates for the postintervention survey were 100% for physicians (20 of 20 subjects) and nurses (20 of 20 subjects) and 91% (10 of 11 subjects) for the nurse practitioners. In the baseline survey, statistically significant underestimates of survival rates were seen for physicians and nurses at 23 to 28 weeks of gestation and for nurse practitioners at 23 to 27 weeks of gestation. Statistically significant overestimates of disability rates were seen for physicians and nurse practitioners at <26 weeks of gestation and for nurses at <28 weeks of gestation. After the intervention, respondents demonstrated significant improvements in the accuracy of survival and disability estimates at many, but not all, gestational ages. Although underestimation of survival rates and overestimation of disability rates decreased after the intervention, it persisted to some degree. After the intervention, a larger proportion of physicians (53% vs 21%) and a smaller proportion of nurses (10% vs 37%) were likely to recommend resuscitation for infants born at 23 weeks of gestation.Conclusions. Physicians, nurses, and nurse practitioners underestimated survival rates and overestimated long-term disability rates for very premature infants. After education, their estimates of survival and long-term disability rates for these infants improved significantly. More accurate estimates of survival and disability rates affected physicians' and nurses' theoretical decisionmaking regarding the appropriateness of resuscitation at 23 weeks of gestation. Pediatrics 2005;115:e478-e487. URL: www.pediatrics.org/cgi

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Impact of Infants Born at the Threshold of Viability on the Neonatal Mortality Rate in Colorado

Cited by 18 publications

References 5 publications

Music and Early Language Acquisition

Music and Early Language Acquisition

Infants born at the threshold of viability in relation to neonatal mortality: Colorado, 1991 to 2003

Ensuring Accurate Knowledge of Prematurity Outcomes for Prenatal Counseling

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