Community-Based Testing for SARS-CoV-2 - Chicago, Illinois, May-November 2020.

On May 13, 2020, Chicago established a free community-based testing (CBT) initiative for SARS-CoV-2, the virus that causes COVID-19, using reverse transcription-polymerase chain reaction (RT-PCR). The initiative focused on demographic groups and geographic areas that were underrepresented in testing by clinical providers and had experienced high COVID-19 incidence, including Hispanic persons and those who have been economically marginalized. To assess the CBT initiative, the Chicago Department of Public Health (CDPH) compared demographic characteristics, economic marginalization, and test positivity between persons tested at CBT sites and persons tested in all other testing settings in Chicago. During May 13-November 14, a total of 253,904 SARS-CoV-2 RT-PCR tests were conducted at CBT sites. Compared with those tested in all other testing settings in Chicago, persons tested at CBT sites were more likely to live in areas that are economically marginalized (38.6% versus 32.0%; p<0.001) and to be Hispanic (50.9% versus 20.7%; p<0.001). The cumulative percentage of positive test results at the CBT sites was higher than that at all other testing settings (11.1% versus 7.1%; p<0.001). These results demonstrate the ability of public health departments to establish community-based testing initiatives that reach communities with less access to testing in other settings and that experience disproportionately higher incidences of COVID-19.

Laboratory diagnostics, phylogenetic analysis and clinical outcome of a subcutaneous Mycoleptodiscus indicus infection in an immunocompetent cat.

BACKGROUND: Mycoleptodiscus indicus is a dematiaceous hyphomycete fungus found on plant leaves. It has been rarely reported as a cause of human or animal disease, possibly because it is difficult to culture and identify from clinical specimens. Infections are presumably acquired by traumatic implantation. CASE PRESENTATION: An 8-year-old non-immunosuppressed cat from Georgia, USA, presented with a left front leg swelling without lameness. Cytology from a fine needle aspirate revealed pyogranulomatous inflammation with both cytoplasmic and extracellular fungal elements. There were septate hyphae with irregularly sized segments, non-staining uneven walls, and rounded yeast-like forms from which longer hyphae arose in a hub-and-spoke pattern. A mold was isolated on agar from a fine needle aspirate collected 1 week later and identified as M. indicus by morphology, DNA sequencing and phylogenetic analysis. The cat recovered completely and uneventfully with antifungal treatment. CONCLUSIONS: We report a previously undescribed presentation of M. indicus causing a subcutaneous infection in a cat with successful antifungal treatment. In this study we highlight the potential of M. indicus to infect immunocompetent animals, and the veterinary medical community should be aware of its unusual but characteristic clinical, microbiological and cytologic presentation.

An exploratory evaluation of the feasibility, acceptability, and efficacy of the mental fitness disordered eating program in schools.

The present study examines the feasibility, acceptability, and efficacy of a tiered professional development disordered eating prevention program. A pretest/posttest quasi-experimental design assessed elementary and junior high school faculty and staff's disordered eating knowledge and attitudes. Findings indicate participants experienced increased awareness of students' susceptibility to and the severity of disordered eating, increased self-efficacy about referring students to appropriate resources, and overall perceived acceptability of the training. Improved knowledge and attitudes suggest faculty and staff are better equipped to identify at-risk individuals at an early stage, increasing the likelihood of recovery from disordered eating behaviors or disordered eating.

"Drunk in Love": The Portrayal of Risk Behavior in Music Lyrics.

The current study investigated the prevalence of multiple risk behaviors in popular music lyrics as well as the contexts within which they occur. We conducted a content analysis of the top 20 Billboard songs from 2009 to 2013 in the genres of rap, country, adult contemporary, rock, R&B/hip-hop, and pop, coding for the presence of alcohol, marijuana, nonmarijuana drugs, and sex as well as the contexts intoxication, binging/addiction, partying/socializing, disregard for consequences, and emotional states. The contexts relationship status and degradation were also coded for when sex was present. Of the 600 songs, 212 mentioned sexual behaviors, which were most frequent in rap and R&B/hip-hop. Alcohol was the next most frequent risk behavior, again with greatest mention in rap and R&B/hip-hop. Alcohol, marijuana, and nonmarijuana drugs were most often associated with positive emotions, and sex was most often described within the context of casual relationships. Alcohol and sex were associated with disregard for consequences most often in 2011, when the "you only live once" motto was most popular. These findings are concerning because exposure to popular music is associated with increased risk behaviors for adolescents and young adults, who are the greatest consumers of music.

The persuasive power of oral health promotion messages: a theory of planned behavior approach to dental checkups among young adults.

Although routine dental checkups are important for both oral and overall health, several factors influence young adults' use or nonuse of dental services. The two studies included in this report tested the theory of reasoned action (TRA), the theory of planned behavior (TPB), and an expanded TPB model in predicting young adults' routine dental checkups. Additionally, the study tested the perceived message effectiveness of TPB-based messages. Results support the use of an expanded TPB model (particularly adding satisfaction with the dentist and environmental constraints to the traditional model) for an understanding of routine dental checkup intention and behavior, and, most notably, provide support for the use of subjective norm-based messages to prompt dental checkups. This study lays the groundwork for a health communication campaign encouraging routine dental checkups among young adults. The use of targeting and tailoring to design effective oral health media campaign messages is discussed.

Isovolemic hemodilution-red cell exchange for prevention of cerebrovascular accident in sickle cell anemia: the standard operating procedure.

Red blood cell exchange is an accepted superior therapy to simple chronic transfusion, due to minimal risk of iron overload, for secondary prevention of cerebrovascular accidents in selected patients with sickle cell anemia. Recently, we described our experience of Isovolemic Hemodilution-Red Blood Cell Exchange (IHD-RBCx), a two-step modification of the conventional RBCx with several advantages, including cost reduction. We are describing our standard operating procedure for IHD-RBCx with COBE Spectra apheresis system to make it widely available to the apheresis centers interested in implementing this procedure.

How Stressed Are They?: Levels and Sources of Stress in Doctor of Physical Therapy Students.

PURPOSE: Stress has detrimental effects on psychological well-being, cognitive function, and physiological health. While students in many healthcare programs experience high levels of stress, it is unknown whether this is true for Doctor of Physical Therapy (DPT) students. The purpose of this study was to explore the levels and sources of stress experienced by first- and second-year DPT students. METHODS: Study participants included first- and second-year DPT students from eight physical therapist education programs in the Midwestern United States. In this cross-sectional, descriptive study, participants completed a survey during the didactic portion of their curriculum that included demographic information, the 10-item Perceived Stress Scale (PSS), and the Undergraduate Sources of Stress (USOS) Scale. RESULTS: The response rate was 84% with a total of 545 returned surveys. The mean PSS score was 15.7 out of a possible 40, with a range from 0 to 34. There were significant differences in levels of stress between universities and based on sex, with females reporting greater levels of stress than males. Respondents identifying higher levels of exercise, sleep, and social support reported lower levels of stress. DISCUSSION: Participants in this study reported lower mean PSS scores compared to age-matched norms and students in other healthcare programs.

Sickness Absence Recommendation Among Outpatients With ADHD and Comorbidity: A Latent Class Analysis.

Objective: Determine sickness absence recommendation (SAR) prevalence for treatment-seeking patients with ADHD depending on comorbidity. Method: Population-based patient chart review of ADHD outpatients aged 19 to 29 years. The outcome, SAR, included both available financial benefit forms; activity compensation and sickness benefit. Latent class analyses (LCA) of demography and psychiatric comorbidities were performed both with and without SAR as an outcome variable. Results: Overall, 38% received SAR. Latent classes ranged from a from a small class of only females with personality disorders where all had SAR to larger groups characterized by lower comorbidity where 15% to 29% had SAR. In between these extremes were other classes of (a) neurodevelopmental disorders, for example, autism diagnosis or intellectual disabilities, and (b) high rate of anxiety disorder, where SAR rates ranged 46% to 65%. Conclusion: Treatment-seeking ADHD patients can be categorized into clinically relevant subgroups providing opportunities to structure rehabilitation efforts to the individuals' needs.

Improvements in global longitudinal strain after transcatheter aortic valve replacement according to race.

OBJECTIVE: In the United States, racial minorities are underrepresented among patients receiving transcatheter aortic valve replacement (TAVR) and data regarding their outcomes is limited. Global longitudinal strain (GLS) is a measure left ventricular function and has independently predicted outcomes after TAVR. The aim of this study is to assess changes in GLS after TAVR according to race and factors predicting these changes. METHODS: Electronic medical records of patients undergoing TAVR at the University of Illinois, Chicago and Jesse Brown Veteran's Administration Medical Center (Chicago, Illinois) from January 2017-February 2020 were reviewed retrospectively. The most recent transthoracic echocardiogram (TTE) prior to TAVR and the TTE 1-month post-procedure were used to determine GLS. Patients were included if both a pre- and post-procedure study were present and TTE images were of sufficient quality to process strain imaging. RESULTS: A total of 103 patients (average age 76 ± 12 years, 80% male, 42% white) were included. At 1-month post-TAVR, GLS improved for all races: white (-2.7 ± 3.5%, P<0.001), African-American (-2.8 ± 3.3%, P<0.001), and Hispanic (-2.0 ± 2.1%, P<0.001). There were no differences in the degree of improvement among races (P=0.62). Baseline GLS was negatively correlated with changes in GLS overall (r=-0.44, P<0.001). Baseline aortic valve area (cm2) was positively correlated with changes in GLS (r=0.2, P=0.036). CONCLUSIONS: This study demonstrated that GLS improved after TAVR independent of race with similar degrees of change across races. Baseline GLS and aortic valve area predicted strain improvement after TAVR, which suggests that those with more impaired LV function may benefit most from the procedure.

Left Atrial Appendage Occlusion for Stroke Prevention in Nonvalvular Atrial Fibrillation.

The majority of embolic strokes in patients with nonvalvular atrial fibrillation are caused by thrombi in the left atrial appendage. It is projected that strokes related to atrial fibrillation will markedly increase in the future unless effective mitigation strategies are implemented. Systemic anticoagulation has been known to be highly effective in reducing stroke risk in patients with atrial fibrillation. However, bleeding complications and nonadherence are barriers to effective anticoagulation therapy. Surgical and percutaneous left atrial appendage occlusion devices are nonpharmacologic strategies to mitigate the challenges of drug therapy. We present a contemporary review of left atrial appendage occlusion for stroke prevention in nonvalvular atrial fibrillation. A thorough review of the history of surgical and percutaneous left atrial appendage occlusion devices, recent trials, and US Food and Drug Administration milestones of current left atrial appendage occlusion devices are discussed.

Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: prospective cohort study.

OBJECTIVE: To investigate maternal immunoglobulins' (IgM, IgG) response to SARS-CoV-2 infection during pregnancy and IgG transplacental transfer, to characterise neonatal antibody response to SARS-CoV-2 infection, and to longitudinally follow actively and passively acquired antibodies in infants. DESIGN: A prospective observational study. SETTING: Public healthcare system in Santa Clara County (California, USA). PARTICIPANTS: Women with symptomatic or asymptomatic SARS-CoV-2 infection during pregnancy and their infants were enrolled between 15 April 2020 and 31 March 2021. OUTCOMES: SARS-CoV-2 serology analyses in the cord and maternal blood at delivery and longitudinally in infant blood between birth and 28 weeks of life. RESULTS: Of 145 mothers who tested positive for SARS-CoV-2 during pregnancy, 86 had symptomatic infections: 78 with mild-moderate symptoms, and 8 with severe-critical symptoms. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56% to 0.73%) and the cord blood was 58% (95% CI 0.49% to 0.66%). IgG levels significantly correlated between the maternal and cord blood (Rs=0.93, p<0.0001). IgG transplacental transfer ratio was significantly higher when the first maternal positive PCR was 60-180 days before delivery compared with <60 days (1.2 vs 0.6, p<0.0001). Infant IgG seroreversion rates over follow-up periods of 1-4, 5-12, and 13-28 weeks were 8% (4 of 48), 12% (3 of 25), and 38% (5 of 13), respectively. The IgG seropositivity in the infants was positively related to IgG levels in the cord blood and persisted up to 6 months of age. Two newborns showed seroconversion at 2 weeks of age with high levels of IgM and IgG, including one premature infant with confirmed intrapartum infection. CONCLUSIONS: Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than 2 months before delivery. Maternally derived passive immunity may persist in infants up to 6 months of life. Neonates are capable of mounting a strong antibody response to perinatal SARS-CoV-2 infection.

Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: Prospective cohort study.

OBJECTIVE: To investigate maternal immunoglobulins' (IgM, IgG) response to SARS-CoV-2 infection during pregnancy and IgG transplacental transfer, to characterize neonatal antibody response to SARS-CoV-2 infection, and to longitudinally follow actively- and passively-acquired SARS-CoV-2 antibodies in infants. DESIGN: A prospective observational study. SETTING: A public healthcare system in Santa Clara County (CA, USA). PARTICIPANTS: Women with SARS-CoV-2 infection during pregnancy and their infants were enrolled between April 15, 2020 and March 31, 2021. OUTCOMES: SARS-CoV-2 serology analyses in the cord and maternal blood at delivery and longitudinally in infant blood between birth and 28 weeks of life. RESULTS: Of 145 mothers who tested positive for SARS-CoV-2 during pregnancy, 86 had symptomatic infections: 78 with mild-moderate symptoms, and eight with severe-critical symptoms. Of the 147 newborns, two infants showed seroconversion at two weeks of age with high levels of IgM and IgG, including one premature infant with confirmed intrapartum infection. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56-0.73) and the cord blood was 58% (95% CI 0.49-0.66). IgG levels significantly correlated between the maternal and cord blood (Rs= 0.93, p< 0.0001). IgG transplacental transfer ratio was significantly higher when the first maternal positive PCR was 60-180 days before delivery compared to <60 days (1.2 vs. 0.6, p=<0.0001). Infant IgG negative conversion rate over follow-up periods of 1-4, 5-12, and 13-28 weeks were 8% (4/48), 12% (3/25), and 38% (5/13), respectively. The IgG seropositivity in the infants was positively related to IgG levels in the cord blood and persisted up to six months of age. CONCLUSIONS: Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than two months before delivery. Maternally-derived passive immunity may protect infants up to six months of life. Neonates mount a strong antibody response to perinatal SARS-CoV-2 infection.

An examination of older immigrants' use of dental services in the United States.

The recent influx of immigrants aged 65 and older in the United States triggers an increasing need to understand older immigrants' dental services use. This paper uses data (n = 9,617) from the 2004 and 2006 waves of the Health and Retirement Study to examine the dental services use of older Americans. In particular, this study focuses on differences in dental services use between immigrants and natives and potential contributing factors. Multivariate logistic regression analyses showed, contrary to expectation, that older immigrants were more likely to use dental services than older natives despite numerous barriers (odds ratio = 1.30 in 2004). The results in 2006 confirmed these findings. The results from 2004 and 2006 analyses showed dental insurance coverage, sex, and marital status were associated differently with dental services use for immigrants and natives. Implications for current oral health policies and future research of older Americans are discussed, as well as methods for meeting older immigrants' growing dental services needs.

Diagnostic accuracy of upper limb neurodynamic tests for the assessment of peripheral neuropathic pain: A systematic review.

BACKGROUND: Upper limb neurodynamic tests (ULNTs) are used to identify a neuropathic pain component in patients' presenting with arm and/or neck pain. Clinical tests with established diagnostic accuracy are required to not only to inform clinical management but also minimise costs associated with expensive medical investigations. OBJECTIVE: To evaluate the role of ULNTs in assessment of peripheral neuropathic pain and to inform their value in clinical practice when assessing patients with arm and/or neck symptoms. DESIGN: Systematic review was undertaken according to published guidelines, and reported in line with PRISMA-DTA. METHOD: Key databases were searched up to 21/11/2017. INCLUSION CRITERIA: Patient population experiencing arm and/or neck symptoms with suspected peripheral neuropathic involvement, studies that compared ULNT to a reference standard, any study design using primary diagnostic accuracy data. Two reviewers independently assessed risk of bias (ROB) using QUADAS-2. The overall quality of evidence was evaluated using GRADE. RESULTS: Of eight included studies (n = 579), four were assessed as low ROB, although all had concerns regarding applicability. For carpal tunnel syndrome, ULNT1 sensitivity values ranged 0.4-0.93, specificity 0.13-0.93, positive likelihood ratio 0.86-3.67 and negative likelihood ratio 0.5-1.9. For cervical radiculopathy ULNT1 and the combined use of four ULNTs had sensitivity of 0.97 (95%CI 0.85-1.00) whereas the ULNT3 was the most specific (0.87, 95%CI 0.62-0.98). Positive likelihood ratio ranged 0.58-5.68 and negative likelihood ratio 0.12-1.62. CONCLUSION: Based on the available evidence ULNTs cannot be utilised as a stand-alone test for the diagnosis of CTS. Limited evidence suggests that ULNTs may be clinically relevant for the diagnosis of CR, but only as a "ruling out" strategy. However, the overall quality of the body of evidence after applying the GRADE approach was low to very low across studies. Further higher quality research is needed to establish firm conclusions.

Eliminating Risk of Intubation in Very Preterm Infants with Noninvasive Cardiorespiratory Support in the Delivery Room and Neonatal Intensive Care Unit.

INTRODUCTION: Avoiding intubation and promoting noninvasive modes of ventilator support including continuous positive airway pressure (CPAP) in preterm infants minimizes lung injury and optimizes neonatal outcomes. Discharge home on oxygen is an expensive morbidity in very preterm infants (VPI) with lung disease. In 2007 a standardized bundle was introduced for VPI admitted to the neonatal care unit (NICU) which included delayed cord clamping (DCC) at birth and noninvasive ventilation as first-line cardiorespiratory support in the delivery room (DR), followed by bubble CPAP upon NICU admission. OBJECTIVE: Our goal was to evaluate the risk of (1) intubation and (2) discharge home on oxygen after adopting this standardized DR bundle in VPI born at a regional perinatal center and treated in the NICU over a ten-year period (2008-2017). MATERIALS AND METHODS: We compared maternal and neonatal demographics, respiratory care processes and outcomes, as well as neonatal mortality and morbidity in VPI (< 33 weeks gestation) and extremely low birth weight (ELBW, < 1000 g) subgroup for three consecutive epochs: 2008-2010, 2011-2013, and 2014-2017. RESULTS: Of 640 consecutive inborn VPI, 55% were < 1500 g at birth and 23% were ELBW. Constant through all three epochs, DCC occurred in 83% of VPI at birth. There was progressive increase in maternal magnesium during the three epochs and decrease in maternal antibiotics during the last epoch. Over the three epochs, VPI had less risk of DR intubation (23% versus 15% versus 5%), NICU intubation (39% versus 31% versus 18%), and invasive ventilation (37% versus 30% versus 17%), as did ELBW infants. Decrease in postnatal steroid use, antibiotic exposure, and increase in early colostrum exposure occurred over the three epochs both in VPI and in ELBW infants. There was a sustained decrease in surfactant use in the second and third epochs. There was no significant change in mortality or any morbidity in VPI; however, there was a significant decrease in pneumothorax (17% versus 0%) and increase in survival without major morbidity (15% versus 41%) in ELBW infants between 2008-2010 and 2014-2017. Benchmarked risk-adjusted rate for oxygen at discharge in a subgroup of inborn VPI (401-1500 g or 22-31 weeks of gestation) is 2.5% (2013-2017) in our NICU compared with > 8% in all California NICUs and > 10% in all California regional NICUs (2014-2016). CONCLUSION: Noninvasive strategies in DR and NICU minimize risk of intubation in VPI without adversely affecting other neonatal or respiratory outcomes. Risk-adjusted rates for discharge home on oxygen remained significantly lower for inborn VPI compared with rates at regional NICUs in California. Reducing intubation risk in ELBW infants may confer an advantage for survival without major morbidity. Prenatal magnesium may reduce intubation risk in ELBW infants.

New body composition reference charts for preterm infants.

BACKGROUND: The American Academy of Pediatrics (AAP) has recommended that nutritional management of the preterm infant should aim to achieve body composition that replicates the in utero fetus, but intrauterine body composition reference charts for preterm infants are lacking. OBJECTIVE: Our objective was to create body composition reference curves for preterm infants that approximate the body composition of the in utero fetus from 30 to 36 wk of gestation. DESIGN: A total of 223 ethnically diverse infants born at 30 + 0 to 36 + 6 wk of gestation were enrolled. Inclusion and exclusion criteria were specified so that the sample would represent healthy appropriately growing fetuses (e.g., singleton, birth weight appropriate for their gestational age, and medically stable). Cross-sectional reference values were generated for fat mass (FM), fat-free mass (FFM), and percentage body fat (PBF) by gestational age (GA), with the use of air-displacement plethysmography (ADP) and the lambda-mu-sigma method for percentile estimation. RESULTS: GA-specific percentile values and a percentile and z score calculator for FFM, FM, and PBF are presented. These values aligned closely with ADP centile values published for term infants from 36 to 38 wk of gestation. The medians were also similar to the mean values for the reference fetus derived from chemical analysis previously. CONCLUSIONS: To our knowledge, these are the first body composition reference charts for total FM and FFM at birth in preterm infants to assist in following AAP guidelines. Future work will test the clinical utility of body composition monitoring for improving nutritional management in this population. This trial was registered at clinicaltrials.gov as NCT02855814.

Diagnosis and Treatment Procedures for Patients With Anxiety Disorders by the Psychiatric Consultation Liaison Service in a General Hospital in Germany: A Retrospective Analysis.

OBJECTIVE: To investigate the population of patients with anxiety disorders in a general hospital in Germany who required treatment by a consultation psychiatrist. METHOD: A retrospective investigation of psychiatric consultations concerning 119 patients with anxiety disorders (DSM-IV criteria) from January 1, 2011, to December 31, 2012, was conducted in a general hospital of the Charité Berlin, Berlin, Germany. The frequency of different anxiety disorders, the distribution of anxiety disorders among the departments of the general hospital, and the recommended treatment procedure were investigated. RESULTS: The largest group of patients with anxiety symptoms presented panic attacks. Many of these patients sought treatment in the emergency department of the hospital primarily due to their anxiety symptoms. Within the group of somatically ill patients, panic attacks were prominent, especially in patients with cardiac or respiratory diseases. Treatment procedures comprised pharmacologic and psychotherapeutic interventions. Benzodiazepines and psychoeducation were common acute treatments; antidepressants, pregabalin, and psychotherapy were recommended for long-term treatment. CONCLUSIONS: Many patients who primarily suffer from symptoms of anxiety seek treatment in a general hospital, especially in the emergency department. It is therefore very important for the individual patient as well as the health care system that the correct treatment is initiated. The consultation-liaison psychiatric service within a general hospital is important to ensure the best possible diagnostic procedures as well as treatment for patients with anxiety disorders.

Microglia from mice transgenic for a provirus encoding a monocyte-tropic HIV type 1 isolate produce infectious virus and display in vitro and in vivo upregulation of lipopolysaccharide-induced chemokine gene expression.

A large body of evidence has indicated that microglia are the predominant cellular location for HIV-1 in the brains of HIV-1-infected individuals and play a direct role in the development of HIV-1-associated dementia (HAD). Therefore, investigation of the mechanism by which HIV-1-infected microglia contribute to the development of HIV-associated dementia should be facilitated by the creation of a mouse model wherein microglia carry replication-competent HIV-1. To circumvent the inability of HIV-1 to infect mouse cells, we developed a mouse line that is transgenic for a full-length proviral clone of a monocyte-tropic HIV-1 isolate, HIV-1(JR-CSF) (JR-CSF mice), whose T cells and monocytes produce infectious HIV-1. We detected expression of the long terminal repeat-regulated proviral transgene in the microglia of these transgenic mice and demonstrated that it was increased by in vitro and in vivo stimulation with lipopolysaccharide. Furthermore, microglia isolated from JR-CSF mouse brains produced HIV-1 that was infectious in vitro and in vivo. We examined the effect that carriage of the HIV-1 provirus had on chemokine gene regulation in the brains of these mice and demonstrated that MCP-1 gene expression by JR-CSF mouse microglia and brains was more responsive to in vitro and in vivo stimulation with lipopolysaccharide than were microglia and brains from control mice. Thus, this study indicates that the JR-CSF mice may represent a new mouse model to study the effect of HIV-1 replication on microglia function and its contribution to HIV-1-associated neurological disease.

Retinopathy of prematurity and pulse oximetry: a national survey of recent practices.

OBJECTIVE: To determine if practices related to the use of pulse oximetry in the first 2 weeks following birth and after 2 weeks of age have a relationship to the rate of retinopathy of prematurity (ROP) and retinal ablation surgery in infants < or =1500 g. STUDY DESIGN: A questionnaire was mailed in July 2001 to 318 neonatal intensive care units (NICUs) in the United States and information was collected regarding SpO2 guidelines and the rate of both severe ROP and retinal ablation surgery. RESULTS: A total of 142 surveys were returned (45%). In all, 87% of the NICUs had SpO2 guidelines, and 60% of these centers maintained a different range of SpO2 for infants < or = or >2 weeks of age. The range of SpO2 was 82 to 100% with an average minimum (min) and maximum (max) of 89 and 95%, respectively. In the NICUs with an SpO2 max of >98% in the first 2 weeks following birth, the rate of retinal ablation surgery was 5.5 vs 3% in those units with a max SpO2 >98% (p<0.05). After 2 weeks of age, the rate of retinal ablation surgery was 3.3% when max SpO2 was >92 vs 1.3% when the max SpO2 was < or =92% (p<0.00001). The rate of > or =stage 3 ROP after 2 weeks of age was 5.5% when max SpO2 was >92 vs 2.4% when max SpO2 was < or =92% (p<0.0005). CONCLUSION: NICUs in the US today have a wide range of SpO2 guidelines. The results of this survey show a "gradient of risk" towards less retinal ablation surgery when the max SpO2 is <98% in the first 2 weeks following birth (p<0.05). There was a statistically significant lower rate of > or =stage 3 ROP and retinal ablation surgery when the max SpO2 was < or =92% after the first 2 weeks of age. A randomized, controlled trial is needed to establish a safe upper limit of SpO2 in the premature infant at risk for developing ROP.