Necrotizing enterocolitis and its association with the neonatal abstinence syndrome.

OBJECTIVE: The purpose of this study was to describe an identified association between necrotizing enterocolitis (NEC) and prenatal opioid exposure with neonatal abstinence syndrome (NAS) in late preterm and full-term neonates. STUDY DESIGN: In this single-center retrospective cohort study, we analyzed inborn neonates with the diagnosis of NEC discharged from 2012 through 2017. We compared infants with NEC > 35 weeks' gestation to those with NEC<35 weeks' gestation. We compared gestational age, birth weight, age of onset of symptoms, and incidence of prenatal drug exposure between groups. Significance was determined using Mann-Whitney and Fisher's exact tests. RESULTS: Over the study period, 23 infants were identified with NEC, 9 (39%) were babies > 35 weeks at birth and 14 (61%) < 35 weeks. Those > 35 weeks had a higher birth weight, earlier onset of symptoms, and a higher percentage of prenatal exposure to opioids compared to those < 35 weeks' gestation. We further described seven infants with late gestational age onset NEC associated with prenatal opioid exposure. CONCLUSIONS: In this cohort of infants with NEC discharged over a 6 year period we found a higher than expected percentage of infants born at a later gestational age. We speculate that prenatal opioid exposure might be a risk factor for NEC in neonates born at > 35 weeks.

A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic.

OBJECTIVE: The purpose of this study was to test a specialized needs-based management model for a high volume of babies born with neonatal abstinence syndrome (NAS) while controlling costs and reducing neonatal intensive care unit (NICU) bed usage. STUDY DESIGN: Data were analyzed from inborn neonates >35 weeks' gestational age with the diagnosis of NAS (ICD9-CM 779.5), requiring pharmacologic treatment and discharged from 2010 through 2015. Significance was determined using Kruskal-Wallis and Mann-Whitney as well as χ2 for trend. RESULTS: NAS requiring medication treatment increased from 34.1 per 1000 live births in 2010 to 94.3 per 1000 live births in 2015 (P<0.0001 for trend). Hospital charges were significantly different in the three described locations (P<0.0001). Median per patient hospital charges for medically treated NAS were $90 601 (interquartile range (IQR) $64 489 to $128 135) for NAS patients managed in the NICU, $68 750 (IQR $44 952 to $92 548) for those managed in an in-hospital dedicated unit and $17 688 (IQR $9933 to $20 033) for those cared for in an outpatient neonatal withdrawal center. NICU admission was avoided in 78% of the population once both alternative locations were fully implemented. CONCLUSIONS: In this cohort of infants, a 219% increase in the number of infants treated for NAS overwhelmed the capacity of our traditional resources. There was a need to develop new treatment approaches dealing with the NAS crisis and a growing population of prenatally exposed babies. We found that the described model of care significantly reduced charges and stabilized admissions to our NICU despite the marked increase in cases. Without this system, our NICU would be in a critical state of gridlock and diversion; instead, we have efficient management of a large NAS population.

The work of rehabilitation.

PURPOSE: To describe three years of activity of a rehabilitation unit and to make comparisons between clients who receive different levels of active rehabilitation. METHOD: A retrospective study set in an inpatient rehabilitation facility located in Dunedin, New Zealand, examining 874 inpatient admissions over three financial years (2000--2002). Outcome measures include Functional Independence Scores (FIM) at admission and discharge, length of stay, weekly gains in FIM scores, and changes in FIM sub-scores. RESULTS: Assessment and rehabilitation patients made significant FIM gains in comparison to assessment only and social relief (respite care) patients. Assessment and rehabilitation patients showed greater gains in the Physical dimensions of the FIM in comparison to the Cognitive although this is probably a function of different scaling. Floor and ceiling effects were not present in the FIM. CONCLUSIONS: The interdisciplinary rehabilitation program brings about real functional and cognitive gains in a range of patients as measured with the FIM. This adds to the considerable body of research which documents FIM gains and further provides evidence that physical and cognitive gains differ.

Traumatic mutism in severe head injury relieved by oral diazepam.

A 34-year-old woman with a severe closed-head injury had many impairments including apparent global aphasia. After a diazepam premedication for a motor point block she was heard to speak a few words. A trial of oral diazepam succeeded in restoring speech adequate to make her needs known, which persisted on a maintenance dose of 5 mg t.d.s. The possible diagnoses and reasons for this phenomenon are discussed. We suggest that diazepam may be useful in assessing speech in selected people with severe head injuries.

Do 'social relief' admissions have any effect on patients or their care-givers?

Dependent patients and their care-givers were studied before and 1 week after a social relief admission in order to assess the effects on physical and psychological problems. Data about care-givers stress and mental health were gathered, as well as patient data. Patients' self-care abilities improved slightly but care requirements remained constant. Care-giver stress levels did not change, but there was a highly significant improvement in their mental health. The results suggest that social relief admissions enabled care-givers to continue to look after very dependent people in the community.

Hospital morbidity due to head injuries in New Zealand in 1980-1988.

We studied the morbidity in New Zealand using hospital discharge data from 1980 to 1988, and found a reduced head injury (HI) rate over this time overall, but no change in the rate among Maori males and an increased rate among Maori females. In 1988 the rate was 228/100,000 with peaks among males and females aged under 10, males aged 15-25, and both sexes over 84 years old. The rate among young Maori males was higher than in other groups until the age of 55. Motor vehicle crashes caused most head injuries, followed by falls, non-intentional incidents (such as sporting injuries), assaults and pedal cycle accidents. Maori females had a high rate of assault. Hospital stay was longest among pedestrians, and increased with increasing age due to co-morbidity. Prevention strategies were based on the causes of HI.

Epidemiology of spinal cord injury in New Zealand.

Spinal cord injury (SCI) is a catastrophic and costly result of both intentional and unintentional injury. We present data from the Health Statistics Services files of New Zealand for the year 1988 on the epidemiology of SCI resulting in morbidity. New Zealand has one of the highest rates of SCI in the western world and since 1979 this has been increasing. It occurs most often to young, caucasian men and is typically the result of motor transport crashes. The ethnicity adjusted rates show high rates for Maori males. Children in New Zealand have greater than 4 times the risk of an SCI than American children. The rehabilitation and hospital costs for SCI are among the highest for all injuries. There were a higher number of high cervical injuries than reported in previous series and 92% of SCI were incomplete indicating the high rehabilitation potential of the sample. Some measures are suggested to reduce the incidence of SCI.

Is the prevalence of Parkinson's disease in New Zealand really changing?

The prevalence of idiopathic Parkinson's Disease (IPD) in Dunedin, New Zealand on 31st July 1990 was 110.4/100,000. When corrected to a standard population based on the 1960 U.S. census, the prevalence fell to 76.0/100,000 due to changes in the age structure of the population. The corrected prevalence in Wellington (another New Zealand city), in 1962 was 99.6 (before the introduction of levodopa), and in Aberdeen, Scotland in 1984 was 102.7. The principal difference was fewer people under 65 years of age in our study. Case finding methods and diagnostic criteria were similar in all three studies, and case ascertainment was adequate. Under representation of younger people could be due to either a lower incidence rate or poorer survival due to treatment with high doses of levodopa compounds. Prospective research is required to explain our findings.