A Prospective Study of Parent Health-Related Quality of Life before and after Discharge from the Neonatal Intensive Care Unit.

OBJECTIVE: To determine how infant illness and parent demographics are associated with parent health-related quality of life (HRQL) during and 3 months after hospitalization in the neonatal intensive care unit (NICU). We hypothesized that parents of extremely preterm infants would report lower NICU HRQL than other parents, and that all parents would report improved HRQL after discharge. STUDY DESIGN: This prospective study of parent-infant dyads admitted to a level IV NICU for ≥14 days from 2016 to 2017 measured parent HRQL before and 3 months after discharge using the Pediatric Quality of Life Inventory Family Impact Module. Multivariable regression was used to identify risk factors associated with HRQL differences during hospitalization and after discharge. RESULTS: Of the 194 dyads, 167 (86%) completed the study (24% extremely preterm; 53% moderate to late preterm; 22% term). During the NICU hospitalization, parents of extremely preterm infants reported lower adjusted HRQL (-7 points; P = .013) than other parents. After discharge, parents of extremely preterm infants reported higher HRQL compared with their NICU score (+10 points; P = .001). Tracheostomy (-13; P = .006), home oxygen (-6; P = .022), and readmission (-5; P = .037) were associated with lower parent HRQL 3 months after discharge, adjusted for NICU HRQL score. CONCLUSIONS: Parents of extremely preterm infants experienced a greater negative impact on HRQL during the NICU hospitalization and more improvement after discharge than parents of other infants hospitalized in the NICU. Complex home care was associated with lower parent HRQL after discharge. The potential benefit of home discharge should be balanced against the potential negative impact of complex home care.

Epidemic Adolescent Binge Drinking at Lollapalooza, A Music Festival in Chicago.

OBJECTIVES: Lollapalooza (LP) is an annual 3-day outdoor music festival in Chicago. Underage drinking and drug use are believed to be common, but the burden on emergency departments (EDs) has not been documented. We assessed the burden on health care resources associated with this music festival. METHODS: We performed a retrospective chart review of adolescent (aged 11-20 years) ED visits during LP weekend and 4 summer comparison weekends at Lurie Children's Hospital in Chicago, Ill, in 2014 (n = 356). We then analyzed adolescent alcohol- and drug-related hospital visits to all Chicago hospitals for each weekend in 2014 0 using Illinois hospital discharge data. RESULTS: Adolescents accounted for a greater proportion of our ED visits during LP weekend than comparison weekends (25% vs 19%, P < 0.02). Lollapalooza weekend patients were more likely female (P = 0.025), older (P = 0.0067), more often unsupervised (P < 0.0001), and less likely to live in the city (P < 0.001) than adolescents seen during comparison weekends. Thirty-one underage adolescents who attended LP were treated in our ED; 84% were intoxicated (blood alcohol content, 88-328 mg/dL). Citywide there was an 11-fold increase in adolescent alcohol-related hospital visits during LP weekend compared with an average weekend. Drug intoxication was much less common. CONCLUSIONS: Adolescents seen in our ED the weekend of LP were older, more often female, frequently unsupervised, and less likely to be city residents than those seen during comparison weekends. Those who attended LP had high rates of alcohol intoxication. This surge of intoxicated adolescent patients affected numerous EDs in the city.

The Relation of Maternal Birth Weight to African-American and Non-Latina White Twin Pregnancy Outcomes: A Population-Based Study.

Objectives The authors investigated the association between maternal birth weight and adverse birth outcome as measured by rates of low birth weight (<2500 g, LBW), preterm birth (<37 weeks, PTB), and small for gestational age (weight <10th percentile for gestational age, SGA) among African American and White twin pregnancies. Methods Stratified and multivariable regression analyses were performed on the Illinois transgenerational dataset of non-Latina African American and non-Latina White twin pairs (born 1989-1991) and their mothers (born 1956-1976). Results Former LBW (n = 104) and non-LBW (n = 742) African American mothers had LBW rates in both twins of 76 and 56 %, respectively; RR (95 % CI) = 1.4 (1.2-1.6). Former LBW (n = 105) and non-LBW (n = 2136) White mothers had LBW rates in both twins of 41 and 34 %, respectively; RR = 1.2 (0.9-1.5). In multivariable regression models, the adjusted (controlling for maternal age, education, marital status, parity, prenatal care usage, and cigarette smoking) RR of LBW in both twins among former LBW (compared to non-LBW) African American and White mothers equaled 1.4 (1.2-1.6) and 1.2 (0.9-1.5), respectively. Maternal LBW was associated with a modestly increased risk of PTB but not SGA among African American twin pregnancies: adjusted RR = 1.3 (1.1-1.4) and 1.1 (0.8-1.5), respectively. Conclusions In African American twin pregnancies, maternal LBW is a risk factor for LBW in both twins. Further research is needed to determine whether a similar generational association occurs among non-Latina White twin pregnancies.

Medical student-developed obesity education program uses modified team-based learning to motivate adolescents.

BACKGROUND: Childhood obesity is reaching epidemic proportions and requires intervention. AIMS: To educate high school (HS) students on the effects of obesity and implement small healthy changes. Train medical students to educate and motivate adolescents and utilize a modified team-based learning format. METHODS: A medical student-created HS-based module was developed to educate adolescents on obesity's effects on health. Over 2 years, 25 medical students from each semester were trained and presented to 1590 freshmen and sophomores at suburban HSs in Milwaukee, Wisconsin. The program included an interactive power point and a 30-day challenge to make small measurable changes in their current health behaviors. A modified team-based learning format was included to engage students and increase classroom interaction. RESULTS: Medical students reported the program improved their ability to communicate with adolescents and enhanced their training as future physicians. Teachers felt students had sustained retention of knowledge at the end of 30 days and the majority of students fulfilled their self-imposed challenge. CONCLUSION: A student-run HS obesity education module using a portion of team-based learning was successfully implemented into HS health science curriculums, exposed medical students to community advocacy while educating and motivating adolescents to improve health behaviors.

Infant illness severity and perinatal post-traumatic stress disorder after discharge from the neonatal intensive care unit.

BACKGROUND: Risk factors for perinatal posttraumatic stress disorder (PTSD) among parents of an infant in the NICU have varied in previous literature. The relationships between perception of illness severity and objective measures of illness severity with PTSD are not well understood. AIMS: To determine if PTSD among parents after an infant NICU discharge can be predicted by 1) objective measures of infant illness severity or 2) perceptions of infant illness severity. STUDY DESIGN: A prospective, observational study. SUBJECTS: Parent/infant dyads who were in the NICU for ≥14 days. OUTCOME MEASURES: Objective measures of illness severity were obtained from the electronic health record. Perceptions of illness were measured by the response to the question, "How sick is your child/patient?" on a 5-point Likert scale. The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was completed by parents three months after discharge. RESULTS: One hundred ninety-four dyads participated in the study, 86% of parents completed follow up screening. 25% of parents screened positive for PTSD. Parents perceived infants to be sick more often than hospital caregivers. In bivariate analysis many objective measures of illness severity were associated with PTSD. Parent perceptions of illness were also associated with PTSD after adjusting for objective measures of illness (OR 3.2, 95% CI 1.1-6.1, p = 0.008). CONCLUSIONS: PTSD in parents after NICU discharge is multifactorial. Objective illness risk factors can be used to screen parents at risk. Hospital caregivers should strive to understand parents' perception of illness and improve communication to potentially decrease PTSD after discharge.

NICU management and outcomes of infants with trisomy 21 without major anomalies.

OBJECTIVE: To describe how trisomy 21 affects neonatal intensive care management and outcomes of full-term infants without congenital anomalies. STUDY DESIGN: Retrospective cohort of full-term infants without anomalies with and without trisomy 21 admitted to Pediatrix NICUs from 2005 to 2012. We compared diagnoses, management, length of stay, and discharge outcomes. RESULTS: In all, 4623 infants with trisomy 21 and 606 770 infants without trisomy 21 were identified. One-third of infants in the NICU with and without trisomy 21 were full term without major anomalies. Trisomy 21 infants had more respiratory distress, thrombocytopenia, feeding problems, and pulmonary hypertension. They received respiratory support for a longer period of time and had a longer length of stay. CONCLUSION: One-third of infants with trisomy 21 admitted to the NICU are full term without major anomalies. Common diagnoses and greater respiratory needs place infants with trisomy 21 at risk for longer length of stay.

Survivorship of penstemon grandiflorus in an oak woodland: combined effects of fire and pocket gophers.

The effects of fire and pocket gophers, Geomys bursarius, on the survivorship of Penstemon grandiflorus growing in an oak woodland in Minnesota were studied from 1986 to 1990. Plants growing in sparse vegetation experienced mortality rates twice that of plants growing in dense vegetation. This difference was due partly to pocket gophers whose earth moving activities reduce the density of vegetation and bury and kill individual Penstemon plants. Laboratory feeding trials showed that gophers readily eat Penstemon, particularly the fleshy roots. An experiment involving the removal of 25-75% of the root tissue in 90 plants showed that root loss significantly reduced survivorship, suggesting that gopher herbivory might also kill plants. When gophers were experimentally excluded, plants growing in sparse vegetation exhibited significantly lower mortality rates than those growing in dense vegetation. Plants in the smallest size class exhibited reduced survivorship following a late spring burn; however, overall patterns of survivorship of plants in burned areas did not differ markedly from those in the unburned areas. A longitudenal analysis of plants with different reproductive histories revealed no survivorship cost to reproduction. Mortality rates decreased with increasing plant size. Small plants were more likely to be killed by fire and by being buried under gopher mounds. Differences in underground energy reserves of small and large plants can account for most of the survivorship patterns observed in this study. The study shows that within openings of the oak woodland, fire and gophers reduce the survival of individual Penstemon plants. Nevertheless, since both gophers and fire also serve to perpetuate suitable habitat in the woodland, Penstemon is ultimately dependent on both for its long term persistence in the landscape.

Cerebellar mutism in acute disseminating encephalomyelitis.

BACKGROUND: Cerebellar mutism in children occurs after posterior fossa tumor resection and can have lasting effects on cognition, language, and behavior. Cerebellar mutism in acute disseminated encephalomyelitis is rare. PATIENT: A 7-year-old boy with a 3-day history of fever, vomiting, and diarrhea presented with altered mental status and expressive aphasia. Magnetic resonance imaging showed new diffusion restriction in the bilateral dentate nuclei and right cerebellum. With treatment, he began to verbalize again but had long-term cognitive and language difficulties. CONCLUSION: Acute disseminated encephalomyelitis is commonly a benign process, but its effect on the cerebellum can be long-lasting.