Graphical exploration of dimensions of preterm infant growth in weight in association with biological, nutritional, and energy expenditure conditions.

The small sample sizes of studies involving preterm infants limit the use of statistics for examination of multivariate conditions contributing to clinically important growth dimensions of weight: rate of weight gain, body composition (fat-free and fat mass), and weight relative to reference infants (z score). The authors used graphical analyses, including multivariate proportional matrix, parallel coordinates, and bivariate plots with regression lines and splines, to explore specific variables derived from a theoretical model of biological, nutritional intake, and energy expenditure conditions influencing growth dimensions. The sample included 28 infants in 4 birth-weight categories: extremely low (<1,000 g), very low/smaller (1,000-1,249 g), very low/larger (1,250-1,499 g), and low (1,500-1,750 g). The authors examined the rate of weight gain before and after nipple feeding initiation. Fat-free mass was estimated with total body water and fetal reference data, and fat mass with skinfold thicknesses. Despite infants achieving the expected rate of weight gain for a fetus of the same postconceptional age, by hospital discharge 13 infants showed growth restriction with weight <10th centile. Infants with respiratory distress syndrome history were highest in negative z-score change from regain of birth weight to discharge, despite higher ordering on protein intake and fat-free mass. Graphical analyses provided visual patterns of distributions and orderings of measures of multiple variables that, taken together, identified potential influencing conditions and raised questions for further study. Other variables, including feeding protocols and practices, infant feeding competence, and health status, may contribute to variability in weight growth dimensions and influence relationships with biologic, nutritional, and energy expenditure conditions.

Screening for maternal depression in the neonatal ICU.

Postpartum depression is common in women with infants in the neonatal ICU. Maternal depression can affect infant health and development adversely. A screening program for depression in the neonatal ICU could identify women who have depressive symptoms and facilitate their referral for follow-up services.

Legal and ethical considerations: risks and benefits of postpartum depression screening at well-child visits.

Pediatric professionals are being asked to provide an increasing array of services during well-child visits, including screening for psychosocial and family issues that may directly or indirectly affect their pediatric patients. One such service is routine screening for postpartum depression at pediatric visits. Postpartum depression is an example of a parental condition that can have serious negative effects for the child. Because it is a maternal condition, it raises a host of ethical and legal questions about the boundaries of pediatric care and the pediatric provider's responsibility and liability. In this article we discuss the ethical and legal considerations of, and outline the risks of screening or not screening for, postpartum depression at pediatric visits. We make recommendations for pediatric provider education and for the roles of national professional organizations in guiding the process of defining the boundaries of pediatric care.

Regionalization of perinatal care in Wisconsin: a changing health care environment.

Wisconsin has recently experienced a rapid increase in the number of neonatal intensive care units (NICUs), from 6 in the 1970s to 18 in 2003. Over the last year, the Wisconsin Association for Perinatal Care (WAPC) convened meetings in response to threats to regionalized care and worsening of perinatal outcomes, noted especially in some racial/ethnic groups. WAPC defined actions to address quality improvement, including adoption of designations for levels of care published by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, definition of perinatal outcomes sensitive to quality of care, collection and analysis of outcome data, and continued statewide discussions about the status of regionalized care and outcomes. WAPC invites others to join in cooperative efforts to address quality of care and responsible utilization of resources.