Secular changes in rehospitalization of very low birth weight infants.

Neonatal survival among very low birth weight infants (less than 1,500 g) has improved dramatically during the last decade. Concern about the quality of life among these survivors has focused mainly on the prevalence of severe motor, sensorineural, and intellectual impairment. This study examined the possible effects of increasing survival on less serious morbidity as evidenced by hospital readmission patterns. The experience of VLBW survivors in a geographically defined population has been compared with that of a randomly selected group of heavier infants. As VLBW infant survival rates improved from 35% to 48% between 1968 to 1972 and 1974 to 1978, the rehospitalization rate before 2 years of age increased from 22% to 27%. In contrast, among heavier infants, rehospitalization rates decreased from 9.8% to 8.9%. The relative risk of readmission associated with VLBW thus increased from 2.2 to 3.0. Although this increase in the overall relative risk of rehospitalization in VLBW infants was not statistically significant, there was a dramatic and statistically significant increase in the relative risk of being readmitted because of structural defects (particularly hernias). Overall, there was a marked decline in the number of days spent in the hospital in both birth weight groups.

Factors affecting the outcome of maternity care. II. Neonatal outcomes and resources beyond the hospital of birth.

Analysis of data about perinatal mortality and indicators of resources at maternity hospitals in the West Midlands region between 1977 and 1983 showed that paediatric staff ratios were inversely related to in-house mortality rates. In this paper, the outcomes for and resources used by transferred babies are added to those of the hospital of birth for three of the study years--1978, 1980, and 1982. Patterns of transfer differ between units and over time in the region, and a regional neonatal intensive care policy was introduced in 1980. Analysis of the new variables showed that in 1978 paediatric staffing was significantly inversely related to neonatal mortality. In later years, neonatal mortality of births at maternity units is explained entirely by the proportion of low or very low weight births.

Warfarin therapy: a review of the literature since the Fifth American College of Chest Physicians' Consensus Conference on Antithrombotic Therapy.

Evidence-based medicine is currently a fashionable term. The evidence that warfarin is safe, effective, and cost beneficial in preventing stroke in AF, DVT treatment, and DVT prophylaxis is mounting. However, the evidence that warfarin remains underutilized in these conditions is also mounting. There is new evidence that supports conservative management of overanticoagulation without bleeding. The amount of time, if any, that patients are off warfarin for various procedures is being reduced. Warfarin interactions with other agents continue to be reported so that practitioners can avoid or treat them. Even the contraindication of warfarin in pregnancy is being reexamined. Those with expertise in anticoagulation therapy have an imperative to inform colleagues about the evidence in favor of warfarin.