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Researchers focus on early discharge of newborns, low birthweight consequences, and parental misconceptions about colds

Researchers supported by the Agency for Healthcare Research and Quality recently examined several children's health issues. The first AHRQ-supported study (National Research Service Award training grant T32 HS00086) found that infants born to low-income mothers are twice as likely as other newborns to be discharged early from the hospital and to not receive timely followup care. The second AHRQ-supported study (HS08385) revealed that, by the time extremely low birthweight (ELBW) babies reach adolescence, they do not perceive that they have more behavioral problems than other adolescents. According to the third AHRQ-supported study (National Research Service Award training grant T32 HS00063) parental misconceptions about the appropriate treatment of colds are predictive of increased use of health services, including inappropriate use of antibiotics.

Galbraith, A.A., Egerter, S.A., Marchi, K.S., and others (2003, February). "Newborn early discharge revisited: Are California newborns receiving recommended postnatal services?" Pediatrics 111(2), pp. 364-371.

Despite an apparent decline in short stays following delivery, this study found that half of 2,828 medically low-risk newborns were discharged early (1-night stay or less after vaginal delivery and 3-night stay or less after cesarean delivery). Newborns from low-income families were more than twice as likely to be discharged early. Among newborns discharged early, 68 percent did not receive followup care within the recommended timeframe (no home or office visit within 2 days of early discharge). Untimely care was nearly twice as likely for infants of women who were low-income, insured by Medicaid, and non-English speaking.

The most socioeconomically vulnerable newborns are receiving fewer postnatal services, conclude the researchers. Their findings were based on a retrospective study of 2,828 medically low-risk infants, using the results of a 1999 California postpartum survey.

Saigal, S., Pinelli, J., Hoult, L., and others (2003, May). "Psychopathology and social competencies of adolescents who were extremely low birth weight." Pediatrics 111(5), pp. 969-975.

These authors previously demonstrated that infants who were extremely low birthweight (ELBW) were particularly vulnerable to problems related to inattention and hyperactivity at school as reported by parents and teachers. In this study, ELBW adolescents aged 12 to 16 years did not perceive themselves to have significantly greater behavioral problems than control teens in the following six areas: conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder (ADHD), overanxious, separation anxiety, and depression.

However, parents of ELBW teens reported significantly higher scores for depression and ADHD for their ELBW teens than parents of control teens. Overall, the findings of this study are reassuring. Although there are still a few mild residual behavioral problems and some concerns with adaptive functioning as reported by parents, the ELBW adolescents seem to view themselves positively and are engaging in fewer risk-seeking behaviors. The results were based on responses to the six behavioral subscales of the Ontario Child Health Study-Revised questionnaire by 141 ELBW teens and 122 control teens and their parents.

Lee, G.M., Friedman, J.F., Ross-Degnan, D., and others (2003, February). "Misconceptions about colds and predictors of health service utilization." Pediatrics 111(2), pp. 231-236.

Most upper respiratory infections, including colds, are caused by viruses which, unlike bacteria, do not respond to antibiotics. Yet in this survey, 93 percent of parents understood that viruses cause colds, but 66 percent of them also believed that colds are caused by bacteria. Over half of parents (53 percent) believed that antibiotics are needed to treat colds. Twenty-three percent said they would visit the emergency department (ED), and 60 percent said they would visit the doctor's office if their child had a cold.

Parental misconceptions about appropriate treatment may contribute to unnecessary health care use. Belief that antibiotics should be used to treat colds increased by four times the likelihood of an ED or office visit for a cold. These findings are based on a survey of parents who were randomly selected from five Massachusetts pediatric practices and had a child who attended child care with at least 5 other children for 10 or more hours a week.

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