Neonatal outcome in newborns from mothers with endocrinopathies

Introduction.?Hypothyroidism and gestational diabetes are common endocrine disorders in pregnancy. Our aim is to evaluate the outcome of newborns from mothers with hypothyroidism and from mothers with gestational diabetes.

Patients and methods.?The study analysed 216 newborns: 112 from mothers with gestational diabetes and 104 from mothers with hypothyroidism. For each case, we included as a control a newborn of same sex and gestational age from a mother without diabetes or thyreopathy.

Results.?In newborns from mothers with gestational diabetes there was an increased frequency of hypoglycaemia and hypocalcaemia, of lower head circumference and of small-for-gestational age (SGA) birth or macrosomy (LGA) than controls. The newborns from mothers with hypothyroidism are more frequently SGA or LGA and they have a slightly increased risk of hypoglycaemia.

Conclusions.?Newborns from mothers with diabetes mellitus or hypothyroidism have an increased risk of being SGA or LGA, and to develop a mild transient hypoglycaemia. Newborns from mothers with diabetes mellitus have also an increased risk to develop hypocalcaemia and to have a lower head circumference than controls. Thus, to prevent SGA or LGA births, it is very important an early diagnosis and treatment, and a strict metabolic control of these conditions.     

The admission rate in neonatal intensive care units of newborns born to adolescent mothers

Aim.?Although the effect of adolescent pregnancy on perinatal mortality and morbidity is known, data on the neonatal hospitalization rate in these deliveries have not been reported. We aimed to assess the possible effects of adolescent pregnancies on the hospital outcomes of the newborns.

Methods.?Three hundred adolescent mothers under 17 years of age and their singleton newborns were enrolled in this retrospective study. The major outcomes of the study were the rates of prematurity and intrauterine growth retardation, and the admission rate of newborns to the neonatal intensive care unit.

Results.?Twenty-nine percent of the newborns were premature, and the intrauterine growth retardation rate was 1%. Forty-one newborns (13.6%), of whom 38 (92.6%) were preterm, were admitted to the neonatal intensive care unit. The admission rate of the study population was higher than the overall newborn neonatal intensive care unit admission rate for our hospital of 9.7% (p?<?0.05).

Conclusion.?The rates of prematurity and neonatal intensive care unit admission were higher in adolescent mothers. This study is the first to demonstrate that the high NICU admission rate was related to premature deliveries in this group.     

Home care after early discharge: Impact on healthy mothers and newborns

Objective

to compare early discharge with home care versus standard postpartum care in terms of mothers' sense of security; contact between mother, newborn and partner; emotions towards breast feeding; and breast-feeding duration at one and three months after birth.

Design

retrospective case-control study.

Setting

a labour ward unit in Stockholm, Sweden handling both normal and complicated births.

Participants

96 women with single, uncomplicated pregnancies and births, and their healthy newborns.

Intervention

early discharge at 12–24 hours post partum with 2–3 home visits during the first week after birth. The intervention group consisted of women who had a normal vaginal birth (n=45). This group was compared with healthy controls who received standard postnatal care at the hospital (n=51).

Instruments

mothers' sense of security was measured using the Parents' Postnatal Sense of Security Scale. Contact between mother, child and father, and emotions towards breast feeding were measured using the Alliance Scale, and breast-feeding rates at one and three months post partum were recorded.

Findings

women in the intervention group reported a greater sense of security in the first postnatal week but had more negative emotions towards breast feeding compared with the control group. At three months post partum, 74% of the newborns in the intervention group were fully breast fed versus 93% in the control group (p=0.021). Contact between the mother, newborn and partner did not differ between the groups.

Conclusion

early discharge with home care is a feasible option for healthy women and newborns, but randomised controlled studies are needed to investigate the effects of home care on breast-feeding rates.     

Outcomes of vacuum-assisted vaginal deliveries of mothers with gestational diabetes mellitus

Objective: To evaluate the outcomes of vacuum-assisted vaginal deliveries (VAD) among neonates of mothers with gestational diabetes mellitus (GDM).

Study design: Retrospective cohort study of women with singleton gestation ≥37?+?0 weeks of gestation who underwent VAD at a single, tertiary, medical center (2007–2014). Women with GDM and their neonates were compared to women without diabetes and their neonates. Composite neonatal outcome was defined as ≥1 of the following: shoulder dystocia, 5-min Apgar score <7, asphyxia, seizure, subgaleal, subarachnoid or subdural hemorrhage, fracture of the clavicle, humerus or skull, or Erb’s palsy.

Results: Overall, 251 (5.2%) women with GDM were compared with 4534 (94.8%) women without GDM. Women with GDM were older, delivered earlier, with higher rates of mild preeclampsia and induction of labor. Their neonates had higher mean birth weight percentile, and higher rates of hypoglycemia, phototherapy, fracture of the humerus (3.2 versus 1.1%, aOR 2.95, 95%CI 1.38–6.30), and subarachnoid hemorrhage (1.2 versus 0.3%, aOR 4.56, 95%CI 1.28–16.26). No difference was found with regards to the composite neonatal outcome (9.2 versus 11.1%, p?=?.34).

Conclusions: GDM is associated with a higher risk for certain birth injuries in VAD at ≥37?+?0 weeks of gestation, yet the overall risk of adverse neonatal outcomes is comparable to women without GDM.     

Predictors of needs in mothers with infants in the neonatal intensive care unit

Forty‐six mothers with infants in an urban hospital's neonatal intensive care unit (NICU) were asked to rate the importance of having various needs met in five categories: (1) support (the need for interpersonal emotional support); (2) comfort (the need for personal physical comfort); (3) information (the need to obtain realistic information about the infant); (4) proximity (the need to remain near the infant); and (5) assurance (the need to feel confident about the infant's outcome). Overall, mothers viewed needs in the area of assurance as most important and needs in the area of support as least important to have fulfilled. Multiple regression analyses revealed significant predictive relationships between annual household income and mothers' needs in the area of support, and infant length of stay in the NICU and mothers' information needs. The findings from this study can be used by professionals when interacting with families, as well as during the design and implementation of parent support programs in the NICU.     

Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers

The objective was to investigate the hypothesis that anthropometric and body composition differences exist between macrosomic infants of diabetic and nondiabetic mothers. Sixteen infants of mothers with diabetes, along with 58 control infants, were studied within 24 hours of delivery. The following measurements were obtained: birthweight, birth length and extremity length; circumferences of the head, chest, shoulders, and extremities; and triceps, subscapular, flank, and thigh skinfolds. Estimation of fat mass and calculation of percent body fat was performed according to the Dauncey method. Macrosomic infants of diabetic mothers were characterized by larger shoulder and extremity circumferences, a decreased head-to-shoulder ratio, significantly higher body fat, and thicker upper extremity skinfolds compared with nondiabetic control infants of similar birthweight and birth length. Differences in body composition and weight distribution may explain the propensity for shoulder dystocia in the diabetic population.     

Pregnancy outcome in gestational diabetes.

OBJECTIVE: To assess maternal and neonatal outcomes of gestational diabetes mellitus (GDM) following glycemic screening and diabetic management, with special focus on concurrent GDM and pre-eclampsia. METHODS: A retrospective chart review of 782 women diagnosed with and treated for GDM at a Chinese university teaching hospital. Data on maternal and neonatal outcome, glycemic control, concurrent pre-eclampsia, and diabetic management were collected and analyzed. RESULTS: The incidence of GDM was 3.8%. Of the affected women, 62.9% were managed with diet only and the remainder received insulin treatment. Overall, 80.7% had good glycemic control. Poor glycemic control and concurrent pre-eclampsia correlated with maternal and neonatal complications. CONCLUSION: Aggressive management for tight glycemic control improves maternal and neonatal outcomes in women with GDM.     

Stress and anxiety among mothers of premature infants in a Malaysian neonatal intensive care unit

Objective: This study aims to determine maternal stress and anxiety as perceived by mothers whose premature infants were admitted to the neonatal intensive care unit (NICU) and to identify maternal stress and its relationship with maternal and infant characteristics and anxiety.

Background: Vulnerable premature infants commonly require special care in the NICUs. In most cases, prolonged hospitalization results in stress and anxiety for the mothers.

Methods: A non-probability convenience survey was used in a public hospital, with 180 mothers completing the 26-item Perceived Stress Scale (PSS) and a 40-item State-Trait Anxiety Inventory (STAI).

Results: 56.5% of mothers had high levels of stress, 85.5% of mothers had a high level of state-anxiety and 67.8% of mothers had a high level of trait-anxiety. The stress experienced by these mothers had a significant relationship with anxiety, and was found to be associated with state and trait anxiety levels, but not with maternal and infant characteristics.

Conclusion: Mothers in this setting revealed high levels of stress and anxiety during their premature infants’ NICU admission. An immediate interventional programme focusing on relieving mothers’ anxiety and stress is needed to prevent maternal stress and anxiety at an early stage.     

Discharge breastmilk feeding rates in asymptomatic term newborns admitted to the neonatal intensive care unit for maternal chorioamnionitis

Purpose: To compare discharge breastmilk feeding rates among asymptomatic term newborns receiving 48-hour versus >48-hour antibiotics in the neonatal intensive care unit (NICU) and a cohort of well-baby nursery (WBN) newborns.

Materials and methods: This retrospective review included asymptomatic term neonates admitted to the NICU due to maternal chorioamnionitis and a comparison group of WBN neonates between January 2012 and December 2015. Demographic, birth, feeding, and lactation consultant visit data were analyzed in univariate and multivariate models.

Results: Among 272 NICU neonates, 237 (87%) received 48-hour antibiotics versus 35 (13%) who received >48-hour (h) antibiotics; a cohort of 428 WBN neonates was studied for comparison. Exclusive breastmilk feeding was seen in 14% of NICU versus 35% of WBN neonates (p?48?h antibiotics was not associated with altered discharge breastmilk feeding (14 versus 14%; p?=?.89). On multivariate logistic regression analysis among NICU subjects, older maternal age (p?p?=?.02), first-feed breastmilk (p?p?=?.012) were associated with increased discharge breastmilk feeding.

Conclusions: NICU admission for presumed early-onset sepsis due to maternal chorioamnionitis was associated with reduced discharge breastmilk feeding in asymptomatic term neonates, but prolonged antibiotic exposure was not. We speculate that demographic factors, such as maternal age and parity, may aid in focusing lactation consultant efforts to potentially improve NICU exclusive discharge breastmilk feeding rates.     

Major determinants of survival and length of stay in the neonatal intensive care unit of newborns from women with premature preterm rupture of membranes

Objective: To assess the predictors of outcome in terms of length of stay in the neonatal intensive care unit (NICU) and survival of neonates from women with preterm premature rupture of membranes (PPROM).

Methods: A population-based retrospective study including 331 singleton pregnant women with PPROM at 24–34 gestational weeks between January 2013 and December 2015 was conducted. Gestational age at delivery, birth weight, route of delivery, newborn gender, maternal age, oligohydramnios, premature retinopathy (ROP), necrotising enterocolitis (NEC), sepsis, fetal growth retardation (FGR), intracranial hemorrhagia (ICH), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), primary pulmonary hypertension (PPH), congenital cardiac disease (CCD), patent ductus arteriosus (PDA), use of cortisol (betamethasone) and maternal complications including gestational diabetes, preeclampsia and chorioamnionitis were used to predict neonatal outcomes in terms of length of stay in the NICU and survival.

Results: In linear regression analyses, birth weight, ROP, CCD, BPD, PDA, NEC and preeclampsia were significant confounders for length of stay in the NICU. Among them, birth weight was the most powerful confounder for prolongation of the NICU stay (t: ?6.43; p?In multivariate logistic regression analyses, birth weight, PDA, ROP and PPH were significantly correlated with neonatal survival. PPH was the most powerful confounder in neonatal survival (β: 7.22; p?=?0.005).

Conclusion: Prematurity-related complications are the most important problems for which precautions should be taken. Therefore, premature deliveries should be avoided to prevent infection and to prolong the latent period in cases of PPROM in order to decrease prematurity-related outcomes.     

Pregnancy outcome in obese and morbidly obese gestational diabetic women

OBJECTIVE: We sought to determine whether pregnancy outcome differs between obese and morbidly obese GDM patients and to assess pregnancy outcome in association with mode of treatment and level of glycemic control. METHODS: A cohort study of 4,830 patients with gestational diabetes (GDM), treated in the same center using the same diabetic protocol, was performed. Obesity was defined as prepregnancy BMI >30 and <35 kg/m(2); morbid obesity was defined as prepregnancy BMI >or=35 kg/m(2). Well-controlled GDM was defined as mean blood glucose <105 mg/dl. Pregnancy outcome measures included the rates of large for gestational age (LGA) and macrosomic babies, metabolic complications, the need for NICU admission and/or respiratory support, rate of shoulder dystocia, and the rate of cesarean section. RESULTS: Among the GDM patients, the rates of obesity and morbid obesity were 15.7% (760 out of 4830, BMI: 32.4+/-1.6 kg/m(2)) and 11.6% (559 out of 4830, BMI: 42.6+/-2.2 kg/m(2)), respectively. No differences were found with regard to maternal age, ethnicity, gestational age at delivery or oral glucose tolerance test (OGTT) results. Moreover, similar rates of cesarean section, fetal macrosomia, shoulder dystocia, composite outcome, and metabolic complications were noted. Insulin treatment was initiated for 62% of the obese and 73% of the morbidly obese GDM patients (P<0.002). Similar rates of obese and morbidly obese patients achieved desired levels of glycemic control (63% versus 61%, respectively). In both obese and morbidly obese patients who achieved a desired level of glycemic control (<105 mg/dl), no difference was found in pregnancy outcome except that both neonatal metabolic complications and composite outcomes were more prevalent in diet-treated subjects in comparison to insulin-treated GDM patients. CONCLUSION: In obese women with GDM, pregnancy outcome is compromised regardless of the level of obesity or treatment modality.     

Effect of second trimester and third trimester weight gain on immediate outcomes in neonates born to mothers with gestational diabetes: a retrospective observational study from India

Abstract

Aim: To evaluate the effect of second trimester and third trimester rate of weight gain on immediate outcomes in neonates born to mothers with Gestational Diabetes Mellitus (GDM).

Method and material: This retrospective observational study enrolled 593 eligible mothers. The records of all pregnant women booked before 24?weeks and screened for diabetes were eligible if they were diagnosed with Gestational Diabetes Mellitus (GDM) anytime during pregnancy. All the necessary maternal and neonatal details were collected from hospital database. The rate of weight gain was calculated at 18–24?weeks, 28–30?weeks, and that before delivery. The enrolled women were categorized into: poor weight gain, normal weight gain, and increased weight.

Results and discussion: The mean birth weight, length, and head circumference of neonates were significantly lower in women who had poor rate of weight gain in comparison with normal weight gain group. The mean prepregnancy BMI was significantly high in women with increased rate of weight gain when compared to normal weight gain women in second and third trimester. Regression analysis done to evaluate the independent effect of weight gain on C section and neonatal complications, showed that the independent predictors for cesarean section were previous cesarean section or 12.5 (95% CI 6.7–23) and conception by assisted reproductive technologies or 1.75 (95% CI 1.01–4.3), and the neonatal complications were influenced by birth weight or 1.5 (95% CI 1.1–2.2) and weight gain during second trimester or 1.26 (95% CI 1–1.6).

Conclusion: In women with GDM, reduced weight gain during pregnancy is associated with small for gestational age neonates. Caesarean section is predicted by previous C-section, and mode of conception whereas neonatal complications were predicted by birth weight and maternal weight gain during second trimester.     

Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization

OBJECTIVE: This study was undertaken to compare the use of glyburide with insulin for the treatment of gestational diabetes mellitus (GDM) unresponsive to diet therapy. STUDY DESIGN: A retrospective study was performed among women with singleton pregnancies who had GDM diagnosed, with fasting plasma glucose 140 mg/dL or less on glucose tolerance testing, between 12 and 34 weeks who failed diet therapy from 1999 to 2002. We identified 584 women and compared those treated with insulin between 1999 and 2000 with women treated with glyburide between 2001 and 2002. Maternal and neonatal outcomes and complications were assessed. Statistical methods included univariate analyses and multivariable logistic regression. RESULTS: In 1999 through 2000, 268 women had GDM diagnosed and were treated with insulin; in 2001 through 2002, 316 women had GDM diagnosed of which 236 (75%) received glyburide. The 2 groups were similar with regard to age, nulliparity, and historical GDM risk factors; however, women in the insulin group had a higher mean body mass index (31.9 vs 30.6 kg/m 2 , P=.04), a greater proportion identified themselves as white (43%, 28%, P<.001) and fewer as Asian (24%, 37%, P=.001), and they had a significantly higher mean fasting on glucose tolerance test (105.4 vs 102.4 mg/dL , P=.005) compared with the glyburide group. There were no significant differences in birth weight (3599+/-650 g vs 3661+/-629 g, P=.3), macrosomia (24%, 25%, P=.7), or cesarean delivery (35%, 39 %, P=.4). Women in the glyburide group had a higher incidence of preeclampsia (12%, 6%, P=.02), and neonates in the glyburide group were more likely to receive phototherapy (9%, 5%, P<.05), and less likely to be admitted to the neonatal intensive care unit (NICU) (15%, 24%, P=.008) though they had a longer NICU length of stay (4.3+/-9.6 vs 8.0+/-10.1, P=.002). Posttreatment glycemic control data were available for 122 women treated with insulin and 137 women treated with glyburide. More women in the glyburide group achieved mean fasting and postprandial goals (86%, 63%, P<.001). These findings remained significant in logistic regression analysis. CONCLUSION: In a large managed care organization, glyburide was at least as effective as insulin in achieving glycemic control and similar birth weights in women with GDM who failed diet therapy. The increased risk of preeclampsia and phototherapy in the glyburide group warrant further study.     

Knowledge of gestational diabetes among a multi-ethnic cohort in Australia

Objectiveto explore knowledge about gestational diabetes (GDM) among a multi-ethnic sample of women who were receiving antenatal care in Melbourne, Australia.Designcross-sectional comparative survey.Settingdiabetes clinic located in a public hospital in Melbourne's Western suburbs.Participants143 pregnant women with GDM from Vietnamese, Indian, Filipino and Caucasian backgrounds.Findings200 questionnaires were distributed and 143 were returned (response rate 71.5%). There were statistically significant differences between ethnic groups in terms of educational level (p=0.001) and fluency in English (p=0.001). Educational levels, measured in completed years of schooling, were lowest among Vietnamese [mean 8.5 years, standard deviation (SD) 1.0], Filipino (mean 8.9 years, SD 1.5) and Caucasian [mean 10.2 years, SD 0.9] women. Indian women had a higher mean level of education (11.6 years, SD 0.9). Fluency in English was reported by 100% of Caucasian, Indian and Filipino women, but 53.3% of Vietnamese women required interpreter services. The women's answers varied with ethnicity and educational status. Vietnamese and Filipino women displayed the least knowledge about GDM and food values. Caucasian women also scored poorly on general knowledge about GDM. Indian women scored highest across all areas of interest.Key conclusionsVietnamese women had the poorest English skills and lowest educational levels, and were identified as the group at greatest risk of misunderstanding GDM. English language proficiency alone, however, was not associated with better comprehension of GDM in this study. Higher educational level was the only factor linked to increased comprehension. It is, therefore, important that new educational strategies are developed to address lower health literacy as well as cultural factors when caring for multi-ethnic populations with GDM. This approach may also serve to address lower levels of comprehension among Caucasian populations.     

Factor analysis of the Parental Stressor Scale in parents of term and near-term surgical newborns

Objective: A confirmatory factor analysis (CFA) of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) in parents of term and near-term surgical newborns.

Background: The PSS:NICU is a common measure of the stressors experienced by parents of NICU newborns. A CFA of the PSS:NICU has not been published.

Methods: A CFA of the 26-item version of the PSS:NICU (PSS:NICU-26) was conducted using data from 216 parents of term and near-term surgical newborns. A multigroup CFA analysis was conducted to determine if the factor structure of the final PSS:NICU model was invariant across gender.

Results: CFA showed the PSS:NICU-26 model was a poor fit for the data. Exploratory factor analysis and CFAs with post hoc modifications resulted in the exclusion of 10 PSS:NICU-26 items. The resultant PSS:NICU-16 model was a good fit for the data and the factor structure was invariant across gender.

Conclusion: The PSS:NICU-16 is a reliable measure of NICU-related parental stressors with a structure that is invariant across gender. Although the study findings should be replicated, researchers should consider using the PSS:NICU-16 in studies of parents of term and near-term surgical newborns and studies where a more parsimonious model of the PSS:NICU may be preferred.     

Maternal serum adiponectin concentration in gestational diabetes

Aim. Adiponectin is an insulin sensitizing protein. Because gestational diabetes mellitus is associated with insulin resistance, we compared serum adiponectin levels in women with gestational diabetes mellitus and healthy pregnant women.

Study design. Twenty-nine women with gestational diabetes and 26 women with impaired glucose tolerance were compared with 27 normal pregnant women in control group. Controls were matched for gestational age, age and body mass index (BMI) before pregnancy with two other groups. At 28 weeks of gestation serum concentration of adiponectin, insulin and insulin resistance (calculated by the homeostasis model assessment) were measured in three groups.

Main findings. The serum adiponectin level in gestational diabetes (6379.31 ± 1934.90 ng/ml), was significantly lower than the impaired glucose tolerance test (7384.61 ± 1626.70 ng/ml) and control groups (7962.96 ± 2667.20 ng/ml),(p = 0.02). Serum level of insulin and HOMA index in gestational diabetes were higher than the normal group (p > 0.05). In patients with gestational diabetes, there was a significant correlation between serum adiponectin level and BMI before pregnancy (r = ?0.531, p = 0.013). Also, the correlation between maternal serum adiponectin levels and neonatal birth weight was not significant (r = ?0.07, p value = 0.73).

Conclusion. Our data show that serum adiponectin level was significantly lower in gestational diabetes in comparison with healthy pregnant women.     

Pregnancy outcome and placental pathology differences in term gestational diabetes with and without hypertensive disorders

Objective: To compare pregnancy outcome and placental pathology in pregnancies complicated by gestational diabetes mellitus (GDM A1 and A2), with and without hypertensive disorders.

Methods: Pregnancy outcome and placental pathology from term deliveries of women complicated with GDM with (GDM?+?H) and without (GDM???H) hypertensive disorders were compared. Results of the GDM?+?H group were compared also with the non-diabetic patients but with hypertensive disorders (non-GDM?+?H). Composite neonatal outcome was defined as one or more of early complications: respiratory distress or need of ventilation support, sepsis, phototherapy, transfusion, seizure, hypoxic-ischemic encephalopathy. Placental lesions were categorized to lesions related to maternal and fetal vascular supply abnormalities, and maternal and fetal inflammatory responses.

Results: Of the 192 women with GDM, the GDM?+?H group (n?=?41) were more obese, p?<?0.001, with higher rate of placental maternal and fetal vascular supply lesions, p?=?0.008, p?=?0.03, respectively, but similar neonatal outcome, compared to the GDM???H (n?=?151) group. Compared to the non-GDM?+?H group (n?=?41), the GDM?+?H group had higher birth weights, similar neonatal outcome and similar rate of placental vascular lesions.

Conclusions: Higher rate of placental maternal and fetal vascular supply lesions express underlying placental pathology in women with diabetes and hypertensive disorders, similar to women without DM and with hypertensive complications.     

Implementation of Cue-Based Feeding to Improve Preterm Infant Feeding Outcomes and Promote Parents’ Involvement

ObjectiveTo implement cue-based feeding for preterm infants and to assess its effects on time to achieve full oral feedings, length of stay, and parents’ involvement in the feeding process.DesignA quality improvement project with a pre–post evidence-based practice implementation design.SettingLevel III NICU in a quaternary hospital in the U.S. Northeast.ParticipantsMedical records of preterm infants from 23 0/7 weeks to 31 6/7 weeks gestational age who were eligible for initiation of oral feeding.Intervention/MeasurementsWe implemented cue-based feeding through staff education and training. We completed a retrospective review of the medical records of 82 preterm infants before implementation and 167 preterm infants after implementation for the outcomes of time to achieve full oral feedings, length of stay, and parents’ involvement in the feeding process.ResultsFor infants 23 0/7 weeks to 27 6/7 weeks gestation, time to achieve full oral feedings decreased by 7 days, length of stay decreased by 4.4 days, and parents’ involvement in the feeding process increased by 80% from before to after implementation. For infants 28 0/7 weeks to 31 6/7 weeks, time to achieve full oral feedings decreased by 6.6 days, length of stay decreased by 2.7 days, and parents’ involvement in the feeding process increased by 49% from before to after implementation. The organization saved $103,950 per year by decreasing length of stay.ConclusionsCue-based feeding decreased time to achieve full oral feedings, decreased length of stay, increased parents’ involvement in the feeding process, and resulted in cost savings for the institution.     

Screening for gestational diabetes mellitus in adolescent pregnancies

Objective: Our purpose was to determine the incidence of gestational diabetes mellitus in an adolescent population and to determine the cost of screening. Study Design: A retrospective review of 509 adolescent pregnancies was performed. The incidence of gestational diabetes mellitus was determined and the cost of screening analyzed. Results: Five hundred nine adolescent pregnancies were screened for gestational diabetes mellitus with a 1-hour, 50 gm oral glucose challenge test. Twenty-three of the screens (4.5%) had positive results at a plasma glucose level of ≥140 mg/dl. Three-hour 100 gm oral glucose tolerance tests were performed on screen-positive women, six of whom were diagnosed with gestational diabetes mellitus, for an incidence of 1.18%. The cost per case diagnosed was $2733. Conclusions: The incidence of gestational diabetes mellitus in an adolescent population is low. The cost of universal screening may be prohibitive in this population. Large prospective studies are needed to better analyze outcome data and efficacy of screening in adolescent pregnancies. (Am J Obstet Gynecol 1998;178:1251-6.)