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BACKGROUND. Although abnormal pulmonary vascular structure and function in preterm infants with bronchopulmonary dysplasia may predispose infants to pulmonary artery hypertension, little is known about the characteristics and outcomes of bronchopulmonary dysplasia-associated pulmonary artery hypertension in the surfactant era.METHODS. We studied 42 premature infants (RESULTS. Eighteen (43%) of 42 patients had severe pulmonary artery hypertension (systemic or suprasystemic right ventricular pressure). Among 13 patients who underwent catheterization, the mean pulmonary artery pressure was 43 ± 8 mmHg and the pulmonary vascular resistance index was 9.9 ± 2.8 Wood units. In 12 patients, pulmonary artery pressure and pulmonary vascular resistance improved with 100% oxygen and 80 ppm inhaled nitric oxide but remained elevated. The pulmonary vascular resistance index decreased to 7.9 ± 3.8 Wood units in 100% oxygen and to 6.4 ± 3.1 Wood units with the addition of nitric oxide. Sixteen patients (38%) died during the follow-up period. Estimated survival rates were 64% ± 8% at 6 months and 53% ± 11% at 2 years after diagnosis of pulmonary artery hypertension. In multivariate analyses, severe pulmonary artery hypertension and small birth weight for gestational age were associated with worse survival rates. Among 26 survivors (median follow-up period: 9.8 months), pulmonary artery hypertension was improved, relative to its most severe level, in 24 patients (89%).CONCLUSION. Premature infants with bronchopulmonary dysplasia and severe pulmonary artery hypertension are at high risk of death, particularly during the first 6 months after diagnosis of pulmonary artery hypertension.

Objectives To describe and compare the incidence and spectrum of complications of varicella pre-vaccine and post-vaccine licensure. Methods We performed a retrospective chart review of children under age 21 years either treated in the emergency department (ED) or admitted to the hospital with varicella at Children’s Hospital, Boston, from January to December 1994 (pre-licensure) and from January 1996 to December 1997 (post-licensure). Results We identified 937 children who made a visit to the ED for varicella and 270 children hospitalized for varicella during the 3-year study period. The ratio of varicella-related visits to the ED to total visits (0.67%) did not vary significantly from the post-vaccine ratio (0.60%). The most common reasons for a visit were cellulitis in immunocompetent patients and treatment with varicella zoster immune globulin (VZIG) in children with immunosuppression. Similarly, the ratio of varicella-related hospitalizations to total hospitalizations did not vary in the pre-vaccine (0.53%) and post-vaccine (0.47%) eras. The most common complications in hospitalized patients were cellulitis in previously healthy children (37%) and uncomplicated varicella in immunocompromised patients (36%). The distribution of diagnoses in the ED and complications among hospitalized children did not differ significantly in the pre-vaccine and post-vaccine eras. Conclusions Despite licensure of the varicella vaccine, varicella-related hospitalizations and ED visits have not changed significantly. Further efforts are needed to increase utilization of the varicella vaccine.

To explore adolescent fatherhood from the perspectives of teen fathers, teen mothers, paternal grandmothers (PGMs), and maternal grandmothers (MGMs). To identify perceived barriers to and recommendations for the enhancement of teen father participation in child rearing.A total of 61 teen parents participated in the design of a structured interview. A community-based sample of 173 teen fathers, 167 teen mothers, 76 PGMs, and 79 MGMs were interviewed by teenage assistants. Multiple logistic regression analysis using maximum likelihood estimation and the best subset algorithm identified barriers most predictive of paternal uninvolvement in child rearing.Fifty-four percent of teen fathers and 70% of partners of teen mothers' met the definition of involvement in child rearing. Disinterest in child rearing most consistently predicted uninvolvement. Fathers were less likely than mothers to report paternal disinterest as a barrier and more likely to attribute their lack of involvement to resistance from mothers and MGMs (p0.05). The best model predicting paternal involvement from the fathers' perspective included paternal disinterest [odds ration (OR) = 0.42, confidence interval (CI) = 0.19-0.92] and age (OR = 0.74, CI = 0.56-0.97). The best model from the mothers' perspective included paternal disinterest (OR = 0.16, CI = 0.07-0.36) and lack of time (OR = 0.31, CI = 0.15-0.91). Of those fathers who cited disinterest, there was an association with lack of money (p = 0.002) and lack of knowledge of child care (p = 0.069. While fathers and mothers disagreed on several interventions, they agreed (82% and 95%, respectively) that availability of jobs would promote paternal involvement.Most teen fathers in this study were involved and interested in child rearing. A young father's financial insecurity or confusion about child care was most likely to lead to a stated disinterest, and that disinterest predicted uninvolvement.A community-based sample of 173 teen fathers, 167 teen mothers, 76 paternal grandmothers, and 79 maternal grandmothers was interviewed by teenage assistants to explore adolescent fatherhood from a range of differing perspectives. 54% of teen fathers and 70% of partners of teen mothers met the definition of involvement in child rearing. Disinterest in child rearing most consistently predicted uninvolvement. Fathers were less likely than mothers to report paternal disinterest as a barrier and more likely to attribute their lack of involvement to resistance from mothers and maternal grandmothers. The best model predicting paternal involvement from the fathers' perspective included paternal disinterest and age, while the best model from the mothers' perspective included paternal disinterest and lack of time. Of those fathers who cited disinterest, there was an association with lack of money and lack of knowledge of child care. While fathers and mothers disagreed upon several interventions, they agreed that an availability of jobs would promote paternal involvement.