Statement of the problem. The purpose of this study was to develop an instrument to measure the content and quality of prenatal care services in a population of low income women. Dimensions of performance as proposed by the Joint Commission on Accreditation of Healthcare Organizations were used to define the quality of prenatal care. The United States Public Health Service Expert Panel Guidelines on the Content of Prenatal Care were used as the standard for the content of care. Methods. The Content and Quality of Prenatal Care Measure (CQPM), a prenatal care record review measure, was developed in this study. An assessment of content validity and intra- and inter-rater reliability was completed. Data collected for the validity sample of 163 records at two county health department sites was scored by content area. The Adequacy of Prenatal Care Utilization Index (APNCU) developed by Kotelchuck was used to categorize each record in the validity sample. Criterion-related validity was assessed with ANOVA using the CQPM scores as the dependent variable and the APNCU groups as the independent variable and by discriminant function analysis using the CQPM content scores as predictors for group membership in APNCU groups. Results. The mean percent agreement for each of the content areas for intra- and inter-rater reliability ranged from 72% to 95% with medical risk assessment having the highest reliability and health promotion having the lowest. Intra and inter-rater percent agreement for items ranking the quality of care was 70% and 51.6%. A significant difference between the groups was found in ANOVA, F(3,157):16.23, p < .00001, confirming criterion-related validity. The discriminant function analysis found an overall Lambda =.451941 (chi2 = 110.79, df 15, p < .00001). The prediction equation accounted for 62% of grouped cases being correctly classified also confirming criterion-related validity. Discussion. These results show that the Content and Quality of Prenatal Care Measure is reliable and valid and may be used to monitor care provided to low income populations and to conduct research on the content of prenatal care. Further research on weighting each item score in the CQPM and the reliability of items for special populations may be indicated.

Home phototherapy using fiberoptic lights for the treatment of newborn hyperbilirubinemia has proven to be safe and effective. The purpose of this study was to explore whether differences in the outcomes of duration, reduction of bilirubin levels, hyperbilirubinemia resolution, or readmission could be explained by initial bilirubin levels and variations in newborn clinical characteristics at the commencement of treatment. This retrospective chart review of 187 newborns, who had received home phototherapy, revealed hyperbilirubinemia resolved in 162 of the cases (86.6 percent). Seventeen (9.1 percent) required readmission to the hospital. The strongest predictor of treatment duration using birthweight, feeding type, age at admission, and bilirubin level at commencement of treatment as independent variables was the age of the newborn at admission (R2 =.03) followed by the bilirubin level at commencement of treatment (R2 = 0.10). No variables showed predictive power in relation to the absolute drop in bilirubin. Furthermore, those newborns whose hyperbilirubinemia resolved and those who required readmission showed no significant differences in relation to their clinical characteristics of birthweight, bilirubin level at commencement of treatment, or age at admission. When variables of absolute drop in bilirubin, bilirubin level at the completion of treatment, duration of treatment, gestational age, and age at admission were analyzed based on feeding type (bottle vs. breast), the only significantly different characteristic was the bilirubin level at the completion of treatment (p =.034). Bilirubin levels at the completion of treatment were on the average lower for bottle-fed newborns when compared to breast-fed newborns. Results suggest that the older the newborn at admission, the shorter the treatment duration, and the higher the bilirubin level on admission, the longer the duration of treatment. Findings also suggest pediatricians tolerate higher bilirubin levels at the completion of treatment for breast-fed newborns than for bottle-fed. This study illustrates implications for nursing and medical management of hyperbilirubinemia by providing information regarding the home phototherapy population, treatment outcomes, and highlighting the need for proper follow-up, documentation, and continued research of this potential public health problem.

Patterns of fetal growth in infants with congenital cardiovascular malformations (CVM) had not been studied previously. This research characterized the extent and pattern of fetal growth differences between live-born control infants and those with transposition of the great arteries (TGA), tetralogy of Fallot (TF), hypoplastic left heart syndrome (HLH), and coarctation of the aorta (CA). A sample of 276 controls and 251 cases with TGA, TF, HLH, and CA were selected from the Baltimore-Washington Infant Study, and detailed anthropometric and gestational age data were abstracted at 26 birth hospitals from the medical records of study infants and mothers. The primary analysis tested the multivariate hypothesis that, after controlling for covariates, fetal growth is different across diagnostic class, as reflected in the joint distribution of: birth weight, birth length, head circumference, ponderal index, and power index (a non-linear function relating head volume to birth weight). The remaining analyses evaluated multivariate and univariate case-control differences in neonatal anthropometry specific to individual diagnostic groups. Two new anthropometric indices were developed which reflect neonatal size and shape, and which correlate highly with multivariate case-control discriminators. Clear and convincing evidence of case-control differences in fetal growth were found. TGA was associated with normal birth weight, but lesser mean head circumference and birth length, relative to birth weight. Infants with TF were smaller than controls in all measured dimensions, but important shape differences were not noted. Infants with HLH were much smaller than controls in all measured dimensions, and head volume was disproportionately small, relative to birth weight. CA was associated with lower mean birth weight, shorter mean birth length, and greater mean head volume, relative to birth weight. These findings are most consistent with the argument that malformation-specific alterations in the fetal circulation predict abnormal gross anatomic patterns of development, as reflected in neonatal anthropometric measurements.