By the year 2050, the population of the United States is projected to be approximately half white and half non-white. Yet the knowledge of child development within ethnic minority groups lags markedly behind knowledge of child development for white Americans, and it is increasingly clear that the rich diversity within minority groups is masked by studies focusing on between-group comparisons. Children of Color: Research, Health, and Public Policy Issues, a collection of original essays, brings together researchers from the fields of education, family and child ecology, nursing, psychology, sociology, pediatrics, anthropology, and social work to explore the rich cultural, familial, and individual diversity of all ethnic minority groups. The essays were generated by round table discussions sponsored by the Society for Research in Child Development and the Irving Harris Foundation, and they cover a broad range of topics including immigration policy, social policy, health status of immigrant infants, children and families, and educational policies related to minority children.

Objective: To determine whether physician gender and patient gender influence the process of communication and parent and child satisfaction during pediatric office visits. DESIGN: Content analysis of videotaped pediatric office visits.

Setting: University-based pediatric primary care practice.

Subjects: Videotaped communication between 212 children, ages 4 to 14 years, parents, and physicians. Thirty-eight percent were child health supervision visits, and 62% were for the management of minor or chronic illnesses.

Main Outcome Measures: An established coding system of physician-patient communication and measures of parent and child satisfaction with medical care.

Results: Female physician visits were 29% longer than those of male physicians (P .001). Compared with male physicians, female physicians engaged in more social exchange (P .01), more encouragement and reassurance (P .01), more communication during the physical examination (P .05), and more information gathering (P .01) with children. Male and female physicians engaged in similar amounts of discussions regarding illness management. Children were more satisfied with physicians of the same gender (P .05), while parents were more satisfied with female physicians (P .05).

Conclusions: Children communicate more with female than with male physicians and show preferences for physicians of the same gender. These findings are consistent with communication patterns in adult patients and may have a significant influence on gender disparities in health care. Efforts at improving the process and outcome of medical care should address gender differences.

Objective: To determine the hospital cost of caring for newborn infants with congenital syphilis.

Study Population: All live-born singleton neonates with birth weight greater than 500 gm at an inner-city municipal hospital in New York City in 1989.

Methods: We compared the characteristics of 114 infants with case-compatible congenital syphilis with those of 2906 infants without syphilis. Cost estimates were based on New York State newborn diagnosis-related groups (DRG) reimbursements adjusted for length of stay, birth weight, preterm delivery, and selected maternal risk factors, including infection with the human immunodeficiency virus, cocaine use during pregnancy, and history of injected drug use.

Results: For infants with congenital syphilis, the unadjusted mean cost ($11,031) and the median cost ($4961) were more than three times larger than those for infants without syphilis (p 0.01). After adjustment, congenital syphilis was associated with an additional length of hospitalization of 7 1/2 days and an additional cost of $4690 (both p 0.01) above mean study population values (7.13 days, $3473).

Conclusions: Based on the number of reported cases (1991 to 1994), the average annual national cost of treating infants with congenital syphilis is approximately $18.4 million (1995 dollars). This estimate provides a benchmark to assess the cost-effectiveness of strategies to prevent, diagnose, and treat the disease.

Objective: To examine the cost effects of a single dose (5 ml/kg) of a protein-free synthetic surfactant (Exosurf) as therapy for neonatal respiratory distress syndrome, for both rescue and prophylactic therapy.

Research Design: Nonblinded, randomized clinical trials of both rescue and prophylactic therapy. Regression analyses were used to control for the independent effects of sex, multiple birth, delivery method, birth weight, and surfactant therapy.

Setting: The prophylactic trial was conducted at a university medical center only; the rescue trial also included a tertiary community hospital.

Patients: Prophylaxis was administered immediately after birth to 36 infants (38 control subjects) with birth weights between 700 and 1350 gm. Rescue therapy was administered at 4 to 24 hours of age to 53 infants (51 control subjects) with established respiratory distress syndrome and birth weights > or = 650 gm (no upper limit). Infants in the prophylactic trial were not eligible for the rescue trial.

Results: For the rescue trial, there was a $16,600 reduction in average hospital costs (p = 0.18), which was larger than the cost of the surfactant ($450 to $900), yielding a probable net savings. For the prophylactic trial, hospital costs were larger for treated infants versus control subjects who weighed less than about 1100 gm at birth and lower for treated infants versus control subjects who weighed more than 1100 gm at birth (p 0.05). For the prophylactic sample, the result was an average cost per life saved of $71,500.

Conclusions: Single-dose rescue surfactant therapy is probably a cost-effective therapy because it produced a lower mortality rate for the same (and probably lower) expenditure. Single-dose prophylactic therapy for smaller infants ( or = 1350 gm) appeared to yield a reduction in mortality rate for a small additional cost. The use of multiple-dose therapy in infants who do not respond to initial therapy may alter the effects described above to either increase or decrease the observed cost-effectiveness of surfactant therapy. Regardless, surfactant therapy will remain a cost-effective method of reducing mortality rates, relative to other commonly used health care interventions.

Background: Low birth weight is a major determinant of neonatal mortality. Yet birth weight, even in conjunction with other demographic markers, is inadequate to explain the large variations in neonatal mortality between intensive care units. This variation probably reflects differences in admission severity. The authors have recently developed the Score for Neonatal Acute Physiology (SNAP), an illness severity index specific for neonatal intensive care, and demonstrated illness severity to be a major determinant of neonatal mortality.

Objective: To define the relative contributions of birth weight and illness severity to the risk of neonatal mortality and to identify other significant independent risk factors.

Methods: Logistic regression was used to analyze data from a cohort of 1621 consecutive admissions to three neonatal intensive care units (92 deaths), to test six alternative predictive models. The best logistic model was then used to develop a simple additive clinical score, the SNAP Perinatal Extension (SNAP-PE).

Results: These analyses demonstrated that birth weight and illness severity are powerful independent predictors across a broad range of birth weights and that their effects are additive. Below 750 g, there is an interaction between birth weight and SNAP. Other factors that showed independent predictive power were low Apgar score at 5 minutes and small size for gestational age. Separate derivation and test samples were used to demonstrate that the SNAP-PE is comparable to the best logistic model and has a sensitivity and specificity superior to either birth weight or SNAP alone (receiver-operator characteristic area .92 +/- .02) as well as excellent goodness of fit.

Conclusion: This simplified clinical score provides accurate mortality risk estimates for application in a broad array of clinical and research settings.

Many neonates are referred to neonatal intensive care units (NICUs) for specialized care far from their parents' residence. This distance can add to the stress of the parents and reduce the contact of the parents with their newborn. Small studies have found that back transporting these neonates to hospitals closer to their homes is safe and cost-effective. Despite these findings, the reluctance of many insurers to pay for back transports prevents or delays many back transports. Insurers may not consider the findings of the previous studies to be conclusive, given that the comparisons were between small numbers of neonates back transported and neonates who remained in tertiary care, and the potential for differences in severity of illness between the groups is significant. In this study the effect on hospital charges of back transports was examined by comparing the charges for care in community hospitals with what these charges would have been in a tertiary care center. The advantage of this method is that it avoids case-mix differences between the groups and thus minimizes the potential for small-sample bias. Data were collected for all back transports from a NICU to non-tertiary care centers (n = 90) for a 9-month period. We were able to obtain the itemized bills for the care at community hospitals for 42 of these patients. Each bill was recalculated using the charges for the NICU to determine potential for savings. The average charges for recovery care were about $6200 lower at the community hospital than they would have been at the NICU.