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Klinger G, Reichman B, Norman M, Kusuda S, Battin M, Helenius K, Isayama T, Lui K, Adams M, Vento M, Hakansson S, Beltempo M, Poggi C, San Feliciano L, Lehtonen L, Bassler D, Yang J, Shah PS. Late-Onset Sepsis among Extremely Preterm Infants of 24-28 Weeks Gestation: An International Comparison in 10 High-Income Countries. Neonatology 2024:1-11. [PMID: 38889700 DOI: 10.1159/000539245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/01/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Despite advances in neonatal care, late-onset sepsis remains an important cause of preventable morbidity and mortality. Neonatal late-onset sepsis rates have decreased in some countries, while in others they have not. Our objective was to compare trends in late-onset sepsis rates in 9 population-based networks from 10 countries and to assess the associated mortality within 7 days of late-onset sepsis. METHODS We performed a retrospective population-based cohort study. Infants born at 24-28 weeks' gestation between 2007 and 2019 were eligible for inclusion. Late-onset sepsis was defined as a positive blood or cerebrospinal fluid culture. Late-onset sepsis rates were calculated for 3 epochs (2007-11, 2012-15, and 2016-19). Adjusted risk ratios (aRRs) for late-onset sepsis were calculated for each network. RESULTS Of a total of 82,850 infants, 16,914 (20.4%) had late-onset sepsis, with Japan having the lowest rate (7.1%) and Spain the highest (44.6%). Late-onset sepsis rates decreased in most networks and remained unchanged in a few. Israel, Sweden, and Finland showed the largest decrease in late-onset sepsis rates. The aRRs for late-onset sepsis showed wide variations between networks. The rate of mortality temporally related to late-onset sepsis was 10.9%. The adjusted mean length of stay for infants with late-onset sepsis was increased by 5-18 days compared to infants with no late-onset sepsis. CONCLUSIONS One in 5 neonates of 24-28 weeks' gestation develops late-onset sepsis. Wide variability in late-onset sepsis rates exists between networks with most networks exhibiting improvement. Late-onset sepsis was associated with increased mortality and length of stay.
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Affiliation(s)
- Gil Klinger
- Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brian Reichman
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mikael Norman
- Karolinska Institutet, Department of Clinical Science, Intervention, and Technology, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan
| | - Malcolm Battin
- Newborn Service, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Kjell Helenius
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Adams
- Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Maximo Vento
- Instituto de Investigación Sanitaria (Health Research Institute) La Fe Valencia, Valencia, Spain
| | - Stellan Hakansson
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Marc Beltempo
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Chiara Poggi
- Neonatal Intensive Care Unit, Department of Mother and Child Care, Careggi University Hospital, Florence, Italy
| | - Laura San Feliciano
- Unidad de Neonatología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Dirk Bassler
- Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Junmin Yang
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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de Bijl-Marcus K, Benders MJNL, Dudink J, Ahaus K, Kahlmann M, Groenendaal F. Morbidity and trends in length of hospitalisation of very and extremely preterm infants born between 2008 and 2021 in the Netherlands: a cohort study. BMJ Open 2024; 14:e078842. [PMID: 38834326 PMCID: PMC11163635 DOI: 10.1136/bmjopen-2023-078842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/14/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVES This study investigated changes in the length of stay (LoS) at a level III/IV neonatal intensive care unit (NICU) and level II neonatology departments until discharge home for very preterm infants and identified factors influencing these trends. DESIGN Retrospective cohort study based on data recorded in the Netherlands Perinatal Registry between 2008 and 2021. SETTING A single level III/IV NICU and multiple level II neonatology departments in the Netherlands. PARTICIPANTS NICU-admitted infants (n=2646) with a gestational age (GA) <32 weeks. MAIN OUTCOME MEASURES LoS at the NICU and overall LoS until discharge home. RESULTS The results showed an increase of 5.1 days (95% CI 2.2 to 8, p<0.001) in overall LoS in period 3 after accounting for confounding variables. This increase was primarily driven by extended LoS at level II hospitals, while LoS at the NICU remained stable. The study also indicated a strong association between severe complications of preterm birth and LoS. Treatment of infants with a lower GA and more (severe) complications (such as severe retinopathy of prematurity) during the more recent periods may have increased LoS. CONCLUSION The findings of this study highlight the increasing overall LoS for very preterm infants. LoS of very preterm infants is presumably influenced by the occurrence of complications of preterm birth, which are more frequent in infants at a lower gestational age.
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Affiliation(s)
- Karen de Bijl-Marcus
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Marijn Kahlmann
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
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Lee J. Neonatal family-centered care: evidence and practice models. Clin Exp Pediatr 2024; 67:171-177. [PMID: 37321589 PMCID: PMC10990654 DOI: 10.3345/cep.2023.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
Although advances in neonatology have reduced the mortality rate of high-risk infants, sick newborns or pre-mature infants undergo more intensive monitoring, pain-ful procedures, and lengthy hospitalization, leading to pro-longed separation from their parents. In recent decades, the importance of parent-infant closeness early in life has become more apparent, especially in preterm infants who are prone to neurodevelopmental deficits. There is an increasing body of evidence regarding the benefits of family-centered care (FCC) in neonatal intensive care units. Key aspects related to neonatal FCC include the parents' presence in the ward and their participation in infants' daily care and decision-making processes. In addition, an environment that supports a private and comfortable space for each family member and infant, such as a single-family room, should be provided. To successfully implement FCC in neonatal intensive care units, the culture of care and hospital policies should be changed to successfully implement FCC in neonatal intensive care units, and appropriate training for medical staff is also required.
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Affiliation(s)
- Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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Lambiase CV, Mansi G, Salomè S, Conelli ML, Vendemmia M, Zurlo MC, Raimondi F, Capasso L. The financial burden experienced by families during NICU hospitalization and after discharge: A single center, survey-based study. Eur J Pediatr 2024; 183:903-913. [PMID: 38038769 PMCID: PMC10912114 DOI: 10.1007/s00431-023-05352-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
To investigate a broad array of costs and perceived financial burden (FB) faced by families of NICU graduates both during hospitalization and after discharge. Cross-sectional survey-based study design. A survey measuring socio-demographics, direct non-medical costs, indirect costs, social support and perceived FB was developed. One-hundred-twenty-two pairs of parents of NICU graduates participated in the study. Most of the families (87.7%) experienced FB due to NICU hospitalization. The median cost of visiting infant during NICU admission was 615 euros (range: 42,7320). FB correlated with cost for drugs (ρ = .271, p < .05, 95%CI:[.020, .490]), dietary supplement (ρ = .385, p < .05, CI:[.010, .665]), behavioral disorders (ρ = -.186, p < .05, 95%CI:[-.356, -.003]), language delay (ρ = .243, p < .01, CI:[-.408, -.063]) and comorbidities (ρ = -.206, p < .05, 95% CI:[-.374, -.024]). Transportation costs due to medical visits (ρ = .415, p < .01, 95% CI:[.239, .564]) and therapy sessions (ρ = .517, p < .05, CI:[.121, .771]) correlated with higher FB. Grandparents of the infant were the most frequent source of help (86.1%). Families having infants with adverse outcome experienced more hospitalizations after NICU discharge (p < .05) and higher FB (p < .01) than families with typically developing infant. Lack of government financial help was associated with higher perceived FB (CI:[1.117,29.127], p < .05). Conclusions: Our findings demonstrated that parents of NICU graduates experience high rates of FB, highlighting their sources (e.g., grandparents support) and difficulties (e.g., private therapy costs) through the lens of patient perspective. Our study promotes reflection on policies which should be adopted from the European health services that are similar to the Italian one to support NICU graduate families and reduce inequalities. What is Known: • Families of NICU graduates face several kinds of costs during hospitalization and after discharge. What is New: • NICU hospitalization is a multifaceted event that impact financial burden experienced by families. • NICU graduate families whose infant had adverse outcome and felt lack of financial help from local policy makers experience higher rates of financial burden.
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Affiliation(s)
- Carmine Vincenzo Lambiase
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Department of Humanities, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy.
| | - Giuseppina Mansi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Laura Conelli
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Vendemmia
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Clelia Zurlo
- Department of Humanities, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy
- Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
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Pricoco R, Mayer-Huber S, Paulick J, Benstetter F, Zeller M, Keller M. Impact of a family-centred clinical care programme on short-term outcomes of very low-birth weight infants. Acta Paediatr 2023; 112:2368-2377. [PMID: 37551158 DOI: 10.1111/apa.16944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023]
Abstract
AIM We evaluated the effects of a family-centred clinical care pathway and case management programme on short-term clinical outcome in a cohort of very low-birth weight (VLBW) infants. METHODS The programme, named NeoPAss, was developed at the Department of Neonatology Children's hospital Passau in 2013. Short-term outcomes of infants were compared to matched controls from the Bavarian neonatology surveillance database before (n = 111; 2008-2012) and after implementation (n = 170; 2014-2017). RESULTS After implementation the rate of late-onset sepsis was significantly lower (2.5% vs. 10.7%, p = 0.005) and the length of stay was significantly shorter (VLBW 28 to 31 weeks' gestational age (GA) 47.5 vs. 53.1 days, p = 0.047; <28 weeks' GA 79.4 vs. 91.9 days, p = 0.007) in the intervention group compared to controls. Infants were discharged with significantly lower weight (mean 2351 vs. 2539 g, p = 0.013). There was no statistically significant difference in the rate of intraventricular haemorrhage (3.7% vs. 8.2%), necrotizing enterocolitis (0.6% vs. 1.9%) and bronchopulmonary dysplasia (0% vs. 6.9%). CONCLUSION Our data confirm that of other studies demonstrating a beneficial effect of family-centred care programmes and provides evidence that structured parental involvement is not associated with increased risk of infection in a VLBW cohort.
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Affiliation(s)
- Rafael Pricoco
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
| | | | - Johannes Paulick
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
| | | | - Michael Zeller
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
- Kinderklinik Dritter Orden, Passau, Germany
| | - Matthias Keller
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
- Kinderklinik Dritter Orden, Passau, Germany
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Bertuzzi A, Martin A, Clarke N, Springate C, Ashton R, Smith W, Orlowski A, McPherson D. Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis. BMJ Open 2023; 13:e068932. [PMID: 37147093 PMCID: PMC10163491 DOI: 10.1136/bmjopen-2022-068932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022. ELIGIBILITY CRITERIA Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised narratively, according to the methods of Campbell et al. RESULTS: Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies. CONCLUSIONS The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness. PROSPERO REGISTRATION NUMBER CRD42022311689.
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Affiliation(s)
| | | | | | | | - Rachel Ashton
- Ashton Editorial Consulting, London, UK
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Wayne Smith
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Andi Orlowski
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Parm Ü, Tiit-Vesingi A, Soeorg H, Štšepetova J, Truusalu K, Vorobjov S, Lutsar I, Metsvaht T. Effect of early directed implementation of family-integrated care measures on colonisation with Enterobacteriaceae in preterm neonates in NICU. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001712. [PMID: 37192777 DOI: 10.1136/bmjpo-2022-001712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/22/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Hospital-acquired strains (HASs) and multiresistant strains in neonatal intensive care unit often harbour virulence and resistance mechanisms, carrying the risk of invasive infections. We describe colonisation with Enterobacteriaceae in neonates receiving early directed versus routine family-integrated care (FIC) within the first month of life. METHODS A prospective cohort study included neonates with a gestational age below 34 weeks. During the first period, neonates were admitted to an open bay unit with transfer to the single-family room if available; feeding with the mother's own breast milk (MOBM) was introduced within 24 hours, and skin-to-skin contact (SSC) within 5 days of life (the routine care group). During the second period, following a wash-in of 2 months, care in a single-family room within 48 hours, the introduction of MOBM within two and SSC in 48 hours were applied (the intervention group). Enterobacteriaceae isolated from neonatal stool, breast milk and parental skin swabs were genotyped, Simpson's Index of Diversity (SID) calculated, and extended-spectrum beta-lactamases (ESBL) detected. RESULTS In 64 neonate-parents' groups, 176 Enterobacteriaceae, 87 in routine care and 89 in the intervention group were isolated; 26 vs 18 were HAS and one vs three ESBL positive, respectively. In the intervention group compared with the routine care group, SSC and MOBM feeding was started significantly earlier (p<0.001); during the first week of life, time spent in SSC was longer (median hours per day 4.8 (4-5.1) vs 1.9 (1.4-2.6), p<0.001) and the proportion of MOBM in enteral feeds was higher (median (IQR) 97.8% (95.1-100) vs 95.1% (87.2-97.4), p=0.011). Compared with the routine care group, the intervention group had higher SID and a reduction of HAS by 33.1% (95% CI 24.4% to 42.4%) in time series analysis. CONCLUSIONS Early implementation of FIC measures may hold the potential to increase diversity and reduce colonisation with HAS Enterobacteriaceae.
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Affiliation(s)
- Ülle Parm
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Annika Tiit-Vesingi
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
- Neonatal Intensive Care Unit, East Tallinn Central Hospital, Tallinn, Estonia
| | - Hiie Soeorg
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Jelena Štšepetova
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Kai Truusalu
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Sigrid Vorobjov
- Department of Risk Behaviour Studies, National Institute of Health Development, Tallinn, Estonia
| | - Irja Lutsar
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Tuuli Metsvaht
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
- Paediatric and Neonatal Intensive Care Unit, Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
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Soni R, Fairhurst N, El Anbari M, Leslie A, Tscherning Wel-Wel C. Staff perceptions and challenges of the single-family room design- experience of a greenfield level 4 neonatal intensive care unit in the Middle East. Acta Paediatr 2022; 111:2291-2298. [PMID: 36017578 DOI: 10.1111/apa.16527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/28/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
AIM This study was undertaken to specifically identify challenges associated with the popular single-family room (SFR) design in our new neonatal intensive care unit (NICU), so as to reap the full benefits of this architectural model. METHODS A survey was sent to all 223, newly recruited staff on our NICU. Questions explored staff perceptions of family experience, safety, and staffs' experience of the SFR in comparison to the open bay model. RESULTS We obtained a response rate of 66%. Most staff perceived SFR as having a positive impact on communication with families, privacy, feasibility for skin-to-skin contact, reduction in noise levels, and family access to their baby. There were however concerns raised about patient safety and isolation of staff and families in the SFR architecture. Lack of opportunities to leave the patient room for breaks, and increased physical demands were highlighted. Staff also felt physically and emotionally less well supported. CONCLUSION Whilst the SFR configuration was felt to be beneficial for infants and families, staff shared their perceived concerns regarding infant safety and isolation and staff satisfaction, and implied modifications to workflows. The survey findings resulted in re-organization of our staff numbers and communication systems and further facilitation of parent interactions in order to optimize benefits of SFR design.
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Affiliation(s)
- Roopali Soni
- Sidra Medical and Research Center, Division of Neonatology, Doha, Qatar.,Mediclinic Parkview Hospital, Neonatology, Dubai, UAE
| | - Natalie Fairhurst
- Sidra Medical and Research Center, Division of Neonatology, Doha, Qatar
| | | | - Ana Leslie
- Sidra Medical and Research Center, Division of Neonatology, Doha, Qatar
| | - Charlotte Tscherning Wel-Wel
- Sidra Medical and Research Center, Division of Neonatology, Doha, Qatar.,Université de Toulouse III, Toulouse, France.,Centre of Physiopathology Toulouse-Purpan (CPTP), Inserm, CNRS, University of Toulouse, Toulouse, France
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Kainiemi E, Flacking R, Lehtonen L, Pasanen M, Axelin A. Psychometric Properties of an Instrument to Measure the Quality of Family-Centered Care in NICUs. J Obstet Gynecol Neonatal Nurs 2022; 51:461-472. [PMID: 35598704 DOI: 10.1016/j.jogn.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine the psychometric properties of the Digi Family-Centered Care-Parent Version (DigiFCC-P), which was developed to measure parents' perceptions of family-centered care (FCC) in NICUs. DESIGN Cross-sectional psychometric study. SETTING Twenty-three NICUs in 15 countries in Europe, Canada, and Australia. PARTICIPANTS Mothers (n = 565) and fathers (n = 406) of preterm infants hospitalized in NICUs. METHODS Participants reported their perceptions of the quality of FCC during their infants' hospitalizations by answering one DigiFCC-P question delivered to their mobile phones every evening. Nine questions rotated in random order. Participants responded on a 7-point Likert scale. We evaluated the instrument's internal consistency, construct and concurrent validity, and sensitivity. RESULTS The internal consistency of the DigiFCC-P was satisfactory; the Cronbach's alpha coefficient was .74 (95% confidence interval [.71, .77]), and all the corrected item-total correlations were greater than .30. We identified that the items formed two factors, support from staff and the parent's active participation, and observed no strong item cross-loadings on the two factors. We discovered some items with weak interitem correlations, and the two factors explained 35.2% of the variance. Scores on the DigiFCC-P and Family-Centered Care Questionnaire were significantly correlated (r = .59, p < .001) and supported the convergent validity of the instrument. In addition, changes were discovered in the participants' ratings over time, which indicated that the instrument was sensitive to detect changes in their evaluations. CONCLUSION The psychometric testing of the DigiFCC-P provided initial support for the convergent validity and reliability of the instrument. The instrument was also sensitive in detecting changes in the evaluations of FCC over time. However, there is a need for further development of the content validity of the instrument.
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Lyngstad LT, Le Marechal F, Ekeberg BL, Hochnowski K, Hval M, Tandberg BS. Ten Years of Neonatal Intensive Care Adaption to the Infants' Needs: Implementation of a Family-Centered Care Model with Single-Family Rooms in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5917. [PMID: 35627454 PMCID: PMC9140644 DOI: 10.3390/ijerph19105917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023]
Abstract
Ten years ago, the Neonatal intensive care unit in Drammen, Norway, implemented Single-Family Rooms (SFR), replacing the traditional open bay (OB) unit. Welcoming parents to stay together with their infant 24 h per day, seven days per week, was both challenging and inspiring. The aim of this paper is to describe the implementation of SFR and how they have contributed to a cultural change among the interprofessional staff. Parents want to participate in infant care, but to do so, they need information and supervision from nurses, as well as emotional support. Although SFR protect infants and provide private accommodation for parents, nurses may feel isolated and lack peer support. Our paper describes how we managed to systematically reorganize the nurse's workflow by using a Plan-Do-Study-Act (PDSA) cycle approach. Significant milestones are identified, and the implementation processes are displayed. The continuous parental presence has changed the way we perceive the family as a care recipient and how we involve the parents in daily care. We provide visions for the future with further developments of care adapted to infants' needs by providing neonatal intensive care with parents as equal partners.
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Affiliation(s)
- Lene Tandle Lyngstad
- Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, 3004 Drammen, Norway; (F.L.M.); (B.L.E.); (K.H.); (M.H.)
| | | | | | | | | | - Bente Silnes Tandberg
- Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, 3004 Drammen, Norway; (F.L.M.); (B.L.E.); (K.H.); (M.H.)
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11
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Isayama T, Kusuda S, Adams M, Berti E, Battin M, Helenius K, Håkansson S, Vento M, Norman M, Reichman B, Noguchi A, Lee SK, Bassler D, Lui K, Lehtonen L, Yang J, Shah PS. International Variation in the Management of Patent Ductus Arteriosus and Its Association with Infant Outcomes: A Survey and Linked Cohort Study. J Pediatr 2022; 244:24-29.e7. [PMID: 34995641 DOI: 10.1016/j.jpeds.2021.12.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/19/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess whether treating patients with a presymptomatic patent ductus arteriosus (PDA), based on early routine echocardiography, performed regardless of clinical signs, improved outcomes. STUDY DESIGN This multicenter, survey-linked retrospective cohort study used an institutional-level questionnaire and individual patient-level data and included infants of <29 weeks of gestation born in 2014-2016 and admitted to tertiary neonatal intensive care units (NICUs) of 9 population-based national or regional neonatal networks. Infants in NICUs receiving treatment of presymptomatic PDA identified by routine echocardiography and those not were compared for the primary composite outcome (early death [≤7 days after birth] or severe intraventricular hemorrhage) and secondary outcomes (any in-hospital mortality and major morbidities). RESULTS The unit survey (response rates of 86%) revealed a wide variation among networks in the treatment of presymptomatic PDA (7%-86%). Among 246 NICUs with 17 936 infants (mean gestational age of 26 weeks), 126 NICUs (51%) with 7785 infants treated presymptomatic PDA. The primary outcome of early death or severe intraventricular hemorrhage was not significantly different between the NICUs treating presymptomatic PDA and those who did not (17% vs 21%; aOR 1.00, 95% CI 0.85-1.18). The NICUs treating presymptomatic PDA had greater odds of retinopathy of prematurity treatment (13% vs 7%; aOR 1.47, 95% CI 1.01-2.12); however, it was not significant in a sensitivity analysis excluding Japanese data. CONCLUSIONS Treating presymptomatic PDA detected by routine echocardiography was commonplace but associated with no significant benefits. Well-designed trials are needed to assess the efficacy and safety of early targeted PDA treatment.
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Affiliation(s)
- Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Elettra Berti
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, Anna Meyer Children's University Hospital, Florence, Italy
| | - Malcolm Battin
- Department of Neonatology, Auckland District Health Board, Auckland, New Zealand
| | - Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Maximo Vento
- Division of Neonatology, Health Research Institute La Fe, Valencia, Spain
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Akihiko Noguchi
- Illinois Neonatal Network, Saint Louis University, Saint Louis, IL
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Junmin Yang
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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12
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Kaempf JW, Gautham K. Do small baby units improve extremely premature infant outcomes? J Perinatol 2022; 42:281-285. [PMID: 34012054 DOI: 10.1038/s41372-021-01076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 11/09/2022]
Abstract
Increasing numbers of neonatal intensive care units have formed small baby units or small baby teams with the intention to optimize care of extremely premature infants. Considerable time, energy, and resources are required to develop and sustain complex quality improvement constructs, so legitimate questions about effectiveness, unintended consequences, and lost opportunity costs warrant scrutiny. The small baby unit literature is diminutive. Errors of chance, bias, and confounding secondary to insufficient definitions of process and outcome metrics, overlapping quality improvement projects, and limited cost analyses restrict firm conclusions. Well-established quality improvement methodologies such as evidence-based guidelines, standardized variability reduction using measurement-and-adjust techniques, family-integrated focus, and developmentally sensitive care, reliably improve outcomes for all-sized premature infants. There is not compelling published evidence that adding specialized small baby units or designated teams for extremely premature infants further enhances short- or long-term health if robust quality improvement fundamentals are already imbedded within local culture.
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Affiliation(s)
- Joseph W Kaempf
- Providence Health System, Women and Children's Services, Providence St. Vincent Medical Center, 9205 SW Barnes Road, Portland, OR, 97225, USA.
| | - Kanekal Gautham
- Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Suite W6104, Houston, TX, 77030, USA
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13
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Lee J, Parikka V, Lehtonen L, Soukka H. Parent-infant skin-to-skin contact reduces the electrical activity of the diaphragm and stabilizes respiratory function in preterm infants. Pediatr Res 2022; 91:1163-1167. [PMID: 34088986 PMCID: PMC8176875 DOI: 10.1038/s41390-021-01607-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The physiological benefit of parent-infant skin-to-skin contact (SSC) is uncertain for preterm infants with ventilatory support. We aimed to investigate whether SSC stabilizes the respiration compared to incubator care in mechanically ventilated preterm infants. METHODS The prospective observational study was performed in Turku University Hospital, Finland. Preterm infants were eligible if they were born before 36 weeks gestation and received respiratory support with either invasive or non-invasive neurally adjusted ventilatory assist (NAVA). SSC was applied as soon as possible after birth. Respiratory variables were collected from the ventilator log data, and SSC episodes were compared with matched control periods during incubator care. RESULTS A total of 167 episodes of SSC were recorded from 17 preterm infants: 138 episodes during invasive NAVA and 29 episodes during non-invasive NAVA. During invasive NAVA, peak electrical activity of the diaphragm (Edi), minimum Edi, respiratory rate, time on backup ventilation, peak inspiratory pressure, and mean airway pressure were significantly lower in SSC than in incubator care. During non-invasive NAVA, peak Edi, minimum Edi, time on backup ventilation, and peak inspiratory pressure were significantly lower in SSC than in incubator care. CONCLUSIONS SSC stabilized and improved the respiratory physiology in mechanically ventilated preterm infants. IMPACT Skin-to-skin contact reduced work of breathing compared to incubator care in mechanically ventilated preterm infants. Skin-to-skin contact reduced the need for backup ventilation during neurally adjusted ventilatory assist in preterm infants. Skin-to-skin contact among ventilated preterm infants was not only safe but also stabilized and improved their respiratory physiology.
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Affiliation(s)
- Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea. .,Department of Pediatrics, Inha University College of Medicine, Incheon, Republic of Korea.
| | - Vilhelmiina Parikka
- grid.410552.70000 0004 0628 215XDepartment of Pediatrics, Turku University Hospital, Turku, Finland ,grid.1374.10000 0001 2097 1371Department of Pediatrics, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- grid.410552.70000 0004 0628 215XDepartment of Pediatrics, Turku University Hospital, Turku, Finland ,grid.1374.10000 0001 2097 1371Department of Pediatrics, University of Turku, Turku, Finland
| | - Hanna Soukka
- grid.410552.70000 0004 0628 215XDepartment of Pediatrics, Turku University Hospital, Turku, Finland ,grid.1374.10000 0001 2097 1371Department of Pediatrics, University of Turku, Turku, Finland
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14
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Seaton SE, Draper ES, Adams M, Kusuda S, Håkansson S, Helenius K, Reichman B, Lehtonen L, Bassler D, Lee SK, Vento M, Darlow BA, Rusconi F, Beltempo M, Isayama T, Lui K, Norman M, Yang J, Shah PS, Modi N. Variations in Neonatal Length of Stay of Babies Born Extremely Preterm: An International Comparison Between iNeo Networks. J Pediatr 2021; 233:26-32.e6. [PMID: 33600820 DOI: 10.1016/j.jpeds.2021.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare length of stay (LOS) in neonatal care for babies born extremely preterm admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks of gestational age (n = 28 204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birth weight z score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. RESULTS Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI 19.3-22.1). Finland had the shortest adjusted LOS (-4.8 days less than reference, 95% CI -7.3 to -2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI -12.3 to -11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI 2.0-3.2) and 2.1 (95% CI 1.6-2.6) days, respectively. CONCLUSIONS We identified between-network differences in LOS of up to 3 weeks for babies born extremely preterm. Some of these may be partly explained by differences in mortality, but unexplained variations also may be related to differences in clinical care practices and healthcare systems between countries.
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Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
| | - Kjell Helenius
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Franca Rusconi
- Unit of Epidemiology, Anna Meyer Children's Hospital, Florence, Italy
| | | | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Junmin Yang
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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