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Amodei N, Nixon E, Zhang S, Hu Y, Vance A, Maye M. Associations between sociodemographic characteristics and neonatal length of the stay. J Perinatol 2024; 44:851-856. [PMID: 38773215 DOI: 10.1038/s41372-024-01976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Infants with past NICU admission have a significantly higher risk of developing neurodevelopmental disorders. Studies have demonstrated an iatrogenic effect of the NICU environment on neurodevelopmental outcomes, even while accounting for physical factors. It is, therefore, critical that an infant's LOS is driven by physical needs versus sociodemographic barriers. METHODS We leveraged electronic health records and a backward selection regression model to explore physical and sociodemographic predictors of infant LOS. RESULTS Our results demonstrated that physical predictors (birthweight and ventilator use) accounted for the majority of variance in our model but that a sociodemographic predictor, mean visits per day, was also significant. CONCLUSIONS Infants who were visited more frequently experienced a shorter LOS, possibly due to increased parental involvement resulting in more individualized care and directly impacting infant stability and morbidity. By supporting visitation, we can reduce the costs of lengthy NICU hospitalizations while improving infant and parent health and well-being.
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Affiliation(s)
- Natalie Amodei
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Ellen Nixon
- American Hospital Association, Chicago, IL, USA
| | | | - Yong Hu
- Henry Ford Health, Detroit, MI, USA
| | - Ashlee Vance
- Henry Ford Health and Michigan State University Health Sciences (HFH+MSU Health Sciences), Center for Health Policy and Health Services Research, One Ford Place, Detroit, MI, USA
| | - Melissa Maye
- Henry Ford Health and Michigan State University Health Sciences (HFH+MSU Health Sciences), Center for Health Policy and Health Services Research, One Ford Place, Detroit, MI, USA.
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2
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Stefanescu BM, Henderson-Sears SE, Stefanescu AR, Allen JD. Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e3074-e3084. [PMID: 37827504 DOI: 10.1055/a-2190-8288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE This study aimed to examine the relationship between virtual technology system utilization and insurance status or type of visitation restrictions in a single-center neonatal intensive care unit. STUDY DESIGN Prospective cohort study with separate analyses performed based on insurance status (public vs. nonpublic) and "in effect" unit visitation restrictions. The three study epochs based on patient visitation restrictions were Epoch 1 (July to October 2019) with standard visitation restrictions, Epoch 2 (November 2019 to February 2020) with respiratory syncytial virus/influenza visitation restrictions, and Epoch 3 (March to June 2020) with coronavirus disease 2019 (COVID-19) visitation restrictions, respectively. RESULTS Families of 357 infants used web-based cameras through most of the infant's hospitalization (median: 86.05%, Q3: 97.9%) with 165,795 total camera logins, indicating consistent utilization. There was a trend for fewer logins per infant and significantly longer time to consent (p = 0.03) in the Public Insurance group. Unit visitation restrictions impacted the time to consent, the shortest being in Epoch 3 during the COVID-19 pandemic (p = 0.03). CONCLUSION Virtual visitation technology is well embraced by neonatal instensive care unit families; however, gaps in access and use among subgroups signals a form of social inequality that needs to be explored further. KEY POINTS · Virtual visitation technology can bridge the distance gap for families of hospitalized infants.. · Utilization of virtual technology is affected by socioeconomic factors and seasonal unit visitation restrictions.. · Factors influencing disparities in access and utilization of virtual technology need to be investigated further..
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Affiliation(s)
- Beatrice M Stefanescu
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Andrei R Stefanescu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jayme D Allen
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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3
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Kellner P, Kwon J, Smith J, Pineda R. Neurodevelopmental Outcomes following Preterm Birth and the Association with Postmenstrual Age at Discharge. Am J Perinatol 2024; 41:561-568. [PMID: 34996118 PMCID: PMC11062498 DOI: 10.1055/a-1733-2690] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to (1) define the prevalence of motor, cognitive, and language delays in preterm infants born <32 weeks estimated gestational age (EGA); and (2) identify the relationship between the timing of discharge from the neonatal intensive care unit (NICU) and neurodevelopmental outcome in early childhood. STUDY DESIGN This retrospective study of 172 preterm infants born <32 weeks EGA and hospitalized in a level-IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1 to 2 years corrected age was conducted in the newborn follow-up clinic. RESULTS At 1 to 2 years corrected age, the sample had an average Bayley Scales of Infant and Toddler Development (Bayley-III) cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for >28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. Higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, β = -1.1 (-1.6, -0.7)], poorer language outcome [p = 0.049, β = -0.5 (-0.9, -0.003)], and poorer motor outcome [p <0.001, β = -1.0 (-1.5, -0.5)]. For every additional week of hospitalization, scores were an average of 1.1 points lower in cognitive, 1.0 point lower in motor, and 0.5 points lower in language domains of the Bayley-III assessment. CONCLUSION Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment in impacting developmental outcomes of infants hospitalized in the NICU. KEY POINTS · There are high rates of developmental impairment among preterm infants born <32 weeks at 1 year to 2 years.. · The longer the infant is exposed to the NICU environment, the higher the risk of neurodevelopmental challenges.. · These findings provide increased motivation for optimizing the early NICU environment..
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Affiliation(s)
- Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Jenny Kwon
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
- Program in Occupational Therapy, Washington University, St. Louis, Missouri
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
- Program in Occupational Therapy, Washington University, St. Louis, Missouri
- Department of Pediatrics, Keck School of Medicine, Los Angeles, California
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California
- Center for the Changing Family, University of Southern California, Los Angeles, California
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Frostig T, Benjamini Y, Kehat O, Weiss-Meilik A, Mandel D, Peleg B, Strauss Z, Mitelpunkt A. Developing a length of stay prediction model for newborns, achieving better accuracy with greater usability. Int J Med Inform 2023; 180:105267. [PMID: 37918217 DOI: 10.1016/j.ijmedinf.2023.105267] [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] [Received: 07/12/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND One in ten newborn children is born prematurely. The elongated length of stay (LOS) of these children in the Neonatal Intensive Care Unit (NICU) has important implications on hospital occupancy figures, healthcare and management costs, as well as the psychology of parents. In order to allow accurate planning and resource allocation, this study aims to create a generalizable and robust model to predict the NICU LOS of preterm newborns. METHODS Data were collected from a large tertiary center NICU between 2011 and 2018 and relates to 5,362 newborns. The selected model was externally validated using a data set of 8,768 newborns from another tertiary center NICU. This report compares several models, such as Random Forest (RF), quantile RF, and other feature selection methods, including LASSO and AIC step-forward selection. In addition, a novel step-forward selection based on False Discovery Rate (FDR) for quantile regression is presented and evaluated. RESULTS A high-orderquantile regression model for predicting preterm newborns' LOS that uses only four features available at birth had more attractive properties than other richer ones. The model achieved a Mean Absolute Error (MAE) of 6.26 days on the internal validation set (average LOS 27.04) and an MAE of 6.04 days on the external validation set (average LOS 29.32). The suggested model surpassed the accuracy obtained by models in the literature. It is shown empirically that the FDR-based selection has better properties than the AIC-based step-forward selection approach. CONCLUSION This paper demonstrates a process to create a predictive model for NICU LOS in preterm newborns, where each step is reasoned. We obtain a simple and robust model for NICU LOS prediction, which achieves far better results than the current model used for financing NICUs. Utilizing this model, we have created an easy-to-use online web application to ease parents' worries and to assist NICU management: https://tzviel.shinyapps.io/calcuLOS.
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Affiliation(s)
- Tzviel Frostig
- Department of Statistics and Operation Research, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel.
| | - Yoav Benjamini
- Department of Statistics and Operation Research, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Sagol School of Neuroscience and the Edmond Safra Bioinformatics Center, Tel Aviv University Ramat Aviv, 69978, Tel Aviv, Israel
| | - Orli Kehat
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Dror Mandel
- Departments of Neonatology and Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
| | - Ben Peleg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Israel
| | - Zipora Strauss
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Israel
| | - Alexis Mitelpunkt
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel; Pediatric Rehabilitation, Department of Rehabilitation, Dana Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel
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Singh D, Manna S, Barik M, Rehman T, Kanungo S, Pati S. Prevalence and correlates of low birth weight in India: findings from national family health survey 5. BMC Pregnancy Childbirth 2023; 23:456. [PMID: 37340388 DOI: 10.1186/s12884-023-05726-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/20/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Childhood mortality and morbidity has become a major public health issue in low-middle-income countries. However, evidence suggested that Low birth weight(LBW) is one of the most important risk factors for childhood deaths and disability.This study is designed to estimate the prevalence of low birth weight (LBW) in India and to identify maternal correlates associated with LBW. METHODS Data has been taken from National Family Health Survey 5 (2019-2021) for analysis. 149,279 women belonging to reproductive age group (15-49) year who had last recent most delivery preceding the NFHS-5 survey. RESULTS Mother's age, female child, birth interval of less than 24 months, their low educational level, low wealth index, rural residence, lack of insurance coverage, women with low BMI, anaemia, and no ANC visits during pregnancy are predictors that contribute to LBW in India. After adjusting for covariates, smoking and alcohol consupmtion is strongly correlated with LBW. CONCLUSION Mother's age, educational attainment and socioeconomic status of living has a highly significant with LBW in India. However, consumption of tobacco and cigarrettes are also associated with LBW.
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Affiliation(s)
- Damini Singh
- Division of Public Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Bhubaneswar, Odisha, India
| | - Sayantani Manna
- Division of Public Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Bhubaneswar, Odisha, India
| | - Manish Barik
- Division of Public Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Bhubaneswar, Odisha, India
| | - Tanveer Rehman
- Division of Public Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Bhubaneswar, Odisha, India
| | - Srikanta Kanungo
- Division of Public Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Bhubaneswar, Odisha, India.
| | - Sanghamitra Pati
- Division of Public Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Bhubaneswar, Odisha, India.
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Kermani F, Zarkesh MR, Vaziri M, Sheikhtaheri A. A case-based reasoning system for neonatal survival and LOS prediction in neonatal intensive care units: a development and validation study. Sci Rep 2023; 13:8421. [PMID: 37225782 DOI: 10.1038/s41598-023-35333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
Early prediction of neonates' survival and Length of Stay (LOS) in Neonatal Intensive Care Units (NICU) is effective in decision-making. We developed an intelligent system to predict neonatal survival and LOS using the "Case-Based Reasoning" (CBR) method. We developed a web-based CBR system based on K-Nearest Neighborhood (KNN) on 1682 neonates and 17 variables for mortality and 13 variables for LOS and evaluated the system with 336 retrospectively collected data. We implemented the system in a NICU to externally validate the system and evaluate the system prediction acceptability and usability. Our internal validation on the balanced case base showed high accuracy (97.02%), and F-score (0.984) for survival prediction. The root Mean Square Error (RMSE) for LOS was 4.78 days. External validation on the balanced case base indicated high accuracy (98.91%), and F-score (0.993) to predict survival. RMSE for LOS was 3.27 days. Usability evaluation showed that more than half of the issues identified were related to appearance and rated as a low priority to be fixed. Acceptability assessment showed a high acceptance and confidence in responses. The usability score (80.71) indicated high system usability for neonatologists. This system is available at http://neonatalcdss.ir/ . Positive results of our system in terms of performance, acceptability, and usability indicated this system can be used to improve neonatal care.
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Affiliation(s)
- Farzaneh Kermani
- Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Reza Zarkesh
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neonatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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7
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Neonatal intensive care unit occupancy rate and probability of discharge of very preterm infants. J Perinatol 2023; 43:490-495. [PMID: 36609482 DOI: 10.1038/s41372-022-01596-y] [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: 08/23/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the association of NICU occupancy with probability of discharge and length of stay (LOS) among infants born <33 weeks gestational age (GA). STUDY DESIGN Retrospective study of 3388 infants born 23-32 weeks GA, admitted to five Level 3/4 NICUs (2014-2018) and discharged alive. Standardized ratios of observed-to-expected number of discharges were calculated for each quintile of unit occupancy. Multivariable linear regression models were used to assess the association between occupancy and LOS. RESULTS At the lowest unit occupancy quintiles (Q1 and Q2), infants were 12% and 11% less likely to be discharged compared to the expected number. At the highest unit occupancy quintile (Q5), infants were 20% more likely to be discharged. Highest occupancy (Q5) was also associated with a 4.7-day (95% CI 1.7, 7.7) reduction in LOS compared Q1. CONCLUSION NICU occupancy was associated with likelihood of discharge and LOS among infants born <33 weeks GA.
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8
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Fu M, Song W, Yu G, Yu Y, Yang Q. Risk factors for length of NICU stay of newborns: A systematic review. Front Pediatr 2023; 11:1121406. [PMID: 36994438 PMCID: PMC10040659 DOI: 10.3389/fped.2023.1121406] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023] Open
Abstract
Background The improvement in survival of preterm infants is accompanied by an increase in neonatal intensive care unit (NICU) admissions. Prolonged length of stay in the NICU (LOS-NICU) increases the incidence of neonatal complications and even mortality and places a significant economic burden on families and strain on healthcare systems. This review aims to identify risk factors influencing LOS-NICU of newborns and to provide a basis for interventions to shorten LOS-NICU and avoid prolonged LOS-NICU. Methods A systematic literature search was conducted in PubMed, Web of Science, Embase, and Cochrane library for studies that were published in English from January 1994 to October 2022. The PRISMA guidelines were followed in all phases of this systematic review. The Quality in Prognostic Studies (QUIPS) tool was used to assess methodological quality. Results Twenty-three studies were included, 5 of which were of high quality and 18 of moderate quality, with no low-quality literature. The studies reported 58 possible risk factors in six broad categories (inherent factors; antenatal treatment and maternal factors; diseases and adverse conditions of the newborn; treatment of the newborn; clinical scores and laboratory indicators; organizational factors). Conclusions We identified several of the most critical risk factors affecting LOS-NICU, including birth weight, gestational age, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. As only a few high-quality studies are available at present, well-designed and more extensive prospective studies investigating the risk factors affecting LOS-NICU are still needed in the future.
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Affiliation(s)
- Maoling Fu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenshuai Song
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Genzhen Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Genzhen Yu
| | - Yaqi Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaoyue Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Boni L, Gradellini C, Miari M, Cocconi P, Montorsi A, Capone R, Costi S, Di Leo S, Puglisi C, Ghirotto L. How parents and health professionals experience prematurity in an Italian neonatal intensive care: A grounded theory study. J Pediatr Nurs 2022; 67:e172-e179. [PMID: 35987669 DOI: 10.1016/j.pedn.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals. DESIGN AND METHODS We conducted a Grounded Theory study through semi-structured interviews. Participants were from an Italian Neonatal Intensive Care Unit, including parents of premature children, and health professionals. Interviews were analyzed according to Grounded Theory coding strategies, to hypothesize a theoretical model. RESULTS On one side, behaviors, emotions, and feelings of parental couples; on the other one, the activities and reactions of professionals have been interpreted in a four-phase negotiated process: 1) the initial breakup; 2) the floating family; 3) the event processing; 4) the reconstruction of a new family. CONCLUSIONS Managing prematurity is a negotiated process which could be better managed through a family-centered approach as fundamental in neonatal and pediatric services. Being open in listening, coherent in the given answers, and knowing the entire process and story of being suddenly parents of a premature child can make the difference in the future definition of a new family. PRACTICE IMPLICATIONS Perinatal care would benefit from the following suggested practical implications: i) reducing feelings of separation and solitude by integrating diverse professionals around the family systems; ii) expediting prematurity-related changes through peer-support during hospitalization and attention to rooms' organization; iii) enhancing information exchange between all professionals involved in the care of dyads/parents and new-borns, starting since the pregnancy and continuing after the child's birth by implementing multidisciplinary meetings or appropriate care pathways.
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Affiliation(s)
- Laura Boni
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, via Giovanni Amendola 2, 42122 Reggio Emilia, Italy
| | - Cinzia Gradellini
- Qualitative Research Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; Nursing Course, University of Modena and Reggio Emilia, Italy.
| | - Monica Miari
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | | | - Annalisa Montorsi
- Ospedale Sassuolo SpA, via Francesco Ruini 2, 41049 Sassuolo, Modena, Italy
| | - Roberto Capone
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Stefania Costi
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Silvia Di Leo
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Chiara Puglisi
- Reserach Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Luca Ghirotto
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
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10
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Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study. J Perinatol 2022; 42:1312-1318. [PMID: 35246625 DOI: 10.1038/s41372-022-01359-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. STUDY DESIGN We conducted a retrospective cohort study of 600 consecutive inborn admissions. A physician used the "Safer Dx NICU Instrument" to review the electronic health record for the first 7 days of admission, and categorized cases as "yes," "unclear," or "no" for diagnostic error. A secondary reviewer evaluated all "yes" charts plus a random sample of charts in the other categories. Subsequently, all secondary reviewers reviewed records with discordance between primary and secondary review to arrive at consensus. RESULTS We identified 37 diagnostic errors (6.2% of study patients) with "substantial agreement" between reviewers (κ = 0.66). The most common diagnostic process breakdown was missed maternal history (51%). CONCLUSION The frequency of diagnostic error in inborn NICU patients during the first 7 days of admission is 6.2%.
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11
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Kramer KP, Minot K, Butler C, Haynes K, Mason A, Nguyen L, Wynn S, Liebowitz M, Rogers EE. Reduction of Severe Intraventricular Hemorrhage in Preterm Infants: A Quality Improvement Project. Pediatrics 2022; 149:184903. [PMID: 35229127 DOI: 10.1542/peds.2021-050652] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this quality improvement project was to reduce the rate of severe intraventricular hemorrhage (sIVH) by 50% within 3 years for extremely preterm infants born at a children's teaching hospital. METHODS A multidisciplinary team developed key drivers for the development of intraventricular hemorrhage in preterm infants. Targeted interventions included the development of potentially better practice guidelines, promoting early noninvasive ventilation, consistent use of rescue antenatal betamethasone, and risk-based indomethacin prophylaxis. The outcome measure was the rate of sIVH. Process measures included the rate of intubation within 24 hours and receipt of rescue betamethasone and risk-based indomethacin prophylaxis. Common markers of morbidity were balancing measures. Data were collected from a quarterly chart review and analyzed with statistical process control charts. The preintervention period was from January 2012 to March 2016, implementation period was from April 2016 to December 2018, and sustainment period was through June 2020. RESULTS During the study period, there were 268 inborn neonates born at <28 weeks' gestation or <1000 g (127 preintervention and 141 postintervention). The rate of sIVH decreased from 14% to 1.2%, with sustained improvement over 2 and a half years. Mortality also decreased by 50% during the same time period. This was associated with adherence to process measures and no change in balancing measures. CONCLUSIONS A multipronged quality improvement approach to intraventricular hemorrhage prevention, including evidence-based practice guidelines, consistent receipt of rescue betamethasone and indomethacin prophylaxis, and decreasing early intubation was associated with a sustained reduction in sIVH in extremely preterm infants.
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Affiliation(s)
- Katelin P Kramer
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Kacy Minot
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Colleen Butler
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Kathryn Haynes
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Amber Mason
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Lan Nguyen
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Samantha Wynn
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Melissa Liebowitz
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
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12
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Zhang M, Wang YC, Feng JX, Yu AZ, Huang JW, Jiang SY, Gu XY, Sun JH, Cao Y, Zhou WH, Lee SK, Wang LL, Yin R. Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units. World J Pediatr 2022; 18:126-134. [PMID: 34984641 PMCID: PMC8844160 DOI: 10.1007/s12519-021-00494-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to describe length of stay (LOS) to discharge and site variations among very preterm infants (VPIs) admitted to 57 Chinese neonatal intensive care units (NICUs) and to investigate factors associated with LOS for VPIs. METHODS This retrospective multicenter cohort study enrolled all infants < 32 weeks' gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network, within 7 days after birth in 2019. Exclusion criteria included major congenital anomalies, NICU deaths, discharge against medical advice, transfer to non-participating hospitals, and missing discharge date. Two multivariable linear models were used to estimate the association of infant characteristics and LOS. RESULTS A total of 6580 infants were included in our study. The overall median LOS was 46 days [interquartile range (IQR): 35-60], and the median corrected gestational age at discharge was 36 weeks (IQR: 35-38). LOS and corrected gestational age at discharge increased with decreasing gestational age. The median corrected gestational age at discharge for infants at 24 weeks, 25 weeks, 26 weeks, 27-28 weeks, and 29-31 weeks were 41 weeks, 39 weeks, 38 weeks, 37 weeks and 36 weeks, respectively. Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals. CONCLUSIONS The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents. Large variation of LOS independent of infant characteristics existed, indicating variation of care practices requiring further investigation and quality improvement.
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Affiliation(s)
- Min Zhang
- Division of Neonatology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Shushan District, Hefei 230022, China
| | - Yan-Chen Wang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Jin-Xing Feng
- Division of Neonatology, Shenzhen Children’s Hospital, Shenzhen 518038, China
| | - Ai-Zhen Yu
- Division of Neonatology, Shenzhen Children’s Hospital, Shenzhen 518038, China
| | - Jing-Wei Huang
- Division of Neonatology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Shushan District, Hefei 230022, China
| | - Si-Yuan Jiang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai 201102, China ,Division of Neonatology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai 201102, China
| | - Xin-Yue Gu
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Jian-Hua Sun
- Division of Neonatology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yun Cao
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai 201102, China ,Division of Neonatology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai 201102, China
| | - Wen-Hao Zhou
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai 201102, China ,Division of Neonatology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai 201102, China
| | - Shoo K. Lee
- Maternal-Infants Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5 Canada ,Professor Emeritus, University of Toronto, Toronto, ON M5T 3M7 Canada
| | - Li-Li Wang
- Division of Neonatology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Shushan District, Hefei 230022, China.
| | - Rong Yin
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai 201102, China.
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13
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de Sousa JCS, de Carvalho AVD, Monte de Prada LDC, Marinho AP, de Lima KF, Macedo SKDO, Santos CDP, da Câmara SMA, Barreto ACDNG, Pereira SA. Nutritional Factors Associated with Late-Onset Sepsis in Very Low Birth Weight Newborns. Nutrients 2021; 14:196. [PMID: 35011069 PMCID: PMC8747100 DOI: 10.3390/nu14010196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Delayed onset of minimal enteral nutrition compromises the immune response of preterm infants, increasing the risk of colonization and clinical complications (e.g., late-onset sepsis). This study aimed to analyze associations between late-onset sepsis in very low birth weight infants (<1500 g) and days of parenteral nutrition, days to reach full enteral nutrition, and maternal and nutritional factors. METHODS A cross-sectional study was carried out with very low birth weight infants admitted to a neonatal intensive care unit (NICU) of a reference maternity hospital of high-risk deliveries. Data regarding days of parenteral nutrition, days to reach full enteral nutrition, fasting days, extrauterine growth restriction, and NICU length of stay were extracted from online medical records. Late-onset sepsis was diagnosed (clinical or laboratory) after 48 h of life. Chi-squared, Mann-Whitney tests, and binary logistic regression were applied. RESULTS A total of 97 preterm infants were included. Of those, 75 presented late-onset sepsis with clinical (n = 40) or laboratory (n = 35) diagnosis. Maternal urinary tract infection, prolonged parenteral nutrition (>14 days), and extrauterine growth restriction presented 4.24-fold, 4.86-fold, and 4.90-fold higher chance of late-onset sepsis, respectively. CONCLUSION Very low birth weight infants with late-onset sepsis had prolonged parenteral nutrition and took longer to reach full enteral nutrition. They also presented a higher prevalence of extrauterine growth restriction than infants without late-onset sepsis.
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Affiliation(s)
- Juliany Caroline Silva de Sousa
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Ana Verônica Dantas de Carvalho
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Lorena de Carvalho Monte de Prada
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Arthur Pedro Marinho
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Kerolaynne Fonseca de Lima
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Suianny Karla de Oliveira Macedo
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Camila Dayze Pereira Santos
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | | | - Anna Christina do Nascimento Granjeiro Barreto
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Silvana Alves Pereira
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal 59075-000, Brazil;
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Salekin MS, Mouton PR, Zamzmi G, Patel R, Goldgof D, Kneusel M, Elkins SL, Murray E, Coughlin ME, Maguire D, Ho T, Sun Y. Future roles of artificial intelligence in early pain management of newborns. PAEDIATRIC AND NEONATAL PAIN 2021; 3:134-145. [PMID: 35547946 PMCID: PMC8975206 DOI: 10.1002/pne2.12060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Md Sirajus Salekin
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| | | | - Ghada Zamzmi
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| | - Raj Patel
- Muma College of Business University of South Florida Tampa FL USA
| | - Dmitry Goldgof
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| | - Marcia Kneusel
- College of Medicine Pediatrics USF Health University of South Florida Tampa FL USA
| | | | | | | | - Denise Maguire
- College of Nursing USF Health University of South Florida Tampa FL USA
| | - Thao Ho
- College of Medicine Pediatrics USF Health University of South Florida Tampa FL USA
| | - Yu Sun
- Computer Science and Engineering Department University of South Florida Tampa FL USA
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15
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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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16
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Yang R, Chen D, Deng Q, Xu X. The effect of donor human milk on the length of hospital stay in very low birthweight infants: a systematic review and meta-analysis. Int Breastfeed J 2020; 15:89. [PMID: 33115488 PMCID: PMC7594457 DOI: 10.1186/s13006-020-00332-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Donor human milk (DHM) is an alternative to preterm infant formula if the mother's own milk is not available. Since the lactation period and preservation treatment of DHM are different from those of mother's own milk, we aimed to determine the reduction in the length of hospital stay by DHM compared to preterm infant formula. METHODS In this systematic review, we searched PubMed/MEDLINE, EMBASE, and the Cochrane Library to retrieve studies on the impact of DHM on the clinical outcomes of preterm infants published before 1 November 2019. The study included very low birthweight (VLBW) infants taking either DHM or infant formula with data on the length of hospital stay. Data were analysed using Review Manager 5.3 software. RESULTS The literature search yielded 136 articles, and four randomised controlled trials (RCTs) and eight observational studies met the inclusion criteria. A meta-analysis of the RCTs (N = 725) showed no reduction in the length of hospital stay in both the DHM and infant formula groups (- 0.22 days; 95% CI -6.38, 5.95 days), whereas that of the eight observational studies (N = 2496) showed a significant reduction in the length of hospital stay in the DHM group (- 11.72 days; 95% CI -22.07, - 1.37 days). A subgroup analysis of the RCTs revealed that the incidence of necrotising enterocolitis (NEC) was significantly lower in the DHM group when the analysis included high-quality RCTs (RR = 0.32; 95% CI 0.15, 0.69). CONCLUSIONS This systematic review of RCTs showed that DHM neither prolonged nor shortened the length of hospital stay in VLBW infants compared to preterm infant formula; however, it reduced the incidence of NEC, further validating the protective role of DHM in the health and safety of VLBW infants.
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Affiliation(s)
- Rui Yang
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Danqi Chen
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qingqi Deng
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinfen Xu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
- Haining Maternal and Child Health Hospital, Branch of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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17
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Murki S, Vardhelli V, Deshabhotla S, Sharma D, Pawale D, Kulkarni D, Kumar P, Kabra NS, Sundaram M, Plakkal N, Mehta A, Tandur B, Chawla D, Sreeram S, Saha B, Suman Rao PN, Kadam S. Predictors of length of hospital stay among preterm infants admitted to neonatal intensive care unit: Data from a multicentre collaborative network from India (INNC: Indian National Neonatal Collaborative). J Paediatr Child Health 2020; 56:1584-1589. [PMID: 32658357 DOI: 10.1111/jpc.15031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/28/2022]
Abstract
AIM Prediction of length of stay (LOS) among preterm neonates is important for counselling of parents and for assessing neonatal intensive care unit (NICU) census and economic burden. The aim of this study is to evaluate perinatal and postnatal factors that influence LOS in preterm infants (25-33 weeks of gestation) admitted to participating NICUs of Indian National Neonatal Collaborative (INNC). METHODS From the INNC database, the data which were prospectively entered using uniformed pre-defined criteria were analysed. RESULTS A total of 3095 infants were included from 12 centres. Every week decrease in gestation increased LOS by 9 days. The median LOS for infants with gestational age of 25, 26, 27, 28, 29, 30, 31, 32 and 33 weeks were 86, 70, 62, 52, 40, 30, 23, 16 and 10 days, respectively. On multivariate analysis, abnormal antenatal umbilical artery doppler, severe small for gestational age (SGA), requirement of resuscitation, respiratory distress syndrome (RDS), seizures, sepsis, necrotising enterocolitis (NEC), major malformations and bronchopulmonary dysplasia (BPD) increased LOS by 5.4 (3.5-7.4), 21.6 (19-23.9), 4.7 (3.3-6.1), 3 (1.7-4.3), 15.2 (8.5-22.1), 11.2 (9.1-13.2), 9.8 (5.2-14.4), 8.8 (4.4-13.3) and 5.6 (0.5-10.7) days, respectively. CONCLUSIONS Apart from lower gestation and birth weight, abnormal antenatal umbilical artery doppler, severe SGA, resuscitation need, major malformations, RDS, seizures, sepsis, NEC and BPD influenced LOS in preterm infants. In comparison with other networks or data from developed countries, LOS in our network was comparatively less for similar gestational age infants.
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Affiliation(s)
- Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | | | | | - Deepak Sharma
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | - Dinesh Pawale
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | | | - Praveen Kumar
- Department of Neonatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandkishor S Kabra
- Department of Neonatology, Surya Mother and Child Care super speciality Hospital, Mumbai, India
| | | | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Ashish Mehta
- Department of Neonatology, Arpan Hospital, Ahmedabad, India
| | - Baswaraj Tandur
- Department of Neonatology, Vijaya Marie Hospital, Hyderabad, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College, Chandigarh, India
| | | | - Bijan Saha
- Department of Neonatology, SSKM Hospital, Kolkata, India
| | - P N Suman Rao
- Department of Neonatology, St John's Medical College, Bengaluru, India
| | - Sandeep Kadam
- Department of Neonatology, Ratna Memorial hospital, Pune, India
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18
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Achan J, Wanzira H, Mpimbaza A, Tumwine D, Namasopo S, Nambuya H, Serwanga A, Nantanda R. Improving the quality of neonatal data capture and clinical care at a tertiary-care hospital in Uganda through enhanced surveillance, training and mentorship. Paediatr Int Child Health 2020; 40:92-104. [PMID: 31290375 DOI: 10.1080/20469047.2019.1638131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Accurate documentation of neonatal morbidity and mortality is limited in many countries in sub-Saharan Africa. This project aimed to establish a surveillance system for neonatal conditions as an approach to improving the quality of neonatal care.Methods: A systematic data capture and surveillance system was established at Jinja Regional Referral Hospital, Uganda using a standardised neonatal medical record form which collected detailed individual patient level data. Additionally, training and mentorship were conducted and basic equipment was provided.Results: A total of 4178 neonates were hospitalised from July 2014 to December 2016. Median (IQR) age on admission was one day (1-3) and 48.0% (1851/3859) were male. Median (IQR) duration of hospitalisation was 17 days (IQR 10-40) and the longest duration of hospitalisation was 47 days (IQR 41-58). The majority were referrals from government health facilities (54.4%, 2012/3699), though 30.6% (1123/3669) presented as self-referrals. Septicaemia (44.9%, 1962/4371), prematurity (21.0%, 917/4371) and birth asphyxia (19.1%, 833/4371) were the most common diagnoses. The overall mortality was 13.8% (577/4178) and the commonest causes of death included septicaemia (26.9%, 155/577), prematurity (24.3%, 140/577), birth asphyxia (21.0%, 121/577), hypothermia (9.9%, 57/577) and respiratory distress (8.0%, 46/577). The majority of deaths (51.5%, 297/577) occurred within the first 24 h of hospitalisation although a significant proportion of deaths also occurred after 7 days of hospitalisation (24.1%, 139/577). A modest decrease in mortality and improvement in clinical outcome were observed.Conclusion: Improvement in neonatal data capture and quality of care was observed following establishment of an enhanced surveillance system, training and mentorship.Abbreviations: aOR: adjusted odds ratio; CHRP: Centre for Health research and Programmes; HC: health centre; HMIS: Health Management Information System; JRRH: Jinja Regional Referral Hospital; NMRF: neonatal medical record form; PMTCT: prevention of mother-to-child transmission of HIV; UPA: Uganda Paediatric Association.
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Affiliation(s)
- Jane Achan
- Uganda Paediatric Association, Kampala, Uganda.,Disease Control and Elimination Theme, Medical Research Council Unit, Banjul, The Gambia
| | | | - Arthur Mpimbaza
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Sophie Namasopo
- Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Harriet Nambuya
- Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | | | - Rebecca Nantanda
- Uganda Paediatric Association, Kampala, Uganda.,Makerere University Lung Institute, Kampala, Uganda
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19
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Ward RM, Turner MA, Hansen-Pupp I, Higginson J, Vanya M, Flood E, Schwartz EJ, Doll HA, Tocoian A, Mangili A, Barton N, Sarda SP. Development of the PREMature Infant Index (PREMII™), a clinician-reported outcome measure assessing functional status of extremely preterm infants. J Matern Fetal Neonatal Med 2020; 35:941-950. [PMID: 32138571 DOI: 10.1080/14767058.2020.1735338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Comprehensive measures to evaluate the effectiveness of medical interventions in extremely preterm infants are lacking. Although length of stay is used as an indicator of overall health among preterm infants in clinical studies, it is confounded by nonmedical factors (e.g. parental readiness and availability of home nursing support).Objectives: To develop the PREMature Infant Index (PREMII™), an electronic content-valid clinician-reported outcome measure for assessing functional status of extremely preterm infants (<28 weeks gestational age) serially over time in the neonatal intensive care unit. We report the development stages of the PREMII, including suggestions for scoring.Methods: We developed the PREMII according to US Food and Drug Administration regulatory standards. Development included five stages: (1) literature review, (2) clinical expert interviews, (3) Delphi panel survey, (4) development of items/levels, and (5) cognitive interviews/usability testing. Scoring approaches were explored via an online clinician survey.Results: Key factors reflective of functional status were identified by physicians and nurses during development of the PREMII, as were levels within each factor to assess functional status. The resulting PREMII evaluates eight infant health factors: respiratory support, oxygen administration, apnea, bradycardia, desaturation, thermoregulation, feeding, and weight gain, each scored with three to six gradations. Factor levels are standardized on a 0-100 scale; resultant scores are 0-100. No usability issues were identified. The online clinician survey identified optimal scoring methods to capture functional status at a given time point.Conclusions: Our findings support the content validity and usability of the PREMII as a multifunction outcome measure to assess functional status over time in extremely preterm infants. Psychometric validation is ongoing.
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Affiliation(s)
- Robert M Ward
- Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ingrid Hansen-Pupp
- Department of Clinical Sciences Lund, Pediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jason Higginson
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Magdalena Vanya
- Patient Centered Outcomes, ICON, South San Francisco, CA, USA
| | - Emuella Flood
- Patient Centered Outcomes, ICON, Gaithersburg, MD, USA
| | | | | | - Adina Tocoian
- Global Clinical Development, Rare Metabolic Diseases, Takeda, Switzerland
| | - Alexandra Mangili
- Global Clinical Development, Rare Metabolic Diseases, Takeda, Switzerland
| | - Norman Barton
- Global Clinical Development, Rare Metabolic Diseases, Takeda, Lexington, MA, USA
| | - Sujata P Sarda
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA
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20
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Williams MD, Lascelles BDX. Early Neonatal Pain-A Review of Clinical and Experimental Implications on Painful Conditions Later in Life. Front Pediatr 2020; 8:30. [PMID: 32117835 PMCID: PMC7020755 DOI: 10.3389/fped.2020.00030] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022] Open
Abstract
Modern health care has brought our society innumerable benefits but has also introduced the experience of pain very early in life. For example, it is now routine care for newborns to receive various injections or have blood drawn within 24 h of life. For infants who are sick or premature, the pain experiences inherent in the required medical care are frequent and often severe, with neonates requiring intensive care admission encountering approximately fourteen painful procedures daily in the hospital. Given that much of the world has seen a steady increase in preterm births for the last several decades, an ever-growing number of babies experience multiple painful events before even leaving the hospital. These noxious events occur during a critical period of neurodevelopment when the nervous system is very vulnerable due to immaturity and neuroplasticity. Here, we provide a narrative review of the literature pertaining to the idea that early life pain has significant long-term effects on neurosensory, cognition, behavior, pain processing, and health outcomes that persist into childhood and even adulthood. We refer to clinical and pre-clinical studies investigating how early life pain impacts acute pain later in life, focusing on animal model correlates that have been used to better understand this relationship. Current knowledge around the proposed underlying mechanisms responsible for the long-lasting consequences of neonatal pain, its neurobiological and behavioral effects, and its influence on later pain states are discussed. We conclude by highlighting that another important consequence of early life pain may be the impact it has on later chronic pain states-an area of research that has received little attention.
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Affiliation(s)
- Morika D. Williams
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Translational Research in Pain Program, North Carolina State University, Raleigh, NC, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States
| | - B. Duncan X. Lascelles
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Translational Research in Pain Program, North Carolina State University, Raleigh, NC, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Center for Translational Pain Medicine, Duke University, Durham, NC, United States
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21
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Al-Matary A, AlJohani E, Qaraqei M. Estimating the neonatal length of stay for preterm babies in a saudi tertiary hospital. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_115_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Tawfik DS, Profit J, Lake ET, Liu JB, Sanders LM, Phibbs CS. Development and use of an adjusted nurse staffing metric in the neonatal intensive care unit. Health Serv Res 2019; 55:190-200. [PMID: 31869865 DOI: 10.1111/1475-6773.13249] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To develop a nurse staffing prediction model and evaluate deviation from predicted nurse staffing as a contributor to patient outcomes. DATA SOURCES Secondary data collection conducted 2017-2018, using the California Office of Statewide Health Planning and Development and the California Perinatal Quality Care Collaborative databases. We included 276 054 infants born 2008-2016 and cared for in 99 California neonatal intensive care units (NICUs). STUDY DESIGN Repeated-measures observational study. We developed a nurse staffing prediction model using machine learning and hierarchical linear regression and then quantified deviation from predicted nurse staffing in relation to health care-associated infections, length of stay, and mortality using hierarchical logistic and linear regression. DATA COLLECTION METHODS We linked NICU-level nurse staffing and organizational data to patient-level risk factors and outcomes using unique identifiers for NICUs and patients. PRINCIPAL FINDINGS An 11-factor prediction model explained 35 percent of the nurse staffing variation among NICUs. Higher-than-predicted nurse staffing was associated with decreased risk-adjusted odds of health care-associated infection (OR: 0.79, 95% CI: 0.63-0.98), but not with length of stay or mortality. CONCLUSIONS Organizational and patient factors explain much of the variation in nurse staffing. Higher-than-predicted nurse staffing was associated with fewer infections. Prospective studies are needed to determine causality and to quantify the impact of staffing reforms on health outcomes.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jochen Profit
- California Perinatal Quality Care Collaborative, Palo Alto, California.,Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Eileen T Lake
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Jessica B Liu
- California Perinatal Quality Care Collaborative, Palo Alto, California.,Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Lee M Sanders
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Ciaran S Phibbs
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Health Economics Research Center and Center for Innovation to Implementation, Veteran's Affairs Palo Alto Health Care System, Palo Alto, California
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23
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Adeyemi S, Demir E. Modelling the neonatal system: A joint analysis of length of stay and patient pathways. Int J Health Plann Manage 2019; 35:704-717. [PMID: 31777100 DOI: 10.1002/hpm.2928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
In the United Kingdom, one in seven babies require specialist neonatal care after birth, with a noticeable increase in demand. Coupled with budgeting constraints and lack of investment means that neonatal units are struggling. This will inevitably have an impact on baby's length of stay (LoS) and the performance of the service. Models have previously been developed to capture individual babies' pathways to investigate the longitudinal cycle of care. However, no models have been developed to examine the joint analysis of LoS and babies' pathways. LoS at each stage of care is a critical driver of both the clinical outcomes and economic performance of the neonatal system. Using the generalized linear mixed modelling approach, extended to accommodate multiple outcomes, the association between neonate's pathway to discharge and LoS is examined. Using the data about 1002 neonates, we noticed that there is a high positive association between baby's pathway and total LoS, suggesting that discharge policies needs to be looked at more carefully. A novel statistical approach that examined the association of key outcomes and how it evolved over time is developed. Its applicability can be extended to other types of long-term care or diseases, such as heart failure and stroke.
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Affiliation(s)
| | - Eren Demir
- Hertfordshire Business School, University of Hertfordshire, Hertfordshire, UK
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24
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Tawfik DS, Thomas EJ, Vogus TJ, Liu JB, Sharek PJ, Nisbet CC, Lee HC, Sexton JB, Profit J. Safety climate, safety climate strength, and length of stay in the NICU. BMC Health Serv Res 2019; 19:738. [PMID: 31640679 PMCID: PMC6805564 DOI: 10.1186/s12913-019-4592-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022] Open
Abstract
Background Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs). Methods Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU’s respondents, i.e., safety climate strength, was determined via intra-unit standard deviation of safety climate scores. The relation between safety climate PPR, safety climate strength, and LOS among VLBW (< 1500 g) infants was evaluated using log-linear regression. Secondary outcomes were infections, chronic lung disease, and mortality. Results NICUs had safety climate PPRs of 66 ± 12%, intra-unit standard deviations 11 (strongest) to 23 (weakest), and median LOS 60 days. NICUs with stronger climates had LOS 4 days shorter than those with weaker climates. In interaction modeling, NICUs with weak climates and low PPR had the longest LOS, NICUs with strong climates and low PPR had the shortest LOS, and NICUs with high PPR (both strong and weak) had intermediate LOS. Stronger climates were associated with lower odds of infections, but not with other secondary outcomes. Conclusions Safety climate strength is independently associated with LOS and moderates the association between PPR and LOS among VLBW infants. Strength and PPR together provided better prediction than PPR alone, capturing variance in outcomes missed by PPR. Evaluations of NICU safety climate consider both positivity (PPR) and consistency of responses (strength) across individuals.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, 770 Welch Road, Suite 435, Stanford, CA, 94304, USA.
| | - Eric J Thomas
- The McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.,The University of Texas - Memorial Hermann Center for Healthcare Quality and Safety, Houston, TX, USA
| | - Timothy J Vogus
- Graduate School of Management, Vanderbilt University, Nashville, TN, USA
| | - Jessica B Liu
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Stanford, CA, USA
| | - Paul J Sharek
- California Perinatal Quality Care Collaborative, Stanford, CA, USA.,Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA, USA.,Division of Pediatric Hospitalist Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Courtney C Nisbet
- California Perinatal Quality Care Collaborative, Stanford, CA, USA.,Division of Pediatric Hospitalist Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Henry C Lee
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Stanford, CA, USA
| | - J Bryan Sexton
- Department of Psychiatry, Duke University Health System, Duke University School of Medicine, Durham, NC, USA.,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Stanford, CA, USA
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25
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Abstract
BACKGROUND Father involvement in the neonatal intensive care unit (NICU) is important for outcomes of children and should be encouraged. Neonatal nurses have been identified as a major source of support for fathers; yet, nurses have identified obstacles to family-centered care of the father. PURPOSE The purpose of this article is to present results that broaden the knowledge of factors that affect time NICU nurses spend with fathers. The information presented here is a portion of results from a larger survey that examined factors affecting NICU nurse caring beliefs of fathers. METHODS This survey study included NICU nurses and was administered anonymously online. Content analysis was completed on responses to open-ended questions. RESULTS Questions asked nurses about the time they spend with fathers. Nurses described problems with workflow and encouraged family bonding. Some nurses described spending equal amounts of time with both parents, whereas others focused on either the mother or the father. Paternal attributes that affected time nurses spent with fathers included confidence, motivation, level of competence, beliefs, attitudes, and availability. Maternal factors included culture and gatekeeping. Infant factors were level of illness and tolerance to activity. IMPLICATIONS FOR PRACTICE Unmotivated fathers may benefit from encouragement from nurses to participate in the care of their infants. Nurses can encourage parental partnerships in caring for their infants. IMPLICATIONS FOR RESEARCH Factors identified in this study can help guide future studies. Understanding the relationship between NICU fathers and nurses can help improve interactions and communication.
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26
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Goodman DC, Ganduglia-Cazaban C, Franzini L, Stukel TA, Wasserman JR, Murphy MA, Kim Y, Mowitz ME, Tyson JE, Doherty JR, Little GA. Neonatal Intensive Care Variation in Medicaid-Insured Newborns: A Population-Based Study. J Pediatr 2019; 209:44-51.e2. [PMID: 30955790 DOI: 10.1016/j.jpeds.2019.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/19/2018] [Accepted: 02/12/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess the contribution of maternal and newborn characteristics to variation in neonatal intensive care use across regions and hospitals. STUDY DESIGN This was a retrospective population-based live birth cohort of newborn infants insured by Texas Medicaid in 2010-2014 with 2 subcohorts: very low birth weight (VLBW) singletons and late preterm singletons. Crude and risk-adjusted neonatal intensive care unit (NICU) admission rates, intensive and intermediate special care days, and imaging procedures were calculated across Neonatal Intensive Care Regions (n = 21) and hospitals (n = 100). Total Medicaid payments were calculated. RESULTS Overall, 11.5% of live born, 91.7% of VLBW, and 37.6% of infants born late preterm were admitted to a NICU, receiving an average of 2 days, 58 days, and 5 days of special care with payments per newborn inpatient episode of $5231, $128 075, and $10 837, respectively. There was little variation across regions and hospitals in VLBW NICU admissions but marked variation for NICU admissions in late preterm newborn infants and for special care days and imaging rates in all cohorts. The variation decreased slightly after health risk adjustment. There was moderate substitution of intermediate for intensive care days across hospitals (Pearson r VLBW -0.63 P < .001; late preterm newborn -0.53 P < .001). CONCLUSIONS Across all risk groups, the variation in NICU use was poorly explained by differences in newborn illness levels and is likely to indicate varying practice styles. Although the "right" rates are uncertain, it is unlikely that all of these use patterns represent effective and efficient care.
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Affiliation(s)
- David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH.
| | - Cecilia Ganduglia-Cazaban
- Department of Management, Policy & Community Health, University of Texas School of Public Health, Houston, TX
| | - Luisa Franzini
- Department of Health Services Administration, University of Maryland School of Public Health, College Park, MD
| | - Therese A Stukel
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jared R Wasserman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Megan A Murphy
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Youngran Kim
- Department of Management, Policy & Community Health, University of Texas School of Public Health, Houston, TX
| | | | - Jon E Tyson
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX
| | - Julie R Doherty
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - George A Little
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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27
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Seaton SE, Barker L, Draper ES, Abrams KR, Modi N, Manktelow BN. Estimating neonatal length of stay for babies born very preterm. Arch Dis Child Fetal Neonatal Ed 2019; 104:F182-F186. [PMID: 29588296 PMCID: PMC6580734 DOI: 10.1136/archdischild-2017-314405] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/09/2018] [Accepted: 03/10/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To predict length of stay in neonatal care for all admissions of very preterm singleton babies. SETTING All neonatal units in England. PATIENTS Singleton babies born at 24-31 weeks gestational age from 2011 to 2014. Data were extracted from the National Neonatal Research Database. METHODS Competing risks methods were used to investigate the competing outcomes of death in neonatal care or discharge from the neonatal unit. The occurrence of one event prevents the other from occurring. This approach can be used to estimate the percentage of babies alive, or who have been discharged, over time. RESULTS A total of 20 571 very preterm babies were included. In the competing risks model, gestational age was adjusted for as a time-varying covariate, allowing the difference between weeks of gestational age to vary over time. The predicted percentage of death or discharge from the neonatal unit were estimated and presented graphically by week of gestational age. From these percentages, estimates of length of stay are provided as the number of days following birth and corrected gestational age at discharge. CONCLUSIONS These results can be used in the counselling of parents about length of stay and the risk of mortality.
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Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lisa Barker
- Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Keith R Abrams
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neena Modi
- Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
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Sekar K, Fuentes D, Krukas-Hampel MR, Ernst FR. Health Economics and Outcomes of Surfactant Treatments for Respiratory Distress Syndrome Among Preterm Infants in US Level III/IV Neonatal Intensive Care Units. J Pediatr Pharmacol Ther 2019; 24:117-127. [PMID: 31019404 DOI: 10.5863/1551-6776-24.2.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare length of stay (LOS), costs, mechanical ventilation (MV), and mortality in preterm infants treated in the Neonatal Intensive Care Unit (NICU) with beractant (BE), calfactant (CA), and poractant alfa (PA) for Respiratory Distress Syndrome (RDS). METHODS This study evaluated preterm infants born between 2010 and 2013 with RDS diagnosis, gestational age of 25 to 36 weeks, birthweight of ≥500 g, and age of ≤2 days on first surfactant administration. Multivariable regression was used to evaluate all NICU outcomes. RESULTS Of 13,240 infants meeting the study criteria, 4136 (31.2%) received BE, 2502 (18.9%) received CA, and 6602 (49.9%) received PA. Adjusted analyses estimated similar mean LOS (BE 26.7 days, CA 27.8 days, and PA 26.2 days) and hospital costs (BE: $50,929; CA: $50,785; and PA: $50,212). Compared to PA, BE and CA were associated with greater odds of MV use on day 3 (OR = 1.56 and 1.60, respectively) and day 7 (OR = 1.39 and 1.28, respectively; all p < 0.05). Adjusted NICU mortality was significantly higher only with CA vs PA (OR = 1.51; p = 0.015). CONCLUSION Adjusted NICU LOS and costs were similar among BE, CA, and PA. Infants receiving PA were less likely to be on MV at 3 and 7 days, and PA treatment was associated with lower odds of NICU mortality when compared to CA.
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29
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Dear Mommy and Daddy, I Wish to Go Home at the Right Date, Not Too Early But Not Too Late…. Pediatr Crit Care Med 2018; 19:1175-1176. [PMID: 30520844 DOI: 10.1097/pcc.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Abstract
OBJECTIVES To compare duration and changes over time in length of hospital stay for very preterm and extremely preterm infants in 10 European regions. DESIGN Two area-based cohort studies from the same regions in 2003 and 2011/2012. SETTING Ten regions from nine European countries. PATIENTS Infants born between 22 + 0 and 31 + 6 weeks of gestational age and surviving to discharge (Models of Organising Access to Intensive Care for Very Preterm Births cohort in 2003, n = 4,011 and Effective Perinatal Intensive Care in Europe cohort in 2011/2012, n = 4,336). INTERVENTIONS Observational study, no intervention. MEASUREMENTS AND MAIN RESULTS Maternal and infant characteristics were abstracted from medical records using a common protocol and length of stay until discharge was adjusted for case-mix using negative binomial regression. Mean length of stay was 63.6 days in 2003 and varied from 52.4 to 76.5 days across regions. In 2011/2012, mean length of stay was 63.1 days, with a narrower regional range (54.0-70.1). Low gestational age, small for gestational age, low 5-minute Apgar score, surfactant administration, any surgery, and severe neonatal morbidities increased length of stay. Infant characteristics explained some of the differences between regions and over time, but large variations remained after adjustment. In 2011/2012, mean adjusted length of stay ranged from less than 54 days in the Northern region of the United Kingdom and Wielkopolska, Poland to over 67 days in the Ile-de-France region of France and the Eastern region of the Netherlands. No systematic decrease in very preterm length of stay was observed over time after adjustment for patient case-mix. CONCLUSIONS A better understanding of the discharge criteria and care practices that contribute to the wide differences in very preterm length of stay across European regions could inform policies to optimize discharge decisions in terms of infant outcomes and health system costs.
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31
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Lee HC, Bennett MV, Crockett M, Crowe R, Gwiazdowski SG, Keller H, Kurtin P, Kuzniewicz M, Mazzeo AM, Schulman J, Nisbet CC, Sharek PJ. Comparison of Collaborative Versus Single-Site Quality Improvement to Reduce NICU Length of Stay. Pediatrics 2018; 142:peds.2017-1395. [PMID: 29899043 DOI: 10.1542/peds.2017-1395] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is unexplained variation in length of stay (LOS) across NICUs, suggesting that there may be practices that can optimize LOS. METHODS Three groups of NICUs in the California Perinatal Quality Care Collaborative were followed: (1) collaborative centers participating in an 18-month collaborative quality improvement project to optimize LOS for preterm infants; (2) individual centers aiming to optimize LOS; and (3) nonparticipants. Our aim in the collaborative project was to decrease postmenstrual age (PMA) at discharge for infants born between 27 + 0 and <32 weeks' gestational age by 3 days. A secondary outcome was "early discharge," the proportion of infants discharged from the hospital before 36 + 5 weeks' PMA. The balancing measure of readmissions within 72 hours was tracked for the collaborative group. RESULTS From 2013 to 2015, 8917 infants were cared for in 20 collaborative NICUs, 19 individual project NICUs, and 71 nonparticipants. In the collaborative group, the PMA at discharge decreased from 37.8 to 37.5 weeks (P = .02), and early discharge increased from 31.6% to 41.9% (P = .006). The individual project group had no significant change. Nonparticipants had a decrease in PMA from 37.5 to 37.3 weeks (P = .01) but no significant change in early discharge (39.8% to 43.6%; P = .24). There was no significant change in readmissions over time in the collaborative group. CONCLUSIONS A structured collaborative project that was focused on optimizing LOS led to a 3-day decrease in LOS and was more effective than individualized quality improvement efforts.
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Affiliation(s)
- Henry C Lee
- Department of Pediatrics, Stanford University, Stanford, California; .,California Perinatal Quality Care Collaborative, Stanford, California
| | - Mihoko V Bennett
- Department of Pediatrics, Stanford University, Stanford, California.,California Perinatal Quality Care Collaborative, Stanford, California
| | | | - Ruth Crowe
- UCSF Benioff Children's Hospital Oakland, Oakland, California
| | | | - Heather Keller
- California Perinatal Quality Care Collaborative, Stanford, California
| | - Paul Kurtin
- California Perinatal Quality Care Collaborative, Stanford, California
| | - Michael Kuzniewicz
- Perinatal Research Unit, Kaiser Permanente Northern California, Oakland, California
| | | | - Joseph Schulman
- California Children's Services, California Department of Health Care Services, Sacramento, California
| | - Courtney C Nisbet
- Department of Pediatrics, Stanford University, Stanford, California.,California Perinatal Quality Care Collaborative, Stanford, California
| | - Paul J Sharek
- Department of Pediatrics, Stanford University, Stanford, California.,California Perinatal Quality Care Collaborative, Stanford, California
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Abstract
Regional and statewide quality improvement collaboratives have been instrumental in implementing evidence-based practices and facilitating quality improvement initiatives within neonatology. Statewide collaboratives emerged from larger collaborative organizations, like the Vermont Oxford Network, and play an increasing role in collecting and interpreting data, setting priorities for improvement, disseminating evidence-based clinical practice guidelines, and creating regional networks for synergistic learning. In this review, we highlight examples of successful statewide collaborative initiatives, as well as challenges that exist in initiating and sustaining collaborative efforts.
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Cantey JB, Anderson KR, Kalagiri RR, Mallett LH. Morbidity and mortality of coagulase-negative staphylococcal sepsis in very-low-birth-weight infants. World J Pediatr 2018. [PMID: 29536341 DOI: 10.1007/s12519-018-0145-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in the neonatal intensive care unit (NICU) and usually require vancomycin treatment. Our objective was to determine whether CoNS are associated with neonatal morbidity and mortality. METHODS This was a retrospective cohort study of very-low-birth-weight (VLBW, ≤ 1500 g) infants from 1989 to 2015. Exclusion criteria were major congenital anomaly or death within 72 h. CoNS was considered a pathogen if recovered from ≥ 2 cultures, or 1 culture if treated for ≥ 5 days and signs of sepsis were present. Logistic regression was used to examine factors associated with morbidity and mortality. RESULTS Of 2242 VLBW infants, 285 (12.7%) had late-onset sepsis. CoNS (125, 44%), Staphylococcus aureus (52, 18%), and Escherichia coli (36, 13%) were the most commonly recovered organisms. In multivariate analysis, CoNS sepsis was not associated with mortality [OR 0.6 (95% CI 0.2-2.6)), but sepsis with other organisms was [OR 4.5 (95% CI 2.6-8.0)]. CoNS sepsis was associated with longer hospitalization but not risk for bronchopulmonary dysplasia, intraventricular hemorrhage, or retinopathy of prematurity. CONCLUSION CoNS sepsis was not associated with mortality or morbidities other than length of stay. These findings support vancomycin-reduction strategies in the NICU.
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Affiliation(s)
- Joseph B Cantey
- Department of Pediatrics, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | | | - Ram R Kalagiri
- Texas A&M Health Science Center, Baylor/Scott & White Health, Temple, TX, USA
| | - Lea H Mallett
- Texas A&M Health Science Center, Baylor/Scott & White Health, Temple, TX, USA
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Through the Eyes of the User: Evaluating Neonatal Intensive Care Unit Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 11:49-65. [DOI: 10.1177/1937586718761017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This article presents a pilot study that employed a user-centered methodology for evaluating and quantifying neonatal intensive care unit (NICU) designs based on the needs of the primary users. Background: The design of NICUs has begun to shift from open-bay to single-family rooms. Both designs present unique advantages and challenges that impact babies, families, and caregivers. Methods: One NICU design was analyzed using the functional scenario (FS) analysis method. For the FS, users’ needs were determined through literature review, interviews with NICU providers and parents, and a review of published design guidelines. Quantitative metrics were developed for each FS, so that characteristics of the NICU design could be analyzed to determine how successful they were in meeting the users’ needs. The results were graphically represented to visualize the success and considerations of the design. Results: A total of 23 FSs and 61 spatial metrics were developed. FSs for babies focused on infection prevention, minimizing exposure to environmental stimuli, and supporting enriching care activities. FSs for family members focused on direct access to the baby, and privacy and adequate space for daily activities. FSs for providers and caregivers focused on infection prevention, care activities, care zones, and visibility. Conclusion: Using an FS approach highlights design characteristics in the NICU that need to be addressed during the design process to more successfully meet the needs of the different users. Additionally, using this approach can inform design professionals’ decision-making by presenting them with the design characteristics that impact the needs of the user groups.
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Dol J, Delahunty-Pike A, Anwar Siani S, Campbell-Yeo M. eHealth interventions for parents in neonatal intensive care units: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2981-3005. [PMID: 29219875 DOI: 10.11124/jbisrir-2017-003439] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND As technology becomes increasingly more advanced, particularly video technology and interactive learning platforms, some neonatal intensive care units are embracing electronic health (eHealth) technologies to enhance and expand their family-centered care environments. Despite the emergence of eHealth, there has been a lack of systematic evaluation of its effectiveness thus far. OBJECTIVES To examine the effect of eHealth interventions used in neonatal intensive care units on parent-related and infant outcomes. INCLUSION CRITERIA TYPES OF PARTICIPANTS This review considered studies that included parents or primary caregivers of infants requiring care in a neonatal intensive care unit. TYPES OF INTERVENTION(S) This review considered studies that evaluated any eHealth interventions in neonatal intensive care units, including education (e.g. web-based platforms, mobile applications); communication (e.g. videos, SMS or text messaging), or a combination of both. Comparators included no eHealth interventions and/or standard care. TYPES OF STUDIES Experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, and analytical cross sectional studies were considered. OUTCOMES This review considered studies that included parent-related outcomes (use and acceptance, stress/anxiety, confidence, financial impact, satisfaction and technical issues) and neonatal outcomes (length of stay, postmenstrual age at discharge, parental presence and visits). SEARCH STRATEGY A systematic search was undertaken across four databases to retrieve published studies in English from inception to November 18, 2016. METHODOLOGICAL QUALITY Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI). DATA EXTRACTION Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI-SUMARI. DATA SYNTHESIS A comprehensive meta-analysis for all outcomes was not possible and data has been reported narratively for all outcomes. RESULTS Eight studies met inclusion criteria and were included in the review. The majority of the studies were low to very low quality. The study design and type of eHealth technology examined varied greatly. There appears to be growing interest in the topic as over half of the included studies were published within the past two years. Primary findings suggest parent acceptance and use of eHealth interventions but an unclear impact on neonatal outcomes, particularly on length of stay, a commonly reported neonatal outcome. Due to the variation in eHealth interventions, and heterogeneity across studies, meta-analysis was not possible. Numerous single studies and small sample sizes limited the degree of adequate strength to determine statistical differences across outcomes. CONCLUSIONS While heterogeneity across studies precluded meta-analysis, consistent trends across all studies examining parental acceptance of eHealth interventions indicate that parents are willing to accept eHealth interventions as part of their neonatal intensive care, suggesting that the incorporation and evaluation of eHealth interventions in the neonatal intensive care unit setting is warranted. Further high quality studies are needed with larger sample sizes to detect changes in outcomes. As eHealth intervention studies move beyond feasibility and implementation, there is a demand for randomized control trials to examine the effect of eHealth interventions on parent and neonatal outcomes compared to usual care. Future studies should consider reporting of outcomes using standardized measures which would allow comparison across eHealth interventions in subsequent reviews.
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Affiliation(s)
- Justine Dol
- Department of Health, Faculty of Health, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change: a Joanna Briggs Institute Affiliated Group, Dalhousie University, Canada
| | | | - Sheren Anwar Siani
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Marsha Campbell-Yeo
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change: a Joanna Briggs Institute Affiliated Group, Dalhousie University, Canada
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Dossetor PJ, Martiniuk ALC, Fitzpatrick JP, Oscar J, Carter M, Watkins R, Elliott EJ, Jeffery HE, Harley D. Pediatric hospital admissions in Indigenous children: a population-based study in remote Australia. BMC Pediatr 2017; 17:195. [PMID: 29166891 PMCID: PMC5700560 DOI: 10.1186/s12887-017-0947-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/14/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND We analysed hospital admissions of a predominantly Aboriginal cohort of children in the remote Fitzroy Valley in Western Australia during the first 7 years of life. METHODS All children born between January 1, 2002 and December 31, 2003 and living in the Fitzroy Valley in 2009-2010 were eligible to participate in the Lililwan Project. Of 134 eligible children, 127 (95%) completed Stage 1 (interviews of caregivers and medical record review) in 2011 and comprised our cohort. Lifetime (0-7 years) hospital admission data were available and included the dates, and reasons for admission, and comorbidities. Conditions were coded using ICD-10-AM discharge codes. RESULTS Of the 127 children, 95.3% were Indigenous and 52.8% male. There were 314 admissions for 424 conditions in 89 (70.0%) of 127 children. The 89 children admitted had a median of five admissions (range 1-12). Hospitalization rates were similar for both genders (p = 0.4). Of the admissions, 108 (38.6%) were for 56 infants aged <12 months (median = 2.5, range = 1-8). Twelve of these admissions were in neonates (aged 0-28 days). Primary reasons for admission (0-7 years) were infections of the lower respiratory tract (27.4%), gastrointestinal system (22.7%), and upper respiratory tract (11.4%), injury (7.0%), and failure to thrive (5.4%). Comorbidities, particularly upper respiratory tract infections (18.1%), failure to thrive (13.6%), and anaemia (12.7%), were common. In infancy, primary cause for admission were infections of the lower respiratory tract (40.8%), gastrointestinal (25.9%) and upper respiratory tract (9.3%). Comorbidities included upper respiratory tract infections (33.3%), failure to thrive (18.5%) and anaemia (18.5%). CONCLUSION In the Fitzroy Valley 70.0% of children were hospitalised at least once before age 7 years and over one third of admissions were in infants. Infections were the most common reason for admission in all age groups but comorbidities were common and may contribute to need for admission. Many hospitalizations were feasibly preventable. High admission rates reflect disadvantage, remote location and limited access to primary healthcare and outpatient services. Ongoing public health prevention initiatives including breast feeding, vaccination, healthy diet, hygiene and housing improvements are crucial, as is training of Aboriginal Health Workers to increase services in remote communities.
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Affiliation(s)
- Philippa J Dossetor
- Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, 97/2 Edinburgh Ave, Canberra, ACT, 2601, Australia.
- University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, Australia.
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia.
| | - Alexandra L C Martiniuk
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- The George Institute for Global Health, PO Box M201, Missenden Rd, Sydney, 2050, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - James P Fitzpatrick
- University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, Australia
- Population Sciences Division, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia
- School of Arts and Science, University of Notre Dame, Broome, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - Rochelle Watkins
- Population Sciences Division, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Elizabeth J Elliott
- University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, Australia
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia
- The Sydney Children's Hospital Network (Westmead), Westmead, Australia
| | - Heather E Jeffery
- RPA Newborn Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - David Harley
- Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, 97/2 Edinburgh Ave, Canberra, ACT, 2601, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Building 62, Corner of Eggleston and Mills Roads, Canberra, ACT, 0200, Australia
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Huvanandana J, Thamrin C, Tracy MB, Hinder M, Nguyen CD, McEwan AL. Advanced analyses of physiological signals in the neonatal intensive care unit. Physiol Meas 2017; 38:R253-R279. [DOI: 10.1088/1361-6579/aa8a13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Fleming PJ, Ingram J, Johnson D, Blair PS. Estimating discharge dates using routinely collected data: improving the preparedness of parents of preterm infants for discharge home. Arch Dis Child Fetal Neonatal Ed 2017; 102:F170-F172. [PMID: 27698193 PMCID: PMC5339560 DOI: 10.1136/archdischild-2016-310944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/31/2016] [Accepted: 09/14/2016] [Indexed: 12/01/2022]
Abstract
The length of stay for moderately preterm infants has progressively become shorter in the UK in recent years but staff still commonly inform parents that their baby will go home around their estimated date of delivery (EDD). Parents need as much notice as possible to prepare for the discharge of their baby, and to gain the necessary skills and knowledge to care for their infant safely. We report the use of routinely collected neonatal data to develop and implement a simple centile chart for date of discharge from hospital, which allows staff and parents to predict the likely discharge date more accurately for preterm infants, most of whom now go home more than 3 weeks before their EDD. This information allows better and timelier planning for discharge of such infants, by parents and staff.
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Affiliation(s)
- Peter J Fleming
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
| | - Jennifer Ingram
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
| | - Debbie Johnson
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
| | - Peter S Blair
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
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Demonstrating the relationships of length of stay, cost and clinical outcomes in a simulated NICU. J Perinatol 2016; 36:1128-1131. [PMID: 27583389 DOI: 10.1038/jp.2016.128] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/23/2016] [Accepted: 07/12/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Health-care leaders place significant focus on reducing the average length of stay (ALOS). We examined the relationships among ALOS, cost and clinical outcomes using a neonatal intensive care unit (NICU) simulation model. STUDY DESIGN A discrete-event NICU simulation model based on the Duke NICU was created. To identify the relationships among ALOS, cost and clinical outcomes, we replaced the standard probability distributions with composite distributions representing the best and worst outcomes published by the National Institutes of Health Neonatal Research Network. RESULT Both average cost per patient and average cost per ⩽28 week patient were lower in the best NICU ($16,400 vs $19,700 and $56,800 vs $76,700, respectively), while LOS remained higher (27 vs 24 days). CONCLUSION Our model demonstrates that reducing LOS does not uniformly reduce hospital resource utilization. These results suggest that health-care leaders should not simply rely on initiatives to reduce LOS without clear line-of-sight on clinical outcomes as well.
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Northrup TF, Evans PW, Lillie ML, Tyson JE. A free parking trial to increase visitation and improve extremely low birth weight infant outcomes. J Perinatol 2016; 36:1112-1115. [PMID: 27654495 PMCID: PMC5130615 DOI: 10.1038/jp.2016.136] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/18/2016] [Accepted: 07/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Frequent parental visits are likely to benefit infants in a neonatal intensive care unit (NICU), particularly extremely low birth weight (ELBW; ⩽1000 g) survivors. Parking costs (⩾$10 per visit in our center) may deter visitation, especially for low-income parents. We assessed whether free parking (FP) decreased survivors' length of stay (LOS). STUDY DESIGN Parents (N=138) of ELBW infants (7 to 14 days old) were randomized to usual care (UC; n=66) or FP (n=72). The primary outcome was LOS. RESULTS Among survivors (n=116), LOS was not significantly less with FP than UC (means: FP=89, UC=102 days, P=0.22; medians: FP=82, UC=84 days, P=0.30). Groups did not differ significantly on proportion of visit days (FP=0.69, UC=0.72, P=0.47), parental involvement, knowledge/skills and satisfaction. Post hoc analyses found that parents with a greater income, a car and fewer children visited more. CONCLUSION More potent interventions than FP are needed to increase parental visits and reduce LOS for ELBW infants in disadvantaged urban populations.
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Affiliation(s)
- Thomas F. Northrup
- Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, TX
| | - Patricia W. Evans
- Department of Pediatrics, UTHealth, McGovern Medical School, Houston, TX
| | - Margaret L. Lillie
- Department of Pediatrics, UTHealth, McGovern Medical School, Houston, TX
| | - Jon E. Tyson
- Department of Pediatrics, UTHealth, McGovern Medical School, Houston, TX
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Seaton SE, Barker L, Draper ES, Abrams KR, Modi N, Manktelow BN. Modelling Neonatal Care Pathways for Babies Born Preterm: An Application of Multistate Modelling. PLoS One 2016; 11:e0165202. [PMID: 27764232 PMCID: PMC5072657 DOI: 10.1371/journal.pone.0165202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/07/2016] [Indexed: 11/18/2022] Open
Abstract
Modelling length of stay in neonatal care is vital to inform service planning and the counselling of parents. Preterm babies, at the highest risk of mortality, can have long stays in neonatal care and require high resource use. Previous work has incorporated babies that die into length of stay estimates, but this still overlooks the levels of care required during their stay. This work incorporates all babies, and the levels of care they require, into length of stay estimates. Data were obtained from the National Neonatal Research Database for singleton babies born at 24–31 weeks gestational age discharged from a neonatal unit in England from 2011 to 2014. A Cox multistate model, adjusted for gestational age, was used to consider a baby’s two competing outcomes: death or discharge from neonatal care, whilst also considering the different levels of care required: intensive care; high dependency care and special care. The probabilities of receiving each of the levels of care, or having died or been discharged from neonatal care are presented graphically overall and adjusted for gestational age. Stacked predicted probabilities produced for each week of gestational age provide a useful tool for clinicians when counselling parents about length of stay and for commissioners when considering allocation of resources. Multistate modelling provides a useful method for describing the entire neonatal care pathway, where rates of in-unit mortality can be high. For a healthcare service focussed on costs, it is important to consider all babies that contribute towards workload, and the levels of care they require.
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Affiliation(s)
- Sarah E. Seaton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- * E-mail:
| | - Lisa Barker
- Leicester Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Elizabeth S. Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Keith R. Abrams
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Neena Modi
- Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College, London, United Kingdom
| | - Bradley N. Manktelow
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
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Seaton SE, Barker L, Jenkins D, Draper ES, Abrams KR, Manktelow BN. What factors predict length of stay in a neonatal unit: a systematic review. BMJ Open 2016; 6:e010466. [PMID: 27797978 PMCID: PMC5073598 DOI: 10.1136/bmjopen-2015-010466] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the UK, 1 in 10 babies require specialist neonatal care. This care can last from hours to months depending on the need of the baby. The increasing survival of very preterm babies has increased neonatal care resource use. Evidence from multiple studies is crucial to identify factors which may be important for predicting length of stay (LOS). The ability to predict LOS is vital for resource planning, decision-making and parent counselling. The objective of this review was to identify which factors are important to consider when predicting LOS in the neonatal unit. DESIGN A systematic review was undertaken which searched MEDLINE, EMBASE and Scopus for papers from 1994 to 2016 (May) for research investigating prediction of neonatal LOS. Strict inclusion and exclusion criteria were applied. Quality of each study was discussed, but not used as a reason for exclusion from the review. MAIN OUTCOME MEASURE Prediction of LOS in the neonatal unit. RESULTS 9 studies were identified which investigated the prediction of neonatal LOS indicating a lack of evidence in the area. Inherent factors, particularly birth weight, sex and gestational age allow for a simple and objective prediction of LOS, which can be calculated on the first day of life. However, other early occurring factors may well also be important and estimates may need revising throughout the baby's stay in hospital. CONCLUSIONS Predicting LOS is vital to aid the commissioning of services and to help clinicians in their counselling of parents. The lack of evidence in this area indicates a need for larger studies to investigate methods of accurately predicting LOS.
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Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lisa Barker
- Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Jenkins
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Keith R Abrams
- Department of Health Sciences, University of Leicester, Leicester, UK
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Clark RH, Spitzer AR. Understanding Outliers and Defining Value in Neonatal Healthcare. J Pediatr 2016; 173:15-6. [PMID: 27016048 DOI: 10.1016/j.jpeds.2016.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/04/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Reese H Clark
- The Pediatrix Center for Research, Education, and Quality, MEDNAX, Inc, Sunrise, Florida.
| | - Alan R Spitzer
- The Pediatrix Center for Research, Education, and Quality, MEDNAX, Inc, Sunrise, Florida
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Temple MW, Lehmann CU, Fabbri D. Predicting Discharge Dates From the NICU Using Progress Note Data. Pediatrics 2015; 136:e395-405. [PMID: 26216319 PMCID: PMC5524203 DOI: 10.1542/peds.2015-0456] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Discharging patients from the NICU may be delayed for nonmedical reasons including the need for medical equipment, parental education, and children's services. We describe a method to predict which patients will be medically ready for discharge in the next 2 to 10 days, providing lead time to address nonmedical reasons for delayed discharge. METHODS A retrospective study examined 26 features (17 extracted, 9 engineered) from daily progress notes of 4693 patients (103,206 patient-days) from the NICU of a large, academic children's hospital. These data were used to develop a supervised machine learning problem to predict days to discharge (DTD). Random forest classifiers were trained by using examined features and International Classification of Diseases, Ninth Revision-based subpopulations to determine the most important features. RESULTS Three of the 4 subpopulations (premature, cardiac, gastrointestinal surgery) and all patients combined performed similarly at 2, 4, 7, and 10 DTD with area under the curve (AUC) ranging from 0.854 to 0.865 at 2 DTD and 0.723 to 0.729 at 10 DTD. Patients undergoing neurosurgery performed worse at every DTD measure, scoring 0.749 at 2 DTD and 0.614 at 10 DTD. This model was also able to identify important features and provide "rule-of-thumb" criteria for patients close to discharge. By using DTD equal to 4 and 2 features (oral percentage of feedings and weight), we constructed a model with an AUC of 0.843. CONCLUSIONS Using clinical features from daily progress notes provides an accurate method to predict when patients in the NICU are nearing discharge.
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Affiliation(s)
- Michael W. Temple
- Departments of Biomedical Informatics, and,Address correspondence to Michael W. Temple, MD, Department of Biomedical Informatics, Vanderbilt University School of Medicine, 2525 West End, Suite 1475, Nashville, TN 37203-8390. E-mail: ,
| | - Christoph U. Lehmann
- Departments of Biomedical Informatics, and,Pediatrics, Vanderbilt University, Nashville, Tennessee
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Handley SC, Sun Y, Wyckoff MH, Lee HC. Outcomes of extremely preterm infants after delivery room cardiopulmonary resuscitation in a population-based cohort. J Perinatol 2015; 35:379-83. [PMID: 25521563 PMCID: PMC4414658 DOI: 10.1038/jp.2014.222] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/08/2014] [Accepted: 11/03/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the relationship of delivery room cardiopulmonary resuscitation (DR-CPR) to short-term outcomes of extremely preterm infants. STUDY DESIGN This was a cohort study of 22 to 27+6/7 weeks gestational age (GA) infants during 2005 to 2011. DR-CPR was defined as chest compressions and/or epinephrine administration. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) associated with DR-CPR; analysis was stratified by GA. RESULT Of the 13 758 infants, 856 (6.2%) received DR-CPR. Infants 22 to 23+6/7 weeks receiving DR-CPR had similar outcomes to non-recipients. Infants 24 to 25+6/7 weeks receiving DR-CPR had more severe intraventricular hemorrhage (OR 1.36, 95% CI 1.07, 1.72). Infants 26 to 27+6/7 weeks receiving DR-CPR were more likely to die (OR 1.81, 95% CI 1.30, 2.51) and have intraventricular hemorrhage (OR 2.10, 95% CI 1.56, 2.82). Adjusted hospital DR-CPR rates varied widely (median 5.7%). CONCLUSION Premature infants receiving DR-CPR had worse outcomes. Mortality and morbidity varied by GA.
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Affiliation(s)
- S C Handley
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Y Sun
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - M H Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - H C Lee
- Department of Pediatrics, Stanford University, California Perinatal Quality Care Collaborative, Stanford, CA, USA
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Lee HC, Powers RJ, Bennett MV, Finer NN, Halamek LP, Nisbet C, Crockett M, Chance K, Blackney D, von Köhler C, Kurtin P, Sharek PJ. Implementation methods for delivery room management: a quality improvement comparison study. Pediatrics 2014; 134:e1378-86. [PMID: 25332503 PMCID: PMC4210793 DOI: 10.1542/peds.2014-0863] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects. METHODS This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support. RESULTS There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12,528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%). CONCLUSIONS Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.
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Affiliation(s)
- Henry C. Lee
- Divisions of Neonatal & Developmental Medicine and,California Perinatal Quality Care Collaborative, Palo Alto, California
| | - Richard J. Powers
- Division of Neonatology, Department of Pediatrics, Good Samaritan Hospital, San Jose, California
| | - Mihoko V. Bennett
- Divisions of Neonatal & Developmental Medicine and,California Perinatal Quality Care Collaborative, Palo Alto, California
| | - Neil N. Finer
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, California
| | | | - Courtney Nisbet
- Divisions of Neonatal & Developmental Medicine and,California Perinatal Quality Care Collaborative, Palo Alto, California
| | | | - Kathy Chance
- California Children’s Services, Sacramento, California
| | | | - Connie von Köhler
- Miller Children’s Hospital Long Beach, MemorialCare Health System, Long Beach, California
| | - Paul Kurtin
- Rady Children’s Hospital, San Diego, California; and
| | - Paul J. Sharek
- General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California;,California Perinatal Quality Care Collaborative, Palo Alto, California;,Center for Quality and Clinical Effectiveness, Lucile Packard Children’s Hospital, Palo Alto, California
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