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Beltempo M, Patel S, Platt RW, Julien AS, Blais R, Bertelle V, Lapointe A, Lacroix G, Gravel S, Cabot M, Piedboeuf B. Association of nurse staffing and unit occupancy with mortality and morbidity among very preterm infants: a multicentre study. Arch Dis Child Fetal Neonatal Ed 2023:archdischild-2022-324414. [PMID: 36609411 DOI: 10.1136/archdischild-2022-324414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE In a healthcare system with finite resources, hospital organisational factors may contribute to patient outcomes. We aimed to assess the association of nurse staffing and neonatal intensive care unit (NICU) occupancy with outcomes of preterm infants born <33 weeks' gestation. DESIGN Retrospective cohort study. SETTING Four level III NICUs. PATIENTS Infants born 23-32 weeks' gestation 2015-2018. MAIN OUTCOME MEASURES Nursing provision ratios (nursing hours worked/recommended nursing hours based on patient acuity categories) and unit occupancy rates were averaged for the first shift, 24 hours and 7 days of admission of each infant. Primary outcome was mortality/morbidity (bronchopulmonary dysplasia, severe neurological injury, retinopathy of prematurity, necrotising enterocolitis and nosocomial infection). ORs for association of exposure with outcomes were estimated using generalised linear mixed models adjusted for confounders. RESULTS Among 1870 included infants, 823 (44%) had mortality/morbidity. Median nursing provision ratio was 1.03 (IQR 0.89-1.22) and median unit occupancy was 89% (IQR 82-94). In the first 24 hours of admission, higher nursing provision ratio was associated with lower odds of mortality/morbidity (OR 0.93, 95% CI 0.89 to 0.98), and higher unit occupancy was associated with higher odds of mortality/morbidity (OR 1.19, 95% CI 1.04 to 1.36). In causal mediation analysis, nursing provision ratios mediated 47% of the association between occupancy and outcomes. CONCLUSIONS NICU occupancy is associated with mortality/morbidity among very preterm infants and may reflect lack of adequate resources in periods of high activity. Interventions aimed at reducing occupancy and maintaining adequate resources need to be considered as strategies to improve patient outcomes.
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Affiliation(s)
- Marc Beltempo
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada .,Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sharina Patel
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Robert W Platt
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Anne-Sophie Julien
- Département de mathématiques et de statistique, Université Laval, Quebec City, Quebec, Canada
| | - Régis Blais
- Département de gestion, d'évaluation et de politique de santé, Université de Montréal, Montreal, Quebec, Canada
| | - Valerie Bertelle
- Departement of Pediatrics, Université de Sherbooke, Sherbrooke, Quebec, Canada
| | - Anie Lapointe
- Departement of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Guy Lacroix
- Department of Economics, Université Laval, Quebec City, Quebec, Canada
| | - Sophie Gravel
- Division of Neonatalogy, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Michèle Cabot
- Division of Neonatalogy, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Bruno Piedboeuf
- Departement of Pediatrics, Université Laval, Quebec City, Quebec, Canada
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Optic Nerve Sheath Diameter Ultrasound: A Non-Invasive Approach to Evaluate Increased Intracranial Pressure in Critically Ill Pediatric Patients. Diagnostics (Basel) 2022; 12:diagnostics12030767. [PMID: 35328319 PMCID: PMC8946972 DOI: 10.3390/diagnostics12030767] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 01/16/2023] Open
Abstract
Early diagnosis of increased intracranial pressure (ICP) is crucial for prompt diagnosis and treatment of intracranial hypertension in critically ill pediatric patients, preventing secondary brain damage and mortality. Although the placement of an external ventricular drain coupled to an external fluid-filled transducer remains the gold standard for continuous ICP monitoring, other non-invasive approaches are constantly being improved and can provide reliable estimates. The use of point-of-care ultrasound (POCUS) for the assessment of ICP has recently become widespread in pediatric emergency and critical care settings, representing a valuable extension of the physical examination. The aim of this manuscript is to review and discuss the basic principles of ultra-sound measurement of the optic nerve sheath diameter (ONSD) and summarize current evidence on its diagnostic value in pediatric patients with ICP. There is increasing evidence that POCUS measurement of the ONSD correlates with ICP, thus appearing as a useful extension of the physical examination in pediatrics, especially in emergency medicine and critical care settings for the initial non-invasive assessment of patients with suspected raised ICP. Its role could be of value even to assess the response to therapy and in the follow-up of patients with diagnosed intracranial hypertension if invasive ICP monitoring is not available. Further studies on more homogeneous and extensive study populations should be performed to establish ONSD reference ranges in the different pediatric ages and to define cut-off values in predicting elevated ICP compared to invasive ICP measurement.
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Ceran B, Beşer E, Karaçağlar NB, Beyoğlu R, Şimşek GK, Canpolat FE, Kutman HGK. Evaluation of the correlation of the new Ballard scoring with the ultrasonographic optical nerve sheath diameter and brain volume of preterm infants. Early Hum Dev 2021; 163:105506. [PMID: 34773864 DOI: 10.1016/j.earlhumdev.2021.105506] [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] [Received: 09/03/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Optic nerve sheath diameter (ONSD) measurements with magnetic resonance imaging and ultrasonography in preterm infants are similar. AIM We measured ultrasonographic ONSD and calculated the brain volumes of preterm infants using two-dimensional cranial ultrasonography and explored the relationships thereof with gestational age, birth weight, head circumference, and new Ballard score. METHOD This prospective study included preterm infants admitted to the neonatal intensive care unit without intracranial pathology. Two images per eye were obtained from a linear array ultrasound transducer placed on the patient's superior eyelid. The ONSD was measured 3 mm behind the globe. The brain was considered an ellipsoid, and estimated absolute brain volumes were calculated by subtracting the volumes of the two lateral ventricles from the total brain volumes. RESULTS A total of 143 preterm infants (male 74, female 69) included in the study. The mean gestational age of the study population was 29.7 weeks (23-36), and the mean birth weight was 1390 g (500-2850). There was a significant difference in ONSD between the male and female gender. A significant, strong, and positive correlation was found between ONSD measurements and gestational age (r 0.901, p < 0.001), new Ballard score (r 0.946, p < 0.001), birth weight, head circumference, and brain volumes. CONCLUSION Our results suggested that ONSD measurements are highly correlated with anthropometry, and it could be a promising bedside, non-invasive objective tool for the determination of exact gestational age postnatally along with the new Ballard score.
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Affiliation(s)
- Burak Ceran
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey.
| | - Esra Beşer
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Nazmiye Bengü Karaçağlar
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Rana Beyoğlu
- Department of Pediatric Radiology, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Gülsüm Kadıoğlu Şimşek
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Fuat Emre Canpolat
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Hayriye Gözde Kanmaz Kutman
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
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Lan SY, Tai HL, Lin JJ, Lan FY, Tsai HY, Lin KL. Measurement of optic nerve sheath diameter by ultrasound in healthy term neonates. Pediatr Neonatol 2021; 62:591-597. [PMID: 34226155 DOI: 10.1016/j.pedneo.2021.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Optic nerve sheath diameter (ONSD) ultrasound is a noninvasive and repeatable tool to dynamically evaluate intracranial pressure with high diagnostic accuracy; however, data in neonates are scarce. The aim of this study was to determine the reference value of ONSD and potential influencing factors in healthy term neonates. METHODS We retrospectively reviewed 250 full-term neonates who underwent cranial ultrasound as part of selective newborn screening over a 2-year period. Neonates with any of the following conditions were excluded: using mechanical ventilation, sedatives and/or vasopressors, or signs of infection which needed cerebrospinal fluid analysis and/or intracranial pathologies. Data on sex, gestational age, birth body weight, birth body height, birth head circumference, Apgar score and types of delivery were collected. The neurodevelopmental outcomes were reviewed. RESULTS A total of 234 neonates (123 girls and 111 boys) were included. The mean ONSD value was 3.30 ± 0.27 mm in the right eye and 3.30 ± 0.23 mm in the left eye, with no significant difference between both eyes (p = 0.797). Male neonates had a larger ONSD than female neonates (3.34 ± 0.22 mm versus 3.26 ± 0.20 mm, p = 0.007), and ONSD was correlated with birth weight in the males. Otherwise, there were no statistically significant associations between ONSD and other birth characteristics in both sexes. Most (63%) cases were followed for at least 12 months, and 98% had normal neurodevelopment. CONCLUSION The reference value reported in this study may be used to evaluate the ONSD in healthy term neonates. Sex differences should be considered in this age group.
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Affiliation(s)
- Shih-Yun Lan
- Department of Pediatric Neurology, Saint Paul's Hospital, Taoyuan, Taiwan; Department of Pediatric Neurology, New Taipei City Hospital, Taiwan
| | - Hung-Lin Tai
- Department of Neonatology, Saint Paul's Hospital, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Hsin-Yu Tsai
- Department of Pediatric Neurology, Saint Paul's Hospital, Taoyuan, Taiwan; Yuan-Shun Lee Pediatric Clinic, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Yildizdas D, Aslan N. Is Ocular Sonography a Reliable Method for the Assessment of Elevated Intracranial Pressure in Children? J Pediatr Intensive Care 2021; 10:14-22. [PMID: 33585057 DOI: 10.1055/s-0040-1716385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/21/2020] [Indexed: 10/23/2022] Open
Abstract
Point-of-care ultrasound has been widely used by clinicians at the bedside in recent years. Various types of point-of-care ultrasound practices are employed, especially in pediatric emergency rooms and intensive care units. Pediatric intensive care specialists perform point-of-care ultrasound virtually as a part of physical examination since it provides just-in-time vital clinical information, which could assist in acute management strategies in critically ill patients. Measurement of optic nerve sheath diameter using point-of-care ultrasound is a noninvasive and radiation-free technique to determine raised intracranial pressure. Ophthalmic artery and central retinal artery Doppler indices can be used as transcranial Doppler to assess raised intracranial pressure. The aim of this review was to provide detailed information on ultrasonographic measurements of optic nerve sheath diameter and central retinal artery Doppler indices as techniques of interest for predicting increased intracranial pressure in pediatric patients in view of the literature.
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Affiliation(s)
- Dincer Yildizdas
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nagehan Aslan
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Turkey
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Yapicioglu H, Aslan N, Sertdemir Y, Yildizdas D, Gulasi S, Mert K. Determination of normal values of optic nerve sheath diameter in newborns with bedside ultrasonography. Early Hum Dev 2020; 145:104986. [PMID: 32335478 DOI: 10.1016/j.earlhumdev.2020.104986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 12/07/2019] [Accepted: 02/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Bedside sonographic opthalmic ultrasound measurement of optic nerve sheath diameter (ONSD) is an easy, portabl, noninvasive and a radiation free technique to determine increased intracranial pressure. This prospective, multicenter study was aimed to establish the range of normal values for ONSD in preterm and term newborns with a large study population. METHODS Newborns without intracranial pathology in the Newborn Intensive Care Units and in Obstetrics and Gynecology Departments were enrolled in the study. ONSD was measured at 3 mm distance behind of the right optic nerve head. As 3 mm distance was beyond the optic nerve head in some of the premature newborns, we had also measurements at 2 and 2.5 mm. RESULTS ONSD was measured in 554 newborns. Mean ONSD of preterm babies at 2, 2.5 and 3 mm distances were 3.2 ± 0.3 mm (range 2.0-4.2 mm), 3.3 ± 0.3 mm (range 2.2-4.5 mm) and 3.6 ± 0.2 mm (range 2.9-4.5 mm), (p2.0-2.5 mm < 0.001, p 2.5-3.0mm < 0.001, p2.0-3.0 mm < 0.001) respectively. Mean ONSD of term babies at 3 mm was higher than the mean ONSD of preterm babies in 33 weeks 0 day- 37 weeks 0 days group (p < 0.001). In correlation analysis, a significant, strong and positive correlation was found between ONSD measurements and gestational age, weight, height and head circumference at 2, 2.5 and 3 mm distances. CONCLUSION The normal values reported by the present study may be used for evaluating the ONSD of newborns with different conditions with increased incracranial pressure.
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Affiliation(s)
- Hacer Yapicioglu
- Cukurova University, Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Turkey
| | - Nagehan Aslan
- Cukurova University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care, Turkey.
| | - Yasar Sertdemir
- Cukurova University, Faculty of Medicine, Department of Biostatistics, Turkey
| | - Dincer Yildizdas
- Cukurova University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care, Turkey
| | - Selvi Gulasi
- Adana City Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Adana, Turkey
| | - Kurthan Mert
- Adana City Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Adana, Turkey
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