Early comprehensive care of preterm infants-effects on quality of life, childhood development, and healthcare utilization: study protocol for a cohort study linking administrative healthcare data with patient reported primary data

Effect of comprehensive nursing on swallowing function and quality of life in patients with ischemic stroke

Hu et al explored the impact of comprehensive nursing model on swallowing function and quality of life in patients with ischemic stroke. They divided 172 patients into the control group (routine care) and the research group (comprehensive care), and used standard scales to evaluate the swallowing function, neurological deficit, anxiety and depression, daily living ability, and exercise of the two groups of patients before and after care. Changes in indicators of function, quality of life, and compliance. The results showed that compared with the control group, patients in the study group achieved significant improvements in various indicators, with a lower incidence of adverse reactions and higher satisfaction with care. These data suggest that the comprehensive nursing model can significantly improve the swallowing function, quality of life and satisfaction of patients with ischemic stroke. In the future, the development of comprehensive nursing models needs to focus on technological innovation, humanized services, continuing education and training, multi-disciplinary collaboration, optimal allocation of resources, standardized practice and evaluation, etc., in order to improve nursing effects and promote the improvement of medical service quality.

Costs of Neonatal Medical Complexity: Impact on New Parent Stress and Decision-Making

OBJECTIVE

Parents of children with medical complexity experience substantial financial burdens. It is unclear how neonatal intensive care unit (NICU) clinicians prepare new parents of medically complex infants for this reality. This study explored new parent awareness of health care costs, desire to discuss costs with clinicians, and impact of costs on parents' medical decision-making.

STUDY DESIGN

The study design comprised semistructured interviews and surveys of parents of infants with medical complexity currently or previously in a NICU. Conventional content analysis was performed on interview transcripts, and descriptive analyses were applied to surveys.

RESULTS

Thematic saturation was reached with 27 families (15 NICU families and 12 post-NICU families) of diverse race/ethnicity/education/household income. Most were worried about their infants' current/future medical expenses and approximately half wanted to discuss finances with clinicians, only one parent had. While finances were not part of most parent's NICU decision-making, some later regretted this and wished cost had been incorporated into treatment choices. The family desire to discuss costs did not vary by family financial status. Parents described their infant's health care costs as: "We are drowning"; and "We'll never pay it off."

CONCLUSION

Most parents were worried about current and future medical expenses related to their infant's evolving medical complexity. Many wanted to discuss costs with clinicians; almost none had. NICU clinicians should prepare families for the future financial realities of pediatric medical complexity.

KEY POINTS

· Many families want to discuss costs with NICU clinicians.. · Some families want costs to be a part of medical decisions.. · Few families currently discuss costs with NICU providers..

[Perinatal Networks: Ensuring Regional Care of Pregnant Woman and Newborns]

Health care of pregnant women and their newborns is facing major challenges due to the decline in birth rate and shortage of specialists. In the current discussion about future concepts, the centralization associated with minimum quantities and the necessary safeguarding of care in the area are often construed as conflicting goals. Instead, concepts are needed to guarantee that pregnant women and their children will continue to receive care close to home. The example of the saxony center for feto/neonatal health is used to show how partners in a region can jointly ensure care during pregnancy, birth and the neonatal period on a supra-local and cross-hospital basis. The close cooperation of maximum care providers with regional partners enables comprehensive health care. At the same time, this cooperation enables hospitals to remain attractive employers in structurally weak regions and to provide comprehensive care for young families in need of medical services related to pregnancy and birth through good family and social integration close to home and work. The overriding goals of the saxony center for feto/neonatal health are optimal, guideline-based, interdisciplinary and intersectoral care of pregnant women and premature or sick newborns in the region.

[Telemedical Support of Feto-Neonatal Care in One Region - Part I: Demand Analysis Using the Example of East Saxony]

Excellence in feto-neonatal care forms the basis for health in adulthood and requires a collaboration of stakeholders in the health care system. As in other regions, demographic changes such as rural depopulation pose a risk to feto-neonatal care in Eastern Saxony. Areas in need of regional, perinatal collaboration have been identified: (I) multi-professional counselling of families with a suspected fetal disease, (II) immediately available expertise of a neonatologist during neonatal resuscitation, (III) evidence-based neonatal antibiotic therapy, (IV) backtransfer of extremely preterm infants or sick neonates, and (V) adequate psychosocial support of families with extremely preterm infants or sick neonates. Telemedicine enables regional partners to communicate efficiently and gives an audiovisual impression of the patient. The Saxony Center for feto/neonatal Health (SCFNH) collaborates with regional partners to establish a feto-neonatal telemedicine network "Sichere Geburt". The network will be scientifically evaluated and might be of help as a model for other regions with structural challenges.

Histological chorioamnionitis is associated with an increased risk of wheezing in preterm children less than 34 gestational weeks

Background

Chorioamnionitis is associated with various neonatal short- and long-term morbidities. The effect of chorioamnionitis on premature children’s outcomes remains controversial. The aim of this study is to investigate the relationship between histological chorioamnionitis (HCA) and physiological development, wheezing, and atopic diseases in preterm children.

Methods

Singleton, preterm children (< 34 weeks), whose mother underwent pathological placental examinations, were retrospectively enrolled and the outcomes were assessed at 24–40 months during follow-up. Wheezing and atopic diseases including eczema, food allergies, and allergic rhinitis were screened by a questionnaire along with medical diagnosis. Anthropometric indexes and blood pressure were measured. Cognitive and behavioural developments were assessed by the Gesell Development and Diagnosis Scale. Blood IgE and routine examination were analyzed with venous blood and serum metabolomic profiling was assessed via liquid chromatography-mass spectrometry (LC-MS). A multivariate logistic regression model was used to estimate the association between HCA and the current outcomes.

Results

Among the 115 enrolled children, 47 were exposed to HCA. The incidence of wheezing was significantly higher in children exposed to HCA, as 38.30% of children who were exposed to HCA and 16.18% of children who were not had been diagnosed with wheezing. After adjusting for related confounders in the multivariate logistic regression model, there remained a 2.72-fold increased risk of wheezing in children with HCA (adjusted odds ratio, aOR, 2.72; 95% confidence interval, 1.02–7.23). Moreover, 163 differential metabolites, such as butanoic acid, annotemoyin 1 and charine, were identified in the HCA exposed children’s serum. Enrichment analysis revealed that these compounds participated in diverse key metabolomic pathways relating to physical and neuro- developments, including glycerophospholipid, alpha-linolenic acid and choline metabolisms. There were no significant differences in atopic diseases, serum IgE, eosinophils’ level, anthropometric indexes, blood pressure, or cognitive or behavioural developments between the two groups.

Conclusion

HCA exposure is associated with an increased risk of wheezing in preterm children less than 34 gestational weeks.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02572-9.

[Association between Socioeconomic Status and Developmental Status: Data Linkage of Results of the Daycare and School Entry Health Examinations of a Saxon Birth Cohort Study]

BACKGROUND

Child development is determined by both biological (e. g. gender, natal maturity) and psychosocial (e. g. socioeconomic status, daycare) factors.

OBJECTIVES

To examine how familial socioeconomic status (SES) as well as biological and other psychosocial factors are associated with the state of development of 4- and 6-year-old children.

METHODS

Data linkage of primary data from a birth cohort study and routine data from the Saxon public health departments on children born between 2007 and 2008, who underwent both daycare health examination and school entry health examination (N=615), was used to examine speech and motor skills, both fine and gross, for associations with psychosocial and biological factors. Potential associations were tested for significance and shown as odds ratios by using binary logistic regression.

RESULTS

There were no noticeable problems in the development of the majority of Saxon children until school entry. Nevertheless, language seems to be a sensitive area of development, since 37% of the children showed problems at both time-points. Furthermore boys, preterm infants and children from a lower socio-economic class were more often affected by developmental delays, with preterm infants with low SES being at very high risk. Furthermore, the point of time of entering daycare seems to be of relevance for child development.

CONCLUSIONS

The results are in line with national and international findings. An important new finding is the significantly increased likelihood of having developmental problems when biological and psychosocial risk factors coincide. However, longitudinal analyses are required to study developmental courses and to evaluate measures initiated to combat these issues.

Impact of birthweight on health-care utilization during early childhood - a birth cohort study

Background

Comprehensive data are needed to evaluate the burden of low birthweight. Analysis of routine data on health-care utilization during early childhood were used to test the hypothesis that infants with low birthweight have (i) increased inpatient health-care utilization, (ii) higher hospital costs and (iii) different morbidity pattern in early childhood when compared with normal birthweight infants.

Methods

Children born between 2007 and 2013 that were insured at birth with the statutory health insurance AOK PLUS were included (N = 118,166, equaling 49% of the Saxon newborns) and classified into very low (< 1500 g, VLBW), low (1500-2499 g, LBW) birthweight and reference group (> 2500 g). Outcomes were: inpatient health-care utilization quantified by number and length of hospital stays; costs of hospitalizations including medication; reasons of hospitalizations for each year of life (YOL).

Results

72, 38 and 22% of VLBW-, LBW- and reference group were hospitalized after perinatal period within the first YOL with a more than 5-fold increased risk in VLBW to be hospitalized for hemangioma, convulsions, hydrocephalus, hernia and respiratory problems. Median (IQR) cumulative cost of inpatient care during the first four YOLs was 2953 (1213-7885), 1331 (0–3451) and 0 (0–2062) Euro for respective groups. Inpatient early childhood health-care utilization (after first YOL) was higher in VLBW compared to healthy, normal birth weight infants (RR 3.92 [95%-CI 3.63, 4.23]), residents of rural areas (RR 1.37 [95%-CI 1.35, 1.40]) and in boys (RR 1.31 [95%-CI 1.29, 1.33]).

Conclusion

This large population-based birth-cohort study indicates a high clinical and economic burden of low birthweight which is not restricted to the first year of life.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1424-8) contains supplementary material, which is available to authorized users.

Adults born preterm: a review of general health and system-specific outcomes

In this review of 126 publications, we report that an overwhelming majority of adults born at preterm gestations remain healthy and well. However, a small, but a significant fraction of them remain at higher risk for neurological, personality and behavioural abnormalities, cardio-pulmonary functional limitations, systemic hypertension and metabolic syndrome compared to their term-born counterparts. The magnitude of increased risk differed across organ systems and varied across reports. The risks were proportional to the degree of prematurity at birth and seemed to occur more frequently among preterm infants born in the final two decades of the 20th century and later. These findings have considerable public health and clinical practice relevance.

CONCLUSION

Preterm birth needs to be considered a chronic condition, with a slight increase in the risk for long-term morbidities among adults born preterm. Therefore, obtaining a history of gestational age and weight at birth should be a routine part of care for patients of all age groups.