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Abstract
Cholestasis in preterm infants has a multifactorial etiology. Risk factors include degree of prematurity, lack of enteral feeding, intestinal injury, prolonged use of parenteral nutrition (PN), and sepsis. Soy-based parenteral lipid emulsions have been implicated in the pathophysiology of PN-associated liver injury. Inflammation plays an important role. Medical therapies are used; however, their effects have not consistently proven effective. Evaluation of cholestasis involves laboratory work; direct bilirubin levels are used for diagnosis and trending. Adverse outcomes include risk for hepatobiliary dysfunction, irreversible liver failure, and death. Early enteral feedings as tolerated is the best way to prevent and manage cholestasis.
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Affiliation(s)
- Katie Satrom
- Division of Neonatology, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th Floor, East Building, Delivery Code: 8952A, Minneapolis, MN 55454, USA.
| | - Glenn Gourley
- Pediatric Gastroenterology, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th Floor, East Building, 8952A, Minneapolis, MN 55454, USA
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Braga MS, Kabbur P, Alur P, Goodstein MH, Roberts KD, Satrom K, Shivananda S, Goswami I, Pappagallo M, Briere CE, Suresh G. Current practice of neonatal resuscitation documentation in North America: a multi-center retrospective chart review. BMC Pediatr 2015; 15:184. [PMID: 26572859 PMCID: PMC4647697 DOI: 10.1186/s12887-015-0503-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
Background To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal documentation. Methods Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant’s record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified. Results Charts of 263 infants were reviewed. The mean gestational age was 28.4 weeks, and the mean birth weight 1050 g. Of the infants, 69 % were singletons, and 74 % were delivered by Cesarean section. A mean of 13.2 (SD 3.5) of the 29 Resuscitation Data Items were registered for each birth. Items most frequently present were; review of obstetric history (98 %), Apgar scores (96 %), oxygen use (77 %), suctioning (71 %), and stimulation (62 %). In our model adjusted for measured covariates, the institution was significantly associated with documentation. Conclusions Neonatal resuscitation documentation is not standardized and has significant variation. Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics. Understanding this variation may lead to efforts to standardize documentation of neonatal resuscitation.
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Affiliation(s)
- Matthew S Braga
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Children's Hospital at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Prakash Kabbur
- Kapi'olani Medical Center for Women and Children, Neonatology, 1319 Punahou St, Honolulu, HI, 96826, USA.
| | - Pradeep Alur
- Wellspan Health, York Hospital, Neonatology, 1001 S. George St., York, 17403, NY, USA.
| | - Michael H Goodstein
- Wellspan Health, York Hospital, Neonatology, 1001 S. George St., York, 17403, NY, USA.
| | - Kari D Roberts
- University of Minnesota Masonic Children's Hospital, Neonatology, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
| | - Katie Satrom
- University of Minnesota Masonic Children's Hospital, Neonatology, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
| | - Sandesh Shivananda
- McMaster University, McMaster Children's Hospital, Neonatology, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | - Ipsita Goswami
- McMaster University, McMaster Children's Hospital, Neonatology, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | - Mariann Pappagallo
- University of Connecticut Health Center, Connecticut Children's Medical Center, Neonatology, 282 Washington St., Farmington, 06106, CT, USA.
| | - Carrie-Ellen Briere
- University of Connecticut Health Center, Connecticut Children's Medical Center, Neonatology, 282 Washington St., Farmington, 06106, CT, USA.
| | - Gautham Suresh
- Texas Children's Hospital, Baylor College of Medicine, Neonatology, 6621 Fannin St, Houston, TX, 77030, USA.
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Abstract
Neonatal hyperbilirubinemia continues to be a leading cause of morbidity and mortality in resource-limited countries. The aim of this study was to measure the effectiveness of existing phototherapy units at a local hospital in Cameroon using an irradiance meter. Phototherapy units (n = 4) in one newborn nursery in Cameroon were evaluated. The average irradiance of the functioning units was 2.87 μW/cm(2)/nm, which is substantially below the recommended range of 10-30 μW/cm(2)/nm. With simple improvements, one new prototype unit was developed. Its irradiance was 23.3 μW/cm(2)/nm. We concluded that irradiance of phototherapy units should be measured, as many local nurseries worldwide may not be delivering effective treatment. Simple and cost-effective changes to phototherapy units can make a substantial improvement in irradiance.
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Affiliation(s)
- Katie Satrom
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA and Department of Energy Management, University of Minnesota, Minneapolis, MN, USA
| | - Tina Slusher
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA and Department of Energy Management, University of Minnesota, Minneapolis, MN, USA
| | - Jared Satrom
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA and Department of Energy Management, University of Minnesota, Minneapolis, MN, USA
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