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Lechner BE, Kukora SK, Hawes K. Equity, inclusion and cultural humility: contemporizing the neonatal intensive care unit family-centered care model. J Perinatol 2024; 44:760-766. [PMID: 38532086 DOI: 10.1038/s41372-024-01949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
Existing NICU family centered care models lack the key elements of equity, inclusion and cultural humility. These models were conceived to support families during the stressful life event of an infant's NICU admission. Their development, however, occurred prior to recognition of the medical field's systematic shortcomings in providing equitable care and their impact on outcome disparities for marginalized communities; thus, they do not include cultural or equitable healthcare considerations. Given the significant neonatal care inequities for marginalized groups, incorporating the experience of these patients in a targeted manner into family centered care frameworks is of critical importance to ensure culturally humble and thus more just and equitable treatment. Here, we review past approaches to NICU family centered care and propose a novel, updated framework which integrates culturally humble care into the NICU family centered care framework.
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Affiliation(s)
- Beatrice E Lechner
- Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI, USA.
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Stephanie K Kukora
- Division of Neonatology and Bioethics Center, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics and Department of Medical Humanities and Bioethics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Katheleen Hawes
- Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI, USA
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
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Chalia M, Seager E, Rao A, Hannam S. Transient abnormal myelopoiesis requiring advanced neonatal intensive care treatment. Acta Paediatr 2024; 113:980-988. [PMID: 38329201 DOI: 10.1111/apa.17142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
AIM Five to thirty percent of neonates with trisomy 21 develop transient abnormal myelopoiesis (TAM) with a high mortality rate. The aim of the study was to identify contributing factors that determine mortality and need for chemotherapy in this patient group. METHODS Six-year, single-centre, retrospective study of neonatal TAM cases requiring admission to intensive care. Data were collected from electronic patient records, laboratory and genetic results. The odds ratio was calculated to assess the likelihood of neonates with certain clinical characteristics having short-term mortality and needing chemotherapy. RESULTS Twenty-one neonates were studied with a mortality rate of 28%. Neonates requiring inotropic support (OR 19, 95% CI: 0.9-399, p = 0.05) and inhaled nitric oxide (iNO) (OR 13, 95% CI: 1.4-124.3, p = 0.03) were less likely to survive to discharge. Neonates needing mechanical ventilation (OR 14, 95% CI: 1.1-185.5, p = 0.04), or a white cell count >50 × 109/L (OR 27, 95% CI: 1.2-605.7, p = 0.04) were more likely to receive chemotherapy. CONCLUSION A high mortality rate was identified in TAM neonates with symptomatic pulmonary hypertension (PH) needing active treatment strategies, such as inotropes and iNO. The presence of PH should be considered in the clinical management, prognosis and parental counselling.
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Affiliation(s)
- Maria Chalia
- Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
| | - Emilie Seager
- Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
| | - Anupama Rao
- Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Simon Hannam
- Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
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Bekkevold M, Solvik-Olsen T, Heyerdahl F, Lang AM, Hagemo J, Rehn M. Reporting interhospital neonatal intensive care transport: international five-step Delphi-based template. BMJ Paediatr Open 2024; 8:e002374. [PMID: 38569741 PMCID: PMC10989109 DOI: 10.1136/bmjpo-2023-002374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To develop a general and internationally applicable template of data variables for reporting interhospital neonatal intensive care transports. DESIGN A five-step Delphi method. SETTING A group of experts was guided through a formal consensus process using email. SUBJECTS 12 experts in neonatal intensive care transports from Canada, Denmark, Norway, the UK and the USA. Four women and eight men. The experts were neonatologists, anaesthesiologists, intensive care nurse, anaesthetic nurse, medical leaders, researchers and a parent representative. MAIN OUTCOME MEASURES 37 data variables were included in the final template. RESULTS Consensus was achieved on a template of 37 data variables with definitions. 30 variables to be registered for each transport and 7 for annual registration of the system of the transport service. 11 data variables under the category structure, 20 under process and 6 under outcome. CONCLUSIONS We developed a template with a set of data variables to be registered for neonatal intensive care transports. To register the same data will enable larger datasets and comparing services.
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Affiliation(s)
- Marit Bekkevold
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Solvik-Olsen
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Fridtjof Heyerdahl
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Air Ambulance, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Astri Maria Lang
- Department of Paediatric, Akershus University Hospital, Lorenskog, Norway
| | - Jostein Hagemo
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Air Ambulance, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Marius Rehn
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Air Ambulance, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
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Exploring Parent Experiences with Early Palliative Care Practices in the NICU. Adv Neonatal Care 2024; 24:E20. [PMID: 38547484 DOI: 10.1097/ANC.0000000000000000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
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Petoello E, Kerkow E, Phad N, Ficial B, de Waal K. Which left atrial volume measurement should we use in the neonatal intensive care? Early Hum Dev 2024; 191:105985. [PMID: 38513546 DOI: 10.1016/j.earlhumdev.2024.105985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Increased left atrial volume (LAV) is a marker of cardiovascular risk. Echocardiography standards to assess LAV in adults and children are the biplane area-length method (AL) and method of disks (MOD). LAV in neonatology is usually derived as M-mode ratio between the LA and the Aorta (LAAo). The aim of this study is to determine feasibility and reliability of these methods in neonatal clinical practice. METHODS Clinically indicated echocardiograms in neonatal intensive care patients were retrospectively analyzed. Feasibility was determined with an image quality score describing insonation angle, foreshortening and wall clarity. Reliability was determined with Bland-Altman and correlation coefficient analysis of intra- and inter-observer measurements. RESULTS 104 infants ranging from 23 to 39 weeks gestation were included. The feasibility of LAAo, AL and MOD was comparable (median image score 4 out of 6 points). Linear regression between AL and MOD was excellent (R2 0.99). LAAo best-fit with MOD was reached with curve-linear regression (R2 0.28) whereby a LAAo of 1.60 correlated with 1.24 ml/kg, but with a wide 95 % CI. The correlation coefficient within and between observers for LAAo, biplane AL, biplane MOD and monoplane MOD was 0.93 (0.87-0.96), 0.98 (0.96-0.99), 0.98 (0.96-0.99), 0.99 (0.97-0.99) and 0.58 (0.11-0.81), 0.75 (0.44-0.89), 0.92 (0.88-0.98), 0.96 (0.88-0.98) respectively. CONCLUSION All methods were equally feasible and reliable when repeated by the same observer, but LAAo reliability was poor when repeated by a different observer. Biplane MOD was the most reliable and thus recommended in neonatal practice. Monoplane MOD performed well and could be considered as alternative but might be less accurate.
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Affiliation(s)
- Enrico Petoello
- John Hunter Children's Hospital, Department of Neonatology, Newcastle, NSW, Australia; Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
| | - Emma Kerkow
- John Hunter Children's Hospital, Department of Neonatology, Newcastle, NSW, Australia
| | - Nilkant Phad
- John Hunter Children's Hospital, Department of Neonatology, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Koert de Waal
- John Hunter Children's Hospital, Department of Neonatology, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
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Weber A, Bakas T, Schulman-Green D, Voos KC, Rice JB, Bailey R, Reigel A, Oudat Q, Holmes M, Tubbs-Cooley HL, Kaplan HC. Family Management Skills Reported by Parents of Preterm Infants in the NICU Using the Self- and Family Management Framework (SFMF). Adv Neonatal Care 2024; 24:119-131. [PMID: 38127650 PMCID: PMC10978294 DOI: 10.1097/anc.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Across the globe, family-integrated care (FICare) has become an evidence-based standard in which parents deliver the majority of infant care in the neonatal intensive care unit (NICU). Because of extensive barriers to parent presence, adaptations to FICare may be required for successful implementation. Family management theory may provide structure to the Parent Education of FICare and help nurses guide parents' skill development as equal care members. PURPOSE To identify family management skills employed by NICU parents using the Self- and Family Management Framework (SFMF). METHODS We conducted secondary analyses of qualitative interview data from NICU parents (n = 17) who shared their experiences of using family management skills to care for their infant. We categorized skills according to 3 main self- and family management processes: Focusing on Infant Illness Needs; Activating Resources; and Living With Infant Illness. RESULTS Parents reported several family management skills currently identified in the SFMF, as well as new skills such as conflict management, power brokerage, and addressing resources related to social determinants of health. Parent activation of resources was critical to sustaining parent focus on the infant's illness needs. IMPLICATIONS FOR PRACTICE AND RESEARCH By teaching skills that parents reported as helping them manage infant care, neonatal nurses may better facilitate parent integration into the care team. Future researchers can incorporate the skills identified in this study into the design of family management interventions that facilitate FICare implementation in the United States.
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Affiliation(s)
- Ashley Weber
- Author Affiliations: University of Cincinnati College of Nursing, Cincinnati, Ohio (Drs Weber and Bakas and Mr Oudat); New York University Rory Meyers College of Nursing, New York City, New York (Dr Schulman-Green); Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Voos, Mr Bailey, and Mss Reigel and Holmes); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Dr Rice); The Ohio State University, Columbus, Ohio (Dr Tubbs-Cooley); and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Kaplan)
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de Waal K, Petoello E. Assessing fluid responsiveness with ultrasound in the neonatal intensive care setting: the mini-fluid challenge. Eur J Pediatr 2024; 183:1947-1951. [PMID: 38276998 PMCID: PMC11001719 DOI: 10.1007/s00431-024-05425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
The mini-fluid challenge (MFC) can guide individualised fluid therapy and prevent fluid overload and associated morbidity in adult intensive care patients. This ultrasound test is based on the Frank-Starling principles to assess dynamic fluid responsiveness, but limited MFC data exists for newborns. This brief report describes the feasibility of the MFC in 12 preterm infants with late onset sepsis and 5 newborns with other pathophysiology. Apical views were used to determine the changes in left ventricular stroke volume before and after a 3 ml/kg fluid bolus was given over 5 min. Four out of the 17 infants were fluid responsive, defined as a post-bolus increase in stroke volume of 15% or more. Conclusion: The MFC was feasible and followed the physiological principles of stroke volume and extravascular lung water changes and 24% were fluid responsive. The MFC could enable future studies to examine whether adding fluid responsiveness to guide fluid therapy in newborns can reduce the risk of fluid overload. What is Known: • Fluid overload is associated with morbidity and mortality. • The mini-fluid challenge (MFC) provides a personalised approach to fluid therapy. What is New: • The MFC is feasible in newborns. • The MFC followed the physiological principles of stroke volume and extravascular lung water changes.
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Affiliation(s)
- Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital, University of Newcastle, Lookout road, New Lambton, Newcastle, NSW, 3205, Australia.
| | - Enrico Petoello
- Department of Neonatology, John Hunter Children's Hospital, University of Newcastle, Lookout road, New Lambton, Newcastle, NSW, 3205, Australia
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Quinn M, Gephart S, Crist J. Exploring Parent Experiences With Early Palliative Care Practices in the NICU. Adv Neonatal Care 2024; 24:98-109. [PMID: 38324727 DOI: 10.1097/anc.0000000000001137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND The anxiety and uncertain outcome of an admission of a seriously ill infant to the neonatal intensive care unit (NICU) can cause great stress for parents and contribute to poor mental health outcomes. Early implementation of family-centered palliative care (PC) may provide support for NICU parents. Key concepts of early PC in the NICU include shared decision-making, care planning, and support for coping with distress. PURPOSE The purpose of this study was to explore parent experiences during their child's NICU admission with the early PC practices of shared decision-making, care planning, and coping with distress. METHODS Qualitative descriptive methodology was used. Strategies of reflexive journaling, peer debriefing, and data audits were used to enhance trustworthiness. Parents (N = 16) were interviewed, and data were analyzed by conventional content analysis. Targeted recruitment of fathers occurred to ensure they comprised 25% of sample. RESULTS Parents' descriptions of decision-making were contextualized in gathering information to make a decision, the emotional impact of the decision, and influences on their decision-making. In experiences with care planning, parents described learning to advocate, having a spectator versus participant role, and experiencing care planning as communication. Key themes expressed regarding parental coping were exposure to trauma, survival mode, and a changing support network. IMPLICATIONS FOR PRACTICE AND RESEARCH These findings highlight key areas for practice improvement: providing more support and collaboration in decision-making, true engagement of parents in care planning, and encouraging peer support and interaction in the NICU and in online communities.
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Affiliation(s)
- Megan Quinn
- Author Affiliations: Oregon Health Sciences University, Portland (Dr Quinn); and University of Arizona, Tucson (Drs Gephart and Crist)
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Conlon TW, Baker D, Bhombal S. Cardiac point-of-care ultrasound: Practical integration in the pediatric and neonatal intensive care settings. Eur J Pediatr 2024; 183:1525-1541. [PMID: 38236402 DOI: 10.1007/s00431-023-05409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/19/2024]
Abstract
Cardiac point-of-care ultrasound (POCUS) is a technology increasingly leveraged at the bedside by pediatric critical care and neonatology providers to identify real-time hemodynamic pathophysiology. We present a framework for (1) identifying the scope of cardiac POCUS within the clinical practice setting, (2) standardizing views for protocolized hemodynamic assessment relevant to pediatric critical illness and (3) integrating POCUS findings for therapeutic guidance. Within the review, we also discuss practical strengths and limitations to image acquisition and interpretation within the varied cardiac POCUS views. Finally, we explore unique considerations within the neonatal population. Conclusion: Cardiac POCUS is a technology and tool that reveals important real-time information at the bedside of the critically ill child and infant. Understanding strengths and limitations of cardiac POCUS views and protocolizing an approach to answer focused clinical questions provides a framework for training and translation to clinical care. What is Known: • Ultrasound technology is now ubiquitous among pediatric critical care and neonatology settings, and growing literature supports an expanded role in not only procedural but also diagnostic applications. • Cardiac POCUS influences provider perception of pathophysiology and changes clinical management. What is New: • Effective cardiac POCUS training and subsequent translation to clinical practice should improve when clinical questions and protocolized approaches to image acquisition are standardized within a specialty. • Cardiac POCUS views have strengths and limitations which must be recognized when assessing the hemodynamic profile of a child or neonate.
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Affiliation(s)
- Thomas W Conlon
- The Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - David Baker
- The Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Shazia Bhombal
- Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Fusch G, Mohamed S, Bakry A, Li EW, Dutta S, Helou SE, Fusch C. Analysis of noise levels in the neonatal intensive care unit: the impact of clinical microsystems. Eur J Pediatr 2024; 183:1245-1254. [PMID: 38095715 DOI: 10.1007/s00431-023-05335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 03/20/2024]
Abstract
Reorganization of neonatal intensive care by introducing clinical microsystems may help to allocate nursing time more appropriately to the needs of patients. However, there is concern that cohorting infants according to acuity may enhance noise levels. This single-center study investigated the impact of reorganization of neonatal intensive care unit by implementing clinical microsystems in a Level III NICU on environmental noise. This prospective study measured 24-h noise levels over a period of 6 months during pre- and post-implementation of microsystems cohorting infants of similar acuity. Comparative analyses of the mixed acuity (i.e., before) and the cohorting (i.e., after) model were performed by creating daily profiles from continuous noise level measurements and calculating the length of exposure to predefined noise levels. Compared to baseline daytime measurements, noise levels were 3-6 dBA higher during physician handover. Noise levels were 2-3 dBA lower on weekends and 3-4 dBA lower at night, independent of the organizational model. The introduction of clinical microsystems slightly increased average noise levels for high-acuity pods (A and B) but produced a much more substantial decrease for low-acuity pods (E), leading to an overall reduction in unit-wide noise levels. Conclusion: Our data show that noise levels are more driven by human behavior than by technical devices. Implementation of microsystems may help to reduce noise exposure in the lower acuity pods in a NICU. What is Known: • Excessive noise levels can lead to adverse effects on the health and development of premature infants and other critically ill newborns. • The reorganization of the neonatal intensive care unit following the clinical microsystems principles might improve quality of care but also affect noise exposure of staff and patients. What is New: • The transition from a mixed -acuity to cohorting model is associated with an overall reduction in noise levels, particularly in low-acuity pods requiring less nursing care. • Nevertheless, baseline noise levels in both models exceeded the standard permissible limits.
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Affiliation(s)
- Gerhard Fusch
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Saber Mohamed
- Department of Mechanical Engineering, McMaster University, Hamilton, Canada
| | - Ahmad Bakry
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Edward W Li
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Sourabh Dutta
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
- Department of Pediatrics, Neonatology Unit, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Salhab El Helou
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Christoph Fusch
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada.
- Department of Pediatrics, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
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Duffy N, Hickey L, Treyvaud K, Delany C. 360-degree phenomenology: A qualitative approach to exploring the infant experience of hospitalisation in neonatal intensive care. Early Hum Dev 2024; 190:105963. [PMID: 38377880 DOI: 10.1016/j.earlhumdev.2024.105963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024]
Abstract
This paper describes the development and justification of a qualitative methodology aimed at exploring the infant's personal experience of hospitalisation in the neonatal intensive care unit (NICU). We begin by briefly reviewing existing methods for documenting and recording infant experiences. These methods focus on the clinical needs of the infant predominantly through quantifiable medical outcome data. Research understanding their experience of receiving clinical care is lacking. By exploring newborn infant behaviour, cues, and communication strategies we assert the infant as a capable participant in neonatal research. We then describe the methodology and methods which we have named 360-degree phenomenology that draws directly from the capabilities and knowledge of the infants themselves. We propose this methodology will address the gap in the literature by enabling a rich and comprehensive overview of the early life experiences of infants hospitalised in NICU.
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Affiliation(s)
- Natalie Duffy
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Medical Education, University of Melbourne, Melbourne, Australia.
| | - Leah Hickey
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Karli Treyvaud
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Psychology and Counselling, La Trobe University, Melbourne, Australia; Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Delany
- Department of Medical Education, University of Melbourne, Melbourne, Australia; Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Australia
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Ergün K, Aktaş E. Evaluating the Effectiveness of Brief Training for Neonatal Intensive Care Nurses on the Prevention of Medical Device-Related Nasal Pressure Injury. Adv Skin Wound Care 2024; 37:1-7. [PMID: 38393709 DOI: 10.1097/asw.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of a brief training in medical device-related pressure injury (MDRPI) prevention for neonatal intensive care nurses. METHODS This single-group, pretest-posttest quasi-experimental study was conducted between April and October 2021 with 81 nurses working in the neonatal ICU of a city hospital. The participants completed a training program consisting of two 40-minute sessions that used a small-group problem-based learning approach developed in accordance with evidence-based research. Data were collected using a neonatal nurse information form, knowledge of MDRPI in preterm infants form, and training evaluation form, all of which were prepared for this study based on the literature. Data collection was performed before the training and repeated at 1 week and 1 month after the training. Data analysis was performed using the Number Cruncher Statistical System. Descriptive statistics, the Shapiro-Wilk test, Mann-Whitney U test, and Spearman correlation analysis were used. RESULTS The participants' mean score on the knowledge of MDRPI in premature infants form was 82.44 ± 7.26 before training and increased significantly to 94.57 ± 5.03 at 1 week and 94.67 ± 3.11 at 1 month after training (P = .001 and P = .001, respectively). No significant relationship was detected between the participants' descriptive characteristics and their knowledge scores before or after the training (P > .05). CONCLUSIONS Brief training on the prevention of nasal pressure injury caused by noninvasive ventilation increased nurses' knowledge level.
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Affiliation(s)
- Kübra Ergün
- Kübra Ergün, MSc, is Training Nurse, Department of Training Unit, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey. Eda Aktaş, PhD, is Assistant Professor of Pediatric Nursing, Department of Pediatric Nursing, University of Health Sciences Hamidiye Faculty of Nursing, Istanbul, Turkey. Acknowledgment: This research was completed as the first author's master thesis at the University of Health Sciences Institute of Graduate Studies, Pediatric Nursing Master Program. The authors have disclosed no financial relationships related to this article. Submitted March 10, 2023; accepted in revised form May 3, 2023
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Jiang S, Parkinson B, Gu Y. Enhancing Neonatal Intensive Care With Rapid Genome Sequencing. JAMA Netw Open 2024; 7:e240097. [PMID: 38386325 DOI: 10.1001/jamanetworkopen.2024.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Affiliation(s)
- Shan Jiang
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
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Marom D, Mory A, Reytan-Miron S, Amir Y, Kurolap A, Cohen JG, Morhi Y, Smolkin T, Cohen L, Zangen S, Shalata A, Riskin A, Peleg A, Lavie-Nevo K, Mandel D, Chervinsky E, Fisch CF, Fleisher Sheffer V, Falik-Zaccai TC, Rips J, Shlomai NO, Friedman SE, Shporen CH, Ben-Yehoshua SJ, Simmonds A, Yaacobi RG, Bauer-Rusek S, Omari H, Weiss K, Hochwald O, Koifman A, Globus O, Batzir NA, Yaron N, Segel R, Morag I, Reish O, Eliyahu A, Leibovitch L, Schwartz ME, Abramsky R, Hochberg A, Oron A, Banne E, Portnov I, Samra NN, Singer A, Baris Feldman H. National Rapid Genome Sequencing in Neonatal Intensive Care. JAMA Netw Open 2024; 7:e240146. [PMID: 38386321 PMCID: PMC10884880 DOI: 10.1001/jamanetworkopen.2024.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Importance National implementation of rapid trio genome sequencing (rtGS) in a clinical acute setting is essential to ensure advanced and equitable care for ill neonates. Objective To evaluate the feasibility, diagnostic efficacy, and clinical utility of rtGS in neonatal intensive care units (NICUs) throughout Israel. Design, Setting, and Participants This prospective, public health care-based, multicenter cohort study was conducted from October 2021 to December 2022 with the Community Genetics Department of the Israeli Ministry of Health and all Israeli medical genetics institutes (n = 18) and NICUs (n = 25). Critically ill neonates suspected of having a genetic etiology were offered rtGS. All sequencing, analysis, and interpretation of data were performed in a central genomics center at Tel-Aviv Sourasky Medical Center. Rapid results were expected within 10 days. A secondary analysis report, issued within 60 days, focused mainly on cases with negative rapid results and actionable secondary findings. Pathogenic, likely pathogenic, and highly suspected variants of unknown significance (VUS) were reported. Main Outcomes and Measures Diagnostic rate, including highly suspected disease-causing VUS, and turnaround time for rapid results. Clinical utility was assessed via questionnaires circulated to treating neonatologists. Results A total of 130 neonates across Israel (70 [54%] male; 60 [46%] female) met inclusion criteria and were recruited. Mean (SD) age at enrollment was 12 (13) days. Mean (SD) turnaround time for rapid report was 7 (3) days. Diagnostic efficacy was 50% (65 of 130) for disease-causing variants, 11% (14 of 130) for VUS suspected to be causative, and 1 novel gene candidate (1%). Disease-causing variants included 12 chromosomal and 52 monogenic disorders as well as 1 neonate with uniparental disomy. Overall, the response rate for clinical utility questionnaires was 82% (107 of 130). Among respondents, genomic testing led to a change in medical management for 24 neonates (22%). Results led to immediate precision medicine for 6 of 65 diagnosed infants (9%), an additional 2 (3%) received palliative care, and 2 (3%) were transferred to nursing homes. Conclusions and Relevance In this national cohort study, rtGS in critically ill neonates was feasible and diagnostically beneficial in a public health care setting. This study is a prerequisite for implementation of rtGS for ill neonates into routine care and may aid in design of similar studies in other public health care systems.
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Affiliation(s)
- Daphna Marom
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Mory
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sivan Reytan-Miron
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yam Amir
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alina Kurolap
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Julia Grinshpun Cohen
- Community Genetics Department, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Yocheved Morhi
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tatiana Smolkin
- Department of Neonatalogy, Baruch Padeh Medical Center, Tzafon Medical Center, Tiberias, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - Lior Cohen
- Genetics Unit, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Shmuel Zangen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Department of Neonatalogy, Barzilai University Medical Center, Ashkelon, Israel
| | - Adel Shalata
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Genetics Institute, Bnai Zion Medical Center, Haifa, Israel
| | - Arieh Riskin
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, Bnai Zion Medical Center, Haifa, Israel
| | - Amir Peleg
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Genetics Institute, Carmel Medical Center, Haifa, Israel
| | - Karen Lavie-Nevo
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, Carmel Medical Center, Haifa, Israel
| | - Dror Mandel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatalogy, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Elana Chervinsky
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- The Genetics Institute and Center of Rare Diseases, Emek Medical Center, Afula, Israel
| | - Clari Felszer Fisch
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, Emek Medical Center, Afula, Israel
| | - Vered Fleisher Sheffer
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Department of Neonatalogy, Galilee Medical Center, Naharia, Israel
| | - Tzipora C Falik-Zaccai
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Genetics Institute, Galilee Medical Center, Naharia, Israel
| | - Jonathan Rips
- Department of Genetics, Hadassah Medical Organization, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
| | - Noa Ofek Shlomai
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Department of Neonatalogy, Hadassah Medical Organization, Jerusalem, Israel
| | - Smadar Eventov Friedman
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Department of Neonatalogy, Hadassah Medical Organization, Jerusalem, Israel
| | - Calanit Hershkovich Shporen
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Department of Neonatalogy, Kaplan Medical Center, Rehovot, Israel
| | - Sagie Josefsberg Ben-Yehoshua
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Genetics Institute, Kaplan Medical Center, Rehovot, Israel
| | - Aryeh Simmonds
- Department of Neonatalogy, Laniado Hospital, Netanya, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Racheli Goldfarb Yaacobi
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Genetics Institute, Meir Medical Center, Kefar-Sava, Israel
| | - Sofia Bauer-Rusek
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatalogy, Meir Medical Center, Kefar-Sava, Israel
| | - Hussam Omari
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Department of Neonatalogy, Saint Vincent Hospital (French Hospital), Nazareth, Israel
| | - Karin Weiss
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Genetics Institute, Rambam Medical Center, Haifa, Israel
| | - Ori Hochwald
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, Rambam Medical Center, Haifa, Israel
| | - Arie Koifman
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Genetics Institute, Samson Assuta University Medical Center, Ashdod, Israel
| | - Omer Globus
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Department of Neonatalogy, Samson Assuta University Medical Center, Ashdod, Israel
| | - Nurit Assia Batzir
- Pediatric Genetics Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Naveh Yaron
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Department of Neonatalogy, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Reeval Segel
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Iris Morag
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatalogy, Shamir Medical Center, Zerifin, Israel
| | - Orit Reish
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Genetics Institute, Shamir Medical Center, Zerifin, Israel
| | - Aviva Eliyahu
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel
| | - Leah Leibovitch
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neonatology Department, Sheba Medical Center, Tel-Hashomer, Israel
| | - Marina Eskin Schwartz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Genetics Institute, Soroka University Medical Center, Be'er Sheva, Israel
| | - Ramy Abramsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Department of Neonatalogy, Soroka University Medical Center, Be'er Sheva, Israel
| | - Amit Hochberg
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, The Hillel Yaffe Medical Center, Hadera, Israel
| | - Anat Oron
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatalogy, Wolfson Medical Center, Holon, Israel
| | - Ehud Banne
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Genetics Institute, Wolfson Medical Center, Hadera, Israel
| | - Igor Portnov
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Department of Neonatalogy, Ziv Medical Center Sefat, Tsfat, Israel
| | - Nadra Nasser Samra
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Genetics Institute, Ziv Medical Center, Safed, Israel
| | - Amihood Singer
- Community Genetics Department, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Welborn AC, Nichols T, Gringle M, Lewallen L. Neonatal intensive care nurses' accounts of care for mothers/families with substance-exposed pregnancies: A critical discourse analysis. J Adv Nurs 2024; 80:566-579. [PMID: 37545100 DOI: 10.1111/jan.15807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023]
Abstract
AIMS To explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance-exposed pregnancy (SEP). DESIGN This secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship-building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique. METHOD Nine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty-one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery. RESULTS Study findings revealed nurses experienced challenges providing high-quality, family-centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care. CONCLUSION The study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high-quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments. IMPACT This study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high-quality care in stressful healthcare environments. REPORTING METHOD EQUATOR guidelines were followed, using the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION NICU nurses were interviewed about their care-provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.
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Affiliation(s)
- Amber C Welborn
- Department of Nursing, Appalachian State University, Boone, North Carolina, USA
| | - Tracy Nichols
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Meredith Gringle
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Lynne Lewallen
- School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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De Silva DTN, Moore BR, Strunk T, Petrovski M, Varis V, Chai K, Ng L, Batty K. Development of a pharmaceutical science systematic review process using a semi-automated machine learning tool: Intravenous drug compatibility in the neonatal intensive care setting. Pharmacol Res Perspect 2024; 12:e1170. [PMID: 38204432 PMCID: PMC10782215 DOI: 10.1002/prp2.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/30/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
Our objective was to establish and test a machine learning-based screening process that would be applicable to systematic reviews in pharmaceutical sciences. We used the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) model, a broad search strategy, and a machine learning tool (Research Screener) to identify relevant references related to y-site compatibility of 95 intravenous drugs used in neonatal intensive care settings. Two independent reviewers conducted pilot studies, including manual screening and evaluation of Research Screener, and used the kappa-coefficient for inter-reviewer reliability. After initial deduplication of the search strategy results, 27 597 references were available for screening. Research Screener excluded 1735 references, including 451 duplicate titles and 1269 reports with no abstract/title, which were manually screened. The remainder (25 862) were subject to the machine learning screening process. All eligible articles for the systematic review were extracted from <10% of the references available for screening. Moderate inter-reviewer reliability was achieved, with kappa-coefficient ≥0.75. Overall, 324 references were subject to full-text reading and 118 were deemed relevant for the systematic review. Our study showed that a broad search strategy to optimize the literature captured for systematic reviews can be efficiently screened by the semi-automated machine learning tool, Research Screener.
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Affiliation(s)
| | - Brioni R. Moore
- Curtin Medical SchoolCurtin UniversityPerthWestern AustraliaAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityPerthWestern AustraliaAustralia
- Medical SchoolThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines and Infectious DiseasesTelethon Kids InstituteNedlandsWestern AustraliaAustralia
| | - Tobias Strunk
- Medical SchoolThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines and Infectious DiseasesTelethon Kids InstituteNedlandsWestern AustraliaAustralia
- Neonatal DirectorateKing Edward Memorial Hospital, Child and Adolescent Health ServiceSubiacoWestern AustraliaAustralia
| | - Michael Petrovski
- Pharmacy Department, King Edward Memorial HospitalWomen and Newborn Health ServiceSubiacoWestern AustraliaAustralia
| | - Vanessa Varis
- University Library, Curtin UniversityPerthWestern AustraliaAustralia
| | - Kevin Chai
- School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Leo Ng
- Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
- School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
| | - Kevin T. Batty
- Curtin Medical SchoolCurtin UniversityPerthWestern AustraliaAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityPerthWestern AustraliaAustralia
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17
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Cortina G, Daverio M, Demirkol D, Chanchlani R, Deep A. Continuous renal replacement therapy in neonates and children: what does the pediatrician need to know? An overview from the Critical Care Nephrology Section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Eur J Pediatr 2024; 183:529-541. [PMID: 37975941 PMCID: PMC10912166 DOI: 10.1007/s00431-023-05318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/13/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
Continuous renal replacement therapy (CRRT) is the preferred method for renal support in critically ill and hemodynamically unstable children in the pediatric intensive care unit (PICU) as it allows for gentle removal of fluids and solutes. The most frequent indications for CRRT include acute kidney injury (AKI) and fluid overload (FO) as well as non-renal indications such as removal of toxic metabolites in acute liver failure, inborn errors of metabolism, and intoxications and removal of inflammatory mediators in sepsis. AKI and/or FO are common in critically ill children and their presence is associated with worse outcomes. Therefore, early recognition of AKI and FO is important and timely transfer of patients who might require CRRT to a center with institutional expertise should be considered. Although CRRT has been increasingly used in the critical care setting, due to the lack of standardized recommendations, wide practice variations exist regarding the main aspects of CRRT application in critically ill children. Conclusion: In this review, from the Critical Care Nephrology section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC), we summarize the key aspects of CRRT delivery and highlight the importance of adequate follow up among AKI survivors which might be of relevance for the general pediatric community. What is Known: • CRRT is the preferred method of renal support in critically ill and hemodynamically unstable children in the PICU as it allows for gentle removal of fluids and solutes. • Although CRRT has become an important and integral part of modern pediatric critical care, wide practice variations exist in all aspects of CRRT. What is New: • Given the lack of literature on guidance for a general pediatrician on when to refer a child for CRRT, we recommend timely transfer to a center with institutional expertise in CRRT, as both worsening AKI and FO have been associated with increased mortality. • Adequate follow-up of PICU patients with AKI and CRRT is highlighted as recent findings demonstrate that these children are at increased risk for adverse long-term outcomes.
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Affiliation(s)
- Gerard Cortina
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Marco Daverio
- Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Demet Demirkol
- Pediatric Intensive Care Unit, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Akash Deep
- Pediatric Intensive Care Unit, Kings College London, London, UK.
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Ettenberger M, Bieleninik Ł, Stordal AS, Ghetti C. The effect of paternal anxiety on mother-infant bonding in neonatal intensive care. BMC Pregnancy Childbirth 2024; 24:55. [PMID: 38212696 PMCID: PMC10782755 DOI: 10.1186/s12884-023-06179-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The hospitalization of a preterm infant in the NICU can lead to mental health difficulties in parents, but not much is known how paternal anxiety might affect the mother-infant relationship. METHODS This prospective cohort study is a secondary analysis investigating how paternal anxiety levels might affect maternal bonding in the NICU using the dataset of the multinational pragmatic randomized controlled trial LongSTEP. A linear mixed-effects model was used for correlations of paternal anxiety (GAD-7) and maternal bonding (PBQ) at NICU discharge, and at 6 and 12 months infant corrected age. Secondary analyses examined effects on paternal anxiety related to: site (Argentina, Colombia, Israel, Norway, and Poland), maternal depression (EPDS), infant gestational age at birth, paternal age, and type of pregnancy. RESULTS Paternal anxiety did not predict maternal bonding at NICU discharge (p = 0.096), at 6 months (p = 0.316), or at 12 months infant corrected age (p = 0.473). Secondary outcomes showed a statistically significant site effect, with higher paternal anxiety levels at the two Colombian sites at baseline (p = 0.014 and p = 0.020) and for one site at discharge (p = 0.012), but not for paternal age (p = 0.925 and p = 0.793), infant gestational age at birth (p = 0.974 and p = 0.686 and p = 0.340), or type of pregnancy (p = 0.381). Maternal depression predicted paternal anxiety at baseline (p < 0.001) and at discharge (p = 0.003). CONCLUSIONS In this study, paternal anxiety did not predict maternal bonding. Paternal anxiety varied by site, indicating a need for research on potential cultural differences in manifestation of paternal anxiety. Maternal depression predicted paternal anxiety, confirming a previously reported correlation. Further research on variations in paternal mental health in the neonatal period is warranted, as well as exploration of the social contagion of mental health in preterm parents. TRIAL REGISTRATION ClinicalTrials.gov NCT03564184.
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Affiliation(s)
- Mark Ettenberger
- Music Therapy Service, Department of Social Management, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Music Therapy Service, Clínica de la Mujer, Bogotá, Colombia
- SONO - Centro de Musicoterapia, Bogotá, Colombia
| | - Łucja Bieleninik
- Institute of Psychology, Faculty of Social Sciences, University of Gdańsk, Gdańsk, Poland
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
- Institute of Pedagogy and Languages, University of Applied Sciences, Elbląg, Poland
| | - Andreas Størksen Stordal
- NORCE Technology, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Claire Ghetti
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway.
- Dept. of Music, GAMUT - The Grieg Academy Music Therapy Research Centre, The Grieg Academy, University of Bergen, Bergen, Norway.
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Barnette BW, Schumacher BT, Armenta RF, Wynn JL, Richardson A, Bradley JS, Lazar S, Lawrence SM. Contribution of Concurrent Comorbidities to Sepsis-Related Mortality in Preterm Infants ≤32 Weeks of Gestation at an Academic Neonatal Intensive Care Network. Am J Perinatol 2024; 41:134-142. [PMID: 34674193 PMCID: PMC10233655 DOI: 10.1055/a-1675-2899] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study sought to identify concurrent major comorbidities in preterm infants ≤32 weeks of gestation that may have contributed to sepsis-related mortality following a diagnosis of bacteremia or blood culture-negative sepsis within the neonatal period (≤28 days of life). STUDY DESIGN This is a retrospective chart review of infants ≤32 weeks of gestation who were admitted to a single academic network of multiple neonatal intensive care units between January 1, 2012, and December 31, 2015, to determine the primary cause(s) and timing of death in those diagnosed with bacteremia or blood culture-negative sepsis. Direct comparisons between early-onset sepsis (EOS; ≤72 hours) and late-onset sepsis (LOS; >72 hours) were made. RESULTS In our study cohort, of 939 total patients with ≤32 weeks of gestation, 182 infants were diagnosed with 198 episodes of sepsis and 7.7% (14/182) died. Mortality rates did not significantly differ between neonates with bacteremia or blood culture-negative sepsis (7/14 each group), and those diagnosed with EOS compared with LOS (6/14 vs. 8/14). Nearly 80% (11/14) of infants were transitioned to comfort care prior to their death secondary to a coinciding diagnosis of severe grade-3 or -4 intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and/or intestinal perforation. CONCLUSION Preexisting comorbidities commonly associated with extreme preterm birth contributed to sepsis-related mortality in our patient cohort. KEY POINTS · Concurrent comorbidities contribute to, and may artificially inflate, sepsis-related mortality.. · Absence of a consensus definition for neonatal sepsis complicates the investigation of infection.. · Accurate assessment of the incidence of sepsis in very low birth weight infants is vital for future investigations..
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Affiliation(s)
- Brian W. Barnette
- University of California, San Diego, College of Medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, San Diego, CA, USA
| | - Benjamin T. Schumacher
- Herbert Wertheim School of Public Health and Longevity Science, UC San Diego School of Medicine, San Diego, CA, USA
| | - Richard F. Armenta
- California State University, San Marco, Department of Kinesiology, College of Education, Health, and Human Services, San Diego, CA, USA
| | - James L. Wynn
- University of Florida, College of Medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Gainesville, FL, USA
- University of Florida, Department of Pathology, Immunology, and Laboratory Medicine, Gainesville, FL, USA
| | - Andrew Richardson
- Rady Children’s Hospital San Diego, San Diego, Clinical Research Informatics, San Diego, CA, USA
| | - John S. Bradley
- University of California, San Diego, College of Medicine, Department of Pediatrics, Division of Infectious Disease, San Diego, CA, USA
| | - Sarah Lazar
- University of California, San Diego, College of Medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, San Diego, CA, USA
| | - Shelley M. Lawrence
- University of California, San Diego, College of Medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, San Diego, CA, USA
- University of California, San Diego, Department of Pediatrics, Division of Host-Microbe Systems and Therapeutics, San Diego, CA, USA
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20
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Bailey SM, Mally PV. Near-Infrared Spectroscopy to Guide and Understand Effects of Red Blood Cell Transfusion. Clin Perinatol 2023; 50:895-910. [PMID: 37866855 DOI: 10.1016/j.clp.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
This review is a summary of available evidence regarding the use of near-infrared spectroscopy (NIRS) to help better guide and understand the effects of red blood cell (RBC) transfusion in neonatal patients. We review recent literature demonstrating the changes that take place in regional tissue oxygen saturation (rSO2) resulting from RBC transfusion. We also discuss in detail if any correlation exists between rSO2 and hemoglobin values in neonates. Finally, we review studies that have evaluated the use of NIRS as a transfusion guide during neonatal intensive care.
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Affiliation(s)
- Sean M Bailey
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital NYU Langone, 317 East 34th Street, Suite 902, New York, NY 10016, USA.
| | - Pradeep V Mally
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital NYU Langone, 317 East 34th Street, Suite 902, New York, NY 10016, USA
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Taha S, Simpson RB, Sharkey D. The critical role of technologies in neonatal care. Early Hum Dev 2023; 187:105898. [PMID: 37944264 DOI: 10.1016/j.earlhumdev.2023.105898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Neonatal care has made significant advances in the last few decades. As a result, mortality and morbidity in high-risk infants, such as extremely preterm infants or those infants with birth-related brain injury, has reduced significantly. Many of these advances have been facilitated or delivered through development of medical technologies allowing clinical teams to be better supported with the care they deliver or provide new therapies and diagnostics to improve management. The delivery of neonatal intensive care requires the provision of medical technologies that are easy to use, reliable, accurate and ideally developed for the unique needs of the newborn population. Many technologies have been developed and commercialised following adult trials without ever being studied in neonatal patients despite the unique characteristics of this population. Increasingly, funders and industry are recognising this major challenge which has resulted in initiatives to develop new ideas from concept through to clinical care. This review explores some of the key medical technologies used in neonatal care and the evidence to support their adoption to improve outcomes. A number of devices have yet to realise their full potential and will require further development to optimise and find their ideal target population and clinical benefit. Examples of emerging technologies, which may soon become more widely used, are also discussed. As neonatal care relies more on medical technologies, we need to be aware of the impact on care pathways, especially from a human factors approach, the associated costs and subsequent benefits to patients alongside the supporting evidence.
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Affiliation(s)
- Syed Taha
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Rosalind B Simpson
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
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Greenberg JM, Gruner KA, Rodney L, Struve JN, Kang D, Cao Y, Lang RA. Biologically aware lighting for newborn intensive care. J Perinatol 2023; 43:49-54. [PMID: 38086967 DOI: 10.1038/s41372-023-01816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE We designed and implemented a novel neonatal intensive care (NICU) lighting system to support the current understanding of daylight-coupled physiology. METHODS We created a system that generates wavelengths corresponding to the known blue and violet activation spectra of non-visual opsins. These are known to mediate energy management and related physiologic activity. RESULTS Light produced by the system spans the visible spectrum, including violet wavelengths that are blocked by modern glazing and not emitted by standard LED fixtures. System features include automated light and dark phases that mimic dawn/dusk. The system also matches length of day seasonality. Spectral composition can be varied to support translational research protocols. Implementation required a comprehensive strategy to inform bedside providers about the value and use of the lighting system. CONCLUSION Full-spectrum lighting for the NICU is feasible and will inform the optimization of the NICU environment of care to support optimal neonatal growth and development.
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Affiliation(s)
- James M Greenberg
- Science of Light Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Katherine A Gruner
- Science of Light Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lousette Rodney
- Science of Light Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jaime N Struve
- Science of Light Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel Kang
- Science of Light Center, Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yuying Cao
- Science of Light Center, Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Richard A Lang
- Science of Light Center, Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Koshida S, Takahashi K. Significant improvement in survival outcomes of trisomy 18 with neonatal intensive care compared to non-intensive care: a single-center study. PeerJ 2023; 11:e16537. [PMID: 38047023 PMCID: PMC10693230 DOI: 10.7717/peerj.16537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
Background Trisomy 18 syndrome, also known as Edwards syndrome, is a chromosomal trisomy. The syndrome has historically been considered lethal owing to its poor prognosis, and palliative care was primarily indicated for trisomy 18 neonates. Although there have been several reports on the improvement of survival outcomes in infants with trisomy 18 syndrome through neonatal intensive care, few studies have compared the impact of neonatal intensive care on survival outcomes with that of non-intensive care. Therefore, we compared the survival-related outcomes of neonates with trisomy 18 between intensive and non-intensive care. Methods Seventeen infants of trisomy 18 admitted to our center between 2007 and 2019 were retrospectively studied. We divided the patients into a non-intensive group (n = 5) and an intensive group (n = 12) and evaluated their perinatal background and survival-related outcomes of the two groups. Results The 1- and 3-year survival rates were both 33% in the intensive group, which was significantly higher than that in the non-intensive group (p < 0.001). Half of the infants in the intensive care group were discharged alive, whereas in the non-intensive care group, all died during hospitalization (p = 0.049). Conclusions Neonatal intensive care for neonates with 18 trisomy significantly improved not only survival rates but also survival-discharge rates. Our findings would be helpful in providing 18 trisomy neonates with standard neonatal intensive care when discussing medical care with their parents.
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Affiliation(s)
- Shigeki Koshida
- Perinatal Center, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, Japan
| | - Kentaro Takahashi
- Perinatal Center, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, Japan
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Davis R, Stuchlik PM, Goodman DC. The Relationship Between Regional Growth in Neonatal Intensive Care Capacity and Perinatal Risk. Med Care 2023; 61:729-736. [PMID: 37449856 PMCID: PMC10564047 DOI: 10.1097/mlr.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND The supply of US neonatal intensive care unit (NICU) beds and neonatologists is known to vary markedly across regions, but there have been no investigation of patterns of recent growth (1991-2017) in NICUs in relation to newborn need. OBJECTIVE The objective of this study was to test the hypothesis that greater growth in NICU capacity occurred in neonatal intensive care regions with higher perinatal risk. RESEARCH DESIGN A longitudinal ecological analysis with neonatal intensive care regions (n=246) as the units of analysis. Associations were tested using linear regression. SUBJECTS All US live births ≥400 g in 1991 (n=4,103,528) and 2017 (n=3,849,644). MEASURES Primary measures of risk were the proportions of low-birth weight and very low-birth weight newborns and mothers who were Black or had low educational attainment. RESULTS Over 26 years, the numbers of NICU beds and neonatologists per live birth increased 42% and 200%, respectively, with marked variation in growth across regions (interquartile range: 0.3-4.1, beds; neonatologists, 0.4-1.0 per 1000 live births). A weak association of capacity with perinatal risk in 1991 was absent in 2017. There was no meaningful (ie, clinical or policy relevant) association between regional changes in capacity and regions with higher perinatal risk or lower capacity in 1991; higher increases in perinatal risk were not associated with higher capacity growth. CONCLUSION The lack of association between newborn medical needs and the supply of NICU resources raises questions about the current effectiveness of newborn care at a population level.
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Affiliation(s)
- Rebekah Davis
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
- University of Colorado School of Medicine, Aurora, CO
| | - Patrick M. Stuchlik
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David C. Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
- The Children’s Hospital at Dartmouth, Lebanon, NH
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Chmelova K, Tinnion R, Zalewski S. Cutaneous mucormycosis in an extremely premature infant. Arch Dis Child Fetal Neonatal Ed 2023; 108:661. [PMID: 36535751 DOI: 10.1136/archdischild-2022-325022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Kristina Chmelova
- Neonatal Unit, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Tinnion
- Neonatal Unit, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stefan Zalewski
- Neonatal Unit, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Nakhla D, Kushnir A, Ahmed R, Bhandari V, Hunter K, Nakhla T. Reticulocyte Count: The Forgotten Factor in Transfusion Decisions for Extremely Low Birth Weight Infants. Am J Perinatol 2023; 40:1638-1643. [PMID: 34560784 DOI: 10.1055/a-1653-4585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Extremely low birth weight (ELBW) infants often receive transfusions of packed red blood cells (PRBCs). Long-term outcomes of infants treated with liberal versus restricted transfusion criteria have been evaluated with conflicting results. Clinicians incorporate a reticulocyte count (RC) in their transfusion decisions. There is a lack of information on reference ranges for RCs in growing ELBW infants and whether infant's chronologic age or corrected gestational age (GA) generates a specific trend in the RCs. Our aim was to evaluate the levels of RCs obtained from ELBW infants over the course of the initial hospitalization. STUDY DESIGN A retrospective chart review of ELBW infants treated in the neonatal intensive care unit (NICU) and had RCs performed. We analyzed the RCs to observe trends based on the chronologic age and corrected GA. RESULTS A total of 738 RCs were analyzed. A positive trend in RCs that reached a peak at 32 to 34 weeks' corrected GA and then experienced a downward trend was observed. CONCLUSION Our report examines a very common hematologic test that is theoretically helpful but is in need of guidelines concerning the appropriate frequency of testing and its utility in making transfusion decisions in ELBW infants. KEY POINTS · RCs should help in making transfusion decisions for ELBW infants.. · No current reference ranges for RC in this population.. · No current reference ranges for RC based on GA and postnatal age..
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Affiliation(s)
- Daniel Nakhla
- Rutgers University, The State University of New Jersey, New Jersey
| | - Alla Kushnir
- Division of Neonatology, Children's Regional Hospital at Cooper University Hospital, Camden, New Jersey
| | - Rafat Ahmed
- Division of Neonatology, Children's Regional Hospital at Cooper University Hospital, Camden, New Jersey
| | - Vineet Bhandari
- Division of Neonatology, Children's Regional Hospital at Cooper University Hospital, Camden, New Jersey
| | - Krystal Hunter
- Division of Neonatology, Children's Regional Hospital at Cooper University Hospital, Camden, New Jersey
| | - Tarek Nakhla
- CHOP Newborn services at Virtua Hospital, Voorhees, New Jersey
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Quinn J, Quinn M, Lieu B, Bohnert J, Halamek LP, Profit J, Fuerch JH, Chitkara R, Yamada NK, Gould J, Lee HC. Neonatal Healthcare Professionals' Experiences When Implementing a Simulation and Debriefing Program in Neonatal Intensive Care Settings: A Qualitative Analysis. Adv Neonatal Care 2023; 23:425-434. [PMID: 37399571 PMCID: PMC10524557 DOI: 10.1097/anc.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Simulation-based training (SBT) and debriefing have increased in healthcare as a method to conduct interprofessional team training in a realistic environment. PURPOSE This qualitative study aimed to describe the experiences of neonatal healthcare professionals when implementing a patient safety simulation and debriefing program in a neonatal intensive care unit (NICU). METHODS Fourteen NICUs in California and Oregon participated in a 15-month quality improvement collaborative with the California Perinatal Quality Care Collaborative. Participating sites completed 3 months of preimplementation work, followed by 12 months of active implementation of the simulation and debriefing program. Focus group interviews were conducted with each site 2 times during the collaborative. Content analysis found emerging implementation themes. RESULTS There were 234 participants in the 2 focus group interviews. Six implementation themes emerged: (1) receptive context; (2) leadership support; (3) culture change; (4) simulation scenarios; (5) debriefing methodology; and (6) sustainability. Primary barriers and facilitators with implementation of SBT centered around having a receptive context at the unit level (eg, availability of resources and time) and multidisciplinary leadership support. IMPLICATIONS FOR PRACTICE AND RESEARCH NICUs have varying environmental (context) factors and consideration of unit-level context factors and support from leadership are integral aspects of enhancing the successful implementation of a simulation and debriefing program for neonatal resuscitation. Additional research regarding implementation methods for overcoming barriers for both leaders and participants, as well as determining the optimal frequency of SBT for clinicians, is needed. A knowledge gap remains regarding improvements in patient outcomes with SBT.
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Affiliation(s)
- Jenny Quinn
- California Perinatal Quality Care Collaborative (CPQCC), Stanford (Drs Jenny Quinn, Profit, Gould, and Lee, Mr Lieu, and Ms Bohnert); NorthBay Medical Center, Fairfield, California (Dr Jenny Quinn); Oregon Health & Science University, School of Nursing, Portland (Dr Megan Quinn); Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California (Drs Halamek, Profit, Fuerch, Chitkara, Yamada, and Gould); Center for Advanced Pediatric & Perinatal Education (CAPE), Palo Alto, California (Drs Halamek, Fuerch, Chitkara, and Yamada); and Division of Neonatology, Department of Pediatrics, UC San Diego School of Medicine, La Jolla, California (Dr Lee)
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Passini L, Le Bouedec S, Dassieu G, Reynaud A, Jung C, Keller ML, Lefebvre A, Katty T, Baleyte JM, Layese R, Audureau E, Caeymaex L. Error disclosure in neonatal intensive care: a multicentre, prospective, observational study. BMJ Qual Saf 2023; 32:589-599. [PMID: 36918264 DOI: 10.1136/bmjqs-2022-015247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 03/16/2023]
Abstract
IMPORTANCE Surveys based on hypothetical situations suggest that health-care providers agree that disclosure of errors and adverse events to patients and families is a professional obligation but do not always disclose them. Disclosure rates and reasons for the choice have not previously been studied. OBJECTIVE To measure the proportion of errors disclosed by neonatal intensive care unit (NICU) professionals to parents and identify motives for and barriers to disclosure. DESIGN Prospective, observational study nested in a randomised controlled trial (Study on Preventing Adverse Events in Neonates (SEPREVEN); ClinicalTrials.gov). Event disclosure was not intended to be related to the intervention tested. SETTING 10 NICUs in France with a 20-month follow-up, starting November 2015. PARTICIPANTS n=1019 patients with NICU stay ≥2 days with ≥1 error. EXPOSURE Characteristics of errors (type, severity, timing of discovery), patients and professionals, self-reported motives for disclosure and non-disclosure. MAIN OUTCOME AND MEASURES Rate of error disclosure reported anonymously and voluntarily by physicians and nurses; perceived parental reaction to disclosure. RESULTS Among 1822 errors concerning 1019 patients (mean gestational age: 30.8±4.5 weeks), 752 (41.3%) were disclosed. Independent risk factors for non-disclosure were nighttime discovery of error (OR 2.40; 95% CI 1.75 to 3.30), milder consequence (for moderate consequence: OR 1.85; 95% CI 0.89 to 3.86; no consequence: OR 6.49; 95% CI 2.99 to 14.11), a shorter interval between admission and error, error type and fewer beds. The most frequent reported reasons for non-disclosure were parental absence at its discovery and a perceived lack of serious consequence. CONCLUSION AND RELEVANCE In the particular context of the SEPREVEN randomised controlled trial of NICUs, staff did not disclose the majority of errors to parents, especially in the absence of moderate consequence for the infant. TRIAL REGISTRATION NUMBER NCT02598609.
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Affiliation(s)
- Loïc Passini
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Gilles Dassieu
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Camille Jung
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Marie-Laurence Keller
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Aline Lefebvre
- Department of Child and Adolescent Psychiatry, APHP, Paris, France
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR 3571 CNRS, University Paris Diderot, Paris, France
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Therese Katty
- Health Law Manager, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Jean-Marc Baleyte
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
| | - Richard Layese
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Etienne Audureau
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Laurence Caeymaex
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
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Crump L, Gosselin É, D'addona M, Feeley N. Factors Influencing Parents' Perception of Their Infants' Transition From a 6-Bed Pod to Single Family Room in a Mixed-Room Neonatal Intensive Care Unit. Adv Neonatal Care 2023; 23:442-449. [PMID: 36719191 DOI: 10.1097/anc.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While hospitalized in the neonatal intensive care unit (NICU), infants and their families undergo multiple transitions, and these have been found to be a source of stress for families. Although mixed-room NICU designs allow for infants to benefit from different room types as their needs evolve during their stay, these can necessitate a transfer from one room type to another, which represents a transition for families. As some NICUs change to mixed-room designs, there is a need to better understand the factors impacting these particular transitions from the perception of parents. PURPOSE Examine parent perceptions of factors affecting the transition from a 6-bed pod to single family room in a mixed-room design NICU. METHODS Using a qualitative descriptive design, semistructured interviews were conducted with 17 parents whose infant had transitioned from a 6-bed pod to single family room. Interviews were transcribed verbatim and then analyzed using content analysis. RESULTS Four categories of factors were identified: (1) framing, timing, and comprehensiveness of information provided by staff regarding the transition; (2) parents' perception of advantages and disadvantages of the new space; (3) parent's own well-being and quality of support from staff; and (4) parent's previous NICU and parenting experience. IMPLICATIONS FOR PRACTICE Staff should frame the information they provide about this transition in a positive way to help parents adjust. A family-centered approach should also be used to provide tailored information and support to individual families. IMPLICATIONS FOR RESEARCH Future studies are needed into intraunit transfers including sources of support for parents, as well as staff perceptions of these transitions.
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Affiliation(s)
- Laura Crump
- Jewish General Hospital, Montreal, Québec, Canada (Mss Laura and D'addona and Dr Gosselin); Université de Sherbrooke, École des Sciences Infirmières, Sherbrooke, Québec, Canada (Dr Gosselin); McGill University, Ingram School of Nursing, Montreal, Québec, Canada (Dr Feeley); and Centre for Nursing Research, Jewish General Hospital, Montreal, Québec, Canada (Dr Feeley)
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Bhandari A, Alexiou S. Outpatient management of established bronchopulmonary dysplasia: An update. Semin Perinatol 2023; 47:151820. [PMID: 37777461 DOI: 10.1016/j.semperi.2023.151820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
As the incidence of infants with bronchopulmonary dyspasia (BPD) has continued to rise, so has their rate of survival. Their medical management is often complex and requires the use of numerous therapies such as steroids, bronchodilators, diuretics and modalities to deliver supplemental oxygen and positive pressure. It also requires multi-disciplinary care to ensure adequate growth and to optimize neurodevelopmental outcomes. This review aims to discuss the most widely used therapies in the treatment of patients with established BPD. The focus will be on ongoing outpatient (post-neonatal intensive care) management of children with BPD. Since many of the mentioned therapies lack solid evidence to support their use, more high quality research, such as randomized controlled trials, is needed to assess their effectiveness using defined outcomes.
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Affiliation(s)
- Anita Bhandari
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Blvd. Philadelphia, PA 19104, United States.
| | - Stamatia Alexiou
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Blvd. Philadelphia, PA 19104, United States
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Persson I, Sampaio F, Samkharadze T, Ssegonja R, Johansen K. Impact of developmental coordination disorder in childhood on educational outcomes in adulthood among neonatal intensive care recipients: a register-based longitudinal cohort study. BMJ Open 2023; 13:e071563. [PMID: 37748851 PMCID: PMC10533808 DOI: 10.1136/bmjopen-2023-071563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES Developmental coordination disorder (DCD) is related to poorer educational outcomes among children and adolescents. Evidence on this association into adulthood is lacking. Therefore, we aimed to investigate whether probable DCD (pDCD) in childhood affected educational outcomes among adults, and whether this was affected by sex or a co-occurring attention deficit in childhood. DESIGN Register-based longitudinal cohort study. SETTING Neonatal intensive care (NIC) recipients born at Uppsala University Children's Hospital, Uppsala, Sweden, from 1986 to 1989 until they reached the age of 28. PARTICIPANTS 185 NIC recipients. PRIMARY AND SECONDARY OUTCOME MEASURES At the age of 6.5, 46 (24.6%) of the NIC recipients were diagnosed with pDCD. Using register-based longitudinal data, we compared participants with and without pDCD in terms of: (1) age at Upper Secondary School (USS) graduation, and (2) highest level of education achieved by age 28. RESULTS The median age at USS graduation was 19 years, with similar graduation ages and ranges between those with or without pDCD. However, a higher proportion of participants without pDCD had graduated from USS at ages 19 and 24. By age 29, most participants had completed USS. At age 28, 33% of participants had attained a bachelor's or master's degree. Although there was no significant difference between the groups, the proportion that had attained a degree was higher among those without pDCD and women without pDCD had achieved the highest level of education. Educational outcomes remained similar for those with pDCD, regardless of childhood attention deficit. CONCLUSIONS pDCD during childhood may have a lasting impact on educational outcomes, particularly among women. Raising awareness of DCD among parents, health and educational professionals is vital for early identification and the provision of appropriate support and interventions in schools, mitigating the potential negative consequences associated with DCD and promoting positive educational outcomes.
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Affiliation(s)
- Isak Persson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tengiz Samkharadze
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Richard Ssegonja
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Kine Johansen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Shane AL, Preidis GA. Probiotics in the Neonatal Intensive Care Unit-A Framework for Optimizing Product Standards. JAMA Pediatr 2023; 177:879-880. [PMID: 37428483 DOI: 10.1001/jamapediatrics.2023.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
This Viewpoint outlines a framework for optimizing probiotic product stringency and use in the neonatal intensive care unit.
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Affiliation(s)
- Andi L Shane
- Division of Pediatric Infectious Disease, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Geoffrey A Preidis
- Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston
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Jeukens-Visser M, Leemhuis A, Flierman M. Response to "Scoping review of interventions to support families with preterm infants post-NICU discharge" by Griffith et. al published in Journal of Pediatric Nursing (). J Pediatr Nurs 2023; 72:207-208. [PMID: 37142494 DOI: 10.1016/j.pedn.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Martine Jeukens-Visser
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - Aleid Leemhuis
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Neonatology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Monique Flierman
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands
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Sassi FC, Ritto AP, Sassi DC, Ansuino AC, de Medeiros GC, Juste F, Béfi-Lopes DM, de Andrade CRF. Characterization of feeding skills and clinical markers of preterm newborns with gastroschisis in a neonatal therapy unit. Codas 2023; 35:e20220145. [PMID: 37610924 PMCID: PMC10449089 DOI: 10.1590/2317-1782/20232022145en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/29/2022] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To describe the clinical and feeding findings of premature infants with gastroschisis (GTQ) in a neonatal intensive care unit and compare them to preterm infants (NBs) without congenital anomalies. METHODS A retrospective case-control study was conducted with 50 premature NBs (25 with GTQ and 25 without comorbidities - control group). The NBs were compared regarding demographic and clinical data: risk of mortality and speech-language assessment (nonnutritive and nutritive sucking). Subsequently, a multiple logistic regression model was applied to determine the variables associated with the negative speech therapy outcome (speech therapy discharge after more than 7 days considering the first speech therapy evaluation). RESULTS The results of the first analysis indicated that there was a difference between the GTQ and the CG for the following variables: total time in days of hospitalization; use of mechanical ventilation (invasive x noninvasive); days of life on the date of the first speech-language assessment; use of alternative feeding route; and the GTQ group had worse results. The results of the multiple logistic regression indicated that the diagnosis of GTQ, the use of invasive mechanical ventilation, and the absence of adequate intraoral pressure during the first speech-language evaluation were risk factors for a negative speech-language outcome. CONCLUSION The feeding skills of preterm infants with QTG are related to the severity of the condition (gastrointestinal tract complications), requiring longer hospitalization, use of invasive mechanical ventilation, prolonged use of alternative feeding route and requiring more speech therapy to start oral feeding.
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Affiliation(s)
- Fernanda Chiarion Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Ana Paula Ritto
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | | | - Ana Carla Ansuino
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Gisele Chagas de Medeiros
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Fabiola Juste
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Débora Maria Béfi-Lopes
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Claudia Regina Furquim de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
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Gallaway KA, Cann K, Oetting K, Rothenberger M, Raibulet A, Slaven JE, Suhrie K, Tillman EM. The Potential Impact of Preemptive Pharmacogenetic Genotyping in the Neonatal Intensive Care Unit. J Pediatr 2023; 259:113489. [PMID: 37201679 DOI: 10.1016/j.jpeds.2023.113489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To evaluate the use of drugs with pharmacogenomic (PGx) guidelines from the Clinical Pharmacogenetics Implementation Consortium in early childhood. STUDY DESIGN A retrospective observational study of patients admitted to the neonatal intensive care (NICU) between 2005 and 2018 with at least 1 subsequent hospitalization at or after 5 years of age was performed to determine PGx drug exposure. Data regarding hospitalizations, drug exposures, gestational age, birth weight, and congenital anomalies and/or a primary genetic diagnosis were collected. Incidence of PGx drug and drug class exposures was determined and patient specific factors predictive of exposure were investigated. RESULTS During the study, 19 195 patients received NICU care and 4196 (22%) met study inclusion; 67% received 1-2, 28% 3-4, and 5% 5 or more PGx-drugs in early childhood. Preterm gestation, low birth weight (<2500 g), and the presence of any congenital anomalies and/or a primary genetic diagnosis were statistically significant predictors of Clinical Pharmacogenetics Implementation Consortium drug exposures (P < .01, P < .01, P < .01, respectively). CONCLUSIONS Preemptive PGx testing in patients in the NICU could have a significant impact on medical management during the NICU stay and throughout early childhood.
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Affiliation(s)
- Katherine A Gallaway
- Division of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN
| | - Kayla Cann
- Purdue University College of Pharmacy, Purdue University, West Lafayette, IN
| | - Katherine Oetting
- Purdue University College of Pharmacy, Purdue University, West Lafayette, IN
| | - Mary Rothenberger
- Purdue University College of Pharmacy, Purdue University, West Lafayette, IN
| | - Andra Raibulet
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN
| | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Kristen Suhrie
- Division of Neonatology, Department of Pediatrics, and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Emma M Tillman
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN.
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Bhandari V, Black R, Gandhi B, Hogue S, Kakkilaya V, Mikhael M, Moya F, Pezzano C, Read P, Roberts KD, Ryan RM, Stanford RH, Wright CJ. RDS-NExT workshop: consensus statements for the use of surfactant in preterm neonates with RDS. J Perinatol 2023; 43:982-990. [PMID: 37188774 PMCID: PMC10400415 DOI: 10.1038/s41372-023-01690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To provide the best clinical practice guidance for surfactant use in preterm neonates with respiratory distress syndrome (RDS). The RDS-Neonatal Expert Taskforce (RDS-NExT) initiative was intended to add to existing evidence and clinical guidelines, where evidence is lacking, with input from an expert panel. STUDY DESIGN An expert panel of healthcare providers specializing in neonatal intensive care was convened and administered a survey questionnaire, followed by 3 virtual workshops. A modified Delphi method was used to obtain consensus around topics in surfactant use in neonatal RDS. RESULT Statements focused on establishing RDS diagnosis and indicators for surfactant administration, surfactant administration methods and techniques, and other considerations. After discussion and voting, consensus was achieved on 20 statements. CONCLUSION These consensus statements provide practical guidance for surfactant administration in preterm neonates with RDS, with a goal to contribute to improving the care of neonates and providing a stimulus for further investigation to bridge existing knowledge gaps.
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Affiliation(s)
- Vineet Bhandari
- The Children's Regional Hospital at Cooper/Cooper Medical School of Rowan University, Camden, NJ, USA.
| | | | - Bheru Gandhi
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | | | - Venkatakrishna Kakkilaya
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Fernando Moya
- Division of Wilmington Pediatric Subspecialists, Department of Pediatrics, UNC School of Medicine, Wilmington, NC, USA
| | - Chad Pezzano
- Department of Cardio-Respiratory Services Pediatric -Albany Medical Center, Albany, NY, USA
| | - Pam Read
- AESARA Inc., Chapel Hill, NC, USA
| | | | - Rita M Ryan
- UH Rainbow Babies and Children's Hospital -Case Western Reserve University, Cleveland, OH, USA
| | | | - Clyde J Wright
- Section of Neonatology, Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO, USA
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Burnett AC, Mainzer RM, Doyle LW, Lee KJ, Anderson PJ, Zannino D, Duff J, Patton GC, Cheong JLY. Mental health in young adults born extremely preterm or extremely low birthweight with contemporary neonatal intensive care. Psychol Med 2023; 53:5227-5234. [PMID: 35866360 PMCID: PMC10476050 DOI: 10.1017/s0033291722002276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND For infants born in the contemporary era of neonatal care, little is known about adult mental health outcomes of extremely preterm birth (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g). This study aimed to compare attention deficit hyperactivity disorder (ADHD), anxiety, mood, and substance use disorder prevalence in young adults born EP/ELBW and normal birthweight (NBW; >2499 g) controls, and to compare change in prevalence of mental health symptoms and disorders from 18 to 25 years. METHODS Participants were a prospective geographical cohort of 297 consecutive survivors born EP/ELBW during 1991-1992 and 260 NBW controls. At age 25 years, 174 EP/ELBW and 139 NBW participants completed the Adult ADHD Rating Scale, Structured Clinical Interview for DSM-IV Disorders, Beck Anxiety Inventory, and Center for Epidemiologic Studies Depression Scale-Revised. Data from follow-up at 18 years were also utilized. Multiple imputation was used to account for attrition. RESULTS Mental health outcomes at 25 years were similar between groups: prevalence rates were ADHD 7% v. 5%; anxiety 32% v. 27%; mood 38% v. 35%; substance use 12% v. 14% in the EP/ELBW and NBW groups, respectively. In both groups, ADHD declined between 18 and 25 years [odds ratio (OR) per year = 0.87, 95% confidence interval (CI) 0.79-0.95], and generalized anxiety disorder and major depressive episode became more common (OR 1.22, 95% CI 1.10-1.35 per year; OR 1.20, 95% CI 1.10-1.30 respectively). CONCLUSIONS This contemporary EP/ELBW cohort has comparable young adult mental health outcomes to controls, and similar patterns of change in mental health from late adolescence.
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Affiliation(s)
- Alice C. Burnett
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Premature Infant Follow-Up Program, Royal Women's Hospital, Melbourne, Australia
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Rheanna M. Mainzer
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Lex W. Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Premature Infant Follow-Up Program, Royal Women's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Katherine J. Lee
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Peter J. Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Julianne Duff
- Premature Infant Follow-Up Program, Royal Women's Hospital, Melbourne, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - George C. Patton
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeanie L. Y. Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Premature Infant Follow-Up Program, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Boutillier B, Biran V, Janvier A, Barrington KJ. Survival and Long-Term Outcomes of Children Who Survived after End-of-Life Decisions in a Neonatal Intensive Care Unit. J Pediatr 2023; 259:113422. [PMID: 37076039 DOI: 10.1016/j.jpeds.2023.113422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/10/2023] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To investigate long-term outcomes of infants who survive despite life-and-death discussions with families and a decision to withdraw or withhold life-sustaining interventions (WWLST) in one neonatal intensive care unit. STUDY DESIGN Medical records for neonatal intensive care unit admissions from 2012 to 2017 were reviewed for presence of WWLST discussions or decisions, as well as the 2-year outcome of all children who survived. WWLST discussions were prospectively recorded in a specific book; follow-up to age 2 years was determined by retrospective chart review. RESULTS WWLST discussions occurred for 266 of 5251 infants (5%): 151 (57%) were born at term and 115 (43%) were born preterm. Among these discussions, 164 led to a WWLST decision (62%) and 130 were followed by the infant's death (79%). Of the 34 children (21%) surviving to discharge after WWLST decisions, 10 (29%) died before 2 years of age and 11 (32%) required frequent medical follow-up. Major functional limitations were common among survivors, but 8 were classified as functionally normal or with mild-to-moderate functional limitations. CONCLUSIONS When a WWLST decision was made in our cohort, 21% of the infants survived to discharge. By 2 years of age, the majority of these infants had died or had major functional limitations. This highlights the uncertainty of WWLST decisions during neonatal intensive care and the importance of ensuring that parents are informed of all possibilities. Additional studies including longer-term follow-up and ascertaining the family's views will be important.
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Affiliation(s)
- Béatrice Boutillier
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital universitaire Robert-Debré, Université de Paris Cité, Paris, France; Division of Neonatology, Centre de recherche, CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Canada.
| | - Valérie Biran
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital universitaire Robert-Debré, Université de Paris Cité, Paris, France; Inserm UMR 1141 Neurodiderot, Université de Paris Cité, Hôpital Robert-Debré, Paris, France
| | - Annie Janvier
- Division of Neonatology, Centre de recherche, CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Canada; Department of Pediatrics, Université de Montréal, Montréal, Canada; Bureau de l'éthique Clinique (BEC), Université de Montréal, Montréal, Canada; Unité d'éthique clinique, Unité de soins palliatifs, CHU Sainte-Justine, Montréal, Canada
| | - Keith J Barrington
- Division of Neonatology, Centre de recherche, CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Canada; Department of Pediatrics, Université de Montréal, Montréal, Canada
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Stevenson PG, Cooper MN, Billingham W, de Klerk N, Simpson SJ, Strunk T, Moore HC. Health service utilisation for acute respiratory infections in infants graduating from the neonatal intensive care unit: a population-based cohort study. BMC Pediatr 2023; 23:335. [PMID: 37393229 PMCID: PMC10314380 DOI: 10.1186/s12887-023-04152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Despite advances in neonatal intensive care, babies admitted to Neonatal Intensive Care Units (NICU) suffer from adverse outcomes. We aim to describe the longer-term respiratory infectious morbidity of infants discharged from NICU using state-wide population-based linked data in Western Australia. STUDY DESIGN We used probabilistically linked population-based administrative data to analyse respiratory infection morbidity in a cohort of 23,784 infants admitted to the sole tertiary NICU, born 2002-2013 with follow up to 2015. We analysed incidence rates of secondary care episodes (emergency department presentations and hospitalisations) by acute respiratory infection (ARI) diagnosis, age, gestational age and presence of chronic lung disease (CLD). Poisson regression was used to investigate the differences in rates of ARI hospital admission between gestational age groups and those with CLD, after adjusting for age at hospital admission. RESULTS From 177,367 child-years at risk (i.e., time that a child could experience an ARI outcome), the overall ARI hospitalisation rate for infants and children aged 0-8 years was 71.4/1000 (95% confidence interval, CI: 70.1, 72.6), with the highest rates in infants aged 0-5 months (242.9/1000). For ARI presentations to emergency departments, equivalent rates were 114/1000 (95% CI: 112.4, 115.5) and 337.6/1000, respectively. Bronchiolitis was the most common diagnosis among both types of secondary care, followed by upper respiratory tract infections. Extremely preterm infants (< 28 weeks gestation at birth) were 6.5 (95% CI: 6.0, 7.0) times more likely and those with CLD were 5.0 (95% CI: 4.7, 5.4) times more likely to be subsequently admitted for ARI than those in NICU who were not preterm or had CLD after adjusting for age at hospital admission. CONCLUSIONS There is an ongoing burden of ARI in children who graduate from the NICU, especially those born extremely preterm, that persists into early childhood. Early life interventions to prevent respiratory infections in these children and understanding the lifelong impact of early ARI on later lung health are urgent priorities.
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Affiliation(s)
- Paul G Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Wesley Billingham
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Shannon J Simpson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Wal-yan Respiratory Centre, Telethon Kids Institute, Perth, WA, Australia
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855, West Perth, WA, 6872, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, PO Box 855, West Perth, WA, 6872, Australia.
- School of Population Health, Curtin University, Perth, WA, Australia.
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Goodman DC, Romano CJ, Hall C, Bukowinski AT, Mu TS, Gumbs GR, Conlin AMS, Vereen RJ, Leyenaar JK. The association of regional perinatal risk factors and neonatal intensive care capacity for Military Health System-insured newborns. J Perinatol 2023; 43:787-795. [PMID: 36792685 DOI: 10.1038/s41372-023-01633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To characterize hospitals where military-insured newborns received care and test the association of regional perinatal risk with neonatal intensive care unit (NICU) capacity. STUDY DESIGN We identified birth hospitals for live newborns October 2015-December 2018 (n = 296,568) and assigned newborns to health service areas (HSAs). Perinatal risk factors and the number of neonatal special care beds and neonatologists were calculated at HSA levels. Cross-sectional correlation analyses assessed perinatal risk factors and capacity across HSAs. RESULTS 27.0% (n = 10) of military birth hospitals had special care beds (intermediate and intensive) compared with 44.3% of civilian hospitals (n = 1224; p < 0.05). The number of special care beds and neonatologists per newborn varied more than twofold across regions and were only weakly associated with the proportion of higher risk newborns (R2 < 0.05). CONCLUSIONS The lack of meaningful association of regional perinatal risk with NICU capacity poses challenges for effective specialized care among military-associated newborns.
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Affiliation(s)
| | - Celeste J Romano
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Clinton Hall
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Anna T Bukowinski
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Thornton S Mu
- Uniformed Services University of the Health Services, Bethesda, MD, USA
- Brooke Army Medical Center, San Antonio, TX, USA
| | - Gia R Gumbs
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | | | - JoAnna K Leyenaar
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Children's Hospital at Dartmouth, Lebanon, NH, USA
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van Dokkum NH, Fagan LJ, Cullen M, Loewy JV. Assessing HeartSong as a Neonatal Music Therapy Intervention: A Qualitative Study on Personal and Professional Caregivers' Perspectives. Adv Neonatal Care 2023; 23:264-271. [PMID: 37075326 DOI: 10.1097/anc.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND The music therapy HeartSong intervention pairs newborn infant heartbeats with parents' Song of Kin. Formal evidence on professional and personal caregiver perspectives of this intervention is lacking. PURPOSE This survey study evaluates the HeartSong music therapy intervention from parent and staff perspectives. METHODS A qualitative study assessing inclusion of HeartSong for family neonatal intensive care unit (NICU) care surveyed 10 professional caregivers comprising medical and psychosocial NICU teams anonymously reflecting their impressions of the intervention. Digital survey of parents/guardians contacted through semistructured phone interviews relayed impressions of recordings: subsequent setup, Song of Kin selection, and use of HeartSong, including thoughts/feelings about it as an intervention. RESULTS Professional and personal caregivers valued the HeartSong intervention for bereavement support, family support, including parental, extended family/infant support, and to enhance bonding. Emergent themes: memory-making, connectedness/closeness, support of parent role, processing mental health needs of stressful NICU days, and subsequent plans for lifelong HeartSong use. Therapeutic experience was named as a crucial intervention aspect and participants recommended the HeartSong as a viable, accessible NICU intervention. IMPLICATIONS FOR PRACTICE AND RESEARCH HeartSong's use showed efficacy as a clinical NICU music therapy intervention for families of critically ill and extremely preterm infants, when provided by trained, specialized, board-certified music therapists. Future research focusing on HeartSong in other NICU populations might benefit infants with cardiac disease, parental stress, and anxiety attending to parent-infant bonding. Costs and time benefits related to investment are needed before implementation is considered.
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Affiliation(s)
- Nienke H van Dokkum
- The Louis Armstrong Center for Music & Medicine, Mount Sinai Hospitals, New York City, New York (Dr van Dokkum and Mss Fagan and Loewy); Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Dr van Dokkum); and Department of Neonatology, Mount Sinai West Hospital, New York City, New York (Ms Cullen)
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Gunes NEO, Cetinkaya S. Assessment the knowledge, care, and experiences of neonatal nurses about enteral nutrition. Medicine (Baltimore) 2023; 102:e31081. [PMID: 37233433 PMCID: PMC10219700 DOI: 10.1097/md.0000000000031081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/07/2022] [Indexed: 05/27/2023] Open
Abstract
Enteral-feeding refers to any nutritional method throughout the gastrointestinal tract, including oral feeding. This qualitative study examined the information, experiences, and records of neonatal nurses of enterally fed patients. The study was conducted between 05.04.2018 and 05.05.2018 with 22 nurses (73.3%) working in the neonatal intensive care clinic of Çukurova University Balcali Hospital, Adana, Turkey. The data were collected by "Observation and Interview Form" developed based on the literature. Nurses were observed, and interviews were conducted depending on their appointments. Data were collected by observing each nurse on 2 different days. In all observations; it was determined that the nurses changed the feeding set daily, regularly checked the location of the feeding tube and amount of residue, and administered medication through the feeding tube. In 22.7% of the observations, nurses did not securely fix the feeding tube, 27.2% did not write a daily date on the injector with the residual volume measured, and 31.8% did not wash the injector. All the nurses recorded the amount of feed, residual amounts, and content. At the end of the interviews, 9% of the nurses stated that they had experienced aspiration among the complications encountered during enteral feeding. During the interview, they stated that all nurses were educated about enteral nutrition, had control of whether the probe was in place before feeding, performed residual control, washed their hands before the procedure, fixed the food injector to 1 place, and allowed the food injector to flow spontaneously with negative pressure. According to the results of the interviews and observations, nurses could not reflect on their nursing practices correctly. Nurses working in neonatal intensive care units should be regularly trained to share the results of evidence-based studies on enteral nutrition.
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Affiliation(s)
| | - Senay Cetinkaya
- Cukurova University, Faculty of Health Sciences, Department of Nursing, Child Health and Diseases Nursing (Associate Professor), Adana, Turkey
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Boghossian NS, Geraci M, Phibbs CS, Lorch SA, Edwards EM, Horbar JD. Trends in Resources for Neonatal Intensive Care at Delivery Hospitals for Infants Born Younger Than 30 Weeks' Gestation, 2009-2020. JAMA Netw Open 2023; 6:e2312107. [PMID: 37145593 PMCID: PMC10163386 DOI: 10.1001/jamanetworkopen.2023.12107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
Importance In an ideal regionalized system, all infants born very preterm would be delivered at a large tertiary hospital capable of providing all necessary care. Objective To examine whether the distribution of extremely preterm births changed between 2009 and 2020 based on neonatal intensive care resources at the delivery hospital. Design, Setting, and Participants This retrospective cohort study was conducted at 822 Vermont Oxford Network (VON) centers in the US between 2009 and 2020. Participants included infants born at 22 to 29 weeks' gestation, delivered at or transferred to centers participating in the VON. Data were analyzed from February to December 2022. Exposures Hospital of birth at 22 to 29 weeks' gestation. Main Outcomes and Measures Birthplace neonatal intensive care unit (NICU) level was classified as A, restriction on assisted ventilation or no surgery; B, major surgery; or C, cardiac surgery requiring bypass. Level B centers were further divided into low-volume (<50 inborn infants at 22 to 29 weeks' gestation per year) and high-volume (≥50 inborn infants at 22 to 29 weeks' gestation per year) centers. High-volume level B and level C centers were combined, resulting in 3 distinct NICU categories: level A, low-volume B, and high-volume B and C NICUs. The main outcome was the change in the percentage of births at hospitals with level A, low-volume B, and high-volume B or C NICUs overall and by US Census region. Results A total of 357 181 infants (mean [SD] gestational age, 26.4 [2.1] weeks; 188 761 [52.9%] male) were included in the analysis. Across regions, the Pacific (20 239 births [38.3%]) had the lowest while the South Atlantic (48 348 births [62.7%]) had the highest percentage of births at a hospital with a high-volume B- or C-level NICU. Births at hospitals with A-level NICUs increased by 5.6% (95% CI, 4.3% to 7.0%), and births at low-volume B-level NICUs increased by 3.6% (95% CI, 2.1% to 5.0%), while births at hospitals with high-volume B- or C-level NICUs decreased by 9.2% (95% CI, -10.3% to -8.1%). By 2020, less than half of the births for infants at 22 to 29 weeks' gestation occurred at hospitals with high-volume B- or C-level NICUs. Most US Census regions followed the nationwide trends; for example, births at hospitals with high-volume B- or C-level NICUs decreased by 10.9% [95% CI, -14.0% to -7.8%) in the East North Central region and by 21.1% (95% CI, -24.0% to -18.2%) in the West South Central region. Conclusions and Relevance This retrospective cohort study identified concerning deregionalization trends in birthplace hospital level of care for infants born at 22 to 29 weeks' gestation. These findings should serve to encourage policy makers to identify and enforce strategies to ensure that infants at the highest risk of adverse outcomes are born at the hospitals where they have the best chances to attain optimal outcomes.
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Affiliation(s)
- Nansi S. Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Marco Geraci
- MEMOTEF Department, School of Economics, Sapienza University of Rome, Rome, Italy
| | - Ciaran S. Phibbs
- Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Perinatal Epidemiology and Health Outcomes Research Unit, Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, California
| | - Scott A. Lorch
- Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, University of Vermont, Burlington
- Department of Pediatrics, University of Vermont College of Medicine, Burlington
| | - Jeffrey D. Horbar
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, University of Vermont College of Medicine, Burlington
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Fucikova H, Blatny J, Stingl J, Miletin J. Capnometry during neonatal transport-Mini review. Acta Paediatr 2023; 112:919-923. [PMID: 36843232 DOI: 10.1111/apa.16729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 02/28/2023]
Abstract
AIM The aim of this review was to give an overview of available data on end-tidal CO2 (etCO2 ) monitoring, also called capnometry, during neonatal transport. METHODS Pubmed/MEDLINE database was searched using research question (capno* OR etCO2 OR detCO2 OR (['end tidal' OR 'end-tidal'] AND [CO2 OR 'carbon dioxide']) AND (neonat* OR infant* OR newborn*) AND transport*). All articles relevant to the topic were reviewed and summarised. RESULTS The lack of studies relevant to neonatal transport prompted us to extend the search to capnometry in a neonatal intensive care setting. The published studies are showing conflicting results. The different study populations, technologies used to measure etCO2 , types of etCO2 sampling and the diverse sites of blood gas tests make the data unsuitable for systematic comparison. CONCLUSION Further research to obtain more data on capnometry during neonatal transport will be necessary to define precisely under what circumstances can end-tidal monitoring of CO2 be reliably used in neonates during transport and also how to interpret the measured values.
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Affiliation(s)
- Hana Fucikova
- Coombe Women and Infants University Hospital, Dublin, Ireland
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Blatny
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Children's University Hospital, Brno, Czech Republic
| | - Jan Stingl
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Miletin
- Coombe Women and Infants University Hospital, Dublin, Ireland
- Institute for the Care of Mother and Child, Prague, Czech Republic
- UCD School of Medicine, University College Dublin, Dublin, Ireland
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Mago-Shah DD, Athavale K, Fisher K, Heyward E, Tanaka D, Cotten CM. Early pumping frequency and coming to volume for mother's own milk feeding in hospitalized infants. J Perinatol 2023; 43:629-634. [PMID: 37037987 DOI: 10.1038/s41372-023-01662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To identify daily pumping frequencies associated with coming to volume (CTV: producing > 500 milliliters of milk per day by postnatal day 14) for mothers of infants in the neonatal intensive care unit (NICU). STUDY DESIGN We compared demographics and daily pumping frequencies for mothers who did and did not experience CTV. RESULTS Of 427 mothers who produced milk, 201 (50.1%) experienced CTV. Race, insurance, delivery type and birthweight were associated with CTV. For mothers who experienced CTV, average pumping episodes increased daily, stabilizing at 5 pumping episodes per day by postnatal day 5 (5 × 5). Women who experienced CTV were also more likely to have pumped between 0100 and 0500 (AM pumping). In multivariable analysis birthweight, 5 × 5 and AM pumping were each independently associated with CTV. CONCLUSION Supporting mothers of NICU infants to achieve 5 or more daily pumping sessions by postnatal day 5 could improve likelihood of achieving CTV.
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Affiliation(s)
- Deesha D Mago-Shah
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA.
| | - Kamlesh Athavale
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
| | - Kimberley Fisher
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
| | - Elizabeth Heyward
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
| | - David Tanaka
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
| | - C Michael Cotten
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
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Agreement of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) With NICU Nurses' Assessments. Adv Neonatal Care 2023; 23:E29. [PMID: 38112003 DOI: 10.1097/ANC.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Fulkoski N, Kecskes Z, Chaudhari T. Minor painful procedures in extremely preterm infants admitted to a tertiary neonatal intensive care unit: Opportunities to improve pain mitigation. J Paediatr Child Health 2023; 59:542-547. [PMID: 36710604 DOI: 10.1111/jpc.16352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/30/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023]
Abstract
AIM This study aims to characterise current pain management practices in extremely preterm infants (gestational age less than or equal to 28 weeks) admitted to neonatal intensive care unit (NICU). METHODS Retrospective audit pertaining to patient characteristics, as well as minor painful procedures (MPP), pain mitigation and pain scoring in 25 extremely preterm infants admitted to a tertiary NICU in 2016 over the first 14 days of NICU admission. Opportunities to bundle MPP were identified according to pre-specified criteria. Bayley Scales of Infant Development, Third Edition (BSID-III) cognitive, language and motor composite scores were available from the neurodevelopmental follow-up clinic at 12- and 24-months of corrected age. Linear mixed methods regression was used to examine for correlation between increased exposure to MPP and BSID-III scores at follow-up. RESULTS Extremely preterm infants underwent an average of 11.24 ± 4.12 MPP per day for the first 14 days of NICU admission. Opportunities to bundle MPP were missed 75.98% (408/537) of the time; most of these were invasive blood collections. A total of 12.2% (481/3933) of MPP occurred within 4 h of pharmacological or non-pharmacological pain mitigation. BSID-III motor composite score was associated with an 11.75 (95% confidence interval 1.99, 21.27) decrease in patients experiencing more than or equal to the third quartile of MPP in the 14 days post-NICU admission (P = 0.0329, n = 42). Association was not found for BSID-III cognitive and language composite scores. CONCLUSIONS There is readily scope for quality improvement initiatives to reduce harm in extremely preterm infants admitted to NICU.
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Affiliation(s)
- Nick Fulkoski
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Zsuzsoka Kecskes
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia
| | - Tejasvi Chaudhari
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia
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Salazar EG, Handley SC, Greenberg LT, Edwards EM, Lorch SA. Association Between Neonatal Intensive Care Unit Type and Quality of Care in Moderate and Late Preterm Infants. JAMA Pediatr 2023; 177:278-285. [PMID: 36648939 PMCID: PMC9857785 DOI: 10.1001/jamapediatrics.2022.5213] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/18/2022] [Indexed: 01/18/2023]
Abstract
Importance A higher level of care improves outcomes in extremely and very preterm infants, yet the impact of neonatal intensive care unit (NICU) level on moderate and late preterm (MLP) care quality is unknown. Objective To examine the association between NICU type and care quality in MLP (30-36 weeks' gestation) and extremely and very preterm (25-29 weeks' gestation) infants. Design, Setting, and Participants This cohort study was a prospective analysis of 433 814 premature infants born in 465 US hospitals between January 1, 2016, and December 31, 2020, without anomalies and who survived more than 12 hours and were transferred no more than once. Data were from the Vermont Oxford Network all NICU admissions database. Exposures NICU types were defined as units with ventilation restrictions without surgery (type A with restrictions, similar to American Academy of Pediatrics [AAP] level 2 NICUs), without surgery (type A) and with surgery not requiring cardiac bypass (type B, similar to AAP level 3 NICUs), and with all surgery (type C, similar to AAP level 4 NICUs). Main Outcomes and Measures The primary outcome was gestational age (GA)-specific composite quality measures using Baby-Measure of Neonatal Intensive Care Outcomes Research (Baby-MONITOR) for extremely and very preterm infants and an adapted MLP quality measure for MLP infants. Secondary outcomes were individual component measures of each scale. Composite scores were standardized observed minus expected scores, adjusted for patient characteristics, averaged, and expressed with a mean of 0 and SD of 1. Between May 2021 and October 2022, Kruskal-Wallis tests were used to compare scores by NICU type. Results Among the 376 219 MLP (204 181 [54.3%] male, 172 038 [45.7%] female; mean [SD] GA, 34.2 [1.7] weeks) and 57 595 extremely and very preterm (30 173 [52.4%] male, 27 422 [47.6%] female; mean [SD] GA, 27.7 [1.4] weeks) infants included, 6.6% received care in type A NICUs with restrictions, 29.3% in type A NICUs without restrictions, 39.7% in type B NICUs, and 24.4% in type C NICUs. The MLP infants had lower MLP-QM scores in type C NICUs (median [IQR]: type A with restrictions, 0.4 [-0.1 to 0.8]; type A, 0.4 [-0.4 to 0.9]; type B, 0.1 [-0.7 to 0.7]; type C, -0.7 [-1.6 to 0.4]; P < .001). No significant differences were found in extremely and very preterm Baby-MONITOR scores by NICU type. In type C NICUs, MLP infants had lower scores in no extreme length of stay and change-in-weight z score. Conclusions and Relevance In this cohort study, composite quality scores were lower for MLP infants in type C NICUs, whereas extremely and very preterm composite quality scores were similar across NICU types. Policies facilitating care for MLP infants at NICUs with less complex subspecialty services may improve care quality delivered to this prevalent, at-risk population.
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Affiliation(s)
- Elizabeth G. Salazar
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Sara C. Handley
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lucy T. Greenberg
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, The University of Vermont, Burlington
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, The University of Vermont, Burlington
- Department of Pediatrics, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Gephart SM, Tolentino DA, Quinn MC, Wyles C. Neonatal Intensive Care Workflow Analysis Informing NEC-Zero Clinical Decision Support Design. Comput Inform Nurs 2023; 41:94-101. [PMID: 35470306 DOI: 10.1097/cin.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Decision support in neonatal ICUs is needed, especially for prevention and risk awareness of the devastating complication of necrotizing enterocolitis, a major cause of emergency surgery among fragile infants. The purpose of this study was to describe the current clinical workflow and sociotechnical processes among clinicians for necrotizing enterocolitis risk awareness, timely recognition of symptoms, and treatment to inform decision support design. A qualitative descriptive study was conducted. Focus groups were held in two neonatal ICUs (five groups in Unit A and six in Unit B). Transcripts were analyzed using content analysis and compared with field notes. Clinicians (N = 27) included nurses (37%), physicians (30%), neonatal nurse practitioners (19%), and other staff (16%). Workflow processes differed for nurses (who see necrotizing enterocolitis signs and notify providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide how to act). Clinicians desired (1) a necrotizing enterocolitis-relevant dashboard to support nutrition tracking and necrotizing enterocolitis recognition; (2) features to support decision-making (eg, necrotizing enterocolitis risk and adherence scoring); (3) breast milk tracking and feeding clinical decision support; (4) tools for necrotizing enterocolitis surveillance and quality reporting; and (5) general EHR optimizations to improve user experience.
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Affiliation(s)
- Sheila M Gephart
- Author Affiliations: College of Nursing, The University of Arizona (Dr Gephart and Mrs Wyles), Tucson; National Clinician Scholars Program, School of Nursing and Institute for Healthcare Policy and Innovation, University of Michigan (Dr Tolentino), Ann Arbor; and School of Nursing, Oregon Health Sciences University (Dr Quinn), Portland
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Trautner S, Andelius TCK, Buhl M, Hahn G, Heiring C, Lauridsen MH, Kyng KJ. [Not Available]. Ugeskr Laeger 2023; 185:V06220412. [PMID: 36636933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This review investigates how point-of-care ultrasound (POCUS) allows individualised treatment based on the patient's clinical and physiological state. Serial examinations enable timely adjustments of interventions, potentially fewer side effects, and less need for x-ray examinations. One of the main barriers to POCUS is the lack of systematic training and quality control. The next step toward more widespread use of neonatal POCUS is systematic theoretical and practical training and implementing standardized examination protocols.
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Affiliation(s)
- Simon Trautner
- Afdeling for Intensiv behandling af nyfødte og mindre børn, Københavns Universitetshospital - Rigshospitalet
| | | | - Mads Buhl
- Nyfødt Intensiv Afsnit, Børn og Unge, Aarhus Universitetshospital
| | - Gitte Hahn
- Afdeling for Intensiv behandling af nyfødte og mindre børn, Københavns Universitetshospital - Rigshospitalet
| | - Christian Heiring
- Afdeling for Intensiv behandling af nyfødte og mindre børn, Københavns Universitetshospital - Rigshospitalet
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