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1.
Am J Perinatol ; 40(7): 773-779, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-34144627

RESUMO

OBJECTIVE: The study aimed to assess the practice of delayed cord clamping (DCC) and the awareness of its benefits for newborns between Obstetric (OB) and neonatal physicians. We examined if provider characteristics including years of experience, level of training, familiarity of the American College of Obstetricians and Gynecologists (ACOG)/American Academy of Pediatrics (AAP) recommendations, institutional policy, and the racial and ethnic background of patient population were associated with implementation of DCC. STUDY DESIGN: This research is a cross-sectional online questionnaire study. RESULTS: 975 questionnaires were returned. Overall, the awareness of ACOG versus AAP recommendations was 94 versus 86% (p < 0.01). 86 versus 78% of OB and neonatal physicians practiced or witnessed DCC >50% of the time, respectively (p < 0.01). An equal number of OB and neonatal physicians believed in the benefits to newborns of DCC. Physicians with >10 years of practice were less likely to acknowledge DCC benefits. Physicians with a majority of non-White patients were less likely to practice/witness DCC (p < 0.05). CONCLUSION: There continues to be room for improvement in the practice of DCC. Institutional policies and awareness of ACOG/AAP recommendations impact the understanding of the benefits of DCC and the likelihood of the practice. There is a significant difference in the practice of DCC among patients with different racial backgrounds. Hospital leadership may consider investing in the education and implementation of updated guidelines to ensure DCC is routinely practiced. KEY POINTS: · Knowledge of AAP/ACOG and institutional policies improved the practice of DCC.. · There is racial disparity in the practice of DCC.. · Physicians in practice for >10 years were less likely to know the benefits of DCC to full-term neonates..


Assuntos
Clampeamento do Cordão Umbilical , Cordão Umbilical , Gravidez , Feminino , Humanos , Recém-Nascido , Criança , Estudos Transversais , Fatores de Tempo , Inquéritos e Questionários , Constrição , Parto Obstétrico
2.
Am J Perinatol ; 2023 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-36724873

RESUMO

OBJECTIVES: This study aimed to determine our ability to shorten birth hospitalization length of stay (LOS) in which patient characteristics were associated with early discharge and had effects on early newborn readmission rate. STUDY DESIGN: Retrospective chart review of births from April 1, 2020 to December 31, 2020, was considered for this study. Delivery mode and maternal and newborn characteristics were evaluated for effect on discharge timing. Hospital readmissions within 7 days of discharge were reviewed. RESULTS: In total, 845 out of 1,077 total live births were included in the study population. Five hundred and eighty-nine (69.7%) newborns were discharged early (<48 hours after vaginal delivery [VD] and <72 hours after cesarean delivery [CS]). Factors associated with early discharge included 79.8% CS (p < 0.001), 84% birth after 2 p.m. (p < 0.001), 71.2% no diagnosis of maternal diabetes (p = 0.02), and 70.6% negative maternal coronavirus disease 2019 (p = 0.01). The overall 7-day readmission rate was 1.2 and 0.5% for newborns discharged early after VD. CONCLUSION: Most newborns can be discharged early without increasing newborn readmission. KEY POINTS: · Most patients were discharged <72 hours after CS.. · Most patients were discharged <48 hours after VD.. · Early discharge does not affect newborn readmissions..

3.
Pediatr Res ; 80(5): 663-667, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27411038

RESUMO

BACKGROUND: We evaluated the potential utility of elevated urinary neutrophil gelatinase-associated lipocalin (UNGAL) concentration as a screening test for early identification of acute kidney injury (AKI) in very low birth weight (VLBW) newborns. METHODS: Urine for UNGAL analysis was collected prospectively daily until 32 wk postmenstrual age in 91 VLBW newborns, yielding 2,899 specimens. UNGAL values > 50 ng/ml were considered elevated. AKI was defined as two or more consecutive elevations in s[Cr] above the 95th percentile adjusted for gestational age and chronological age within a 48 h period. We compared UNGAL values taken during the 5 d prior to AKI onset (pre-AKI) to values taken during non-AKI days. RESULTS: Overall, 15 episodes of AKI were identified in 13 infants. UNGAL was available in 44 pre-AKI days and 969 non-AKI days. UNGAL > 50 ng/ml occurred more often in pre-AKI days than in non-AKI days (risk ratio 3.48 (1.89, 6.40)). Positive and negative likelihood ratios were 1.92 (1.52, 2.41) and 0.52 (0.34, 0.78), respectively. CONCLUSION: Although UNGAL elevation > 50 ng/ml discriminates between pre-AKI and non-AKI days, high false positive and false negative rates limit utility as a screening test in VLBW newborns.


Assuntos
Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/urina , Lipocalina-2/urina , Biomarcadores/urina , Creatinina/urina , Eletrólitos , Reações Falso-Positivas , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Funções Verossimilhança , Masculino , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
4.
AJP Rep ; 11(2): e99-e101, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34178425

RESUMO

There are a limited number of documented cases of acute otitis media (AOM) in preterm infants while hospitalized in the neonatal intensive care unit (NICU). We present a case of a former 26 weeks old infant who at 29 weeks, 6 days postmenstrual age presented with acute signs and symptoms of systemic sepsis subsequently found to be secondary to AOM with purulent ear drainage. The patient received a septic evaluation, including urine, blood, and cerebrospinal fluid studies. Treatment included intravenous antibiotics with full resolution of symptoms. AOM in extreme preterm infants is multifactorial, with leading causes that include prematurity, the use of oropharyngeal and nasogastric tube placement and endotracheal intubation, eustachian tube dysfunction, and a distinct immune response. To our knowledge, there is not another published case of AOM of a preterm baby while in the NICU.

5.
Pediatr Res ; 67(6): 636-40, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20496473

RESUMO

Need for the early identification of sepsis in very low birth weight (VLBW) infants has led to the search for reliable biomarkers. This study aims to determine whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) rises in culture-positive sepsis and, if so, is elevated at the time sepsis is suspected. This is a prospective study of 91 VLBW infants whose urine was collected daily for uNGAL analysis. In 65 episodes of suspected sepsis, four groups were identified: a) culture-positive sepsis; b) single culture positive for Staphylococcus epidermidis; c) and d) negative culture with antibiotic treatment for >or=7 d and <7 d, respectively. Daily means of uNGAL of each group were estimated for comparison. Mean uNGAL in group A (179 ng/mL) was significantly elevated on the day blood culture was drawn (day 0) compared with the mean of healthy VLBW infants (6.5 ng/mL), and to the means in groups B, C, and D (p<0.05). In group A, mean uNGAL was significantly elevated on day 0 and daily for 5 days when compared with that of the day before culture (p<0.05 to <0.005). uNGAL shows promise as an early marker for culture-positive sepsis in VLBW infants.


Assuntos
Proteínas de Fase Aguda/urina , Recém-Nascido de muito Baixo Peso/urina , Lipocalinas/urina , Proteínas Proto-Oncogênicas/urina , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Biomarcadores/urina , Diagnóstico Precoce , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Lipocalina-2 , Masculino , Cidade de Nova Iorque , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Sepse/tratamento farmacológico , Sepse/microbiologia , Sepse/urina , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
6.
Jt Comm J Qual Patient Saf ; 46(9): 516-523, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32690465

RESUMO

BACKGROUND: Identification of congenital cytomegalovirus (cCMV) infection in neonates is important for early diagnosis of sensorineural hearing loss. Therefore, a quality improvement project was designed with an aim to improve newborn CMV screening by 25% from a baseline rate of 22%. METHODS: This project was conducted across two hospital sites at one medical center with two tertiary care newborn nurseries and neonatal intensive care units. Symptomatic neonates with suggestive findings of cCMV, who had failed the newborn hearing screen, who had not had a hearing screen performed by 10 days of age, or who were infants of HIV-positive mothers were screened for cCMV. Serial interventions (formalized teaching sessions using an algorithm and involving a nurse educator, creation of electronic medical record order sets, huddle board reminders, and regular audits) were conducted, and statistical process control p-charts were used to identify any signals and to determine if there was any special cause variation. RESULTS: Of 5,817 infants born in 2018, 903 were eligible for screening. Small for gestational age (46%) was the most common indication for screening. After multiple interventions, the median screening rate increased from a baseline of 22% in 2016 to 74% during the one-year study period. Four infants had positive CMV screen and received appropriate treatment as a result of these interventions. CONCLUSION: Multidisciplinary quality improvement initiatives can improve newborn screening for cCMV infection in a tertiary care environment.


Assuntos
Infecções por Citomegalovirus , Perda Auditiva Neurossensorial , Pré-Escolar , Citomegalovirus , Infecções por Citomegalovirus/diagnóstico , Humanos , Lactente , Recém-Nascido , Triagem Neonatal , Melhoria de Qualidade
7.
Pediatr Res ; 66(5): 528-32, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19680166

RESUMO

In very low birth weight (VLBW) infants, acute renal impairment (ARI) is common, but there is no consensus about criteria for its diagnosis. Neutrophil gelatinase-associated lipocalin (NGAL) is an early and sensitive indicator of renal impairment in experimental animals, children, and adults. Urinary NGAL (UNGAL) is detectable in VLBW infants; however, there is no reference range in this population. The objective of this study is to define the reference range for UNGAL in VLBW infants with no risk factors for acute renal impairment. UNGAL concentration was determined in urine samples collected from day of life (DOL) 4 through DOL 30 in 50 newborns with uncomplicated clinical courses, selected from a total of 145 prospectively enrolled appropriate for gestational age inborn VLBW premature infants. The birth weight and gestational age ranges were 790-1490 g and 26-33 wk, respectively. The median, 95th and 99th percentiles, and range of pooled UNGAL values were 5 ng/mL, 50 ng/mL, 120 ng/mL, and 2-150 ng/mL, respectively. Greater variability and higher quantile levels of UNGAL were observed in females versus males. In conclusion, a reference range for UNGAL in VLBW infants, similar to that in children and adults, has been established.


Assuntos
Proteínas de Fase Aguda/urina , Recém-Nascido de muito Baixo Peso/urina , Lipocalinas/urina , Proteínas Proto-Oncogênicas/urina , Feminino , Humanos , Recém-Nascido , Nefropatias/diagnóstico , Nefropatias/urina , Lipocalina-2 , Masculino , Estudos Prospectivos , Valores de Referência , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
8.
Am J Perinatol ; 26(6): 437-40, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19263333

RESUMO

We sought to determine the reference range for urinary neutrophil gelatinase-associated lipocalin (UNGAL) in very low-birth-weight (VLBW) infants with uncomplicated clinical courses. Samples of urine from 53 VLBW infants between 3 and 28 days of life were prospectively collected weekly for measurement of UNGAL. A subset of 22 infants with uncomplicated medical courses without risk factors for renal impairment was selected for study. Mean +/- standard deviation and range for birth weight and gestational age of study infants were 1156 +/- 191, 790 to 1440 g and 29 +/- 2, 27 to 33 weeks, respectively. The 95th and 99th percentiles for UNGAL concentration from this group of infants were 25 ng/mL and 75 ng/mL, respectively. Bootstrapped mean 95th and 99th percentile values and their standard errors and 95 percent confidence intervals in ng/mL were 33.1 +/- 13.0 (7.7, 58.6) and 67.5 +/- 15.1 (37.9, 97.1), respectively. These values fall within the adult reference range. UNGAL values were stable across the ranges of gestational and postnatal age of the study infants. A preliminary reference range for UNGAL in VLBW infants has been established. Further investigation with more frequent urine collections in a larger population of VLBW infants that includes those with birth weights < 750 g and gestational ages < 27 weeks is necessary to confirm this reference range.


Assuntos
Proteínas de Fase Aguda/urina , Recém-Nascido de muito Baixo Peso/urina , Lipocalinas/urina , Proteínas Proto-Oncogênicas/urina , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Lipocalina-2 , Masculino , Estudos Prospectivos , Valores de Referência , Fatores Sexuais
10.
11.
Am J Perinatol ; 25(10): 661-6, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18850514

RESUMO

We sought to determine the rate of spontaneous closure of the ductus arteriosus (DA) in very-low-birth-weight infants. This prospective observational study included 65 infants whose birth weight (BW) < 1500 g. Echocardiograms were done on day of life (DOL) 3 and 7, weekly for the first month, and bimonthly until ligation, discharge, or death. Treatment was reserved for infants with heart failure, acute renal impairment, or those with significant persistent or escalating respiratory support. Chi-square tests, Student T tests, and logistic regression models were used to identify possible associations between spontaneous ductal closure by DOL 7 and predictor variables. Patterns of spontaneous DA closure over time were examined using Kaplan-Meier survival analysis. The DA closed spontaneously in 49% infants by DOL 7. Rates of spontaneous closure by DOL 7 differed significantly by BW strata: 67% for BW > 1000 g, 31% for BW 1000 g did not require intervention, and the DA closed spontaneously prior to discharge in 94%. In a logistic regression model, only BW > 1000 g and male gender were significantly associated with spontaneous closure by 1 week of life. The median time to spontaneous closure differed significantly between infants in the two BW strata: 7 days for > 1000 g versus 56 days for 1000 g BW is rarely indicated. In infants

Assuntos
Permeabilidade do Canal Arterial , Canal Arterial , Recém-Nascido de muito Baixo Peso , Peso ao Nascer , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores Sexuais
12.
Am J Med Qual ; 33(3): 313-320, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28978224

RESUMO

The New York State Department of Health recommends the administration of the hepatitis B vaccine birth dose within 12 hours of life (HOL) for all full-term babies irrespective of maternal hepatitis B status. The primary and secondary aims of the project were to improve the timeliness of vaccine administration and increase the total number of infants vaccinated prior to discharge. Multiple Plan-Do-Study-Act cycles were performed. Statistical process charts of percentages of vaccination within 12 HOL and prior to discharge were constructed with 3-σ (data within 3 standard deviations from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Administration within 12 HOL improved from 13% to ≥65% within 6 months, and has been sustained for >1 year. Vaccine administration prior to discharge increased from 94% to 98%. Quality improvement methods can rapidly improve adherence to newborn vaccine recommendations and these effects are sustainable.


Assuntos
Vacinas contra Hepatite B/administração & dosagem , Esquemas de Imunização , Melhoria de Qualidade/organização & administração , Cobertura Vacinal/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Humanos , Recém-Nascido , Masculino , Cidade de Nova Iorque , Guias de Prática Clínica como Assunto , Fatores de Tempo , Fluxo de Trabalho
13.
J Am Coll Radiol ; 15(11): 1580-1586, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29501502

RESUMO

BACKGROUND: In pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), patient management decisions are sometimes based on preliminary interpretations of radiographs by pediatric intensivists (PIs) before a formal interpretation by a pediatric radiologist (PR). OBJECTIVE: To quantify and classify discrepancies in radiographic interpretation between PRs and PIs in the PICU and NICU. MATERIALS AND METHODS: This institutional review board-approved multi-institutional prospective study included three PRs and PIs at two PICUs and three NICUs. Interpretations of chest and abdominal radiographs by PIs and PRs were recorded on online forms and compared. Discrepancies in interpretations were classified as "miss," "misinterpretation," or "overcall." The discrepancies were also categorized as "actionable" or "nonactionable" based on extrapolation of the ACR actionable reporting work group's list of actionable findings. RESULTS: In 960 radiographic interpretations, the total, nonactionable, and actionable discrepancy rates between PRs and PIs were 34.7%, 26.8%, and 7.9%, respectively. The most common actionable discrepancies were line or tube positions and identification and interpretation of parenchymal opacities in the lungs. Identification of air leaks in the PICU and differentiation of normal from abnormal bowel gas patterns in the NICU followed in frequency. Air leaks accounted for 1% of total discrepancies and 11% of actionable discrepancies. Most discrepancies were nonactionable and included retrocardiac atelectasis and mischaracterization of neonatal lung disease in the PICU and NICU, respectively. CONCLUSION: Although the total discrepancy rate was high, most discrepancies were nonactionable. Actionable discrepancies were predominantly due to line and tube position, which should be an area of focused education.


Assuntos
Competência Clínica , Erros de Diagnóstico/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica , Pediatria/normas , Radiologia/normas , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Variações Dependentes do Observador , Estudos Prospectivos
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