Fatal Hypernatremic Dehydration in a Term Exclusively Breastfed Newborn.

Hypernatremic dehydration in term newborns has steadily increased in incidence with increasing efforts to promote exclusive breastfeeding before hospital discharge, a key metric of the Baby-Friendly Hospital Initiative. The following report details a case of a term newborn infant who had evidence of poor intake while exclusively breastfeeding during his hospital stay that may not have been recognized by health care providers. The infant was discharged home and was subsequently found by the parents in cardiac arrest 12 h after discharge and was found to have hypernatremic dehydration. Although return of spontaneous circulation was achieved after fluid resuscitation, the infant sustained extensive hypoxic-ischemic brain injury due to cardiovascular collapse. Due to the infant's extremely poor prognosis, life support was withdrawn at 19 days of age and the infant expired. This sentinel case demonstrates multiple pitfalls of current perceptions of normal vs. abnormal newborn feeding behavior, weight loss percentages, elimination patterns, and acceptable clinical thresholds believed to be safe for neonates. Newer data have shown that hypernatremia occurs commonly in healthy, term breastfed newborns at weight loss percentages previously deemed normal by most health professionals and hospital protocols. In-hospital strategies to prevent excessive weight loss and screening for hypernatremia in response to signs of inadequate feeding have the potential to prevent tens of thousands of readmissions for feeding complications a year, as well as hundreds of millions in health care costs.

A Quality Improvement Initiative to Improve the Care of Infants Born Exposed to Opioids by Implementing the Eat, Sleep, Console Assessment Tool.

OBJECTIVES: The incidence of infants born exposed to opioids continues to rise. Historically, newborns with neonatal abstinence syndrome have been treated with medication-weaning protocols, leading to costly and prolonged hospital stays. We aimed to reduce the proportion of newborns with neonatal abstinence syndrome who receive opioid medications for treatment of withdrawal symptoms through a quality improvement program. METHODS: In 2016, we formed a multidisciplinary team and used quality improvement methodology to conduct plan-do-study-act cycles. Interventions included prenatal education, family engagement, nonpharmacologic treatments, morphine as needed, and the eat, sleep, console assessment tool. Primary metrics were the proportion of newborns exposed to opioids requiring pharmacologic treatment and the cumulative dose of opioids per exposed newborn requiring pharmacologic treatment. RESULTS: There were 81 infants in the baseline period (January 2015-September 2016) and 100 infants in the postintervention group (October 2016-August 2018). For infants who required medication for treatment, the postintervention group had significantly lower total cumulative dose in methadone equivalents (1.3 mg vs 6.6 mg), shorter length of stay (10.9 days vs 18.7 days), and nonsignificant lower direct costs ($11 936 vs $15 039). CONCLUSIONS: The described intervention effectively replaced the Finnegan Neonatal Abstinence Scoring System and had improved outcomes in more exposed infants receiving no opioid treatment, and when medication was required, the total cumulative dose of opioids was lower. The postintervention group had shorter average length of stay and lower costs.

Adolescent suicide myths in the United States.

In the United States, teen suicide rates tripled over several decades, but have declined slightly since the mid-1990s. Suicide, by its nature, is a complex problem. Many myths have developed about individuals who complete suicide, suicide risk factors, current prevention programs, and the treatment of at-risk youth. The purpose of this article is to address these myths, to separate fact from fiction, and offer recommendations for future suicide prevention programs. Myth #1: Suicide attempters and completers are similar Myth #2: Current prevention programs work. Myth #3: Teenagers have the highest suicide rate. Myth #4: Suicide is caused by family and social stress. Myth #5: Suicide is not inherited genetically. Myth #6: Teen suicide represents treatment failure. Psychiatric illnesses are often viewed differently from other medical problems. Research should precede any public health effort, so that suicide prevention programs can be designed, implemented, and evaluated appropriately. Too often suicide prevention programs do not use evidence-based research or practice methodologies. More funding is warranted to continue evidence-based studies. We propose that suicide be studied like any medical illness, and that future prevention efforts are evidence-based, with appropriate outcome measures.

Utah youth suicide study, phase I: government agency contact before death.

OBJECTIVE: To delineate the probability of contact between government agencies and youths who complete suicide, to investigate the nature of those contacts, and to identify new risk factors for suicide. METHOD: A descriptive epidemiological analysis of data from multiple Utah government agencies on consecutive youth suicides (n = 151) between August 1, 1996, and June 6, 1999, aged 13-21 years. Data were collected from four government agencies: Office of the Medical Examiner, Juvenile Justice, Department of Human Services, and the Department of Education. RESULTS: Utah descriptive data were similar to national statistics, with the majority of completers being male (89%) and firearms the most common method of suicide (58%). The data demonstrated an association between youth suicide and contact with Juvenile Justice. Sixty-three percent of youths who completed suicide in Utah had contact with Juvenile Justice, and there was a direct correlation between number of referrals and increased suicide risk. Suicide completers had multiple minor offenses over many years. A significant minority of school-age subjects could not be located within the school system. Few suicide completers had evidence of active psychiatric treatment. CONCLUSIONS: Juvenile Justice is identified as a novel site for the screening and identification of youths at risk for suicide.