RESUMEN
BACKGROUND: Within the neonatal intensive care unit (NICU), infants frequently receive packed red blood cell (PRBC) transfusions. Although medically necessary, potential negative long- and short-term outcomes exist following PRBC transfusions in very low birth-weight (VLBW) infants (<1500 g). Synthesis of the literature demonstrates that the use of a restrictive PRBC transfusion policy can lead to a decreased number of transfusions administered with no increase in long-term neurodevelopmental outcomes. Blood transfusions have also been linked to the diagnosis of necrotizing enterocolitis (NEC) or intraventricular hemorrhage (IVH) in VLBW infants. PURPOSE: For this quality improvement project, a restrictive PRBC transfusion policy was implemented in a level IV NICU to promote consistent care and evaluate changes in PRBC administration. METHODS: The data were collected both pre- and post-policy implementation including: the number of blood transfusions, diagnosis of NEC, and diagnosis of IVH among infants <1500 g. RESULTS: The data showed no significant change in the number of PRBC transfusions administered. Likewise, few infants were diagnosed with NEC or IVH during this same time period with minimal change between pre- and post-policy implementation data. IMPLICATIONS FOR PRACTICE AND RESEARCH: Following policy implementation, there was a significant improvement in communication among providers regarding transfusion ordering and the inclusion of hematocrit thresholds in daily progress notes. This unintended outcome has helped to promote sustainability and enhance patient care within the NICU where this policy was implemented. Continued data collection may be beneficial in indicating whether a standardized PRBC transfusion policy will impact the administration of transfusions and diagnosis of NEC or IVH.
Asunto(s)
Enterocolitis Necrotizante , Transfusión de Eritrocitos , Recién Nacido de muy Bajo Peso , Unidades de Cuidado Intensivo Neonatal , Mejoramiento de la Calidad , Humanos , Transfusión de Eritrocitos/métodos , Transfusión de Eritrocitos/normas , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/normas , Recien Nacido Prematuro , Femenino , MasculinoRESUMEN
Video review (VR) of procedures in the medical environment can be used to drive quality improvement. However, first it has to be implemented in a safe and effective way. Our primary objective was to (re)define a guideline for implementing interprofessional VR in a neonatal intensive care unit (NICU). Our secondary objective was to determine the rate of acceptance by providers attending VR. For 9 months, VR sessions were evaluated with a study group, consisting of different stakeholders. A questionnaire was embedded at the end of each session to obtain feedback from providers on the session and on the safe learning environment. In consensus meetings, success factors and preconditions were identified and divided into different factors that influenced the rate of adoption of VR. The number of providers who recorded procedures and attended VR sessions was determined. A total of 18 VR sessions could be organised, with an equal distribution of medical and nursing staff. After the 9-month period, 101/125 (81%) of all providers working on the NICU attended at least 1 session and 80/125 (64%) of all providers recorded their performance of a procedure at least 1 time. In total, 179/297 (61%) providers completed the questionnaire. Almost all providers (99%) reported to have a positive opinion about the review sessions. Preconditions and success factors related to implementation were identified and addressed, including improving the pathway for obtaining consent, preparation of VR, defining the role of the chair during the session and building a safe learning environment. Different strategies were developed to ensure findings from sessions were used for quality improvement. VR was successfully implemented on our NICU and we redefined our guideline with various preconditions and success factors. The adjusted guideline can be helpful for implementation of VR in emergency care settings.
Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Mejoramiento de la Calidad , Grabación en Video , Humanos , Unidades de Cuidado Intensivo Neonatal/organización & administración , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Unidades de Cuidado Intensivo Neonatal/normas , Encuestas y Cuestionarios , Recién Nacido , Grabación en Video/métodos , Grabación en Video/estadística & datos numéricos , Investigación sobre Servicios de Salud/métodosRESUMEN
The American Academy of Pediatrics (AAP) Standards for Levels of Neonatal Care, published in 2023, highlights key components of a Neonatal Patient Safety and Quality Improvement Program (NPSQIP). A comprehensive Neonatal Intensive Care Unit (NICU) quality and safety infrastructure (QSI) is based on four foundational domains: quality improvement, quality assurance, safety culture, and clinical guidelines. This paper serves as an operational guide for NICU clinical leaders and quality champions to navigate these domains and develop their local QSI to include the AAP NPSQIP standards.
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Unidades de Cuidado Intensivo Neonatal , Seguridad del Paciente , Mejoramiento de la Calidad , Humanos , Unidades de Cuidado Intensivo Neonatal/normas , Unidades de Cuidado Intensivo Neonatal/organización & administración , Seguridad del Paciente/normas , Recién Nacido , Garantía de la Calidad de Atención de Salud , Guías de Práctica Clínica como Asunto , Estados Unidos , Cultura Organizacional , Administración de la Seguridad/normas , Administración de la Seguridad/organización & administraciónRESUMEN
BACKGROUND: To shorten the hospital stay in preterm infants, it is important to understand the factors extending the length of stay. AIMS: To understand how different discharge criteria affect the length of stay in preterm infants. STUDY DESIGN: A retrospective comparison study. SUBJECTS: Preterm infants born at 28 to 31 gestational weeks in 2020-2021 in a Level IV NICU in Japan (n = 22) and a Level III NICU in Finland (n = 49). OUTCOME MEASURES: We compared the most common last discharge criteria and the postmenstrual age (PMA) between the two NICUs. The potential extending effects of each discharge criterion on the length of stay were also evaluated. The discharge criteria were classified into six categories: temperature, respiration, feeding, examination, weight limit, and family readiness. RESULTS: The PMA at discharge was significantly higher in Japan than in Finland: median 40.7 (interquartile range 39.9-41.3) vs. 37.9 (36.9-39.0) weeks; r = 0.58; p < 0.001. The most common last discharge criterion was the family criterion in Japan (n = 19; 86 %) and the respiration criterion in Finland (n = 43; 88 %). In Japan, the length of stay was extended by 7.9 (standard deviation [SD] 7.0) days due to a lack of family readiness for discharge and 8.7 (SD 8.7) days due to not having discharged home with a feeding tube as a common practice. CONCLUSIONS: The length of stay of preterm infants in Japan could be notably reduced by supporting the parents' earlier readiness for discharge and allowing tube feeding at home.
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Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Tiempo de Internación , Alta del Paciente , Humanos , Recién Nacido , Alta del Paciente/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Finlandia , Japón , Femenino , Masculino , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Unidades de Cuidado Intensivo Neonatal/normas , Estudios RetrospectivosRESUMEN
BACKGROUND: Extrauterine growth restriction from inadequate nutrition remains a significant morbidity in very low birth weight infants. Participants in the California Perinatal Quality Care Collaborative Quality Improvement Collaborative, Grow, Babies, Grow! developed or refined tools to improve nutrition and reduce practice variation. METHOD: Five Neonatal Intensive Care Units describe the development and implementation of nutrition tools. Tools include Parenteral Nutrition Guidelines, Automated Feeding Protocol, electronic medical record Order Set, Nutrition Time-Out Rounding Tool, and a Discharge Nutrition Recommendations. 15 of 22 participant sites completed a survey regarding tool value and implementation. RESULTS: Reduced growth failure at discharge was observed in four of five NICUs, 11-32% improvement. Tools assisted with earlier TPN initiation (8 h) and reaching full feeds (2-5 days). TPN support decreased by 5 days. 80% of survey respondents rated the tools as valuable. CONCLUSION: Evidence and consensus-based nutrition tools help promote standardization, leading to improved and sustainable outcomes.
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Unidades de Cuidado Intensivo Neonatal , Mejoramiento de la Calidad , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/normas , California , Recién Nacido de muy Bajo Peso , Guías de Práctica Clínica como Asunto , Nutrición Parenteral/normas , Medicina Basada en la Evidencia , Fenómenos Fisiológicos Nutricionales del Lactante , FemeninoRESUMEN
OBJECTIVES: The authors sought to measure and compare practice preference variation in neonatal respiratory care within and between neonatal intensive care units (NICUs) using the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT). STUDY DESIGN: Eleven NICUs completed the NSIGHT between 2019 and 2021. Net preference was measured by mean response; agreement was ranked by standard distribution of response values. Heat maps showed comparisons between NICUs and disciplines. RESULTS: NICUs and individuals agreed most often on use of pressure support with mandatory ventilation and on use of non-invasive positive pressure ventilation for apnea. High preference variation surrounded decisions for invasive ventilation versus continuous positive airway pressure for extremely low birth weight infants. Preference difference was most frequent between neonatologists and nurses. CONCLUSIONS: Patterns of practice preference variation in neonatal respiratory care are specific to clinical scenario. Measuring preference variation may inform psychology of change and strengthen quality improvement efforts.
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Unidades de Cuidado Intensivo Neonatal , Mejoramiento de la Calidad , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neonatología/normas , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Encuestas y Cuestionarios , Presión de las Vías Aéreas Positiva ContínuaRESUMEN
NICU clinicians strive to provide family-centered care and often encounter complex and ethical challenges. Emerging evidence suggests that NICU clinicians likely interact with families experiencing intimate partner violence (IPV). However, little research and training exists to guide NICU clinicians in their thinking and practice in the midst of IPV. In this review, we use a structural violence framework to engage in a critical analysis of commonly held assumptions about IPV. These assumptions include an overreliance on binaries including male-female and offender-victim, the belief that people need to be rescued, prioritization of physical safety, and the notion that mandatory reporting helps families who experience violence. By reexamining these assumptions, this review guides NICU clinicians to consider alternatives to carceral and punitive responses to IPV, such as transformative justice and reflexive engagement.
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Unidades de Cuidado Intensivo Neonatal , Violencia de Pareja , Humanos , Violencia de Pareja/prevención & control , Unidades de Cuidado Intensivo Neonatal/normas , Femenino , MasculinoRESUMEN
BACKGROUND: Intubated preterm infants 32 6 / 7 weeks or less of gestation in a mid-Atlantic level IV neonatal intensive care unit (NICU) faced a high number of ventilator days. Based on 6 weeks of electronic health record (EHR) chart audits of extubations in this NICU in 2021, 44% of preterm infants 32 6 / 7 weeks or less of gestation were intubated for more than 28 days, with an average of 23 days on a ventilator. This NICU lacked a standardized extubation guideline providing criteria to drive extubation eligibility. PURPOSE: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of an extubation readiness guideline in preterm infants 32 6 / 7 weeks or less of gestation in a mid-Atlantic level IV NICU. METHODS: This project occurred over a 17-week period in 2021. Implementation included a multidisciplinary committee formation, identification of champions, NICU staff education, completion of a guideline checklist by bedside nursing (for eligible patients), clinician reminders, and chart audits for collection of pre-/postimplementation data. Staff education completion, guideline use and compliance, demographic patient data, ventilator days, time to first extubation, and need for reintubation were tracked. RESULTS: Postimplementation data indicated decreased need for intubation for more than 28 days, ventilator days, and days to first extubation attempt. IMPLICATIONS FOR PRACTICE AND RESEARCH: Results suggested that implementation of the evidence-based guideline was effective in decreasing average total ventilator days for preterm infants 32 6 / 7 weeks or less of gestation.
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Extubación Traqueal , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Mejoramiento de la Calidad , Humanos , Recién Nacido , Extubación Traqueal/métodos , Extubación Traqueal/normas , Unidades de Cuidado Intensivo Neonatal/normas , Guías de Práctica Clínica como Asunto , Intubación Intratraqueal/normas , Intubación Intratraqueal/métodos , Femenino , Adhesión a Directriz , Masculino , Respiración Artificial/métodos , Respiración Artificial/normasRESUMEN
BACKGROUND: Neonatal acute kidney injury (AKI) is a common yet underdiagnosed condition in neonates with significant implications for long-term kidney health. Lack of timely recognition and documentation of AKI contributes to missed opportunities for nephrology consultation and follow-up, potentially leading to adverse outcomes. METHODS: We conducted a quality improvement (QI) project to address this by incorporating an automated real-time electronic medical record (EMR)-AKI alert system in the Neonatal Intensive Care Unit (NICU) at Le Bonheur Children's Hospital. Our primary objective was to improve documentation of neonatal AKI (defined as serum creatinine (SCr) > 1.5 mg/dL) by 25% compared to baseline levels. The secondary goal was to increase nephrology consultations and referrals to the neonatal nephrology clinic. We designed an EMR-AKI alert system to trigger for neonates with SCr > 1.5 mg/dL, automatically adding AKI diagnosis to the problem list. This prompted physicians to consult nephrology, refer neonates to the nephrology clinic, and consider medication adjustments. RESULTS: Our results demonstrated a significant improvement in AKI documentation after implementing the EMR-AKI alert, reaching 100% compared with 7% at baseline (p < 0.001) for neonates with SCr > 1.5 mg/dL. Although the increase in nephrology consultations was not statistically significant (p = 0.5), there was a significant increase in referrals to neonatal nephrology clinics (p = 0.005). CONCLUSIONS: Integration of an EMR alert system with automated documentation offers an efficient and economical solution for improving neonatal AKI diagnosis and documentation. This approach enhances healthcare provider engagement, streamlines workflows, and supports QI. Widespread adoption of similar approaches can lead to improved patient outcomes and documentation accuracy in neonatal AKI care.
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Lesión Renal Aguda , Documentación , Registros Electrónicos de Salud , Unidades de Cuidado Intensivo Neonatal , Mejoramiento de la Calidad , Humanos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/terapia , Registros Electrónicos de Salud/estadística & datos numéricos , Recién Nacido , Documentación/normas , Documentación/métodos , Documentación/estadística & datos numéricos , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Unidades de Cuidado Intensivo Neonatal/normas , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Creatinina/sangre , Masculino , Nefrología/normas , Nefrología/métodos , FemeninoRESUMEN
OBJECTIVE: To increase compliance with standardized safe sleep recommendations for patients in a cohort of regional level III/IV neonatal intensive care units (NICUs) in accordance with recently revised guidelines issued by the American Academy of Pediatrics (AAP). STUDY DESIGN: A regional quality improvement (QI) initiative led by a multidisciplinary task force standardized safe sleep criteria across participating NICU sites. Universal and unit-specific interventions were implemented via Plan-Do-Study-Act (PDSA) cycles with evaluation of compliance through routine crib audits, run chart completion, and Pareto chart analysis. RESULTS: Following QI implementation, compliance with safe sleep guidelines for eligible NICU infants improved from 34% to 90% from October 2019 through September 2022. CONCLUSION: Compliance with early, consistent modeling of safe sleep practices nearly tripled in this cohort of regional NICUs. A standardized, timely approach to safe sleep transition demonstrated dramatic and sustained improvement in the practice and modeling of safe sleep behaviors in the NICU.
Asunto(s)
Adhesión a Directriz , Unidades de Cuidado Intensivo Neonatal , Mejoramiento de la Calidad , Humanos , Unidades de Cuidado Intensivo Neonatal/normas , Recién Nacido , Sueño , Guías de Práctica Clínica como Asunto , Muerte Súbita del Lactante/prevención & control , Seguridad del Paciente , FemeninoRESUMEN
Objetivo: verificar os níveis de pressão sonora, a influência do turno e das ocorrências nesses níveis em uma unidade neonatal do Rio de Janeiro. Método: estudo longitudinal, exploratório, descritivo, com dados coletados entre novembro de 2021 e janeiro de 2022. As variáveis categóricas foram descritas por meio de frequências absoluta e relativa. A aderência à distribuição normal foi verificada pelo teste Shapiro-Wilk. Para a análise da associação entre variáveis de exposição e desfecho, utilizou-se teste Mann-Whitney, Kruskal Wallis e Qui-quadrado. Considerou-se estatisticamente significativos resultados de p<0,05. Resultados: foram coletados 10.122 registros de decibéis e 56 eventos relacionados as atividades, que ocorreram predominantemente no período diurno. Houve variação de 38,6 a 93,1 decibéis (dB). Em 96,3% do período observado, os níveis de pressão sonora estiveram acima do recomendado. Na comparação entre os períodos, o noturno apresentou menores níveis (p=0,000). Conclusão: os níveis de pressão sonora registrados estão acima do recomendado para um ambiente seguro(AU)
Objective: to verify the sound pressure levels (SPL) and the influence of the shift and the occurrences in these levels in a neonatal unit in Rio de Janeiro. Method: longitudinal, exploratory, descriptive study. Collected from November 2021 to January 2022. Categorical variables were described using absolute and relative frequencies. To verify adherence to the normal distribution, the Shapiro-Wilk test was used. For the association between exposure and outcome variables, the Mann-Whitney, Kruskal Wallis and Qui-square tests were used. Results of p < 0.05 were considered statistically significant. Results: 10,122 decibel records and 56 events related to activities were collected, these occurred predominantly during the day. There was a variation from 38.6 to 93.1 decibels (dB). In 96.3% of the observed period, the NPS were above the recommended. Comparing the periods, nighttime had lower SPL (p=0.000). Conclusion: the registered NPS are above the recommended for a safe environment(AU)
Objetivo: Verificar los niveles de presión sonora y la influencia del turno y de las incidencias en esos niveles en una unidad neonatal en Rio de Janeiro. Método: Estudio longitudinal, exploratorio, descriptivo, cuyos datos se recopilaron de noviembre de 2021 a enero de 2022. Las variables categóricas se describieron mediante frecuencias absoluta y relativa. Para verificar la adherencia a la distribución normal se utilizó la prueba de Shapiro-Wilk. Para el análisis de la asociación entre variables de exposición y de resultado se utilizaron las pruebas de Mann-Whitney, Kruskal Wallis y Qui-quadrado. Los resultados de p < 0,05 se consideraron estadísticamente significativos. Resultados: se recolectaron 10.122 registros de decibelios y 56 eventos relacionados con actividades, que ocurrieron predominantemente durante el día. Hubo una variación de 38,6 a 93,1 decibelios (dB). En el 96,3% del período observado, los niveles de presión sonora estuvieron por encima de lo recomendado. Comparando los períodos, el nocturno presentó niveles más bajos (p=0,000). Conclusión: Los niveles de presión sonora registrados están por encima de lo recomendado para un ambiente seguro(AU)
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/normas , Medición del Ruido , Ruido , Estudios Longitudinales , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Management of high-risk newborns should involve the use of standardized protocols and training, continuous and specialized brain monitoring with electroencephalography (EEG), amplitude integrated EEG, Near Infrared Spectroscopy, and neuroimaging. Brazil is a large country with disparities in health care assessment and some neonatal intensive care units (NICUs) are not well structured with trained personnel able to provide adequate neurocritical care. To reduce this existing gap, an advanced telemedicine model of neurocritical care called Protecting Brains and Saving Futures (PBSF) Guidelines was developed and implemented in a group of Brazilian NICUs. METHODS: A prospective, multicenter, and observational study will be conducted in all 20 Brazilian NICUs using the PBSF Guidelines as standard-of-care. All infants treated accordingly to the guidelines during Dec 2021 to Nov 2024 will be eligible. Ethical approval was obtained from participating centers. The primary objective is to describe adherence to the PBSF Guidelines and clinical outcomes, by center and over a 3-year period. Adherence will be measured by quantification of neuromonitoring, neuroimaging exams, sub-specialties consultation, and clinical case discussions and videoconference meetings. Clinical outcomes of interest are detection of seizures during hospitalization, use of anticonvulsants, inotropes, and fluid resuscitation, death before hospital discharge, length of hospital stay, and referral of patients to specialized follow-up. DISCUSSION: The study will provide evaluation of PBSF Guidelines adherence and its impact on clinical outcomes. Thus, data from this large prospective, multicenter, and observational study will help determine whether neonatal neurocritical care via telemedicine can be effective. Ultimately, it may offer the necessary framework for larger scale implementation and development of research projects using remote neuromonitoring. TRIAL REGISTRATION: NCT03786497, Registered 26 December 2018, https://www.clinicaltrials.gov/ct2/show/NCT03786497?term=protecting+brains+and+saving+futures&draw=2&rank=1.
Asunto(s)
Encéfalo/fisiología , Atención a la Salud/normas , Enfermedades del Recién Nacido/prevención & control , Unidades de Cuidado Intensivo Neonatal/normas , Guías de Práctica Clínica como Asunto/normas , Convulsiones/diagnóstico , Telemedicina/métodos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Multicéntricos como Asunto , Neuroimagen , Monitorización Neurofisiológica , Estudios Observacionales como Asunto , Estudios Prospectivos , Convulsiones/diagnóstico por imagen , Grabación en VideoRESUMEN
OBJECTIVE: Therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE), delivered mainly in tertiary cooling centres (CCs), reduces mortality and neurodisability. It is unknown if birth in a non-cooling centre (non-CC), without active TH, impacts short-term outcomes. DESIGN: Retrospective cohort study using National Neonatal Research Database and propensity score-matching. SETTING: UK neonatal units. PATIENTS: Infants ≥36 weeks gestational age with moderate or severe HIE admitted 2011-2016. INTERVENTIONS: Birth in non-CC compared with CC. MAIN OUTCOME MEASURES: Primary outcome was survival to discharge without recorded seizures. Secondary outcomes were recorded seizures, mortality and temperature on arrival at CCs following transfer. RESULTS: 5059 infants were included with 2364 (46.7%) born in non-CCs. Birth in a CC was associated with improved survival without seizures (35.1% vs 31.8%; OR 1.15, 95% CI 1.02 to 1.31; p=0.02), fewer seizures (60.7% vs 64.6%; OR 0.84, 95% CI 0.75 to 0.95, p=0.007) and similar mortality (15.8% vs 14.4%; OR 1.11, 95% CI 0.93 to 1.31, p=0.20) compared with birth in a non-CC. Matched infants from level 2 centres only had similar results, and birth in CCs was associated with greater seizure-free survival compared with non-CCs. Following transfer from a non-CC to a CC (n=2027), 1362 (67.1%) infants arrived with a recorded optimal therapeutic temperature but only 259 (12.7%) of these arrived within 6 hours of birth. CONCLUSIONS: Almost half of UK infants with HIE were born in a non-CC, which was associated with suboptimal hypothermic treatment and reduced seizure-free survival. Provision of active TH in non-CC hospitals prior to upward transfer warrants consideration.
Asunto(s)
Hospitales/normas , Hipotermia Inducida , Hipoxia-Isquemia Encefálica/terapia , Edad Gestacional , Humanos , Hipoxia-Isquemia Encefálica/complicaciones , Hipoxia-Isquemia Encefálica/mortalidad , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/normas , Análisis por Apareamiento , Transferencia de Pacientes , Puntaje de Propensión , Estudios Retrospectivos , Convulsiones/etiología , Análisis de Supervivencia , Resultado del Tratamiento , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed. OBJECTIVE: To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality. METHODS: Prospective observational cohort study of newborns admitted to the hospital between mid-February and mid-March 2019 after birth in other institutions. Data were collected on maternal/prenatal history, delivery, and in-hospital care via convenience sampling. Associations of patient characteristics with in-hospital death were assessed using cause-specific Cox proportional-hazards models. RESULTS: Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42-11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10-3.65, p = 0.023). CONCLUSION: Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.
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Hospitalización , Mortalidad Infantil , Unidades de Cuidado Intensivo Neonatal/normas , Calidad de la Atención de Salud/normas , Estudios de Cohortes , Parto Obstétrico , Geografía , Guinea , Indicadores de Salud , Humanos , Incidencia , Lactante , Recién Nacido , Salud Materna , Morbilidad , Modelos de Riesgos ProporcionalesAsunto(s)
Servicios de Salud Materna/normas , Leche Humana , Relaciones Madre-Hijo , Enfermeras Obstetrices/psicología , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal/organización & administración , Unidades de Cuidado Intensivo Neonatal/normas , Relaciones Madre-Hijo/psicología , Padres , Sociedades de EnfermeríaRESUMEN
BACKGROUND: Summary measures are used to quantify a hospital's quality of care by combining multiple metrics into a single score. We used Baby-MONITOR, a summary quality measure for NICUs, to evaluate quality by race and ethnicity across and within NICUs in the United States. METHODS: Vermont Oxford Network members contributed data from 2015 to 2019 on infants from 25 to 29 weeks' gestation or of 401 to 1500 g birth weight who were inborn or transferred to the reporting hospital within 28 days of birth. Nine Baby-MONITOR measures were individually risk adjusted, standardized, equally weighted, and averaged to derive scores for African American, Hispanic, Asian American, and American Indian infants, compared with white infants. RESULTS: This prospective cohort included 169 400 infants at 737 hospitals. Across NICUs, Hispanic and Asian American infants had higher Baby-MONITOR summary scores, compared with those of white infants. African American and American Indian infants scored lower on process measures, and all 4 minority groups scored higher on outcome measures. Within NICUs, the mean summary scores for African American, Hispanic, and Asian American NICU subsets were higher, compared with those of white infants in the same NICU. American Indian summary NICU scores were not different, on average. CONCLUSIONS: With Baby-MONITOR, we identified differences in NICU quality by race and ethnicity. However, the summary score masked within-measure quality gaps that raise unanswered questions about the relationships between race and ethnicity and processes and outcomes of care.
Asunto(s)
Unidades de Cuidado Intensivo Neonatal/normas , Calidad de la Atención de Salud , Grupos Raciales , Etnicidad , Femenino , Humanos , Recién Nacido , Masculino , Estudios Prospectivos , Estados UnidosRESUMEN
BACKGROUND AND OBJECTIVES: Laboratory testing is performed frequently in the NICU. Unnecessary tests can result in increased costs, blood loss, and pain, which can increase the risk of long-term growth and neurodevelopmental impairment. Our aim was to decrease routine screening laboratory testing in all infants admitted to our NICU by 20% over a 24-month period. METHODS: We designed and implemented a multifaceted quality improvement project using the Institute for Healthcare Improvement's Model for Improvement. Baseline data were reviewed and analyzed to prioritize order of interventions. The primary outcome measure was number of laboratory tests performed per 1000 patient days. Secondary outcome measures included number of blood glucose and serum bilirubin tests per 1000 patient days, blood volume removed per 1000 patient days, and cost. Extreme laboratory values were tracked and reviewed as balancing measures. Statistical process control charts were used to track measures over time. RESULTS: Over a 24-month period, we achieved a 26.8% decrease in laboratory tests performed per 1000 patient days (â½51 000 fewer tests). We observed significant decreases in all secondary measures, including a decrease of almost 8 L of blood drawn and a savings of $258 000. No extreme laboratory values were deemed attributable to the interventions. Improvement was sustained for an additional 7 months. CONCLUSIONS: Targeted interventions, including guideline development, dashboard creation and distribution, electronic medical record optimization, and expansion of noninvasive and point-of-care testing resulted in a significant and sustained reduction in laboratory testing without notable adverse effects.