Renal Oxygenation (rSO 2 ) Population Parameter Estimates in Premature Infants Routinely Monitored With Near-Infrared Spectroscopy.

BACKGROUND: Currently, reference ranges for renal oxygenation measured by near-infrared spectroscopy (NIRS) in preterm infants beyond the first days of life are lacking, especially those born prior to 29 weeks' gestation. Population estimates of renal oxygenation (rSO 2 ) levels among preterm infants over time have yet to be established, leading to reluctance in clinical application. PURPOSE: To characterize the distribution and estimate population parameters for renal oxygenation measured by NIRS during the first 14 days of life among preterm infants. METHODS: We prospectively observed rSO 2 trends of 37 infants before 34 weeks' gestation and 1800-g or less birth weight for the first 14 days of life. Analyses included distribution fit tests, ordinary least squares (OLS) regression, and t tests. RESULTS: Average daily rSO 2 variation steadily increased with 42% difference through the first 14 days of life. For all infants, renal rSO 2 means peaked during the first 3 days of life and plateaued around 7 days. Daily rSO 2 slopes were significantly lower among males and infants 29 weeks' or less gestation. IMPLICATIONS FOR PRACTICE: Renal rSO 2 during the first 14 days of life reflects normal extrauterine transition reaching stabilization around 7 days of life. Gestational age, birth weight, and gender may predict the early trajectory of rSO 2 patterns. Population estimates provide parameters for renal rSO 2 that may indicate early-onset tissue hypoxia when acute or significant drops from baseline occur. IMPLICATIONS FOR RESEARCH: We present a framework to guide future research using renal NIRS technology in preterm infants to determine deviations from expected trends that may precede renal injury.

Follow-up after a failed newborn hearing screen: a quality improvement study.

OBJECTIVE: Universal newborn hearing screening (UNHS) has been implemented for several decades to screen for congenital hearing loss; however, the lost to follow-up (LFU) rate for newborns with a failed screen is nearly 50%. Many studies have examined risk factors rendering infants susceptible to being LFU, but there are no quality improvement studies using evidence-based practice that aim to improve follow-up rates. This study utilized a nurse practitioner (NP) to provide a teaching intervention to educate parents on recommended follow-up after a failed hearing screen, including the Healthy People 2020 objectives. METHODS: Seventeen newborn/mother couplets were recruited to participate in a multi-site quality improvement project over a six week period prior to hospital discharge. At the bedside with the NP, mothers completed a demographic survey and were provided education on Georgia's UNHS Program and recommended follow-up based on the Healthy People 2020 objectives. An appointment with the hospital's audiologist was given to the mother in writing. A retrospective chart review was performed three months after the newborn's birth to document follow-up with audiology or to see if the infant was lost to follow-up for audiologic evaluation (LFUAE). RESULTS: Of the 17 newborns enrolled, 14 had adequate follow-up with audiology within three months of birth. Hospital A showed statistical significance with one newborn that was LFUAE when compared to the nation LFU rate (n=12, p=0.01). Prior to project intervention, Hospital B had a 70% LFUAE rate; however, its post intervention LFUAE rate decreased to 40% (n=5). Statistical significance was unable to be obtained due to small sample size. Two mothers reported smoking during pregnancy and both of their newborns were LFUAE. CONCLUSIONS: This project suggests that education by the NP prior to hospital discharge was statistically significant at Hospital A. Health care providers should actively engage in educating parents regarding expected follow-up guidelines and incorporating the Healthy People 2020 objectives. Further studies are needed that can also examine the six month follow-up with pediatric otolaryngology for hearing aid fitting and early intervention.