Effect of Routine, Screening Head Ultrasounds on Clinical Interventions for Premature Infants.

OBJECTIVE: This article assesses whether routine, screening head ultrasound (HUS) studies performed at 7 to 14 postnatal days for premature infants are followed by clinical interventions. STUDY DESIGN: This retrospective cohort study included all inborn infants delivered at < 30 weeks' gestational age (GA) between January 1, 2012 and December 31, 2015 at a single center who had a routine, screening HUS performed between 7 and 14 postnatal days (n = 303). We defined "clinical intervention" as a 7 to 14 postnatal day HUS that was followed by neurosurgical intervention prior to a 36- to 40-week postmenstrual age (PMA) HUS or elective withdrawal of critical care within 30 days of a positive HUS finding. RESULTS: Four infants (1.3%) had neurosurgical intervention prior to a 36- to 40-week PMA HUS; all four had a diagnostic HUS performed prior to postnatal day 7 to assess for an intraventricular hemorrhage (IVH) due to clinical instability. No infant had critical care electively withdrawn following a 7 to 14 postnatal day HUS. CONCLUSION: Clinical intervention rarely followed routine, screening HUS studies performed at 7 to 14 postnatal days for inborn infants delivered at < 30 weeks' GA. In no case did clinical intervention related to HUS results occur when a 7 to 14 postnatal day HUS was the initial HUS performed.

Teamwork, communication and resident leadership at resident-attended, neonatal delivery room resuscitations.

OBJECTIVE: Determine if a NICU resident delivery room (DR) skills educational curriculum is associated with changes in neonatal resuscitation team characteristics, including teamwork, communication and leadership. STUDY DESIGN: This prospective, observational study of resident-attended neonatal resuscitations utilized team questionnaire, video assessment and chart review. Each resident NICU block included a curriculum consisting of two educational programs focusing on NRP knowledge and skills with additional emphasis on teamwork and communication strategies. RESULTS: Ninety-nine resuscitations met inclusion criteria. Comparing behaviors at the beginning versus end of a NICU block, residents demonstrated increased frequency of initiating leadership (31% vs. 93%, p < 0.001) and maintaining leadership (19% vs. 79%, p < 0.001) at low-risk, resident-attended DR resuscitations. Overall measurements of teamwork and communication were unchanged. CONCLUSIONS: A NICU DR skills educational curriculum is associated with increased resident leadership at low-risk DR resuscitations over the course of NICU blocks, without compromising measurements of teamwork or communication.