Physiological Effects of Handling in Moderate to Late Preterm Infants Receiving Neonatal Intensive Care.

BACKGROUND: Of all preterm births, approximately 82% are moderate to late preterm. Moderate to late preterm infants are often treated like full-term infants despite their physiological and metabolic immaturity, increasing their risk for mortality and morbidity. PURPOSE: To describe the relationship between routine caregiving methods and physiological markers of stress and hypoxemia in infants born between 32 and 36 6/7 weeks' gestation. METHODS: This descriptive study used a prospective observational design to examine the relationship between routine caregiving patterns (single procedure vs clustered care) and physiological markers of stress and hypoxemia such as regional oxygen saturation, quantified as renal and cerebral regional oxygen saturation (StO 2 ), systemic oxygen saturation (Sp o2 ), and heart rate (HR) in moderate to late preterm infants. Renal and cerebral StO 2 was measured using near-infrared spectroscopy during a 6-hour study period. Sp o2 and HR were measured using pulse oximetry. RESULTS: A total of 231 procedures were captured in 37 participants. We found greater alterations in cerebral StO 2 , renal StO 2 , Sp o2 , and HR when routine procedures were performed consecutively in clusters than when procedures were performed singly or separately. IMPLICATIONS FOR PRACTICE AND RESEARCH: Our results suggest that the oxygen saturation and HR of moderate to late preterm infants were significantly altered when exposed to routine procedures that were performed consecutively, in clusters, compared with when exposed to procedures that were performed singly or separately. Adequately powered randomized controlled trials are needed to determine the type of caregiving patterns that will optimize the health outcomes of this vulnerable population.

Latent Tuberculosis Infection Testing and Treatment at a Federally Qualified Health Center in Southern California: A Quality Improvement Project.

BACKGROUND: A key strategy to eliminate tuberculosis (TB) in the United States is to increase latent tuberculosis infection (LTBI) screening, testing, and treatment among non-US-born Asian populations. PURPOSE: The purpose was to increase LTBI screening, testing, and treatment at a community clinic. METHODS: Retrospective baseline LTBI data were retrieved through electronic medical record review. Interventions included adoption of standardized TB risk assessment, training providers to use shorter LTBI treatment regimens, and use of a care coordinator. Chart abstraction to examine outcomes was conducted postintervention at 4 months. RESULTS: In 2017, only 3 patients (7%) with LTBI were started on treatment. At 4 months postintervention, 28 (72%) patients with LTBI were started on treatment, of which 27 (96%) were placed on 3- to 4-month regimens. CONCLUSIONS: Training for providers and changes to clinic workflow, including use of a care coordinator, can help increase LTBI screening, testing, and treatment in community clinics.