Effects of semi-upright swings on vital signs in NICU infants.

BACKGROUND: The aim of this study was to compare the impact of a semi-upright swing with a standard crib on vital signs in infants in the neonatal intensive care unit (NICU). METHODS: We performed a within-subjects' comparison of vital signs of NICU infants corrected to ≥34 weeks of gestation and placed in the supine position versus the semi-upright position in a swing. The primary outcome was the mean oxygen saturation, and the secondary outcomes were the mean heart rate, the proportion of time with oxygen saturation (SpO2) <90%, and respiratory rate. RESULTS: Of the 65 infants, 34 (57%) were male and 32 (50%) were black. The mean ± SD gestational age at birth was 32.4 ± 5.1 weeks. In all, 40% were on noninvasive respiratory support. There were no significant differences in oxygen saturation, heart rate, time with oxygen desaturation defined by SpO2 < 90%, or respiratory rate between the supine and semi-upright positions. A higher risk of desaturations was observed in infants without respiratory support (RR, 1.24, 95% CI, 1.15-1.33) and low-birth-weight infants (RR, 1.55, 95% CI, 1.42-1.69). CONCLUSIONS: The placement of infants in a semi-upright swing resulted in no discernible differences in averaged vital signs compared to the supine position in NICU infants. IMPACT: We identified no significant differences in averaged oxygen saturation, heart rate, or respiratory rate among NICU infants placed in a semi-upright swing compared to the supine position. Desaturation events occurred at a higher frequency in low-birth-weight infants and those on room air when placed in the swing, although none required oxygen supplementation. The results from the current study support that it is probably safe to use semi-upright swings in the NICU environment, although additional studies are necessary for generalization to the unmonitored home environment.

Fellow Perceptions of Program Culture Conveyed Through Virtual Interviews: Aligning Perceptions With Reality.

OBJECTIVE: Due to the COVID-19 pandemic, medical education training programs had to rapidly switch to a virtual interview (VI) format for the 2021 application cycle. Studies have demonstrated a gap in applicant perceptions of program culture through the VI. The objectives of this study were to assess the perceptions of culture from VIs compared to direct experience after beginning training and explore VI gaps in representing culture. STUDY DESIGN: An anonymous questionnaire was emailed to first-year neonatal-perinatal medicine fellows who participated in the 2020-2021 and 2021-2022 VI process. Demographic and interview data and information regarding the presentation of and gaps in the portrayal of program culture through VIs were collected. Responses were evaluated using descriptive statistics, the Wilcoxon signed-rank test, and qualitative analysis. RESULTS: Eighty-five survey responses were received. In determining how well the respondent perceptions of program culture from the VI aligned with their direct experiences, respondent scores showed a median of 80 (scale of 0-100%) with an IQR of 57.5-90. There were significant differences in the perception of fellow-faculty relationships (p = 0.044), the priority placed on fellow teaching (p < 0.001), respect and value for fellows (p = 0.001), and fellow work-life integration (p = 0.004). Nineteen percent of respondents reported not meeting with fellows during their VI and only 15% reported usage of social media in their VI. Respondents noted fellows to be the most important people contributing to perceptions of program culture and provided possible solutions to address challenges in representing culture. CONCLUSION: Despite the small number of respondents, the quantitative and qualitative results offer enlightening information on the gaps in presenting culture through VIs. Notably, the perception of program culture from the VI did not align well with direct experience, particularly in areas addressing fellow relationships and the value placed on fellow teaching, respect, and work-life integration. Increasing fellow involvement, arranging informal settings, and the usage of social media may be important tools to improve accuracy in the representation of culture through VIs.

Ten-year review of neonatal neurosurgical outcomes and cost analysis.

Background: Neurosurgical interventions in neonates may contribute to increased neonatal intensive care unit (NICU) stay. The impact of neurosurgical interventions on length of stay (LOS) and cost is not well-documented in the literature. In addition to LOS, other factors may impact overall resource utilization. Our objective was to perform a cost analysis of neonates who underwent neurosurgical procedures. Methods: A retrospective chart review was performed on NICU patients who underwent ventriculoperitoneal and/or subgaleal shunt placement between January 1, 2010, and April 30, 2021. Postoperative outcomes were analyzed, including LOS, revisions, infections, emergency department (ED) visits following discharge, and readmissions accounting for health care utilization cost. Results: Sixty-six neonates underwent shunt placement during our study period. Out of our 66 patients, 40% of infants had intraventricular hemorrhage (IVH). About 81% had hydrocephalus. Specific diagnoses for our patient population varied and included: 37.9% of patients had IVH complicated by posthemorrhagic hydrocephalus, 27.3% had Chiari II malformation, 9.1% had a cystic malformation leading to hydrocephalus, 7.5% had solely hydrocephalus or ventriculomegaly, 6.0% had myelomeningocele, 4.5% had Dandy-Walker malformation, 3.0% had aqueductal stenosis, and the remaining 4.5% had varying other pathologies. In our patient population, 11% of patients had an identified or suspected infection within 30 days after surgery. The average LOS was 59 days versus 67 days for patients with a postoperative infection. Number of patients who visited the ED within 30 days of discharge was 21%. Of these ED visits, 57% led to readmission. Complete cost analysis was available for 35 out of 66 patients. The average LOS was 63 days with average cost of admission of $209,703.43. Average cost for readmission was $25,757.02. Average daily cost for neurosurgical patients was $1,672.98 versus $1,298.17 for all NICU patients. Conclusion: Neonates who underwent neurosurgical procedures had longer LOS as well as higher daily cost. LOS for infants with infections following procedures was increased by 10.6%. Further research is needed to optimize health-care utilization for these high-risk neonates.

The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review.

In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.