ABSTRACT
Premie BiliRecs is a novel electronic clinical decision support tool for the management of hyperbilirubinemia in moderately preterm infants less than 35 weeks gestational age. It serves to operationalize and automate current expert consensus-based guidelines, and to aid in the generation of new practice-based evidence to inform future guidelines.
Subject(s)
Decision Support Systems, Clinical , Exchange Transfusion, Whole Blood , Hyperbilirubinemia, Neonatal/therapy , Internet , Phototherapy/methods , Disease Management , Electronic Health Records , Gestational Age , Humans , Infant, Newborn , Infant, PrematureABSTRACT
BACKGROUND: Early childhood media exposure is associated with obesity and multiple adverse health conditions. The aims of this study were to assess parental attitudes toward childhood television (TV) viewing in a low-income population and examine the extent to which child BMI, child/parent demographics, and household media environment are associated with adherence to American Academy of Pediatrics (AAP) guidelines for screen time. METHODS: This was a cross-sectional survey study of 314 parents of children ages 0-5 years surveyed in English or Spanish by self-administered questionnaire at a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinic in Oregon. RESULTS: In this majority Latino sample (73%), half (53%) of the children met AAP guidelines on screen time limits, 56% met AAP guidelines for no TV in the child's bedroom, and 29% met both. Children were more likely to meet AAP guidelines when there were <2 TVs in the home, there was no TV during dinner, or their parents spent less time viewing electronic media. Parents who spent less time viewing electronic media were more likely to report believing that TV provides little value or usefulness. CONCLUSIONS: In this low-income, predominantly Latino population attending WIC, parent media-viewing and household media environment are strongly associated with child screen time. Programs aimed at reducing child screen time may benefit from interventions that address parental viewing habits.
Subject(s)
Child Behavior/psychology , Feeding Behavior/psychology , Health Knowledge, Attitudes, Practice/ethnology , Hispanic or Latino , Parenting/psychology , Parents/psychology , Sedentary Behavior , Social Environment , Television , Adult , Child Nutritional Physiological Phenomena , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , Nutrition Policy , Oregon/epidemiology , Parent-Child Relations , Parenting/ethnology , Parenting/trends , PovertyABSTRACT
OBJECTIVE: To explore the association between red blood cell transfusion and necrotizing enterocolitis (NEC) in a neonatal intensive care unit with liberal transfusion practices. STUDY DESIGN: A retrospective cohort study was conducted for all infants weighing <1500 g who received at least 1 packed red blood cell transfusion between January 2008 and June 2013 in a tertiary neonatal intensive care unit. The primary outcome was NEC, defined as Bell stage II or greater. The temporal association of NEC and transfusion was assessed using multivariate Poisson regression. RESULTS: The study sample included 414 very low birth weight infants who received 2889 consecutive red blood cell transfusions. Twenty-four infants (5.8%) developed NEC. Four cases of NEC occurred within 48 hours of a previous transfusion event. Using multivariate Poisson regression, we did not find evidence of a temporal association between NEC and transfusion (P = .32). CONCLUSION: There was no association between NEC and red blood cell transfusion. Our results differ from previous studies and suggest that the association between NEC and transfusion may be contextual.
Subject(s)
Enterocolitis, Necrotizing/etiology , Erythrocyte Transfusion/adverse effects , Intensive Care, Neonatal/organization & administration , Birth Weight , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/therapy , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Male , Multivariate Analysis , Poisson Distribution , Retrospective Studies , Tertiary Care Centers/organization & administration , Time Factors , Treatment OutcomeABSTRACT
Extreme hyperbilirubinemia (EHB) caused by neonatal glucose-6-phosphate dehydrogenase (G6PD) deficiency is strongly associated with mortality and long-term neurodevelopmental impairment, yet there are limited national strategies to reduce this burden in South Asia. Current known and predicted prevalence of G6PD deficiency in Afghanistan, Bangladesh, Bhutan, India, Nepal, and Pakistan ranges from 3.8 to 15 %, with regional "hot spots" exceeding 22 %. Annually, 3.14 million infants are born at risk for this condition. In 2010, South Asian countries reported 37 million (27 %) of world-wide livebirths ≥ 32 wk gestational-age and G6PD deficiency accounted for > 33 % of the global EHB burden, in contrast to 2.2 % for those born in high-income nations. Traditional national approach includes universal newborn screening in malaria-endemic countries or those with prevalence >3.5 %. However, screening implementation should be best optimized using timely quantitative enzyme assay and identification of at-risk female newborns. Furthermore, economic and social constraints, in context of sub-regional variances, call for flexible problem-solving methods in anticipation of changing community demographics. Thus, incremental and need-based newborn screening programs could be the most optimal approach. A human-centered design (HCD) approach, as an alternate pathway, could build the evidence to translate the complex biology of G6PD deficiency and the biodesign of affordable technologies, allowing facilitation of access to knowledge and services, in order to deliver on a long-term public health mandate. Key steps would encompass the initiation of local inquiry of both quantitative and qualitative data to identify at-risk communities and to prospectively design for local innovative solutions.
