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Am J Perinatol ; 33(14): 1415-1419, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27183000


Objective The aim of this article is to examine characteristics of birth tourism (BT) neonates admitted to a neonatal intensive care unit (NICU). Methods This was a retrospective review over 3 years; BT cases were identified, and relevant perinatal, medical, social, and financial data were collected and compared with 100 randomly selected non-birth tourism neonates. Results A total of 46 BT neonates were identified. They were more likely to be born to older women (34 vs. 29 years; p < 0.001), via cesarean delivery (72 vs. 48%; p = 0.007), and at a referral facility (80 vs. 32%; p < 0.001). BT group had longer hospital stay (15 vs. 7 days; p = 0.02), more surgical intervention (50 vs. 21%; p < 0.001), and higher hospital charges (median $287,501 vs. $103,105; p = 0.003). One-third of BT neonates were enrolled in public health insurance program and four BT neonates (10%) were placed for adoption. Conclusion Families of BT neonates admitted to the NICU face significant challenges. Larger studies are needed to better define impacts on families, health care system, and society.

Cesárea/estatística & dados numéricos , Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Turismo Médico/economia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , California , Análise Custo-Benefício , Feminino , Mortalidade Hospitalar , Hospitais Pediátricos , Humanos , Recém-Nascido , Masculino , Parto , Gravidez , Estudos Retrospectivos , Adulto Jovem
Breastfeed Med ; 11(2): 75-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26901619


BACKGROUND: Mothers of very-low-birth-weight (VLBW) infants often struggle to establish and maintain a milk supply. Children's Hospital of Orange County (CHOC Children's) data from 2005 to 2011 showed that while the total percentage of all neonatal intensive care unit (NICU) babies being discharged on breastmilk had remained stable, the percentage of VLBW babies with breastmilk at discharge had declined. This information resulted in a quality improvement initiative to remove barriers and implement programs shown to have the greatest impact on initiating and sustaining lactation in this patient subset. The objective of this initiative was to increase breastmilk availability at discharge for the VLBW population. MATERIALS AND METHODS: A multidisciplinary program was initiated, which included NICU parent and staff education, clarification of roles, and improved access to pumping supplies. Physicians and nurses completed online education. An algorithm defining roles in lactation support was developed, and a resource team of trained bedside nurses was formed. Lactation consultant time was then refocused on the VLBW population. In addition, "Lactation Support" was added to the physician daily documentation to bring the topic to daily bedside rounds. Twice weekly lactation rounds between the lactation consultant and neonatologist addressed lactation concerns for each dyad. To address pumping issues, the loaner pump program was enhanced. RESULTS: To assess the effectiveness of the initiative, breastmilk availability at discharge for the VLBW population at CHOC Children's was compared from baseline (2011) to the end of June 2015. VLBW breastmilk availability at discharge upon project initiation was 58.7% and increased by 36% to a final rate of 80% by 2013--a rate sustained through the first 6 months of 2015. CONCLUSIONS: The results of this initiative suggest that a multidisciplinary approach, including education, changes in workflow, and redefinition of roles, is effective in improving breastmilk rates at discharge in the VLBW patient population.

Aleitamento Materno/métodos , Aconselhamento Diretivo/métodos , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Lactação , Mães , Alta do Paciente/estatística & dados numéricos , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Masculino , Leite Humano , Mães/educação , Mães/psicologia , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade
Am J Respir Crit Care Med ; 192(12): 1504-13, 2015 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-26214043


RATIONALE: Subglottic edema and acquired subglottic stenosis are potentially airway-compromising sequelae in neonates following endotracheal intubation. At present, no imaging modality is capable of in vivo diagnosis of subepithelial airway wall pathology as signs of intubation-related injury. OBJECTIVES: To use Fourier domain long-range optical coherence tomography (LR-OCT) to acquire micrometer-resolution images of the airway wall of intubated neonates in a neonatal intensive care unit setting and to analyze images for histopathology and airway wall thickness. METHODS: LR-OCT of the neonatal laryngotracheal airway was performed a total of 94 times on 72 subjects (age, 1-175 d; total intubation, 1-104 d). LR-OCT images of the airway wall were analyzed in MATLAB. Medical records were reviewed retrospectively for extubation outcome. MEASUREMENTS AND MAIN RESULTS: Backward stepwise regression analysis demonstrated a statistically significant association between log(duration of intubation) and both laryngeal (P < 0.001; multiple r(2) = 0.44) and subglottic (P < 0.001; multiple r(2) = 0.55) airway wall thickness. Subjects with positive histopathology on LR-OCT images had a higher likelihood of extubation failure (odds ratio, 5.9; P = 0.007). Longer intubation time was found to be significantly associated with extubation failure. CONCLUSIONS: LR-OCT allows for high-resolution evaluation and measurement of the airway wall in intubated neonates. Our data demonstrate a positive correlation between laryngeal and subglottic wall thickness and duration of intubation, suggestive of progressive soft tissue injury. LR-OCT may ultimately aid in the early diagnosis of postintubation subglottic injury and help reduce the incidences of failed extubation caused by subglottic edema or acquired subglottic stenosis in neonates. Clinical trial registered with (NCT 00544427).

Intubação Intratraqueal/efeitos adversos , Laringoestenose/diagnóstico , Tomografia de Coerência Óptica/métodos , Diagnóstico Precoce , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
Clin Ther ; 32(2): 265-71, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20206784


OBJECTIVE: This study was conducted to evaluate once-weekly liposomal amphotericin B (L-AmB) for Candida prophylaxis in very low birth weight (VLBW) neonates. METHODS: This prospective, randomized, open-label, placebo-controlled study included neonates who were <32 weeks' gestational age, <7 days old, and weighing <1500 g at birth. Subjects were randomized to receive L-AmB 5 mg/kg per week or placebo (dextrose water) and were followed until 6 weeks of age. Surveillance cultures were obtained at baseline, at 72 hours, and weekly thereafter. Study drug was continued until 6 weeks after birth or the discontinuation of high-risk treatments and invasive devices, whichever occurred first. Blood cultures were obtained as clinically indicated. The primary end point was development of Candida colonization by 6 weeks' postnatal age; secondary end points included development of invasive candidiasis and occurrence of treatment-related adverse events. Safety variables included renal and hepatic function tests, incidence of grade III-IV intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC), and mortality. RESULTS: Forty subjects were enrolled and randomized to receive L-AmB (12 males, 8 females; 50% white) or placebo (12 males, 8 females; 35% white). Subjects were evenly distributed by gestational age, age at enrollment, birth weight, race, and sex. Consent was withdrawn after completion of study treatment in 1 subject (L-AmB); 1 subject in each study arm died during the study; and 3 subjects were transferred back to their referring institutions (1 L-AmB, 2 placebo). Thus, 17 subjects in each arm completed all study procedures, although all 40 subjects were evaluable. Colonization before administration of study drug was noted in 4 L-AmB subjects (20%) and 1 placebo subject (5%); 1 (5%) and 3 (15%) subjects in the respective groups developed colonization while receiving study drug. No L-AmB subjects and 1 placebo subject developed candidiasis. One subject in each group died; these deaths were not considered related to study drug or fungal infection. There were no clinical differences between groups in the incidence of grade III-IV IVH, NEC, hypokalemia, nephrotoxicity, need for platelet or packed red blood cell transfusion, or mortality. CONCLUSIONS: L-AmB 5 mg/kg once weekly was generally well tolerated in these VLBW infants. The data did not allow evaluation of efficacy. A larger, multicenter, randomized clinical trial of L-AmB for Candida prophylaxis that is appropriately powered is warranted.

Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Candidíase/prevenção & controle , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Anfotericina B/efeitos adversos , Antifúngicos/efeitos adversos , Candidíase/diagnóstico , Candidíase/etiologia , Esquema de Medicação , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento