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2.
Crit Care ; 24(1): 65, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32093763

RESUMO

BACKGROUND: Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. METHODS: Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. RESULTS: Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). CONCLUSIONS: Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.


Assuntos
Terapia Intensiva Neonatal , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Cuidados Críticos/métodos , Estado Terminal , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/normas , Sistemas Automatizados de Assistência Junto ao Leito/normas , Revisões Sistemáticas como Assunto , Ultrassonografia/métodos , Ultrassonografia/normas
3.
Adv Exp Med Biol ; 1232: 285-290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893422

RESUMO

In neonatal intensive care units (NICUs), 87.5% of alarms by the monitoring system are false alarms, often caused by the movements of the neonates. Such false alarms are not only stressful for the neonates as well as for their parents and caregivers, but may also lead to longer response times in real critical situations. The aim of this project was to reduce the rates of false alarms by employing machine learning algorithms (MLA), which intelligently analyze data stemming from standard physiological monitoring in combination with cerebral oximetry data (in-house built, OxyPrem). MATERIALS & METHODS: Four popular MLAs were selected to categorize the alarms as false or real: (i) decision tree (DT), (ii) 5-nearest neighbors (5-NN), (iii) naïve Bayes (NB) and (iv) support vector machine (SVM). We acquired and processed monitoring data (median duration (SD): 54.6 (± 6.9) min) of 14 preterm infants (gestational age: 26 6/7 (± 2 5/7) weeks). A hybrid method of filter and wrapper feature selection generated the candidate subset for training these four MLAs. RESULTS: A high specificity of >99% was achieved by all four approaches. DT showed the highest sensitivity (87%). The cerebral oximetry data improved the classification accuracy. DISCUSSION & CONCLUSION: Despite a (as yet) low amount of data for training, the four MLAs achieved an excellent specificity and a promising sensitivity. Presently, the current sensitivity is insufficient since, in the NICU, it is crucial that no real alarms are missed. This will most likely be improved by including more subjects and data in the training of the MLAs, which makes pursuing this approach worthwhile.


Assuntos
Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Aprendizado de Máquina , Monitorização Fisiológica , Oximetria , Teorema de Bayes , Circulação Cerebrovascular , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Terapia Intensiva Neonatal/métodos , Monitorização Fisiológica/métodos , Oximetria/métodos , Oximetria/normas
4.
CMAJ ; 192(4): E81-E91, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31988152

RESUMO

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.


Assuntos
Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Melhoria de Qualidade , Canadá , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Avaliação de Programas e Projetos de Saúde , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Análise de Sobrevida
6.
Neonatal Netw ; 38(2): 107-108, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470374

RESUMO

Babies in the NICU should be managed in a neurodevelopment-friendly environment. Frequent handling by multiple examiners potentially increases the risk of cross infection. Interruption in kangaroo care is not advisable unless urgent. A minimum of three-point exam should be done (chest, heart, and abdomen) using a stethoscope and gentle palpation. However, the infant should not be wakened from sleep and all handling should be synchronized with the touch time.


Assuntos
Cuidado do Lactente , Doenças do Recém-Nascido , Terapia Intensiva Neonatal , Administração dos Cuidados ao Paciente , Humanos , Cuidado do Lactente/ética , Cuidado do Lactente/métodos , Cuidado do Lactente/psicologia , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/terapia , Unidades de Terapia Intensiva Neonatal/organização & administração , Terapia Intensiva Neonatal/ética , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/psicologia , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Conforto do Paciente , Exame Físico/métodos , Exame Físico/psicologia , Relações Profissional-Família , Fatores de Tempo
7.
Neonatal Netw ; 38(3): 135-143, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470380

RESUMO

Stress in parents who have an infant in the NICU is well documented in literature. Prematurity and related comorbid conditions, high-tech NICU environments, presence of multidisciplinary health care professionals, altered parenting roles, and concerns of health outcomes in the infant are common stress factors. Further, inadequate management of stress can result in poor parent-infant bonding, poor infant outcome, and postpartum depression in parents. Effective stress management strategies may help parents adapt to their parental role thereby improving infant outcomes. Research has shown mindfulness-based strategies help reduce stress in the general population. Can this strategy be applied in the context of parents of infants in the NICU? Literature is scant on the impact of mindfulness-based strategies on parents of infants in the NICU and on the infant's health outcomes. This article explores the application of mindfulness-based strategies to reduce stress in parents of infants in the NICU.


Assuntos
Terapia Intensiva Neonatal/métodos , Atenção Plena/educação , Pais/educação , Pais/psicologia , Estresse Psicológico/prevenção & controle , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
8.
BMC Med Educ ; 19(1): 323, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464614

RESUMO

BACKGROUND: The training of neonatal resuscitation is an important part in the clinical teaching of neonatology. This study aimed to identify the educational efficacy of high-fidelity simulation compared with no simulation or low-fidelity simulation in neonatal resuscitation training. METHODS: The PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, Chinese databases (CBM, CNKI, WanFang, and Weipu), ScopeMed and Google Scholar were searched. The last search was updated on April 13, 2019. Studies that reported the role of high-fidelity simulation in neonatal resuscitation training were eligible for inclusion. For the quality evaluation, we used the Cochrane Risk of Bias tool for RCTs and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for non-RCTs. A standardized mean difference (SMD) with a 95% confidence interval (CI) was applied for the estimation of the pooled effects of RCTs. RESULTS: Fifteen studies (10 RCTs and 5 single arm pre-post studies) were ultimately included. Performance bias existed in all RCTs because participant blinding to the simulator is impossible. The assessment of the risk of bias of single arm pre-post studies showed only one study was of high quality with a low risk of bias whereas four were of low quality with a serious risk of bias. The pooled results of single arm pre-post studies by meta-analysis showed a large benefit with high-fidelity simulation in skill performance (SMD 1.34; 95% CI 0.50-2.18). The meta-analysis of RCTs showed a large benefit in skill performance (SMD 1.63; 95% CI 0.49-2.77) and a moderate benefit in neonatal resuscitation knowledge (SMD 0.69; 95% CI 0.42-0.96) with high-fidelity simulation when compared with traditional training. Additionally, a moderate benefit in skill performance (SMD 0.64; 95% CI 0.06-1.21) and a small benefit was shown in knowledge (SMD 0.39; 95% CI 0.08-0.71) with high-fidelity simulation when compared with low-fidelity simulation. CONCLUSIONS: Improvements of efficacy were shown both in resuscitation knowledge and skill performance immediately after training. However, in current studies, the long-time retention of benefits is controversial, and these benefits may not transfer to the real-life situations.


Assuntos
Reanimação Cardiopulmonar/educação , Competência Clínica/normas , Treinamento com Simulação de Alta Fidelidade , Terapia Intensiva Neonatal , Ansiedade , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/métodos
9.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31358664

RESUMO

CONTEXT: Racial and ethnic disparities in health outcomes of newborns requiring care in the NICU setting have been reported. The contribution of NICU care to disparities in outcomes is unclear. OBJECTIVE: To conduct a systematic review of the literature documenting racial/ethnic disparities in quality of care for infants in the NICU setting. DATA SOURCES: Medline/PubMed, Scopus, Cumulative Index of Nursing and Allied Health, and Web of Science were searched until March 6, 2018, by using search queries organized around the following key concepts: "neonatal intensive care units," "racial or ethnic disparities," and "quality of care." STUDY SELECTION: English language articles up to March 6, 2018, that were focused on racial and/or ethnic differences in the quality of NICU care were selected. DATA EXTRACTION: Two authors independently assessed eligibility, extracted data, and cross-checked results, with disagreements resolved by consensus. Information extracted focused on racial and/or ethnic disparities in quality of care and potential mechanism(s) for disparities. RESULTS: Initial search yielded 566 records, 470 of which were unique citations. Title and abstract review resulted in 382 records. Appraisal of the full text of the remaining 88 records, along with the addition of 5 citations from expert consult or review of bibliographies, resulted in 41 articles being included. LIMITATIONS: Quantitative meta-analysis was not possible because of study heterogeneity. CONCLUSIONS: Overall, this systematic review revealed complex racial and/or ethnic disparities in structure, process, and outcome measures, most often disadvantaging infants of color, especially African American infants. There are some exceptions to this pattern and each area merits its own analysis and discussion.


Assuntos
Grupos de Populações Continentais/etnologia , Grupos Étnicos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/normas , Unidades de Terapia Intensiva Neonatal/normas , Terapia Intensiva Neonatal/normas , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/métodos , Qualidade da Assistência à Saúde/normas
10.
Indian Pediatr ; 56(6): 463-467, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-31278224

RESUMO

OBJECTIVE: To compare the prevalence of vitamin K deficiency after intramuscular vitamin K or no treatment in neonates with sepsis on prolonged (>7 days) antibiotic therapy. STUDY DESIGN: Open label randomized controlled trial. SETTING: Level 3 Neonatal Intensive Care Unit (NICU). PARTICIPANTS: Neonates with first episode of sepsis on antibiotics for ≥7 days were included. Neonates with clinical bleeding, vitamin K prior to start of antibiotic therapy (except the birth dose), cholestasis or prenatally diagnosed bleeding disorder were excluded. INTERVENTIONS: Randomized to receive 1 mg vitamin K (n=41) or no vitamin K (n=39) on the 7th day of antibiotic therapy. MAIN OUTCOME MEASURES: Vitamin K deficiency defined as Protein Induced by Vitamin K Absence (PIVKA-II) >>2 ng/mL after 7 ± 2 days of enrolment. RESULTS: The prevalence of vitamin K deficiency was 100% (n=80) at enrolment and it remained 100% even after 7 ± 2 days of enrolment in both the groups. CONCLUSIONS: Neonates receiving prolonged antibiotics have universal biochemical vitamin K deficiency despite vitamin K administration on 7th day of antibiotic therapy.


Assuntos
Antibacterianos/uso terapêutico , Terapia Intensiva Neonatal/métodos , Síndrome de Lemierre/tratamento farmacológico , Deficiência de Vitamina K/prevenção & controle , Vitamina K/uso terapêutico , Vitaminas/uso terapêutico , Feminino , Seguimentos , Humanos , Recém-Nascido , Injeções Intramusculares , Unidades de Terapia Intensiva Neonatal , Síndrome de Lemierre/complicações , Masculino , Prevalência , Resultado do Tratamento , Deficiência de Vitamina K/diagnóstico , Deficiência de Vitamina K/epidemiologia , Deficiência de Vitamina K/etiologia
11.
Adv Neonatal Care ; 19(4): 275-284, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31268866

RESUMO

BACKGROUND: Children with complex medical needs (CMN) are high healthcare resource utilizers, have varying underlying diagnoses, and experience repeated hospitalizations. Outcomes on neonatal intensive care (NICU) patients with CMN are unknown. PURPOSE: The primary aim is to describe the clinical profile, resource use, prevalence, and both in-hospital and postdischarge outcomes of neonates with CMN. The secondary aim is to assess the feasibility of sustaining the use of the neonatal complex care team (NCCT). METHODS: A retrospective cohort study was conducted after implementing a new model of care for neonates with CMN in the NICU. All neonates born between January 2013 and December 2016 and who met the criteria for CMN and were cared for by the NCCT were included. RESULTS: One hundred forty-seven neonates with a mean (standard deviation) gestational age of 34 (5) weeks were included. The major underlying diagnoses were genetic/chromosomal abnormalities (48%), extreme prematurity (26%), neurological abnormality (12%), and congenital anomalies (11%). Interventions received included mechanical ventilation (69%), parenteral nutrition (68%), and technology dependency at discharge (91%). Mortality was 3% before discharge and 17% after discharge. Postdischarge hospital attendances included emergency department visits (44%) and inpatient admissions (58%), which involved pediatric intensive care unit admissions (26%). IMPLICATIONS FOR PRACTICE: Neonates with CMN have multiple comorbidities, high resource needs, significant postdischarge mortality, and rehospitalization rates. These cohorts of NICU patients can be identified early during their NICU course and serve as targets for implementing innovative care models to meet their unique needs. IMPLICATIONS FOR RESEARCH: Future studies should explore the feasibility of implementing innovative care models and their potential impact on patient outcomes and cost-effectiveness.


Assuntos
Anormalidades Congênitas , Lactente Extremamente Prematuro , Terapia Intensiva Neonatal , Malformações do Sistema Nervoso , Alta do Paciente/estatística & dados numéricos , Colúmbia Britânica/epidemiologia , Estudos de Coortes , Comorbidade , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/genética , Anormalidades Congênitas/mortalidade , Anormalidades Congênitas/terapia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/estatística & dados numéricos , Malformações do Sistema Nervoso/epidemiologia , Malformações do Sistema Nervoso/mortalidade , Malformações do Sistema Nervoso/terapia , Estudos Retrospectivos , Resultado do Tratamento
12.
Early Hum Dev ; 137: 104828, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31357084

RESUMO

BACKGROUND: Neonates that have been subjected to perinatal asphyxia and fulfill criteria for therapeutic hypothermia are cooled to 33.5 °C for 72 h. There is no consensus regarding sedation and analgesic use during hypothermia, but there is evidence supporting the importance of pain relief and adequate sedation. There is a need for assessment of the neonates need for pain relief and sedation, and for adjustments of medication to ensure adequate treatment. There are many different scoring tools available. We found the N-PASS (Neonatal Pain, Agitation and Sedation Scale) scoring tool to be the most suitable for this patient group as it assesses both pain and sedation. METHODS: We translated the scoring tool according to guidelines published by Wilder et al., and scored neonates treated with therapeutic hypothermia. Sedation and analgesia were adjusted according to scoring results. At the end of the study a questionnaire was filled out by the nurses in charge of this group of patients. RESULTS: Both pain and sedation scores did not reach the desired levels until day 3. The nurses reported a high level of satisfaction (79.7% were extremely of very satisfied), and 96.7% of the nurses found the neonates to be better pain relieved after the initiation of the study. CONCLUSION: The implementation of the N-PASS scoring tool in our unit has been successful, and has led to better pain relief and sedation than before the implementation.


Assuntos
Sedação Consciente/normas , Hipotermia Induzida/métodos , Terapia Intensiva Neonatal/normas , Manejo da Dor/normas , /métodos , Sedação Consciente/efeitos adversos , Sedação Consciente/métodos , Feminino , Humanos , Hipotermia Induzida/efeitos adversos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/normas , Terapia Intensiva Neonatal/métodos , Masculino , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos
13.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31248940

RESUMO

Ventilatory support may affect the short- and long-term neurologic and respiratory morbidities of preterm infants. Ongoing monitoring of oxygenation and ventilation and control of adequate levels of oxygen, pressures, and volumes can decrease the incidence of such adverse outcomes. Use of pulse oximetry became a standard of care for titrating oxygen delivery, but continuous noninvasive monitoring of carbon dioxide (CO2) is not routinely used in NICUs. Continuous monitoring of CO2 level may be crucial because hypocarbia and hypercarbia in extremely preterm infants are associated with lung and brain morbidities, specifically bronchopulmonary dysplasia, intraventricular hemorrhage, and cystic periventricular leukomalacia. It is shown that continuous monitoring of CO2 levels helps in maintaining stable CO2 values within an accepted target range. Continuous monitoring of CO2 levels can be used in the delivery room, during transport, and in infants receiving invasive or noninvasive respiratory support in the NICU. It is logical to hypothesize that this will result in better outcome for extremely preterm infants. In this article, we review the different noninvasive CO2 monitoring alternatives and devices, their advantages and disadvantages, and the available clinical data supporting or negating their use as a standard of care in NICUs.


Assuntos
Dióxido de Carbono/sangue , Terapia Intensiva Neonatal/métodos , Monitorização Fisiológica/métodos , Biomarcadores/sangue , Gasometria/instrumentação , Gasometria/métodos , Gasometria/normas , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/normas , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Respiração Artificial , Padrão de Cuidado
15.
Pediatr Int ; 61(8): 797-801, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31206956

RESUMO

BACKGROUND: Procedural pain is one of the most significant problems in neonates, especially in premature babies. Harmless and effective pain relief modalities in newborns should thus be applied. Although sucrose is the most commonly used agent, the most effective dose and concentration of sucrose is not clear. In this study, we compared the efficacy of two different doses of sucrose during venepuncture in neonates. METHODS: This was a prospective, randomized, double-blind study. The study was conducted during venous sampling. Oral 24% sucrose (Tool sweet™ Natus Medical, San Carlos, CA, USA) was given by sterile syringe onto the anterior part of the tongue. Group 1 (n = 65) received 0.2 mL/kg 24% sucrose and group 2 (n = 64) received 0.5 mL/kg 24% sucrose. The Bernese Pain Scale for Neonates (BPSN) was used to assess the pain scores before, during and after the procedure. RESULTS: One hundred and twenty-nine premature infants were enrolled in the study, consisting of 67 girls (51.9%) and 62 boys (48.1%) aged 1-24 days (mean age, 8.34 ± 6.25 days). There was no significant difference in BPSN score between the groups (P > 0.05). There was also no statistically significant difference in BPSN subscale scores between the groups (P > 0.05). CONCLUSIONS: Twenty-four percent sucrose 0.2 mL/kg may be the minimum effective dose to relieve pain during venepuncture procedures in premature babies.


Assuntos
Analgésicos/administração & dosagem , Terapia Intensiva Neonatal/métodos , Dor Processual/prevenção & controle , Flebotomia/efeitos adversos , Sacarose/administração & dosagem , Analgésicos/uso terapêutico , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Medição da Dor , Dor Processual/diagnóstico , Dor Processual/etiologia , Estudos Prospectivos , Sacarose/uso terapêutico , Resultado do Tratamento
16.
Cardiol Young ; 29(6): 749-755, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31179950

RESUMO

PURPOSE: Developmental care of neonates with CHD is essential for proper neurodevelopment. Measurement of developmental care specific to these neonates is needed to ensure consistent implementation within and across cardiac ICUs. The purpose of this study was to psychometrically test the Developmental Care Scale for Neonates with Congenital Heart Disease, which measures the quality of developmental care provided by bedside nurses to neonates in the cardiac ICU. METHODS: Psychometric testing was conducted with 119 cardiac ICU nurses to provide evidence of internal consistency reliability and construct validity. Participants were predominantly young (median = 32 years), white (90%) females (93%) with bachelor's degrees (78%) and a median experience in the cardiac ICU of 7 years. RESULTS: Evidence of internal consistency reliability (α =.89) was provided with corrected item-total correlations ranging from .31 to .77. Exploratory factor analysis provided evidence of construct validity as a unidimensional scale, as well as a multidimensional scale consisting of four subscales: creating the external environment, assessment of family well-being, caregiver activities toward the neonate, and basic human needs. CONCLUSIONS: Evidence of reliability and validity of the 31-item Developmental Care Scale for Neonates with Congenital Heart Disease was established with nurses caring for neonates in the cardiac ICU. This instrument will serve as a valuable outcome measure tasked with improving developmental care performance and makes it possible to identify relationships between developmental care performance and neonatal neurodevelopmental outcomes in future research.


Assuntos
Cuidadores , Cardiopatias Congênitas/diagnóstico , Terapia Intensiva Neonatal/métodos , Psicometria/métodos , Adulto , Idoso , Feminino , Cardiopatias Congênitas/terapia , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
17.
Eur J Pediatr ; 178(8): 1207-1218, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31172278

RESUMO

Genetic disorders are one of the leading causes of infant mortality and are frequent in neonatal intensive care units (NICUs). Rapid genome-wide sequencing (GWS; whole genome or exome sequencing (ES)), due to its diagnostic capabilities and immediate impacts on medical management, is becoming an appealing testing option in the NICU setting. RAPIDOMICS was a trio-based rapid ES pilot study of 25 babies with suspected genetic disorders in the BC Women's Hospital NICU. ES and bioinformatic analysis were performed after careful patient ascertainment. Trio analysis was performed using an in-house pipeline reporting variants in known disease-causing genes. Variants interpreted by the research team as definitely or possibly causal of the infant's phenotype were Sanger validated in a clinical laboratory. The average time to preliminary diagnosis was 7.2 days. Sanger validation was pursued in 15 patients for 13 autosomal dominant and 2 autosomal recessive disorders, with an overall diagnostic rate (partial or complete) of 60%.Conclusion: In total, 72% of patients enrolled had a genomic diagnosis achieved through ES, multi-gene panel testing or chromosomal microarray analysis. Among these, there was an 83% rate of significant and immediate impact on medical decision-making directly related to new knowledge of the diagnosis. Health service implementation challenges and successes are discussed. What is Known: • Rapid genome-wide sequencing in the neonatal intensive care setting has a greater diagnostic hit rate and impact on medical management than conventional genetic testing. However, the impact of consultation with genetics and patient ascertainment requires further investigation. What is New: • This study demonstrates the importance of genetic consultation and careful patient selection prior to pursuing exome sequencing (ES). • In total, 15/25 (60%) patients achieved a diagnosis through ES and 18/25 (72%) through ES, multi-gene panel testing or chromosomal microarray analysis with 83% of those having immediate effects on medical management.


Assuntos
Doenças Genéticas Inatas/diagnóstico , Testes Genéticos/métodos , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Sequenciamento Completo do Exoma/métodos , Tomada de Decisão Clínica/métodos , Estado Terminal , Feminino , Aconselhamento Genético , Doenças Genéticas Inatas/genética , Humanos , Recém-Nascido , Masculino , Análise em Microsséries , Seleção de Pacientes , Projetos Piloto
18.
Pediatr Int ; 61(7): 664-671, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31145817

RESUMO

BACKGROUND: This study of umbilical catheterization deliberate practice training compared skill and knowledge outcomes of umbilical catheterization using a tissue-hybrid simulator (REAL) versus a synthetic simulated umbilical cord task trainer (ART). METHODS: This was a prospective randomized control study. Pediatric residents were randomized to REAL or ART umbilical catheterization deliberate practice training. Pre-post-training changes in skill performance and knowledge scores for REAL and ART groups were compared. Fidelity of REAL and ART were compared by neonatologists. RESULTS: Twenty-seven pediatric residents completed training. Post-training mean skill scores were improved compared to pre-test scores (REAL, P < 0.001; ART, P < 0.0001). Post-training skill, knowledge, and self-efficacy scores were not different between the REAL and ART groups. Fidelity of REAL was higher than ART for neonatologists (P < 0.01). CONCLUSIONS: The face validity of REAL was superior to ART, but resident umbilical cord deliberate practice training demonstrated no difference in skill, knowledge, and self-efficacy improvements between REAL and ART. Further studies on real patients are needed to evaluate the impact of using real or simulated umbilical cords for umbilical venous catheter/umbilical arterial catheter training.


Assuntos
Cateterismo , Internato e Residência , Pediatria/educação , Treinamento por Simulação/métodos , Cordão Umbilical , Cateterismo/instrumentação , Cateterismo/métodos , Competência Clínica , Feminino , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/métodos , Japão , Masculino , Neonatologia/educação , Estudos Prospectivos , Autoeficácia
20.
Early Hum Dev ; 133: 29-35, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31054467

RESUMO

INTRODUCTION: There is evidence to support the use of positive sensory exposures (music, touch, skin-to-skin) with preterm infants in the neonatal intensive care unit (NICU), but strategies to improve their consistent use are lacking. The Supporting and Enhancing NICU Sensory Experiences (SENSE) program was developed to promote consistent, age-appropriate, responsive, and evidence-based positive sensory exposures for the preterm infant every day of NICU hospitalization. METHODS: A systematic and rigorous process of development of the SENSE program included an integrative review of evidence on sensory exposures in the NICU, stakeholder feedback, expert opinion, and focus groups. RESULTS: SENSE implementation materials consist of parent education materials, tailored doses of sensory exposures for each postmenstrual age, an infant assessment of tolerance, bedside logs and implementation considerations for integrating the SENSE program into the NICU. DISCUSSION: Research is needed to evaluate the SENSE program as an implementation strategy and to assess its impact on parent and infant outcomes.


Assuntos
Recém-Nascido Prematuro/fisiologia , Terapia Intensiva Neonatal/métodos , Guias de Prática Clínica como Assunto , Sensação , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Terapia Intensiva Neonatal/normas , Masculino , Pais/educação , Percepção , Estimulação Física/métodos , Psicoterapia/métodos
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