Impact of mother-baby friendly initiative plus approach on improving human milk feeding for neonates in hospital: a quality improvement before-and-after uncontrolled study

The apparent increase in frequency of neonatal necrotizing enterocolitis1 and the recognition that the gastrointestinal tract is often the portal of entry in neonatal sepsis2 has renewed interest in breast milk as a source of newborn immunity. Attention has recently focussed on milk leukocytes. The purpose of this commentary is to summarize the available information on this subject and to examine the implications that this knowledge may have on the possible use of human milk-feeding to protect the newborn from infection. Human colostrum and early milk contain 1 to 2 x 106 leukocytes; 80% to 90% of these are monocytic phagocytes and the remainder are lymphocytes.3,4

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Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO: A Retrospective Study Examining Quality Improvement Outcomes

Wound Management & Prevention ◽

10.25270/wmp.2021.9.1424 ◽

2021 ◽

Vol 67 (9) ◽

pp. 14-24

Author(s):

Jordan Jackson ◽

Holly Kirkland-Kyhn ◽

Laura Kenny ◽

Alana Beres ◽

Stephanie Mateev

Keyword(s):

Quality Improvement ◽

Pediatric Patients ◽

Wound Care ◽

Occipital Region ◽

Provider Education ◽

Before And After ◽

Prevention Interventions ◽

Improvement Interventions ◽

Quality Improvement Interventions ◽

Hospital Acquired

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3–6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8–32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.

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Abstract 8: Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a8 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Sarah Song ◽

Gregg Fonarow ◽

Wenqin Pan ◽

DaiWai Olson ◽

Adrian F Hernandez ◽

...

Keyword(s):

Quality Improvement ◽

Ischemic Stroke ◽

Clinical Outcomes ◽

Early Period ◽

Quality Improvement Program ◽

Administrative Claims ◽

Improvement Program ◽

All Cause Mortality ◽

Before And After ◽

Get With The Guidelines

Background: Get With The Guidelines (GWTG)-Stroke is a national, hospital-based quality improvement program developed by the American Heart Association. While studies have shown a beneficial effect of hospital participation in GWTG-Stroke upon processes of care, whether there are associated improvements in clinical outcomes has not been previously investigated. Methods: From among all acute care US hospitals, we matched 366 hospitals that joined the GWTG-Stroke program between April 2004 and December 2007, with 366 hospitals that did not. Matching was based on ischemic stroke case volume, calendar year, baseline hospital post-stroke 1-year all-cause mortality rates, teaching status, and geographic region. Outcomes of all acute ischemic stroke (AIS) patients admitted to the study hospitals were abstracted from the CMS administrative claims database (65 years and older). Outcomes at matched hospitals were compared in the PRE-GWTG-Stroke period (-540 to -181 days before program launch), RUN-UP period (-180- to -1 day), EARLY period (0 to 180 days) and SUSTAINED period (181 to 540 days). Additional analysis was performed of the entire BEFORE (-540 to -1 days) and AFTER periods (0 to 540 days). The main analytical approach was stratified Cox proportional hazard modeling, with matched site ID at stratum. We adjusted for patient characteristics (age, gender, race, medical history) and hospital characteristics (rural vs. urban, # beds, annual IS discharges.) Results: The study analyzed 88,584 AIS admissions at the 366 GWTG-Stroke hospitals and 85,401 admissions at the 366 matched non-GWTG-Stroke hospitals. In adjusted analysis comparing BEFORE and AFTER periods, GWTG-Stroke hospitals achieved reduced 30 day mortality (30M - HR 0.911, p<0.0001), reduced 1 year mortality (1YM - HR 0.902, p<0.0001), reduced 30 day all-cause rehospitalization (HR 0.956, p=0.013), reduced 30 day stroke rehospitalization (HR 0.927, p=0.038), and reduced 1 year all-cause rehospitalization (HR 0.972, p=0.007). Conversely, matched, non-GWTG-Stroke hospitals showed only reduced 30M (HR 0.954, p=0.010) between the BEFORE and AFTER periods. Comparing the degree of change at GWTG-Stroke with non-GWTG Stroke hospitals, there were greater improvements in discharge to home (DCH), 30M, and 1YM at GWTG-Stroke hospitals in each of the intervention periods: EARLY: DCH, HR 1.090, p<0.0001; 30M, HR 0.894, p=0.0006; 1YM, HR 0.889, p<0.0001; SUSTAINED: DCH, HR 1.097, p<0.0001; 30M, HR 0.934, p=0.004; 1YM, HR 0.918, p<0.0001. Conclusions: Hospitals joining the GWTG-Stroke quality improvement program between 2004-2008 achieved significantly greater improvement in stroke patient outcomes than matched hospitals not joining the program, with lower all-cause mortality at 30 days and 1 year and higher rates of discharge directly to home.

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Quality improvement in melanoma care: Multidisciplinary quality program development and comparison of care before and after implementation

The American Journal of Surgery ◽

10.1016/j.amjsurg.2018.10.025 ◽

2019 ◽

Vol 217 (3) ◽

pp. 527-531

Author(s):

Barrett A. Kielhorn ◽

Jensen B. Jantz ◽

Mark S. Kosten ◽

Stephen S. Phillips ◽

Sarat C. Khandavalli ◽

...

Keyword(s):

Quality Improvement ◽

Program Development ◽

Quality Program ◽

Before And After

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AN EVALUATION OF FORMULA TOLERANCE AFTER HUMAN MILK FEEDING. 1814

Pediatric Research ◽

10.1203/00006450-199604001-01838 ◽

1996 ◽

Vol 39 ◽

pp. 305-305

Author(s):

Beate Blennemann ◽

Geraldine Baggs ◽

Marc Masor

Keyword(s):

Human Milk ◽

Milk Feeding

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Human Milk Feeding of the High-Risk Neonate

Gastroenterology and Nutrition: Neonatology Questions and Controversies ◽

10.1016/b978-1-4377-2603-9.00013-2 ◽

2012 ◽

pp. 203-212

Author(s):

Christina J. Valentine ◽

Ardythe L. Morrow

Keyword(s):

High Risk ◽

Human Milk ◽

High Risk Neonate ◽

Milk Feeding

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Effectiveness of Probiotic for Primary Prevention of Clostridium difficile Infection: A Single-Center Before-and-After Quality Improvement Intervention at a Tertiary-Care Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.76 ◽

2018 ◽

Vol 39 (07) ◽

pp. 765-770 ◽

Cited By ~ 6

Author(s):

William E. Trick ◽

Stephen J. Sokalski ◽

Stuart Johnson ◽

Kristen L. Bunnell ◽

Joseph Levato ◽

...

Keyword(s):

Quality Improvement ◽

Primary Prevention ◽

Clostridium Difficile ◽

Incidence Rate ◽

Tertiary Care ◽

Prophylactic Antibiotic ◽

Quality Improvement Intervention ◽

Tertiary Care Medical Center ◽

Before And After ◽

Improvement Intervention

OBJECTIVETo evaluate probiotics for the primary prevention of Clostridium difficile infection (CDI) among hospital inpatients.DESIGNA before-and-after quality improvement intervention comparing 12-month baseline and intervention periods.SETTINGA 694-bed teaching hospital.INTERVENTIONWe administered a multispecies probiotic comprising L. acidophilus (CL1285), L. casei (LBC80R), and L. rhamnosus (CLR2) to eligible antibiotic recipients within 12 hours of initial antibiotic receipt through 5 days after final dose. We excluded (1) all patients on neonatal, pediatric and oncology wards; (2) all individuals receiving perioperative prophylactic antibiotic recipients; (3) all those restricted from oral intake; and (4) those with pancreatitis, leukopenia, or posttransplant. We defined CDI by symptoms plus C. difficile toxin detection by polymerase chain reaction. Our primary outcome was hospital-onset CDI incidence on eligible hospital units, analyzed using segmented regression.RESULTSThe study included 251 CDI episodes among 360,016 patient days during the baseline and intervention periods, and the incidence rate was 7.0 per 10,000 patient days. The incidence rate was similar during baseline and intervention periods (6.9 vs 7.0 per 10,000 patient days; P=.95). However, compared to the first 6 months of the intervention, we detected a significant decrease in CDI during the final 6 months (incidence rate ratio, 0.6; 95% confidence interval, 0.4–0.9; P=.009). Testing intensity remained stable between the baseline and intervention periods: 19% versus 20% of stools tested were C. difficile positive by PCR, respectively. From medical record reviews, only 26% of eligible patients received a probiotic per the protocol.CONCLUSIONSDespite poor adherence to the protocol, there was a reduction in the incidence of CDI during the intervention, which was delayed ~6 months after introducing probiotic for primary prevention.Infect Control Hosp Epidemiol 2018;765–770

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Fecal Bacterial Communities Differ by Lactation Status in Post-Partum Women and Their Infants

Journal of Human Lactation ◽

10.1177/08903344211060343 ◽

2021 ◽

pp. 089033442110603

Author(s):

Eliot N. Haddad ◽

Lynn E. Ferro ◽

Kathleen E. B. Russell ◽

Kameron Y. Sugino ◽

Jean M. Kerver ◽

...

Keyword(s):

Body Mass Index ◽

Gut Microbiota ◽

Human Milk ◽

Body Mass ◽

Beta Diversity ◽

Bifidobacterium Longum ◽

Univariate Analysis ◽

Body Mass Index Category ◽

Fecal Samples ◽

Milk Feeding

Background: Previous research examined effects of human milk on the infant gut microbiota, but little attention has been given to the microbiota of lactating women. Research Aim: To determine associations between exclusive human milk feeding and gut microbiota characteristics in mothers and infants at 6-weeks postpartum. Methods: A sample of mother–infant dyads ( N = 24) provided fecal samples and questionnaire responses at 6-weeks postpartum as part of the Pregnancy, EAting & POstpartum Diapers study. Deoxyribonucleic acid was extracted from stool samples, followed by (V4) 16S ribosomal ribonucleic acid gene amplicon sequencing. Alpha and beta diversity, in addition to taxa differences, were compared by human milk exposure status, exclusive versus non-exclusive. A subset of dyads (those exclusively fed human milk; n = 14) was analyzed for shared bifidobacterial species using polymerase chain reaction. Results: Alpha diversity was significantly lower in exclusively human milk-fed infants. Maternal lactation status (exclusive vs. partial) and Shannon diversity were associated in univariate analysis but were no longer associated in multivariable regression including body mass index category in the model. Beta diversity (Sorensen dissimilarity) of fecal samples from women and infants was significantly associated with human milk feeding. Of six infants with Bifidobacterium longum subspecies longum in their fecal samples, all their mothers shared the same species. Conclusion: Maternal gut microbiotas differ by lactation status, a relationship potentially confounded by body mass index category. Further research is needed to identify whether lactation directly influences the maternal gut microbiota, which may be another mechanism by which lactation influences health.

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