Neonatal Intensive Care Unit Length of Stay Reduction by Heart Rate Characteristics Monitoring

Objective The aim of this study is to evaluate the feasibility, safety, and efficacy of discharge with supplemental nasogastric tube (NGT) feeds in medically complex infants. Study Design Cohort study of 400 infants enrolled in the Transitional Medical Home (TMH) program at Duke University Level IV neonatal intensive care unit from January 2013 to 2017. Results Among 400 infants enrolled in the TMH, 57 infants were discharged with an NGT. A total of 45 infants with a variety of diagnoses and comorbidities were included in final analysis. Among 45 infants, 5 obtained a gastrostomy tube (GT) postdischarge. Median (25–75th percentile) length of use of NGT in 40 infants was 12 days (4–37). Excluding four outliers who used NGT for ≥140 days, the median length of use was 8 days (3–24). This extrapolates to a median of 288 hospital days saved for the remaining 36 infants. There were only three emergency room visits related to parental concern for incorrect NGT placement. There was no statistically significant difference in percent oral feeding predischarge or growth in first month postdischarge between infants who orally fed versus those who obtained GTs. Conclusion Discharge with supplemental NGT feeds is safe and feasible utilizing a standardized protocol and close postdischarge follow-up. This practice can decrease length of stay and prevent need for GT. Key Points

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Domain Adaptation for Heart Rate Extraction in the Neonatal Intensive Care Unit

2020 IEEE International Conference on Bioinformatics and Biomedicine (BIBM) ◽

10.1109/bibm49941.2020.9313123 ◽

2020 ◽

Author(s):

Diogo Malafaya ◽

Sara Domingues ◽

Helder P. Oliveira

Keyword(s):

Intensive Care Unit ◽

Heart Rate ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Domain Adaptation

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1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1594 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S713-S713

Author(s):

Carlo Fopiano Palacios ◽

Eric Lemmon ◽

James Campbell

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Linear Regression ◽

Length Of Stay ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

P Value ◽

Fisher Exact Test ◽

The Mean ◽

Pcr Test

Abstract Background Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU. Methods We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed. Results Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value < 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay. Conclusion Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU. Disclosures All Authors: No reported disclosures

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Characterisation of Textile Embedded Electrodes for Use in a Neonatal Smart Mattress Electrocardiography System

Sensors ◽

10.3390/s21030999 ◽

2021 ◽

Vol 21 (3) ◽

pp. 999

Author(s):

Henry Dore ◽

Rodrigo Aviles-Espinosa ◽

Zhenhua Luo ◽

Oana Anton ◽

Heike Rabe ◽

...

Keyword(s):

Intensive Care Unit ◽

Heart Rate ◽

Intensive Care ◽

High Resolution ◽

Neonatal Intensive Care Unit ◽

Real Time ◽

Neonatal Intensive Care ◽

Delivery Room ◽

Proof Of Concept ◽

Heart Rate Monitoring

Heart rate monitoring is the predominant quantitative health indicator of a newborn in the delivery room. A rapid and accurate heart rate measurement is vital during the first minutes after birth. Clinical recommendations suggest that electrocardiogram (ECG) monitoring should be widely adopted in the neonatal intensive care unit to reduce infant mortality and improve long term health outcomes in births that require intervention. Novel non-contact electrocardiogram sensors can reduce the time from birth to heart rate reading as well as providing unobtrusive and continuous monitoring during intervention. In this work we report the design and development of a solution to provide high resolution, real time electrocardiogram data to the clinicians within the delivery room using non-contact electric potential sensors embedded in a neonatal intensive care unit mattress. A real-time high-resolution electrocardiogram acquisition solution based on a low power embedded system was developed and textile embedded electrodes were fabricated and characterised. Proof of concept tests were carried out on simulated and human cardiac signals, producing electrocardiograms suitable for the calculation of heart rate having an accuracy within ±1 beat per minute using a test ECG signal, ECG recordings from a human volunteer with a correlation coefficient of ~ 87% proved accurate beat to beat morphology reproduction of the waveform without morphological alterations and a time from application to heart rate display below 6 s. This provides evidence that flexible non-contact textile-based electrodes can be embedded in wearable devices for assisting births through heart rate monitoring and serves as a proof of concept for a complete neonate electrocardiogram monitoring system.

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