Is the Quality of Care in Twins and in Singletons Related?

AbstractWe investigated if it is possible to use the data collected in twins to identify areas with high rates of operative deliveries, preterm deliveries and low birthweight infants in singletons. Our data correspond to all deliveries registered in Belgium in 1983. A significant correlation was found between the rates of cesarean sections in twins and in singletons. A significant correlation was also found between the rate of deliveries at a gestational age of less than 32 weeks in twins and the rate of deliveries at less than 37 weeks in singletons. However, correlations between other preterm rates, low birthweight rates and vacuum extraction or forceps rates, were nonsignificant. We conclude that the use of twins as tracers of the quality of care in singletons is of limited value.

Download Full-text

Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care

BMJ Open ◽

10.1136/bmjopen-2018-023706 ◽

2019 ◽

Vol 9 (2) ◽

pp. e023706 ◽

Cited By ~ 1

Author(s):

Marzia Lazzerini ◽

Hematha Senanayake ◽

Rishard Mohamed ◽

Athula Kaluarachchi ◽

Roshini Fernando ◽

...

Keyword(s):

Quality Of Care ◽

Sri Lanka ◽

Data Collection ◽

Low Birthweight ◽

Technical Problem ◽

International Standards ◽

High Rate ◽

Technical Problems ◽

Data Completeness

ObjectivesThis study was aimed at piloting a prospective individual patient database on hospital deliveries in Colombo, Sri Lanka, and at exploring its use for developing recommendations for improving quality of care (QoC).DesignObservational study.SettingDe Soysa Maternity Hospital, the largest referral hospital for maternity care in Sri Lanka.Data collection and analysisFrom July 2015 to June 2017, 150 variables were collected for each delivery using a standardised form and entered into a database. Data were analysed every 8 months, and the results made available to local staff. Outcomes of the study included: technical problems; data completeness; data accuracy; key database findings; and use of data.Results7504 deliveries were recorded. No technical problem was reported. Data completeness exceeded that of other existing hospital recording systems. Less than 1% data were missing for maternal variables and less than 3% for newborn variables. Mistakes in data collection and entry occurred in 0.01% and 0.09% of maternal and newborn data, respectively. Key QoC indicators identified in comparison with international standards were: relatively low maternal mortality (0.053%); relatively high maternal near-miss cases (3.4%); high rate of induction of labour (24.6%), caesarean section (30.0%) and episiotomy (56.1%); relatively high rate of preterm births (9.4%); low birthweight rate (16.5%); stillbirth (0.97%); and of total deaths in newborn (1.98%). Based on key indicators identified, a list of recommendations was developed, including the use checklists to standardise case management, training, clinical audits and more information for patients. A list of lessons learnt with the implementation of the data collection system was also drawn.ConclusionsThe study shows that the implemented system of data collection can produce a large quantity of reliable information. Most importantly, this experience provides an example on how database findings can be used for discussing hospital practices, identifying gaps and to agree on recommendations for improving QoC.

Download Full-text

Milk Protein Quantity and Quality in Low-Birthweight Infants: I. Metabolic Responses and Effects on Growth

PEDIATRICS ◽

10.1542/peds.57.5.659 ◽

1976 ◽

Vol 57 (5) ◽

pp. 659-674 ◽

Cited By ~ 1

Author(s):

Niels C. R. Räihä ◽

Kirsti Heinonen ◽

David K. Rassin ◽

Gerald E. Gaull

Keyword(s):

Human Milk ◽

Gestational Age ◽

Low Birthweight ◽

Caloric Intake ◽

Ammonia Concentration ◽

Total Serum Protein ◽

Total Serum ◽

Serum Globulin ◽

Crown Rump Length

The optimal quantity and quality of protein for low-birthweight infants is undefined. In this study, 106 well, appropriate-for-gestational age, low-birthweight infants weighing 2,100 gm or less were grouped in three gestational age categories: T1 = 28 to 30 weeks; T2 = 31 to 33 weeks; T3 = 34 to 36 weeks. Each group was assigned randomly to either banked human milk (BM) or to one of four isocaloric formulas varying in quantity and quality of protein but not in mineral content or in fat content: formula 1 = 1.5 gm of protein per 100 ml, 60 parts bovine whey proteins to 40 parts bovine caseins: formula 2 = 3.0 gm of protein per 100 ml, 60:40; formula 3 = 1.5 gm of protein per 100 ml, 18:82; formula 4 = 3.0 gm of protein per 100 ml, 18:82. Caloric intake was 117 kcal/150 ml/kg/day for the formulas. Human milk was fed at 170 ml/kg/day in order to attain a caloric intake approximately equal to that of the formulas. No significant differences were found in the rate of growth in crown-rump length, in femoral length, in head circumference, or in rate of gain in weight from time of regaining birthweight to time of discharge at 2,400 gm. Blood urea nitrogen, urine osmolarity, total serum protein, serum albumin, aiud serum globulin varied directly with the quantity of protein in the diet: F2, F4 > F1, F3 > BM. Blood ammonia concentration varied with both quantity and qualtiy of protein in the diet: F2, F3, F4 > F1, BM. Metabolic acidosis was more frequent, more severe, and more prolonged in the infants fed the casein-predominant formulas (F3, F4) than in those fed the whey protein-predominant formulas (Fl, F2).

Download Full-text