Prenatal Care Adherence and Neonatal Intensive Care Unit Admission or Stillbirth among Women with Gestational and Preexisting Diabetes Mellitus

2017 ◽  
Vol 35 (02) ◽  
pp. 103-109 ◽  
Author(s):  
Jeffrey Sperling ◽  
Lindsay Maggio ◽  
Phinnara Has ◽  
Julie Daley ◽  
Amrin Khander ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prenatal Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Perinatal Outcomes ◽  
Nicu Admission ◽  
Glycemic Monitoring ◽  
Lower Adherence

Objective To determine if there was an association between prenatal care adherence and neonatal intensive care unit (NICU) admission or stillbirth, and adverse perinatal outcomes in women with preexisting diabetes mellitus (DM) and gestational DM (GDM). Materials and Methods This is a retrospective cohort study among women with DM and GDM at a Diabetes in Pregnancy Program at an academic institution between 2006 and 2014. Adherence with prenatal care was the percentage of prenatal appointments attended divided by those scheduled. Adherence was divided into quartiles, with the first quartile defined as lower adherence and compared with the other quartiles. Results There were 443 women with DM and 499 with GDM. Neonates of women with DM and lower adherence had higher rates of NICU admission or stillbirth (55 vs. 39%; p = 0.003). A multivariable logistic regression showed that the lower adherence group had higher likelihood of NICU admission (adjusted odds ratio: 1.61 [1.03–2.5]; p = 0.035). Those with lower adherence had worse glycemic monitoring and more hospitalizations. Among those with GDM, most outcomes were similar between groups including NICU admission or stillbirth. Conclusion Women with DM with lower adherence had higher rates of NICU admission and worse glycemic control. Most outcomes among women with GDM with lower adherence were similar.

Diagnosis of Auditory Neuropathy Spectrum Disorder in the Neonatal Intensive Care Unit Population

2021 ◽  
pp. 019459982110298
Author(s):  
Chengetai Mahomva ◽  
Yi-Chun Carol Liu ◽  
Nikhila Raol ◽  
Samantha Anne
Keyword(s):  
Intensive Care Unit ◽  
Information System ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Health Information ◽  
Neonatal Intensive Care ◽  
Health Information System ◽  
Auditory Neuropathy ◽  
Spectrum Disorder ◽  
Nicu Admission

Objective To determine the incidence of auditory neuropathy spectrum disorder (ANSD) and its risk factors among the neonatal intensive care unit (NICU) population from 2009 to 2018 in the Pediatric Health Information System database. Study Design Retrospective national database review. Setting Population-based study. Methods The Pediatric Health Information System database was queried to identify patients ≤18 years old with NICU admission and ANSD diagnosis. Patient demographics, jaundice diagnosis, use of mechanical ventilation, extracorporeal membrane oxygenation, furosemide, and/or aminoglycosides were extracted. Multivariable linear regression was used to assess trends in incidence. Chi-square analysis was used to assess differences between patients with and without ANSD. Logistic regression was used to assess factors associated with ANSD. Results From 2009 to 2018, there was an increase in (1) NICU admissions from 14,079 to 24,851 ( P < .001), (2) total ANSD diagnoses from 92 to 1847 ( P = .001), and (3) annual total number of patients with ANSD and NICU admission increased from 4 to 16 ( P = .005). There was strong correlation between the increases in total number of NICU admissions and total ANSD diagnoses over time ( R = 0.76). The average ANSD incidence was 0.052% with no statistically significant change over 10 years. When compared with all NICU admissions, children with ANSD had a higher association with use of furosemide ( P < .001) and ventilator ( P < .001). Conclusion Despite a statistically significant increase in NICU admissions and total ANSD diagnosis, the incidence of ANSD in the NICU population has not increased from 2009 to 2018. Furosemide and mechanical ventilator use were associated with increased likelihood of ANSD.

Labor and Delivery Outcomes with the Sequential Use of Misoprostol Followed by Cervical Foley Catheter

2020 ◽  
Author(s):  
Maeve K. Hopkins ◽  
Rebecca F. Hamm ◽  
Sindhu K. Srinivas ◽  
Lisa D. Levine
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Maternal Morbidity ◽  
Neonatal Intensive Care ◽  
Foley Catheter ◽  
Catheter Placement ◽  
Increased Risk ◽  
Nicu Admission ◽  
Time To Delivery

Objective Studies demonstrate shorter time to delivery with concurrent use of misoprostol and cervical Foley catheter. However, concurrent placement may not be feasible. If misoprostol is used to start an induction, little is known regarding the benefit of sequentially using Foley catheter. We examine obstetrical outcomes in women with Foley catheter placed after misoprostol compared with those only requiring misoprostol. Study design Retrospective cohort study of singleton pregnancies, intact membranes, and an unfavorable cervix (Bishop score of ≤6 and dilation ≤2 cm) undergoing term induction May 2013 to June 2015. We compared obstetrical outcomes between women receiving misoprostol alone versus those that had a Foley catheter placed after misoprostol. Outcomes are mode of delivery, time to delivery, chorioamnionitis, admission to neonatal intensive care unit, and maternal morbidity. Chi-square and Fisher's exact tests were used for categorical variables, Mann–Whitney U-tests compared continuous variables. Results Among 364 women, 281 began induction with misoprostol alone. A total of 135 (48%) subsequently had a Foley catheter placed. Characteristics were similar between the groups, although nulliparity and cervical dilation <1 cm at start of induction were more likely to have subsequent Foley catheter. Women with Foley catheter placement after misoprostol had a longer median time to delivery (15 vs. 11 hours, p < 0.001), twofold higher rate of cesarean (42 vs. 26%, odds ratio: 2.1, 95% confidence interval: 1.26–3.44, p = 0.004), and increased risk of neonatal intensive care unit (NICU) admission (21 vs. 11%, p = 0.024). There was a nonsignificant increased risk of chorioamnionitis (12 vs. 7%, p = 0.1) and maternal morbidity (15 vs. 8%, p = 0.08) in the misoprostol followed by Foley catheter group. Conclusion In women receiving misoprostol for induction, nulliparas and those with dilation <1 cm are more likely to have subsequent Foley catheter placement. Sequential use of cervical Foley catheter after misoprostol is associated with longer labor, higher cesarean rate, and increased NICU admission. Requirement of Foley catheter after misoprostol confers higher risk and may guide counseling. Key Points

scholarly journals MATERNAL VIRTUAL INFANT NUTRITION SUPPORT CLINIC FOR THE NEONATAL INTENSIVE CARE UNIT (MAVINS-NICU) - A QUALITATIVE STUDY

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e28-e28
Author(s):  
Stientje Rai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Breast Milk ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Infant Nutrition ◽  
Discussion Forum ◽  
Breastfeeding Support ◽  
Lactation Consultant ◽  
Nicu Admission

Abstract BACKGROUND Canadian exclusive breastfeeding rates at 6 months of age are only 24.2%, and are even lower in mothers of infants requiring Neonatal Intensive Care Unit (NICU) admission. An interactive website was developed that provides professional (articles, videos) and peer (discussion forum for peers, access to a lactation consultant) breastfeeding support to mothers of infants requiring NICU admission. OBJECTIVES The objective of the study is to outline maternal perceptions of the breastfeeding support website (MAVINS-NICU) in a level-III NICU setting. DESIGN/METHODS This study represents the qualitative research component of the MAVINS-NICU project. Semi-structured interviews were conducted antenatally with women at risk of delivering an infant requiring NICU admission (n=6), and postnatally with mothers of infants admitted to the NICU (n=7), regarding their experiences with the MAVINS-NICU website. Interviews were audio-recorded and transcribed by a professional transcriptionist. Analysis occurred in an iterative fashion using open and axial coding strategies to identify majors themes. RESULTS Several themes were identified: 1) Women seemed comforted that a reliable hospital-provided resource would be available to them after birth, “…I’m very happy that I’m going to have lots of support”; 2) Women felt overwhelmed after birth, but often accessed the website on their phone or read newly posted comments on the discussion forum in response to automatically generated weekly emails from the website, “I’m just, overwhelmed… because I’m [in the NICU a lot], I only have my phone and it’s just easier to look at the emails… [they] just pop up”; 3) Mothers felt extremely comforted by the peer support component of the website, “to see what other moms are going through … similar emotions or issues … to see that I’m not the only one [helps]”; 4) Mothers enjoyed remote access and quick online lactation consultant response times, “ … [you can] get help even when there’s no one around”, “I was really surprised … by how quickly I got responses”; 5) Majority of mothers expressed a sense of empowerment to provide breast milk with the help of MAVINS support, “…being able to breastfeed eventually is a big deal for me… [it made me feel] like I was accomplishing something”. CONCLUSION Mothers of infants admitted to the NICU found the MAVINS-NICU website very helpful and considered it part of their success in providing breast milk for their babies.

Abstract P387: Risk Factors for Neonatal Intensive Care Unit Admission; Project Watch, 2012-2017

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Ksheeraja Sriram ◽  
Amna Umer ◽  
Candice Hamilton ◽  
Collin C John ◽  
Christa LILLY
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Maternal Smoking ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Insurance Status ◽  
Nicu Admission

Background: Neonatal intensive care unit (NICU) admission is often due to specific cardiovascular conditions. Low birthweight, another common reason for NICU admission, is also linked to later cardiovascular risk. Within the past decade, the rate of NICU admissions in the United States has significantly increased. Identification of emerging risk factors for NICU admission will help inform efforts to reduce the number of newborns requiring intensive care. Methods: The objective of this study was to identify risk factors for NICU admission in all infants born in West Virginia (WV), 2012-2017, via Project WATCH. Fifteen exposure variables including demographics, maternal and infant characteristics, were included in multivariable logistic regression analyses, stratified by preterm and term births. Results: Of 120,894 neonates, 6,393 (5.3%) were admitted to NICU. Among preterm infants (Table 1), predictors included male sex (OR: 1.11), insurance status (OR: 1.29), APGAR scores less than or equal to 3 (OR: 2.57), maternal diabetes (OR: 1.68 and 2.01), residence outside WV (OR: 1.27), intrauterine substance exposure (OR: 1.94), congenital abnormalities (OR: 2.58), and low birthweight (OR: 1.73 and 6.64). Risk factors in term infants included all factors identified for preterm infants, as well as maternal smoking, maternal age, and number of previous pregnancies. Conclusions: In addition to infant characteristics predictive of NICU admission (e.g., birthweight and APGAR score), socioeconomic factors (e.g., insurance status and rurality) and preventable risk factors (e.g., maternal smoking and substance use) provide an opportunity for intervention during pregnancy, with the goal to decrease the number of newborns requiring intensive care.

scholarly journals Identification and Eradication of Methicillin-Resistant Staphylococcus aureus Colonization in the Neonatal Intensive Care Unit: Results of a National Survey

2010 ◽  
Vol 31 (7) ◽  
pp. 766-768 ◽  
Author(s):  
Aaron M. Milstone ◽  
Xiaoyan Song ◽  
Susan Coffin ◽  
Alexis Elward ◽  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Current Practice ◽  
Methicillin Resistant ◽  
Nicu Admission ◽  
Healthcare Epidemiology ◽  
Mrsa Colonization

We surveyed members of the Society for Healthcare Epidemiology of America to assess current practice with regard to identifying and eradicating methicillin-resistant Staphylococcus aureus (MRSA) colonization in the neonatal intensive care unit (NICU). Although most respondents (86%) screened patients for MRSA colonization, variation existed in the number of anatomic sites sampled and in the use of culture at NICU admission, empirical institution of isolation precautions, and MRSA decolonization therapy. Evidence-based prevention strategies for MRSA transmission and infection are needed.

Unexpected Term Neonatal Intensive Care Unit Admissions and a Potential Role for Centralized Remote Fetal Monitoring

2021 ◽  
Author(s):  
Jane K. Martin ◽  
Eboni G. Price-Haywood ◽  
Mariella M. Gastanaduy ◽  
Daniel G. Fort ◽  
Mary K. Ford ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Multivariable Analysis ◽  
Fetal Monitoring ◽  
Exposed Group ◽  
Univariable Analysis ◽  
Unexposed Group ◽  
Nicu Admission

Objective Centralized remote fetal monitoring (CRFM) has been proposed as a method to improve the performance of intrapartum fetal heart rate (FHR) monitoring and perinatal outcomes. The purpose of this study is to determine whether CRFM was associated with a reduction in unexpected term neonatal intensive care unit (NICU) admissions. Study Design A pre–post design was used to examine the effectiveness of CRFM which was implemented in stages across five hospitals. The exposure group was all women who underwent intrapartum monitoring via CRFM. The unexposed group was of women who delivered at the same hospitals prior to implementation of CRFM. Pregnancies with expected NICU admissions, gestational age <37 weeks, birth weight <2,500 g, or major fetal anomalies detected prenatally were excluded. The primary outcome was unexpected term NICU admission; secondary outcomes were cesarean and operative vaginal delivery (OVD), and 5-minute Apgar score of <7 rates. Maternal and delivery characteristics were examined with Student's t, Wilcoxon's, Chi-square, and Fisher's exact tests. Multivariable logistic regression was performed to control for potential confounders. Results There were 19,392 live births included in this analysis. In the univariable analysis, the odds of unexpected term NICU admission was lower among the CRFM exposed group compared with the unexposed group (odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.75–0.99; p = 0.038). In multivariable analysis, this did not reach statistical significance (OR = 0.92, 95% CI: 0.79–1.06; p = 0.24). Cesarean and OVD were less likely in the exposed group (OR = 0.91, 95% CI: 0.85–0.97; p = 0.008) and (OR = 0.70, 95% CI: 0.59–0.83, p < 0.001), respectively, in univariable analysis. When adjusted for potential confounders, the effect remained statistically significant for cesarean delivery (OR = 0.92, 95% CI: 0.85–0.98; p = 0.012). When adjusted for hospital, OVD rate was lower at the highest volume and highest acuity site (OR = 0.48, 95% CI: 0.36–0.65, p < 0.001). Conclusion In some practice settings, utilization of a CRFM system may decrease the risk of unexpected term NICU admission, cesarean, and OVD rate. Key Points

scholarly journals Incidence of Respiratory distress and its predictors among neonates admitted at neonatal intensive care unit, Black Lion Specialized Hospital, Addis Ababa, Ethiopia, 2018

2019 ◽  
Author(s):  
Yared Asmare ◽  
Hussien Mekonen ◽  
Tadesse Yirga ◽  
Tesfa Dejenie Habtewold ◽  
Aklilu Endalamaw ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Caesarean Section ◽  
Neonatal Intensive Care Unit ◽  
Respiratory Distress ◽  
Apgar Score ◽  
Neonatal Intensive Care ◽  
Addis Ababa ◽  
Specialized Hospital

AbstractBackgroundAlthough Respiratory distress is one of the major causes of neonatal morbidity and mortality throughout the globe, it is a serious concern more of in resource limited nations, like Ethiopia. Besides, few studies are available in developing countries. Data from different settings is needed to tackle it. Therefore, we intended to assess the incidence and predictors of respiratory distress among neonates who were admitted in neonatal Intensive care unit (NICU) at Black Lion Specialized Hospital, Ethiopia.MethodsInstitution-based retrospective follow-up study was conducted among 571 neonates from January 2013 to March 2018. Data were collected by reviewing patients chart using systematic sampling technique with a pretested checklist; entered using Epi-data 4.2 and analyzed with STATA 14. Median time, Kaplan-Meier survival estimation curve and Log-rank test were computed. Bivariable and multivariable Gompertz parametric hazards models were fitted to detect the determinant of respiratory distress. Hazard ratio with a 95% confidence interval was calculated. Variables with reported p-values < 0.05 were considered statistically significant.ResultsThe proportion of respiratory distress among of neonates admitted in Black Lion specialized hospital neonatal intensive care unit was 42.9 % (95%CI: 39.3-46.1%) with incidence of 8.1/100(95%CI: 7.3, 8.9)).Being male [AHR=2.4 (95%CI:1.1,3.1)], neonates born via caesarean section [AHR:1,.9((95%CI:1.6,2.3)], home delivery [AHR :2.9 (95%CI:1.5, 5,2)], maternal diabetes mellitus [AHR 2.3(95%CI: 1.4, 3.6)], preterm birth [AHR:2.9(95%CI:1.6, 5.1)] and APGAR score less than 7 [AHR: 3.1 (95%CI:1.8,5.0)] were found to be significant predictors of respiratory distress.ConclusionsThe incidence of respiratory distress among neonates was found to be high. Those neonates delivered at home, delivered through caesarean section, preterm neonates, whose APGAR score<7, and born from diabetic mothers were more likely to develop respiratory distress. All concerned bodies should work on preventing RD and give special attention for multifactorial cause of it. Thus; it is indicated to promote health institutional delivery more. Besides, a need to establish and/or strengthen strategies to prevent the occurrence of respiratory distress among babies with low APGAR score, preterm babies, born from diabetes mellitus mothers, and delivered through caesarean section.

Clinical manifestation, outcomes in pregnant women with COVID-19 and the possibility of vertical transmission: a systematic review of the current data

2020 ◽  
Vol 48 (9) ◽  
pp. 912-924
Author(s):  
Yu Han ◽  
Huijing Ma ◽  
Mingli Suo ◽  
Fang Han ◽  
Fang Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Vertical Transmission ◽  
Neonatal Intensive Care ◽  
Perinatal Outcomes ◽  
Current Data ◽  
Premature Delivery ◽  
Shortness Of Breath ◽  
Nicu Admission ◽  
Mother To Child

AbstractObjectivesTo assess perinatal outcomes of COVID-19 infections during pregnancy and the possibility of vertical transmission.MethodsAn analysis was performed using Stata 15.0, and Q-test was used to evaluate the heterogeneity of the included studies.ResultsThe most common symptoms were found to be fever (64.78%), cough (59.81%) and shortness of breath or dyspnea (23.86%). Of this 88.73% patients demonstrated typical COVID-19 signs on chest CT or X-ray. Intubation was carried out in 35.87% of patients, and 4.95% of mothers were admitted to the intensive care unit, where the rate of maternal death was <0.01% and that of premature delivery was 25.32%. The rate of the birth weight being <2,500 g was 30.65% and that of Neonatal intensive care unit (NICU) admission was 24.41%. Positive nasopharynx swabs or sputum from newborns was <0.01%.ConclusionsPregnant patients with COVID-19 most commonly presented with fever, cough, shortness of breath and dyspnea, most of which possessed imaging manifestations. The risk of intubation and admission to intensive care unit were high. The risk of premature delivery was higher, leading to a high risk of NICU admission and low neonatal birthweight. Vertical transmission of SARS-CoV-2 from mother to child was found to be unlikely.

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