Variability in Immunization Practices for Preterm Infants

2018 ◽  
Vol 35 (14) ◽  
pp. 1394-1398 ◽  
Author(s):  
Srirupa Gopal ◽  
Kathryn Edwards ◽  
Buddy Creech ◽  
Joern-Hendrik Weitkamp
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Online Survey ◽  
Vaccine Safety ◽  
The United States ◽  
Perinatal Medicine ◽  
Term Infants ◽  
American Academy Of Pediatrics ◽  
Clinical Instability ◽  
Clinical Illness

Introduction The Advisory Committee on Immunization Practices and the American Academy of Pediatrics (AAP) recommend the same immunization schedule for preterm and term infants. However, significant delays in vaccination of premature infants have been reported. Objective The objective of this study was to assess the variability of immunization practices in preterm infants. Study Design We conducted an online survey of 2,443 neonatologists in the United States, who are members of the Section for Neonatal-Perinatal Medicine of the AAP. Questions were targeted at immunization practices in the neonatal intensive care unit (NICU). Results Of the 420 responses (17%) received, 55% of providers administer the first vaccine at >2-month chronological age. Most providers (83%) surveyed reported delaying vaccines in the setting of clinical illness. Sixty percent reported increasing frequency of apnea–bradycardia events following immunization. More than half administer the initial vaccines over several days despite lack of supporting data. Reported considerations in delaying or spreading out 2-month vaccines were clinical instability, provider preference, lower gestational age, and lower birth weight. Conclusion This survey substantiates the variability of immunizations practices in the NICU and identifies reasons for this variability. Future studies should inform better practice guidance for immunization of preterm NICU patients based on vaccine safety and effectiveness.

scholarly journals Bottle-Feeding Challenges in Preterm-Born Infants in the First 7 Months of Life

2020 ◽  
Vol 7 ◽  
pp. 2333794X2095268
Author(s):  
Rebecca R. Hill ◽  
Jinhee Park ◽  
Britt F. Pados
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Online Survey ◽  
Linear Models ◽  
Assessment Tool ◽  
Bottle Feeding ◽  
Oral Feeding ◽  
Term Infants ◽  
Very Preterm Infants ◽  
Preterm Born

Preterm infants frequently experience oral feeding challenges while in the neonatal intensive care unit, with research focusing on infant feeding during this hospital stay. There is little data on symptoms of problematic feeding in preterm-born infants in the months after discharge. The purpose of this study was to describe symptoms of problematic bottle-feeding in the first 7 months of life in infants born preterm, compared to full-term infants. Parents of infants less than 7 months old completed an online survey that included the Neonatal Eating Assessment Tool—Bottle-feeding and questions about the infant’s medical and feeding history. General linear models were used to evaluate differences in NeoEAT—Bottle-feeding total score and subscale scores by preterm category, considering other significant factors. Very preterm infants had more symptoms of problematic bottle-feeding than other infants. Current age, presence of gastroesophageal reflux, and anomalies of the face/mouth were associated with problematic bottle-feeding.

scholarly journals Trends in Costs of Birth Hospitalization and Readmissions for Late Preterm Infants

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 127
Author(s):  
Rebecca R. Speer ◽  
Eric W. Schaefer ◽  
Mahoussi Aholoukpe ◽  
Douglas L. Leslie ◽  
Chintan K. Gandhi
Keyword(s):  
Preterm Infants ◽  
Private Insurance ◽  
The United States ◽  
Late Preterm ◽  
Term Infants ◽  
Late Preterm Infants ◽  
Hospitalization Costs ◽  
Analysis Of Claims Data ◽  
Mean Cost ◽  
Birth Hospitalization

Background: The objective is to study previously unexplored trends of birth hospitalization and readmission costs for late preterm infants (LPIs) in the United States between 2005 and 2016. Methods: We conducted a retrospective analysis of claims data to study healthcare costs of birth hospitalization and readmissions for LPIs compared to term infants (TIs) using a large private insurance database. We used a generalized linear regression model to study birth hospitalization and readmission costs. Results: A total of 2,123,143 infants were examined (93.2% TIs; 6.8% LPIs). The proportion of LPIs requiring readmission was 4.2% compared to 2.1% of TIs, (p < 0.001). The readmission rate for TIs decreased during the study period. LPIs had a higher mean cost of birth hospitalization (25,700 vs. 3300 USD; p < 0.001) and readmissions (25,800 vs. 14,300 USD; p < 0.001). For LPIs, birth hospitalization costs increased from 2007 to 2013, and decreased since 2014. Conversely, birth hospitalization costs of TIs steadily increased since 2005. The West region showed higher birth hospitalization costs for LPIs. Conclusions: LPIs continue to have a higher cost of birth hospitalization and readmission compared to TIs, but these costs have decreased since 2014. Standardization of birth hospitalization care for LPIs may reduce costs and improve quality of care and outcomes.

Vaccinations in Infants Born Preterm: An Update

2020 ◽  
Vol 16 (2) ◽  
pp. 148-155
Author(s):  
Areti Aphrodite Sioriki ◽  
Despoina Gkentzi ◽  
Evangelia Papadimitriou ◽  
Gabriel Dimitriou ◽  
Ageliki Karatza
Keyword(s):  
Preterm Infants ◽  
Vaccine Safety ◽  
Full Term ◽  
Morbidity And Mortality ◽  
Term Infants ◽  
Safety And Efficacy ◽  
Vaccine Preventable Diseases ◽  
Increased Risk ◽  
Protective Antibodies

Infants born prematurely (before completion of 37 weeks of gestation) are at increased risk of morbidity and mortality due to vaccine preventable diseases, mostly because of their immunological immaturity and failure of transfer of maternal protective antibodies. Despite their great need of being vaccinated, concerns on vaccine safety and efficacy, constitute the main reasons for which vaccinations are often delayed in this group. In this review we summarize the latest evidence on vaccine safety, efficacy and immunogenicity in preterm infants which is similar to full-term infants. Therefore there is no reason for delaying vaccination in this population.

119 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e85-e85
Author(s):  
Emily Fong ◽  
Ronit Mesterman
Keyword(s):  
High Risk ◽  
Preterm Infants ◽  
Average Length ◽  
Sensitive Information ◽  
Neurocognitive Deficits ◽  
Biological Father ◽  
Perinatal Medicine ◽  
Term Infants ◽  
Neurologic Recovery ◽  
High Risk Infants

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Preterm infants are at high risk of experiencing a range of impairments that may contribute to long-term challenges such as neurocognitive deficits. Physicians are often expected to give an outlook on future developmental outcomes of high-risk infants, often before sufficient time has elapsed to observe whether that particular child will demonstrate neurologic recovery from the initial injury. Clinicians often struggle with communicating this information, especially a poor prognosis, because of the worry about how these conversations affect families and their future expectations of the child. Objectives Our aim was to capture parents' retrospective perceptions of how their infant’s prognosis was communicated to them during their NICU stay. Design/Methods Semi-structured interviews were conducted over the phone with parents of former preterm infants with a birthweight below 1500 grams or parents of term infants who have sustained HIE requiring cooling. Parents were invited to participate when their child was between 12-36 months old at the time of the interview, so that parents would be able to have a sense of their child’s development and possible impairments. The data was analyzed thematically, with particular focus around the discourse of communication and prognostication. Results Twenty-three interviews were conducted: 20 with the biological mother, two with both biological parents, and one with the biological father. The average length of the interviews was 30 minutes. The main themes that recurred in the interviews included parental loss of control, needing to prepare for the unexpected, the value of shared decision making between the health care practitioners and parents, recognition and conveyance of uncertainty by the physician, and the importance of celebrating the present. Above all, a recurring theme mentioned by the majority of interviewees was the power of hope. While wanting to receive transparent and honest updates, parents felt strongly that giving them realistic hope was of utmost importance. Conclusion Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.

scholarly journals New charts for the assessment of body composition, according to air-displacement plethysmography, at birth and across the first 6 mo of life

2019 ◽  
Vol 109 (5) ◽  
pp. 1353-1360 ◽  
Author(s):  
Tom Norris ◽  
Sara E Ramel ◽  
Patrick Catalano ◽  
Carol ni Caoimh ◽  
Paola Roggero ◽  
...  
Keyword(s):  
United States ◽  
Body Composition ◽  
Preterm Infants ◽  
Fat Mass ◽  
Gestational Age ◽  
The United States ◽  
Fat Free Mass ◽  
Term Infants ◽  
Air Displacement Plethysmography ◽  
Young Infants

ABSTRACT Background Air-displacement plethysmography (ADP) is a good candidate for monitoring body composition in newborns and young infants, but reference centile curves are lacking that allow for assessment at birth and across the first 6 mo of life. Objective Using pooled data from 4 studies, we aimed to produce new charts for assessment according to gestational age at birth (30 + 1 to 41 + 6 wk) and postnatal age at measurement (1–27 wk). Methods The sample comprised 222 preterm infants born in the United States who were measured at birth; 1029 term infants born in Ireland who were measured at birth; and 149 term infants born in the United States and 57 term infants born in Italy who were measured at birth, 1 and 2 wk, and 1, 2, 3, 4, 5, and 6 mo of age. Infants whose birth weights were <3rd or >97th centile of the INTERGROWTH-21st standard were excluded, thereby ensuring that the charts depict body composition of infants whose birth weights did not indicate suboptimal fetal growth. Sex-specific centiles for fat mass (kg), fat-free mass (kg), and percentage body fat were estimated using the lambda-mu-sigma (LMS) method. Results For each sex and measure (e.g., fat mass), the new charts comprised 2 panels. The first showed centiles according to gestational age, allowing term infants to be assessed at birth and preterm infants to be monitored until they reached term. The second showed centiles according to postnatal age, allowing all infants to be monitored to age 27 wk. The LMS values underlying the charts were presented, enabling researchers and clinicians to convert measurements to centiles and z scores. Conclusions The new charts provide a single tool for the assessment of body composition, according to ADP, in infants across the first 6 mo of life and will help enhance early-life nutritional management.

scholarly journals Platelets in the neonatal period: developmental differences in platelet production, function, and hemostasis and the potential impact of therapies

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 506-511 ◽  
Author(s):  
Martha Sola-Visner
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Developmental Differences ◽  
Full Term ◽  
Term Infants ◽  
Platelet Production ◽  
Primary Hemostasis ◽  
Wall Interaction ◽  
And Function

Abstract Thrombocytopenia is a common problem among sick neonates admitted to the neonatal intensive care unit. Frequently, platelet transfusions are given to thrombocytopenic infants in an attempt to decrease the incidence or severity of hemorrhage, which is often intracranial. Whereas there is very limited evidence to guide platelet transfusion practices in this population, preterm infants in the first week of life (the highest risk period for bleeding) are nearly universally transfused at higher platelet counts than older infants or children. To a large extent, this practice has been influenced by the observation that neonatal platelets are hyporeactive in response to multiple agonists in vitro, although full-term infants exhibit normal to increased primary hemostasis. This apparently paradoxical finding is due to factors in the neonatal blood that enhance the platelet-vessel wall interaction and counteract the platelet hyporeactivity. Relatively few studies have evaluated the platelet function and primary hemostasis of preterm infants, the subset of neonates at highest risk of bleeding and those most frequently transfused. Current understanding of platelet production and function in preterm and full-term neonates, how these factors affect their response to thrombocytopenia and their primary hemostasis, and the implications of these developmental differences to transfusion medicine are reviewed herein.

scholarly journals Update from the Advisory Committee on Immunization Practices

2020 ◽  
Vol 9 (1) ◽  
pp. 3-5
Author(s):  
Sean T O’Leary ◽  
Yvonne A Maldonado ◽  
David W Kimberlin
Keyword(s):  
Advisory Committee ◽  
Safety Data ◽  
Vaccine Safety ◽  
The United States ◽  
Vaccine Research ◽  
Vaccine Preventable Diseases ◽  
American Academy Of Pediatrics ◽  
Control And Prevention ◽  
Adult Immunization ◽  
Health Experts

Abstract The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. There are usually 15 voting members; members’ terms are for 4 years. ACIP members and Centers for Disease Control and Prevention staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and results from clinical trials. Representatives from the American Academy of Pediatrics (Y. A. M., D. W. K.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met on 23–24 October 2019 to discuss pertussis vaccines, the child/adolescent and adult immunization schedule, influenza vaccine effectiveness and safety, Ebola vaccine, orthopoxvirus vaccines, Dengue vaccine, rabies vaccine, measles, and vaccine safety update.

scholarly journals Respiratory Syncytial Virus Hospitalizations among U.S. Preterm Infants Compared with Term Infants Before and After the 2014 American Academy of Pediatrics Guidance on Immunoprophylaxis: 2012–2016

2018 ◽  
Vol 35 (14) ◽  
pp. 1433-1442 ◽  
Author(s):  
Mitchell Goldstein ◽  
Leonard Krilov ◽  
Jaime Fergie ◽  
Kimmie McLaurin ◽  
Sally Wade ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
American Academy ◽  
Preterm Infants ◽  
Term Infants ◽  
American Academy Of Pediatrics ◽  
Before And After ◽  
Syncytial Virus ◽  
Using Data ◽  
Rate Ratios ◽  
Calculated Difference

Objective The objective of this study was to compare risk for respiratory syncytial virus (RSV) hospitalizations (RSVH) for preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after 2014 guidance changes for immunoprophylaxis (IP), using data from the 2012 to 2016 RSV seasons. Study Design Using commercial and Medicaid claims databases, infants born between July 1, 2011 and June 30, 2016 were categorized as preterm or term. RSVH during the RSV season (November–March) were identified for infants aged <6 months and rate ratios (RRs) for hospitalization comparing preterm and term infants were calculated. Difference-in-difference models were fit to evaluate the changes in hospitalization risks in preterm versus term infants from 2012 to 2014 seasons to 2014 to 2016 seasons. Results In all seasons, preterm infants had higher RSVH rates than term infants. Seasonal RRs prior to the guidance change for preterm wGA categories versus term infants ranged from 1.6 to 3.4. After the guidance change, the seasonal RRs ranged from 2.6 to 5.6. In 2014 to 2016, the risk associated with prematurity of 29 to 34 wGA versus term was significantly higher than in 2012 to 2014 (P<0.0001 for commercial and Medicaid samples). Conclusion In infants aged <6 months, the risk for RSVH for infants 29 to 34 wGA compared with term infants increased significantly after the RSV IP recommendations became more restrictive.

scholarly journals Maternal experiences with specificities of prematurity that hinder breastfeeding

2015 ◽  
Vol 24 (1) ◽  
pp. 55-63 ◽  
Author(s):  
Luciana Barbosa Pereira ◽  
Ana Cristina Freitas de Vilhena Abrão ◽  
Conceição Vieira da Silva Ohara ◽  
Circéa Amália Ribeiro
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Clinical Instability ◽  
Mothers Of Preterm Infants ◽  
Late Start

A qualitative study which has Symbolic Interactionism as theoretical framework and Interpretative Interactionism as its methodological one, aiming to unveil motherly experiences against prematurity peculiarities that hinder breastfeeding during infant's hospitalization at the Neonatal Intensive Care Unit. Were interviewed 13 mothers of preterm infants assisted at an Outpatient Follow-up Clinic of Montes Claros MG, Brazil. Results show that as trying to breastfeed a premature infant, the mother interacts with situations signified by her as obstacles to breastfeeding: the "torment" of their child's hospitalization and clinical instability, the fear of baby's death, its difficulty to suck, the late start of breastfeeding interpreted a something difficult, as a risk to weight. We consider that although breastfeeding a preterm infant is a challenge, appropriate professional conducts and hospital procedures might facilitate it and therefore should be implemented, aiming at promoting, protecting and supporting breastfeeding.

scholarly journals Cost-benefit analysis of VKA versus NOAC treatment in German patients with atrial fibrillation utilizing patient self-testing

10.36469/9774 ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. 142-159
Author(s):  
Roland Diel ◽  
Niklas Lampenius
Keyword(s):  
Neonatal Intensive Care ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
The United States ◽  
Inpatient Setting ◽  
Index Hospitalization ◽  
Related Factors ◽  
Term Infants ◽  
Near Term ◽  
New Treatments

Objectives: This study quantified the burden of hypoxic respiratory failure (HRF)/persistent pulmonary hypertension of newborn (PPHN) in preterm and term/near-term infants (T/NTs) by examining health care resource utilization (HRU) and charges in the United States. Methods: Preterms and T/NTs (≤34 and >34 weeks of gestation, respectively) having HRF/PPHN, with/without meconium aspiration in inpatient setting from January 1, 2011-October 31, 2015 were identified from the Vizient database (first hospitalization=index hospitalization). Comorbidities, treatments, HRU, and charges during index hospitalization were evaluated among preterms and T/NTs with HRF/PPHN. Logistic regression was performed to evaluate mortality-related factors. Results: This retrospective study included 504 preterms and 414 T/NTs with HRF/PPHN. Preterms were more likely to have respiratory distress syndrome, neonatal jaundice, and anemia of prematurity than T/NTs. Preterms had significantly longer inpatient stays (54.1 vs 29.0 days), time in a neonatal intensive care unit (34.1 vs 17.5 days), time on ventilation (4.7 vs 2.2 days), and higher total hospitalization charges ($613,350 vs $422,558) (all P<0.001). Similar rates were observed for use of antibiotics (96.2% vs 95.4%), sildenafil (9.5% vs 8.2%), or inhaled nitric oxide (93.8% vs 94.2%). Preterms had a significantly higher likelihood of mortality than T/NTs (odds ratio: 3.6, 95% confidence interval: 2.3-5.0). Conclusions: The findings of more severe comorbidities, higher HRU, hospitalization charges, and mortality in preterms than in T/NTs underscore the significant clinical and economic burden of HRF/PPHN among infants. The results show significant unmet medical need; further research is warranted to determine new treatments and real-world evidence for improved patient outcomes.

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