Quantifying Medication Exposure in Very Low Birth Weight Neonates

2019 ◽  
Author(s):  
Natalie L. Davis ◽  
Temitope O. Akinmboni ◽  
Sandra M. Mooney
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Medication Use ◽  
Length Of Hospital Stay ◽  
Vlbw Infants ◽  
Medication Exposure ◽  
Male Sex ◽  
Record Review

Abstract Objective Very low birth weight (VLBW) infants are exposed to medications with insufficient evidence describing pharmacokinetics and safety. Objective was to quantify and identify risk factors associated with the highest quartile of medication exposure. Study Design Retrospective record review of VLBW infants admitted to a level-IV neonatal intensive care unit (NICU). We obtained baseline clinical and demographic characteristics, as well as data on all medications received during admission. Characteristics of patients within the upper quartile of medication use were compared with remaining patients. Results Identified 106 infants, mean birth weight (BW) = 961 g, gestational age = 27.3 weeks. Infants received a median = 20 medications (range, 4–72). Those in the top quartile of medication use received ≥30 medications while in the NICU and had higher odds of being male sex, lower BW, longer length of hospital stay (LOHS), and bronchopulmonary dysplasia. Sepsis did not affect medication exposure. Antibiotics, opiates, and reflux medications were among the top prescribed. Conclusion Infants are exposed to a large number of medications during NICU hospitalization, including potentially unnecessary antibiotics and reflux medications. Male sex, the presence of certain comorbidities such as necrotizing enterocolitis, and LOHS, are associated with higher exposure. Increased awareness of this issue may assist in decreasing medication exposure in VLBW populations.

scholarly journals Sex-Specific Long-Term Trends in Length of Hospital Stay, Postmenstrual Age at Discharge, and Survival in Very Low Birth Weight Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Matthias Fröhlich ◽  
Tatjana Tissen-Diabaté ◽  
Christoph Bührer ◽  
Stephanie Roll
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Hospital Stay ◽  
Very Low Birth Weight ◽  
Survival Rates ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Vlbw Infants ◽  
Postmenstrual Age ◽  
Over Time

<b><i>Introduction:</i></b> In very low birth weight (&#x3c;1,500 g, VLBW) infants, morbidity and mortality have decreased substantially during the past decades, and both are known to be lower in girls than in boys. In this study, we assessed sex-specific changes over time in length of hospital stay (LOHS) and postmenstrual age at discharge (PAD), in addition to survival in VLBW infants. <b><i>Methods:</i></b> This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. <b><i>Results:</i></b> In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978–1982 and 1993–1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978–1982 vs. 2013–2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). <b><i>Discussion/Conclusions:</i></b> LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.

Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage

2021 ◽  
Author(s):  
Santina A. Zanelli ◽  
Maryam Abubakar ◽  
Robert Andris ◽  
Kavita Patwardhan ◽  
Karen D. Fairchild ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Vital Sign ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Cranial Ultrasound ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Arterial Blood

Objective Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH. Study Design This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight <1.5 kg and gestational age (GA) <32 weeks, at least 12 hours of systemic oxygen saturation from pulse oximetry (SpO2) data over the first 24 hours and cUS imaging. Infants were categorized as early sIVH (sIVH identified in the first 48 hours), late sIVH (sIVH identified after 48 hours and normal imaging in the first 48 hours), and no IVH. Infants with grades 1 and 2 or unknown timing IVH were excluded. Mean heart rate (HR), SpO2, mean arterial blood pressure (MABP), number of episodes of bradycardia (HR < 100 bpm), and desaturation (SpO2 < 80%) were compared. Results A total of 639 infants (mean: 27 weeks' gestation) were included (567 no IVH, 34 early sIVH, and 37 late sIVH). In the first 48 hours, those with sIVH had significantly higher HR compared with those with no IVH. Infants with sIVH also had lower mean SpO2 and MABP and more desaturations <80%. No significant differences in VS patterns were identified in early versus late sIVH. Logistic regression identified higher HR and greater number of desaturations <80% as independently associated with sIVH. Conclusion VLBW infants who develop sIVH demonstrate VS differences with significantly lower SpO2 and higher mean HR over the first 48 hours after birth compared with VLBW infants with no IVH. Abnormalities in early VS patterns may be a useful biomarker for sIVH. Whether VS abnormalities predict or simply reflect sIVH remains to be determined. Key Points

Fathers' Visitation of Very Low Birth Weight Infants in the Neonatal Intensive Care Unit during the First Week of Life

2020 ◽  
Author(s):  
Khushbu Patel ◽  
Lindsay Cortright ◽  
Dmitry Tumin ◽  
John A. Kohler
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Preterm Neonates ◽  
Vlbw Infants ◽  
Extremely Preterm

Abstract Background The perceived fragility of extremely preterm neonates may deter paternal visitation early during the neonatal intensive care unit (NICU) stay. We retrospectively analyzed the correlation between paternal visitation of very low birth weight (VLBW) infants in our NICU and sociodemographic characteristics. Study Design We identified inborn VLBW infants admitted to our NICU from 2017 to 2018. The rate of visit days in the first week of life was analyzed using Spearman's correlation and Poisson's regression. Results The analysis included 292 infants (median gestational age [GA]: 29 weeks), with fathers present on a median of 3 days of the first week of life. GA was not correlated with visitation (rho = –0.04). On multivariable regression, fathers visited less frequently if they did not live with the mother or if the mother lived 25 to 75 km from the hospital versus < 25 km. Conclusion Fathers' visitation in our NICU was constrained by socioeconomic factors rather than VLBW infants' characteristics.

scholarly journals Cytomegalovirus Infection among Infants in Neonatal Intensive Care Units, California, 2005 to 2016

2019 ◽  
Vol 37 (02) ◽  
pp. 146-150
Author(s):  
Chinh Tran ◽  
Mihoko V. Bennett ◽  
Jeffrey B. Gould ◽  
Henry C. Lee ◽  
Tatiana M. Lanzieri
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Hospital Stay ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Length Of Hospital Stay ◽  
Neonatal Intensive Care Units ◽  
Cmv Infection ◽  
Vlbw Infants

Aim The main purpose of this article is to assess trends in cytomegalovirus (CMV) infection reported among infants in California neonatal intensive care units (NICUs) during 2005 to 2016. Study Design The California Perinatal Quality Care Collaborative collects data on all very low birth weight (VLBW, birth weight ≤ 1,500 g) and acutely ill infants > 1,500 g, representing 92% of NICUs in California. We compared clinical characteristics and length of hospital stay among infants with and without reported CMV infection (CMV-positive viral culture or polymerase chain reaction). Results During 2005 to 2016, CMV infection was reported in 174 VLBW infants and 145 infants > 1,500 g, or 2.7 (range: 1.5–4.7) and 1.2 (range: 0.8–1.7) per 1,000 infants, respectively (no significant annual trend). Among infants > 1,500 g, 12 (8%) versus 4,928 (4%) of those reported with versus without CMV infection died (p < 0.05). The median hospital stay was significantly longer among infants reported with versus without CMV infection for both VLBW infants (98 vs. 46 days) and infants > 1,500 g (61 vs. 14 days) (p < 0.001). Conclusion Reports of CMV infection remained stable over a 12-year period. Although we were not able to assess whether infection was congenital or postnatal, CMV infection among infants > 1,500 g was associated with increased mortality.

scholarly journals Teamwork in the NICU Setting and Its Association with Health Care–Associated Infections in Very Low-Birth-Weight Infants

2017 ◽  
Vol 34 (10) ◽  
pp. 1032-1040 ◽  
Author(s):  
Paul Sharek ◽  
Peiyi Kan ◽  
Joseph Rigdon ◽  
Manisha Desai ◽  
Courtney Nisbet ◽  
...  
Keyword(s):  
Health Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Clinical Care ◽  
Random Effect ◽  
Low Birth Weight Infants ◽  
Cross Sectional ◽  
Vlbw Infants

Background and Objective Teamwork may affect clinical care in the neonatal intensive care unit (NICU) setting. The objective of this study was to assess teamwork climate across NICUs and to test scale-level and item-level associations with health care–associated infection (HAI) rates in very low-birth-weight (VLBW) infants. Methods Cross-sectional study of the association between HAI rates, defined as any bacterial or fungal infection during the birth hospitalization, among 6,663 VLBW infants cared for in 44 NICUs between 2010 and 2012. NICU HAI rates were correlated with teamwork climate ratings obtained in 2011 from 2,073 of 3,294 eligible NICU health professionals (response rate 63%). The relation between HAI rates and NICU teamwork climate was assessed using logistic regression models including NICU as a random effect. Results Across NICUs, 36 to 100% (mean 66%) of respondents reported good teamwork. HAI rates were significantly and independently associated with teamwork climate (odds ratio, 0.82; 95% confidence interval, 0.73–0.92, p = 0.005), such that the odds of an infant contracting a HAI decreased by 18% with each 10% rise in NICU respondents reporting good teamwork. Conclusion Improving teamwork may be an important element in infection control efforts.

scholarly journals IHI ID 06 Improved growth of very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU)

2018 ◽  
Author(s):  
Michelande Ridore ◽  
Caitlin Forsythe ◽  
Victoria Catalano ◽  
Rebecca Vander Veer ◽  
Erin Fauer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Vlbw Infants

scholarly journals The Evidence Base for the Cues Program for Mothers of Very Low Birth Weight Infants: An Innovative Approach to Reduce Anxiety and Support Sensitive Interaction

2011 ◽  
Vol 20 (3) ◽  
pp. 142-153 ◽  
Author(s):  
Nancy Feeley ◽  
Phyllis Zelkowitz ◽  
Ruta Westreich ◽  
David Dunkley
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Intervention Program ◽  
Very Low Birth Weight ◽  
Evidence Base ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Developmental Problems ◽  
Program Content

Very low birth weight (VLBW) infants, born weighing less than 1,500 g, are at risk for several developmental problems. Consequently, there has been interest in developing intervention programs to prevent such problems. This article describes the empirical evidence that guided the development of an innovative, multicomponent intervention program for mothers of VLBW infants, as well as the program content and features. Based on the evidence, the program was designed to include six sessions and commence shortly after birth to reduce maternal psychological distress during the infant’s hospitalization in the neonatal intensive care unit and to promote sensitive mother–infant interaction. The program incorporates various learning activities, including written materials, observational exercises, discussion, and video feedback.

Reduced Formula Intake with Donor Milk (DM) Impacts Necrotizing Enterocolitis (NEC) in Very Low Birth Weight (VLBW) Infants:

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 443A-443A
Author(s):  
Jennifer S. Wicks ◽  
Anita L. Esquerra-Zwiers ◽  
Laura M. Rogers ◽  
Celina M. Scala ◽  
Shirley Chen ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Very Low Birth Weight ◽  
Donor Milk ◽  
Vlbw Infants
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