scholarly journals Impact of Extending the Timing of Maternal Pertussis Vaccination on Hospitalized Infant Pertussis in England, 2014–2018

2020 ◽  
Author(s):  
Elise Tessier ◽  
Helen Campbell ◽  
Sonia Ribeiro ◽  
Norman K Fry ◽  
Colin Brown ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Policy Change ◽  
Vaccine Coverage ◽  
Length Of Hospital Stay ◽  
Term Infants ◽  
Hospital Stays ◽  
Clinical Records ◽  
The Impact ◽  
Median Hospital ◽  
Optimal Window

Abstract Background In October 2012, a maternal pertussis vaccination program was introduced in England for women between 28 and 32 weeks of pregnancy. In April 2016, the recommended optimal window was extended to 20–32 weeks to improve vaccine coverage and protect preterm infants. This study assesses the impact of offering maternal pertussis vaccination earlier in pregnancy on hospitalized infant pertussis cases. Methods Hospitalized pertussis cases ≤60 days old in England were extracted from Hospital Episode Statistics pre- and post-policy change. Data were linked to laboratory-confirmed cases, and clinical records were reviewed where cases were not matched. Maternal vaccine status of identified cases was established. Median hospital duration was calculated, and a competing risk survival analysis was undertaken to assess multiple factors. Results A total of 201 cases were included in the analysis. Of the 151 cases with reported gestational age, the number of hospitalizations among full-term infants was 60 cases pre-policy and 62 cases post-policy, respectively, while preterm cases declined from 20 to 9 (P = .06). Length of hospital stay did not differ significantly after the policy change. Significantly longer hospital stays were seen in cases aged 0–4 weeks (median of 3 more days than infants aged 5–8 weeks), premature infants (median of 4 more days than term infants), and cases with coinfections (median of 1 more day than those without coinfection). Conclusions The number of preterm infants hospitalized with pertussis in England was halved after the policy change and preterm infants were no longer overrepresented among hospitalized cases.

scholarly journals Management of superficial and deep surgical site infection: an international multidisciplinary consensus

2021 ◽  
Author(s):  
Gabriele Sganga ◽  
Mohamed Baguneid ◽  
Pascal Dohmen ◽  
Evangelos J. Giamarellos-Bourboulis ◽  
Emilio Romanini ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Early Discharge ◽  
Multidrug Resistant ◽  
Steering Committee ◽  
Resistant Bacteria ◽  
Modified Delphi ◽  
Hospital Stays ◽  
New Treatment ◽  
The Impact

AbstractSurgical site infections represent a considerable burden for healthcare systems. To obtain a consensus on the impact and future clinical and economic needs regarding SSI management in an era of multidrug resistance. A modified Delphi method was used to obtain consensus among experts from five European countries. The Delphi questionnaire was assembled by a steering committee, verified by a panel of experts and administered to 90 experts in 8 different surgical specialities (Abdominal, Cancer, Cardiac, General surgery, Orthopaedic, Thoracic, Transplant and Vascular and three other specialities (infectious disease, internal medicine microbiology). Respondents (n = 52) reached consensus on 62/73 items including that resistant pathogens are an increasing matter of concern and increase both treatment complexity and the length of hospital stay. There was strong positive consensus on the cost-effectiveness of early discharge (ED) programs, improvement of quality of life with ED and association between increased length of stay and economic burden to the hospital. However, established ED protocols were not widely available in their hospitals. Respondents expressed a positive consensus on the usefulness of antibiotics that allow ED. Surgeons are aware of their responsibility in an interdisciplinary team for the treatment of SSI, and of the impact of multidrug-resistant bacteria in the context of SSI. Reducing the length of hospital stays by applying ED protocols and implementing new treatment alternatives is crucial to reduce harm to patients and costs for the hospital.

Increasing Rates of RSV Hospitalization among Preterm Infants: A Decade of Data

2021 ◽  
Author(s):  
Amanda M. Kong ◽  
Isabelle H. Winer ◽  
Nicole M. Zimmerman ◽  
David Diakun ◽  
Adam Bloomfield ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Policy Change ◽  
Relative Rate ◽  
Medical Conditions ◽  
Term Infants ◽  
Convenience Sample ◽  
Hospitalization Rates ◽  
Observational Cohort ◽  
Syncytial Virus ◽  
Rate Ratios

Objective In 2014, the American Academy of Pediatrics (AAP) changed its policy on the use of respiratory syncytial virus immunoprophylaxis (RSV-IP) so that RSV-IP was no longer recommended for use among infants without other medical conditions born >29 weeks gestational age (wGA). This study examines 10-year trends in RSV-IP and RSV hospitalizations among term infants and preterm infants born at 29 to 34 wGA, including the 5 RSV seasons before and 5 RSV seasons after the AAP guidance change. Study Design A retrospective observational cohort study of a convenience sample of infants less than 6 months of age during RSV season (November–March) born between July 1, 2008, and June 30, 2019, who were born at 29 to 34 wGA (preterm) or >37 wGA (term) in the IBM MarketScan Commercial and Multi-State Medicaid databases. We excluded infants with medical conditions that would independently qualify them for RSV-IP. We identified RSV-IP utilization along with RSV and all-cause bronchiolitis hospitalizations during each RSV season. A difference-in-difference model was used to determine if there was a significant change in the relative rate of RSV hospitalizations following the 2014 policy change. Results There were 53,535 commercially insured and 85,099 Medicaid-insured qualifying preterm infants and 1,111,670 commercially insured and 1,492,943 Medicaid-insured qualifying term infants. Following the 2014 policy change, RSV-IP utilization decreased for all infants, while hospitalization rates tended to increase for preterm infants. Rate ratios comparing preterm to term infants also increased. The relative rate for RSV hospitalization for infants born at 29 to 34 wGA increased significantly for both commercially and Medicaid-insured infants (1.95, 95% CI: 1.67–2.27, p <0.001; 1.70, 95% CI: 1.55–1.86, p <0.001, respectively). Findings were similar for all-cause bronchiolitis hospitalizations. Conclusion We found that the previously identified increase in RSV hospitalization rates among infants born at 29 to 34 wGA persisted for at least 5 years following the policy change. Key Points

scholarly journals Impact of physiotherapy on neuromotor development of premature newborns

2014 ◽  
Vol 27 (3) ◽  
pp. 413-420 ◽  
Author(s):  
Giselle Athayde Xavier Coutinho ◽  
Daniela de Mattos Lemos ◽  
Antônio Prates Caldeira
Keyword(s):  
Preterm Infants ◽  
Motor Development ◽  
Perinatal Care ◽  
Monitoring Program ◽  
Full Term ◽  
Control Group ◽  
Term Infants ◽  
Significance Level ◽  
The Impact ◽  
Neuromotor Development

Introduction The population of children born prematurely has increased in line with improving the quality of perinatal care. It is essential to ensure to these children a healthy development. Objective We evaluate the neuromotor development of a group of preterm infants regularly assisted by a physiotherapy service in comparison to full-term newborns, checking, so the impact of the service. Materials and methods We randomly assigned preterm and full-term infants that formed two distinct groups. The group of preterm infants was inserted into a monitoring program of physiotherapy while the other infants were taken as a control group not receiving any assistance in physiotherapy. The groups were compared using the Alberta Infant Motor Scale (AIMS) at forty-week, four and six months of corrected gestational age and the scores were compared using Student's t-test, assuming a significance level of 5% (p < 0.05). Results The preterm group had significantly lower scores at 40th week compared to the control group, but subsequent scores showed no significant differences between the two groups. Conclusion The timely and adequate stimulation was efficient to promote the motor development of premature infants included in a follow up clinic.

scholarly journals Impact of Rotavirus Vaccine on Premature Infants

2014 ◽  
Vol 21 (10) ◽  
pp. 1404-1409 ◽  
Author(s):  
Jean-Michel Roué ◽  
Emmanuel Nowak ◽  
Grégoire Le Gal ◽  
Thomas Lemaitre ◽  
Emmanuel Oger ◽  
...  
Keyword(s):  
Premature Infants ◽  
Vaccine Coverage ◽  
Vaccination Campaign ◽  
University Hospital ◽  
Vaccination Program ◽  
National Study ◽  
Rotavirus Vaccine ◽  
Term Infants ◽  
Rotavirus Diarrhea ◽  
The Impact

ABSTRACTInfants born preterm are at a higher risk of complications and hospitalization in cases of rotavirus diarrhea than children born at term. We evaluated the impact of a rotavirus vaccination campaign (May 2007 to May 2010) on hospitalizations for rotavirus gastroenteritis in a population of children under 3 years old born prematurely (before 37 weeks of gestation) in the Brest University Hospital birth zone. Active surveillance from 2002 to 2006 and a prospective collection of hospitalizations for rotavirus diarrhea were initiated in the pediatric units of Brest University Hospital until May 2010. Numbers of hospitalizations for rotavirus diarrhea among the population of children born prematurely, before and after the start of the vaccination program, were compared using a Poisson regression model controlling for epidemic-to-epidemic variation. A total of 217 premature infants were vaccinated from 2007 to 2010. Vaccine coverage for a complete course of three doses was 41.9%. The vaccine safety in premature infants was similar to that in term infants. The vaccination program led to a division by a factor of 2.6 (95% confidence interval [CI], 1.3 to 5.2) in the number of hospitalizations for rotavirus diarrhea during the first two epidemic seasons following vaccine introduction and by a factor of 11 (95% CI, 3.5 to 34.8) during the third season. We observed significant effectiveness of the pentavalent rotavirus vaccine on the number of hospitalizations in a population of prematurely born infants younger than 3 years of age. A multicenter national study would provide better assessment of this impact. (This study [Impact of Systematic Infants Vaccination Against Rotavirus on Gastroenteritis Hospitalization: a Prospective Study in Brest District, France (IVANHOE)] has been registered at ClinicalTrials.gov under registration no. NCT00740935.)

scholarly journals Impact of Carbon Dioxide on Cerebral Oxygenation and Vital Parameters in Stable Preterm and Term Infants Immediately after Birth

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Christina Helene Wolfsberger ◽  
Marlies Bruckner ◽  
Bernhard Schwaberger ◽  
Lukas Peter Mileder ◽  
Berndt Urlesberger ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Gestational Age ◽  
Oxygen Extraction ◽  
Arterial Oxygen ◽  
Secondary Outcome ◽  
Tissue Oxygen ◽  
Term Infants ◽  
The Impact

<b><i>Introduction:</i></b> Carbon dioxide (pCO<sub>2</sub>) induces changes in the tone of cerebral vessels. The aim of the present study was to evaluate the impact of pCO<sub>2</sub> on cerebral regional tissue oxygen saturation (crSO<sub>2</sub>), cerebral fractional tissue oxygen extraction (cFTOE), and cerebral tissue oxygen extraction (cTOE), measured with near-infrared spectroscopy (NIRS), in preterm and term infants 15 min after birth. <b><i>Methods:</i></b> Post hoc analyses of secondary outcome parameters of prospective observational studies were performed. Stable preterm and term infants with cerebral NIRS monitoring (INVOS 5100C) until minute 15 after birth and a blood gas analysis, performed between minutes 14–18 after birth, were included. Heart rate (HR) and arterial oxygen saturation (SpO<sub>2</sub>) were recorded. pCO<sub>2</sub> was correlated with crSO<sub>2</sub>, cFTOE, cTOE, SpO<sub>2</sub>, HR, and partial pressure of oxygen (pO<sub>2</sub>). <b><i>Results:</i></b> Eleven preterm infants with a median (IQR) gestational age of 34.8 (32.7–36.1) weeks were analyzed. Mean ± SD pCO<sub>2</sub> was 53.5 ± 4.2 mm Hg. At minute 15 after birth, crSO<sub>2</sub> was 82.6 (74.3–91.3)%, cFTOE 0.15 ± 0.09, cTOE 14.6 ± 8.4%, SpO<sub>2</sub> 97.4 ± 2.1%, and HR 152 (136–167) bpm. pCO<sub>2</sub> correlated negatively with crSO<sub>2</sub> (<i>p</i> = 0.012) and positively with cFTOE (<i>p</i> = 0.035) and cTOE (<i>p</i> = 0.037). Eighty-four term infants with a gestational age of 39.0 (38.5–38.9) weeks were analyzed. pCO<sub>2</sub> was 53.5 ± 6.3 mm Hg. At minute 15 after birth, crSO<sub>2</sub> was 84.4 (80.8–85.1)%, cFTOE 0.14 ± 0.08, cTOE 13.6 ± 7.9%, SpO<sub>2</sub> 96.5 ± 2.6%, and HR 155 (153–163) bpm. pCO<sub>2</sub> did only negatively correlate with pO<sub>2</sub> (<i>p</i> = 0.034) in term infants. <b><i>Conclusion:</i></b> In preterm infants, higher pCO<sub>2</sub> was associated with lower crSO<sub>2</sub> and higher cFTOE/cTOE. In term infants, no associations were observed. The present findings suggest that the vasodilatative effect of pCO<sub>2</sub> is less pronounced in preterm infants during immediate postnatal transition.

scholarly journals Preterm birth alters the maturation of the GABAergic system in the human prefrontal cortex

2021 ◽  
Author(s):  
Helene Lacaille ◽  
Claire-Marie Vacher ◽  
Anna A Penn
Keyword(s):  
Prefrontal Cortex ◽  
Preterm Infants ◽  
Gene List ◽  
Gabaergic System ◽  
Developmental Changes ◽  
Term Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Maturation Index ◽  
The Impact

Developmental changes in GABAergic and glutamatergic systems during frontal lobe development have been hypothesized to play a key role in neurodevelopmental disorders seen in children born very preterm or low birth weight, but the associated cellular changes have not yet been identified. Here we studied the molecular development of the GABAergic system specifically in the dorsolateral prefrontal cortex, a region that that has been implicated in neurodevelopmental and psychiatric disorders. The maturation state of the GABAergic system in this region was assessed in human post-mortem brain samples, from term infants ranging in age from 0 to 8 months (n=17 male, 9 female). Gene expression was measured for 47 GABAergic genes and used to calculate a maturation index. This maturation index was significantly more dynamic in male than female infants. To evaluate the impact of premature birth on the GABAergic system development, samples from one-month-old term (n=9 male, 4 female) and one-month corrected-age (n=8 male, 6 female) very preterm infants, were compared using the same gene list and methodology. The maturation index for the GABAergic system was significantly lower in male preterm infants, with major alterations in genes linked to GABAergic function in astrocytes, suggesting astrocytic GABAergic developmental changes as a new cellular mechanism underlying preterm brain injury.

Neural Correlates of Voice Perception in Newborns and the Influence of Preterm Birth

2020 ◽  
Vol 30 (11) ◽  
pp. 5717-5730 ◽  
Author(s):  
Alexandra Adam-Darque ◽  
Marie P Pittet ◽  
Frédéric Grouiller ◽  
Tonia A Rihs ◽  
Russia Ha-Vinh Leuchter ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Full Term ◽  
Oddball Paradigm ◽  
Memory Representation ◽  
Term Infants ◽  
Voice Perception ◽  
Term Newborns ◽  
Maternal Voice ◽  
The Impact ◽  
Voice Processing

Abstract Maternal voice is a highly relevant stimulus for newborns. Adult voice processing occurs in specific brain regions. Voice-specific brain areas in newborns and the relevance of an early vocal exposure on these networks have not been defined. This study investigates voice perception in newborns and the impact of prematurity on the cerebral processes. Functional magnetic resonance imaging (fMRI) and high-density electroencephalography (EEG) were used to explore the brain responses to maternal and stranger female voices in full-term newborns and preterm infants at term-equivalent age (TEA). fMRI results and the EEG oddball paradigm showed enhanced processing for voices in preterms at TEA than in full-term infants. Preterm infants showed additional cortical regions involved in voice processing in fMRI and a late mismatch response for maternal voice, considered as a first trace of a recognition process based on memory representation. Full-term newborns showed increased cerebral activity to the stranger voice. Results from fMRI, oddball, and standard auditory EEG paradigms highlighted important change detection responses to novelty after birth. These findings suggest that the main components of the adult voice-processing networks emerge early in development. Moreover, an early postnatal exposure to voices in premature infants might enhance their capacity to process voices.

scholarly journals 2638. Respiratory Syncitial Virus Hospitalizations (RSVH) and All-Cause Bronchiolitis Hospitalizations (BH) Among 29–34 Weeks Gestational Age (wGA) Preterm Infants Before and After the 2014 American Academy of Pediatrics (AAP) Immunoprophylaxis Policy Change Using the Children’s Hospital Association’s Pediatric Health Information System (PHIS)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S922-S922
Author(s):  
Jaime Fergie ◽  
Tara Gonzales ◽  
Xiaohui Jiang ◽  
Jon Fryzek
Keyword(s):  
Preterm Infants ◽  
Policy Change ◽  
Gestational Age ◽  
Health Information System ◽  
Admission Rate ◽  
Term Infants ◽  
Time Period ◽  
Wilcoxon Rank Sum Test ◽  
Co Morbidity ◽  
Before And After

Abstract Background In 2014, the AAP stopped recommending RSV immunoprophylaxis for otherwise healthy 29–34 wGA preterm infants. This study examined the risk of RSVH and BH among 29–34 wGA infants before the AAP policy change (November 1, 2010–March 31, 2014) and after (November 1, 2014–March 31, 2017) using PHIS hospital-level encounter data from 51 US children’s hospitals. Methods The study population included the first November to March RSVH (ICD9 = 79.6, 480.1, 466.11, ICD10 = B97.4, J12.1, J21.0) or BH (RSVH or unspecified bronchiolitis [ICD9 = 466.19, ICD10 = J21.1, J21.8, J21.9]) among infants 6 months of age or younger admitted to a PHIS hospital between November 1, 2010 and March 31, 2017. The proportion of RSVH and BH by wGA categories (22–28 wGA, 29–34 wGA, 35–36 wGA, and term infants [37+ wGA]) were compared in the time period before and after 2014. Frequencies and proportions were calculated overall for all infants and by demographic and clinical factors for 29–34 wGA infants for RSVH and BH, separately. Statistically significant differences before and after the AAP policy were compared using χ 2 test or Wilcoxon rank-sum test, as appropriate. Results 96,281 infants with BH, including 67,570 with RSVH, were studied. Among infants with known gestational age, the proportions of hospitalizations for RSVH and BH increased after the AAP policy change for all wGA categories, except for term infants (table). Infants 29–34 wGA represented 8.7% of all RSVH before the policy change and 14.2% of all RSVH after the policy change (P < 0.0001). No significant differences were found by gender or co-morbidity for infants 29–34 wGA. Among infants 29–34 wGA, the intensive care unit admission rate increased significantly for RSVH (from 54.5% to 64.2%, P < 0.0001) and BH (from 46.7% to 54.5%, P < 0.0001) after the policy change. The median RSVH length of stay (from 6 to 7 days, P = 0.047) and median adjusted estimated cost (from $14,077 to $16,058, P = 0.038) increased significantly after the policy change. Conclusion RSV and all-cause bronchiolitis hospitalizations and their severity increased among preterm infants 29–34 wGA in the 3-year period following the 2014 AAP policy change on RSV immunoprophylaxis. Disclosures All authors: No reported disclosures.

scholarly journals Multidisciplinary Team Care in the Surgical Management of Pituitary Adenoma

2019 ◽  
Author(s):  
Jessica W. Grayson ◽  
Agnish Nayak ◽  
Mark Winder ◽  
Benjamin Jonker ◽  
Raquel Alvarado ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Multidisciplinary Team ◽  
Length Of Hospital Stay ◽  
Multidisciplinary Care ◽  
Residual Tumor ◽  
Pituitary Surgery ◽  
Csf Leak ◽  
Before And After ◽  
Hospital Stays ◽  
The Impact

Abstract Purpose Despite multidisciplinary care being commonly recommended, there remains limited evidence supporting its benefits in pituitary disease management. This study aimed to assess the impact of multidisciplinary care in pituitary surgery. Methods A retrospective cohort study was performed comparing pituitary surgery outcomes among consecutive patients within a quaternary referral center in 5 years before and after introduction of a multidisciplinary team (MDT). Primary outcomes were endocrine (transient diabetes insipidus [DI], syndrome of inappropriate antidiuretic hormone [SIADH], and new hypopituitarism) and surgical (cerebrospinal fluid [CSF] leak, epistaxis, intracranial hemorrhage, and meningitis) complications, length of hospital stay, and intrasellar residual tumor. Results 279 patients (89 pre-MDT vs. 190 post-MDT) were assessed (age 54 ± 17 years, 48% female). Nonfunctioning adenomas were most common (54%). In the post-MDT era, more clinically functioning tumors (42 vs. 28%, p = 0.03) were treated. Transient DI and SIADH occurred less often post-MDT (20 vs. 36%, p < 0.01 and 18 vs. 39%, p < 0.01), as well as new hypothyroidism (5 vs. 15, p < 0.01). Hospital stay was shorter post-MDT (5[3] vs. 7[5] days, p < 0.001) and intrasellar residuals were less common (8 vs. 35%, p < 0.001). Complications were more frequent pre-MDT independent of tumor size, hormone status, and surgical technique (odds ratio [OR] = 2.14 [1.05–4.32], p = 0.04). Conclusion Outcomes of pituitary surgery improved after the introduction of an MDT. Pituitary MDTs may benefit both patients and the health system by improving quality of care and reducing hospital stays.

scholarly journals Impact of the 2014 American Academy of Pediatrics Immunoprophylaxis Policy on the Rate, Severity, and Cost of Respiratory Syncytial Virus Hospitalizations among Preterm Infants

2019 ◽  
Vol 37 (02) ◽  
pp. 174-183 ◽  
Author(s):  
Leonard R. Krilov ◽  
Jaime Fergie ◽  
Mitchell Goldstein ◽  
Lance Brannman
Keyword(s):  
Respiratory Syncytial Virus ◽  
American Academy ◽  
Preterm Infants ◽  
Policy Change ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Administrative Claims ◽  
Term Infants ◽  
American Academy Of Pediatrics ◽  
Syncytial Virus

Objective This study examined the rate, severity, and cost of respiratory syncytial virus (RSV) hospitalizations among preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after a 2014 change in the American Academy of Pediatrics policy for RSV immunoprophylaxis. Study Design Preterm (29–34 wGA) and term infants born from July 2011 to March 2017 and aged < 6 months were identified in a U.S. commercial administrative claims database. RSV hospitalization (RSVH) rate ratios, severity, and costs were evaluated for the 2011 to 2014 and 2014 to 2017 RSV seasons. Postpolicy changes in RSVH risks for preterm versus term infants were assessed with difference-in-difference (DID) modeling to control for patient characteristics and temporal trends. Results In the DID analysis, prematurity-associated RSVH risk was 55% greater in 2014 to 2017 versus 2011 to 2014 (relative risk = 1.55, 95% confidence interval: 1.10–2.17, p = 0.011). RSVH severity increased among preterm infants after 2014 and was highest among those aged < 3 months. Differences in mean RSVH costs for preterm infants in 2014 to 2017 versus 2011 to 2014 were not statistically significant. Conclusion RSVH risk for preterm versus term infants increased after the policy change, confirming previous national analyses. RSVHs after the policy change were more severe, particularly among younger preterm infants.

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