51 Donor Milk in the NICU: A Community Pediatrics Perspective

Abstract Primary Subject area Community Paediatrics Background Use of pasteurized donor human milk (PDHM) has been recommended as an alternative to formula for preterm or low birth weight infants when mom’s own breast milk (MOM) is unavailable. Studies show that compared to PDHM, formula-fed neonates had better growth rates but were at increased risk of necrotizing enterocolitis (NEC) and feeding intolerance. Notably, most of these studies were conducted in tertiary-level NICUs. The Canadian Paediatric Society recommends PDHM as an alternative to formula for neonates admitted to NICUs. However, at time of study, PDHM was not offered in many community NICUs. Objectives The aim of this project is to determine whether the introduction of donor milk in the Level 2B NICU at Grand River Hospital has made a difference in rates of suspected NEC, feeding intolerance, growth, and length of hospital stay. Design/Methods We conducted a retrospective pre-post study comparing medical records of neonates in the NICU who met the criteria to receive PDHM 2 years after the introduction of PDHM at our centre (October 2017 to September 2019) to neonates who met the same criteria but were admitted prior to introduction of PDHM (October 2015 to September 2017) and thus received formula. Neonates who received privately purchased donor milk were excluded from our analysis. Results Gestational age and birth weight was similar for the PDHM (n=127) and control (n=120) groups. Compared to the PDHM group, formula-fed neonates were more likely to be transferred to a tertiary care NICU for concerns of suspected NEC (8.9% vs. 3.1%, p=0.017). When comparing any feeding intolerance, there was no significant difference between the two groups (p=0.23). Neonates receiving PDHM had higher average daily weight gain (33.9 vs. 28.9, p < 0 .001), but were more likely to receive additional calorie supplementation. There were no differences in length of hospital stay. Conclusion The data from our community NICU support the current literature that infants who receive formula are at increased risk for transfer for suspected NEC compared to those who receive PDHM. However, in our centre, there appears to be no difference in rates of feeding intolerance, and neonates fed fortified PDHM appeared to have better growth rates. Results from this study can be used to guide the allocation of health care resources, and can be applied to other community centres. Future studies can look to replicating these results on a larger scale and analyze the cost-effectiveness of PDHM use in community centers.

Download Full-text

The Effect of Omentoplasty on the Rate of Anastomotic Leakage after Intestinal Resection: A Randomized Controlled Trial

The American Surgeon ◽

10.1177/000313481708300215 ◽

2017 ◽

Vol 83 (2) ◽

pp. 157-160 ◽

Cited By ~ 1

Author(s):

Shirzad Nasiri ◽

Babak Mirminachi ◽

Reyhaneh Taherimehr ◽

Roya Shadbakhsh ◽

Mohsen Hojat

Keyword(s):

Hospital Stay ◽

Anastomotic Leakage ◽

Controlled Trial ◽

Randomized Study ◽

Intestinal Resection ◽

Length Of Hospital Stay ◽

Fistula Formation ◽

Intestinal Surgery ◽

Increased Risk ◽

Significant Difference

Anastomotic leakage is a major postoperative complication after intestinal surgery leading to increased risk of morbidity and mortality. Omentoplasty has been evaluated to prevent anastomotic leakage in several studies. However, there is no consensus regarding whether or not omentoplasty should be used to decrease the rate of anastomotic leakage after intestinal resection. A prospective, randomized study was conducted to evaluate the influence of omentoplasty on anastomotic leakage after intestinal resection. A total of 124 patients who underwent intestinal resection were enrolled in this prospective study. Patients were randomly assigned to receive either the omentoplasty or nonomentoplasty. In the omentoplasty group, the omentum was wrapped around the anastomotic region. Age, gender, site and type of anastomosis, duration of hospital stay, and performance of omentoplasty were recorded. This study was registered in Iranian Registry of clinical trial (number: IRCT201412316925N3). The rate of anastomotic leakage was significantly lower in the omentoplasty group (P = 0.04). Patients in the omentoplasty group developed a significantly lower rate of postoperative infection and peritonitis (P < 0.05). There was no significant difference of abscess and fistula formation between the two groups (P > 0.05). The length of hospital stay was longer in the nonomentoplasty group, compared with that for omentoplasty patients (P < 0.05). No death occurred in the omentoplasty subjects, while six nonomentoplasty patients died (P < 0.05). Our data demonstrated that omentoplasty is useful to lower the rate of postoperative complications in patients underwent intestinal surgery.

Download Full-text

Effects of Intermittent Kangaroo Mother Care on Low-Birth-Weight Neonates: A Retrospective Before-and-After Study

Acta Medica Philippina ◽

10.47895/amp.v55i9.3769 ◽

2021 ◽

Vol 55 (9) ◽

Author(s):

Jannie Lyne C. Notarte-Palisbo ◽

Cindy D. Canceko-Llego

Keyword(s):

Birth Weight ◽

Mortality Rate ◽

Low Birth Weight ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Kangaroo Mother Care ◽

Equal Distribution ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Before And After

Objective. To compare outcomes of low-birth-weight neonates delivered before and after implementation of intermittent kangaroo mother care (KMC) in terms of duration of hospital stay, mortality rate, and clinical outcome. Methods. This is a retrospective analytical study that included all neonates delivered in a tertiary government hospital with birth weight of less than 2000 grams before and after intermittent KMC implementation from January 2015 to December 2016. Chart review was done for demographics, mortality profile, and length of hospital stay. Chi-square test and Student’s t-test were used to compare mortality rate and length of hospital stay, and odds ratio was used for mortality outcome. Results. A total of 677 low birth weight newborns were reviewed and of these, 276 (79.8%) neonates in group 1 (Pre-intermittent KMC implementation), and 263 (79.4%) neonates in group 2 (Post-intermittent KMC implementation) fulfilled the inclusion criteria. The duration of hospital stay of neonates enrolled in KMC was significantly shorter (p ≤ 0.05). In Groups 1 and 2, 93–94% of neonates were discharged improved with a 5–6% mortality of almost equal distribution. There was no significant difference in mortality between groups 1 and 2 (OR 1.19, 95% CI 0.59, 2.42). Conclusion. There was no significant difference in mortality rate and cause of death pre- and post-intermittent KMC implementation. However, the length of hospital stay among the LBW neonates discharged improved was significantly shortened.

Download Full-text

Travel Burden and the Direct Medical Costs of Urologic Surgery

Journal of Health Economics and Outcomes Research ◽

10.36469/9825 ◽

2016 ◽

Vol 4 (1) ◽

pp. 47-54

Author(s):

Daniel J. Olson ◽

John L. Gore ◽

Kenn B. Daratha ◽

Kenneth P. Roberts

Keyword(s):

Hospital Stay ◽

Statistical Significance ◽

Length Of Hospital Stay ◽

High Volume ◽

Medical Costs ◽

Urologic Surgery ◽

Significant Difference ◽

Hospitalization Costs ◽

To Receive ◽

Travel Burden

Background: Increased surgical volume is associated with better patient outcomes and shorter lengths of hospitalization. As a consequence, traveling to receive care from a high volume provider may be associated with better outcomes. However, travel may also be associated with a decision by the healthcare provider to increase the length of stay due to a decreased ability to return to the primary hospital should complications arise. Thus, research is needed to understand the relationship between the distance a patient must travel and their outcomes following urologic surgery. Objective: The purpose of this study was to determine whether the distance a patient travels to receive urologic surgery is associated with their length of hospital stay and direct medical hospitalization costs. Methods: This was a retrospective observational cohort study of 12 106 patients over 50 years of age undergoing transurethral resection of the prostate (TURP), radical prostatectomy (RP) or radical cystectomy (RC) in Washington State hospitals between 2009 and 2013. Distance traveled was determined by calculating the linear distance between zip code centroids of patient residence and the hospital performing their procedure. Patients were sorted into four groups classified by distance traveled (≤5 miles, 6-20 miles, 21-50 miles and ≥51 miles) and cost calculated using a charges-to-reimbursement ratio for each hospital. Statistical significance was determined using a Kruskal-Wallis test. Results: Patients traveling greater distances had significantly lower median medical costs compared with patients who lived closer to the hospitals where they underwent TURP and RP (TURP: ≤5 miles, $6243 and ≥51 miles, $5105, p≤0.001; RP: ≤5 miles, $12 407 and ≥51 miles, $11 882, p≤0.001), whereas there was no significant difference for patients undergoing RC (≤5 miles, $27 554 and ≥51 miles, $26 761, p=0.17). Likewise, patients traveling greater distances had significantly lower median lengths of hospitalization for TURP and RP (TURP: p≤0.001, RP: p≤0.001), while there was no difference for RC (p=0.50). Conclusions: Patient travel burden does appear to play a role in cost and length of hospital stay for select urologic procedures with variable levels of morbidity and recovery time. Although these findings are statistically significant, the magnitude of the effect is small.

Download Full-text

Hyperglycemia: A bad prognostic factor for neonate.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.10.4499 ◽

2020 ◽

Vol 27 (10) ◽

pp. 2133-2137

Author(s):

Muhammad Anwar ◽

Muhammad Asghar Ali ◽

Ali Hammad

Keyword(s):

Birth Weight ◽

Hospital Stay ◽

Case Control Study ◽

Length Of Hospital Stay ◽

Case Control ◽

P Value ◽

Increased Risk ◽

Study Participants ◽

Study Setting ◽

Control Study

Objectives: The study was aimed to find out morbidity and mortality associated with hyperglycemia among neonates at our setting. Study Design: Observational Case-Control study. Setting: Department of Neonatology, Civil Hospital, Bahawalpur. Period: From 1st July 2019 to 31st December 2019. Material & Methods: The study included 194 neonates (97 each for cases and controls). Data like age (days), gender and weight were noted for all while presence of morbidities like IVH, NEC or infections were also recorded. Outcome among study participants of both groups was noted in terms of length of hospital stay and discharged/expired. Results: Out of a total of 194 study participants, majority, 114 (58.8%) were male, 101 (52.1%) had age between 1 to 7 days, and 84 (43.3%) had birth weight below 1.5 kilograms. Significantly more neonates had morbidity. Significantly more cases, 57 (58.8%) expired in comparison to 38 (39.2%) controls (p value 0.006). Length of hospital stay was also significantly more prolonged among cases. Conclusion: Neonates having hyperglycemia not only are at significantly increased risk of having morbidities and mortality.

Download Full-text

Outcome of kangaroo mother care in terms of hospital stay among preterm infants in a tertiary health care center Bhuj, Kutch: a cross-sectional study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20210114 ◽

2021 ◽

Vol 8 (2) ◽

pp. 285

Author(s):

Jaivik Sureshbhai Patel ◽

Gopi Alabhai Solanki

Keyword(s):

Birth Weight ◽

Hospital Stay ◽

Premature Infants ◽

Hospital Admissions ◽

Average Length ◽

Length Of Hospital Stay ◽

Time Frame ◽

Kangaroo Mother Care ◽

Health Care Center ◽

Significant Difference

Background: Neonates born before 37 completed weeks of pregnancy are called premature infants. The birth of premature infants is associated with several problems, such as frequent hospital admissions, infections, apnea and others. Evidence suggests that kangaroo mother care is effective and safe alternative to conventional neonatal care, especially in under-resourced settings and may reduce morbidity and mortality in low birth weight infants as well as increase breastfeeding.Methods: Present observational study conducted in the department of pediatrics, Gujarat Adani Institute of Medical Sciences, Bhuj, Kutch, Gujarat for the Duration of 1 year. Source of data are all live new born of gestational age of less than 37 weeks and birth weight below 2500 gm delivered at GAIMS, Bhuj. Primary outcome measures were: rate of infection time frame 1-2 weeks (during hospital stay), frequency of presume sepsis and need for antibiotics, length of stay (time frame 1-2 weeks) and total days in hospital during recruitment period.Results: An average length of hospital stay was 15.31±12.01 days among neonates in our study group. Among those with infection duration of stay was 21.03±15.627 days and among those without infection were 12.09±10.402 days. There was significant difference in length of hospital stay among those with infection and without infection.Conclusions: Kangaroo mother care improves physiological indices in normal levels, thus it might positively influence the premature infant’s physical health. The present study has important implications in the care of preterm and LBW infants in the developing countries, where expensive facilities for conventional care may not be available at all places.

Download Full-text

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i06/04 ◽

2018 ◽

Vol 3 (06) ◽

Author(s):

Dr.Randa Mohammed AboBaker

Keyword(s):

Cesarean Section ◽

Hospital Stay ◽

Demographic Data ◽

Length Of Hospital Stay ◽

Chewing Gum ◽

Control Group ◽

Controlled Clinical Trial ◽

Bowel Motility ◽

Gum Chewing ◽

Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay. Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

Download Full-text

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

Neonatology ◽

10.1159/000515899 ◽

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

Introduction: In very low birth weight (<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. Methods: 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. Results: 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). Discussion/Conclusions: 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.

Download Full-text

SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽

10.1136/gutjnl-2020-323364 ◽

2021 ◽

pp. gutjnl-2020-323364

Author(s):

Sanjay Pandanaboyana ◽

John Moir ◽

John S Leeds ◽

Kofi Oppong ◽

Aditya Kanwar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Organ Failure ◽

Collaborative Study ◽

Length Of Hospital Stay ◽

Secondary Outcome ◽

Icu Admission ◽

Local Complications ◽

Persistent Organ Failure ◽

Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

Download Full-text

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab040 ◽

2021 ◽

Author(s):

Jonathan P Scoville ◽

Evan Joyce ◽

Joshua Hunsaker ◽

Jared Reese ◽

Herschel Wilde ◽

...

Keyword(s):

Hospital Stay ◽

Chart Review ◽

Statistical Tests ◽

Case Series ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Opioid Use ◽

Pain Scores ◽

Surgical Methods ◽

Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

Download Full-text

Effects of early corticosteroid use in patients with severe coronavirus disease 2019

BMC Infectious Diseases ◽

10.1186/s12879-021-06221-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jong Hoon Hyun ◽

Moo Hyun Kim ◽

Yujin Sohn ◽

Yunsuk Cho ◽

Yae Jee Baek ◽

...

Keyword(s):

Hospital Stay ◽

Clinical Outcomes ◽

Case Fatality ◽

Length Of Hospital Stay ◽

Corticosteroid Treatment ◽

Threshold Value ◽

Steroid Use ◽

Corticosteroid Administration ◽

Significant Difference ◽

Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

Download Full-text