scholarly journals Early Discharge after Delivery. A Study of Safety and Risk Factors

2003 ◽  
Vol 3 ◽  
pp. 1363-1369 ◽  
Author(s):  
Deena R. Zimmerman ◽  
Gil Klinger ◽  
Paul Merlob
Keyword(s):  
Medical Center ◽  
Newborn Infants ◽  
Hip Dislocation ◽  
Born Term ◽  
Cost Effective ◽  
Early Discharge ◽  
Metabolic Disturbances ◽  
Suspected Sepsis ◽  
Medical Diagnoses ◽  
Missed Diagnoses

The increased frequency of early discharge of newborns has led to questions of its safety. Most studies have looked at mortality and rehospitalization, not all missed diagnoses. The purpose of this study was to determine diagnoses in newborn infants that would have been missed if the infant had been discharged in <24 h. The design was a cohort study at Rabin Medical Center-Beilinson Campus (average monthly deliveries 1996 [250], 1997 [500]), a university-affiliated community hospital with all in-born term (≥37 weeks) infants born September through November 1996 and June 1997.The main outcome measures were medical diagnoses (except trivial physical descriptions) noted at discharge (generally at ≥48 h) exam, not noted on admission exam (<24 h).The results showed that 54 infants (5.1%) had diagnoses that were not detected before the infant was 24 h of age. The leading diagnosis was hyperbilirubinemia. Other potentially missed diagnoses included congenital heart disease (n = 10), morbidity of birth trauma (n = 9), metabolic disturbances (n = 2), hip dislocation (n = 1), suspected sepsis (n = 2), excessive weight loss (n = 2), polycythemia (n = 2), inguinal hernia (n = 1), and abducens paresis (n = 1).It is concluded that diagnoses can be missed by discharging infants in 24 h or less. These diagnoses have the potential for adverse sequela. Even if early discharge is felt to be cost effective, parents should be counseled that it is not risk free. Better mechanisms should be put in place for assuring the safety of such infants.

scholarly journals Continuation of Indoor Prescribed Antibiotics in the Outpatient Treatment of Neonatal Sepsis

2017 ◽  
Vol 42 (3) ◽  
pp. 137-141
Author(s):  
SM Rafiqul Islam ◽  
Khurshid Talukder ◽  
Monira Akter
Keyword(s):  
Neonatal Sepsis ◽  
Cost Effective ◽  
Early Discharge ◽  
Outpatient Setting ◽  
Suspected Sepsis ◽  
Group Data ◽  
Effective Option ◽  
Long Time ◽  
Initial Improvement ◽  
Time Of Admission

Neonatal sepsis is a common problem whose antibiotic treatment is usually recommended whilst admitted in hospital for at least 10-14 days. Families in Bangladesh however are reluctant to stay in hospital to complete the treatment for such a long time due to reasons such as financial difficulties and either or both are working parents. This leads to incomplete treatment of neonatal sepsis. We hypothesised that after initial improvement in neonatal sepsis with injectable antibiotics whilst admitted, the same treatment could be safely continued in the outpatient setting to complete the full course. This intervention study was carried out in 66 newborns (0-28 days) recruited at the time of admission with suspected sepsis in the Department of Paediatrics, Centre for Woman and Child Health (CWCH), Dhaka. After investigations, treatment was initiated with injectable antibiotics according to clinical diagnosis and severity. Families who agreed to stay and complete the treatment as inpatient were given the complete course of antibiotics in hospital as IPD group and those who wanted to shorten their stay in hospital, were discharged with injectable antibiotics and follow-up in the outpatient department as OPD group. Data were analysed on 59 neonates, 37 in the OPD and 22 in the IPD group, admitted to hospital between April 2014 and December 2015. There were no readmissions or complications in either group, but one newborn died in the IPD group. Cure rate was 100% in both OPD and IPD groups. Average duration of hospital stay was 3.95±1.76 days and 6.14±2.99 days in the OPD and IPD groups respectively. Treatment cost per patient was 5,823±3,752 Bangladesh Taka (BDT) and 7,082±6,520 BDT in the OPD and IPD groups respectively. Findings of this study suggest that early discharge with injectable antibiotics as an outpatient is a safe and cost effective option for neonatal sepsis.

TeleNICU: Extending the reach of level IV care and optimizing the triage of patient transfers

2021 ◽  
pp. 1357633X2110381
Author(s):  
Jawahar Jagarapu ◽  
Vishal Kapadia ◽  
Imran Mir ◽  
Venkat Kakkilaya ◽  
Kristin Carlton ◽  
...  
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Demographic Data ◽  
Newborn Infants ◽  
Cost Savings ◽  
Neonatal Care ◽  
Transport Cost ◽  
Medical Diagnoses

Background The use of telemedicine to provide care for critically ill newborn infants has significantly evolved over the last two decades. Children's Health System of Texas and University of Texas Southwestern Medical Center established TeleNICU, the first teleneonatology program in Texas. Objective To evaluate the effectiveness of Tele Neonatal Intensive Care Unit (TeleNICU) in extending quaternary neonatal care to more rural areas of Texas. Materials and methods We conducted a retrospective review of TeleNICU consultations from September 2013 to October 2018. Charts were reviewed for demographic data, reasons for consultation, and consultation outcomes. Diagnoses were classified as medical, surgical, or combined. Consultation outcomes were categorized into transferred or retained. Transport cost savings were estimated based on the distance from the hub site and the costs for ground transportation. Results TeleNICU had one hub (Level IV) and nine spokes (Levels I–III) during the study period. A total of 132 direct consultations were completed during the study period. Most consultations were conducted with Level III units (81%) followed by level I (13%) and level II (6%) units. Some common diagnoses included prematurity (57%), respiratory distress (36%), congenital anomalies (25%), and neonatal surgical emergencies (13%). For all encounters, 54% of the patients were retained at the spoke sites, resulting in an estimated cost savings of USD0.9 million in transport costs alone. The likelihood of retention at spoke sites was significantly higher for medical diagnoses compared to surgical diagnoses (89% vs. 11%). Conclusion Telemedicine effectively expands access to quaternary neonatal care for more rural communities, helps in the triage of neonatal transfers, promotes family centered care, and significantly reduces health care costs.

Trends in Early Discharge and Associated Costs after Transcatheter Aortic Valve Replacement: A National Perspective

2021 ◽  
pp. 155698452110133
Author(s):  
Alexis K. Okoh ◽  
Emaad Siddiqui ◽  
Cassandra Soto ◽  
Nehal Dhaduk ◽  
Sameer Hirji ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Cost Effective ◽  
Early Discharge ◽  
Real World Data ◽  
Transcatheter Aortic Valve ◽  
Nationally Representative ◽  
National Perspective

Objective The current study aims to report trends of early discharges and identify associated direct costs using a nationally representative database of real-world data experience. Methods We used nationally weighted data on all patients who had transfemoral transcatheter aortic valve replacement (TAVR) from 2012 to 2017 and discharged alive from the National Inpatient Sample. Patients were divided into early (discharge ≤3 days of admission) and late discharge. Demographics and clinical characteristics were compared. Trends in early discharge and costs associated with admissions were analyzed over the study period. Results Of the 125,188 patients identified, 59,424 (46.9%) were discharged early. The proportion of early discharge increased from 15% in early 2012 to 68% in late 2017 ( P < 0.001), with the largest increase occurring from 2014 to 2015. Overall, the average cost of TAVR decreased from $58,408 in 2012 to $49,875 in 2017 ( P < 0.001). Compared to late discharge, patients discharged early reported costs savings of ≥$20,000 over the study period. Among the early discharge group, no significant differences in costs were observed for patients discharged on 0 to 1, 2, or 3 days after the procedure. Conclusions Postoperative length of stay after TAVR has decreased dramatically within the last decade with an observed reduction in procedural costs. While discharge within 3 days appeared cost effective, no differences in costs were noted among patients discharged ≤3 days.

THE DEVELOPMENT OF ENZYME SYSTEMS DURING EARLY INFANCY

PEDIATRICS ◽  
1958 ◽  
Vol 22 (4) ◽  
pp. 785-845
Author(s):  
Shirley G. Driscoll ◽  
David Yi-Yung Hsia
Keyword(s):  
Newborn Infants ◽  
Material Characteristic ◽  
Metabolic Disturbances ◽  
Newborn Period ◽  
Similar Work ◽  
Functional Immaturity ◽  
Human Material ◽  
Term Baby ◽  
General Response ◽  
Diabetic Mothers

PEDIATRIC literature and clinical experience contain abundant indications of physiologic immaturity in newborn infants, especially in those born prior to term. Functional immaturity of brain, liver, kidney, immune response and blood coagulation are among the well-recognized peculiarities of the newborn period. Exaggerations of these usually mild, transitory phenomena may contribute to grave disorders and possibly prove to be lethal. In addition to apparent derangements of particular systems or organs, there are occasional infants, notably the delicate offspring of diabetic mothers, whose general response and appearance suggest immaturity disproportionate to size and gestational age. In this group, general metabolic disturbances are suspected which await biochemical localization and characterization. Conventional post-mortem examinations may be discouragingly unrevealing in these babies. For example, one of the most commonly encountered problems is that of infants dying following unexplained respiratory distress. Pathologically, only so-called "hyaline membranes" with atelectasis have been found. This pattern can be noted in at least half of all infants of diabetic mothers and prematures and occasionally in a full-term baby, and constitutes one of the most baffling problems in clinical pediatrics today. In contrast, the increasing availability of biochemical methods of study are providing a rapidly growing fund of information concerning the normal fetus and newborn. From studies on the chemical embryology of other species and from limited similar work with human material, characteristic patterns of chemical differentiation are emerging. Extension of such observations may be expected to permit the establishment of new metabolic parameters by which to assess the developing fetus and infant.

scholarly journals Early Postnatal Metabolic Profile in Neonates With Different Birth Weight Status: A Pilot Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Serdar Beken ◽  
Saygin Abali ◽  
Neslihan Yildirim Saral ◽  
Bengisu Guner ◽  
Taha Dinc ◽  
...  
Keyword(s):  
Birth Weight ◽  
Amino Acid ◽  
Energy Metabolism ◽  
Gestational Age ◽  
Weight Status ◽  
Newborn Infants ◽  
Ponderal Index ◽  
Large For Gestational Age ◽  
Metabolic Disturbances ◽  
Intrauterine Growth

Introduction: Restricted or enhanced intrauterine growth is associated with elevated risks of early and late metabolic problems in humans. Metabolomics based on amino acid and carnitine/acylcarnitine profile may have a role in fetal and early postnatal energy metabolism. In this study, the relationship between intrauterine growth status and early metabolomics profile was evaluated.Materials and Methods: A single-center retrospective cohort study was conducted. Three hundred and sixty-one newborn infants were enrolled into the study, and they were grouped according to their birth weight percentile as small for gestational age (SGA, n = 69), appropriate for gestational age (AGA, n = 168), and large for gestational age (LGA, n = 124) infants. In all infants, amino acid and carnitine/acylcarnitine profiles with liquid chromatography-tandem mass spectrometry (LC-MS/MS) were recorded and compared between groups.Results: LGA infants had higher levels of glutamic acid and lower levels of ornithine, alanine, and glycine (p &lt; 0.05) when compared with AGA infants. SGA infants had higher levels of alanine and glycine levels when compared with AGA and LGA infants. Total carnitine, C0, C2, C4, C5, C10:1, C18:1, C18:2, C14-OH, and C18:2-OH levels were significantly higher and C3 and C6-DC levels were lower in SGA infants (p &lt; 0.05). LGA infants had higher C3 and C5:1 levels and lower C18:2 and C16:1-OH levels (p &lt; 0.05). There were positive correlations between free carnitine and phenylalanine, arginine, methionine, alanine, and glycine levels (p &lt; 0.05). Also, a positive correlation between ponderal index and C3, C5-DC, C14, and C14:1 and a negative correlation between ponderal index and ornithine, alanine, glycine, C16:1-OH, and C18:2 were shown.Conclusion: We demonstrated differences in metabolomics possibly reflecting the energy metabolism in newborn infants with intrauterine growth problems in the early postnatal period. These differences might be the footprints of metabolic disturbances in future adulthood.

NEWS AND ANNOUNCEMENTS

PEDIATRICS ◽  
1972 ◽  
Vol 50 (3) ◽  
pp. 504-506
Keyword(s):  
Pediatric Cardiology ◽  
Medical Center ◽  
Newborn Infants ◽  
Heart Association ◽  
University Of Tennessee ◽  
Children's Hospital ◽  
Hospital Medical ◽  
Clinical Cardiology ◽  
Children’S Hospital ◽  
The University

Conference on Newborn Infants: The University of Tennessee College of Medicine will present the Fourth Memphis Conference on the Newborn at the Holiday Inn-Rivermont, Memphis, Tennessee, on September 21, 1972. Faculty will include Drs. Marshall Klaus, Leo Stern, and Paul Swyer. For further information write the Division of Continuing Education and Conferences, The University of Tennessee Medical Units, 800 Madison Avenue, Memphis, Tennessee 38103. Problems in Pediatric Cardiology: The American Heart Association Council on Clinical Cardiology, the Council on Rheumatic Fever and Congenital Heart Disease, and the Departments of Pediatrics, Surgery, and Pathology of Children's Hospital Medical Center and Harvard Medical School, in cooperation with the Massachusetts Heart Association, will cosponsor a course: Problems in Pediatric Cardiology, September 25-27, 1972, at Children's Hospital Medical Center, Boston, Massachusetts.

Abstract 17309: Validation of a Novel Prediction Tool for Circulatory Etiology Death After Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Karen Bascom ◽  
John Dziodzio ◽  
Samip Vasaiwala ◽  
Michael Mooney ◽  
Nainesh Patel ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical Center ◽  
Cost Effective ◽  
Circulatory Support ◽  
Prediction Tool ◽  
Data Set ◽  
Derivation Cohort ◽  
Maine Medical ◽  
St Elevation ◽  
Simple Bedside

Introduction: Post-resuscitation cardiac arrest (CA) triage to urgent angiography, percutaneous intervention, and mechanical circulatory support is hampered by inconclusive risk stratification, especially among patients without ST elevation myocardial infarction (STEMI). We analyzed registry data to develop a prediction tool to determine the risk of circulatory-etiology (CV) death in patients without STEMI, and validated it in a separate cohort. Methods: Using the International Cardiac Arrest Registry (INTCAR)-Cardiology data set and stepwise linear regression with an inclusion rule of P≤0.1, we determined demographic and clinical factors independently associated with CV death, and created a weighted prediction model for patients presenting after CA without STEMI. The model was then validated in a separate, larger cohort from INTCAR. This project was approved by the Maine Medical Center IRB. Results: Of 468 patients in the derivation cohort, 90 met criteria for the endpoint. In the multivariable model, age greater than 65 (OR=2.4, p=0.0001), preexisting coronary disease (OR=1.9, P=0.0065), diabetes (OR=1.8, P=0.01), in-hospital arrest (OR=1.5, P=0.1), time from collapse to return of circulation (TTROSC) greater than 25 minutes (OR=1.7, p=0.02), shock at presentation (OR=3.9, P<0.0001), and EF<30% on first echo (OR=1.6, P=0.05) were independently associated with CV death. Using weighted predictors (age>65 =1, prior CAD =1, diabetes =1, in-hospital arrest =1, TTROSC>25 =1, admission LVEF<30% =1, shock =2,), an additive score of 0-2 predicted CV death in 8.5% and ≥3 in 34% in the derivation cohort. In the validation cohort, which comprised 1197 patients, of whom 263 met criteria for CV death, a score of 0-2 was associated with 13.1% and ≥3 with 35.1% CV death, respectively. Conclusions: A simple bedside prediction tool can predict high (34-35.1%) vs. low (8.5-13.1%) risk of circulatory-etiology death in cardiac arrest survivors without STEMI. This model could be used to risk-stratify cardiac arrest survivors, and aid in the triage of patients to appropriate and cost-effective post-resuscitation treatments.

The Effect of a Methadone Treatment Program Upon Pregnant Heroin Addicts and Their Newborn Infants

PEDIATRICS ◽  
1974 ◽  
Vol 54 (3) ◽  
pp. 300-305
Author(s):  
Rita G. Harper ◽  
George I. Solish ◽  
Henry M. Purow ◽  
Edward Sang ◽  
William C. Panepinto
Keyword(s):  
New York ◽  
Psychosocial Support ◽  
Past History ◽  
Medical Center ◽  
Methadone Treatment ◽  
Newborn Infants ◽  
Care Program ◽  
State University ◽  
Downstate Medical ◽  
History Of

A Family and Maternity Care Program (FMCP) for pregnant addicts, their spouses and the newborn infants was organized at the State University of New York Downstate Medical Center. Twenty-five percent of the women were treated for syphilis; 18% had a recurrent or recent past history of hepatitis. Obstetrical complications were reduced or eliminated by careful obstetrical surveillance. None of the mothers signed out against medical advice postpartum. Of the 51 living infants delivered within the study period, there were 17 infants weighing less than 2,500 gm. The Apgar score at one minute was 7 or higher in 84% of the infants. An excessive incidence of congenital malformation was not seen. Ninety-four percent of the infants developed withdrawal symptoms, 6% of whom convulsed repetitively. Infant withdrawal, however, was unassociated with an increase in mortality or known prolonged morbidity. This low-dose methadone program coupled with intense psychosocial support appeared to alleviate many of the common problems associated with addiction in pregnancy, but failed to prevent withdrawal in the newborn.

scholarly journals Detection of Intravascular Hemolysis in Newborn Infants Using Urinary Carbonic Anhydrase I Immunoreactivity

2020 ◽  
Vol 5 (5) ◽  
pp. 921-934
Author(s):  
Alzbeta Hulikova ◽  
Holger Kramer ◽  
Hammad Khan ◽  
Pawel Swietach
Keyword(s):  
Carbonic Anhydrase ◽  
Point Of Care ◽  
Newborn Infants ◽  
Cost Effective ◽  
Specific Protein ◽  
Intravascular Hemolysis ◽  
Genetic Traits ◽  
Healthcare Facilities ◽  
Abo Incompatibility ◽  
Carbonic Anhydrase I

Abstract Background Mild hemolysis occurs physiologically in neonates, but more severe forms can lead to life-threatening anemia. Newborns in developing regions are particularly at-risk due to the higher incidence of triggers (protozoan infections, sepsis, certain genetic traits). In advanced healthcare facilities, hemolysis is monitored indirectly using resource-intensive methods that probe downstream ramifications. These approaches could potentially delay critical decisions in early-life care, and are not suitable for point-of-care testing. Rapid and cost-effective testing could be based on detecting red blood cell (RBC)-specific proteins, such as carbonic anhydrase I (CAI), in accessible fluids (e.g., urine). Methods Urine was collected from 26 full-term male neonates and analyzed for CAI using immunoassays (ELISA, western blot) and proteomics (mass spectrometry). The cohort included a range of hemolytic states, including admissions with infection, ABO incompatibility, and receiving phototherapy. Data were paired with hemoglobin, serum bilirubin (SBR), and C-reactive protein (CRP) measurements. Results Urine from a control cohort (CRP &lt; 20 mg/L, SBR &lt; 125µmol/L) had no detectable CAI, in line with results from healthy adults. CAI excretion was elevated in neonates with raised SBR (&gt;125 µmol/L), including those qualifying for phototherapy. Newborns with low SBR (&lt;125 µmol/L) but elevated CRP (&gt;20 mg/L) produced urine with strong CAI immunoreactivity. Proteomics showed that CAI was the most abundant RBC-specific protein in CAI-immunopositive samples, and did not associate with other RBC-derived peptides, indicating an intravascular hemolytic source followed by CAI-selective excretion. Conclusions CAI is a direct biomarker of intravascular hemolysis that can be measured routinely in urine using non-invasive methods under minimal-laboratory conditions.

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