Auditory exposure of high‐risk infants discharged from the NICU and the impact of social factors

Background: Chronic heart failure (CHF) affects more than 5 million Americans and accounts for approximately 1 million hospitalizations annually. Readmission in CHF patients is associated with higher mortality and consumes a significant portion of hospital resources. Readmission rates may be higher when socioeconomic factors limit medication compliance and follow-up. In light of the high prevalence of CHF and the penalties associated with readmission rates, our study aims to identify factors that place our veterans with CHF at higher risk for readmission and in so doing, develop a profile for patients with a high risk of readmission that will benefit from focused intervention. Our goal is to use the information acquired in this study to reduce CHF readmission in the Miami VAMC by 10% over a 12-month period. Methods: This is an ongoing retrospective study conducted at the Miami VAMC. The Strategic Analysis for Improvement and Learning (SAIL) report was used to identify patients with CHF who were admitted to the Miami VAMC over fiscal year 2019 (FY19), the period from September 2018 to August 2019. Data was collected on various clinical baseline characteristics and social determinants of health from the patients' electronic health records for those admitted as well as for those with recurrent admissions within FY19. Using a previously validated questionnaire, identified patients will undergo further interview, in person or by phone, to identify social factors that may place them at higher risk for readmission. Results/Anticipated Results: A total of 185 patients were admitted during FY19 and of these, 38 had recurrent admissions. The mean time to readmission was 82 days. 76% of the patients readmitted had heart failure with reduced ejection fraction. Multiple co-morbidities were seen in the readmitted group, the commonest being hypertension (82%), diabetes (63%) and chronic kidney disease (39%). Thirty percent of those readmitted had a history of illicit drug use compared to 26% of those who were not readmitted. This population was also found to have multiple psychiatric co-morbidities - depression, anxiety and post-traumatic stress disorder. The odds of having one or more readmission within 12 months was 25% greater in those with psychiatric illness than in those without. Conclusion: Preliminary data analysis shows that psycho-social factors may play a role in recurrent admission in CHF patients. Further data will be collected to determine the impact of factors such as housing, education level and income on readmission risk so that patients at high risk can be identified and targeted with improved care co-ordination services to reduce this risk. As a unified health system, the VAMC is uniquely equipped with resources to address these disparities.

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Sound Level Exposure of High-Risk Infants in Different Environmental Conditions

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.25.1.25 ◽

2006 ◽

Vol 25 (1) ◽

pp. 25-32 ◽

Cited By ~ 53

Author(s):

Jacqueline Byers ◽

W. Randolph Waugh ◽

Linda Lowman

Keyword(s):

High Risk ◽

Environmental Conditions ◽

Sound Level ◽

Outcome Variable ◽

Improvement Program ◽

Convenience Sample ◽

Sound Levels ◽

Centered Care ◽

High Risk Infants ◽

The Impact

Purposes: To provide descriptive information about the sound levels to which high-risk infants are exposed in various actual environmental conditions in the NICU, including the impact of physical renovation on sound levels, and to assess the contributions of various types of equipment, alarms, and activities to sound levels in simulated conditions in the NICU.Design: Descriptive and comparative design.Sample: Convenience sample of 134 infants at a southeastern quarternary children’s hospital.Main Outcome Variable: A-weighted decibel (dBA) sound levels under various actual and simulated environmental conditions.Results: The renovated NICU was, on average, 4–6 dBA quieter across all environmental conditions than a comparable nonrenovated room, representing a significant sound level reduction. Sound levels remained above consensus recommendations despite physical redesign and staff training. Respiratory therapy equipment, alarms, staff talking, and infant fussiness contributed to higher sound levels.Conclusion: Evidence-based sound-reducing strategies are proposed. Findings were used to plan environment management as part of a developmental, family-centered care, performance improvement program and in new NICU planning.

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Faktor Predisposisi Masyarakat Tetap Tinggal Di Wilayah Resiko Tinggi Bencana Di Kabupaten Garut

Jurnal Surya Medika ◽

10.33084/jsm.v6i1.1632 ◽

2020 ◽

Vol 6 (1) ◽

pp. 163-170

Author(s):

Zahara Farhan ◽

Tantri Puspita ◽

Devi Ratnasari ◽

Cyntia Rianasari

Keyword(s):

Logistic Regression ◽

High Risk ◽

Environmental Factors ◽

Social Factors ◽

Dominant Factor ◽

Rank Test ◽

Economic Factors ◽

Test Results ◽

Risk Areas ◽

The Impact

Garut Regency is one of the areas that have the highest potential for disasters in West Java with the most frequent types of natural disasters, namely earthquakes, landslides, flash floods, and tsunamis. The impact of those disasters inflicts many casualties, infrastructure damage, loss of property, paralyzed life activities, and the emergence of various diseases. However, this does not affect the community to remain in high-risk areas due to several factors underlying the community to remain in the region such as; social factors, environmental factors, economic factors, and cultural factors. This study's aim was to find out the most dominant factors that motivate the community to remain in high-risk disaster areas in Garut Regency This study was used as a cross-sectional method with a sample of 120 families. The sampling technique was purposive sampling with logistic regression analysis. Spearman rank test results showed that social and economic factors were factors that have a community relationship still living in high-risk areas of disaster ( p values = 0.02 and 0.01, respectively), The logistic regression test results indicate that environmental factors were the most dominant factor for the community to remain living in a high-risk disaster area in Cibatu Sub-District, Garut Regency with a 2.265 Wald at a 95% significance level. Social factors were not proven to be the most dominant factors among the 4 other factors in the background of the community still living in high-risk areas of disaster in the District of Cibatu, Garut Regency.

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P05 A service review of the palivizumab outpatient rsv prophylaxis clinic

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314584.16 ◽

2018 ◽

Vol 103 (2) ◽

pp. e1.8-e1

Author(s):

Mitchell Michael ◽

O’Reilly Kathleen

Keyword(s):

Respiratory Syncytial Virus ◽

High Risk ◽

Therapeutic Drug ◽

List Type ◽

Close Monitoring ◽

Median Dose ◽

Related Hospitalisation ◽

Syncytial Virus ◽

High Risk Infants ◽

The Impact

AimAs the administration of palivizumab, shown to provide effective passive prophylaxis to respiratory syncytial virus (RSV) and reduce RSV-related hospitalisation in high-risk infants,1 will continue and remains a high-cost drug, it is important to ensure continual review of the outpatient immunisation clinic. The aim of this study was to investigate if clinical outcome was affected by the current dosing schedule and suggest possible measures to improve the efficiency and cost-effectiveness of the clinic.MethodThe following data were collected for all patients receiving palivizumab between October 2014 and March 2015; indication for treatment, weight at start and end of treatment, details of dose and date given and reasons for discontinuation or transfer of treatment. The following were then calculated from the data; rates of RSV- related hospitalisation, median dose administered (mg/kg) basedon predicted weight (using the standardised neonatal and infant close monitoring growth charts) to ascertain under or over dosing and current and additional costs of any suggested service developments. A two-tailed paired student t-test was used to assess statistical significance. The study methodology was approved by the local research ethics committee and the Caldicott guardian.Results0.98% and 3.92% of all patients receiving palivizumab contracted RSV with an underlying cardiac condition or prematurity respectively. Median weight gain over the 5 month period was 37.18% (n=54, p<0.001). Median dose (mg/kg) based on predicted weight was 15.6, 15, 14.29, 13.79, 13.33 from clinic 1 to 5 respectively. Median percentage difference from target dose of 15 mg/kg was 4.01, 0,–4.76, −8.05,–11.1 from clinic 1 to 5 respectively. The estimated incremental cost for weighing and dosing each patient at every clinic was £7,077.66 (6.3%).ConclusionPatients receiving palivizumab for RSV prophylaxis require to be weighed more frequently and subsequently prescribed a more appropriate dose at the outpatient immunisation clinic if optimal doses are to be achieved. However, the sub-optimal dosing did not affect RSV-related hospitalisation rate when compared with rates in current literature2 and further work is required to model mean trough concentrations achieved from the median doses administered.3 The increased cost of prescribing a dose based on increased weight can be justified due to expected improvementin patient outcome and potential reduction in RSV-related hospitalisation. As pharmacists are being actively encouraged to become independent prescribers within the next few years,4 it would be an ideal opportunity to utilise this resource in an effort to potentially improve prescribing efficiency within the clinic and provide additional benefits such as improved parent/carer education.ReferencesThe Impact-RSV Study Group. Palivizumab, a humanised respiratory syncytial virus monoclonal antibody, reduces hospitalisation from respiratory syncytial virus infection in high-risk infants. Paediatrics1998;102:531–537.Deshpande SA, Northern V. Community child health, public health, and epidemiology: The clinical and health economic burden of respiratory syncytial virus disease among children under 2 years of age in a defined geographical area. Arch Dis Child2003;88:1065–1069.Zaaijer HL. Vandenbroucke-grauls CMJE, Franssen EJF. Optimum Dosage Regimen of Palivizumab?Therapeutic Drug Monitoring2002;24:444–445.The Scottish Government. Prescription for excellence: A vision and action plan for the right pharmaceutical care through integrated partnerships and innovation 2013. http://tinyurl.com/z9etgch [Accessed: 03/08/2017].

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Working with Families Using a Family-Centered Approach for Improved Development Outcomes in High-Risk Children

Physiotherapy and Occupational Therapy Journal ◽

10.21088/potj.0974.5777.14121.1 ◽

2021 ◽

Vol 14 (1) ◽

pp. 9-17

Author(s):

Aarti Nair ◽

◽

Ajay Sharma ◽

Sandeep Kumar ◽

Manish Jha ◽

...

Keyword(s):

Early Intervention ◽

High Risk ◽

Birth Asphyxia ◽

Structured Learning ◽

Intervention Programme ◽

Development Outcomes ◽

High Risk Infants ◽

The Impact ◽

Family Centered ◽

High Risk Children

Introduction: Around the world, almost half of all deaths in children under five occur in the newborn period. Ninety-nine percent of newborn deaths are in low- and middle-income countries and prematurity, intrapartumrelated neonatal deaths (‘birth asphyxia’), sepsis and meningitis account for 75% of these1. Developmental disability is a diverse group of chronic conditions that are due to mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, especially in “language, mobility, learning, self-help, and independent living”2. Aim of Study: To analyze the impact of family centered-approach on child’s development outcomes. To quantify and validate the advantages of family-centered- approach for parents and children. Method: A low-cost, family-centered intervention programme to promote child and family wellbeing is provided at an Early Intervention Centre in Latika Roy Foundation, Dehradun, India. It follows a familycentered approach of empowering families through respect, collaboration, information, training and support. The effectiveness of this methodology is evaluated in this study. Discussion: This study evaluates the effectiveness of this family-centred interventions programme, provided by early intervention Centre, for improving development outcomes of high-risk infants. This study explores, for the first time in a resource limited country, the relationship between the reduction of family stress achieved through a family empowerment programme and improvement in development outcomes of high-risk children. Families of High-risk infants enrolled at the Centre during January 2015 through July 2017, who were in NICU for 5 or >5 days are partners in the study. Conclusion: The importance of family-centred care cannot be over-emphasized. Early intervention services and support to families can significantly improve quality of life of high-risk children. Intervention studies for children with disability state that the best way of improving children’s outcomes is by empowering parents through a structured learning programme. Given the scope and potential of such programs, this study quantifies and validates the advantages of the family-centred approach.

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Coached, Coordinated, Enhanced Neonatal Transition (CCENT): protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants

BMJ Open ◽

10.1136/bmjopen-2020-046706 ◽

2021 ◽

Vol 11 (7) ◽

pp. e046706

Author(s):

Julia Orkin ◽

Nathalie Major ◽

Kayla Esser ◽

Arpita Parmar ◽

Elise Couture ◽

...

Keyword(s):

High Risk ◽

Research Ethics ◽

Parental Stress ◽

Life Years ◽

Nurse Navigator ◽

High Risk Infants ◽

Randomised Controlled ◽

The Impact ◽

Neonatal Transition

IntroductionHaving an infant admitted to the neonatal intensive care unit (NICU) is associated with increased parental stress, anxiety and depression. Enhanced support for parents may decrease parental stress and improve subsequent parent and child outcomes. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) programme is a novel bundled intervention of psychosocial support delivered by a nurse navigator that includes Acceptance and Commitment Therapy-based coaching, care coordination and anticipatory education for parents of high-risk infants in the NICU through the first year at home. The primary objective is to evaluate the impact of the intervention on parent stress at 12 months.Methods and analysisThis is a multicentre pragmatic randomised controlled superiority trial with 1:1 allocation to the CCENT model versus control (standard neonatal follow-up). Parents of high-risk infants (n=236) will be recruited from seven NICUs across three Canadian provinces. Intervention participants are assigned a nurse navigator who will provide the intervention for 12 months. Outcomes are measured at baseline, 6 weeks, 4, 12 and 18 months. The primary outcome measure is the total score of the Parenting Stress Index Fourth Edition Short Form at 12 months. Secondary outcomes include parental mental health, empowerment and health-related quality of life for calculation of quality-adjusted life years (QALYs). A cost-effectiveness analysis will examine the incremental cost of CCENT versus usual care per QALY gained. Qualitative interviews will explore parent and healthcare provider experiences with the intervention.Ethics and disseminationResearch ethics approval was obtained from Clinical Trials Ontario, Children’s Hospital of Eastern Ontario Research Ethics Board (REB), The Hospital for Sick Children REB, UBC Children’s and Women’s REB and McGill University Health Centre REB. Results will be shared with Canadian level III NICUs, neonatal follow-up programmes and academic forums.Trial registration numberClinicalTrials.gov Registry (NCT03350243).

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Impact of the Withdrawal of Palivizumab Immunoprophylaxis on the Incidence of Respiratory Syncytial Virus (RSV) Hospitalizations Among Infants Born at 33 to 35 Weeks’ Gestational Age in the Province of Quebec, Canada: The RSV-Quebec Study

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa046 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jesse Papenburg ◽

Isabelle Defoy ◽

Edith Massé ◽

Georges Caouette ◽

Marc H Lebel

Keyword(s):

Respiratory Syncytial Virus ◽

High Risk ◽

Gestational Age ◽

Retrospective Cohort ◽

Lower Respiratory Tract ◽

Primary Outcome ◽

Birth Month ◽

Syncytial Virus ◽

High Risk Infants ◽

The Impact

Abstract Background Infants born at 33–35 completed weeks’ gestational age (wGA) aged <6 months at the start of or born during respiratory syncytial virus (RSV) season and classified as moderate/high risk of severe RSV disease were included in a palivizumab RSV prophylaxis program in the province of Quebec, Canada, until 2014–2015. We assessed the impact of withdrawal of this indication on lower respiratory tract infection (LRTI)/RSV hospitalizations (H) in this population. Methods We conducted a 4-year, retrospective, cohort study in 25 Quebec hospitals (2 seasons with and 2 without palivizumab prophylaxis for moderate- to high-risk infants). Our primary outcome was LRTI/RSV-H incidence. We compared LRTI/RSV-H incidence before (2013–2015; seasons 1 + 2 [S1/2]) and after (2015–2017; S3/4) the change in indication. Results We identified 6457 33–35 wGA births. LRTI/RSV-H occurred in 105/3353 infants (3.13%) in S1/2 and 130/3104 (4.19%) in S3/4. Among LRTI/RSV-H, 86.4% were laboratory-confirmed RSV-H. Adjusting for sex, wGA, and birth month, S3/4 was significantly associated with increased LRTI/RSV-H incidence (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 1.04–1.76) but not with laboratory-confirmed RSV-H (aOR, 1.19; 95% CI, 0.90–1.58). Mean duration of LRTI/RSV-H was 5.6 days; 22.6% required intensive care unit admission. Comparing S3/4 with S1/2, infant percentage with LRTI/RSV-H classified as moderate/high risk increased from 27.8% to 41.9% (P = .11). Conclusions In a province-wide study, we observed a significant increase in LRTI/RSV-H incidence among infants born at 33–35 wGA in the 2 years after withdrawal of RSV prophylaxis.

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