P27 Introduction of oral caffeine rounds on the neonatal units

2018 ◽  
Vol 103 (2) ◽  
pp. e2.30-e2 ◽  
Author(s):  
Fiona Robertson ◽  
Adriece Al Rifai ◽  
Jenny Machell
Keyword(s):  
Preterm Infants ◽  
Respiratory Control ◽  
Cost Savings ◽  
Fold Increase ◽  
Average Dose ◽  
List Type ◽  
Cochrane Database ◽  
One Year ◽  
The Uk ◽  
Apnea Of Prematurity

AimApnoea of prematurity is common in babies born at less than 34 weeks gestation due to immature respiratory control systems.1–4 The current mainstay of treatment in the UK is a methylxanthine – caffeine – which acts as a respiratory stimulant. Our local guideline follows the Caffeine for Apnea of Prematurity (CAP) study with a single loading dose followed by 24-hourly maintenance doses, given either intravenously or orally1.In August 2012 a UK licenced oral caffeine product was launched, however various safety concerns were raised over this product and its presentation which led to delays in use on our Neonatal Units (NNUs). Unfortunately the single patient, single use product would also lead to a massive increase in our oral caffeine spend – with the cost of an average dose of oral caffeine rising from just £0.13 to £24.41. This equates to an annual cost increase of approximately £53,140 – around a 150-fold increase from the previous £360 per annum. We have therefore considered and implemented a new initiative to avoid unacceptable cost pressures within the neonatal service.MethodsConsideration was made to administering caffeine doses in ‘rounds’ on NNU to allow doses for more than one patient from a single bottle.However, there were a number of issues to overcome – the oral caffeine rounds would require the product to be used outside of its licence. We also needed to be sure that limiting the timing of caffeine administration to standard times on the NNUs – provisionally twice daily rounds at 10:00 and 22:00 – would not affect its therapeutic and potentially toxic effects in this vulnerable patient group.Savings as a result of this initiative were to be tracked for one year post implementation.ResultsTotal savings in the first 10 months following implementation were £15,945 – a projected saving of £19 134 per annum. There have been no reports of any adverse clinical outcomes related to timing of caffeine doses.ConclusionGiven the success of this initiative we plan to move towards a once daily oral caffeine round on our NNUs at 10:00. The majority of babies currently receive their dose at this time but formal implementation will lead to further cost savings. A morning oral caffeine round will also help to minimise the at least theoretical risk of the CNS stimulant effects and cardiac effects of caffeine, principally tachycardia, disrupting a baby’s sleep pattern. There is some evidence of this in the literature although these effects are more common at supratherapeutic levels.ReferencesNottingham Neonatal Service. Clinical guideline B7 – Use of caffeine in apnoea of prematurityMay 2016.Schmidt B, Roberts RS, Davis P, et al. Caffeine for Apnea of Prematurity Trial Group. Caffeine therapy for apnea of prematurity. N Engl J Med2006;354(20):2112–21.Henderson-Smart DJ, Steer PA. Caffeine versus theophylline for apnea in preterm infants. Cochrane Database of Systematic Reviews2010:Issue 1.Art No:CD000273.Henderson-Smart DJ, De Paoli AG. Methylxanthine treatment for apnea in preterm infants. Cochrane Database of Systematic Reviews2010:Issue 12.Art. No:CD0001.

scholarly journals Oral health promotion: the economic benefits to the NHS of increased use of sugarfree gum in the UK

BDJ ◽  
2016 ◽  
Vol 220 (3) ◽  
pp. 121-127 ◽  
Author(s):  
L. Claxton ◽  
M. Taylor ◽  
E. Kay
Keyword(s):  
Oral Health ◽  
Cost Savings ◽  
Economic Benefits ◽  
Sensitivity Analyses ◽  
General Anaesthetic ◽  
Oral Health Promotion ◽  
Potential Cost ◽  
Primary Care Settings ◽  
One Year ◽  
The Uk

Abstract Introduction The effect of sugarfree gum (SFG) on the prevention of dental caries has been established for some time. With increased constraints placed on healthcare budgets, the importance of economic considerations in decision-making about oral health interventions has increased. The aim of this study was to demonstrate the potential cost savings in dental care associated with increased levels of SFG usage. Methods The analysis examined the amount of money which would hypothetically be saved if the UK 12-year-old population chewed more SFG. The number of sticks chewed per year and the caries risk reduction were modelled to create a dose response curve. The costs of tooth restoration, tooth extraction in primary care settings and under general anaesthetic were considered, and the effects of caries reduction on these costs calculated. Results If all members of the UK 12-year-old population chewed SFG frequently (twice a day), the potential cost savings for the cohort over the course of one year were estimated to range from £1.2 to £3.3 million and if they chewed three times a day, £8.2 million could be saved each year. Sensitivity analyses of the key parameters demonstrated that cost savings would still be likely to be observed even in scenarios with less significant increases in SFG use. Conclusion This study shows that if levels of SFG usage in the teenage population in the UK could be increased, substantial cost savings might be achieved.

THE SUCCESS OF THE LUCERNE MESSAGE IN MARLBOROUGH

1981 ◽  
pp. 179-183
Author(s):  
A.J. Cresswell
Keyword(s):  
North America ◽  
Weed Control ◽  
Seed Yield ◽  
Insect Pest ◽  
Fold Increase ◽  
Plant Spacing ◽  
Insect Pest Control ◽  
One Year ◽  
Seed Yields ◽  
New Cultivars

This paper, as well as being a testimonial to the benefit the writer has received from the Grassland Association, shows how the knowledge of scientists has been used to increase lucerne seed yields by methods of growing resistant cultivars especially for seed production as opposed to growing for hay, silage or grazing. It shows how new cultivars can be multiplied quickly by growing two crops in one year, one in each hemisphere, by using low seeding rates, wide plant spacing and very good weed control. Increased flowering of the crop has been achieved by the use of boron and the choice of time of closing; better pollination has been achieved by the use of more efficient bees - two varieties of which have been imported from North America. Weed and insect pest control and the use of a desiccant at harvest are contributing to a four-fold increase in seed yield, which should double again soon,

Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program

2000 ◽  
Vol 35 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Robert A. Quercia ◽  
Ronald Abrahams ◽  
C. Michael White ◽  
John D'Avella ◽  
Mary Campbell
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
Hemodialysis Patients ◽  
Cost Avoidance ◽  
Number Of Patients ◽  
Epoetin Alpha ◽  
Clinical Benefits ◽  
Unit Dose ◽  
One Year ◽  
Alpha Therapy

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

scholarly journals Early oxygen levels contribute to brain injury in extremely preterm infants

2021 ◽  
Author(s):  
Krista Rantakari ◽  
Olli-Pekka Rinta-Koski ◽  
Marjo Metsäranta ◽  
Jaakko Hollmén ◽  
Simo Särkkä ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Brain Structures ◽  
High Oxygen ◽  
List Type ◽  
Neurodevelopmental Outcomes ◽  
Oxygen Levels ◽  
Arterial Blood ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Extremely low gestational age newborns (ELGANs) are at risk of neurodevelopmental impairments that may originate in early NICU care. We hypothesized that early oxygen saturations (SpO2), arterial pO2 levels, and supplemental oxygen (FiO2) would associate with later neuroanatomic changes. Methods SpO2, arterial blood gases, and FiO2 from 73 ELGANs (GA 26.4 ± 1.2; BW 867 ± 179 g) during the first 3 postnatal days were correlated with later white matter injury (WM, MRI, n = 69), secondary cortical somatosensory processing in magnetoencephalography (MEG-SII, n = 39), Hempel neurological examination (n = 66), and developmental quotients of Griffiths Mental Developmental Scales (GMDS, n = 58). Results The ELGANs with later WM abnormalities exhibited lower SpO2 and pO2 levels, and higher FiO2 need during the first 3 days than those with normal WM. They also had higher pCO2 values. The infants with abnormal MEG-SII showed opposite findings, i.e., displayed higher SpO2 and pO2 levels and lower FiO2 need, than those with better outcomes. Severe WM changes and abnormal MEG-SII were correlated with adverse neurodevelopment. Conclusions Low oxygen levels and high FiO2 need during the NICU care associate with WM abnormalities, whereas higher oxygen levels correlate with abnormal MEG-SII. The results may indicate certain brain structures being more vulnerable to hypoxia and others to hyperoxia, thus emphasizing the role of strict saturation targets. Impact This study indicates that both abnormally low and high oxygen levels during early NICU care are harmful for later neurodevelopmental outcomes in preterm neonates. Specific brain structures seem to be vulnerable to low and others to high oxygen levels. The findings may have clinical implications as oxygen is one of the most common therapies given in NICUs. The results emphasize the role of strict saturation targets during the early postnatal period in preterm infants.

scholarly journals Neonatal and Postneonatal Pulmonary Hypertension

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 131
Author(s):  
Satyan Lakshminrusimha
Keyword(s):  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Right Ventricular Dysfunction ◽  
Fold Increase ◽  
Pulmonary Vein Stenosis ◽  
Term Infants ◽  
Pulmonary Vasodilators ◽  
Non Invasive Ventilation ◽  
Early Closure

During transition at birth with ventilation of the lungs, pulmonary vascular resistance (PVR) decreases from high fetal values, leading to an 8 to 10-fold increase in pulmonary blood flow (Qp). In some infants, this transition does not occur, resulting in pulmonary hypertension (PH). In infants, PH can present as: (a) primary PH in term neonates (idiopathic), (b) PH secondary to lung disease or hypoplasia in term infants, (c) acute PH in preterm infants with respiratory distress syndrome (RDS), (d) chronic PH with bronchopulmonary dysplasia (BPD) in preterm infants and (e) post-neonatal PH. A hemodynamically significant patent ductus arteriosus (PDA) can exacerbate PH in preterm infants due to increased Qp. Pulmonary vein stenosis (PVS) can complicate BPD with PH. Diagnosis of PH is based on clinical features, echocardiography and, in some intractable cases, cardiac catheterization. Therapy of PH includes oxygen, invasive or non-invasive ventilation, correction of acidosis, surfactant and selective and non-selective pulmonary vasodilators such as inhaled nitric oxide and sildenafil, respectively. Early closure of a hemodynamically significant PDA has the potential to limit pulmonary vascular remodeling associated with BPD and PH. The role of thiamine in pathogenesis of PH is also discussed with the recent increase in thiamine-responsive acute pulmonary hypertension in early infancy. Recognition and prompt therapy of PH can prevent right ventricular dysfunction, uncoupling and failure.

scholarly journals Carbon dioxide levels in neonates: what are safe parameters?

2021 ◽  
Author(s):  
Sie Kei Wong ◽  
M. Chim ◽  
J. Allen ◽  
A. Butler ◽  
J. Tyrrell ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Systematic Review ◽  
Side Effects ◽  
Preterm Infants ◽  
Periventricular Leukomalacia ◽  
List Type ◽  
Permissive Hypercapnia ◽  
Prisma Statement ◽  
Carbon Dioxide Levels ◽  
Online Software

Abstract There is no consensus on the optimal pCO2 levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates. A systematic review was conducted in accordance with the PRISMA statement and MOOSE guidelines. Two hundred and ninety-nine studies were screened and 37 studies included. Covidence online software was employed to streamline relevant articles. Hypocapnia was associated with predominantly neurological side effects while hypercapnia was linked with neurological, respiratory and gastrointestinal outcomes and Retinpathy of prematurity (ROP). Permissive hypercapnia did not decrease periventricular leukomalacia (PVL), ROP, hydrocephalus or air leaks. As safe pCO2 ranges were not explicitly concluded in the studies chosen, it was indirectly extrapolated with reference to pCO2 levels that were found to increase the risk of neonatal disease. Although PaCO2 ranges were reported from 2.6 to 8.7 kPa (19.5–64.3 mmHg) in both term and preterm infants, there are little data on the safety of these ranges. For permissive hypercapnia, parameters described for bronchopulmonary dysplasia (BPD; PaCO2 6.0–7.3 kPa: 45.0–54.8 mmHg) and congenital diaphragmatic hernia (CDH; PaCO2 ≤ 8.7 kPa: ≤65.3 mmHg) were identified. Contradictory findings on the effectiveness of permissive hypercapnia highlight the need for further data on appropriate CO2 parameters and correlation with outcomes. Impact There is no consensus on the optimal pCO2 levels in the newborn. There is no consensus on the effectiveness of permissive hypercapnia in neonates. A safe range of pCO2 of 5–7 kPa was inferred following systematic review.

scholarly journals AB0750 FUNCTIONAL CONDITION OF KIDNEYS IN THE LONG-TERM COURSE OF SLE IN ADOLESCENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1403.2-1403
Author(s):  
L. Bohmat ◽  
N. Shevchenko ◽  
I. Bessonova
Keyword(s):  
Renal Function ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Clinical Analysis ◽  
Average Dose ◽  
One Year

Background:Lupus nephritis is the most severe and adverse systemic lupus erythematosus (SLE) syndrome. According to modern recommendations, the clinical manifestations of active nephritis should be taken under medical control in 6 months after the start of the disease’s treatment1.Objectives:The aim of this study was to examine the functional status of the kidneys in children with SLE in the course of the disease for more than one year.Methods:The analysis included case histories of 43 patients with SLE, mostly females (41), aged 7 to 18 years (mean age 14.4 years) with disease duration of 4.75 ± 0.58 years of whom 22 were less than three years, 21 - more than three years. All children received corticosteroid therapy, at the time of the examination the average dose was 13.85 ± 1.86 mg per day in terms of prednisolone. The second component of therapy was azathioprine (average dose 97.61 ± 2.11 mg). All children received hydroxychloroquine (5 mg/kg per day).To determine the functional state of the kidneys a clinical analysis of urine, a study of the scope of specific gravity of urine during the day (Zymnytsky test), the content of creatinine and urea in serum to determine the glomerular filtration rate (GFR), the level of microalbuminuria per day were evaluated.Results:Renal involvement in the developed SLE occurred in 73.08% of patients. Among them, therapy during the first 6 months was considered quite effective in 58.06% of patients. It was found that in children with disease duration from one to three years proteinuria was registered in 68.18%, a decrease in GFR in 4.45% and hyperfiltration in 9.09%. In the group of children with duration of SLE more than three years revealed deeper changes in renal function; there was proteinuria in 90.47%, the frequency of GFR decreased was in 19.04%, a decrease of renal concentration function was in 14.28% of cases.Indicators of renal function in children with SLE depending on the duration of the disease (M ± m)IndicatorDuration of the diseasefrom 1 year to 3 years n = 22over 3 yearsn = 21Creatinine, mmol/l0,080 ± 0,0140,090 ± 0,018Мочевина, mmol/l5,66 ± 1,425,63 ± 1,61GFR, ml/min117,05 ± 19,68100,20 ± 18,98 *Microalbuminuria, mg/day24,41 ± 13,1334,73 ± 24,76Density min1,007 ± 0,0051,006 ± 0,005Density max1,024 ± 0,0051,019 ± 0,005 ***р<0,03;**р<0,01 the probability of differences when comparing between groupsConclusion:Long-term follow-up of children with SLE over one year reveals a prolongation of renal dysfunction, which worsens after three years, and is the basis for the development of irreversible renal impairment.References:[1]European evidence-based recommendations for the diagnosis and treatment of childhood-onset lupus nephritis: the SHARE initiative /Noortje Groot, Nienke de Graeff, Stephen D Marks et all. //Ann Rheum Dis. 2017 Dec;76(12):1965-1973.Disclosure of Interests:None declared

Caffeine dosing regimens in preterm infants with or at risk for apnea of prematurity

2021 ◽  
Author(s):  
Matteo Bruschettini ◽  
Petter Brattström ◽  
Chiara Russo ◽  
Wes Onland ◽  
Peter G Davis ◽  
...  
Keyword(s):  
At Risk ◽  
Preterm Infants ◽  
Dosing Regimens ◽  
Apnea Of Prematurity

ELFIN, the United Kingdom preterm lactoferrin trial: interpretation and future questions

2020 ◽  
Author(s):  
Janet Elizabeth Berrington ◽  
William McGuire ◽  
NIcholas David Embleton
Keyword(s):  
United Kingdom ◽  
Preterm Infants ◽  
Late Onset ◽  
Disease Onset ◽  
Intervention Group ◽  
Control Group ◽  
Bovine Lactoferrin ◽  
The United Kingdom ◽  
Late Onset Sepsis ◽  
The Uk

Previous studies suggested that supplemental bovine lactoferrin (BLF) given to preterm infants (<32 weeks gestation) may reduce late onset sepsis (LOS) and necrotising enterocolitis (NEC), but have been underpowered. The Enteral Lactoferrin in Neonates (ELFIN) study, performed in the United Kingdom (UK), aimed to further address this issue with a well powered double blinded placebo controlled trial of >2200 preterm infants. ELFIN did not demonstrate a reduction in LOS or NEC, or several other clinically important measures. 316 (29%) of 1093 infants in the intervention group developed late-onset sepsis versus 334 (31%) of 1089 in the control group with an adjusted risk ratio of 0·95 (95% CI 0·86–1·04; p=0· 233). Reasons for the differences in ELFIN trial results and other studies may include population differences, the routine use of antifungals in the UK, timing of administration of the lactoferrin in relation to disease onset, or specific properties of the lactoferrin used in different trials. Further exploration is being undertaken in the UK NIHR funded Mechanisms Affecting the Guts of Preterm Infants in Enteral feeding trials (MAGPIE) study, for which results should be available soon.

scholarly journals IAU Commission 25, and the development of early photometric systems

2018 ◽  
Vol 13 (S349) ◽  
pp. 357-373
Author(s):  
Christiaan Sterken
Keyword(s):  
List Type ◽  
Basic Principles ◽  
Half Century ◽  
Stellar Photometry ◽  
Select Group ◽  
International Astronomical ◽  
Calibration Methods ◽  
Standard Calibration ◽  
One Year ◽  
Basic Philosophy

AbstractThe International Astronomical Union was conceived in 1918, and was formed one year later in Brussels. One of the 32 initial Commissions was the Committee on Stellar Photometry that later on became IAU Commission 25 Astronomical Photometry and Polarimetry, and since 2015 Commission B6 with the same name. The initial functions to be exercised by the Committee were (a)to advise in the matter of notation, nomenclature, definitions, conventions, etc., and(b)to plan and execute investigations requiring the cooperation of several observers or institutions.The basic philosophy was that IAU Commission 25 was to be an advisory body, rather than a decision-making committee that imposes its regulations. This position was reconfirmed at the 10th IAU General Assembly in 1958.From the early days on, the Commission members engaged in the teaching of the principles of photometric measurement – either via the Commission meetings and the ensuing reports, or via external means, such as lectures and publications. The topics of instruction dealt with absorption of light in the atmosphere, the modification imposed by the character of the receiving apparatus, the unequal response of different receivers to a same stimulus, and variations in the data-recorder response from one experiment to another.From the 1930s on it was suggested that IAU Commission 25 takes responsibility in matters of standard stars, standard filters and standard calibration methods.During the first half-century since its foundation, Commission 25 was an active forum for discussions on the basic principles of astronomical photometry, including the associated problems of transformability of magnitudes and colour indices from one instrumental configuration to another. During the second half-century of its existence, the Commission has served as a sort of news agency reporting on the developments in detector engineering, filter technology and data reduction. All along the Commission members were committed to accuracy and precision, a struggle that was primarily driven by the jumps forward in performance and sensitivity of every new detector that was introduced.The development over one century shows that the Commission was continuously touching on the philosophy of precise measurement, where accurate measuring – for a select group of pioneers – was an end in itself.This presentation looks back on the opinions of key players in the photometric standardisation debate, and briefly presents two case studies that illustrate the illusionary accuracy reached over a century in determining, as Commission member Ralph Allan Sampson put it, “a detail like magnitude”.

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