11 A service improvement project to optimise the perioperative pathway for emergency laparotomy in extremely low birthweight neonates at great ormond street hospital

2019 ◽  
Author(s):  
Joy Dawes ◽  
Paul Stevens ◽  
Simon Blackburn ◽  
Kate Cross ◽  
Simon Hannam ◽  
...  
Keyword(s):  
Low Birthweight ◽  
Emergency Laparotomy ◽  
Service Improvement ◽  
Improvement Project ◽  
Street Hospital ◽  
Great Ormond Street Hospital ◽  
Extremely Low Birthweight

Segmental absence of intestinal musculature in an extremely low birthweight preterm infant

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Joana Matias ◽  
Maria Cabral ◽  
Luísa Carmona ◽  
Margarida Cabral ◽  
João Franco
Keyword(s):  
Intestinal Perforation ◽  
Low Birthweight ◽  
Histopathological Examination ◽  
Muscularis Propria ◽  
Rare Condition ◽  
Emergency Laparotomy ◽  
Distended Bowel ◽  
Very Low Birthweight Infants ◽  
Intestinal Musculature ◽  
Extremely Low Birthweight

Abstract Background The segmental absence of intestinal musculature is a rare clinical entity, usually manifested in the neonatal period. It is more frequent in preterm infants, particularly in very low birthweight infants. Typically, there are intestinal perforation or intestinal obstruction symptoms. Case presentation The authors report a case of a 30-week-gestational age extremely low birthweight newborn who presented, on the fourth day of life, with a progressively acute abdomen and radiological findings suggestive of intestinal perforation. An emergency laparotomy with segmental ileal resection was performed; intestinal perforation was not confirmed. The histopathological examination of the resected distended bowel revealed an area of severe hypoplastic muscularis propria (with remaining layers intact). Conclusion Preoperative diagnosis of segmental absence of intestinal musculature is extremely difficult; its definitive diagnosis relies solely on the histopathological examination. The clinicians and pathologists should be aware of this rare condition, the treatment and prognosis of which differs from the more common necrotising enterocolitis.

scholarly journals Sustainable approach to reducing unnecessary combined biochemistry tests on a paediatric cardiology ward

2018 ◽  
Vol 7 (4) ◽  
pp. e000372 ◽  
Author(s):  
William Regan ◽  
Daljit Hothi ◽  
Kevin Jones
Keyword(s):  
Carbon Dioxide ◽  
Renal Function ◽  
Daily Basis ◽  
Environmental Cost ◽  
Lead Author ◽  
Biochemical Tests ◽  
Improvement Project ◽  
Street Hospital ◽  
Paediatric Cardiology ◽  
Great Ormond Street Hospital

We describe a quality improvement project (QIP) designed to reduce unnecessary biochemistry samples requested on a paediatric cardiology ward in Great Ormond Street Hospital. Prior to the intervention biochemistry tests were requested on a daily basis by nursing and junior doctor staff at an annual cost of around £27 000 for the ward. The lead author observed that for the majority the true indication for these biochemistry tests was for the purpose of monitoring renal function and plasma electrolytes. However, during a diagnostic analysis trying to understand the behaviours around ordering tests it appeared that a broader profile and more expensive combined test set was being requested that included unnecessary liver and bone profile analyses. A driver diagram identified three areas to target in order to rationalise blood test requests: (1) a critical understanding of the purpose of the test by those requesting the tests; (2) effective communication between professionals; and (3) improved utilisation of the computer system. An education-based QIP was initiated with the aim of reducing requests of these costly, unnecessary combined biochemical tests by half, by supporting and encouraging staff to switch to a simpler renal function assay. The project was designed to be engaging and fun and invited clinical teams to consider the cost of wasted resources in terms of the financial implications for the hospital, and in terms of the wider environmental impact of wasted resources illustrated in terms of estimated carbon dioxide use. This perhaps unusual approach of encouraging an awareness of both financial and environmental cost led to a sustained reduction in the ordering of expensive combined biochemical tests, saving an estimated £11 338 (or 13.5%) on biochemistry tests and around 17.8 tonnes of carbon dioxide across a 32-month follow-up period.

Provision of perinatal services and survival of extremely low birthweight infants in Victoria

1983 ◽  
Vol 2 (7) ◽  
pp. 314-318 ◽  
Author(s):  
William H. Kitchen ◽  
Laurence J. Murton ◽  
Robert N. D. Roy ◽  
Neil Campbell ◽  
John H. Drew ◽  
...  
Keyword(s):  
Low Birthweight ◽  
Perinatal Services ◽  
Extremely Low Birthweight

scholarly journals Unprecedented reduction in births of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants during the COVID-19 lockdown in Ireland: a ‘natural experiment’ allowing analysis of data from the prior two decades

2020 ◽  
Vol 5 (9) ◽  
pp. e003075 ◽  
Author(s):  
Roy K Philip ◽  
Helen Purtill ◽  
Elizabeth Reidy ◽  
Mandy Daly ◽  
Mendinaro Imcha ◽  
...  
Keyword(s):  
Poisson Regression ◽  
Rate Ratio ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Well Being ◽  
Very Low Birthweight ◽  
Live Births ◽  
Regional Trends ◽  
Extremely Low Birthweight ◽  
Health And Well Being

BackgroundAetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland’s response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants.MethodsRegional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Regional data covering most of the lockdown period of 2020 were compared with historical regional and national data and forecasted national figures for 2020.ResultsPoisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001–2019 was 8.18 (95% CI 7.21 to 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed, reflecting a rate ratio of 3.77 (95% CI 1.21 to 11.75), p=0.022, representing a 73% reduction of VLBW during the first 4 months of 2020 compared with same period for the preceding two decades. There were no ELBW infants admitted to the regional neonatal intensive care unit. National Irish VLBW rate for 2020 is forecasted to be reduced to approximate 400 per 60 000 births compared with the historical 500–600 range.ConclusionAn unprecedented reduction in regional births of VLBW and ELBW infants was observed in Ireland coinciding with the COVID-19 lockdown. Potential determinants of this unique temporal trend possibly reside in the summative socioenvironmental impact of the COVID-19 lockdown. Our findings, if mirrored in other regions that have adopted a lockdown, demonstrate the potential to evaluate these implicated behavioural and socioenvironmental modifiers to positively influence VLBW and ELBW rates globally.

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