scholarly journals Introduction of a Quality Improvement Bundle Is Associated with Reduced Exposure to Mechanical Ventilation in Very Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Stacey Chi-Yan Lo ◽  
Risha Bhatia ◽  
Calum T. Roberts
Keyword(s):  
Mechanical Ventilation ◽  
Quality Improvement ◽  
Preterm Infants ◽  
Demographic Data ◽  
Neonatal Morbidity ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Antenatal Steroids ◽  
Cord Clamping ◽  
The Impact

<b><i>Introduction:</i></b> Exposure to mechanical ventilation (MV) is a risk factor for bronchopulmonary dysplasia (BPD) in very preterm infants (VPTIs). We assessed the impact of a quality improvement (QI) bundle in VPTIs (&#x3c;32 week gestation) on exposure to MV. <b><i>Methods:</i></b> We introduced a QI bundle consisting of deferred cord clamping (DCC), nasal bubble continuous positive airway pressure (bCPAP) in the delivery room (DR), and minimally invasive surfactant therapy (MIST). We compared respiratory outcomes and neonatal morbidity in historical pre-QI (July–December 2017) and prospective post-QI (February–July 2019) cohorts (QICs) of VPTIs. We pre-specified an adjusted analysis to account for the effects of gestational age, sex, antenatal steroids, and any demographic data that significantly differed between cohorts. <b><i>Results:</i></b> The pre-QI and post-QICs included 87 and 98 VPTIs, respectively. The post-QIC had decreased rates of MV in the DR (adjusted odds ratio [aOR] 0.26, 95% confidence interval [CI] 0.09–0.71), in the first 72 h of life (aOR 0.27, 95% CI 0.11–0.62) and during admission (aOR 0.28, 95% CI 0.12–0.66). Rates of BPD, combined BPD/death, and BPD severity were similar. The post-QIC was less likely to be discharged with home oxygen (aOR 0.27, 95% CI 0.08–0.91). Necrotising enterocolitis grade ≥2 increased (aOR 19.01, 95% CI 1.93–188.6) in the post-QIC. <b><i>Conclusion:</i></b> In this rapid-cycle QI study, implementation of a QI bundle consisting of DCC, early nasal bCPAP, and MIST in VPTIs was associated with reduced rates of MV in the DR, in the first 72 h of life and during admission, and reduced need for home oxygen.

scholarly journals The Impact of Neonatal Morbidities on Smooth Pursuit Eye Movements in Very Preterm Infants

2011 ◽  
Vol 70 ◽  
pp. 352-352 ◽  
Author(s):  
K Strand Brodd ◽  
K Rosander ◽  
H Grönqvist ◽  
G Holmström ◽  
B Strömberg ◽  
...  
Keyword(s):  
Eye Movements ◽  
Preterm Infants ◽  
Smooth Pursuit ◽  
Smooth Pursuit Eye Movements ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Pursuit Eye Movements ◽  
The Impact

scholarly journals Impact of macro-socioeconomic determinants on perinatal healthcare quality for very preterm infants

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Doetsch ◽  
S C S Marques ◽  
T Krafft ◽  
H Barros
Keyword(s):  
Private Sector ◽  
Preterm Infants ◽  
Economic Crisis ◽  
Healthcare Quality ◽  
Wage Distribution ◽  
Very Preterm Infants ◽  
Socioeconomic Determinants ◽  
Very Preterm ◽  
Secondary Stage ◽  
The Impact

Abstract The WHO identified the importance of macro-socioeconomic determinants and the political context as interlinked key factors affecting health equity. The 2008 economic crisis was associated with a significant low-birth-weight increase in Portugal, 2007-2014. The Economic Adjustment Programme (EAP), implemented to economize non-essential health care costs (2011-2014), substantially affected healthcare delivery and occupational environment of Healthcare Professionals (HCPs). This study aims to analyse the impact observed by HCPs of the economic crisis and EAP on equitable quality of perinatal healthcare for very preterm infants in Portugal. A Qualitative study design with 21 HCPs in clinical settings equally distributed among Portuguese mainland were selected according to their response. Semi-structured interviews were conducted between October 2018-April 2019 until saturation point was achieved. A content analysis was performed using Nvivo2011 software. Preliminary results on macro-socioeconomic determinants, classified and conceptualized into a three-stage-effect framework, disclosed an interrelation between factors impacting perinatal healthcare quality, according to HCPs. Primary-stage: increase in working hours and patient-ratio per HCPs, cuts in salaries and investment, increasing waiting time and HCPs demotivation. Secondary-stage: burnout, work-absence, time constraints, decreasing quality and consultation availability. Tertiary-stage: HCPs Brain-drain to private sector, double-shifts in public-private sector, increasing inadequacy of transmissivity within sector communication. The economic crisis and EAP were perceived to have modified equitable perinatal healthcare quality for very preterm infants in Portugal. Increased private-public sector transparency to maximise quality assurance, equal HCP wage distribution to sustain capability, strengthening of social maternity protection strategies to enhance socioeconomic equity in perinatal healthcare, is recommended. Key messages The added value is the disclosure of an in-depth understanding on the interrelation of macro-socioeconomic determinants and healthcare permitting a distinct representation from quantitative methods. The non-linearity between policy response and expected outcomes chiefly complements its comprehension and demonstrates its relevance for further research on assessing effects of austerity measures.

Effect of delayed cord clamping on very preterm infants

2015 ◽  
Vol 213 (5) ◽  
pp. 676.e1-676.e7 ◽  
Author(s):  
Arpitha Chiruvolu ◽  
Veeral N. Tolia ◽  
Huanying Qin ◽  
Genna Leal Stone ◽  
Diana Rich ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Delayed Cord Clamping ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Cord Clamping

scholarly journals Adverse effects of small for gestational age differ by gestational week among very preterm infants

2018 ◽  
Vol 104 (2) ◽  
pp. F192-F198 ◽  
Author(s):  
Erik A Jensen ◽  
Elizabeth E Foglia ◽  
Kevin C Dysart ◽  
Rebecca A Simmons ◽  
Zubair H Aghai ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Intraventricular Haemorrhage ◽  
Neonatal Morbidity ◽  
Excess Risk ◽  
Very Preterm Infants ◽  
Adjusted Risk ◽  
Very Preterm ◽  
Grade 3

ObjectiveTo characterise the excess risk for death, grade 3–4 intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD) and stage 3–5 retinopathy of prematurity independently associated with birth small for gestational age (SGA) among very preterm infants, stratified by completed weeks of gestation.MethodsRetrospective cohort study using the Optum Neonatal Database. Study infants were born <32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRDs).ResultsOf 6708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared with non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3–4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13 to 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20 to 0.44) and the composites of death or BPD (0.35; 95% CI 0.24 to 0.46) and death or major morbidity (0.35; 95% CI 0.24 to 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2–3 weeks less mature.ConclusionThe excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age.

Misdiagnosing Midgut Volvulus in Very Preterm Infants: What is the Impact of Delay Before Surgery?

2020 ◽  
Vol 88 (1) ◽  
pp. 89-90
Author(s):  
Louise Montalva ◽  
Liza Ali ◽  
Alice Heneau ◽  
Florence Julien-Marsollier ◽  
Valérie Biran ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Midgut Volvulus ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
The Impact

scholarly journals The impact of prenatal and neonatal infection on neurodevelopmental outcomes in very preterm infants

2014 ◽  
Vol 34 (10) ◽  
pp. 741-747 ◽  
Author(s):  
I Lee ◽  
J J Neil ◽  
P C Huettner ◽  
C D Smyser ◽  
C E Rogers ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Infection ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
The Impact

scholarly journals Persistent Ductus Arteriosus in Critically Ill Preterm Infants

2016 ◽  
Vol 2 (4) ◽  
pp. 175-184 ◽  
Author(s):  
Maria Livia Ognean ◽  
Oana Boantă ◽  
Simona Kovacs ◽  
Corina Zgârcea ◽  
Raluca Dumitra ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Ductus Arteriosus ◽  
Respiratory Support ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Group 1

Abstract Introduction: Persistent ductus arteriosus (PDA) is found with increased incidence in preterm infants, significantly affecting neonatal morbidity and mortality rates. Aim: To evaluate the association between the presence of PDA and the severity of clinical condition at birth in critically ill preterm infants, with gestational ages (GA) ≤ 32 weeks and severe respiratory distress. Methods: All preterm infants with GA ≤ 32 weeks admitted to the neonatal intensive care unit (NICU) of the Clinical County Emergency Hospital, Sibiu between 1 January 2010 and 31 December 2015 were included in the study. These were categorized as Group 1 [Preterm infants with PDA; n=154] and Group 2 [Preterm infants without PDA; n=186]. Epidemiological and clinical data were collected in the National Registry for Respiratory Distress Syndrome for all children, and data related to prenatal period, clinical characteristics at birth i.e GA, weight, gender, Apgar scores, and clinical features such as resuscitation at birth, surfactant administration, need and duration of respiratory support, neonatal sepsis, complications associated with prematurity, and death, were analyzed. Results: Group 1 infants had significantly lower GA and birth weights, were more often out born (p=0.049, HR 1.69), and had significantly lower Apgar scores at 1 and 10 minutes (p=0.022, p=0.000). They presented a significantly higher need for surfactant administration (42.9% vs 24.7%, p<0.0001) and respiratory support (96.8% vs 90.3%, HR 3.19, p=0.019 for need of CPAP and 22.1% vs 10.8%, HR 2.35, p=0.004 for mechanical ventilation). Duration of respiratory support was also significantly higher in the Group 1 (7.6%±7.5 vs. 5.1±3.8 days, p<0.0001 for CPAP and 20.1±22.5 vs. 12.0±15.7 days, p<0.0001 for mechanical ventilation). Conclusion: In very preterm infants, PDA may be associated with a critical clinical condition leading to serious complications. The presence of PDA after the seventh day of life was associated with an increased need for respiratory support, both CPAP and mechanical ventilation, increased severity of the respiratory distress syndrome, requiring a longer duration of respiratory support, and increased the hospitalization length. In very preterm infants, PDA presence was also associated with a higher rate of severe complications and death, indicating the need for a careful and proper management of these critical cases in neonatal intensive care units.

scholarly journals Serious neonatal morbidities are associated with differences in DNA methylation among very preterm infants

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Todd M. Everson ◽  
T. Michael O’Shea ◽  
Amber Burt ◽  
Karen Hermetz ◽  
Brian S. Carter ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Preterm Infants ◽  
Risk Score ◽  
Neonatal Morbidity ◽  
Differential Methylation ◽  
Neonatal Health ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Bonferroni Adjustment ◽  
Morbidity Risk

Abstract Background Infants born very preterm are more likely to experience neonatal morbidities compared to their term peers. Variations in DNA methylation (DNAm) associated with these morbidities may yield novel information about the processes impacted by these morbidities. Methods This study included 532 infants born < 30 weeks gestation, participating in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants study. We used a neonatal morbidity risk score, which was an additive index of the number of morbidities experienced during the NICU stay, including bronchopulmonary dysplasia (BPD), severe brain injury, serious neonatal infections, and severe retinopathy of prematurity. DNA was collected from buccal cells at discharge from the NICU, and DNAm was measured using the Illumina MethylationEPIC. We tested for differential methylation in association with the neonatal morbidity risk score then tested for differentially methylated regions (DMRs) and overrepresentation of biological pathways. Results We identified ten differentially methylated CpGs (α Bonferroni-adjusted for 706,278 tests) that were associated with increasing neonatal morbidity risk scores at three intergenic regions and at HPS4, SRRD, FGFR1OP, TNS3, TMEM266, LRRC3B, ZNF780A, and TENM2. These mostly followed dose–response patterns, for 8 CpGs increasing DNAm associated with increased numbers of morbidities, while for 2 CpGs the risk score was associated with decreasing DNAm. BPD was the most substantial contributor to differential methylation. We also identified seven potential DMRs and over-representation of genes involved in Wnt signaling; however, these results were not significant after Bonferroni adjustment for multiple testing. Conclusions Neonatal DNAm, within genes involved in fibroblast growth factor activities, cellular invasion and migration, and neuronal signaling and development, are sensitive to the neonatal health complications of prematurity. We hypothesize that these epigenetic features may be representative of an integrated marker of neonatal health and development and are promising candidates to integrate with clinical information for studying developmental impairments in childhood.

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