Comparison of healthcare utilization and outcomes by gestational diabetes diagnostic criteria

2018 ◽  
Vol 46 (4) ◽  
pp. 401-409 ◽  
Author(s):  
Julianne R. Lauring ◽  
Allen R. Kunselman ◽  
Jaimey M. Pauli ◽  
John T. Repke ◽  
Serdar H. Ural
Keyword(s):  
Gestational Diabetes ◽  
Healthcare Utilization ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Hospital Admissions ◽  
Neonatal Intensive Care Units ◽  
Maternal Healthcare ◽  
Number Of Patients ◽  
Significant Difference ◽  
Data Group

Abstract Objective: To compare healthcare utilization and outcomes using the Carpenter-Coustan (CC) criteria vs. the National Diabetes Data Group (NDDG) criteria for gestational diabetes mellitus (GDM). Methods: This is a retrospective cohort study. Prior to 8/21/2013, patients were classified as “GDM by CC” if they met criteria. After 8/21/2013, patients were classified as “GDM by NDDG” if they met criteria and “Meeting CC non-GDM” if they met CC, but failed to reach NDDG criteria. “Non-GDM” women did not meet any criteria for GDM. Records were reviewed after delivery. Results: There was a 41% reduction in GDM diagnosed using NDDG compared to CC (P=0.01). There was no significant difference in triage visits, ultrasounds for growth or hospital admissions. Women classified as “Meeting CC non-GDM” were more likely to have preeclampsia than “GDM by CC” women [OR 11.11 (2.7, 50.0), P=0.0006]. Newborns of mothers “Meeting CC non-GDM” were more likely to be admitted to neonatal intensive care units than “GDM by CC” [OR 6.25 (1.7, 33.3), P=0.006], “GDM by NDDG” [OR 5.56 (1.3, 33.3), P=0.018] and “Non-GDM” newborns [OR 6.47 (2.6, 14.8), P=0.0003]. Conclusion: Using the NDDG criteria may increase healthcare costs because while it decreases the number of patients being diagnosed with GDM, it may also increase maternal and neonatal complications without changing maternal healthcare utilization.

Early ultrasonographic follow up in neonatal pneumatocele. Two case reports

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Eugenia Maranella ◽  
Arianna Mareri ◽  
Marialuisa Tataranno ◽  
Luisa Di Luca ◽  
Alessandra Marciano ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Case Reports ◽  
Central Area ◽  
Neonatal Intensive Care Units ◽  
Promising Technique ◽  
Progressive Reduction ◽  
Number Of Patients ◽  
Chest X Ray ◽  
Pulmonary Parenchyma

Abstract Pulmonary pneumatocele is a thin-walled, air-filled cyst originating spontaneously within the lungs’ parenchyma, generally after infections or prolonged mechanical respiratory support. The diagnosis of pneumatocele is usually made using both chest X-ray (CXR) and computed tomography (CT) scan. Lung ultrasonography (LUS) is a promising technique used to investigate neonatal pulmonary diseases. We hereby present two cases of pneumatocele in newborns with respiratory distress syndrome (RDS) in which CXR and LUS were used to evaluate pulmonary parenchyma. LUS showed a multilobed cyst with a thin hyperechoic wall and a hypoechoic central area. Repeated LUS demonstrated a progressive reduction of the cyst’s size. After a few weeks, the small lesions were no longer detectable by ultrasound, therefore CXR was used, for follow-up, in the following months, until complete resolution. No data are available in the literature regarding ultrasonographic follow-up of neonatal pneumatocele. A larger number of patients are required to confirm our results and increase the use of LUS in the neonatal intensive care units (NICUs) to reduce neonatal radiations exposure.

scholarly journals THE COMPARATIVE ANALYSIS OF MICROBIOLOGICAL MONITORING IN NEONATAL INTENSIVE CARE UNITS IN KRASNIDAR REGIONAL CLINICAL HOSPITAL №2

2018 ◽  
Vol 25 (3) ◽  
pp. 125-128
Author(s):  
N. E. SHABANOVA ◽  
G. YU. MODEL ◽  
O. G. NI ◽  
I. N. OCHAKOVSKAYA ◽  
L. V. PETROVA
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Medical Unit ◽  
Clinical Hospital ◽  
Microbiological Monitoring ◽  
Significant Difference ◽  
Perinatal Center ◽  
Krasnodar Region

Aim. To compare proportion of different microorganisms in neonatal intensive care units and to assess bacterial susceptibility to antimicrobial agents.Materials and methods. Microbiological monitoring was carried out in neonatal intensive care units (NICU) №1 and №2 of Perinatal center of Krasnodar Region clinical hospital №2.Results. The results of microbiological monitoring demonstrated significant difference in proportions and susceptibility of detected microorganisms.Conclusion. The detected differences determine the need to develop protocols of empirical antimicrobial therapy separately for each medical unit.

Necrotising enterocolitis in newborns receiving diazoxide

2020 ◽  
pp. fetalneonatal-2020-319057
Author(s):  
Laura A Prado ◽  
Marina Castro ◽  
Dany E Weisz ◽  
Amish Jain ◽  
Jaques Belik
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Necrotising Enterocolitis ◽  
Neonatal Intensive Care Units ◽  
Feeding Intolerance ◽  
Neonatal Hypoglycaemia ◽  
Older Children ◽  
Network Database

BackgroundFrequent and severe gastrointestinal disturbances have been reported with the use of diazoxide in adults and older children. However, no studies have investigated the incidence of necrotising enterocolitis (NEC) in diazoxide-exposed newborns.ObjectiveTo evaluate a possible association between diazoxide treatment for neonatal hypoglycaemia and the occurrence of NEC.DesignMulticentre retrospective cohort study.SettingThree tertiary neonatal intensive care units in Toronto, Canada.PatientsAll patients treated with diazoxide for persistent hypoglycaemia between July 2012 and June 2017 were included. Overall incidence of NEC during those years on the participating units was obtained for comparison from the Canadian Neonatal Network database.Main outcomeIncidence of NEC after diazoxide exposure.ResultsFifty-five neonates were exposed to diazoxide during the study period. Eighteen patients (33%) showed signs of feeding intolerance, and 7 developed NEC (13%). A diagnosis of NEC was more prevalent in the diazoxide-exposed, as compared with non-exposed infants of similar gestational age (OR 5.07, 95% CI 2.27 to 11.27; p<0.001), and greatest among infants born at 33–36 weeks’ gestation (OR 13.76, 95% CI 3.77 to 50.23; p<0.001). All but one of the neonates diagnosed with NEC developed the disease within 7 days from initiation of diazoxide treatment.ConclusionThe present data suggest a possible association between diazoxide exposure and the development of NEC in neonates. Further evaluation of the diazoxide-associated risk of NEC in neonates treated for persistent hypoglycaemia is warranted.

scholarly journals 39 Care Home Liaison Role- Bridging the Gap Between Acute Hospitals and Care Homes

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i11-i13
Author(s):  
C Sendall ◽  
P Wright ◽  
R Downes
Keyword(s):  
Hospital Admissions ◽  
Positive Impact ◽  
Care Home ◽  
Care Homes ◽  
Care Plan ◽  
Patient Pathways ◽  
Number Of Patients ◽  
Significant Difference ◽  
Acute Hospitals ◽  
Liaison Nurse

Abstract Introduction There are over 400,000 people over 65 in UK care homes, three times the number than that in acute hospitals. They are amongst the frailest in our community, with average life expectancy of 15months once in the home. Their needs are often complex and challenging, which when unmet, often result in unwanted and unnecessary hospital admissions. Imperial College Healthcare Trust (ICHT), along with funding from Health Education England (HEE), have introduced a care home liaison nurse. The aim is to bridge the boundaries, making a significant difference to cross organisation communication and support. Methods The care home liaison nurse manages a frailty liaison service with the largest local nursing care home. This home has 140 residents with complex needs. The care home liaison nurse provides a point of contact for advice, guidance and support for individual patient pathways, she provides face to face assessment and treatment or verbal advice. In addition, the nurse supports discharge from the acute setting. This direct contact allows rapid access to specialist advice, and aims to build confidence both within the care home team and within the acute team, that the patients’ needs can be met in their own surroundings. Results The preliminary data demonstrates a positive impact this role is having both to the acute trust and most importantly patient’s experience. Comparing ICHT data from April-May 2018 to April-May 2019 it showing that the number of avoidable admissions has decreased from 54.3% to 37.5%, length of stay when patients are admitted has decreased from 11.7 days to 6.5 days, and the number of patients with an advanced care plan has risen 14.9%. Feedback from nursing staff at the care centre as well as that from patients and families has been overwhelmingly positive. Conclusions The role is still in the pilot phase. Given the already positive impact it is hoped that it will continue and expand into other care homes and extra sheltered accommodations.

Admissions for Stroke and Strategies to Optimize Healthcare Delivery During the COVID-19 Pandemic - Experience from a Tertiary Care Hospital in South India

2021 ◽  
Vol 8 (36) ◽  
pp. 3300-3305
Author(s):  
Kevin John John ◽  
Rhea Anne Roy ◽  
Bincy Baby ◽  
Deep P. Pillai ◽  
Anilkumar Sivan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Hospital Type ◽  
Stroke Incidence ◽  
Nihss Score ◽  
Number Of Patients ◽  
Significant Difference ◽  
Time Periods

BACKGROUND COVID-19 is associated with a hypercoagulable state and stroke is one of its most common neurological complications. The current study is aimed at investigating the effect of the COVID-19 pandemic on hospital admissions for stroke. METHODS We conducted a retrospective observational study to determine if there was a significant difference in the number of hospital admissions for stroke during the 2 months of lockdown and the two preceding months, (starting on 24 March 2020). The numbers were also compared with the figures during the same months in the previous year. The numbers were also compared to the same months one year prior. The secondary objectives were to compare the time between the onset of stroke and presentation to the hospital, type of strokes that presented to the hospital, severity of stroke, number of code activations, number of thrombolysis conducted, and in-hospital mortality between the same time periods. RESULTS The total number of patients admitted for stroke during the time periods from 25th March 2019 to 24th May 2019, 25th January 2020 to 24th March 2020 and 25th March 2020 to 24th May 2020 were 82, 72 and 75 respectively, and there was no statistically significant difference between these numbers. However, there was a significant increase in the proportion of stroke cases when compared to total hospital admissions. This suggests that an increase in stroke incidence may have been masked by a reduction in the total number of patients presenting to the hospital. The National Institutes of Health Stroke Scale (NIHSS) score of the patients who presented during the lockdown were higher. There were no significant differences in the time between the onset of stroke and presentation to the hospital, type of strokes that presented to the hospital, severity of stroke, number of code activations, number of thrombolysis conducted, and in-hospital mortality between the periods under study. CONCLUSIONS The present study suggests that there may be a relative increase in the incidence of stroke in the community, as a result of the COVID-19 pandemic. The patients who presented with stroke during the lockdown period had a higher NIHSS score. KEYWORDS COVID-19, Stroke, Lockdown

scholarly journals Hospital infections in neonatal intensive care units

2005 ◽  
Vol 58 (9-10) ◽  
pp. 490-493
Author(s):  
Jasna Djurisic ◽  
Ljiljana Markovic-Denic ◽  
Slobodanka Ilic ◽  
Ruzdi Ramadani
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Hospital Infections ◽  
Hospital Acquired Infections ◽  
Number Of Patients ◽  
Increased Risk ◽  
Hospital Acquired ◽  
Epidemiological Characteristics

Introduction Sick newborn babies in the neonatal intensive care units (NICU) are al increased risk for hospital-acquired infections (HI). The aim of our study was to determine the incidence and localization of neonatal hospital infections in NICU. Material and methods A prospective, six-month study was carried out in a NICU. All patients hospitalized in NICU longer then 48 hours were examined according to their basic descriptive-epidemiological characteristics and the incidence of all hospital-acquired infections (diagnosed using CDC criteria) were accounted for. Results The incidence of patients with HI was 46.1% while the incidence of HI was 57.2%. On the basis of patients' records in the NICU, the incidence of HI was 43.9 per WOO patient- hospital days. Patients with HI were hospitalized significantly longer in NICU than patients without HI (t=9.2 DF=267 p<0.001). In terms of localization of HI, a large number of patients had pneumonia - 74.7% (115/154), followed by sepsis (37/154), while two had meningitis. Conclusion This study suggests that it is necessary to maintain continuous surveillance of HI in NICU, as well as infection control measures, which are also very beneficial.

scholarly journals Extremely preterm infant admissions within the SafeBoosC-III consortium during the COVID-19 lockdown

2020 ◽  
Author(s):  
Marie Isabel Rasmussen ◽  
Mathias Lühr Hansen ◽  
Gerhard Pichler ◽  
Eugene Dempsey ◽  
Adelina Pellicer ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Ad Hoc ◽  
Preterm Births ◽  
Neonatal Intensive Care Units ◽  
Time Period ◽  
Extremely Preterm ◽  
Significant Difference ◽  
The Everyday ◽  
Local Impact ◽  
Major Reduction

AbstractObjectiveTo evaluate if the number of admitted extremely preterm (EP) infants (born before 28 weeks of gestational age) has changed in the neonatal intensive care units (NICUs) of the SafeBoosC-III consortium during the global lockdown when compared to the corresponding time period in 2019.DesignThis is a retrospective, observational study. Forty-six out of 79 NICUs (58%) from 17 countries participated. Principal investigators were asked to report the following information: 1) Total number of EP infant admissions to their NICU in the three months where the lockdown restrictions were most rigorous during the first phase of the COVID-19 pandemic, 2) Similar EP infant admissions in the corresponding three months of 2019, 3) the level of local restrictions during the lockdown period and 4) the local impact of the COVID-19 lockdown on the everyday life of a pregnant woman.ResultsThere was no significant difference between the number of EP infant admissions during the three most rigorous lockdown months of the COVID-19 pandemic compared to the corresponding three months in 2019 (n=428 versus n=457 respectively, p=0.33). There were no significant changes within individual geographic regions and no significant association between the level of lockdown restrictions and change in the number of EP infant admissions (p=0.334).ConclusionThis larger ad hoc study did not confirm previous studies’ report of a major reduction in the number of extremely preterm births during the first phase of the COVID-19 pandemic.

scholarly journals Obstetric and neonatal outcomes of gestational diabetes mellitus in twin pregnancies according to changes in its diagnostic criteria from National Diabetes Data Group criteria to Carpenter and Coustan criteria: a retrospective cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Yejin Kim ◽  
Sir-yeon Hong ◽  
Seo-yeon Kim ◽  
Yoo-min Kim ◽  
Ji-Hee Sung ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Gestational Diabetes ◽  
Diagnostic Criteria ◽  
Retrospective Cohort ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Period 2 ◽  
Twin Pregnancies ◽  
Data Group

Abstract Background To compare obstetric and neonatal outcomes in twin pregnancies with or without gestational diabetes mellitus (GDM) before and after changes in GDM diagnostic criteria. Methods This was a retrospective cohort study of 1,764 twin pregnancies including 130 women with GDM (GDM group) and 1,634 women without GDM (non-GDM group). Patients with pregestational diabetes, unknown GDM status, and fetal death at < 24 gestational weeks were excluded. Obstetric and neonatal outcomes were compared between the two groups by two periods: period 1 (1995–2005) and period 2 (2005–2018) when National Diabetes Data Group criteria and Carpenter and Coustan criteria were used for diagnosis of GDM, respectively. Results The incidence of GDM in twin pregnancies increased from 4.0% in period 1 to 9.3% in period 2. Composite obstetric complications rate was significantly higher in the GDM group than that in the non-GDM group during period 1 (72.0% vs. 45.5%, P = 0.009). However, it became comparable during period 2 (60.0% vs. 57.4%, P = 0.601). Interaction between GDM and period indicated a significant differential effect of GDM by period on the rate of composite obstetric complications. The rate of composite neonatal complications was similar between the two groups during both periods. The interaction between GDM and period was not significant. Conclusion After changes of GDM diagnostic criteria, the incidence of GDM increased more than twice, and the rate of composite obstetric complications decreased, but the rate of composite neonatal complications did not change significantly.

scholarly journals Sildenafil Exposure in the Neonatal Intensive Care Unit

2018 ◽  
Vol 36 (03) ◽  
pp. 262-267 ◽  
Author(s):  
Elizabeth Thompson ◽  
Krystle Perez ◽  
P. Smith ◽  
Reese Clark ◽  
Matthew Laughon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Meconium Aspiration ◽  
Safety And Efficacy ◽  
Respiratory Outcome ◽  
Pulmonary Arterial ◽  
Substantial Morbidity

Objective Pulmonary hypertension causes substantial morbidity and mortality in infants. Although Food and Drug Administration approved to treat pulmonary arterial hypertension in adults, sildenafil is not approved for infants. We sought to describe sildenafil exposure and associated diagnoses and outcomes in infants. Study Design Retrospective cohort of neonates discharged from more than 300 neonatal intensive care units from 2001 to 2016. Results Sildenafil was administered to 1,336/1,161,808 infants (0.11%; 1.1 per 1,000 infants); 0/35,977 received sildenafil in 2001 versus 151/90,544 (0.17%; 1.7 per 1,000 infants) in 2016. Among infants <32 weeks' gestational age (GA) with enough data to determine respiratory outcome, 666/704 (95%) had bronchopulmonary dysplasia (BPD). Among infants ≥32 weeks GA, 248/455 (55%) had BPD and 76/552 (14%) were diagnosed with meconium aspiration. Overall, 209/921 (23%) died prior to discharge. Conclusion The use of sildenafil has increased since 2001. Exposed infants were commonly diagnosed with BPD. Further studies evaluating dosing, safety, and efficacy of sildenafil are needed.

Continuity of Nurse Caregivers in the Neonatal Intensive Care Unit

2016 ◽  
Vol 22 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Margaret Doyle Settle
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Social Competencies ◽  
Significant Difference ◽  
Conservation Model ◽  
Relationship Of ◽  
The Relationship

There is growing evidence that continuity of nurse caregivers (CNC) has an effect on outcomes for infants admitted to neonatal intensive care units. Using Levine’s conservation model, the relationship of infant acuity and CNC for 50 infants born between 24 and 40 weeks gestation was explored. A statistically significant difference was found between the variable acuity and CNC (F = 8.65, p = .01). Results suggest that high infant acuity is strongly related to high CNC but may be the effect of a third variable. CNC may support the emergence of physiological, structural, and social competencies for convalescing premature infants.

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