The Effect of the Transfusion Protocol on Transfusion Rates and Short-term Outcomes of Preterm Infants in a Tertiary Neonatal Intensive Care Unit

2021 ◽  
Author(s):  
Emel Okulu ◽  
Yasemin Ezgi Kostekci ◽  
Elvis Kraja ◽  
Omer Erdeve ◽  
Saadet Arsan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Inverse Relationship ◽  
Short Term ◽  
Total Blood ◽  
Period 2 ◽  
Before And After ◽  
Transfusion Guidelines ◽  
Transfusion Protocol ◽  
Rbc Transfusion

Background: The aim of this study was to compare the epochs before and after the revision of the transfusion guideline, and determine their effects on transfusion rates and short-term outcomes in preterm infants. Materials and Methods: This retrospective study was conducted to investigate the effect of the new transfusion guideline. Infants who were born <32 weeks of gestation and received red blood cell (RBC) transfusion in their first 6-weeks of life were divided into two epochs according to adopting the new transfusion guideline. The demographic and clinical data of the patients were compared between these two periods. Results: Fifty-six infants were included (Period 1, n=22; Period, n=34). The number of transfusions, total and cumulative volume of the transfusions were similar in the two periods. There was an inverse relationship between the gestational age and the number of transfusions in both periods (r=-0.575, p=0.005, and r=-0.494, p=0.003), and there was an inverse relationship between the birth weight and the number of transfusions in period 2 (r=-0.423, p=0.013). The ratio of total phlebotomy volume to estimated total blood volume was higher in period 2 (p=0.029). There was a direct relationship between the phlebotomy loss and volume of RBC transfused in period 2 (r=0.487, p=0.003). The incidence of morbidities was similar in the two periods. Conclusion: Changing only the transfusion protocol did not decrease the transfusion number. Although transfusion guidelines were adopted rigorously, it seems to be impossible to reduce RBC transfusion rates unless anemia prevention strategies were also in place.

scholarly journals The value of autopsy in preterm infants at a Swedish tertiary neonatal intensive care unit 2002–2018

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alice Hoffsten ◽  
Laszlo Markasz ◽  
Katharina Ericson ◽  
Leif D. Nelin ◽  
Richard Sindelar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Causes Of Death ◽  
Perinatal Care ◽  
Clinical Findings ◽  
Period 2 ◽  
Centralized Care

AbstractReliable data on causes of death (COD) in preterm infants are needed to assess perinatal care and current clinical guidelines. In this retrospective observational analysis of all deceased preterm infants born < 37 weeks’ gestational age (n = 278) at a Swedish tertiary neonatal intensive care unit, we compared preliminary COD from Medical Death Certificates with autopsy defined COD (2002–2018), and assessed changes in COD between two periods (period 1:2002–2009 vs. period 2:2011–2018; 2010 excluded due to centralized care and seasonal variation in COD). Autopsy was performed in 73% of all cases and was more than twice as high compared to national infant autopsy rates (33%). Autopsy revised or confirmed a suspected preliminary COD in 34.9% of the cases (23.6% and 11.3%, respectively). Necrotizing enterocolitis (NEC) as COD increased between Period 1 and 2 (5% vs. 26%). The autopsy rate did not change between the two study periods (75% vs. 71%). We conclude that autopsy determined the final COD in a third of cases, while the incidence of NEC as COD increased markedly during the study period. Since there is a high risk to determine COD incorrectly based on clinical findings in preterm infants, autopsy remains a valuable method to obtain reliable COD.

scholarly journals Preterm infants comfort before and after capillary blood sampling procedure

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Karolina Balciunaite ◽  
Alina Vaskelyte
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Inverse Relationship ◽  
Sampling Procedure ◽  
Capillary Blood ◽  
Blood Sampling ◽  
University Hospital ◽  
Negative Consequences ◽  
Before And After ◽  
Capillary Blood Sampling

Abstract Background Because of the immaturity and severe condition preterm infants undergoes a lot of painful and stressful procedures during their care that can cause short-term and long-term negative consequences. Maintenance of optimal comfort is essential for good clinical practice. To assess the comfort of preterm infants before and after the capillary blood sampling procedure. Methods The quantitative observational study was conducted in May 2019—February 2020 in the University hospital NICU. The research instrument was a neonatal comfort scale COMFORTneo, which total scores ranged 6–30. Higher scores indicated higher discomfort. Preterm infant comfort was assessed before the capillary blood sampling procedure and 30 min. after applying non-pharmacological pain relief and comfort assurance methods and implementing the procedure. The research was conducted in accordance with ethical principles. Results Comfort was assessed in 157 preterm newborns with a gestational age of 30 ± 3.3 weeks and a postnatal age of 6.0 ± 5.7 days. The mean value of neonatal comfort before the capillary blood sampling procedure was 10.0 ± 3.2 points, after the procedure 9.1 ± 2.4 points. A statistically significant inverse relationship was found between pre-procedure and post-procedure comfort (Z = -5.374; P &lt; 0.001). A statistically significant weak inverse relationship was found between gestational age and comfort scores before the procedure (r = -0.204; P = 0.01) and after the procedure (r = -0.321; P = 0.008). Conclusions In most cases, preterm infants were feeling moderate discomfort before and after the capillary blood sampling procedure. Newborns had more discomfort before the procedure than 30 min. after the completion of the procedure. Lower gestational age newborns were feeling greater discomfort.

Short-Term Outcomes following Standardized Admission of Late Preterm Infants to Family-Centered Care

2019 ◽  
Author(s):  
Jonathan Reiss ◽  
Pavan S. Upadhyayula ◽  
Hyeri You ◽  
Ronghui Xu ◽  
Lisa M. Stellwagen
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Transitions Of Care ◽  
Late Preterm ◽  
Family Centered Care ◽  
Short Term ◽  
Late Preterm Infants ◽  
Car Seat ◽  
Centered Care ◽  
Family Centered

Abstract Objective The study compares the short-term outcomes of late preterm infants (LPI) at an academic center in San Diego, California after a change in protocol that eliminated a previously mandatory 12-hour neonatal intensive care unit (NICU) observation period after birth. Study Design This is a retrospective observational study examining all LPI born with gestational age 35 to 366/7 weeks between October 1, 2016 and October 31, 2017. A total of 189 infants were included in the review. Short-term outcomes were analyzed before and after the protocol change. Results Transfers to the NICU from family-centered care (FCC) were considerably higher (23.2%) following the protocol change, compared to before (8.2%). More infants were transferred to the NICU for failed car seat tests postprotocol compared to preprotocol. Length of stay before the protocol change was 5.13 days compared to 4.80 days after. Conclusion LPI are vulnerable to morbidities after delivery and through discharge. We found an increase in failed car seat tests in LPI cared for in FCC after elimination of a mandatory NICU observation after birth. The transitions of care from delivery to discharge are key checkpoints in minimizing complications.

Association of Resident Duty Hour Reform and Neonatal Outcomes of Very Preterm Infants

2017 ◽  
Vol 34 (14) ◽  
pp. 1396-1404
Author(s):  
Bruno Piedboeuf ◽  
Robert Platt ◽  
Keith Barrington ◽  
Victoria Bizgu ◽  
Prakesh Shah ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Neonatal Intensive Care Units ◽  
Composite Outcome ◽  
Major Morbidity ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Before And After ◽  
Resident Duty

Objective To assess the association of the 2011 Quebec provincial resident duty hour reform, which reduced the maximum consecutive hours worked by all residents from 24 to 16 hours, with neonatal outcomes. Study Design Retrospective observational study of 4,271 infants born between 23 and 32 weeks, admitted at five Quebec neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network (CNN) between 2008 and 2015 was conducted. Adjusted odds ratios (AORs) were calculated to compare mortality and the composite outcome of mortality or major morbidity before and after the implementation of the duty hour reform. Results The mortality rate was 8.4% (218/2,598) before the resident duty hour reform and 8.6% (182/2,123) after the reform (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.83–1.26). The composite outcome rate was 32% (830/2,598) before the duty hour reform and 29% (615/2,123) after the reform (OR = 0.87, 95% CI = 0.77–0.98). In the adjusted analyses, the resident call-hour reform was not associated with a significant change in mortality (AOR = 1.17, 95% CI = 0.91–1.50) or composite outcome (AOR = 0.87, 95% CI = 0.74–1.03). Conclusion Reducing residents' duty hours from 24 to 16 hours in Quebec was not associated with a difference in mortality or the composite outcome of very preterm infants.

scholarly journals Cardiorespiratory monitoring of red blood cell transfusions in preterm infants

2021 ◽  
Author(s):  
Jarinda A. Poppe ◽  
Tanja van Essen ◽  
Willem van Weteringen ◽  
Sten P. Willemsen ◽  
Irwin K. M. Reiss ◽  
...  
Keyword(s):  
Blood Cell ◽  
Preterm Infants ◽  
Red Blood Cell ◽  
Hemoglobin Concentration ◽  
Repeated Measurements ◽  
Before And After ◽  
Red Blood Cell Transfusions ◽  
Monitor Data ◽  
Preterm Newborns ◽  
Rbc Transfusion

AbstractClinical improvement after red blood cell (RBC) transfusions in preterm infants remains debated. This study aims to investigate the effect of RBC transfusion on the occurrence of desaturations and hypoxia, and other cardiorespiratory outcomes in preterm infants. In this longitudinal observational study, prospectively stored cardiorespiratory parameters of preterm infants who received at least one RBC transfusion between July 2016 and June 2017 were retrospectively analyzed. Sixty infants with 112 RBC transfusions, median GA of 26.7 weeks, were included. The number of desaturations and area < 80% SpO2 limit, as a measure of the hypoxic burden, were calculated in 24 h before and after RBC transfusion. A mixed effects model was used to account for repeated measurements. Overall, the mean (SE) number of desaturations per hour decreased from 3.28 (0.55) to 2.25 (0.38; p < 0.001), and area < 80% SpO2 limit decreased from 0.14 (0.04) to 0.08 (0.02) %/s (p = 0.02). These outcomes were stratified for the number of desaturations in 24 h prior to RBC transfusion. The largest effect was observed in the group with the highest mean number of desaturations (≥ 6) prior to RBC transfusion, with a decrease from 7.50 (0.66) to 4.26 (0.38) (p < 0.001) in the number of desaturations and 0.46 (0.13) to 0.20 (0.06) in the area < 80% SpO2. Perfusion index increased significantly after RBC transfusion (p < 0.001). No other significant effects of RBC transfusion on cardiorespiratory data were observed.Conclusions: RBC transfusions in preterm newborns could help decrease the incidence of desaturations and the area < 80% SpO2 as a measure of the hypoxic burden. The higher the number of desaturations prior to the RBC transfusion, the larger the effect observed. What is Known:•Red blood cell transfusions potentially prevent hypoxia in anemic preterm infants by increasing the circulatory hemoglobin concentration and improving tissue oxygenation.•There is not a predefined hemoglobin concentration cut-off for the occurrence of symptomatic anemia in preterm infants. What is New:•Oxygen desaturations and hypoxia in anemic preterm infants can be improved by RBC transfusions, especially if more desaturations have occurred before transfusion.•Cardiorespiratory monitor data may help identify infants who will benefit most from red blood cell transfusions.

Fat-Soluble Vitamin Supplements for Enterally Fed Preterm Infants

2001 ◽  
Vol 20 (5) ◽  
pp. 7-11 ◽  
Author(s):  
Frank Greer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Low Birth Weight Infants ◽  
Important Concern ◽  
Before And After ◽  
Vitamin Requirements

Fat-soluble vitamin requirements for the enterally fed premature infant are an important concern, both before and after discharge from the neonatal intensive care unit. Because preterm infants fed unsupplemented human milk receive deficient quantities of these vitamins (A, D, E, and K), supplements are very important for this population. Vitamin intakes with special formulas for low birth weight infants and human milk fortifiers are also reviewed.

scholarly journals Quality Improvement to Increase Breastfeeding in Preterm Infants: Systematic Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Lingyu Fang ◽  
Lianqiang Wu ◽  
Shuping Han ◽  
Xiaohui Chen ◽  
Zhangbin Yu
Keyword(s):  
Quality Improvement ◽  
Publication Bias ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Meta Analysis ◽  
Interrupted Time Series ◽  
Primary Outcome Measure ◽  
Cochrane Library ◽  
Term Infants ◽  
Before And After

Background and Objective: Due to its numerous health benefits, breast milk (BM) is recommended for preterm infants. Despite such recommendations, the rates of breastfeeding in preterm infants are lower than that in term infants. Quality improvement (QI) bundles increase breastfeeding in preterm infants, but their replication in neonatal intensive care units has had inconsistent outcomes.Methods: We used the Population or Problem, Intervention, Comparison, and Outcomes (PICO) framework to develop our search strategy, and searched MEDLINE, Embase, and the Cochrane Library from inception through January 15, 2021. Studies describing any active QI intervention to increase BM use in preterm infants were included. The primary outcome measure was the rate of any breastfeeding or exclusive mother's own milk (MOM) at discharge or during hospitalization.Results: Sixteen studies were eligible for inclusion and showed an acceptable risk of bias, and included 1 interrupted time series, study 3 controlled before-and-after studies, and 12 uncontrolled before-and-after studies; of these, 3 studies were excluded due to insufficient dichotomous data, 13 were included in the meta-analysis. In the meta-analysis, the rate of any breastfeeding was significantly improved at discharge and during hospitalization after QI [risk ratio (RR) = 1.23, 95% confidence interval (CI): 1.14–1.32, P &lt; 0.00001 and RR = 1.89, 95% CI: 1.09–3.29, P = 0.02, respectively]. The rate of exclusive MOM after QI was also significantly increased at discharge (RR = 1.51, 95% CI: 1.04–2.18, P = 0.03), but not during hospitalization (RR = 1.53, 95% CI: 0.78–2.98, P = 0.22). However, after sensitivity analysis, the comprehensive results still suggested that QI could significantly improve the rate of exclusive MOM during hospitalization (RR = 1.21, 95% CI: 1.08–1.35, P = 0.001). Funnel plots and Egger's test indicated publication bias in the rate of any BF at discharge. We corrected publication bias by trim and fill analysis, and corrected RR to 1.272, 95% CI: (1.175, 1.369), which was consistent with the results of the initial model.Conclusions: A QI bundle appears to be effective for promoting BM use in preterm infants at discharge or during hospitalization.

Short-term Pasteurization of Breast Milk to Prevent Postnatal Cytomegalovirus Transmission in Very Preterm Infants

2018 ◽  
Vol 69 (3) ◽  
pp. 438-444 ◽  
Author(s):  
Sascha Bapistella ◽  
Klaus Hamprecht ◽  
Wolfgang Thomas ◽  
Christian P Speer ◽  
Klaus Dietz ◽  
...  
Keyword(s):  
Breast Milk ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Severe Illness ◽  
Short Term ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Cox Proportional Hazard ◽  
Level 3 ◽  
Historical Controls

Abstract Background Postnatally acquired cytomegalovirus (pCMV) infection through breast milk (BM) may cause severe illness and even death, yet BM is advantageous for preterm infants. Therefore, effective methods to prevent CMV transmission are needed. Methods To assess the effectiveness of short-term pasteurization (62°C for 5 seconds) in preventing CMV transmission via BM in preterm infants. Design: Prospective interventional bicentric cohort study with infant enrollment between 6/2010 and 1/2012. A cohort from the Tuebingen neonatal intensive care unit (NICU) from 1995–1998 served as historical controls. Differences in CMV transmission were compared with reference to the cumulative time at risk for CMV transmission. Setting: Two German level-3 NICUs. Eighty-seven preterm infants of 69 CMV immunoglobulin G-positive mothers with birth weight <1500 g or gestational age <32 weeks and 83 historical controls were included. Intervention: BM samples were short-term pasteurized from postnatal day 4 to discharge. Primary endpoint: CMV status at discharge, evaluated by polymerase chain reaction and short-term microculture from urine. Results Two of 87 (2.3%) study infants had a pCMV transmission. This compared to 17 of 83 (20.5%) controls. Total time under risk for infection was 9.6 years vs 10.0 years in controls, yielding an incidence of 0.21/year (95% confidence interval [CI], 0.03 to 0.75/year) vs 1.70/year (95% CI, 0.99 to 2.72/year), respectively. The risk ratio controls vs study infants was 8.3 (95% CI, 2.4 to 52.4) according to Cox proportional hazard model (P = .0003). Conclusions Short-term pasteurization significantly reduces the incidence of pCMV infection through BM in the NICU. Clinical Trials Registration NCT01178905.

Retrospective Analysis of Short-Term Respiratory Outcomes of Three Different Steroids Used in Clinical Practice in Intubated Preterm Infants

2019 ◽  
Vol 37 (14) ◽  
pp. 1425-1431 ◽  
Author(s):  
Sfurti Nath ◽  
Anne Marie Reynolds ◽  
Satyan Lakshminrusimha ◽  
ChangXing Ma ◽  
Mark L. Hudak ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Low Dose ◽  
Clinical Decision Making ◽  
Quantitative Measure ◽  
Short Term ◽  
Neurodevelopmental Outcomes ◽  
Respiratory Status ◽  
Short Course ◽  
Respiratory Outcomes

Objective This study aimed to compare short-term respiratory outcomes of three steroids (dexamethasone, hydrocortisone, and methylprednisolone) to facilitate extubation by improving respiratory status in preterm infants. Study Design This is a retrospective, single-center, cohort study of 98 intubated preterm infants ≤346/7 weeks' gestation, admitted to a 64-bed, level III neonatal intensive care unit at the Women & Children's Hospital of Buffalo, Buffalo, NY, between 2006 and 2012, who received a short course of low-dose steroids for lung disease after first week of life. Results Study infants received dexamethasone (34%), hydrocortisone (44%), or methylprednisolone (22%) based on clinical team preference. By day 7 after initiation of steroids, extubation occurred in 59, 44, and 41%, respectively, in infants on dexamethasone, hydrocortisone, and methylprednisolone (p = 0.3). The mean respiratory severity score (RSS = fraction of inspired oxygen × mean airway pressure), a quantitative measure of respiratory status, decreased by 44% for all infants and by 59% in the dexamethasone group by day 7. Conclusion Steroids improved short-term respiratory outcomes in all infants (RSS and extubation); by day 7, dexamethasone treatment was associated with the greatest decrease in RSS. Additional prospective, randomized trials of short-course low-dose steroids are warranted to substantiate these findings to guide clinical decision making and in evaluating differential steroid effects on long-term neurodevelopmental outcomes.

Considerations for Touch and Massage in the Neonatal Intensive Care Unit

2000 ◽  
Vol 19 (1) ◽  
pp. 61-64 ◽  
Author(s):  
Joy Browne
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Short Term ◽  
Term Infants ◽  
Developmental Care ◽  
The Family ◽  
Potential Impact

AN EXPANDING BODY OF research has documented the short-term advantages of gentle touch and massage for healthy term infants and some growing and medically stable preterm infants. These findings have provided the impetus for extension of massage techniques to very small, fragile newborns, promoting the utilization of new personnel in NICUs specifically to provide massage therapy for newborns. It is important, before engaging in these approaches, for professionals in the NICU to consider the potential impact of massage on the infant and the family. It is also imperative that professionals in the NICU take into account the current growing knowledge base regarding developmental care and the implications for decision making regarding provision of stimuli of any sort to fragile, sick newborns in the NICU.

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