scholarly journals Targeted Quality Improvement Project Dramatically Reduced Admission Hypothermia in Very Low Birth Weight Infant in China: A Multicentre Study

2020 ◽  
Author(s):  
Li Wang ◽  
Yong-hui Yu ◽  
Zhi-jie Liu ◽  
Feng-min Liu ◽  
Shu-yu Bi ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Very Low Birth Weight ◽  
Tertiary Care ◽  
Improvement Project ◽  
Vlbw Infants ◽  
Targeted Interventions ◽  
Medical University

Abstract Background: Hypothermia is still a common problem and is associated with increased mortality and morbidity in preterm infants, especially in China. The objective of this study was to evaluate the efficacy of a targeted quality improvement (QI) project of hypothermia preventive measures in very low-birth weight (VLBW) infants in 3 tertiary neonatal intensive care unit (NICU) in China.Methods: Based on the literature, our preliminary findings and the needs of each unit, our team decided to focus efforts on equipment (transport incubator, pre-warmed hats and polyethylene wrap), team training and education, as well as temperature documentation and workflow. The primary outcome measure was the incidence of hypothermia, defined as temperature (rectal temperature) below 36.5ºC on admission to the NICU. This quality improvement (QI) initiative used the rapid cycle Plan - Do - Study - Act (PDSA) approach. The outcomes of pre–quality improvement (pre-QI) group (January 1, 2018– December 31, 2018) were compared with post-QI group (January 1, 2019–December 31, 2019). The study enrolled preterm infants born at less than 32 weeks’ gestation with very low birth weight less than 1500 g born at 3 academic, tertiary-care hospitals including Shandong Provincial Hospital, The First Affiliated Hospital of Shandong First Medical University, LiaoCheng People’s Hospital Affiliated to Shandong First Medical University between January 2018 and December 2019.Results: A total of 636 VLBW infants were included in this analysis, of which 235 infants (36.9%) were included in the pre-QI group and 295 infants (46.4%) in the post-QI group. The incidence of hypothermia decreased significantly from 92.3% to 62% (P < 0.001), and the mean body temperature on admission to NICU increased significantly from 35.5˚C to 36˚C (P < 0.001). There were one cases (0.3%) of neonatal hyperthermia. Infants in the post-QI group had lower rates of mortality (16.1% vs 8.8%, P = 0.01). Conclusions: Targeted interventions can dramatically reduce admission hypothermia and improve the outcome of VLBW infants in China.

scholarly journals A multicentre study on admission hypothermia in very low-birth weight preterm infants in China: distribution, causes and risk factors

2019 ◽  
Author(s):  
Yong-hui Yu ◽  
Li Wang ◽  
Xiao-yu Dong ◽  
Wen Li ◽  
Lei Huang ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Negative Correlation ◽  
Apgar Score ◽  
Very Low Birth Weight ◽  
Delivery Room ◽  
Vlbw Infants ◽  
Improvement Measures

Abstract Background Neonatal hypothermia, defined as a temperature < 36.5°C, is a major contributor to neonatal mortality and morbidity. Hypothermia in preterm infants remains a challenge in the neonatal intensive care unit (NICU) for many reasons.Objective To investigate the incidence of admission hypothermia (AH) in very low-birth weight (VLBW) infants in multiple NICUs in Shandong Province, China, and to provide clinical evidence for the implementation of quality improvement practices to reduce the incidence of AH in NICU.Methods This retrospective, observational study was carried out over a period of 12 months, from January 1, 2018 to December 31, 2018. The correlations between hypothermia preventive measures and the incidence of AH were analysed by descriptive statistical methods and a Spearman analysis. The associations between AH and maternal and neonatal variables were tested with bivariate analyses, followed by stepwise logistic regression. P <0.05 was considered statistically significant.Results A total of 1639 in-born infants who were born at a weight less than 1500 g were enrolled in the study on their day of birth. Among them, 1295 VLBW infants fulfilled the inclusion criteria. The incidence of AH was 87.9% in VLBW infants among the 28 NICUs. We investigated whether team training and education, such as monthly chart reporting on hypothermia in preterm infants on admission to the NICU, which was associated with 10.7% of all the cases, could decrease the rate of AH. Indeed, transport with a heated transport incubator was associated with 9.3% of the cases. here was a negative correlation between the incidence of AH and the number of quality improvement measures implemented to prevent hypothermia (r= -0.242, p <0.05). A low birth weight, intubation in the delivery room , and a low 5-min Apgar score were significantly associated with AH. Conclusion: The incidence of AH was high. There was a negative correlation between the incidence of AH and the number of quality improvement measures implemented to prevent hypothermia. It is important to monitor for AH in newborns who have a low birth weight, who have a low Apgar score at 5 min and who require intubation in the delivery room.

scholarly journals Dose-dependent effect of human milk on Bronchopulmonary dysplasia in very low birth weight infants

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yan Xu ◽  
Zhangbin Yu ◽  
Qianqian Li ◽  
Jinjun Zhou ◽  
Xiaoguang Yin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Very Low Birth Weight ◽  
Research Database ◽  
Vlbw Infants ◽  
Dose Dependent

Abstract Background and aim Human milk has potential protective effects against bronchopulmonary dysplasia (BPD). However, studies on the association between the dose of human milk and BPD in China are limited. This study aimed to evaluate the dose-dependent effects of human milk on BPD and other neonatal morbidities in very low birth weight (VLBW) infants. Methods This retrospective cohort study of preterm infants was conducted on preterm infants of gestational age ≤ 34 weeks and birth weight < 1500 g admitted to the multicenter clinical research database for breastfeeding quality improvement in Jiangsu province. The multivariate analysis was performed to compare the effect outcomes of daily graded doses [1–24 mL/(kg · day), 25–49 mL/(kg · day), and ≥ 50 mL/(kg · day) of body weight] of human milk on neonatal outcomes throughout the first 4 weeks of life versus a reference group receiving no human milk. The models were adjusted for potential confounding variables. Results Of 964 included infants, 279 (28.9%) received exclusive preterm formula, 128 (13.3%) received 1–24 ml/(kg · day), 139 (14.4%) received 25–49 ml/(kg · day), and 418 (43.4%) received ≥50 ml/(kg · day) human milk for the first 4 weeks of life. Compared with infants receiving exclusive formula, those receiving the highest volume of human milk daily [≥50 mL/(kg · day)] had lower incidences of BPD [27.5% in ≥50 mL/(kg · day) vs 40.1% in 0 mL/(kg · day) human milk, P = 0.001)], moderate and severe BPD [8.9% in ≥50 mL/(kg · day) vs 16.1% in 0 mL/(kg · day), P = 0.004], necrotizing enterocolitis [NEC; 3.8% in ≥50 mL/(kg · day) vs 10.8% in 0 mL/(kg · day), P = 0.001], late-onset sepsis [LOS; 9.3% in ≥50 mL/(kg · day) vs 19.7% in 0 mL/(kg · day), P <0.01], and extrauterine growth retardation [EUGR; 38.5% in ≥50 mL/(kg · day) vs 57.6% in 0 mL/(kg · day), P <0.01)]. The logistic regression indicated that those receiving ≥50 ml/kg · day human milk had lower odds of BPD [adjusted odds ratio (AOR) 0.453; 95% confidence interval (CI): 0.309, 0.666], moderate and severe BPD (AOR 0.430; 95% CI: 0.249, 0.742), NEC (AOR 0.314; 95% CI: 0.162, 0. 607), LOS (AOR 0.420; 95% CI: 0.263, 0.673), and EUGR (AOR 0.685; 95% CI: 0.479, 0.979). Conclusions A daily threshold amount of ≥50 ml/(kg · day) human milk in the first 4 weeks of life was associated with lower incidence of BPD as well as NEC, LOS, and EUGR in VLBW infants. Trial registration ClinicalTrials.gov Identifier: NCT03453502. Registration date: March 5, 2018. This study was retrospectively registered.

scholarly journals The Potential Effects of Human Milk on Morbidity in Very-Low-Birth-Weight Preterm Infants

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1882
Author(s):  
Paola Roggero ◽  
Nadia Liotto ◽  
Orsola Amato ◽  
Fabio Mosca
Keyword(s):  
Quality Of Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Very Low Birth Weight ◽  
Mortality And Morbidity ◽  
Vlbw Infants

Improvements in quality of care have led to a significant reduction in mortality and morbidity in preterm infants, especially very-low-birth-weight (VLBW) infants [...]

Higher Incidence Rates of Hypothyroidism and Late TSH Rise in Preterm Very-Low-Birth-Weight Infants at a Tertiary Care Center

2018 ◽  
Vol 89 (4) ◽  
pp. 224-232 ◽  
Author(s):  
Hala Tfayli ◽  
Lama Charafeddine ◽  
Hani Tamim ◽  
Joanne Saade ◽  
Rose T. Daher ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Newborn Screening ◽  
Preterm Infants ◽  
Very Low Birth Weight ◽  
Care Center ◽  
Compliance Rate ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Low Birth Weight Infants

Background/Aims: Preterm newborns with a very low birth weight (VLBW) of < 1,500 g have an atypical form of hypothyroidism with a delayed rise in TSH, necessitating a second newborn screening specimen collection. The aims of this study were to survey the compliance with second newborn screening to detect delayed TSH rise in VLBW preterm infants at a tertiary care center, and to determine the rate of atypical hypothyroidism. Methods: Retrospective review of the records of 104 preterm VLBW infants. Late TSH rise was defined as an increase in TSH concentration after 14 days of age in the presence of a normal initial screen. Results: The compliance rate was 92% for the second screening. High rates of hypothyroidism (16.3%) and of late TSH rise (4.8%) were detected. Patients with hypothyroidism had a significantly lower birth weight (p = 0.01) and longer hospital stay (p = 0.004). Patients with late versus those with early TSH rise had a significantly lower mean birth weight (851 ± 302 vs. 1,191 ± 121 g, p = 0.004). Conclusion: The rates of early and late TSH rise in this VLBW population were higher than those in the literature and could be due to the use of povidone-iodine disinfectants. The yield of a second TSH screening in this study was high indicating the need for vigilance in screening VLBW preterm infants.

scholarly journals Growth and nutrient intake among very-low-birth-weight infants fed fortified human milk during hospitalisation

2009 ◽  
Vol 102 (8) ◽  
pp. 1179-1186 ◽  
Author(s):  
Christine Henriksen ◽  
Ane C. Westerberg ◽  
Arild Rønnestad ◽  
Britt Nakstad ◽  
Marit B. Veierød ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Nutrient Intake ◽  
Very Low Birth Weight ◽  
Growth Restriction ◽  
Vlbw Infants ◽  
Uterine Growth ◽  
Discharge From Hospital

Postnatal growth failure in preterm infants is due to interactions between genetic and environmental factors, which are not fully understood. We assessed dietary supply of nutrients in very-low-birth-weight (VLBW, < 1500 g) infants fed fortified human milk, and examined the association between nutrient intake, medical factors and growth during hospitalisation lasting on average 70 d. We studied 127 VLBW infants during the early neonatal period. Data were obtained from medical records on nutrient intake, growth and growth-related factors. Extra-uterine growth restriction was defined as body weight < 10th percentile of the predicted value at discharge. Using logistic regression, we evaluated nutrient intake and other relevant factors associated with extra-uterine growth restriction in the subgroup of VLBW infants with adequate weight for gestational age at birth. The proportion of growth restriction was 33 % at birth and increased to 58 % at discharge from hospital. Recommended values for energy intake (>500 kJ/kg per d) and intra-uterine growth rate (15 g/kg per d) were not met, neither in the period from birth to 28 weeks post-conceptional age (PCA), nor from 37 weeks PCA to discharge. Factors negatively associated with growth restriction were energy intake (Ptrend = 0·002), non-Caucasian ethnicity (P = 0·04) and weight/predicted birth weight at birth (Ptrend = 0·004). Extra-uterine growth restriction is common in VLBW infants fed primarily fortified human milk. Currently recommended energy and nutrient intake for growing preterm infants was not achieved. Reduced energy supply and non-Caucasian ethnicity were risk factors for growth restriction at discharge from hospital.

scholarly journals Routine Administration of a Multispecies Probiotic Containing Bifidobacterium and Lactobacillus to Very Low Birth Weight Infants Had No Significant Impact on the Incidence of Necrotizing Enterocolitis

2021 ◽  
Vol 9 ◽  
Author(s):  
Brian A. Juber ◽  
Timothy J. Boly ◽  
Graeme J. Pitcher ◽  
Steven J. McElroy
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Very Low Birth Weight ◽  
Extremely Low Birth Weight ◽  
Vlbw Infants ◽  
Routine Administration ◽  
Significant Difference ◽  
All Cause Mortality

Background: Necrotizing enterocolitis (NEC) is the leading cause of gastrointestinal morbidity in preterm infants, and prevention and treatment strategies have remained largely unchanged over the past several decades. As understanding of the microbiome has increased, probiotics have been hypothesized as a possible strategy for decreasing rates of NEC, and several studies have noted significant decreases in rates of NEC after initiation of probiotics in preterm infants. However, a recent AAP report cited caution on the use of probiotic use in part because studies of probiotic use in ELBW infants are lacking. As our unit began routine use of probiotics for all infants &lt;33 weeks in 2015 and we are a leading institution for intact survival of ELBW infants, we attempted to answer if probiotic use can impact the rate of NEC in VLBW and ELBW infants.Methods: We conducted a single-center retrospective chart review of infants with modified Bell's stage ≥2a NEC for the 4 years prior to and 5 years after initiation of a protocol involving routine supplementation of a multispecies probiotic to premature infants at the University of Iowa, Stead Family Children's Hospital. The primary outcome measures were rates of modified Bell's stage ≥2a NEC and all-cause pre-discharge mortality at our institution before and after initiation of routine probiotic supplementation in 2015.Results: In our institution, neither the rates of modified Bell's stage ≥2a NEC, nor the rates of all-cause mortality were significantly altered in very low birth weight (VLBW) infants by the initiation of routine probiotic use (NEC rates pre-probiotic 2.1% vs. post-probiotic 1.5%; all-cause mortality rates pre-probiotic 8.4% vs. post-probiotic 7.4%). Characteristics of our two cohorts were overall similar except for a significantly lower 5-minute APGAR score in infants in the post-probiotic epoch (pre-probiotic 8 vs. post-probiotic 6 p = 0.0316), and significantly more infants in the post-probiotic epoch received probiotics (pre-probiotics 0% vs. post-probiotics 65%; p &lt; 0.0001). Similarly, probiotic use had no impact on the incidence of NEC when we restricted our data to only extremely low birth weight (ELBW) infants (pre-probiotics 1.6% vs post-probiotics 4.1%). When we restricted our analysis to only inborn infants, probiotics still had no impact on NEC rates in VLBW infants (1.5% pre- and 1.1% post-probiotic, p = 0.61) or ELBW infants (2% pre- and 2.1% post-probiotic, p = 0.99)Conclusions: Contrary to other studies, we found no significant difference in rates of modified Bell's stage ≥2a NEC or all-cause pre-discharge mortality in VLBW infants following routine administration of a multispecies probiotic supplement.

scholarly journals Survival and morbidities in very low birth weight (VLBW) infants in a tertiary care teaching hospital

2017 ◽  
Vol 4 (6) ◽  
pp. 2170
Author(s):  
Sweta Mukherjee ◽  
Subhash Chandra Shaw ◽  
Amit Devgan ◽  
Ajay K Srivastava ◽  
Ashish Mallige
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress ◽  
Teaching Hospital ◽  
Very Low Birth Weight ◽  
Tertiary Care ◽  
Maternal Risk ◽  
Vlbw Infants ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching

Background: Very low birth weight (VLBW) infants often need institutional advanced neonatal care. There is paucity of literature about the survival and morbidities of this very vulnerable group of preterm very low birth weight infants in tertiary care teaching hospitals. The aim of the study was to measure the outcome of VLBW infants in terms of survival and various short-term morbidities in a tertiary care teaching hospital.Methods: This was a retrospective data analysis of all VLBW infants born in a tertiary care teaching hospital of eastern India, between 01 July 2014 and 31 December 2016. 35 VLBW infants were studied for the outcomes in terms of survival and morbidities like respiratory distress, apnoea of prematurity, intra ventricular haemorrhage, necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity and broncho pulmonary dysplasia.Results: The overall survival rate of VLBW infants weighing >750 g (n=30) was 96.6% and <750 gm (n=5), was 40%. The commonest complications were respiratory distress (65.7%), neonatal hyperbilirubinemia (74.3%) and suspect early onset sepsis (51.4%) based on maternal risk factors.Conclusions: The majority of VLBW infants above 750 g at birth or ≥ 26 weeks POG, survived in a tertiary care teaching hospital. 

scholarly journals Morbidity and mortality pattern of very low birth weight infants admitted in SNCU in a South Asian tertiary care centre

2018 ◽  
Vol 5 (3) ◽  
pp. 720 ◽  
Author(s):  
Kabilan S. ◽  
Mekalai Suresh Kumar
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Normal Vaginal Delivery ◽  
Vlbw Infants ◽  
The Mean

Background: Around 4-8% of all live births are very low birth weight (VLBW) infants.  In India currently 8 million VLBW infants are born each year which constitutes 40% of global burden the highest for any country. The present study was done to determine frequency of disease, complications, survival rate and risk factors for morbidity and mortality in VLBW babies.Methods: Between October 2016 and September 2017, we did a cross-sectional retrospective study at level three SNCU with >98% inborn admissions and about more than 10000 deliveries per year. The American Academy of Pediatrics protocol for neonatal resuscitation was followed for the management of VLBW. Data were entered in predetermined proforma and statistical analysis was done.Results: There were 154 registered cases of VLBW [75 females (48.7%) and 79 males (51.3%)]. The mean birth weight=1.198 (SD=0.211). The mean gestational age in weeks was 31.9 (SD=3.095).  Majority of them were in the gestational age 33-36 weeks (n=68, 44.2%), small for gestational age (n=89, 57.8), delivered through normal vaginal delivery (n=95, 61.7%), singletons (n=126, 81.8%), inborn (n=152, 98.7%), maternal age between 21-30 (n=95, 61.6%), clear amniotic fluid (n=137, 89%), on antenatal steroids (n=59, 38.3%), maternal disease were present in 55 mothers (33%) and gestational hypertension being more common (n=14, 9.6%). Majority of babies had Respiratory Distress Syndrome (n=56, 33.6%), birth asphyxia (n=54 32.4%) and sepsis (n=46, 27.6%). Mortality of 40.3% (n=62) observed in present study. Forty three babies with RDS, twenty babies with asphyxia and eight babies with sepsis expired.Conclusions: Multiple regression analysis with adjusted estimates of odds ratio showed that very low birth weight, low Apgar score at 5 minute, intubation and mechanical ventilation were predictors of outcome of VLBW babies. Birth weight and mechanical ventilation were significant predictors of the outcome of ELBW babies.

Sign in / Sign up

Export Citation Format

Share Document