scholarly journals A Standardized Implementation of Multicenter Quality Improvement Program of Very Low Birth Weight Newborns Could Significantly Reduce Admission Hypothermia and Improve Outcomes Within a Certain Region in China

2021 ◽  
Author(s):  
Shu-yu Bi ◽  
Yong-hui Yu ◽  
Cong Li ◽  
Ping Xu ◽  
Hai-yan Xu ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Birth Weight ◽  
Clinical Data ◽  
Gestational Age ◽  
Clinical Characteristics ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Improvement Program ◽  
Two Phases ◽  
The Impact

Abstract Background: Admission hypothermia (AH, <36.5℃) remains a major challenge for global neonate survival, especially in China. Due to high incidence of reginal AH, we developed a prospective multicenter quality improvement (QI) initiative to reduce regional AH and evaluate the impact on outcome among VLBW neonates.Methods: The study used sequential Plan - Do - Study - Act (PDSA) approach. Clinical data were collected prospectively with 5 NICUs from Sino-Northern Neonatal Network (SNN) in China. Bundle come into practice since January 1, 2019. The clinical data in pre-QI phase (January 1, 2018– December 31, 2018) were compared with post-QI phase (January 1, 2019–December 31, 2020). Clinical characteristics and outcomes data were analysed.Results: A total of 750 in-born VLBW infants were enrolled in the study, 270 in pre-QI period and 480 in post- QI period, respectively. There had no significant differences in clinical characteristics in two phases. Compared with pre-QI period, the percentage of AH decreased in the QI period (95.9 %vs 71.3%, P < 0.01). Admission mod-severe hypothermia (AMSH) was improved significantly, reduced by 38.5% after QI (68.5 %vs 30%, P < 0.01). Average admission temperature improved after QI [36.0 ˚C（35.8˚C，36.5˚C）vs 35.5 ˚C（35.2 ˚C，36.0 ˚C）, P < 0.01 ]. No significant increase in AH rate and thermal burns (0.4%VS 0%). Risks of mortality and late-onset neonatal sepsis (LOS) were significantly lower in post-QI period as compared to pre-QI period (aRR 0.19, 95% CI 0.09–0.39; aRR 0.55, 95% CI 0.41–0.80) whether adjusting for birth weight (BW), gestational age (GA)，small for gestational age (SGA), Apgar score at 5 min < 7.Conclusion：Implementation of multicenter thermoregulatory QI help in significant reduction of AH and AMSH of VLBW neonates within a certain area, which in turn can help to improve reginal neonatal outcomes. We gained a lot from QI, learned and explored a suitable method to continuous QI, this may provide reference for similar developing countries.

scholarly journals Synbiotics use for preventing sepsis and necrotizing enterocolitis in very low birth weight neonates: a randomized controlled trial

2020 ◽  
Vol 63 (6) ◽  
pp. 226-231 ◽  
Author(s):  
Ozge Serce Pehlevan ◽  
Derya Benzer ◽  
Tugba Gursoy ◽  
Guner Karatekin ◽  
Fahri Ovali
Keyword(s):  
Randomized Controlled Trial ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Significant Difference

Background: Probiotics and prebiotics have strain-specific effects on the host. Synbiotics, a mixture of probiotics and prebiotics, are proposed to have more beneficial effects on the host than either agent has alone.Purpose: We performed a randomized controlled trial to investigate the effect of Lactobacillus and Bifidobacterium together with oligosaccharides and lactoferrin on the development of necrotizing enterocolitis (NEC) or sepsis in very low birth weight neonates.Methods: Neonates with a gestational age ≤32 weeks and birth weight ≤1,500 g were enrolled. The study group received a combination of synbiotics and lactoferrin, whereas the control group received 1 mL of distilled water as placebo starting with the first feed until discharge. The outcome measures were the incidence of NEC stage ≥2 or late-onset cultureproven sepsis and NEC stage ≥2 or death.Results: Mean birth weight and gestational age of the study (n=104) and the control (n=104) groups were 1,197±235 g vs. 1,151±269 g and 29±1.9 vs. 28±2.2 weeks, respectively (P>0.05). Neither the incidence of NEC stage ≥2 or death, nor the incidence of NEC stage ≥2 or late-onset culture-proven sepsis differed between the study and control groups (5.8% vs. 5.9%, P=1; 26% vs. 21.2%, P=0.51). The only significant difference was the incidence of all stages of NEC (1.9% vs. 10.6%, P=0.019).Conclusion: The combination of synbiotics and lactoferrin did not reduce NEC severity, sepsis, or mortality.

Risk for Late-onset Blood-culture Proven Sepsis in Very-low-birth Weight Infants Born Small for Gestational Age

2014 ◽  
Vol 33 (3) ◽  
pp. 238-243 ◽  
Author(s):  
Birte Tröger ◽  
Wolfgang Göpel ◽  
Kirstin Faust ◽  
Thilo Müller ◽  
Gerhard Jorch ◽  
...  
Keyword(s):  
Birth Weight ◽  
Blood Culture ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Low Birth Weight Infants

scholarly journals Differences in clinical characteristics of early- and late-onset neonatal sepsis caused by Klebsiella pneumoniae

2020 ◽  
Vol 34 ◽  
pp. 205873842095058
Author(s):  
Ting You ◽  
Han Zhang ◽  
Lu Guo ◽  
Ke-Ran Ling ◽  
Xiao-Yu Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Klebsiella Pneumoniae ◽  
Parenteral Nutrition ◽  
Exposure Time ◽  
Gestational Age ◽  
Clinical Characteristics ◽  
Late Onset ◽  
Univariate Analysis ◽  
Antibiotic Exposure

To identify differences in the clinical characteristics of early- and late-onset sepsis (EOS and LOS) caused by Klebsiella pneumoniae ( K. pneumoniae) and to describe the risk factors for multidrug-resistant K. pneumoniae (MDR-KP) infection. Infants with K. pneumoniae-induced sepsis who were admitted to a children’s Hospital between Jan 2000 and Dec 2019 were included. All infants were divided into EOS and LOS groups, as well as MDR-KP and non-MDR-KP groups. Demographics, clinical characteristics, and risk factors were compared between the two groups. One hundred eighty infants (66 with EOS and 114 with LOS) were further analyzed, accounting for 36.8% of sepsis cases caused by MDR-KP. The frequency of respiratory failure, bronchopulmonary dysplasia, and intraventricular hemorrhage were more common in the LOS group and a higher rate of acute respiratory distress syndrome was more common in infants in the EOS group ( P < 0.05). K. pneumoniae showed a low sensitivity to penicillin, beta-lactams and cephalosporins, and it showed a high sensitivity to levofloxacin, ciprofloxacin, and amikacin. Prematurity, low birth weight, longer antibiotic exposure time, long duration of peripheral catheter insertion, long mechanical ventilation time, and long parenteral nutrition time were associated with an increased rate of MDR-KP infection by univariate analysis ( P < 0.05). The regression analysis identified a long antibiotic exposure time (OR = 1.37, 95% CI: 1.01–1.89) and long parenteral nutrition time (OR = 1.39, 95% CI: 1.01–1.89) as independent risk factors for a MDR-KP infection, and a greater gestational age and birth weight were associated with a lower risk of MDR-KP infection (OR = 0.57, 95% CI: 0.40–0.79). LOS caused by K. pneumoniae may lead to a higher frequency of complications. The risk factors for MDR-KP infection were longer duration of antibiotic exposure and parenteral nutrition. A greater gestational age and larger birth weight may decrease the risk of MDR-KP infection.

scholarly journals Lenticulostriate Vasculopathy in Very-Low-Birth-Weight Preterm Infants: A Longitudinal Cohort Study

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1166
Author(s):  
Yi-Li Hung ◽  
Chung-Min Shen ◽  
Kun-Long Hung ◽  
Wu-Shiun Hsieh
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Cranial Ultrasound ◽  
Linear Type ◽  
Vlbw Infants ◽  
Lenticulostriate Vasculopathy

Background: The pathogenesis and clinical significance of lenticulostriate vasculopathy (LSV) are unclear. Our study aimed to determine the prevalence, presentation, and evolution of LSV, and the perinatal risk factors associated with LSV among very-low-birth-weight (VLBW) preterm infants. Methods: One-hundred-and-thirty VLBW preterm infants were retrospectively enrolled in this study. Serial cranial ultrasound examinations were performed regularly from birth until a corrected age of 1 year. Infants with LSV were assigned to early-onset (≤10 postnatal days) and late-onset (>10 postnatal days) groups. Data describing the infants’ perinatal characteristics, placental histopathology, and neonatal morbidities were collected, and the groups were compared. Results: Of the VLBW infants, 39.2% had LSV before they were 1 year old. Linear-type LSV was the most common presentation, and >50% of the infants had bilateral involvement. LSV was first detected at 112 ± 83 postnatal days, and its detection timing correlated negatively with gestational age (GA) (R2 = 0.153, p = 0.005) and persisted for 6 months on average. The infants with and without LSV had similar perinatal characteristics, placental pathologies, cytomegalovirus infection rates, and clinical morbidities. The late-onset LSV group comprised 45 (88.2%) infants who had a significantly higher rate of being small for gestational age (SGA) and used oxygen for longer than the infants without LSV. After adjusting a multivariable regression model for GA and SGA, analysis showed that the duration of oxygen usage was an independent risk factor for late-onset LSV development in VLBW infants (odds ratio: 1.030, p = 0.032). Conclusion: LSV may be a nonspecific marker of perinatal insult to the developing brains of preterm infants. Prolonged postnatal oxygen usage may predispose VLBW preterm infants to late-onset LSV development. The long-term clinical impacts of LSV should be clarified.

Sign in / Sign up

Export Citation Format

Share Document