Scalability of the Basic Care Model for  Very Low Birth Weight Infants and Implementation Research Considerations

Objectives: To study the scalability of the rural hospital (RH) model of basic newborn care in a general hospital (GH) by including very low birth weight (VLBW) infants, and to assess the implementation aspects. Study design: Observational Settings: RH (1988-1992) and General Hospital, (GH) (2010-2013). Subjects: VLBW infants with birth weight ranging from 1000 g to 1500 g. Interventions: (1) RH: Basic care including warmth, feeding, antibiotics, and oxygen (2) GH: Basic plus circulatory care (2010-12), and continuous positive airway pressure (CPAP) support (2013). Mechanical ventilation and surfactant therapy were not available. Main outcome measure: Mortality Results: The cumulative mortality (38.5%) with basic neonatal care in the RH model declined to 26.6% at the GH with the addition of circulatory support and a “home-made” CPAP system. Conclusions: The RH package may be scaled up by adding CPAP and circulatory support to reduce the mortality among VLBW infants. The RH model is scalable horizontally and vertically. What is already known about this subject? Implementation research constitutes a relatively new and underdeveloped field, One of the facets of health system research is the implementation research. Implementation research aims at bridging the gaps between knowledge and action. What does this study add? Tertiary care center can help in developing basic newborn care at a rural hospital. The rural hospital model can be upscaled vertically as well as horizontally. Addition of circulatory support and CPAP to basic newborn care can significantly lower neonatal mortality. How might it impact on clinical practice in the foreseeable future? The study may encourage tertiary care centers to facilitate the development of basic newborn care centers at the rural hospitals. These centers, in turn, can spread horizontally.

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

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20174751 ◽

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.

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

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181025 ◽

2018 ◽

Vol 5 (3) ◽

pp. 720 ◽

Cited By ~ 2

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.

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

10.21203/rs.3.rs-73093/v1 ◽

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.

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Iatrogenic Blood Loss in Very Low Birth Weight Infants and Transfusion of Packed Red Blood Cells in a Tertiary Care Neonatal Intensive Care Unit

Children ◽

10.3390/children8100847 ◽

2021 ◽

Vol 8 (10) ◽

pp. 847

Author(s):

Ahmed Aboalqez ◽

Philipp Deindl ◽

Chinedu Ulrich Ebenebe ◽

Dominique Singer ◽

Martin Ernst Blohm

Keyword(s):

Birth Weight ◽

Length Of Stay ◽

Low Birth Weight ◽

Blood Loss ◽

Very Low Birth Weight ◽

Tertiary Care ◽

Blood Sampling ◽

Absolute Amount ◽

Study Objective ◽

Vlbw Infants

An adequate blood volume is important for neonatal adaptation. The study objective was to quantify the cumulative iatrogenic blood loss in very low birth weight (VLBW) infants by blood sampling and the necessity of packed red cell transfusions from birth to discharge from the hospital. In total, 132 consecutive VLBW infants were treated in 2019 and 2020 with a median birth weight of 1180 g (range 370–1495 g) and a median length of stay of 54 days (range 0–154 days) were included. During the initial four weeks of life, the median absolute amount of blood sampling was 16.5 mL (IQR 12.3–21.1 mL), sampling volume was different with 14.0 mL (IQR 12.1–16.2 mL) for non-transfused infants and 21.6 mL (IQR 17.5–29.4 mL) for transfused infants. During the entire length of stay, 31.8% of the patients had at least one transfusion. In a generalized logistic regression model, the cumulative amount of blood sampling (p < 0.01) and lower hematocrit at birth (p = 0.02) were independent predictors for the necessity of blood transfusion. Therefore, optimized patient blood management in VLBW neonates should include sparse blood sampling to avoid iatrogenic blood loss.

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Reduced Formula Intake with Donor Milk (DM) Impacts Necrotizing Enterocolitis (NEC) in Very Low Birth Weight (VLBW) Infants:

PEDIATRICS ◽

10.1542/peds.137.supplement_3.443a ◽

2016 ◽

Vol 137 (Supplement 3) ◽

pp. 443A-443A

Author(s):

Jennifer S. Wicks ◽

Anita L. Esquerra-Zwiers ◽

Laura M. Rogers ◽

Celina M. Scala ◽

Shirley Chen ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Necrotizing Enterocolitis ◽

Very Low Birth Weight ◽

Donor Milk ◽

Vlbw Infants

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A study to determine the factors influencing the respiratory support in very low birth weight babies in a tertiary care hospital

MedPulse International Journal of Pediatrics ◽

10.26611/10141111 ◽

2019 ◽

Vol 11 (1) ◽

pp. 01-05

Author(s):

Shivanagouda , ◽

◽

Srinivas Arer ◽

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Respiratory Support ◽

Care Hospital ◽

Factors Influencing ◽

Low Birth Weight Babies

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Sex-Specific Long-Term Trends in Length of Hospital Stay, Postmenstrual Age at Discharge, and Survival in Very Low Birth Weight Infants

Neonatology ◽

10.1159/000515899 ◽

2021 ◽

pp. 1-9

Author(s):

Matthias Fröhlich ◽

Tatjana Tissen-Diabaté ◽

Christoph Bührer ◽

Stephanie Roll

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Hospital Stay ◽

Very Low Birth Weight ◽

Survival Rates ◽

Length Of Hospital Stay ◽

Mortality Rates ◽

Vlbw Infants ◽

Postmenstrual Age ◽

Over Time

Introduction: In very low birth weight (<1,500 g, VLBW) infants, morbidity and mortality have decreased substantially during the past decades, and both are known to be lower in girls than in boys. In this study, we assessed sex-specific changes over time in length of hospital stay (LOHS) and postmenstrual age at discharge (PAD), in addition to survival in VLBW infants. Methods: This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. Results: In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978–1982 and 1993–1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978–1982 vs. 2013–2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). Discussion/Conclusions: LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.

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Predictors of Mortality Among Very Low Birth Weight Infants With Gastrointestinal Perforation

The American Surgeon ◽

10.1177/0003134820956928 ◽

2020 ◽

pp. 000313482095692

Author(s):

Marina L. Reppucci ◽

Eliza H. Hersh ◽

Prerna Khetan ◽

Brian A. Coakley

Keyword(s):

Metabolic Acidosis ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Severe Metabolic Acidosis ◽

Related Factors ◽

Vlbw Infants ◽

Risk Of Death ◽

Portal Venous Gas ◽

Elevated Lactate

Background Gastrointestinal (GI) perforation is a risk factor for mortality in very low birth weight (VLBW) infants. Little data exist regarding pretreatment factors and patient characteristics known to independently correlate with risk of death. Materials and Methods A retrospective review of all VLBW infants who sustained GI perforation between 2011 and 2018 was conducted. Birth, laboratory, and disease-related factors of infants who died were compared to those who survived. Results 42 VLBW infants who sustained GI perforations were identified. Eleven (26.19%) died. There were no significant differences in birth-related factors, hematological lab levels at diagnosis, presence of pneumatosis, or bacteremia. Portal venous gas ( P = .03), severe metabolic acidosis ( P < .01), and elevated lactate at diagnosis ( P < .01) were statistically more likely to occur among infants who died. Discussion Portal venous gas, severe metabolic acidosis, and elevated lactate were associated with an increased risk of mortality among VLBW infants who develop a GI perforation. Further research is required to better identify risk factors.

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A Single-Center Experience with Very Low Birth Weight Infants and Focal Intestinal Perforation: Comparison of Primary Anastomosis versus Stoma Opening

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1605348 ◽

2017 ◽

Vol 28 (05) ◽

pp. 426-432

Author(s):

Dario Consonni ◽

Francesco Macchini ◽

Giovanni Parente ◽

Andrea Zanini ◽

Stefania Franzini ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Intestinal Perforation ◽

Very Low Birth Weight ◽

Primary Anastomosis ◽

P Value ◽

Single Center ◽

Vlbw Infants ◽

Single Center Experience ◽

Focal Intestinal Perforation

Introduction We present a single-center experience with very low birth weight (VLBW) infants with focal intestinal perforation (FIP), comparing the results of primary anastomosis (PA) and stoma opening (SO). Materials and Methods Clinical records of VLBW infants with FIP who underwent surgery between 2006 and 2015 were reviewed. Patients were divided into two groups according to the procedure performed: limited bowel resection and PA or SO. Patients with gastric perforation or patients who underwent clip and drop were excluded. Information regarding birth weight (BW), gestational age (GA), weight at surgery (WS), number of abdominal reoperations, duration of parenteral nutrition (PN), and demise was recorded. Results In this study, 40 patients were included: 22 in PA group and 18 in SO group. BW was 865 g in PA and 778 in SO (p-value: 0.2). GA was 26.1 weeks in PA and 25.6 in SO (p-value: 0.3). WS was 1,014 g in PA and 842 in SO (p-value: 0.09). Duration of surgery was 115 minutes in PA and 122 in SO (p-value: 0.67). Five patients (23%) belonging to PA group developed complications and required SO. Five patients (23%) demised in PA group and six (33%) in SO (p-value: 0.2). Seventeen abdominal reoperations were performed in PA group and 22 in SO group (p-value: 0.08). Conclusion Both procedures appear to be safe. When possible, PA should be performed as it reduces the number of abdominal reinterventions.

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