Adverse Events and Unsuccessful Intubation Attempts Are Frequent During Neonatal Nasotracheal Intubations

Background: Intubation of neonates is difficult and hazardous. Factors associated with procedure-related adverse events and unsuccessful intubation attempts are insufficiently evaluated, especially during neonatal nasotracheal intubations.Objective: Aim of this study was to determine the frequency of tracheal intubation–associated events (TIAEs) during neonatal nasotracheal intubations and to identify factors associated with TIAEs and unsuccessful intubation attempts in our neonatal unit.Methods: This was a prospective, single-site, observational study from May 2017 to November 2019, performed at a tertiary care neonatal intensive care unit in a German academic teaching hospital. All endotracheal intubation encounters performed by the neonatal team were recorded.Results: Two hundred and fifty-eight consecutive intubation encounters in 197 patients were analyzed. One hundred and forty-eight (57.4%) intubation encounters were associated with at least one TIAE. Intubation inexperience (<10 intubation encounters) (OR = 2.15; 95% CI, 1.257–3.685) and equipment problems (OR = 3.43; 95% CI, 1.12–10.52) were predictive of TIAEs. Intubation at first attempt (OR = 0.10; 95% CI, 0.06–0.19) and videolaryngoscopy (OR = 0.47; 96% CI, 0.25–0.860) were predictive of intubation encounters without TIAEs. The first intubation attempt was commonly done by pediatric residents (67.8%). A median of two attempts were performed until successful intubation. Restricted laryngoscopic view (OR = 3.07; 95% CI, 2.08–4.53; Cormack-Lehane grade 2 vs. grade 1), intubation by pediatric residents when compared to neonatologists (OR = 1.74; 95% CI, 1.265–2.41) and support by less experienced neonatal nurses (OR = 1.60; 95% CI, 1.04–2.46) were associated with unsuccessful intubation attempts.Conclusions: In our unit, TIAEs and unsuccessful intubation attempts occurred frequently during neonatal nasotracheal intubations. To improve success rates, quality improvement und further research should target interprofessional education and training, equipment problems and videolaryngoscopy.

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Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line–Associated Bloodstream Infections

Infection Control and Hospital Epidemiology ◽

10.1086/674862 ◽

2014 ◽

Vol 35 (2) ◽

pp. 158-163 ◽

Cited By ~ 32

Author(s):

Caroline Quach ◽

Aaron M. Milstone ◽

Chantal Perpête ◽

Mario Bonenfant ◽

Dorothy L. Moore ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Adverse Events ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Tertiary Care ◽

Bloodstream Infections ◽

Central Line ◽

The Impact

Background.Despite implementation of recommended best practices, our central line-associated bloodstream infection (CLABSI) rates remained high. Our objective was to describe the impact of chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates.Methods.Infants with a central venous catheter (CVC) admitted to the neonatal intensive care unit from April 2009 to March 2013 were included. Neonates with a birth weight of 1,000 g or less, aged less than 28 days, and those with a birth weight greater than 1,000 g were bathed with mild soap until March 31, 2012 (baseline), and with a 2% CHG-impregnated cloth starting on April 1, 2012 (intervention). Infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with mild soap during the entire period. Neonatal intensive care unit nurses reported adverse events. Adjusted incidence rate ratios (aIRRs), using Poisson regression, were calculated to compare CLABSIs/1,000 CVC-days during the baseline and intervention periods.Results.Overall, 790 neonates with CVCs were included in the study. CLABSI rates decreased during the intervention period for CHG-bathed neonates (6.00 vs 1.92/1,000 CVC-days; aIRR, 0.33 [95% confidence interval (CI), 0.15-0.73]) but remained unchanged for neonates with a birth rate of 1,000 g or less and aged less than 28 days who were not eligible for CHG bathing (8.57 vs 8.62/1,000 CVC-days; aIRR, 0.86 [95% CI, 0.17-4.44]). Overall, 195 infants with a birth weight greater than 1,000 g and 24 infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with CHG. There was no reported adverse event.Conclusions.We observed a decrease in CLABSI rates in CHG-bathed neonates in the absence of observed adverse events. CHG bathing should be considered if CLABSI rates remain high, despite the implementation of other recommended measures.

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Variáveis associadas a eventos adversos em neonatos com cateter central de inserção periférica

Enfermería Global ◽

10.6018/eglobal.387451 ◽

2020 ◽

Vol 19 (3) ◽

pp. 36-67

Author(s):

Nanete Caroline da Costa Prado ◽

Rebecca Stefany da Costa Santos ◽

Romanniny Hévillyn Silva Costa Almino ◽

Dhyanine Morais de Lima ◽

Sylvia Silva de Oliveira ◽

...

Keyword(s):

Adverse Events ◽

Neonatal Intensive Care ◽

Maternity Hospital ◽

Cross Sectional Study ◽

Central Position ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

Objetivo: Identificar los factores asociados con la aparición de eventos adversos en el catéter de inserción central periférica en recién nacidos.Métodos: Un estudio transversal con un enfoque cuantitativo realizado en una Unidad de Cuidados Intensivos Neonatales de un hospital de maternidad de referencia en atención materna e infantil de alto riesgo en el noreste de Brasil. Muestra de 108 neonatos recolectados de febrero a noviembre de 2016.Resultados: La prevalencia de eventos adversos en los recién nacidos fue del 53,70%, asociada a las siguientes variables: sexo masculino (p = 0,033), peso inferior a 2500 gramos (p = 0,003), inserción después de 48 horas (p = 0,027), más de tres intentos de punción (p = 0,024), dificultad de progresión del catéter (p = 0,040), presencia de intercurrencias durante la inserción del catéter (p = 0,027), sobre dos cambios de apósito = 0.009) y ubicación no central del dispositivo (p = 0.042).Conclusión: Los resultados indican la necesidad de estrategias para la prevención de eventos adversos, con énfasis en la educación continua y el mejoramiento de habilidades en la gestión de este dispositivo. Objective: To identify the factors associated with the occurrence of adverse events by a peripherally inserted central catheter in newborns. Methods: A quantitative, cross-sectional study carried out in the Neonatal Intensive Care Unit of a reference maternity hospital in high-risk maternal and child care in Northeast Brazil. The sample of 108 neonates was collected from February to November 2016. Results: The prevalence of adverse events in newborns was 53.70%, associated with the following variables: male gender (p=0.033), weight below 2500 grams (p=0.003), insertion performed after 48 hours of life (p=0.027), more than three puncture attempts (p=0.024), difficulty in inserting the catheter (p=0.040), intercurrence during catheter insertion (p=0.027), over two dressing changes (p=0.009), and non-central position of the device (p=0.042). Conclusion: The results indicate the need for strategies to prevent adverse events, with emphasis on continuing education and on the improvement of skills regarding the use of this device.

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Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

Endoscopy ◽

10.1055/a-1139-9313 ◽

2020 ◽

Vol 52 (08) ◽

pp. 654-661 ◽

Cited By ~ 1

Author(s):

Christer Julseth Tønnesen ◽

Juliet Young ◽

Tom Glomsaker ◽

Tom Mala ◽

Magnus Løberg ◽

...

Keyword(s):

Gastric Bypass ◽

Adverse Events ◽

Tertiary Care ◽

Patient Characteristics ◽

Biliary Disease ◽

Success Rates ◽

Serious Adverse Events ◽

Balloon Enteroscopy ◽

Increased Risk ◽

Concomitant Cholecystectomy

Background Patients who have undergone Roux-en-Y gastric bypass (RYGB) are at increased risk of biliary disease necessitating endoscopic retrograde cholangiopancreatography (ERCP). The most widely used approaches to perform ERCP after RYGB are laparoscopy-assisted ERCP (LA-ERCP) and balloon enteroscopy-assisted ERCP (BEA-ERCP). There are few studies comparing these procedures. We aimed to compare the performance, benefits, and harms of LA-ERCP and BEA-ERCP in RYGB patients. Methods We identified all RYGB patients who underwent ERCP at two tertiary care endoscopy centers in Oslo, Norway between May 2013 and December 2017. One center performed BEA-ERCP, the other LA-ERCP. Procedure success was defined as fulfillment of the therapeutic or diagnostic aim, according to the procedure description. Adverse events were classified according to the Clavien–Dindo grading system. Results During the study period, 40 BEA-ERCP and 39 LA-ERCP procedures were performed in 68 patients. Procedure success rate was 72.5 % for BEA-ERCP and 87.2 % for LA-ERCP (P = 0.14). Adverse events occurred in 18 % of BEA-ERCP and 28 % of LA-ERCP (P = 0.23). Serious adverse events (Clavien–Dindo grade ≥ 3b) occurred in 2.5 % of BEA-ERCP and 7.7 % of LA-ERCP procedures (P = 0.36). Concomitant cholecystectomy was performed in 25 of the 39 LA-ERCP procedures. The median procedure times for LA-ERCP performed with and without concomitant cholecystectomy were 201 minutes and 140 minutes, respectively, and for BEA-ERCP was 125 minutes. Conclusions In experienced hands, both LA-ERCP and BEA-ERCP have high success rates after RYGB. The choice of approach should be individualized according to patient characteristics and available physician competence.

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Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study

Endoscopy ◽

10.1055/a-1209-0155 ◽

2020 ◽

Author(s):

Clémence Mercier ◽

Mathieu Pioche ◽

Eliane Albuisson ◽

Thierry Ponchon ◽

Jean-Michel Gonzalez ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Multicenter Study ◽

Pediatric Population ◽

Tertiary Care ◽

Success Rates ◽

Endoscopic Retrograde ◽

Therapeutic Procedures ◽

Long Term Follow Up ◽

History Of

Introduction The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography (ERCP) procedures in children in French and Belgian centers. Methods All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included. Results 271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72 % of our patients (340/470 procedures). The median age at intervention was 10.9 years. ERCP was therapeutic in 90 % (423/470) and diagnostic in cases of neonatal cholestasis in 10 % of the patients. The most common biliary indication was choledocholithiasis; the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92 % of cases (270/294); pancreatic cannulation in 96 % of cases (169/176); and planned therapeutic procedures in 92 % of cases (388/423). The overall complication rate was 19 % (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12 % of cases (40/340) and sepsis in 5 % (18/340). On univariate analyses, pancreatic stent removal was protective against PEP (odds ratio [OR] 0.1, 95 % confidence interval [CI] 0.01 – 0.75; P = 0.03), and sepsis was associated with history of liver transplantation (OR 7.27, 95 %CI 1.7 – 31.05; P = 0.01). Five patients had post-ERCP hemorrhage and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality. Conclusion Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.

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Clinical spectrum and outcomes of neonatal candidiasis in a tertiary care hospital in Karachi, Pakistan

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1232 ◽

2011 ◽

Vol 5 (03) ◽

pp. 216-223 ◽

Cited By ~ 12

Author(s):

Shabina Ariff ◽

Ali Faisal Saleem ◽

Sajid Bashir Soofi ◽

Reema Sajjad

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Neonatal Intensive Care ◽

Protective Factor ◽

Tertiary Care ◽

Causative Organism ◽

Care Hospital ◽

Factors Associated ◽

Discharge Disposition ◽

Positive Bacterial Culture

Introduction: Candidal infections are a serious problem in neonatal intensive care units, increasing morbidity and mortality in low birth weight infants in addition to escalating health-care costs. Studies exploring the epidemiology of candidiasis in developing country hospitals are rare. This retrospective case-control study aimed to evaluate epidemiology and risk factors associated with candidiasis in a neonatal intensive care unit in Karachi, Pakistan. Methodology: Cases (neonates (age < 28days, (n = 45) with NICU discharge diagnosis of candidal sepsis or candidemia between January 1996 and December 2006 were matched with controls (newborns with discharge diagnoses other than the above during the same study period) for gender, gestational age, and admission within 72 hours of admission of an index case. Risk factors were identified and clinical course and outcomes (discharge disposition) described. P-value and match-adjusted odds ratios were calculated. Results: A frequency of 0.9% candidemia was documented in the NICU. The incidence was highest (46%) in VLBW (< 1500gm). C. albicans was the leading causative organism (55%), and neonatal risk factors identified were mechanical ventilation (> 7 days), positive bacterial culture, and duration of hospitalization of > 7 days. Conclusions: Prolonged ventilation, positive bacterial blood culture, and prolonged duration of NICU stay were the major risk factors associated with newborn fungal sepsis in our center. Presence of antenatal care was a significant protective factor in our subset of neonatal population.

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nvasive candidiasis outbreak in a neonatal intensive care unit (NICU), a descriptive study from tertiary care teaching hospital of western part of Maharashtra

MedPulse International Journal of Microbiology ◽

10.26611/1008921 ◽

2019 ◽

Vol 9 (2) ◽

pp. 09-12

Author(s):

Shilpa Putta ◽

◽

Neeta Jangale ◽

Sushma Pednekar ◽

Vijay Kulkarni ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Teaching Hospital ◽

Neonatal Intensive Care ◽

Tertiary Care ◽

Descriptive Study ◽

Tertiary Care Teaching Hospital ◽

Care Teaching

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Neonatal Outcome of Macrosomia

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v40i2.28917 ◽

2020 ◽

Vol 40 (2) ◽

pp. 114-119

Author(s):

Subhash Chandra Shah ◽

Anusmriti Guragain ◽

Shreejana Pandey ◽

Ajaya Kumar Dhakal

Keyword(s):

Maternal Age ◽

Neonatal Outcome ◽

Tertiary Care ◽

Public Health Problem ◽

Pregnancy Induced Hypertension ◽

Factors Associated ◽

Adverse Neonatal Outcome ◽

Induced Hypertension ◽

Appropriate For Gestational Age ◽

Prolonged Hospital

Introduction: Macrosomia is an emerging public health problem, both in the developed as well as in the developing countries. This study was aimed to examine the maternal and neonatal risk factors associated with macrosomia and compare adverse neonatal outcome between appropriate for gestational age (AGA) and macrosomia. Methods: Records of all live singleton AGA and macrosomic babies delivered at a tertiary care teaching hospital in Lalitpur, Nepal, between 14th April 2013 and 13th April 2014 were retrospectively reviewed. Results: Of the 769 deliveries, 684 neonates were eligible of which 93 were born macrosomic with an incidence of 12.1%. We observed the most significant neonatal outcome to be neonatal sepsis (14%; p = 0.005) compared to AGA babies (5.9%). Macrosomia was found to be associated with increasing maternal age and parity (p = 0.007) relative to mothers of AGA babies, most of whom underwent caesarean section (55.9%) whilst the same outcome was fewer for mothers of AGA babies (29.9%). A higher incidence of pregnancy induced hypertension (PIH) as maternal comorbidity (5.4%) was associated with macrosomia contrasted with mothers of AGA babies (4.4%). Conclusion: Macrosomic birth was found to be associated with relatively higher adverse neonatal outcome, warranting prolonged hospital admission than AGA births.

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