Impacting Neonatal Patient Care: Reducing Needle Sticks, with an Extended Dwell Catheter

Highlights Abstract Background: The use and efficacy of extended dwell peripheral intravenous catheters (EPIVs) has been extensively described at scientific conferences and in recent literature. The ramifications of repeated needle sticks include damage to vessels and ultimately the need for more invasive and costly access devices, which clearly support the need for reliable forms of vascular access. Methods: This quality improvement project spanned 4 years, 2017 through 2020, and included 128 patients who required a peripherally inserted catheter as their primary or secondary access site for a prescribed therapy. The EPIV utilized was a 4-cm, 22-gauge catheter made of thermosensitive polyurethane inserted using the Seldinger technique. Results: Over the course of 4 years, 128 patients received an EPIV for 2 or more days, totaling 849 days of therapy. Total insertion attempts were 174 or an average of 1.4 per patient. An estimated number of short PIVs needed for 849 days would have been 404 with 1011 attempts. Resultant savings with EPIV are estimated to be $30,686. Conclusions: Reducing the number of patient peripheral intravenous attempts while extending the dwell time results in less patient trauma, reliable longer-term access, reduced infection risk, reduced supply usage, and savings in terms of nursing time. The ultimate result for preterm newborns is more efficient delivery of care with less cost.

Patient safety in Neonatal Intensive Care Units: Neonatal patient safety

Introduction: Patient Safety in a Neonatal Intensive Care Unit is to reduce as little as possible the risk of causing harmful acts in the course of care. Objective: This study aimed to search together with the scientific literature which factors compromise patient safety in the neonatal care unit. Methods: For this an integrative review was performed on the Pubmed and Scielo platforms, using a combination of the descriptors “Patient Safety” or “Patient Safety” and “Neonatology” or “Neonatology” and “Hospital” and “Infection” or “Infection”. 27 articles that after the inclusion and exclusion criteria were analyzed and totaled in 7 manuscripts for the study. Results: The results showed that patient safety is compromised by factors related to multiprofessional work and the treatment received. Conclusion: Proposals include the elaboration of tools (protocols, checklists, among others) that could effectively help the establishment of a safety culture and promote the theme.

Redefining the Relationship: Palliative Care in Critical Perinatal and Neonatal Cardiac Patients

Patients with perinatal and neonatal congenital heart disease (CHD) represent a unique population with higher morbidity and mortality compared to other neonatal patient groups. Despite an overall improvement in long-term survival, they often require chronic care of complex medical illnesses after hospital discharge, placing a high burden of responsibility on their families. Emerging literature reflects high levels of depression and anxiety which plague parents, starting as early as the time of prenatal diagnosis. In the current era of the global COVID-19 pandemic, the additive nature of significant stressors for both medical providers and families can have catastrophic consequences on communication and coping. Due to the high prognostic uncertainty of CHD, data suggests that early pediatric palliative care (PC) consultation may improve shared decision-making, communication, and coping, while minimizing unnecessary medical interventions. However, barriers to pediatric PC persist largely due to the perception that PC consultation is indicative of “giving up.” This review serves to highlight the evolving landscape of perinatal and neonatal CHD and the need for earlier and longitudinal integration of pediatric PC in order to provide high-quality, interdisciplinary care to patients and families.

Identification of a novel FUS/ETV4 fusion and comparative analysis with other Ewing sarcoma fusion proteins

Ewing sarcoma is an aggressive pediatric bone cancer defined by a chromosomal translocation fusing one of the FET family members to a member of the ETS transcription factor family. To date, there have been seven reported translocations, with the most recent translocation reported over a decade ago. We now report the first identification of a novel translocation occurring between the FUS gene and ETS family member ETV4 detected in a neonatal patient with Ewing sarcoma. Given its apparent rarity, we conducted an initial characterization of FUS/ETV4 function by performing genomic localization and transcriptional regulatory studies. We knocked down endogenous EWS/FLI in the A673 cell line, and expressed FUS/ETV4 in its stead, and performed CUT&Tag and RNA-sequencing analyses. We compared these data to similar knock-down/rescue analyses of other rare (non-EWS/FLI) Ewing sarcoma-associated translocation products. Through this comparative analysis in the same genetic background, we demonstrate significant similarities across these fusions, and in doing so, validate this novel FUS/ETV4 translocation as a bona fide Ewing sarcoma translocation. This study presents the first genomic comparisons of the rare Ewing sarcoma-associated translocation products, and reveals that the FET/ETS fusions share highly similar, but not identical, genomic localization and transcriptional regulation patterns. These data provide insights into the roles of both the FET and ETS sides of these fusions, and provide a generic strategy to provide further strength to the notion that FET/ETS fusions are key drivers of, and thus pathognomonic for, Ewing sarcoma.

Estimation of dose and cancer risk to newborn from chest X-ray in South-South Nigeria: a call for protocol optimization

Background The use of X-ray as a diagnostic tool for complication and anomaly in the neonatal patient has been helpful, but the effect of radiation on newborn stands to increase their cancer risk. This study aims to determine the mean, 50th percentile (quartile 2 (Q2)), and 75th percentile (quartile 3 (Q3)) entrance surface dose (ESD) from anteroposterior (AP) chest X-ray and to compare our findings with other relevant studies. The study used calibrated thermoluminescent dosimeters (TLDs), which was positioned on the central axis of the patient. The encapsulated TLD chips were held to the patients’ body using paper tape. The mean kilovoltage peak (kVp) and milliampere seconds (mAs) used was 56.63(52–60) and 5.7 (5–6.3). The mean background TLD counts were subtracted from the exposed TLD counts and a calibration factor was applied to determine ESD. Results The mean ESDs of the newborn between 1 and 7, 8 and 14, 15 and 21, and 22 and 28 days were 1.09 ± 0.43, 1.15 ± 0.50, 1.19 ± 0.45, and 1.32 ± 0.47 mGy respectively. A one-way ANOVA test shows that there were no differences in the mean doses for the 4 age groups (P = 0.597). The 50th percentile for the 4 age groups was 1.07, 1.26, 1.09, and 1.29 mGy respectively, and 75th percentile were 1.41, 1.55, 1.55, and 1.69 mGy respectively. The mean effective dose (ED) in this study was 0.74 mSv, and the estimated cancer risk was 20.7 × 10−6. Conclusion ESD was primarily affected by the film-focus distance (FFD) and the patient field size. The ESD at 75th percentile and ED in this study was higher compared to other national and international studies. The estimated cancer risk to a newborn was below the International Commission on Radiological Protection (ICRP) limit for fatal childhood cancer (2.8 × 10−2Sv−1).

Current standard protocols of RT-PCR of nasopharyngeal swab in neonatal patient is not sensitive enough for determination of vertical transmission

The pandemic experienced in recent months has raised questions that should be investigate in the clinical practice. Transplacental transmission of SARS-CoV-2 and the consequences to the fetus and newborn have called attention due to the increasing number of infections, contradicting previous evidences that there was no possibility of coronavirus transmission from the mother to the fetus. We presented three cases of pregnant women with positive SARS-CoV-2 antibodies serology on admission in Naval Hospital Marcílio Dias (HNMD), Rio de Janeiro, Brazil. Samples of umbilical cord blood was double positive (IgM and IgG) for one patient, double negative for one patient and positive for IgG and negative for IgM for third patient. Maternal and neonatal nasopharyngeal swab samples analyzed by PCR for SARS-CoV-2 was positive for two maternal patients and negative for all newborns tested. It was possible to detect the SARS-CoV-2 in amniotic fluid and umbilical cord blood using the nested-PCR technics, thus being successfully evidenced transplacental transmission. We suggested that nasopharyngeal swab PCR test of neonates does not have a correlation with vertical transmission and thus, this molecular test is not useful for investigation of transplacental infection.

Current standart protocols of RT-PCR of nasopharyngeal swab in neonatal patient is not sensitive enough for determination of vertical transmission

The pandemic experienced in recent months has raised questions that should be investigate in the clinical practice. Transplacental transmission of SARS-CoV-2 and the consequences to the fetus and newborn have called attention due to the increasing number of infections, contradicting previous evidences that there was no possibility of coronavirus transmission from the mother to the fetus. In this work we showed three cases of pregnant women with positive SARS-CoV-2 antibodies serology on admission in Naval Hospital Marcílio Dias (HNMD), Rio de Janeiro, Brazil. Samples of umbilical cord blood was double positive (IgM and IgG) for one patient, double negative for one patient and positive for IgG and negative for IgM for third patient. Maternal and neonatal nasopharyngeal swab samples analyzed by PCR for SARS-CoV-2 was positive for two maternal patients and negative for all newborns tested. It was possible to detect the SARS-CoV-2 in amniotic fluid and umbilical cord blood using the nested-PCR technics, thus being successfully evidenced transplacental transmission. We suggested that nasopharyngeal swab PCR test of neonates does not have a correlation with vertical transmission and thus, this molecular test is not useful for investigation of transplacental infection.

Forensic genomics of a novel Klebsiella quasipneumoniae type from a neonatal intensive care unit in China reveals patterns of colonization, evolution and epidemiology

During March 2017, a neonatal patient with severe diarrhoea subsequently developed septicaemia and died, with Klebsiella isolated as the causative microorganism. In keeping with infection control protocols, the coincident illness of an attending staff member and three other neonates with Klebsiella infection triggered an outbreak response, leading to microbiological assessment of isolates collected from the staff member and all 21 co-housed neonates. Multilocus sequence typing and genomic sequencing identified that the isolates from the 21 neonates were of a new Klebsiella sequence type, ST2727, and taxonomically belonged to K. quasipneumoniae subsp. similipneumoniae (formerly referred to as KpIIB). Genomic characterization showed that the isolated ST2727 strains had diverged from other K. quasipneumoniae subsp. similipneumoniae strains at least 90 years ago, whereas the neonatal samples were highly similar with a genomic divergence of 3.6 months. There was no relationship to the Klebsiella isolate from the staff member. This demonstrates that no transmission occurred from staff to patient or between patients. Rather, the data suggest that ST2727 colonized each neonate from a common hospital source. Sequence-based analysis of the genomes revealed several genes for antimicrobial resistance and some virulence features, but suggest that ST2727 is neither extremely-drug resistant nor hypervirulent. Our results highlight the clinical significance and genomic properties of ST2727 and urge genome-based measures be implemented for diagnostics and surveillance within hospital environments. Additionally, the present study demonstrates the need to scale the power of genomic analysis in retrospective studies where relatively few samples are available.