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Neonatal quality improvement

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https://www.readbyqxmd.com/read/29346344/development-of-immune-and-microbial-environments-is-independently-regulated-in-the-mammary-gland
#1
K Niimi, K Usami, Y Fujita, M Abe, M Furukawa, Y Suyama, Y Sakai, M Kamioka, N Shibata, E J Park, S Sato, H Kiyono, H Yoneyama, H Kitazawa, K Watanabe, T Nochi, H Aso
Breastfeeding is important for mammals, providing immunological and microbiological advantages to neonates, together with the nutritional supply from the mother. However, the mechanisms of this functional diversity in the mammary gland remain poorly characterized. Here, we show that, similar to the gastrointestinal tract, the mammary gland develops immune and microbial environments consisting of immunoglobulin A (IgA) and the microflora, respectively, both of which are important for protecting neonates and the mother from infectious diseases...
December 20, 2017: Mucosal Immunology
https://www.readbyqxmd.com/read/29346142/neonatal-abstinence-syndrome-an-update
#2
Lauren A Sanlorenzo, Ann R Stark, Stephen W Patrick
PURPOSE OF REVIEW: The current review provides an update focused on the evolving epidemiology of neonatal abstinence syndrome (NAS), factors influencing disease expression, advances in clinical assessment of withdrawal, novel approaches to NAS treatment, and the emerging role of quality improvement in assessment and management of NAS. RECENT FINDINGS: The rise in the incidence of NAS disproportionately occurred in rural and suburban areas. Polysubstance exposure and genetic polymorphisms have been shown to modify NAS expression and severity...
January 17, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29343190/factors-affecting-effective-ventilation-during-newborn-resuscitation-a-qualitative-study-among-midwives-in-rural-tanzania
#3
R Moshiro, H L Ersdal, P Mdoe, H L Kidanto, C Mbekenga
BACKGROUND: Intrapartum-related hypoxia accounts for 30% of neonatal deaths in Tanzania. This has led to the introduction and scaling-up of the Helping Babies Breathe (HBB) programme, which is a simulation-based learning programme in newborn resuscitation skills. Studies have documented ineffective ventilation of non-breathing newborns and the inability to follow the HBB algorithm among providers. OBJECTIVE: This study aimed at exploring barriers and facilitators to effective bag mask ventilation, an essential component of the HBB algorithm, during actual newborn resuscitation in rural Tanzania...
2018: Global Health Action
https://www.readbyqxmd.com/read/29338992/subsequent-fertility-pregnancy-and-gynecologic-outcomes-after-fetoscopic-laser-therapy-for-twin-twin-transfusion-syndrome-compared-to-normal-monochorionic-twin-gestations
#4
Simen Vergote, Liesbeth Lewi, Willem Gheysen, Luc de Catte, Roland Devlieger, Jan Deprest
BACKGROUND: An improved survival and quality of life for neonatal survivors after fetoscopic laser therapy (FLC) for twin-twin transfusion syndrome (TTTS) has been reported. However, little is known about the medium-term maternal effects after FLC with respect to reproductive and gynecologic outcomes. OBJECTIVE: To document reproductive, obstetric, gynecologic and psychological outcomes in women who underwent FLC for TTTS. STUDY DESIGN: Monocentric controlled study on consecutive women who underwent FLC for TTTS between 2007 and 2013 at the University Hospitals Leuven (cases; n=198)...
January 12, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29338867/validation-of-a-definition-of-excessive-postoperative-bleeding-in-infants-undergoing-cardiac-surgery-with-cardiopulmonary-bypass
#5
Rachel S Bercovitz, Allison C Shewmake, Debra K Newman, Robert A Niebler, John P Scott, Eckehard Stuth, Pippa M Simpson, Ke Yan, Ronald K Woods
OBJECTIVE: To derive and validate an objective definition of postoperative bleeding in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Using a retrospective cohort of 124 infants and neonates, we included published bleeding definitions and cumulative chest tube output over different postoperative periods (eg, 2, 12, or 24 hours after intensive care unit admission) in a classification and regression tree model to determine chest tube output volumes that were associated with red blood cell transfusions and surgical re-exploration for bleeding in the first 24 hours after intensive care unit admission...
December 13, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29332610/improvements-in-the-conception-rate-milk-composition-and-embryo-quality-of-rabbit-does-after-dietary-enrichment-with-n-3-polyunsaturated-fatty-acids
#6
M Rodríguez, R M García-García, M Arias-Álvarez, P Millán, N Febrel, N Formoso-Rafferty, J López-Tello, P L Lorenzo, P G Rebollar
This work attempts to confirm the effect of an enriched diet with n-3 polyunsaturated fatty acids (PUFA) trying to mitigate the reproductive performances issues such as low conception rate of primiparous rabbits. A total of 127 does were fed ad libitum throughout their two first cycles with two diets with different fat sources: mixed fat in the control and salmon oil in the enriched one, with 3.19 g/100 g (n=63 does) and 28.77 g/100 g (n=64 does) of n-3 of the total fatty acid, respectively. Feed intake was similar between groups (P>0...
January 15, 2018: Animal: An International Journal of Animal Bioscience
https://www.readbyqxmd.com/read/29316996/a-randomised-trial-of-early-palliative-care-for-maternal-stress-in-infants-prenatally-diagnosed-with-single-ventricle-heart-disease
#7
Hayley S Hancock, Ken Pituch, Karen Uzark, Priya Bhat, Carly Fifer, Maria Silveira, Sunkyung Yu, Suzanne Welch, Janet Donohue, Ray Lowery, Ranjit Aiyagari
Children with single-ventricle disease experience high mortality and complex care. In other life-limiting childhood illnesses, paediatric palliative care may mitigate maternal stress. We hypothesised that early palliative care in the single-ventricle population may have the same benefit for mothers. In this pilot randomised trial of early palliative care, mothers of infants with prenatal single-ventricle diagnoses completed surveys measuring depression, anxiety, coping, and quality of life at a prenatal visit and neonatal discharge...
January 10, 2018: Cardiology in the Young
https://www.readbyqxmd.com/read/29304879/neonatal-intensive-care-parent-satisfaction-a-multicenter-study-translating-and-validating-the-italian-empathic-n-questionnaire
#8
Immacolata Dall'Oglio, Martina Fiori, Emanuela Tiozzo, Rachele Mascolo, Anna Portanova, Orsola Gawronski, Angela Ragni, Patrizia Amadio, Antonello Cocchieri, Roberta Fida, Rosaria Alvaro, Gennaro Rocco, Jos M Latour
BACKGROUND: In Neonatal Intensive Care Units (NICUs), parent satisfaction and their experiences are fundamental to assess clinical practice and improve the quality of care delivered to infants and parents. Recently, a specific instrument, the EMpowerment of PArents in THe Intensive Care-Neonatology (EMPATHIC-N), has been developed in the Netherlands. This instrument investigated different domains of care in NICUs from a family-centered care perspective. In Italy, no rigorous instruments are available to evaluate parent satisfaction and experiences in NICU with family-centered care...
January 5, 2018: Italian Journal of Pediatrics
https://www.readbyqxmd.com/read/29304769/a-comparison-of-misoprostol-vaginal-insert-and-misoprostol-vaginal-tablets-for-induction-of-labor-in-nulliparous-women-a-retrospective-cohort-study
#9
Kjersti Engen Marsdal, Ingvil Krarup Sørbye, Lise C Gaudernack, Mirjam Lukasse
BACKGROUND: Since Misoprostol Vaginal Insert (MVI - Misodel ®) was approved for labor induction in Europe in 2013, to date, no study has been published comparing MVI to Misoprostol vaginal tablets (MVT). The aim of this study, performed as part of a quality improvement project, was to compare the efficacy and safety of 200 μg MVI versus 25 μg MVT for labor induction in nulliparous women. METHODS: This retrospective cohort study included 171 nulliparous singleton term deliveries induced with MVI (n = 85) versus MVT (n = 86) at Oslo University Hospital Rikshospitalet, Norway, from November 2014 to December 2015...
January 5, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29304250/how-people-centred-health-systems-can-reach-the-grassroots-experiences-implementing-community-level-quality-improvement-in-rural-tanzania-and-uganda
#10
Tara Tancred, Rogers Mandu, Claudia Hanson, Monica Okuga, Fatuma Manzi, Stefan Peterson, Joanna Schellenberg, Peter Waiswa, Tanya Marchant
Background: Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health...
January 1, 2018: Health Policy and Planning
https://www.readbyqxmd.com/read/29303230/planned-birth-at-or-near-term-for-improving-health-outcomes-for-pregnant-women-with-gestational-diabetes-and-their-infants
#11
REVIEW
Linda M Biesty, Aoife M Egan, Fidelma Dunne, Eugene Dempsey, Pauline Meskell, Valerie Smith, G Meabh Ni Bhuinneain, Declan Devane
BACKGROUND: Gestational diabetes is a type of diabetes that occurs during pregnancy. Women with gestational diabetes are more likely to experience adverse health outcomes such as pre-eclampsia or polyhydramnios (excess amniotic fluid). Their babies are also more likely to have health complications such as macrosomia (birthweight > 4000 g) and being large-for-gestational age (birthweight above the 90th percentile for gestational age). Current clinical guidelines support elective birth, at or near term in women with gestational diabetes to minimise perinatal complications, especially those related to macrosomia...
January 5, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29301343/the-neonatal-intensive-care-unit-environmental-stressors-and-supports
#12
Kristen G Williams, Kayla T Patel, Julie M Stausmire, Christy Bridges, Mary W Mathis, Jennifer L Barkin
The relationship between maternal mental health and infant development has been established in the literature. The Neonatal Intensive Care Unit (NICU) is a particularly challenging environment for new mothers as several natural processes are disrupted. The objective of this study is to elucidate protective factors and environmental deficits associated with the NICU. The experiences of forty-six (n = 46) mothers of infants admitted to a Level III NICU in the Midwestern United States, who responded to a related open-ended question, were analyzed thematically...
January 3, 2018: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29298857/using-a-composite-morbidity-score-and-cultural-survey-to-explore-characteristics-of-high-proficiency-neonatal-intensive-care-units
#13
Joseph W Kaempf, Lian Wang, Michael Dunn
BACKGROUND: Continuous quality improvement (CQI) collaboration has not eliminated the morbidity variability seen among neonatal intensive care units (NICUs). Factors other than inconstant application of potentially better practices (PBPs) might explain divergent proficiency. OBJECTIVE: Measure a composite morbidity score and determine whether cultural, environmental and cognitive factors distinguish high proficiency from lower proficiency NICUs. DESIGN/METHODS: Retrospective analysis using a risk-adjusted composite morbidity score (Benefit Metric) and cultural survey focusing on very low birth weight (VLBW) infants from 39 NICUs, years 2000-2014...
January 3, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/29297386/illness-recognition-decision-making-and-care-seeking-for-maternal-and-newborn-complications-a-qualitative-study-in-sarlahi-district-nepal
#14
Tsering P Lama, Subarna K Khatry, Joanne Katz, Steven C LeClerq, Luke C Mullany
BACKGROUND: Identification of maternal and newborn illness and the decision-making and subsequent care-seeking patterns are poorly understood in Nepal. We aimed to characterize the process and factors influencing recognition of complications, the decision-making process, and care-seeking behavior among families and communities who experienced a maternal complication, death, neonatal illness, or death in a rural setting of Nepal. METHODS: Thirty-two event narratives (six maternal/newborn deaths each and 10 maternal/newborn illnesses each) were collected using in-depth interviews and small group interviews...
December 21, 2017: Journal of Health, Population, and Nutrition
https://www.readbyqxmd.com/read/29297352/tackling-the-hard-problems-implementation-experience-and-lessons-learned-in-newborn-health-from-the-african-health-initiative
#15
Hema Magge, Roma Chilengi, Elizabeth F Jackson, Bradley H Wagenaar, Almamy Malick Kante
BACKGROUND: The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life...
December 21, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29297054/differences-in-morbidity-and-mortality-rates-in-black-white-and-hispanic-very-preterm-infants-among-new-york-city-hospitals
#16
Elizabeth A Howell, Teresa Janevic, Paul L Hebert, Natalia N Egorova, Amy Balbierz, Jennifer Zeitlin
Importance: Substantial quality improvements in neonatal care have occurred over the past decade yet racial and ethnic disparities in morbidity and mortality remain. It is uncertain whether disparate patterns of care by race and ethnicity contribute to disparities in neonatal outcomes. Objectives: To examine differences in neonatal morbidity and mortality rates among non-Hispanic black (black), Hispanic, and non-Hispanic white (white) very preterm infants and to determine whether these differences are explained by site of delivery...
January 2, 2018: JAMA Pediatrics
https://www.readbyqxmd.com/read/29288070/neonatal-erythropoietin-mitigates-impaired-gait-social-interaction-and-diffusion-tensor-imaging-abnormalities-in-a-rat-model-of-prenatal-brain-injury
#17
Shenandoah Robinson, Christopher J Corbett, Jesse L Winer, Lindsay A S Chan, Jessie R Maxwell, Christopher V Anstine, Tracylyn R Yellowhair, Nicholas A Andrews, Yirong Yang, Laurel O Sillerud, Lauren L Jantzie
Children who are born preterm are at risk for encephalopathy of prematurity, a leading cause of cerebral palsy, cognitive delay and behavioral disorders. Current interventions are limited and none have been shown to reverse cognitive and behavioral impairments, a primary determinant of poor quality of life for these children. Moreover, the mechanisms of perinatal brain injury that result in functional deficits and imaging abnormalities in the mature brain are poorly defined, limiting the potential to target interventions to those who may benefit most...
December 26, 2017: Experimental Neurology
https://www.readbyqxmd.com/read/29278643/response-biomarkers-in-neonatal-intervention-studies
#18
Lauren E Kelly, Kimberly Caswell, Mary Short, Prabhu S Parimi, Martin Offringa, Thomas Diacovo
BACKGROUND: Up to 90% of all drugs used in neonatal intensive care units (NICUs) have not been clinically tested for safety and efficacy. To further drug development for neonates the pharmaceutical industry is moving towards rigorous testing, necessitating the need to development and validate biomarkers in neonates to predict response. The objective of this review is to evaluate the quality of response biomarker reporting in neonatal clinical trials. METHODS: A validated literature search strategy was applied...
August 21, 2017: Pediatric Research
https://www.readbyqxmd.com/read/29278452/sulfonylurea-vs-insulin-therapy-in-individuals-with-sulfonylurea-sensitive-permanent-neonatal-diabetes-mellitus-attributable-to-a-kcnj11-mutation-and-poor-glycaemic-control
#19
J Stanik, A Dankovcikova, L Barak, M Skopkova, M Palko, J Divinec, I Klimes, D Gasperikova
BACKGROUND: Therapy with sulfonylurea is preferable to insulin in the majority of individuals with KCNJ11 mutations, but not all of these people achieve target levels of HbA1c in long-term follow-up. We aimed to compare sulfonylurea therapy with insulin treatment in two sulfonylurea-sensitive individuals with a KCNJ11 mutation who had poorly controlled permanent neonatal diabetes mellitus. CASE REPORT: We report on two individuals with a KCNJ11 mutation (p.R201H) who are currently aged 35 (SVK1) and 21 years (SVK2)...
December 26, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/29274836/outcomes-in-children-undergoing-surgery-for-congenital-pulmonary-airway-malformations-in-the-first-year-of-life
#20
Katerina Dukleska, Erin Teeple, Scott Cowan, Charles Vinocur, Loren Berman
BACKGROUND: Treatment of congenital pulmonary airway malformations (CPAMs) is generally surgical resection; however, there is controversy regarding the optimal timing of surgical intervention, especially in asymptomatic patients. STUDY DESIGN: Using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric Participant Use Files from 2012-2015, children who underwent lung resection for CPAM were identified. Outcomes in children who underwent lung resection during the neonatal period were compared with those who underwent resection beyond the neonatal period, but during the first year of life (non-neonates)...
December 21, 2017: Journal of the American College of Surgeons
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