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NICU management

Dean B Percy, Candace Haddock, Vivian Ma, Amie Nowak, Julia Panczuk, Sonia Butterworth
OBJECTIVE: The purpose of this study was to describe outcomes and resource utilization in patients treated with twice-weekly silver impregnated (SI) nanocrystalline dressings for initial non-operative management of giant omphalocele (GO). METHODS: A retrospective review of patients with GO treated with SI dressings was undertaken. Clinical parameters, cost, and complications were recorded. RESULTS: Five patients with GO were treated with SI dressings between 2014 and 2016...
February 8, 2018: Journal of Pediatric Surgery
Vera Spatenkova, Ondrej Bradac, Daniela Fackova, Zdenka Bohunova, Petr Suchomel
BACKGROUND: Nosocomial infection (NI) control is an important issue in neurocritical care due to secondary brain damage and the increased morbidity and mortality of primary acute neurocritical care patients. The primary aim of this study was to determine incidence of nosocomial infections and multidrug-resistant bacteria and seek predictors of nosocomial infections in a preventive multimodal nosocomial infection protocol in the neurointensive care unit (NICU). The secondary aim focused on their impact on stay, mortality and cost in the NICU...
March 7, 2018: BMC Neurology
Elisabetta Villa, Roberta Barachetti, Mario Barbarini
Preterm infants are at risk for poor growth while in the Neonatal Intensive Care Unit (NICU) and after discharge from the NICU. The main objective is to reach the body composition and rate of growth of a normal fetus/infant of the same post-menstrual age during the first entire year of life. In case of human milk, the limited data do not provide convincing evidence that feeding preterm infants after discharge with multi-nutrient fortified human milk, compared with unfortified, affects important outcomes including growth rates during infancy...
December 22, 2017: La Pediatria Medica e Chirurgica: Medical and Surgical Pediatrics
Adam Z Fink, Terry L Levin, Einat Blumfield, Sheri L Nemerofsky, Mark C Liszewski, Kandi George, Suhas Nafday, Mark Shlomovich, K Allen Eddington, Eliza H Myers, H Michael Ushay
BACKGROUND: In pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), patient management decisions are sometimes based on preliminary interpretations of radiographs by pediatric intensivists (PIs) before a formal interpretation by a pediatric radiologist (PRs). OBJECTIVE: To quantify and classify discrepancies in radiographic interpretation between PRs and PIs in the PICU and NICU. MATERIALS AND METHODS: This institutional review board-approved multi-institutional prospective study included three PRs and PIs at two PICUs and three NICUs...
February 28, 2018: Journal of the American College of Radiology: JACR
Candace Haddock, Al Ghalgya Al Maawali, Joseph Ting, Julie Bedford, Kourosh Afshar, Erik D Skarsgard
BACKGROUND/PURPOSE: Elimination of unnecessary practice variation through standardization creates opportunities for improved outcomes and cost-effectiveness. A quality improvement (QI) initiative at our institution used evidence and consensus to standardize management of gastroschisis (GS) from birth to discharge. METHODS: An interdisciplinary team utilized best practice evidence and expert opinion to standardize GS care. Following stakeholder engagement and education, care standardization was implemented in September 2014...
February 7, 2018: Journal of Pediatric Surgery
Parika Pahwa, Sarah Lunsford, Nigel Livesley
BACKGROUND: Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes...
March 1, 2018: JMIR Medical Informatics
Thomas A Hooven, Tara M Randis, Richard A Polin
Asymptomatic term and late-preterm newborns with risk factors for early onset sepsis commonly undergo laboratory evaluation and receive empiric antibiotic therapy. Some have challenged the rationale for current "rule-out sepsis" practices, arguing that they lead to unnecessary overtreatment and healthcare costs. A series of recent clinical studies has explored scheduled serial observations as an alternative to laboratory testing and empiric antibiotics for asymptomatic newborns with historical risk factors for sepsis...
February 26, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Katie Murphy, Helen Coo, Ruth Warre, Vibhuti Shah, Kimberly Dow
Background: There are no evidence-based national guidelines for managing neonatal abstinence syndrome (NAS) and surveys from other countries have demonstrated considerable variations in practice. Objective: To describe NAS management practices in Canada. Method: The directors of all Level 2 and Level 3 neonatal intensive care units (NICUs) were contacted to request their participation in a structured telephone survey. Frequency distributions were generated and associations between practice variations and unit type (Level 2 or 3) and size were examined...
June 2017: Paediatrics & Child Health
Taito Kitano, Kumiko Takagi, Ikuyo Arai, Hajime Yasuhara, Reiko Ebisu, Ayako Ohgitani, Daisuke Kitagawa, Miyako Oka, Kazue Masuo, Hideki Minowa
OBJECTIVES: Although routine catheter tip cultures are not recommended, previous reports have indicated that some cases of colonization, such as with S. aureus, can lead to subsequent bacteremia. To evaluate the safety of colonized cases without antimicrobial treatment, as well as the effectiveness of routine catheter tip cultures in the neonatal intensive care unit (NICU), we performed a retrospective data analysis in a Japanese community hospital. METHODS: We reviewed all peripherally inserted central venous catheter tip culture results from the NICU ward between April 2012 and June 2017 to determine whether they had antimicrobial treatments or subsequent infections...
February 22, 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
Mohamed Sayed Abdelhafez, Mahmoud Mohamed Abdelrazik, Ahmed Badawy
OBJECTIVE: To compare the obstetric outcomes of triplet gestations managed by early fetal reduction to twins with those managed by prophylactic cervical cerclage in women conceived with assisted reproductive techniques (ART). MATERIALS AND METHODS: Retrospective study of the pregnancy and neonatal outcomes of trichorionic triplet gestations achieved by ART and managed either by early transvaginal fetal reduction to twins (n = 53) or by prophylactic placement of cervical cerclage (n = 65)...
February 2018: Taiwanese Journal of Obstetrics & Gynecology
Josh E Petrikin, Julie A Cakici, Michelle M Clark, Laurel K Willig, Nathaly M Sweeney, Emily G Farrow, Carol J Saunders, Isabelle Thiffault, Neil A Miller, Lee Zellmer, Suzanne M Herd, Anne M Holmes, Serge Batalov, Narayanan Veeraraghavan, Laurie D Smith, David P Dimmock, J Steven Leeder, Stephen F Kingsmore
Genetic disorders are a leading cause of morbidity and mortality in infants in neonatal and pediatric intensive care units (NICU/PICU). While genomic sequencing is useful for genetic disease diagnosis, results are usually reported too late to guide inpatient management. We performed an investigator-initiated, partially blinded, pragmatic, randomized, controlled trial to test the hypothesis that rapid whole-genome sequencing (rWGS) increased the proportion of NICU/PICU infants receiving a genetic diagnosis within 28 days...
2018: NPJ Genomic Medicine
Sherry LeBlanc, Jamie Haushalter, Carl Seashore, Karen S Wood, Michael J Steiner, Ashley G Sutton
BACKGROUND AND OBJECTIVE: Neonatal hypoglycemia is a common problem, often requiring management in the NICU. Nonpharmacologic interventions, including early breastfeeding and skin-to-skin care (SSC), may prevent hypoglycemia and the need to escalate care. Our objective was to maintain mother-infant dyads in the mother-infant unit by decreasing hypoglycemia resulting in NICU transfer. METHODS: Inborn infants ≥35 weeks' gestation with at least 1 risk factor for hypoglycemia were included...
February 8, 2018: Pediatrics
Deborah Discenza
Family-centered care is a constant buzzword in a NICU. However, there are consistent gaps in units across the country and beyond. Addressing this goes beyond a simple certification. That is where Sara Mosher, former NICU nurse, NICU manager, and NICU support specialist, steps in with an online course and community to support parents and ease the family-centered care strain on NICUs.
January 1, 2018: Neonatal Network: NN
Susan Givens Bell
Using rapid whole-genome sequencing (WGS), an infant's genome can now be sequenced in as little as 26 hours allowing for rapid diagnosis and precise, individualized management of monogenetic causes of disease. The potential for decreasing cost and valuable time to diagnosis along with pain and suffering is becoming a reality in the NICU. Coupled with rapidly developing technology is a need to explore the associated ethical implication.
January 1, 2018: Neonatal Network: NN
Denise J Maguire, Emily Shaffer-Hudkins, Kathleen Armstrong, Leah Clark
PURPOSE: The purpose of this study is to learn how caregivers who are expert in feeding infants with neonatal abstinence syndrome (NAS) successfully feed these infants during withdrawal. DESIGN/SAMPLE: Focus group methodology was used to gather information from self-identified experts from three large regional NICUs. Twelve NICU nurses and speech therapists participated in open-ended, recorded discussions. Detailed flip chart notes were taken, reviewed, and verified by the participants before the group ended...
January 1, 2018: Neonatal Network: NN
Ashraf Sadat Mousavi, Neda Hashemi, Maryam Kashanian, Narges Sheikhansari, Arash Bordbar, Shayesteh Parashi
The study was performed on pregnant women with a gestational age of 26-32 weeks of pregnancy, who had been admitted to the hospital with a confirmed diagnosis of premature rupture of membranes. In all eligible women, ultrasounds were performed for the evaluation of amniotic fluid index. Then, the women were divided into two groups according to amniotic fluid index of ≥5 cm and <5 cm. These women were followed and monitored up to delivery. The women of the two groups did not have significant difference between them according to age, gestational age at the time of ruptured membrane, body mass index, gravidity, parity, gestational age at delivery and route of delivery...
February 9, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Brian S Carter
The application of palliative and hospice care to newborns in the neonatal intensive care unit (NICU) has been evident for over 30 years. This article addresses the history, current considerations, and anticipated future needs for palliative and hospice care in the NICU, and is based on recent literature review. Neonatologists have long managed the entirety of many newborns' short lives, given the relatively high mortality rates associated with prematurity and birth defects, but their ability or willingness to comprehensively address of the continuum of interdisciplinary palliative, end of life, and bereavement care has varied widely...
February 7, 2018: Children
Sunah S Hwang, Patrice Melvin, Hafsatou Diop, Margaret Settle, Jack Mourad, Munish Gupta
OBJECTIVE: To increase the use of safe sleep practices (SSP) among high-risk infants discharged from Massachusetts (MA) NICUs to 90% in 2 years. DESIGN/METHODS: The Neonatal Quality Improvement Collaborative of MA (NeoQIC) is a consortium of neonatal providers that provides infrastructure to lead and manage state-wide quality improvement initiatives. The safe sleep initiative was started in July 2015 with participation of all 10 MA level III NICUs. Based upon the project algorithm, infants are eligible for two sleep practices: SSP or NICU therapeutic positioning (NTP) depending on their gestational age, weight, and clinical illness...
February 6, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Ramachandra Bhat, Haidee Custodio, Cathy McCurley, Richard Whitehurst, Rashmi Gulati, Om Prakash Jha, Jayalakshmi Bhat, Benjamin Estrada, Amy Hill, Fabien Eyal, Michael Zayek
BACKGROUND: Judicious use of antibiotic therapy in preterm infants is necessary as prolonged and unwarranted use of antibiotics have been associated with adverse short-term and long-term outcomes. LOCAL PROBLEM: Our baseline data review revealed overuse and unnecessary prolonged antibiotic exposure among preterm infants despite a low suspicion for sepsis. METHODS AND INTERVENTIONS: The baseline overall AUR was calculated retrospectively from our pharmacy database for a period of 4 months prior to the quality improvement (QI) initiative (pre-QI phase)...
February 2, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Jorine de Haan, Magali Verheecke, Kristel Van Calsteren, Ben Van Calster, Roman G Shmakov, Mina Mhallem Gziri, Michael J Halaska, Robert Fruscio, Christianne A R Lok, Ingrid A Boere, Paolo Zola, Petronella B Ottevanger, Christianne J M de Groot, Fedro A Peccatori, Karina Dahl Steffensen, Elyce H Cardonick, Evgeniya Polushkina, Lukas Rob, Lorenzo Ceppi, Gennady T Sukhikh, Sileny N Han, Frédéric Amant
BACKGROUND: Awareness is growing that cancer can be treated during pregnancy, but the effect of this change on maternal and neonatal outcomes is unknown. The International Network on Cancer, Infertility and Pregnancy (INCIP) registers the incidence and maternal, obstetric, oncological, and neonatal outcomes of cancer occurring during pregnancy. We aimed to describe the oncological management and obstetric and neonatal outcomes of patients registered in INCIP and treated in the past 20 years, and assess associations between cancer type or treatment modality and obstetric and neonatal outcomes...
January 25, 2018: Lancet Oncology
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