PEDIATRICS: Kangaroo mother care for preterm infants in neonatal intensive care units

To improve the NICU experience for mothers and promote the health of preterm infants, social supports, such as improved maternity leave policies and reliable hospital access through child care, accommodation, and transportation supports are required, even for parents with insurance coverage.”

This is a small study based on interviews with 20 mothers who gave birth to preterm infants in 2016 at Tufts Medical Center (Boston).  The objective was to evaluate how these mothers of infants in the neonatal intensive care unit viewed the practice of kangaroo mother care – which involves skin-to-skin contact and frequent breast feeding.  Barriers to use of this practice are explored.

Source: Lewis, T.P., Andrews, K.G., Shenberger, E., and others. (2019). Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy and Childbirth, 19:227. Click here for free full text:     https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2363-y#Abs1  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

OPIOIDS: Neonatal abstinence syndrome treatment

The national incidence of NAS [neonatal abstinence syndrome] increased from 3.4 to 5.8 per 1,000 hospital births between 2009 and 2012…”

Babies born to mothers who have taken opiates may experience withdrawal symptoms after they are born.  In Kentucky, care for these newborns is usually provided in the neonatal intensive care unit.  In 2014, a task force was convened to develop a best practice treatment protocol.  This study, done at the University of Louisville Hospital, evaluated this new protocol for babies carried to term, finding a decrease in the number of days that the infants needed morphine therapy and a decrease in the need for adjunctive pharmacologic therapy.  Length of stay was shortened by 9 days and hospital charges were about $27,000 lower per patient.

Source: Devlin, L.A., Lau, T., and Radmacher, P.G. (2017, October 10). Frontiers in Pediatrics. 5(216).  Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641300/pdf/fped-05-00216.pdf

NICUs: Disparities in care for very low birth weight infants

[From the medical journal literature]

Significant racial and/or ethnic variation in quality of care exists between and within NICUs.  Providing feedback of disparity scores to NICUs could serve as an important starting point for promoting improvement and reducing disparities.”

This was a study of data from the California Perinatal Quality Care Collaborative of 18,616 very low birth weight (VLBW) infants cared for in 134 neonatal intensive care units in California during the 5-year period 2010 to 2014.  Besides the conclusions on disparities (noted in the quote above), there were interesting descriptive findings about the characteristics of the VLBW infants.  Here are some of these findings:

VERY LOW BIRTH WEIGHT INFANTS

•   9 percent (Less than 751 grams)
• 23 percent (751-1000 grams)
• 29 percent (1001-1250 grams)
• 39 percent (1251-1500 grams)
• 28 percent (multiple gestation)
• 76 percent (C-section)
•   4 percent (in-hospital mortality)

Source: Profit, J., and others. (2017, September), 140(3).  Click here for OPEN ACCESS to free full text: http://pediatrics.aappublications.org/content/140/3/e20170918  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

OPIOIDS: Hospital reinvents care model for NAS infants

Neonatal abstinence syndrome (NAS) refers to a withdrawal period that newborns must undergo if they have been exposed to opioids prenatally.  This study was conducted at Cabell Huntington Hospital in Huntington, WV, which is located in an area of the country with a high rate of opioid use.  At the beginning of the study period, newborns with NAS were treated in the 36-bed Level III neonatal intensive care unit at the hospital.  In mid-2012, a new unit was opened at the hospital – a 15-bed neonatal therapeutic unit (NTU) with low lights and low noise and volunteers to rock the babies.  In late 2014, a 12-bed offsite version of the NTU called Lily’s Place was opened.

Comparing Median Charges in These 3 Settings

• $90,601 (NAS infants cared for in the NICU)
• $68,750 (NAS infants cared for in the NTU)
• $17,688 (NAS infants cared for at Lily’s Place – and this figure includes a brief stay in the NTU)

Sources:

Loudin, S., and others. (2017). A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic. Journal of Perinatology, 37, 1108-1111.   Click here for FREE OPEN ACCESS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633652/pdf/jp2017101a.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Lily’s Place video here: https://youtu.be/xoAPKF-mOfM

CRITICAL CARE: Incidence of sepsis cases 2009 to 2014

Sepsis is a complication of an infection, for example pneumonia, that can lead to death.  Older people are at higher risk of developing sepsis.  This study, based on data from 409 hospitals, had a dual purpose – to determine the incidence rate of sepsis among hospital inpatients and to compare two different data sources.

In 2014, the incidence of sepsis was found to be 6 percent of adult hospitalizations.  Of patients with sepsis, 15 percent died in the hospital with an additional 6 percent discharged to hospice.

Analysis of these incidence and mortality data over time (2009 to 2014) shows that the incidence rate and overall mortality rate (including inhospital and discharge to hospice) have remained about the same.  This finding, based on a study of hospitals’ electronic medical records, differs from other estimates based on claims data.

Sources:

Mayo Clinic Staff. Sepsis.  Click here: http://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214

Rhee, C., Dantes, R., and Epstein, L. (2017, October 3). Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA, 318(13), 1241-1249.  Click here for publisher’s website: https://jamanetwork.com/journals/jama/article-abstract/2654187?widget=personalizedcontent&previousarticle=2654186  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

NICUs: What is a small baby unit?

Small baby units take the neonatal intensive care unit (NICU) concept to a new level by specializing in the care of the smallest babies – known as micro-preemies – born at fewer than 27 weeks gestation and/or weighing less than 1,000 grams (2.2 pounds).  The design of the units, which are part of a larger NICU, includes providing a dark, quiet environment.  Parents are encouraged to participate in skin-to-skin care (SSC) techniques that fosters bonding, such as Kangaroo Mother Care.  Caregivers are teamed up to deliver two-person care when the micro-preemies need to be touched.  As the babies grow, they may be transitioned out of the small baby unit to the NICU.

Hospitals with Small Baby Units (this is not a comprehensive list)

• Advocate Lutheran General Hospital (Park Ridge, IL)
• Children’s Hospital (Orange, CA)
• Greenville Health System (Greenville, SC)
• Helen Devos Children’s Hospital (Grand Rapids, MI)
• Mercyhealth Hospital-Rockton Avenue (Rockford, IL)
• Nationwide Children’s Hospital (Columbus, OH)

Sources:

Gonya, J., and others. (2017). Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: A retrospective cohort study. BMJ Open, 7.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372108/pdf/bmjopen-2016-012985.pdf

GHS launches NICU small baby unit. (2017, May 12). WSPA-TV. http://wspa.com/2017/05/12/ghs-launches-nicu-small-baby-unit/

Jackson, A. (2015, December 9).  Born at 25 weeks weighing less than 2 pounds, ‘spunky’ girl survives in small baby unit. MLive. http://www.mlive.com/news/grand-rapids/index.ssf/2015/12/small_baby_nicu_at_devos_child.html

Morris, M., Cleary, P., and Soliman, A. (2015, October). Small baby unit improves quality and outcomes in extremely low birth weight infants. Pediatrics, 136(4).  http://pediatrics.aappublications.org/content/pediatrics/136/4/e1007.full.pdf

Watley, K. (2017, February 6). Mercyhealth in Rockford opens region’s first small baby unit to care for micro-preemies. https://mercyhealthsystem.org/mercyhealth-opens-small-baby-unit-rockford/

Woloshyn, E. (2017, April 20). Special unit mimics mother’s womb. Health enews.

http://www.ahchealthenews.com/2017/04/20/special-unit-mimics-mothers-womb/  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

ISOLATION ROOMS: How many air changes per hour?

Design considerations for negative isolation and positive isolation rooms are discussed in this brief article by an engineering consultant.  Negative-pressure isolation rooms are intended to keep an infectious patient from infecting others in the hospital.  Positive isolation rooms are the opposite – intended to keep germs away from an immunocompromised patient in the room.  The recommendation for both types of isolation rooms is reported to be at least 12 air changes per hour.  Some hospitals use isolation rooms for general patients when they are available.  Although allowed in the past, it is no longer possible to operate isolation rooms that can be switched back and forth from negative to positive pressure.

Source: Herrick, M. (2017, February). Pressure points: Planning and maintaining air isolation rooms. Health Facilities Management, 30(2), 29-32.  Click here: http://www.hfmmagazine.com/articles/2671-planning-and-maintaining-hospital-air-isolation-rooms  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PATIENT SAFETY: Handoffs between ICU and OR

There is a lot of literature describing problems with, and best practices for, the transfer of care of post-surgical patients moving into the intensive care unit setting.  However, after conducting a comprehensive literature search, the authors of this brief commentary found no comparable literature about the reverse type of handoff – for patients going from the special care unit into surgery.  They suggest that a checklist be adopted and give an example of one such checklist.  They also recommend that a verbal handoff be required.

What do I like about this article?  The authors are authoritative (Mount Sinai and Johns Hopkins medical schools) and I like the actual example of the handoff checklist.  Also, I like it that they appear to be filling a gap in the medical literature – at least at the time that they wrote this commentary.

Source: Evans, A.S., Yee, M.S., and Hogue, C.W. (2014, Mar.). Often overlooked problems with handoffs: From the intensive care unit to the operating room.  Anesthesia & Analgesia, 118(3), 687-689.  Click here for free full text: http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/03000/Often_Overlooked_Problems_with_Handoffs___From_the.31.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ICUs: How do high-performing hospitals reduce CLABSI rates?

This is a study out of Johns Hopkins of 17 intensive care units at 7 hospitals – comparing practices related to reducing the central line-associated bloodstream infection (CLABSI) rate.  High performers were defined as those with less than 1 infection per 1000 catheter-days over the period of at least one year.  Low performers were defined as having over 3 infections per 1000 catheter-days.

I particularly like the tables and the appendices to this article.  The tables identify characteristics of high-performers in bullet-point brevity for each of the following levels of hospital employees: senior leadership, ICU managers, infection prevention and quality improvement staff, and frontline staff.  The appendices contain specific questions that make up a CLABSI Conversation – again differentiated between senior management, infection control / quality improvement staff, and ICU staff.

Source: Pham, J.C., and others. (2016, Apr.-June). CLABSI Conversations: Lessons from peer-to-peer assessments to reduce central line-associated bloodstream infections. Quality Management in Health Care, 25(2), 67-78.  Click here for publisher’s website:  http://journals.lww.com/qmhcjournal/pages/articleviewer.aspx?year=2016&issue=04000&article=00001&type=abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

NICU: Length of stay 109 days for technology-dependent babies at Rainbow Babies & Children’s

What is this study? A retrospective medical record review for 93 babies discharged from NICU at one hospital.

More about it: Researchers studied the care needed by babies who were discharged home from the neonatal intensive care unit at Rainbow Babies & Children’s Hospital (Cleveland) during a recent two- year period.  Data on 71 babies who were technology dependent were compared with 22 who were not.  Here are some findings:

Technology-Dependent Newborns Discharged from NICU

• 66 percent needed supplemental oxygen at home
• 46 percent needed feeding tubes at home
• 16 percent needed tracheostomy at home
• 16 percent needed mechanical ventilation at home

Newborns discharged home dependent on technology had an initial stay in the NICU of about 109 days compared to about 26 days for those discharged home non-dependent on technology.

Hospital readmission risk indicators for the technology-dependent group included: being female, having a gastrostomy tube or having initial lengthy NICU stay.

Sources:

NICU-t0-home transition can be tricky. (2016, June). Managed Care, 25(6), 8.  Click here: http://www.managedcaremag.com/archives/2016/6/nicu-home-transition-can-be-tricky

Toly, V.B., and others. (2016, June 7). Neonates and infants discharged home dependent on medical technology: Characteristics and outcomes. Advances in Neonatal Care,   Click here:  http://journals.lww.com/advancesinneonatalcare/pages/articleviewer.aspx?year=9000&issue=00000&article=99928&type=abstract