African-American women in Houston, Texas are disproportionately burdened with high rates of premature births, 1.5 times higher than white women. Prematurity remains a leading cause of high infant ...mortality rates. African-American women have the highest infant mortality rates compared to White and Hispanic women. Breast milk is the best source of nutrition for infants and has been shown to be protective against adverse outcomes, including necrotizing enterocolitis, lower respiratory infections, and chronic diseases such as asthma, obesity, and type 2 diabetes. Exclusive breastfeeding has also been shown to be protective against infant mortality due to SIDS. However, significant race/ethnic disparities exist in the rate of women who have ever breastfed their infants. Black mothers in Texas report lower rates of ever breastfeeding than White mothers. The Honey Child Program is a faith-based initiative to increase breastfeeding aimed at tackling the disparity in poor birth outcomes during the first year of life for African-American babies. The Honey Child Program utilizes group prenatal education, one-on-one mentoring with lactation consultants and faith-based community support to target equity in access and outcomes in breastfeeding. Preliminary results showed an increase in African-American mothers breastfeeding from 75% to 100% of participants who ever breastfed their infants. No infants developed a major illness or died during the time period of the study. The Honey Child Program developed a care delivery model to increase breastfeeding in this vulnerable population and help decrease infant mortality.
Spontaneous intestinal perforations in the neonatal population are mostly associated with low birth weight, prematurity, and necrotizing enterocolitis. Spontaneous intestinal perforation in the ...absence of these risk factors is extremely rare and should raise clinical concern for an underlying bowel pathology. Here we present a unique case of a normal-weight, full-term girl with spontaneous intestinal perforation due to a spindle cell neoplasm with a novel
BRAF
mutation and infantile fibrosarcoma-like morphology. Though rare, malignancy should be considered in the differential diagnosis for bowel perforation in an otherwise healthy, term infant as complete surgical excision can be curative.
Long-standing health disparities in maternal reproductive health, infant morbidity and mortality, and long-term developmental outcomes are rooted in a foundation of structural racism. Social ...determinants of health profoundly affect reproductive health outcomes of Black and Hispanic women disproportionately; they have higher rates of death during pregnancy and preterm birth. Their infants are also more likely to be cared for in poorer quality neonatal intensive care units (NICUs), receive poorer quality of NICU care, and are less likely to be referred to an appropriate high-risk NICU follow-up program. Interventions that mitigate the impact of racism will help to eliminate health disparities.
There are known short and long term health benefits to using "mother's own milk" MOM for infants in the NICU. There are also formidable barriers to breast pumping for mothers with infants in the ...NICU. In their overall efforts to increase the use of MOM in the NICU, our hospital started facilitating breast pump provision to mothers before their discharge from the postpartum unit in May of 2017. This quality improvement project wanted to examine the effect on percentage of MOM overall for infants in the NICU as well as for specific groups. Groups were stratified based on insurance type (Medicaid vs. private), race/ethnicity (Asian, Black, White, and Hispanic), and birthweight (<1500g vs >1500g). We wanted to see statistically significant increases in percentage of MOM with a p value < 0.05. To collect data, we used a data warehouse management system, which pulls data directly from EPIC flowsheets after discharge, to extract: BW, number of MOM feeds, and total feeds over entire stay. Demographic information, including race/ethnicity, and insurance at time of birth, was pulled from EPIC chart review. Inclusion criteria included: all inborn infants admitted to the NICU >2 days. The pre-intervention group infants were discharged between Jan-Mar 2017 (admitted on or after Oct 1, 2016) and the post-intervention group infants were discharged between Aug-Oct 2017 (admitted on or after May 1, 2017). While we did not find a statistically significant increase overall in percentage of MOM feeds during NICU stays, we did see statistically signifanct increases in percentage of MOM feeds for infants with a BW <1500g, black infants, and infants with private insurance with increases from 36% to 50% (p=0.0403), 20% to 32% (p=0.0185), and 48% to 55% (p=0.0325), respectively . We can infer that for these groups breast pump provision was a barrier to providing MOM for infants during their stays in the NICU. We celebrate these successful increases because infants <1500g are high risk for medical complications and known to benefit from MOM. Furthermore, Black infants have had historically low levels of breastfeeding and this intervention seems to address a barrier for these families. Infants with Medicaid insurance did not benefit from the intervention, leading us to believe that their families have more complicated barriers to providing breast milk. In our continued efforts to address barriers to MOM usage, in October 2017, we initiated another phase of our QI work centered on increasing MOM. We are focusing on the first two weeks post birth - the so-called "coming to volume" phase. The Coming to Volume intervention provides daily monitoring by a lactation consultant of maternal milk volume and expression patterns until the mother reaches a specific milk volume goal known to correlate with optimal lactation.
Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the provider clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS could be ...considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing quality of care and improving outcomes.
In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation.
Recently, the first international evidence-based POCUS guidelines for use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved.
This technical report describes many potential POCUS applications in the NICU for diagnostic and procedural purposes.
To support decision-making in the primary care medical home, this clinical report links preterm birth and perinatal complications to early childhood developmental disability risks. It consolidates ...extensive contemporary outcome research from 2005 onward into an easy-to-use framework and stratifies prematurity and NICU experiences by degree of risk for developmental impairments. This framework informs and prioritizes point-of-care screening and surveillance strategies for pediatricians caring for children born preterm, guides additional assessment and referral for appropriate therapies, and offers opportunities for reassurance (when applicable) in office settings.
Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the provider clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS could be ...considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing quality of care and improving outcomes. In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation. Recently, the first international evidence-based POCUS guidelines for use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved. This technical report describes many potential POCUS applications in the NICU for diagnostic and procedural purposes.
Inguinal hernia repair is one of the most commonly performed surgical procedures in children. However, a number of controversial issues, such as optimal timing and approach to repair, continue to be ...debated. This publication reviews the available data pertaining to these controversial issues and identifies best practices in management of inguinal hernias in children.
Critical congenital heart disease (CCHD) is a leading cause of death in infants. Newborn screening (NBS) by pulse oximetry allows early identification of CCHD in asymptomatic newborns. To improve ...readiness of hospital neonatal birthing facilities for mandatory screening in Texas, an educational and quality improvement (QI) project was piloted to identify an implementation strategy for CCHD NBS in a range of birthing hospitals.
Thirteen Texas hospitals implemented standardized CCHD screening by pulse oximetry. An educational program was devised and a tool kit was created to facilitate education and implementation. Newborn nursery nurses' knowledge was assessed using a pre- and posttest instrument.
The nurses' knowledge assessment improved from 71 to 92.5% (
< 0.0001). Of 11,322 asymptomatic newborns screened after 24 hours of age, 11 had a positive screen, with 1 confirmed case of CCHD. Pulse oximetry CCHD NBS had sensitivity of 100%, specificity of 99.91%, false-positive rate of 0.088%, positive predictive value of 9.09%, and negative predictive value of 100%.
Our educational program, including a tool kit, QI processes, and standardized pulse oximetry CCHD NBS, is applicable for a range of hospital birthing facilities and may facilitate wide-scale implementation, thereby improving newborn health.
