Abstract Objective To reduce airway injury secondary to high suction pressures, the American Academy of Pediatrics Neonatal Resuscitation Program (NPR) recommends that suction pressures be less than ...100 mm Hg. This study was conducted to determine if suction bulbs conform to these recommendations. Study design In this prospective in vitro study, 25 personnel involved in neonatal resuscitation squeezed a new bulb three times for each of six commercially available bulbs using their delivery suite technique. A calibrated, pneumatic transducer measured the pressure of each squeeze. Results Only one bulb met the NRP guidelines with none of the participants exceeding 100 mm Hg ( p < 0.001). Conclusions Only one bulb met the NRP guidelines of generating pressures less than 100 mm Hg. This bulb's large size (3 oz) may preclude its use in premature infants. Individuals involved in resuscitating newborns need to be aware of the pressures generated to avoid injuring the delicate oral airway.
Background: The study purpose was to examine the incidence of hypoglycemia in very low birth weight (VLBW) infants with cholestasis while on complete enteral nutrition.Methods: A retrospective study ...of 270 VLBW (<1500 grams) infants born between 2008 and 2012 at York Hospital with cholestasis was performed. A blood glucose concentration ≤50 mg/dl was used to define hypoglycemia, and hypoglycemic events were recorded while infants were on full enteral feeds. Characteristics of infants with cholestasis were compared with those without cholestasis.Results: Cholestasis was noted in 9.6% (26/270) of VLBW infants, four babies were excluded. Twenty-two infants with cholestasis were analyzed and compared. Among those with cholestasis, hypoglycemic episodes occurred in 12 (54.5%) infants at 17±13 days (mean ±SD) after being on exclusive enteral nutrition and at a post-conception age between 31-42 weeks. Three infants (25%) needed transient reintroduction of parenteral glucose and/or alteration of feeding regimen to correct hypoglycemia. In contrast, the incidence of hypoglycemia in the control group (VLBW infants without cholestasis on full enteral feeds) was 4.5% (3/67) (P= <0.001). Receiver operating characteristic curve analysis showed a peak direct bilirubin of >4.1mg/dl (before full enteral feeds) predicts hypoglycemia while on full enteral feeds, with a sensitivity of 100%, specificity of 50%, and negative predictive value of 100%.Conclusions: Hypoglycemia is an unrecognized complication occurring in a high percentage of VLBW infant with history of cholestatic jaundice while receiving full enteral feeds. We propose that care-givers in the neonatal ICU monitor glucose levels in this select group of VLBW infants to avoid recurrent asymptomatic hypoglycemia.
To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal ...documentation.
Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant's record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified.
Charts of 263 infants were reviewed. The mean gestational age was 28.4 weeks, and the mean birth weight 1050 g. Of the infants, 69 % were singletons, and 74 % were delivered by Cesarean section. A mean of 13.2 (SD 3.5) of the 29 Resuscitation Data Items were registered for each birth. Items most frequently present were; review of obstetric history (98 %), Apgar scores (96 %), oxygen use (77 %), suctioning (71 %), and stimulation (62 %). In our model adjusted for measured covariates, the institution was significantly associated with documentation.
Neonatal resuscitation documentation is not standardized and has significant variation. Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics. Understanding this variation may lead to efforts to standardize documentation of neonatal resuscitation.
Phenomenal evolution of the Internet in recent times is shifting the mode of distribution of medical knowledge from conventional lecture rooms to one that is web based. No guidelines are yet set for ...medical teaching websites. Hence, the authors set out to determine whether these sites uniformly reflected the Learning Paradigm. Most of the medical teaching websites were endowed with good technical support but were surprisingly falling short in reflecting the principles of learning. It is strongly suggested that a team consisting of a clinician as content provider, a web designer and a medical educationist is required to create an ideal medical teaching website.
Summary
Background
Health literacy is critical for understanding complex medical problems and necessary for the well being of the patient. Printed educational materials (PM) have limitations in ...explaining the dynamics of a disease process. Multimedia formats may be useful for enhancing the educational process.
Objective:
To evaluate whether a printed format or animation with commentary on a handheld personal computer (PC) is preferred as an educational tool by parents of a baby in the NICU.
Methods:
Parents evaluated two formats: A 1-page illustrated document from the American Heart Association explaining patent ductus arteriosus (PDA) and animation with commentary on a handheld PC that explained the physiology of PDA in 1 minute. The reading grade level of the PM was 8.6 versus 18.6 for the audio portion of the animated presentation. Parents viewed each format and completed a four-item questionnaire. Parents rated both formats and indicated their preference as printed, animation, or both.
Results:
Forty-six parents participated in the survey. Parents preferred animation over PM (50% vs. 17.4%. p = 0.02); 39.1% expressed that the animation was excellent; whereas 4.3% expressed that the PM was excellent (p<0.001). The order of presentation of formats, sex, age, and educational level of parents did not influence the method preferred (p>0.05).
Conclusion:
Parents preferred animation on a small screen handheld PC despite a much higher language level. Because handheld PCs are portable and inexpensive, they can be used effectively at the bedside with low-cost animation to enhance understanding of complex disease conditions.
Citation:
Alur P, Cirelli J, Goodstein M, Bell T, Liss J. Audiovisual Presentations on a Handheld PC Are Preferred As an Educational Tool by NICU Parents. Appl Clin Inf 2010; 1: 142-148 http://dx.doi.org/10.4338/ACI-2010-01-RA-0005
Normative data for hematologic values in the very low birth weight infants are limited and inconsistent, with the reported mean hematocrit (HCT) in these infants ranging from 43.5% to 60%. No data ...are available on the effect of race.
To establish normative data for hemoglobin (Hb) and HCT by arterial sampling obtained during the first 3 hours after birth in black and white premature infants </=31 weeks of gestation.
Retrospective chart review of all infants </= 31 weeks of gestation born between June 1994 and October 1998.
infant </=31 weeks of gestation who had an arterial blood sample obtained in the first 3 hours after birth.
infants were excluded if they had any medical condition that may affect the red blood cell indices (eg, twin-to-twin transfusion or fetomaternal hemorrhage).
Of 428 infants, 188 who met both inclusion and exclusion criteria were classified into 3 gestational age groups: group 1 = 23 to 25 weeks of gestation (n = 40); group 2 = 26 to 28 weeks (n = 60); and group 3 = 29 to 31 weeks (n = 88). There were statistically significant differences between groups 1 and 3 in HCT, Hb, mean corpuscular Hb (MCH), and mean corpuscular volume (MCV). No differences in HCT and Hb values were noted in relation to sex, mode of delivery, multiple gestation, antenatal steroids, or maternal smoking. In group 3, the mean Hb, HCT, and MCV values were higher in white infants than in black infants (16.7 +/- 1.6 g/dL vs 15.4 +/- 1. 7 g/dL; 50.0 +/- 5.0 vs 45.5 +/- 4.6; and 112 +/- 5 fL vs 107 +/- 8 fL, respectively).
Hb, HCT, and MCH values are described for premature infants </=31 weeks of gestation born in North America. Hb and HCT increased, whereas MCV decreased with gestational age. Hb, HCT, and MCV values are statistically higher in white infants than in black infants.
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