Objective To measure the changes in whole blood fatty acid levels in premature infants and evaluate associations between these changes and neonatal morbidities. Study design This was a retrospective ...cohort study of 88 infants born at <30 weeks’ gestation. Serial fatty acid profiles during the first postnatal month and infant outcomes, including chronic lung disease (CLD), retinopathy of prematurity, and late-onset sepsis, were analyzed. Regression modeling was applied to determine the association between fatty acid levels and neonatal morbidities. Results Docosahexaenoic acid (DHA) and arachidonic acid levels declined rapidly in the first postnatal week, with a concomitant increase in linoleic acid levels. Decreased DHA level was associated with an increased risk of CLD (OR, 2.5; 95% CI, 1.3-5.0). Decreased arachidonic acid level was associated with an increased risk of late-onset sepsis (hazard ratio, 1.4; 95% CI, 1.1-1.7). The balance of fatty acids was also a predictor of CLD and late-onset sepsis. An increased linoleic acid:DHA ratio was associated with an increased risk of CLD (OR, 8.6; 95% CI, 1.4-53.1) and late-onset sepsis (hazard ratio, 4.6; 95% CI, 1.5-14.1). Conclusion Altered postnatal fatty acid levels in premature infants are associated with an increased risk of CLD and late-onset sepsis.
The aim of this study was to report the use casirivimab/imdevimab therapy in pregnant women with moderate coronavirus disease 2019 (COVID-19).
We report 12 cases of unvaccinated pregnant patients ...with mild-to-moderate COVID-19 treated with casirivimab/imdevimab.
Twelve unvaccinated pregnant patients with mild-to-moderate COVID-19 received casirivimab/imdevimab at the dose of 1200/1200 mg by intravenous infusion over 60 minutes. All women were managed outpatient. None experienced severe adverse drug reaction and none progressed to severe disease.
Casirivimab/imdevimab should be considered for outpatient treatment of unvaccinated pregnant women with mild-to-moderate COVID-19 to decrease the risk of severe disease.
· Casirivimab/imdevimab is not well studied in pregnant women.. · Casirivimab/imdevimab in pregnant women with mild-to-moderate COVID-19 decreases the risk of severe disease.. · Casirivimab/imdevimab in pregnant women with mild-to-moderate COVID-19 is well tolerated..
We aimed to establish a quantitative electroencephalography-based prognostic prediction model specifically tailored for nontraumatic coma patients to guide clinical work.
This retrospective study ...included 126 patients with nontraumatic coma admitted to the First Affiliated Hospital of Chongqing Medical University from December 2020 to December 2022. Six in-hospital deaths were excluded. The Glasgow Outcome Scale assessed the prognosis at 3 months after discharge. The least absolute shrinkage and selection operator regression analysis and stepwise regression method were applied to select the most relevant predictors. We developed a predictive model using binary logistic regression and then presented it as a nomogram. We assessed the predictive effectiveness and clinical utility of the model.
After excluding six deaths that occurred within the hospital, a total of 120 patients were included in this study. Three predictor variables were identified, including APACHE II score 39.129 (1.4244–1074.9000), sleep cycle OR: 0.006 (0.0002–0.1808), and RAV 0.068 (0.0049–0.9500). The prognostic prediction model showed exceptional discriminative ability, with an AUC of 0.939 (95 % CI: 0.899–0.979).
A lack of sleep cycles, smaller relative alpha variants, and higher APACHE II scores were associated with a poor prognosis of nontraumatic coma patients in the neurointensive care unit at 3 months after discharge.
This study presents a novel methodology for the prognostic assessment of nontraumatic coma patients and is anticipated to play a significant role in clinical practice.
White matter injury in infants born preterm is associated with adverse neurodevelopmental outcomes, depending on the extent and location. White matter injury can be visualized with MR imaging in the ...initial weeks following preterm birth but is more commonly defined at term-equivalent-age MR imaging. Our aim was to see how white matter injury detection in MR imaging compares between the 2 time points.
This study compared white matter injury on early brain MR imaging (30-34 weeks' postmenstrual age) with white matter injury assessment at term-equivalent (37-42 weeks) MR imaging, using 2 previously published and standardized scoring systems, in a cohort of 30 preterm infants born at <33 weeks' gestational age.
There was a strong association between the systematic assessments of white matter injury at the 2 time points (
= .007) and the global injury severity (
< .001).
Although the optimal timing to undertake neuroimaging in the preterm infant remains to be determined, both early (30-34 weeks) and term-equivalent MR imaging provide valuable information on white matter injury and the risk of associated sequelae.
The purpose of this nurse-led telehealth intervention was to support caregivers and infants during the difficult period of transition from the neonatal intensive care unit (NICU) to home.
The Baby ...Steps project was designed using quality improvement methodology, and was implemented in April 2020 at a stand-alone pediatric institution in South Florida. Using a nurse-led telehealth model, follow-up nursing care was provided in the home setting for two weeks after discharge. Any infant cared for in the NICU and discharged to a home setting in the state of Florida was eligible for services. Encounters included assessment, anticipatory guidance, connection with community resources, and general support. Caregiver satisfaction, unplanned emergency care use, and 30-day readmissions were assessed.
Within the first 18 months of the program, a total of 378 infants were enrolled, and 74.6% received follow-up services in the home setting (n = 282). Caregivers reported high satisfaction with the program (100% strongly agree or agree). There was a 46% decrease in 30-day readmissions from baseline rates, and a substantial decrease in use of emergency care services within a month of discharge as compared to infants discharged during the same time period who did not receive services (30.9% vs.13.8%).
This nurse-led intervention was found to be a feasible and highly satisfactory approach to improve NICU patient outcomes and support caregivers during transition from hospital to home.
Nurses can provide post-discharge telehealth support, which not only improves caregiver satisfaction but also decreases readmissions and emergency care use among NICU patients.
•Transition from the neonatal intensive care unit (NICU) to home is challenging•A nurse-led telehealth intervention, Baby Steps, addresses this gap•Within the first 18 months of the program, 378 infants were enrolled•Caregivers indicated high satisfaction and high likelihood to act on nursing advice•Readmissions and unplanned emergency care use were significantly decreased
Most of the studies on the costing of neonatal intensive care has concentrated on the costs associated with preterm infants which takes up more than half of neonatal intensive care unit (NICU) costs. ...The focus has been on determining the cost-effectiveness of extreme preterm infants and those at threshold of viability. While the costs of care have an inverse relationship with gestational age (GA) and the lifetime medical costs of the extreme preterm can be as high as $450,000, the total NICU expenditure are skewed towards the care of moderate and late preterm infants who form the main bulk of patients. Neonatal intensive care, has been found to be very cost-effective at $1,000 per term infant per QALY and $9,100 for extreme preterm survivor per QALY. For low and LMIC, where NICU resources are limited, the costs of NICU care is lower largely due to a patient profile of more term and preterm of greater GAs and correspondingly less intensity of care. Public health measures, neonatal resuscitation training, empowerment of nurses to do resuscitation, increasing the accessibility to essential newborn care are recommended cheaper cost-effective measures to reduce neonatal mortality in countries with high neonatal mortality rate, whilst upgraded neonatal intensive care services are needed to further reduce neonatal mortality rate once below 15 per 1,000 livebirths. Economic evaluation of neonatal intensive care should also include post discharge costs which mainly fall on the health, social and educational sectors. Strategies to reduce neonatal intensive care costs could include more widespread implementation of cost-effective methods of improving neonatal outcome and reducing neonatal morbidities, including access to antenatal care, perinatal interventions to delay preterm delivery wherever feasible, improving maternal health status and practising cost saving and effective neonatal intensive care treatment.
Family-centred care (FCC) in the Neonatal Intensive Care Unit (NICU) is an aspect of high-quality neonatal nursing. The aim of this manuscript is to clarify the meaning of FCC in the NICU to inform ...future research.
Rodger's evolutionary concept analysis. Three databases were searched, each representing a different discipline: CINAHL, Medline, and PsycINFo.
A total of 188 full-text papers were included. The concept of FCC in the NICU was defined according to its surrogate and related terms, antecedents, attributes, and consequences.
Although interdisciplinary in nature, academic literature about FCC in the NICU is dominated by a biomedical perspective. Important conceptual departures, namely developmental care and family-integrated care are discussed.
Considering FCC as a model of care may be too reductionist; it should be regarded as a philosophy. Further work should explore the delivery of FCC for increasingly specialized NICU populations, such as perioperative infants.
There is debate regarding the optimal timing of central line removal in the neonatal intensive care unit (NICU). The purpose was to evaluate outcomes of idle peripherally inserted central catheters ...(PICCs) and tunneled central venous catheters (TCVCs) and determine the incidence of line-related infections and replacements.
Patients in the NICU with T-CVCs placed between 11/2008 and 8/2015 (n=134) or PICCs placed between 7/2013 and 10/2015 (n=467) were included. Demographics and outcomes were compared.
The most common indications for line placement were parenteral nutrition for PICCs (74%) and lack of access for T-CVCs (53%). T-CVCs had a greater proportion of idle days (T-CVC- 25.2% vs PICC- 5.1%, p<0.001) and removal within 24h of discharge (T-CVC-53% vs PICC-5.8%, p<0.001). Conversely, 81% of PICCs were removed within 24h of nonuse. Line replacement after removal for nonuse was required in 6% of PICCs and zero T-CVCs. In both groups, the central line-associated bloodstream infection (CLABSI) rate was lower in idle lines compared to ones in use.
Patients treated with PICCs and T-CVCs are different populations and should have different guidelines for removal. In neonates with difficult access, the low risk of CLABSIs in idle surgically placed catheters may justify maintaining access until discharge.
Treatment study.
III.
Opioid addiction and the NICU are common themes in the news. Yet, we never hear from the mothers in these situations. I interviewed Victoria, a Mom who had an addiction and had desperately wanted to ...be clean. She got pregnant and was desperate to help her baby not have the same affliction. Enter the ICON (Improving Care for the Opiate-exposed Newborn) program, which not only turned her life around but gave her son a chance at a normal life. The ICON program changes the stereotype of the addicted mother in the NICU for the better. We all have something to learn here.
Objective To determine the association between direct costs for the initial neonatal intensive care unit hospitalization and 4 potentially preventable morbidities in a retrospective cohort of very ...low birth weight (VLBW) infants (birth weight <1500 g). Study design The sample included 425 VLBW infants born alive between July 2005 and June 2009 at Rush University Medical Center. Morbidities included brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and late-onset sepsis. Clinical and economic data were retrieved from the institution's system-wide data and cost accounting system. A general linear regression model was fit to determine incremental direct costs associated with each morbidity. Results After controlling for birth weight, gestational age, and sociodemographic characteristics, the presence of brain injury was associated with a $12 048 ( P = .005) increase in direct costs; necrotizing enterocolitis, with a $15 440 ( P = .005) increase; bronchopulmonary dysplasia, with a $31 565 ( P < .001) increase; and late-onset sepsis, with a $10 055 ( P < .001) increase. The absolute number of morbidities was also associated with significantly higher costs. Conclusion This study provides collective estimates of the direct costs incurred during neonatal intensive care unit hospitalization for these 4 morbidities in VLBW infants. The incremental costs associated with these morbidities are high, and these data can inform future studies evaluating interventions aimed at preventing or reducing these costly morbidities.
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