Hours Of Life Research Articles

Respiratory Severity Score and Oxygen Saturation Index during the First 2 Hours of Life as Predictors for Noninvasive Respiratory Support Failure in Respiratory Distress Syndrome.

Noninvasive respiratory support (NRS) failure is common in preterm infants with respiratory distress syndrome (RDS). We evaluated the utility of respiratory severity score (RSS) and oxygen saturation index (OSI) during the first 2 hours of life (HOL) as predictors for NRS failure in moderate preterm infants. We conducted a retrospective cohort study of infants born between 280/7 and 336/7 weeks with RDS. Univariate and multivariable logistic regression analyses were used to assess whether the RSS and OSI summary measures were associated with NRS failure. A total of 282 infants were included in the study. Median gestational age and birth weights were 32 weeks and 1.7 kg, respectively. Fifty-eight infants (21%) developed NRS failure at the median age of 10.5 hours. RSS and OSI summary measures in the first 2 HOL were associated with NRS failure within 72 HOL. RSS and OSI during the first 2 HOL can predict NRS failure. Optimal RSS and OSI cutoffs for the prediction of NRS failure need to be determined in large cohort studies. · Nearly one in five moderate preterm infants on NRS at 2 hours of life developed NRS failure.. · RSS and OSI during the first 2 HOL can predict NRS failure.. · Optimal RSS and OSI cutoffs for the prediction of NRS failure need to be determined..

Variability in Diagnosis and Management of Hypoglycemia in Neonatal Intensive Care Unit.

Hypoglycemia, the most common metabolic derangement in the newborn period remains a contentious issue, not only due to various numerical definitions, but also due to limited therapeutical options which either lack evidence to support their efficacy or are increasingly recognized to lead to adverse reactions in this population. This study aimed to investigate neonatologists' current attitudes in diagnosing and managing transient and persistent hypoglycemia in newborns admitted to the Neonatal Intensive Care Unit (NICU). A web-based electronic survey which included 34 questions and a clinical vignette was sent to U.S. neonatologists. There were 246 survey responses with most respondents using local protocols to manage this condition. The median glucose value used as the numerical definition of hypoglycemia in first 48 hours of life (HOL) for symptomatic and asymptomatic term infants and preterm infants was 45 mg/dL (2.5 mmol/L; 25-60 mg/dL; 1.4-3.3 mmol/L), while after 48 HOL the median value was 50 mg/dL (2.8 mmol/L; 30-70 mg/dL; 1.7-3.9 mmol/L). There were various approaches used to manage transient and persistent hypoglycemia that included dextrose gel, increasing caloric content of the feeds using milk fortifiers, using continuous feedings, formula or complex carbohydrates, and use of various medications such as diazoxide, glucocorticoids, and glucagon. There is still large variability in current practices related to hypoglycemia. Further research is needed not only to provide evidence to support the values used as a numerical definition for hypoglycemia, but also on the efficacy of current strategies used to manage this condition. · Numerical definition of glucose remains variable.. · Strategies managing transient and persistent hypoglycemia are diverse.. · There is a need for further research to investigate efficacy of various treatment options..

AEEG in the first 3 days after extremely preterm delivery relates to neurodevelopmental outcomes

ObjectivesInvestigate relationships between aEEG in the first 72 h in extremely preterm infants with 1) infant, medical, and environmental factors, and 2) infant feeding and neurobehavioral outcomes at term and school-age.MethodsSixty-four preterm infants (≤28 weeks gestation) were enrolled within the first 24-hours of life and had two-channel aEEG until 72 h of life. Standardized neurobehavioral and feeding assessments were conducted at term, and parent-reported outcomes were documented at 5–7 years.ResultsLower aEEG Burdjalov scores (adjusted for gestational age) were related to vaginal delivery (p = 0.04), cerebral injury (p = 0.01), Black race (p < 0.01) and having unmarried parents (p = 0.02). Lower Burdjalov scores related to less NICU Network Neurobehavioral Scale arousal (p = 0.002) at term and poorer BRIEF global executive function (p = 0.004), inhibition (p = 0.007), working memory (p = 0.02), material organization (p = 0.0008), metacognition (p = 0.01), and behavioral regulation (p = 0.02) at 5–7 years. We did not observe relationships of early aEEG to feeding outcomes or sensory processing measures.ConclusionEarly aEEG within the first 72 h of life was related to medical and sociodemographic factors as well as cognitive outcome at 5–7 years.

Sample entropy correlates with intraventricular hemorrhage and mortality in premature infants early in life.

Mortality and intraventricular hemorrhage (IVH) are common adverse outcomes in preterm infants and are challenging to predict clinically. Sample entropy (SE), a measure of heart rate variability (HRV), has shown predictive power for sepsis and other morbidities in neonates. We evaluated associations between SE and mortality and IVH in the first week of life. Participants were 389 infants born before 32 weeks of gestation for whom bedside monitor data were available. A total of 29 infants had IVH grade 3 or 4 and 31 infants died within 2 weeks of life. SE was calculated with the PhysioNet open-source benchmark. Logistic regressions assessed associations between SE and IVH and/or mortality with and without common clinical covariates over various hour of life (HOL) censor points. Lower SE was associated with mortality by 4 HOL, but higher SE was very strongly associated with IVH and mortality at 24-96 HOL. Bootstrap testing confirmed SE significantly improved prediction using clinical variables at 96 HOL. SE is a significant predictor of IVH and mortality in premature infants. Given IVH typically occurs in the first 24-72 HOL, affected infants may initially have low SE followed by a sustained period of high SE. SE correlates with IVH and mortality in preterm infants early in life. SE combined with clinical factors yielded ROC AUCs well above 0.8 and significantly outperformed the clinical model at 96 h of life. Previous studies had not shown predictive power over clinical models. First study using the PhysioNet Cardiovascular Toolbox benchmark in young infants. Relative to the generally accepted timing of IVH in premature infants, we saw lower SE before or around the time of hemorrhage and a sustained period of higher SE after. Higher SE after acute events has not been reported previously.

Caffeine and Less Invasive Surfactant Administration for Respiratory Distress Syndrome of the Newborn

BackgroundManagement strategies for preterm neonates with respiratory distress syndrome include early initiation of continuous positive airway pressure (CPAP) and titration of fractional inspired oxygen and may include the use of less invasive surfactant administration (LISA) to avoid the need for endotracheal intubation. This randomized trial investigated whether early administration of caffeine and LISA would decrease the need for endotracheal intubation in the first 72 hours of life (HoL) compared with caffeine and CPAP alone.MethodsEligible neonates born at 24 weeks 0 days to 29 weeks 6 days of gestational age were randomly assigned to receive intravenous caffeine in the first 2 HoL followed by surfactant administration via the LISA method (intervention) or caffeine followed by CPAP (control). The primary outcome was the frequency of neonates requiring endotracheal intubation or meeting respiratory failure criteria between groups (caffeine and LISA vs. caffeine and CPAP) within the first 72 HoL. Multivariable logistic regression modeling was used to adjust for gestational age strata in normally distributed primary and secondary outcomes.ResultsEnrollment occurred between January 2020 and December 2022. Endotracheal intubation or meeting respiratory failure criteria within the first 72 HoL occurred in 21 (23%) of 92 neonates randomly assigned to receive caffeine and LISA compared with 47 (53%) of 88 neonates in the caffeine and CPAP group (odds ratio, 0.258; 95% confidence interval, 0.136 to 0.490; P<0.001), which remained significant after adjusting for gestational age strata (odds ratio, 0.227; 95% confidence interval, 0.112 to 0.460; P<0.001). Adverse events were similar between groups, except bronchopulmonary dysplasia, which occurred in 26% of the LISA group and 39% of the control group (P=0.049).ConclusionsIn preterm neonates supported with CPAP, early caffeine and LISA resulted in a lower frequency of endotracheal intubation within the first 72 HoL. (Funded by Chiesi USA; ClinicalTrials.gov number, NCT04209946.)

Pattern of Inflammatory Markers and Use of Antibiotics in Meconium Aspiration Syndrome: A Retrospective Cohort Study.

Objectives To study the pattern of inflammatory markers in meconium aspiration syndrome (MAS) and their correlation with illness severity/antibiotic usage. Study design This is a retrospective analysis of neonates who were admitted with MAS and had inflammatory markers done during the first week of life. Results Seventy-six neonates with MAS were identified. White cell count (WCC), absolute neutrophil count (ANC), and immature to total neutrophil count (I/T) ratiopeaked at 12 and CRP (43.75 mg/dl) at 48 hours of life (HOL). Neonates needing nasal cannula oxygen had lower CRP at 12 (p=0.035) and 24 HOL (p=0.046). There was no correlation between CRP at 48 HOL and score for neonatal acute physiology and perinatal extension II (SNAPPE-II; R2 0.0004). High CRP at 24 HOL was associated with longer duration of antibiotics (p<0.001) despite no correlation with the blood cultures. Conclusion MAS was associated with inflammatory markers peaking at 12 to 48 HOL; however, antibiotics should not be determined based on them as their correlation for illness severity or blood culture is poor.

Respiratory Severity Score during the First 3 Hours of Life as a Predictor for Failure of Noninvasive Respiratory Support and Need for Late Rescue Surfactant Administration.

Preterm infants often develop failure of noninvasive respiratory support. These infants miss the advantages of early rescue surfactant therapy. In this study, we evaluate the utility of respiratory severity score (RSS) during the first 3 hours of life (HOL) as a predictor for failure of noninvasive respiratory support. We conducted a post hoc analysis of infants between 23 and 40 weeks' gestational age who received usual care in the AERO-02 clinical trial. Univariate and multivariable logistic regression analysis were used to assess whether the RSS summary measures were associated with the odds of surfactant administration. Study involved 146 infants. Sixty-four infants (45%) received surfactant within the first 72 hours. Administration of surfactant was associated with the mean RSS (p < 0.01) and the linear trend (p < 0.01). We demonstrated that RSS during the first 3 HOL can predict failure of noninvasive respiratory support and need for late rescue surfactant administration. Optimal RSS cutoffs for early rescue surfactant therapy need to be determined in large cohort studies. · Early recognition of infants at risk of failure of noninvasive ventilation is important to prevent complications.. · It is desirable to identify patients who would benefit from early rescue surfactant treatment.. · RSS in first 3 hours can be used as a predictor of failure of noninvasive respiratory support..

Sedation in pediatric palliative care: The role of pediatric palliative care teams.

Palliative sedation (PS) consists of the use of drugs to alleviate the suffering of patients with refractory symptoms, through a reduction in consciousness. The aim of this study is to describe the incidence of and indications for PS in patients treated by pediatric palliative care teams (PPCT), and the relationship between PS, the place of death, and the characteristics of the care teams. Ambispective study with the participation of 14 PPCT working in Spain. From January to December 2019, a total of 164 patients attended by these PPCT died. Of these, 83 (50.6%) received PS during their last 24hours. The most frequent refractory symptoms were terminal suffering (n=40, 48.2%), dyspnea (n=9, 10.8%), pain (n=8, 9.6%), and convulsive state (n=7, 8.4%). Sedation in the last 24hours of life was more likely if the patient died in hospital, rather than at home (62.9% vs. 33.3%, p<0.01); if the parents had not expressed their preference regarding the place of death (69.2% vs. 45.2%, p=0.009); and if the PPCT had less than 5 years' experience (66.7% vs. 45.5%, p=0.018). PS is a real possibility in pediatric end-of-life care and relates to care planning and team expertise.

Critical Hypoglycemia in a Newborn with Pituitary Stalk Interruption Syndrome in Conjunction with 16p11.2 Deletion Syndrome and Duplication of Xp22.33/Yp11.32

This report is about a male newborn with pituitary stalk interruption syndrome (PSIS) who presented with apneic episodes associated with critical hypoglycemia at 3 hours of life (HOL). The onset of manifestations of PSIS varies in timing with the mean age of presentation between 4 and 5 years of age. The cause is unclear, but birth-related complications are considered potential factors. There is also a growing recognition of increasingly complex PSIS inheritance patterns. Further genetic workup for our patient revealed the deletion of the 16p11.2 gene with duplication of Xp22.33/Yp11.32. This is the first case report that describes PSIS in conjunction with these mutations, so the clinical correlation is unknown. However, 16p11.2 deletion is known to be associated with epilepsy and brain abnormalities. Additionally, duplication of Xp22.33/Yp11.32 is noted to be associated with short stature.

Inotropic score and vasoactive inotropic score as predictors of outcomes in congenital diaphragmatic hernia: A single center retrospective study.

Neonates with congenital diaphragmatic hernia (CDH) have varying degrees of pulmonary hypoplasia, pulmonary hypertension (PH) and cardiac dysfunction. These neonates frequently require vasoactive support and are at high risk for mortality and morbidity, including prolonged ventilator support, need for extracorporeal membrane oxygenation (ECMO), prolonged length of stay, and need for tracheostomy. However, identifying which infants are at increased risk can be challenging. In this study, we sought to investigate the utility of the inotropic score (IS) and vasoactive inotropic score (VIS) as tools to predict significant clinical outcomes and overall survival in patients with CDH. Additionally, we evaluated the correlation between IS/VIS and postnatal echocardiographic variables. This was a retrospective chart review of 57 patients with CDH whose postnatal care was based on a standardized institutional protocol. We calculated the IS/VIS at 6-, 12-, 24-, 48 hours of life (HOL), on the day of CDH repair and 24- and 48 hours after surgical repair. The association of these scores with postnatal echocardiographic markers was analyzed using Pearson's correlation and linear regression, while logistic regression was used for binary outcomes, and Cox proportional hazards regression was used to assess associations with survival. We found that every one-unit increase in IS/VIS at 6 HOL was associated with 13% increase in the odds of ECMO (p = 0.034) and 10.1% increase in risk of death (p = 0.021). An increase in IS/VIS at 12-, 24- and 48-HOL was associated with posterior septal bowing in the first postnatal echocardiogram (p < 0.05 for all). Additionally, we noted an inverse relationship between IS (r = -0.281, p = 0.036) and VIS (r = -0.288, p = 0.031) on the day of repair and left ventricle (LV) systolic function in first postnatal echocardiogram. Increase in IS (r = -0.307, p = 0.024) and VIS (r = -0.285, p = 0.037) on the day of repair was associated with decreased LV function on the post-repair echocardiogram. This retrospective study showed a significant association between IS/VIS obtained at various time points with clinical outcomes and echocardiographic findings in CDH, which could be used to guide prognosis and management in this patient population.

ODP188 Does Introduction of Oral Dextrose Gel Pathway Decrease the Length of stay in Neonates with Asymptomatic Hypoglycemia?

Abstract Background Neonatal hypoglycemia has been associated with various forms of neurological impairment including developmental delay, seizures, visual processing problems, and cognitive difficulties [1]. Consensus guidelines have been created to expedite the identification and resolution of hypoglycemic episodes. Interventions, such oral dextrose gel, have been shown to quickly and effectively reverse episodes of severe hypoglycemia [2]. However, more research needs to be conducted to quantify potential effects of oral glucose gel pathways on prevention of hypoglycemia in the neonatal period. Objective We evaluated the effects of introducing a clinical pathway for improving hypoglycemia with oral dextrose gel. We hypothesized a decrease in the length of stay of neonates with hypoglycemia after the introduction of the clinical pathway. Design/Methods We conducted a retrospective chart review evaluating neonates born ≥ 35 weeks gestational age, who exhibited asymptomatic hypoglycemia within 48 hours of life (HOL) while receiving exclusive oral feeds. The primary outcome was overall length of hospital stay. We extracted data from charts of children born prior and after the implementation of this oral dextrose gel pathway in both the well-baby nursery and Neonatal Intensive Care Unit (NICU) of a single medical center over a one-year period. Results 385 total neonates who fit the aforementioned criteria were included, with 175 neonates representing the historical control group and 210 neonates in the intervention group receiving oral dextrose gel. Analysis demonstrated no significant difference in the overall length of stay, as well as the total episodes of hypoglycemia and number of days the neonate received intravenous fluid therapy with dextrose. Conclusion(s) Our study demonstrates that the introduction of oral dextrose gel pathway did not have a significant effecton the overall length of hospital stay, as well as the total episodes of hypoglycemia and number of days the neonate received intravenous fluid therapy with dextrose at our institution. Further research is needed to evaluate whether response to oral dextrose gel can be used as a predictor of severe hypoglycemia in the neonatal period. Presentation: No date and time listed

Applicability of the hour of life approach in hyperbilirubinemia among Filipino term infants.

BackgroundHyperbilirubinemia remains a common morbidity among infants. Additional research on bilirubin kinetics and associated risk factors will contribute to providing a more targeted management approach for the Filipino infant.ObjectiveTo develop a Filipino bilirubin nomogram by studying bilirubin patterns during the first 5 days of life.MethodologyThis prospective study recruited 1,412 stable, full-term infants (≥37 weeks age of gestation) born at the Philippine General Hospital (PGH). Using the Dräger-Minolta JM-103 jaundice meter, transcutaneous bilirubin (TcB) levels were determined at the 3rd, 6th, 12th, 24th, 36th, 48th, 72nd, 96th, and 120th hour of life (HOL). A bilirubin nomogram was created using the averages of 3 TcB forehead and sternal measurements at each time epoch. Simultaneous measurement of TcB and total serum bilirubin (TsB) on a subset of 106 infants was done to determine correlation.ResultsCorrelation coefficients were high between TsB and forehead TcB (r2 = 0.88), and between TsB and sternal TcB (r2 = 0.91). The Filipino bilirubin nomogram reflected a steep rise until the 48th hour, followed by plateauing of values. Inadequate nursing and bilirubin levels at 12th and 48th HOL were risk factors for developing significant hyperbilirubinemia at 72nd HOL.ConclusionTcB is a reliable, non-invasive bilirubin screening tool. Among healthy, full-term, Filipino infants, their nomogram features a sudden increase in bilirubin values during the first 48 h, followed by a plateau. To aid in identification of infants at risk for significant hyperbilirubinemia, healthcare providers can assess breastfeeding adequacy and perform bilirubin screening at the 24th−48th HOL. Registration No. (RGAO-2016-0686).

Quality Initiative to Reduce Extrauterine Growth Restriction in Very Low Birth Weight Infants.

We report a statewide quality improvement initiative aimed to decrease the incidence of extrauterine growth restriction among very low birth weight infants cared for in Tennessee NICUs. The cohort consisted of infants born appropriate for gestational age between May 2016 and December 2018 from 9 NICUs across Tennessee. The infants were 23 to 32 weeks gestation and 500 to 1499 g birth weight. The process measures were the hours of life (HOL) when parenteral protein and intravenous lipid emulsion were initiated, the number of days to first enteral feeding, and attainment of full enteral caloric intake (110-130 kcal/kg per day). The primary outcome was extrauterine growth restriction, defined as weight <10th percentile for weight at 36 weeks postmenstrual age. Statistical process control charts and the Shewhart control rules were used to find special cause variation. Although special cause variation was not indicated in the primary outcome measure, it was indicated for the reduction in specific process measures: HOL when parenteral protein was initiated, HOL when intravenous lipid emulsion was initiated, and the number of days to attainment of full enteral caloric intake (among the hospitals considered regional perinatal centers). A statewide quality improvement initiative led to earlier initiation of parenteral and enteral nutrition and improved awareness of the importance of postnatal nutrition.

Echogenic Bowel as an Indicator of Necrotizing Enterocolitis in a Term Newborn

A 3.5-kilogram infant was born at 40 weeks gestation with an uncomplicated delivery. Prenatal ultrasounds showed echogenic bowel and a ventricular septal defect (VSD), of no clinical significance. Abdominal radiographs showed pneumatosis at 21, 36, and 48 hours of life (HOL). She was treated for necrotizing enterocolitis (NEC) with intravenous antibiotics and parenteral nutrition for 7 days, before working up on feeds and discharging home with breast milk. The only prenatal finding in this case was hyperechogenic bowel, which is a soft marker and often disregarded in the absence of other signs. Chronic intrauterine gut ischemia can cause hyperechogenicity of the bowel. That same intrauterine gut ischemia may have been responsible for NEC in our patient. If a patient has persistent echogenic bowel on prenatal imaging, a critical need exists to make sure NEC is not present.

Early predictors of continuous positive airway pressure failure in preterm neonates.

To develop a prediction model to identify infants admitted on continuous positive airway pressure (CPAP) requiring intubation within seventy-two hours of life (HOL). Infants born ≤29 weeks' gestational age between 2013 and April 2018 were randomly assigned to either a modeling cohort (MC) or a validation cohort (VC) in a 2:1 ratio. Variables available within two HOL were compared between the CPAP failure group (CFG) and the CPAP success group (CSG). Of the 189 infants in the MC, 50% failed CPAP. Compared to CSG, infants in the CFG had lower antenatal steroid exposure, birth weight, higher radiographic severe respiratory distress syndrome (RDS) and fraction of inspired oxygen (FiO2). A forward stepwise logistic regression modeling in both MC and VC showed that FiO2 >0.3 and radiographic severe RDS predicted CPAP failure. FiO2 >0.3 within two HOL and radiographic severe RDS predicts CPAP failure in preterm infants.

A Feasibility Study to Detect Neonatal Hypoglycemia in Infants of Diabetic Mothers Using Real-Time Continuous Glucose Monitoring.

Infants born to mothers with diabetes commonly experience asymptomatic hypoglycemia after birth. Continuous glucose monitors (CGM) can detect asymptomatic hypoglycemia in this population without the need for painful glucose checks. Infants born after 34 weeks of gestation to mothers with diabetes had a CGM placed after birth. One group of infants was remotely monitored in real-time by research staff during the hospitalization, whereas another group wore a blinded CGM. In both groups, hospital standard-of-care (SOC) glucose checks were performed. Clinical staff and families were blinded to CGM data. For CGM readings <45 mg/dL, research staff requested a verification blood glucose (BG) using the point-of-care glucometer. Sixteen infants were studied; 4 with a blinded CGM and 12 with remote monitoring (RM). When there were confirmatory hospital glucometer readings, the sensitivity of the CGM to detect hypoglycemia was 86% and the specificity was 91%. The positive predictive value was 55% and the negative predictive value was 98%. In the full cohort, hypoglycemia (<45 mg/dL) was confirmed in 12 of 16 infants with 30 events at <12 hours of life (HOL), 3 events between 12 and 24 HOL, and 1 event at >48 HOL. In the RM group, CGM detected hypoglycemia five times when the infant was not due for a BG check based on the SOC. Overall, the CGM detected five false-positive alerts and six true-positive alerts for hypoglycemia. Only one hypoglycemic episode was missed by CGM in the RM group. Barriers to recruitment included fear of pain with glucose checks, concerns with CGM use, satisfaction with the hospital SOC, personal reasons independent of the study, and lack of interest in participating in research. Although there were barriers to recruitment and retention in the study, we conclude that CGM can provide added benefit for detecting hypoglycemia when used early after birth.

Selective prophylactic solvent-detergent plasma and cryoprecipitate transfusion to prevent intraventricular hemorrhage in extreme preterm infants: A case-historical control.

Contradictory evidence exists whether a prophylactic coagulation factor transfusion in the first hours of life (HOL) prevents intraventricular hemorrhage (IVH) in extreme preterm infants (EPI, <28 weeks gestation). We aimed to determine whether selective prophylactic solvent-detergent plasma and cryoprecipitate transfusion within 12 hours of life (SP-SDP/Cryoprecipitate-T) could prevent IVH in EPI. This is a retrospective analysis, case-historical control, of prospectively collected data from a pre-existing electronic neonatal database at a Saudi tertiary neonatal intensive care unit. We compared the IVH rate in EPI born in the first 4 years (Jan 2010-Dec 2013) of the SP-SDP/Cryoprecipitate-T period with that of EPI born during the last 4 years (Jan 2006-Dec 2009) of the rescue SDP/Cryoprecipitate-T period. The IVH rate was lower in the SP compared to the rescue- SDP/Cryoprecipitate-T period (30.8% versus 51.2%, odds ratio 0.42, 95% confidence interval 0.21, 0.88, p = 0.02). This difference remained significant after controlling for six other IVH risk factors. Early SP-SDP/Cryoprecipitate-T may reduce the IVH rate in EPI. A large multicenter clinical trial is required for confirm the short and long-term benefit and risk of this intervention. Until then, early SP-SDP/Cryoprecipitate-T may be considered by an institution with a persistently high IVH rate.

A Feasibility Study to Detect Neonatal Hypoglycemia Using Real-Time Continuous Glucose Monitoring

Introduction: Infants of diabetic mothers are at high risk of hypoglycemia (&amp;lt;47 mg/dl) after birth, with rates approaching 50% in the first 48 hours of life (HOL). Methods: Infants born at ≥34 weeks gestation to mothers with diabetes had a CGM placed after birth and were remotely monitored by research staff during their hospitalization. Clinical staff and families were blinded to CGM data. For CGM readings &amp;lt;45 mg/dl, research staff requested a heelstick blood glucose (BG) using the hospital glucometer. Results: Eleven infants were studied. Mothers had an average A1c of 5.6% (range 4.7-6.8%) prior to delivery and 82% required insulin. Hypoglycemia (&amp;lt;45 mg/dl) was confirmed in 7 of 11 infants with 14 events at less than 12 HOL, 2 events between 12-24 HOL, and 1 event at &amp;gt;48 HOL. CGM detected hypoglycemia 4 times when the infant was not due for a BG check based on the standard of care. The true positive rate for sensor-detected hypoglycemia was 40% and the false positive rate was 60%. CGM detected 24% of the hypoglycemic events that the usual intermittent pre-prandial BG checks would have missed. Conclusion: We conclude that CGM is safe and may provide added benefit for detecting hypoglycemia when used early after birth.Table. Neonatal characteristics and duration of hypoglycemia based on CGM readings. Reported as mean ± SD, (range).Neonatal CharacteristicsRemote Monitoring (n=11)Gestational Age (wk)38.4 ± 1.6 (34 - 39.4)Birth weight (kg)3.4 ± 0.6 (2.4 - 4.2)Mean CGM Glucose (mg/dl)64 ± 20 (50 - 114)CGM placed (HOL)2.9 ± 0.6 (1.5 - 3.7)CGM recording started (HOL)6.0 ± 0.7 (5.1 - 7.3)Duration of CGM records (hr) **Median (IQR)31.2 (13.2 - 41.5)Duration of Time BG &amp;lt;45 mg/dl (hr) **Median (IQR)2.7 (0.1 - 5.0) Disclosure L.M. Nally: None. N.W. Bondy: None. J. Doiev: None. B. Buckingham: Advisory Panel; Self; Novo Nordisk Inc., ConvaTec Inc.. Research Support; Self; Medtronic, Insulet Corporation, Dexcom, Inc., Tandem Diabetes Care, Inc.. Consultant; Self; Tandem Diabetes Care, Inc., Becton, Dickinson and Company. D. Wilson: Research Support; Self; T1D Exchange, Medtronic MiniMed, Inc., Dexcom, Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Insulet Corporation. Advisory Panel; Self; Tolerion.

Effect of Delayed Cord Clamping Above Versus Below the Perineum on Preterm Neonatal Hematocrit [13OP

INTRODUCTION: The objective is to determine the difference in neonatal hematocrit when delayed cord clamping is performed above versus below the perineum. METHODS: Patients with anticipated preterm delivery between 30–36 6/7 weeks were randomized to 60 second delayed cord clamping either above or below the perineum after vaginal delivery. Primary outcome was difference in twenty-four hour neonatal hematocrit between groups. Secondary outcomes included Neonatal Intensive Care Unit (NICU) admissions, neonate's need for phototherapy or blood transfusion, one minute APGAR&lt;4 and five minute APGAR&lt;7. RESULTS: Of 103 patients consented to the study, 29 were ineligible prior to randomization and 13 did not complete to study. Sixty one patients completed the study (31 above and 30 below to perineum). There were no significant differences in maternal demographic characteristics or comorbidities. Mean gestational age was 35.5 (above) and 34.6 (below), P=.119. No statistical difference was found in neonatal hematocrit at 24-hours of life between the two groups; 51.5 above versus 52.6 below (P=.572). Correspondingly, none of the secondary outcomes were statistically different. CONCLUSION: When comparing delayed cord clamping above versus below the perineum in preterm deliveries greater than or equal to 30 weeks gestation, there is no difference in the neonatal hematocrit at 24 hrs of life or secondary neonatal outcomes. Delayed cord clamping can safely be performed above the perineum concomitant with skin to skin contact for vigorous preterm infants.

Sustained Improvement in Administration of the Hepatitis B Vaccine Birth Dose: A Quality Improvement Initiative.

The New York State Department of Health recommends the administration of the hepatitis B vaccine birth dose within 12 hours of life (HOL) for all full-term babies irrespective of maternal hepatitis B status. The primary and secondary aims of the project were to improve the timeliness of vaccine administration and increase the total number of infants vaccinated prior to discharge. Multiple Plan-Do-Study-Act cycles were performed. Statistical process charts of percentages of vaccination within 12 HOL and prior to discharge were constructed with 3-σ (data within 3 standard deviations from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Administration within 12 HOL improved from 13% to ≥65% within 6 months, and has been sustained for >1 year. Vaccine administration prior to discharge increased from 94% to 98%. Quality improvement methods can rapidly improve adherence to newborn vaccine recommendations and these effects are sustainable.