Length Of Stay For Infants Research Articles

Impact of COVID-19 on Perinatal Outcomes and Birth Locations in a Large US Metropolitan Area

This was a population-based study to determine the impact of COVID-19 on birth outcomes in the Chicago metropolitan area, comparing pre-pandemic (April–September 2019) versus pandemic (April–September 2020) births. Multivariable regression models that adjusted for demographic and neighborhood characteristics were used to estimate the marginal effects of COVID-19 on intrauterine fetal demise (IUFD)/stillbirth, preterm birth, birth hospital designation, and maternal and infant hospital length of stay (LOS). There were no differences in IUFD/stillbirths or preterm births between eras. Commercially insured preterm and term infants were 4.8 percentage points (2.3, 7.4) and 3.4 percentage points (2.5, 4.2) more likely to be born in an academic medical center during the pandemic, while Medicaid-insured preterm and term infants were 3.6 percentage points less likely (−6.5, −0.7) and 1.8 percentage points less likely (−2.8, −0.9) to be born in an academic medical center compared to the pre-pandemic era. Infant LOS decreased from 2.4 to 2.2 days (−0.35, −0.20), maternal LOS for indicated PTBs decreased from 5.6 to 5.0 days (−0.94, −0.19), and term births decreased from 2.5 to 2.3 days (−0.21, −0.17). The pandemic had a significant effect on the location of births that may have exacerbated health inequities that continue into childhood.

Ten-year review of neonatal neurosurgical outcomes and cost analysis.

Neurosurgical interventions in neonates may contribute to increased neonatal intensive care unit (NICU) stay. The impact of neurosurgical interventions on length of stay (LOS) and cost is not well-documented in the literature. In addition to LOS, other factors may impact overall resource utilization. Our objective was to perform a cost analysis of neonates who underwent neurosurgical procedures. A retrospective chart review was performed on NICU patients who underwent ventriculoperitoneal and/or subgaleal shunt placement between January 1, 2010, and April 30, 2021. Postoperative outcomes were analyzed, including LOS, revisions, infections, emergency department (ED) visits following discharge, and readmissions accounting for health care utilization cost. Sixty-six neonates underwent shunt placement during our study period. Out of our 66 patients, 40% of infants had intraventricular hemorrhage (IVH). About 81% had hydrocephalus. Specific diagnoses for our patient population varied and included: 37.9% of patients had IVH complicated by posthemorrhagic hydrocephalus, 27.3% had Chiari II malformation, 9.1% had a cystic malformation leading to hydrocephalus, 7.5% had solely hydrocephalus or ventriculomegaly, 6.0% had myelomeningocele, 4.5% had Dandy-Walker malformation, 3.0% had aqueductal stenosis, and the remaining 4.5% had varying other pathologies. In our patient population, 11% of patients had an identified or suspected infection within 30 days after surgery. The average LOS was 59 days versus 67 days for patients with a postoperative infection. Number of patients who visited the ED within 30 days of discharge was 21%. Of these ED visits, 57% led to readmission. Complete cost analysis was available for 35 out of 66 patients. The average LOS was 63 days with average cost of admission of $209,703.43. Average cost for readmission was $25,757.02. Average daily cost for neurosurgical patients was $1,672.98 versus $1,298.17 for all NICU patients. Neonates who underwent neurosurgical procedures had longer LOS as well as higher daily cost. LOS for infants with infections following procedures was increased by 10.6%. Further research is needed to optimize health-care utilization for these high-risk neonates.

Factors influencing infant length of stay and time to full oral feeding in the neonatal intensive care unit

For premature infants in the Neonatal Intensive Care Unit, feeding is a complex task. Multiple factors affect length of stay (LOS) and time to full oral feeding (TTFF). Researchers employed a retrospective chart review to examine how 14 primary and 10 secondary predictor variables influenced LOS and TTFF, if variables influenced LOS and TTFF in the same way, and how LOS and TTFF were related. Stratified random sampling identified 150 infants meeting age-range and medical inclusion criteria. Researchers used multiple- and simple linear regression and Pearson's correlation analyses. Gestational age, birthweight, type of respiratory support, number of breastfeeding episodes, number of feedings offered by either professionals or family, and number of distinct caregivers significantly influenced LOS and TTFF. Length of stay and TTFF were directly correlated (r = 0.87, p < .001). Seven secondary variables were also predictive, indicating an infant's LOS and TTFF is dependent upon various intrinsic and extrinsic factors. To support shorter LOS and TTFF, professionals should understand the impact of comorbidities on infant feeding progression, promote continuous family involvement, and advocate for consistency in caregivers and feeding practices.

Impact of CSF Meningitis and Encephalitis Panel on Resource Use for Febrile Well-Appearing Infants.

To determine whether the BioFire FilmArray Meningitis/Encephalitis (ME) panel is associated with decreased resource use for febrile infants. The ME panel has a rapid turnaround time (1-2 hours) and may shorten length of stay (LOS) and antimicrobial use for febrile well-appearing infants. Retrospective cohort study of febrile well-appearing infants ≤60 days with cerebrospinal fluid culture sent in the emergency department from July 2017 to April 2019. We examined the frequency of ME panel use and its relationship with hospital LOS and initiation and duration of antibiotics and acyclovir. We used nonparametric tests to compare median durations. The ME panel was performed for 85 (36%) of 237 infants. There was no difference in median hospital LOS for infants with versus without ME panel testing (42 hours, interquartile range [IQR] 36-52 vs 40 hours, IQR: 35-47, P = .09). More than 97% of infants with and without ME panel testing were initiated on antibiotics. Patients with ME panel were more likely to receive acyclovir (33% vs 18%; odds ratio: 2.2, 95%: confidence interval 1.2-4.0). There was no difference in median acyclovir duration with or without ME panel testing (1 hour, IQR: 1-7 vs 4.2 hours, IQR: 1-21, P = .10). When adjusting for potential covariates, these findings persisted. ME panel use was not associated with differences in hospital LOS, antibiotic initiation, or acyclovir duration in febrile well-appearing infants. ME panel testing was associated with acyclovir initiation.

Implementation of Interprofessional Rounds Decreases Neonatal Abstinence Syndrome Length of Stay.

Neonatal abstinence syndrome (NAS) occurs due to abrupt discontinuation of chronic fetal exposure to substances used by the mother during pregnancy. As the incidence of NAS continues to increase, medical teams are evaluating strategies to reduce length of stay (LOS). Increased LOS contributes to poorer mother-infant bonding and neurodevelopmental outcomes as well as increased health care cost. As part of an ongoing quality improvement project, the objective of this study was to determine if formal interprofessional rounds affected LOS for infants with NAS. This was a retrospective analysis at a single hospital system to determine if interprofessional rounds had an impact on NAS LOS. On February 5, 2016, introduction of formal weekly interprofessional NAS-specific rounds occurred in addition to daily patient care rounds. Every patient with opioid exposure undergoing Finnegan scoring, treated with weight-based morphine, and >35 weeks gestation was included. Data were collected on LOS and length of therapy for eligible patients. This study evaluated the impact of interprofessional rounds on LOS 17 months after its implementation compared with 13 months immediately preceding. Among the 119 infants (51 pre and 68 post) meeting inclusion criteria, the median LOS for the post-rounds group was significantly shorter than the pre-rounds group (13 vs 16 days, p = 0.001). The median length of therapy (morphine with or without clonidine) was also significantly shorter in the post-rounds versus the pre-rounds group (8 vs 12 days, p = 0.001). Formal weekly interprofessional NAS rounds decreased LOS and length of therapy.

Birth Hospital Length of Stay and Rehospitalization During COVID-19.

To determine if birth hospitalization length of stay (LOS) and infant rehospitalization changed during the coronavirus disease 2019 (COVID-19) era among healthy, term infants. Retrospective cohort study using Epic's Cosmos data from 35 health systems of term infants discharged ≤5 days of birth. Short birth hospitalization LOS (vaginal birth <2 midnights; cesarean birth <3 midnights) and, secondarily, infant rehospitalization ≤7 days after birth hospitalization discharge were compared between the COVID-19 (March 1 to August 31, 2020) and prepandemic eras (March 1 to August 31, 2017, 2018, 2019). Mixed-effects models were used to estimate adjusted odds ratios (aORs) comparing the eras. Among 202 385 infants (57 110 from the COVID-19 era), short birth hospitalization LOS increased from 28.5% to 43.0% for all births (vaginal: 25.6% to 39.3%, cesarean: 40.1% to 61.0%) during the pandemic and persisted after multivariable adjustment (all: aOR 2.30, 95% confidence interval [CI] 2.25-2.36; vaginal: aOR 2.12, 95% CI 2.06-2.18; cesarean: aOR 3.01, 95% CI 2.87-3.15). Despite shorter LOS, infant rehospitalizations decreased slightly during the pandemic (1.2% to 1.1%); results were similar in adjusted analysis (all: aOR 0.83, 95% CI 0.76-0.92; vaginal: aOR 0.82, 95% CI 0.74-0.91; cesarean: aOR 0.87, 95% CI 0.69-1.10). There was no change in the proportion of rehospitalization diagnoses between eras. Short infant LOS was 51% more common in the COVID-19 era, yet infant rehospitalization within a week did not increase. This natural experiment suggests shorter birth hospitalization LOS among family- and clinician-selected, healthy term infants may be safe with respect to infant rehospitalization, although examination of additional outcomes is needed.

What are the Expectations for Length of Stay after Pediatric Lung Transplantation?

<h3>Purpose</h3> Pediatric lung transplantations (LTx) consists of a relatively small but significant population. Without pooling of multi-institutional data, setting expectations for length of stay (LOS) is difficult. This study aims to investigate the LOS in LTx over the last 20 years to help benchmarking and quality improvement work. <h3>Methods</h3> The United Network for Organ Sharing (UNOS) database was used to identify patients ages 0-18 at time of listing for LTx between 2000 and 2019. This timeframe was divided into two eras: first (2000-2009) and second (2010-2019) eras. LOS was defined as number of days from LTx to discharge. <h3>Results</h3> 905 LTx were identified. 471 transplantations occurred in the first era and 434 in the second. Overall length of stay [median days (IQR)] was 19 (13-31) and comparable between the eras [18 (13-29) vs 20 (14-35), p=0.082]. Specifically by age, LOS for infants was 44 (29-80), for ages 2-11 was 21 (13-37), and for ages 12-18 was 17 (12-26). Compared to patients who did not have each of the following, LOS was increased in patients on ECMO (p<0.001), with ventilator-dependence (p<0.001), with renal dysfunction (eGFR<60 mL/min/1.73m², p=0.006), or with hepatic dysfunction (total bilirubin≥1mg/dl, p=0.012) at the time of transplantation; and in patients re-intubated post-transplantation (p<0.001). However, these patient groups had no change in LOS when comparing eras. On KM analysis, post-transplantation survival in the second era (one-year survival 85%) was not significantly different compared to the first era (one-year survival 84%, p=0.464). <h3>Conclusion</h3> Over the past two decades, lung transplantation patients who are younger or who have pre- or post-transplantation end-organ dysfunction consistently have longer LOS. With these stable patterns, healthcare moving towards a bundled-care system, and an increase in UNOS required & institutional Quality Improvement projects, establishing benchmarks and expectations in pediatric post-lung transplant LOS is important.

1331. Reducing Inpatient Antimicrobial Treatment Duration for Febrile Infants through Implementation of Rapid Diagnostic Testing and Clinical Risk Definition

BackgroundThe management approach to febrile infants remain challenging. Despite new advances in rapid diagnostic testing, febrile infants with a viral infection could receive prolonged antimicrobial treatment due to concerns for co-existing serious bacterial infection (SBI). We sought to decrease the duration of antibiotic treatment in febrile infants less than 8 weeks of age hospitalized on inpatient infectious disease service following sepsis evaluation, who have enterovirus, parechovirus, or respiratory viruses detected, from average 30 hours to 24 hours and sustain for six months.Figure 1. Antibiotic Treatment Duration of Infants Underfoing Evaluation for Sepsis Figure 2. Length of Stay in Infants Underfoing Sepsis Evaluation MethodsA new management guideline that defined “low-risk” infants, as well as inclusion and exclusion criteria, was created to monitor the accurate duration of parenteral treatment and length of hospitalization. Respiratory viruses were detected by a multiplex PCR assay. We created a QlikSense App for further clinical characterization of patients and follow-up. This management guideline was adapted as a quality improvement division initiative. Control charts were used to assess the impact of the interventions.Figure 3. Readmissions in Infants Underfoing Sepsis Evaluation ResultsThe management guideline was developed and implemented by pediatric infectious disease faculty. Febrile infants < 8 weeks of age were included if they had both documented viral infections and sepsis evaluation. 178 infants were admitted with fevers in 2018 and 148 infants were admitted in 2019. The mean inpatient antibiotic treatment duration decreased from 27.7 hours in 2018 to 24.9 hours in 2019 (P > 0.05) (Figure 1). There was no significant difference in length of hospitalization or 30-day readmission rates (Figure 2 and 3). There was no reported readmission for SBI.ConclusionAntibiotic treatment could be discontinued in clinically stable infants with a documented viral infection after 24 hours of negative blood, CSF, and urine bacterial culture incubation so as not to receive unnecessary prolonged inpatient treatment that may increase side effects. In addition to possible decreased treatment side effects our protocol led to decreased patient care costs with no documented changes in readmission rates.Disclosures Octavio Ramilo, MD, Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support, Advisor or Review Panel member)Medimmune (Grant/Research Support)Merck (Advisor or Review Panel member)NIH/NIAID (Grant/Research Support)Pfizer (Consultant, Advisor or Review Panel member)Sanofi/Medimmune (Consultant, Advisor or Review Panel member)

Effectiveness of Alberta Family Integrated Care on infant length of stay in level II neonatal intensive care units: a cluster randomized controlled trial

BackgroundParents of infants in neonatal intensive care units (NICUs) are often unintentionally marginalized in pursuit of optimal clinical care. Family Integrated Care (FICare) was developed to support families as part of their infants’ care team in level III NICUs. We adapted the model for level II NICUs in Alberta, Canada, and evaluated whether the new Alberta FICare™ model decreased hospital length of stay (LOS) in preterm infants without concomitant increases in readmissions and emergency department visits.MethodsIn this pragmatic cluster randomized controlled trial conducted between December 15, 2015 and July 28, 2018, 10 level II NICUs were randomized to provide Alberta FICare™ (n = 5) or standard care (n = 5). Alberta FICare™ is a psychoeducational intervention with 3 components: Relational Communication, Parent Education, and Parent Support. We enrolled mothers and their singleton or twin infants born between 32 0/7 and 34 6/7 weeks gestation. The primary outcome was infant hospital LOS. We used a linear regression model to conduct weighted site-level analysis comparing adjusted mean LOS between groups, accounting for site geographic area (urban/regional) and infant risk factors. Secondary outcomes included proportions of infants with readmissions and emergency department visits to 2 months corrected age, type of feeding at discharge, and maternal psychosocial distress and parenting self-efficacy at discharge.ResultsWe enrolled 654 mothers and 765 infants (543 singletons/111 twin cases). Intention to treat analysis included 353 infants/308 mothers in the Alberta FICare™ group and 365 infants/306 mothers in the standard care group. The unadjusted difference between groups in infant hospital LOS (1.96 days) was not statistically significant. Accounting for site geographic area and infant risk factors, infant hospital LOS was 2.55 days shorter (95% CI, − 4.44 to − 0.66) in the Alberta FICare™ group than standard care group, P = .02. Secondary outcomes were not significantly different between groups.ConclusionsAlberta FICare™ is effective in reducing preterm infant LOS in level II NICUs, without concomitant increases in readmissions or emergency department visits. A small number of sites in a single jurisdiction and select group infants limit generalizability of findings.Trial registrationClinicalTrials.gov Identifier NCT02879799, retrospectively registered August 26, 2016.

Predictors of length of hospital stay among preterm infants admitted to neonatal intensive care unit: Data from a multicentre collaborative network from India (INNC: Indian National Neonatal Collaborative).

Prediction of length of stay (LOS) among preterm neonates is important for counselling of parents and for assessing neonatal intensive care unit (NICU) census and economic burden. The aim of this study is to evaluate perinatal and postnatal factors that influence LOS in preterm infants (25-33 weeks of gestation) admitted to participating NICUs of Indian National Neonatal Collaborative (INNC). From the INNC database, the data which were prospectively entered using uniformed pre-defined criteria were analysed. A total of 3095 infants were included from 12 centres. Every week decrease in gestation increased LOS by 9 days. The median LOS for infants with gestational age of 25, 26, 27, 28, 29, 30, 31, 32 and 33 weeks were 86, 70, 62, 52, 40, 30, 23, 16 and 10 days, respectively. On multivariate analysis, abnormal antenatal umbilical artery doppler, severe small for gestational age (SGA), requirement of resuscitation, respiratory distress syndrome (RDS), seizures, sepsis, necrotising enterocolitis (NEC), major malformations and bronchopulmonary dysplasia (BPD) increased LOS by 5.4 (3.5-7.4), 21.6 (19-23.9), 4.7 (3.3-6.1), 3 (1.7-4.3), 15.2 (8.5-22.1), 11.2 (9.1-13.2), 9.8 (5.2-14.4), 8.8 (4.4-13.3) and 5.6 (0.5-10.7) days, respectively. Apart from lower gestation and birth weight, abnormal antenatal umbilical artery doppler, severe SGA, resuscitation need, major malformations, RDS, seizures, sepsis, NEC and BPD influenced LOS in preterm infants. In comparison with other networks or data from developed countries, LOS in our network was comparatively less for similar gestational age infants.

Increased Adiposity Associated With Increased Length of Stay for Infants With Bronchiolitis.

Excess adiposity upregulates proinflammatory adipokines in infancy that have also been implicated in the pathogenesis of bronchiolitis. The association between excess adiposity and severity of disease in bronchiolitis is unclear. We sought to examine the association between adiposity and length of hospitalization and risk of PICU transfer in children with bronchiolitis. We conducted a retrospective cohort study examining infants 24 months and younger hospitalized at an academic children's hospital with bronchiolitis, grouped by weight status (BMI z score and ponderal index). Data were extracted from the medical record, including the following relevant covariates: age, sex, race and/or ethnicity, and International Classification of Diseases, 10th Revision codes. Outcomes included length of stay (LOS) and PICU transfer. We used multiple regression to examine the association between each anthropometric measure and LOS and likelihood of PICU transfer. There were 765 children in the final sample, 599 without a significant comorbidity (eg, prematurity, congenital heart disease). The median LOS was 2.8 days (interquartile range 1.7-4.9 days). LOS increased with increasing ponderal index quartile (P = .001). After accounting for age and significant comorbidities, we used multivariable regression to identify a significant association between increasing ponderal index and LOS (P = .04) and no association between BMI and LOS. Logistic regression did not reveal an association between either anthropometric measure and PICU transfer. In this study, we identified an association between a measure of excess adiposity in infants and length of hospitalization for bronchiolitis. Further work is needed to confirm this association, examine potential mechanisms, and account for other potential confounders.

What are the Expectations for Length of Stay after Pediatric Lung Transplantation?

Pediatric lung transplantations (LTx) consists of a relatively small but significant population. Without pooling of multi-institutional data, setting expectations for length of stay (LOS) is difficult. This study aims to investigate the LOS in LTx over the last 20 years to help benchmarking and quality improvement work. The United Network for Organ Sharing (UNOS) database was used to identify patients ages 0-18 at time of listing for LTx between 2000 and 2019. This timeframe was divided into two eras: first (2000-2009) and second (2010-2019) eras. LOS was defined as number of days from LTx to discharge. 905 LTx were identified. 471 transplantations occurred in the first era and 434 in the second. Overall length of stay [median days (IQR)] was 19 (13-31) and comparable between the eras [18 (13-29) vs 20 (14-35), p=0.082]. Specifically by age, LOS for infants was 44 (29-80), for ages 2-11 was 21 (13-37), and for ages 12-18 was 17 (12-26). Compared to patients who did not have each of the following, LOS was increased in patients on ECMO (p<0.001), with ventilator-dependence (p<0.001), with renal dysfunction (eGFR<60 mL/min/1.73m2, p=0.006), or with hepatic dysfunction (total bilirubin≥1mg/dl, p=0.012) at the time of transplantation; and in patients re-intubated post-transplantation (p<0.001). However, these patient groups had no change in LOS when comparing eras. On KM analysis, post-transplantation survival in the second era (one-year survival 85%) was not significantly different compared to the first era (one-year survival 84%, p=0.464). Over the past two decades, lung transplantation patients who are younger or who have pre- or post-transplantation end-organ dysfunction consistently have longer LOS. With these stable patterns, healthcare moving towards a bundled-care system, and an increase in UNOS required & institutional Quality Improvement projects, establishing benchmarks and expectations in pediatric post-lung transplant LOS is important.

What are the Expectations for Length of Stay after Pediatric Heart Transplantation?

As the field of heart transplantation (HTx) has undergone much growth over the last several years, it is essential that healthcare systems are able to anticipate the typical hospital courses these patients will take. This study aims to investigate the length of stay (LOS) in HTx over the last 20 years. The United Network for Organ Sharing (UNOS) database was used to identify patients ages 0-18 at time of listing for HTx between 2000-2019. This timeframe was divided into two eras: first (2000-2009) and second (2010-2019) eras. LOS was defined as number of days from HTx to discharge. 6990 HTx cases were identified. 3059 cases occurred in the first era and 3931 in the second. Overall, length of stay [median days (IQR)] was 18 (12-32) and was increased in the second era compared to the first [19 (13-34) vs 17 (11-30), p<0.001]. Specifically by age, LOS for infants was 24 (15-44), for ages 2-11 was 17 (12-29), and for ages 12-18 was 15 (11-23). Compared to those who did not have each of the following, patients on ECMO (p<0.001), on a ventilator (p<0.001), with renal dysfunction (eGFR<60 mL/min/1.73m2, p<0.001), or with hepatic dysfunction (total bilirubin≥1mg/dl, p=0.039) at time of HTx had longer LOS (Table 1). Patients with MCS (VAD or TAH) pre-HTx had similar LOS to those without (p=0.107). LOS was longer for CHD patients than cardiomyopathy patients (p<0.001). On KM analysis, post-HTx survival in the second era (one-year survival 93%) was better than in the first era (one-year survival 88%, p<0.001). Over the past two decades, HTx patients who are younger, have pre-HTx end-organ dysfunction or have congenital heart disease consistently have longer LOS. With these stable patterns, healthcare moving towards a bundled-care system, and an increase in UNOS required & institutional Quality Improvement projects, establishing benchmarks and expectations in pediatric post-HTx LOS is important.

The Infant Cuddler Study: Evaluating the effectiveness of volunteer cuddling in infants with neonatal abstinence syndrome.

St. Michael's Hospital launched a volunteer cuddling program for all infants admitted into the neonatal intensive care unit in October 2015. The program utilizes trained volunteers to cuddle infants when caregivers are not available. This was a pilot study to assess the impact of a volunteer cuddle program on length of stay (LOS) and feasibility of implementation of the program. A mixed methods approach was utilized to measure both quantitative and qualitative impact. A pilot cohort study with a retrospective control group assessed the feasibility of implementing a volunteer cuddling program for infants with neonatal abstinence syndrome (NAS). Length of stay was used as a surrogate marker to measure the impact of cuddling on infants being treated for Neonatal Abstinence Syndrome. Focus groups using semi-structured interviews were conducted with volunteers and nurses at the end of the pilot study. LOS was reduced by 6.36 days (U=34, P=0.072) for infants with NAS in the volunteer cuddling program. Focus groups with both bedside nurses and program volunteers described a positive impact of cuddling programs on infants, families, staff, and volunteers alike. The study results suggest that the volunteer cuddling program may reduce LOS in infants with NAS and have potential economic savings on hospital resources. However, larger prospective cohort studies are needed to confirm these results.

Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis.

Although neonatal herpes simplex virus (HSV) causes significant morbidity, utilization of the cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) test remains variable. Our objective was to examine the association of CSF HSV PCR testing with length of stay (LOS) in a 20-center retrospective cohort of hospitalized infants aged ≤60 days undergoing evaluation for meningitis after adjustment for patient-level factors and clustering by center. Of 20,496 eligible infants, 7,399 (36.1%) had a CSF HSV PCR test performed, and 46 (0.6% of those tested) had a positive test. Infants who had a CSF HSV PCR test performed had a 23% longer hospital LOS (incident rate ratio 1.23; 95% CI: 1.14-1.33). Targeted CSF HSV PCR testing may mitigate the impact on LOS for low-risk infants.

Influence of n-3 Fish Oil-Enriched Intravenous Lipid Emulsion on Length of Stay and Mortality in Infants Post Intestinal Surgery

Background: Parenteral nutrition plays an important role in the infants post intestinal surgery. Currently, n-6 soybean oil-based intravenous lipid emulsion (IVLE) is used as a standard. n-6 have been shown increases biomarkers of inflammation while n-3 have shown positively influence clinical outcomes due to their immunomodulatory action. The aim of this study is to investigate the influence of n-3 fish oil-enriched IVLE on mortality and length of stay in infants post intestinal surgery. Methods: A medical record retrospective study was undertaken in infants post intestinal surgery at Dr. Soetomo Hospital in 2016-2017. Infants with intestinal atresia who had PN for at least three days were included. The n-6 soybean oil-based and n-3 fish oil-enriched IVLE were used. Incomplete data was excluded. Results: There were 19 infants (12/19 boys) included in this study. 10/19 infants received the n-6 soybean oil-based IVLE. The duration and dose of IVLE used were 16.52±11.34 days and 1.80±0.44 g/kg/day. Mortality rate was significantly lower in n-3 fish oil-enriched IVLE group (P=0.02) while there was no difference on length of stay (P=0.484).Conclusion: Infants who received the n-3 fish oil-enriched IVLE have a lower mortality rate but there is no difference on length of stay. Keywords: Infants, Intestinal surgery, Intravenous lipid emulsion, Length of stay, Mortality

Length of Stay and Complications Associated With Febrile Infants

Zangwill et al1 present a statistically rigorous study designed to evaluate whether there was a change in length of stay (LOS) for young, febrile infants hospitalized for evaluation between 2000 and 2012. Using a national data set, in combination with state agencies’ discharge databases, the authors of this study retrospectively analyzed LOS, risk factors for prolonged LOS, complications, and results of viral testing of >40 000 infants <90 days of age. The authors conclude that LOS for febrile infants did not change significantly during this 12-year period. This was contrary to their hypothesis that changes in epidemiology of bacterial infections and increased use of viral testing should have led to a decrease in LOS for these infants. The authors conclude that “targeted effort to raise awareness and implications of these issues in the care of inpatients”1 is needed. If the authors’ hypothesis is correct (that LOS should have decreased and did not), our field has work to do. If we have failed to appropriately shorten LOS in a population deserving of it, then we are falling short of adequately using the tools and knowledge at our disposal to meaningfully adapt our practice, which would be concerning. However, we must critically assess the 2 points made by the authors with regard as to why a shorter LOS was hypothesized for well-appearing, febrile infants: …

Length of stay and cost of birth hospitalization: effects of subfertility and ART.

Objective:To measure delivery length of stay (LOS) and cost as proxies for infant morbidity in assisted reproductive technology (ART) and subfertile deliveries.Study Design:Massachusetts singleton births, ≥23 weeks gestational age (GA) between 2004 and 2010 were linked with ART data, vital records, and hospital discharges. LOS and costs (2010 US Dollars) of infants born to fertile (no ART or indicators of infertility), subfertile (indicators of infertility but no ART), and ART-treated (linked to ART data) deliveries were compared. Least square means and standard errors (SE) were calculated.Results:Of 345,756 singletons, (fertile n=332,481, subfertile n=4,987 and ART-treated n=8,288), overall LOS was 3.79±0.01, 4.32±0.05, and 4.90±0.04 days and costs were $2,980±6, $3,217±58, and $4,483 ±62, respectively. GA and birthweight predicted much of the intergroup difference.Conclusions:Maternal fertility group was not an independent predictor of infant LOS and costs. Prematurity and birthweight were driving factors in resource utilization.

Treating Neonatal Abstinence Syndrome in a Rural Hospital: Lessons Learned

ObjectiveOur level 1 nursery and pediatric unit in a rural hospital adopted a family-centered, symptom-based oral morphine weaning protocol for neonatal abstinence syndrome (NAS) in 2009. Length of stay (LOS), treatment duration (TD), and hospital charges for infants treated for NAS were then compared to published data in neonatal intensive care units (NICUs) nationwide. MethodsThe electronic medical records of infants born January 1, 2011, to April 1, 2017, whose discharge diagnosis included an ICD-9 or ICD-10 code for NAS or prenatal drug exposure were paired with maternal electronic medical record and reviewed. TD was calculated by subtracting the last day morphine was provided from the day it was started, and LOS was calculated by subtracting the discharge date from the date of birth. Infant characteristics, maximum Finnegan score, breastfeeding, discharge disposition, maternal demographics, prenatal use of drugs or medications, and toxicology results were abstracted. Predictors of TD and LOS were analyzed, and hospital charges were enumerated. ResultsChart review identified 167 infants with prenatal drug exposure, 33 of whom were treated for NAS. Median TD for infants with NAS was 18 days (range, 9–37 days) compared to 15 days (range, 9–25 days) in NICUs. Median LOS for infants treated for NAS was 22 days (range, 12–41 days) compared to 20 days (range, 12–32 days) in NICUs, but hospital charges were less. Maternal prenatal use of cocaine (P = .016) predicted LOS. ConclusionsFamily-centered NAS treatment in a rural hospital lasted 2 to 3 days longer than in NICUs, largely as a result of social issues; however, hospital charges were less.

Use of quality improvement (QI) methodology to decrease length of stay (LOS) for newborns with uncomplicated gastroschisis

PurposeGastroschisis is a congenital defect of the abdominal wall leading to considerable morbidity and long hospitalizations. The purpose of this study was to use quality improvement methodology to standardize care in the management of gastroschisis that may contribute to length of stay (LOS). MethodsA gastroschisis quality improvement team established a best-practice protocol in order to decrease LOS in infants with uncomplicated gastroschisis. The specific aim was to decrease median LOS from a baseline of 34days. We used statistical process control charts including rational subgroup analysis to monitor LOS. ResultsFrom December 2008 to December 2016, 119 patients with uncomplicated gastroschisis were evaluated. Retrospective data were obtained on 25 patients prior to protocol implementation. Ninety-four patients with uncomplicated gastroschisis comprised the prospective process stage. The median LOS for this retrospective cohort was 34days (IQR: 30.5–50.5), while the median LOS for the prospective cohort following implementation of the protocol decreased to 29days (IQR: 23–43). ConclusionsWith the use of quality improvement methodology, including standardization of care and a change in surgical approach, the median LOS for newborns with uncomplicated gastroschisis at our institution decreased from 34days to 29days. Level of evidence3.