Neonatal Intensive Care Unit Length Of Stay Research Articles

Morbidity and trends in length of hospitalisation of very and extremely preterm infants born between 2008 and 2021 in the Netherlands: a cohort study

ObjectivesThis study investigated changes in the length of stay (LoS) at a level III/IV neonatal intensive care unit (NICU) and level II neonatology departments until discharge home for very preterm...

Evaluation of Post-neonatal Intensive Care Unit Home Irrigations Prior to Pull-through: Implications for Hirschsprung Disease Management

BackgroundPull-through procedures for Hirschsprung disease (HD) can be performed during the Neonatal Intensive Care Unit (NICU) stay or delayed until discharge following home irrigations. This study assesses the safety of a delayed pull-through as an alternative to neonatal reconstruction in infants with successful abdomen decompression with home irrigations based on Hirschsprung-associated enterocolitis (HAEC) development. MethodsA single-institution retrospective review of neonates with HD who underwent delayed or neonatal pull-through from July 2018–July 2022. Endpoints included post-pull-through HAEC incidence, recurrence at an 18-month follow-up, time to the first HAEC episode, NICU length of stay (LOS), and HAEC-related LOS. ResultsTwenty-four neonates were included. Eighteen were discharged from the NICU with home irrigations. Of these, 3 (28%) developed enterocolitis preoperatively, 12 (67%) underwent a delayed pull-through. NICU LOS in the delayed cohort was 3 times shorter than in the neonatal (6 vs. 18 days, p < 0.01). The incidence of enterocolitis (82% vs. 80%), time to the first episode (43 vs. 57 days), and HAEC-related LOS (median of 3 days) were similar. ConclusionsDelayed HD pull-through is a viable neonatal reconstruction alternative that reduces NICU stay without increasing the risk of postoperative HAEC development. Type of StudyOriginal Research Article. Level of EvidenceIII.

Developing a length of stay prediction model for newborns, achieving better accuracy with greater usability

BackgroundOne in ten newborn children is born prematurely. The elongated length of stay (LOS) of these children in the Neonatal Intensive Care Unit (NICU) has important implications on hospital occupancy figures, healthcare and management costs, as well as the psychology of parents. In order to allow accurate planning and resource allocation, this study aims to create a generalizable and robust model to predict the NICU LOS of preterm newborns. MethodsData were collected from a large tertiary center NICU between 2011 and 2018 and relates to 5,362 newborns. The selected model was externally validated using a data set of 8,768 newborns from another tertiary center NICU. This report compares several models, such as Random Forest (RF), quantile RF, and other feature selection methods, including LASSO and AIC step-forward selection. In addition, a novel step-forward selection based on False Discovery Rate (FDR) for quantile regression is presented and evaluated. ResultsA high-orderquantile regression model for predicting preterm newborns’ LOS that uses only four features available at birth had more attractive properties than other richer ones. The model achieved a Mean Absolute Error (MAE) of 6.26 days on the internal validation set (average LOS 27.04) and an MAE of 6.04 days on the external validation set (average LOS 29.32). The suggested model surpassed the accuracy obtained by models in the literature. It is shown empirically that the FDR-based selection has better properties than the AIC-based step-forward selection approach. ConclusionThis paper demonstrates a process to create a predictive model for NICU LOS in preterm newborns, where each step is reasoned. We obtain a simple and robust model for NICU LOS prediction, which achieves far better results than the current model used for financing NICUs. Utilizing this model, we have created an easy-to-use online web application to ease parents' worries and to assist NICU management: https://tzviel.shinyapps.io/calcuLOS.

MT47 Does the Use of New Technology By Care Managers Have an Impact on Neonatal Intensive Care Unit (NICU) Admissions and Length of Stay?

Neonatal intensive care units (NICU) provide essential medical care to neonates; however, they are associated with hospital-acquired infections, less maternal-newborn bonding, and high costs. Implementing strategies to lower NICU admission rates and shorten NICU length of stay (LOS) is essential. This study uses causal-inference methods to evaluate the impact of care managers using new technology to identify and risk stratify pregnancies on NICU admissions and NICU LOS.

The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention

BackgroundNeonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model’s key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation’s impact/outcomes.MethodsA stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation.DiscussionThe primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources.Trial registrationClinicalTrials.gov, NCT0522662. Registered February 4th, 2022.

Prenatal Buprenorphine/Naloxone or Methadone Use on Neonatal Outcomes in Michigan.

BackgroundMaternal opioid exposure during pregnancy has various effects on neonatal health. Buprenorphine/naloxone and methadone are examples of medications for opioid use disorder (MOUD) used for the treatment of opioid use disorder (OUD). Research comparing the impacts of these MOUD modalities on neonatal outcomes when used to treat pregnant people with OUD remains limited. We evaluated the differences in outcomes between neonates with in-utero exposure to buprenorphine/naloxone versus methadone.MethodologyWe performed a retrospective cohort chart review between October 15, 2008, and October 15, 2019, evaluating mother/neonate dyads at two medical centers in Michigan. The charts of female patients, aged 18+, with OUD and buprenorphine/naloxone or methadone treatment, were examined. The charts of the corresponding neonates were also examined. Multiple regression analysis was performed.ResultsIn total, 343 mother/infant dyads were included: 99 patients were treated with buprenorphine/naloxone and 232 patients were treated with methadone. The buprenorphine/naloxone group had significant differences in maternal age, hepatitis status, asthma, gestational age in weeks, neonatal intensive care unit (NICU) length of stay (LOS), neonatal opioid withdrawal syndrome (NOWS) peak score, birth head circumference, and birth weight compared to the methadone group at baseline. Adjusted multivariable regression analysis demonstrated neonates with exposure to buprenorphine/naloxone had a NOWS peak score 3.079 points less (95% confidence interval (CI): -4.525, 1.633; p = 0.001) and NICU LOS 8.955 days less (95% CI: -14.399, -3.511; p = 0.001) than neonates exposed to methadone.ConclusionsNeonates with in-utero exposure to buprenorphine/naloxone had significantly lower NOWS scores and shorter NICU LOS compared to neonates with in-utero exposure to methadone. These findings demonstrate that buprenorphine/naloxone is potentially a more favorable treatment for the reduction in metrics representing adverse neonatal outcomes in pregnant people with OUD than methadone.

Impact of Docosahexaenoic acid supplementation on proinflammatory cytokines release and the development of Necrotizing enterocolitis in preterm Neonates: A randomized controlled study

IntroductionPreterm neonates have under-developed immune-regulatory system; consequently, there is a risk for developing chronic inflammation. Necrotizing enterocolitis (NEC) is an acute devastating neonatal intestinal inflammatory disorder. Due to the obscure multifactorial etiology, early diagnosis and effective treatment of NEC are limited. Consequently, effective strategies in the prevention of NEC, including nutritional approaches, are critically needed. The current study was conducted to assess the potential immunomodulatory effect of Docosahexaenoic Acid (DHA) supplementation in preterm neonates at neonatal intensive care unit (NICU) and subsequently its effect on preventing or reducing NEC incidence. MethodsThis was a prospective randomized controlled study. A total of 67 neonates, with gestational age equal or less than 32 weeks at birth and weight less than or equal 1500 g, were randomly assigned to either DHA group or the control group. Modified Bell’s staging criteria for NEC was used as an objective tool for diagnosis and staging of NEC. Levels of Interleukin 1 beta (IL-1β) were measured at baseline and after 10 days. Mortality and NICU length of stay (LOS) were also monitored. ResultsThirty neonates of each group completed the study. A statistically significant difference was observed between the two groups regarding diagnosis and staging of NEC (p = 0.0001). There was also a statistically significant difference between DHA group 22(73.3), 95% CI [55.9, 86.5] and the control group 8 (26.7), 95% CI [13.5, 44.1] in the percentage change in IL-1β levels (p = 0.0001).A statistically significant association was found between IL and 1 β change and NEC diagnosis (p = 0.001). NICU LOS was significantly lower among DHA group 21.63 ± 6.67 compared to the control group 25.07 ± 4.67 (p = 0.025). Mortality n (%) among the control group 4 (11.8) was higher than DHA group 3 (9.1), however, no significant difference was detected (p = 1.0). ConclusionFindings of this study suggest that enteral DHA supplementation can reduce NEC incidence in preterm neonates through its immunoregulatory effect that modulates production of regulatory cytokines.Trial registration: Registered at clinical trials.gov (NCT03700957), 6 October 2018.

Influence of Gestational Age and Mode of Delivery on Neonatal Outcomes in Prenatally Diagnosed Isolated Congenital Diaphragmatic Hernia

Aim: The optimal gestational age (GA) at delivery and mode of delivery (MoD) for pregnancies with fetal congenital diaphragmatic hernia (CDH) is undetermined. The impact of early term (37–38 weeks 6 days) versus full term (39–40 weeks 6 days) and MoD on immediate neonatal outcomes in prenatally diagnosed isolated CDH cases was evaluated. Material and Methods: A retrospective chart review of pregnancies evaluated and delivered with the prenatal diagnosis of CDH between July 1, 2008, and December 31, 2018. The primary outcome was survival to hospital discharge. Secondary outcomes included neonatal intensive care unit (NICU) length of stay (LOS), extracorporeal membrane oxygenation (ECMO) requirement and need for supplemental oxygen at day 30 of life. Results: A total of 296 patients were prenatally evaluated for CDH and delivered in a single center during the study period. After applying exclusion criteria, data were available on 113 women who delivered early term and 72 women who delivered full term. Survival to hospital discharge was comparable between the 2 groups – 83.2% in the early term versus 93.1% in the full term (p = 0.07; 95% CI of 0.13–1.04). No difference was observed in any other secondary outcomes. MoD was stratified into spontaneous vaginal, induced vaginal, unplanned cesarean and scheduled cesarean delivery with associated neonatal survival rates of 74.2, 90.6, 89.7 and 88.2%, respectively, p = 0.13. The 5-min Apgar score was higher in the elective cesarean group (7.94) followed by the induced vaginal delivery group (7.8) compared to 7.17 and 7.18 in the spontaneous vaginal and unplanned cesarean groups, respectively (p = 0.03). The GA and MoD did not influence survival to hospital discharge nor NICU LOS in multivariate analysis. Conclusions: Though there were no significant differences in neonatal outcomes for early term compared to full term deliveries of CDH neonates, a trend toward improved survival rates and lower ECMO requirements in the full term group may suggest an underlying importance GA at delivery. Further studies are warranted to validate these findings.

635 Neonatal morbidity associated with pregnancies complicated by vasa previa: a comparative study

Vasa previa (VP) affects 2.5 per 1000 deliveries. Neonatal complications of VP are thought to result from peripartum fetal hemorrhage from ruptured vessels and/or sequelae of iatrogenic prematurity, but there is scarce data on the post-natal course. This study aims to better characterize post-natal complications which may occur in pregnancies affected by VP. This is a retrospective cohort study of subjects with VP identified on ultrasound at a single tertiary care University center from 2011-2020. VP cohort was matched 2:1 with gestational-age-matched and birthweight-matched control group delivered after spontaneous preterm labor (SPB). Primary outcome was the difference in early neonatal morbidity between groups. Secondary outcomes included differences in neonatal intensive care unit (NICU) length of stay (LOS) and neonatal transfusion rates. Outcomes were evaluated with descriptive statistics, Mann-Whitney-U tests, and T-tests. There were 23 subjects (19 singleton, 3 dichorionic, 1 monochorionic twins) with VP and 46 singleton controls. Descriptive characteristics shown in Table 1. Completion of antenatal steroids (ANC) course was significantly more common in VP group (78.3% vs 42.9%, p<0.01). Neonatal transfusion rates were elevated in VP group (17.4% VP versus 4.7% SPB, p=0.08) and mean neonatal hematocrit was significantly lower (42.6% VP versus 47.5% SPB, p<0.01) (Table 1). Immediate assisted ventilation and prolonged assisted ventilation (>6hrs) were significantly higher in the VP cohort (Table 1). NICU LOS was significantly longer in neonates with VP (median 13 days (IQR 9-24) versus 5 days (IQR 0-13); p<0.01) and this persisted when stratified by gestational age (Figure 1). Neonates of pregnancies complicated by VP had significantly higher ventilatory requirements, despite higher rates of ANC completion. In addition, neonates had a longer NICU LOS implying more complex post-natal course. Neonatal transfusion rates were also 4 times higher in VP, but this did not reach statistical significance.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Neonatal Intensive Care Unit Demographics and Subsequent Development of Food Allergies

We aimed to determine the association between neonatal intensive care unit (NICU) length of stay (LOS), gestational age (GA) and birth weight (BW), and the diagnosis of food allergies later in childhood. We hypothesized that infants that had longer NICU LOS and lower GA would have a lower prevalence of food allergies than the control group due to an incidental finding by a large prospective Swedish study (Mitselou et. al.) along with evidence from studies on early exposure to allergens and varied microbiota.

Perinatal Outcomes in Fetuses Prenatally Diagnosed with Congenital Diaphragmatic Hernia and Concomitant Lung Lesions: A 10-Year Review

Aim: To describe perinatal outcomes of fetuses with a prenatal diagnosis of a concomitant lung lesion in the setting of congenital diaphragmatic hernia (CDH) and to compare outcomes with an isolated CDH control group without a lung lesion, matched by ultrasound-based prognostic markers including presence of liver herniation and lung measurements. Material and Methods: This was a retrospective case-control study, wherein all pregnancies diagnosed with CDH and concomitant lung lesions were identified between July 1, 2008, and December 31, 2018. For each case, 2 controls with isolated CDH from the same study period were selected after matching for the presence of liver herniation into the thoracic cavity and ultrasound-based lung measurements either observed over expected lung-to-head ratio (LHR) or absolute LHR with their corresponding gestational age. The outcomes analyzed in the 2 groups included survival to hospital discharge, neonatal intensive care unit (NICU) length of stay (LOS), extracorporeal membrane oxygenation (ECMO) requirement and need for supplemental oxygen (O₂) at day 30 of life. Results: A total of 21 pregnancies were identified with CDH and a concomitant lung lesion in the study period. All the lung lesions were stratified into a “low-risk category” with a congenital cystic adenomatoid malformation volume ratio of less than 1.0 at the time of presentation. None of these fetuses developed hydrops or required in utero intervention. Overall survival in the group was 80.7% (17/21) and rate of ECMO was 38.1%. Causes of mortality included pulmonary insufficiency, sepsis, renal failure, and bowel infarction. Upon comparison between the cases and controls, the 2 groups were similar with respect to pregnancy demographics. There were no fetal demises in either group. Outcomes including survival rate, NICU LOS, ECMO requirements and need for supplemental O₂ at day 30 of life, were comparable among the 2 groups. Conclusions: In our descriptive series, the presence of a concomitant, low-risk lung lesion in the setting of fetal CDH did not have a significant impact on the natural course of the disease, nor was it associated with a worse prognosis.

Health Economics and Outcomes of Surfactant Treatments for Respiratory Distress Syndrome Among Preterm Infants in US Level III/IV Neonatal Intensive Care Units.

To compare length of stay (LOS), costs, mechanical ventilation (MV), and mortality in preterm infants treated in the Neonatal Intensive Care Unit (NICU) with beractant (BE), calfactant (CA), and poractant alfa (PA) for Respiratory Distress Syndrome (RDS). This study evaluated preterm infants born between 2010 and 2013 with RDS diagnosis, gestational age of 25 to 36 weeks, birthweight of ≥500 g, and age of ≤2 days on first surfactant administration. Multivariable regression was used to evaluate all NICU outcomes. Of 13,240 infants meeting the study criteria, 4136 (31.2%) received BE, 2502 (18.9%) received CA, and 6602 (49.9%) received PA. Adjusted analyses estimated similar mean LOS (BE 26.7 days, CA 27.8 days, and PA 26.2 days) and hospital costs (BE: $50,929; CA: $50,785; and PA: $50,212). Compared to PA, BE and CA were associated with greater odds of MV use on day 3 (OR = 1.56 and 1.60, respectively) and day 7 (OR = 1.39 and 1.28, respectively; all p < 0.05). Adjusted NICU mortality was significantly higher only with CA vs PA (OR = 1.51; p = 0.015). Adjusted NICU LOS and costs were similar among BE, CA, and PA. Infants receiving PA were less likely to be on MV at 3 and 7 days, and PA treatment was associated with lower odds of NICU mortality when compared to CA.

The Effect of Delayed Cord Clamping on Moderate and Early Late-Preterm Infants.

This study aims to evaluate the clinical consequences of protocol-driven delayed umbilical cord clamping (DCC) implementation in moderate and early late-preterm (MELP) infants born between 320/7 and 346/7 weeks gestation. We conducted a prospective cohort study with a historic control cohort comparison. The prospective study period was 1 year when DCC was performed for 60 seconds duration (DCC cohort, n = 106). The study period for historic control cohort with no DCC was also 1 year before DCC implementation (historic cohort, n = 137). The mean hematocrit at birth was significantly higher in the DCC cohort compared with the historic cohort (49.1 ± 14.9 vs. 45.7 ± 15.7; p = 0.01). Fewer infants in the DCC cohort were admitted to neonatal intensive care unit (NICU) on respiratory support compared with the historic cohort (17.9 vs. 29.9%; p = 0.04). The incidence of respiratory distress syndrome was significantly lower in the DCC cohort compared with the historic cohort (2.8 vs. 14.6%; p = 0.002). There were no differences in the incidence of phototherapy or NICU length of stay (LOS) between groups. In MELP infants, DCC was associated with increased hematocrit and better respiratory transition at birth. DCC was not associated with increased phototherapy or NICU LOS.

The contribution of maternal psychological functioning to infant length of stay in the Neonatal Intensive Care Unit.

ObjectiveAssess maternal psychological functioning within the Neonatal Intensive Care Unit (NICU) and its contribution to neonate length of stay (LOS) in the NICU.Study designMothers of infants admitted to the NICU (n=111) were assessed regarding postpartum depression, postpartum social support, postpartum NICU stress, and maternal anxiety at 2 weeks postpartum. Illness severity was assessed with the Clinical Risk Index for Babies (CRIB).ResultsPostpartum depression was not significantly correlated with LOS, but was significantly correlated with trait anxiety (r=0.620), which was significantly correlated with LOS (r=0.227). Among mothers with previous mental health history, substance abuse history and CRIB score were the best predictors of LOS. For mothers without a prior mental health issues, delivery type, stress associated with infant appearance, and CRIB scores were the best predictors of LOS. In this group, LOS was found to increase on average by 7.06 days per one unit increase in stress associated with infant appearance among mothers with the same delivery type and CRIB score.ConclusionSignificant correlations of trait anxiety, stress associated with infant appearance, and parental role with LOS support the tenet that postpartum psychological functioning can be associated with NICU LOS.

The Influence of Early‐Term Birth on NICU Admission, Length of Stay, and Breastfeeding Initiation and Duration

To examine hospitalization and breastfeeding (BF) experiences for early-term (ET) and full-term (FT) infants to determine if differences existed between them. Retrospective descriptive cohort study. United States 2009. Stratified systematic sample of ET (n = 4052) and FT (n = 6825) infants. Infants whose mothers completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey were eligible for inclusion. Extreme discordant phenotype design was used to establish infant groups (ET=37weeks/260-267 days; FT=40-41 weeks/282-294days). Secondary data analysis was used to examine neonatal intensive care unit (NICU) admission, length of stay (LOS), BF initiation and duration, maternal reasons for BF noninitiation, and predictors of BF start and continuance. Early-term infants had higher incidences of NICU admission (OR = 1.56), LOS 3-14days (OR = 1.16), and BF noninitiation (OR = 1.5) when compared (weighted analysis) to FT infants. Early-term gestation was a predictor of BF noninitiation (OR = 1.42) and duration of BF fewer than 4weeks (OR = 1.309) in nonweighted models. Other predictors of BF noninitiation included African American race, White versus other non-African American race, less maternal education, marital status other, maternal smoking, and maternal medical risk factors. Predictors of shortened BF duration for the sample included African American race versus White race, White versus other non-African American race, less maternal education, marital status other, maternal age younger than age 20years, and maternal smoking. Differences in care experienced by ET versus FT infants were identified. Maternal report of ET infant NICU admission and LOS was consistent with studies based on medical records data while new knowledge about ET infant BF patterns emerged.

Neonatal intensive care unit: predictive models for length of stay

Hospital length of stay (LOS) is important to administrators and families of neonates admitted to the neonatal intensive care unit (NICU). A prediction model for NICU LOS was developed using predictors birth weight, gestational age and two severity of illness tools, the score for neonatal acute physiology, perinatal extension (SNAPPE) and the morbidity assessment index for newborns (MAIN). Consecutive admissions (n=293) to a New England regional level III NICU were retrospectively collected. Multiple predictive models were compared for complexity and goodness-of-fit, coefficient of determination (R (2)) and predictive error. The optimal model was validated prospectively with consecutive admissions (n=615). Observed and expected LOS was compared. The MAIN models had best Akaike's information criterion, highest R (2) (0.786) and lowest predictive error. The best SNAPPE model underestimated LOS, with substantial variability, yet was fairly well calibrated by birthweight category. LOS was longer in the prospective cohort than the retrospective cohort, without differences in birth weight, gestational age, MAIN or SNAPPE. LOS prediction is improved by accounting for severity of illness in the first week of life, beyond factors known at birth. Prospective validation of both MAIN and SNAPPE models is warranted.

Use of polymerase chain reaction as a diagnostic tool for neonatal sepsis can result in a decrease in use of antibiotics and total neonatal intensive care unit length of stay

To retrospectively determine if a negative 16S ribosomal RNA (rRNA) polymerase chain reaction (PCR) (PCR(-)) could lead to a decrease in the number of antibiotic doses and neonatal intensive care unit (NICU) length of stay (LOS) for infants admitted to the NICU for presumed early-onset sepsis (EOS) with negative blood culture results (BC(-)). Analysis included 419 infants, greater than 35 weeks gestational age, with PCR(-), BC(-) and LOS > 48 h. Both the investigators and clinical care team were unaware of the PCR results. The actual number of antibiotic doses (AAD) administered was compared to an estimated number of antibiotics doses (EAD) that would have been given until PCR(-) results were available by 18 h. The number of antibiotic doses saved was calculated as (AAD-EAD). The actual NICU LOS in hours (aLOS) for a subset of infants who remained in the hospital primarily for antibiotic therapy was compared to an estimated LOS (eLOS) if infants with PCR(-) were discharged from the NICU when clinically stable. The number of hours saved was calculated as (aLOS-eLOS). Approximately eight antibiotic doses and 85 NICU hours per infant could be saved using PCR(-) results available at 18 h. Use of 16S rRNA PCR could decrease the number of antibiotics doses and NICU LOS for infants admitted for EOS. This may facilitate: (1) earlier NICU discharge; (2) parental satisfaction; and (3) decreased health care costs.

Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes.

To determine the rates, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in extremely preterm neonates in a neonatal intensive care unit (NICU). A prospective cohort study was conducted at the St Louis Children's Hospital on all patients who had birth weight <or=2000 g and were admitted to the NICU for >or=48 hours from October 2000 to July 2001. Extremely preterm neonates were defined as neonates with estimated gestational age (EGA) <28 weeks. The primary outcome was the development of VAP. Secondary outcomes were death and NICU length of stay (LOS). Multiple logistic regression was performed to determine independent predictors for VAP and mortality. A total of 229 patients were enrolled. Sixty-seven (29%) had EGA <28 weeks. Nineteen episodes of VAP occurred in 19 (28.3%) of 67 mechanically ventilated patients. VAP rates were 6.5 per 1000 ventilator days for patients with EGA <28 weeks and 4 per 1000 ventilator days for EGA >or=28 weeks. By multivariate analysis, bloodstream infection before VAP (adjusted odds ratio: 3.5; 95% confidence interval [CI]: 1.2-10.8) was an independent risk factor for VAP after adjustment for the duration of endotracheal intubation. Ventilator-associated pneumonia (adjusted odds ratio: 3.4; 95% CI: 1.2-12.3) was an independent predictor of mortality. A strong association between VAP and mortality was observed in neonates who stayed in the NICU >30 days (relative risk: 8.0; 95% CI: 1.9-35.0). Patients with VAP also had prolonged NICU LOS (median: 138 vs 82 days). VAP occurred at high rates in extremely preterm neonates and was associated with increased mortality. Additional studies are needed to develop interventions to prevent VAP in NICU patients.

Mask Continuous Positive Airway Pressure in The Delivery Room Improves Outcomes of Term and Near-Term Infants With Respiratory Distress 1952

Objective: To evaluate the effect of delivery room mask continuous positive airway pressure (mCPAP) on the outcomes of newborns with respiratory distress (RD). Design: Retrospective chart review.Setting: Tertiary perinatal center in a private community hospital. Patients: All inborn infants of gestational age (GA)>34 wks with RD at birth (persistent grunting, nasal flaring, retractions, tachypnea) who were discharged between January 1 and June 30, 1997.Interventions: Use of mCPAP, excluding bag-mask ventilation (BMV) and endotracheal intubation (ETT). Outcome measures: Admission to Neonatal Intensive Care Unit (NICU), NICU length of stay (LOS), RD duration, pneumothorax, and total LOS. Logistic regression analysis was used to compare the use of mCPAP with non-treatment. Results: A total of 1,228 charts were reviewed; 71 (5.8%) represented births at GA <35 wks, a main exclusion criterion. Of the remainder, 171 infants (14.8%) had RD in the delivery room and were the focus of this study. The Cesarean section rate of these symptomatic infants was 31.6% vs. 21.6% of all cases reviewed (p<0.01, Chi-square). Of the infants with RD at birth, 109 received mCPAP, 13 received BMV, 3 received ETT, and 53 received no ventilatory intervention(some received multiple interventions). The 15 cases who received BMV and/or ETT were excluded from analysis. The 103 infants who received only mCPAP(group 1) vs. 53 with no ventilatory intervention (group 2) did not differ statistically in birthweight, GA, Apgar scores, mode of delivery, or RD (based on a scoring system). Twenty-two (21%) of group 1 vs. 19 (36%) of group 2 were admitted to the NICU [odds ratio 0.28 (95% CI 0.09-0.82), p=0.032]. Two (1.9%) of group 1 vs. 5 (9.4%) of group 2 developed a pneumothorax [odds ratio 0.18(95% CI 0.02-1.26), p=0.036]. RD persisted for 0.55 days (SD 1.3) for group 1 vs. 1.1 days (SD 2.0) for group 2 (p=0.008). Of infants admitted to the NICU, NICU LOS was 5.3 (SD 5.2) for group 1 vs. 5.3 (SD 4.5) for group 2 (NS). Total LOS was 4.1 (SD 5.5) for group 1 vs 3.6 (SD 3.2) for group 2 (NS).Conclusions: RD is common in term and near-term infants in the delivery room. In this study, the use of mCPAP to treat infants with RD in the first minutes after birth: 1) decreased the likelihood of admission to the NICU; 2) decreased the duration of RD; and 3) may have reduced the risk of pneumothorax. NICU LOS and total LOS were not affected. These findings have major implications with respect to parent-infant separation and cost of care.