Newborn Nursery Research Articles

Correlations between the Status of the Umbilical Cord and Neonatal Health Status.

PurposeThis study aimed to identify correlations between the status of the umbilical cord and neonatal health status.MethodsIn total, 172 newborns were enrolled who were admitted to the newborn nursery with a gestational age of 35 weeks or older and a body weight of 2 kg or above. Data were collected on the basic personal information of the newborns, the diameter and soft tissue status of the umbilical cord, and neonatal health status after birth. Analyses were performed using t-test, analysis of variance, x2 test, and Fisher exact test.ResultsUmbilical cord diameter exhibited a statistically significant difference by sex (t=2.71, p=.007). A thin umbilical cord diameter was associated with a 1-minute Apgar score less than 8 points (t=2.47, p=.015) and with being transferred to the intensive care unit (t=2.45, p=.015). Poor soft tissue status of the umbilical cord was associated with a 1-minute Apgar score of less than 8 points (x2=16.68, p<.001) and with oxygen being supplied (x2=4.81, p=.028).ConclusionAssessing the umbilical cord diameter and status in newborns is an important tool for evaluating neonatal health status after birth, and this point also underscores the importance of professionals' careful observations in the newborn nursery.

Introducing the Eating, Sleeping, Consoling Care Tool at The University of Vermont Children's Hospital (UVMCH)

Introduction: Given wide variation in care practices for infants with Neonatal Abstinence Syndrome (NAS) many clinicians aim to improve care through standardization. The Eating, Sleeping, Consoling (ESC) Care Tool standardizes both non-pharmacologic and pharmacologic care based on assessment of functional symptoms of opioid withdrawal and has been associated with a decrease in length of stay and pharmacologic treatment. Goal: Decrease the median percent of newborns who receive methadone postnatally for NAS by 30% between July, 2018 and January, 2019 by implementing the ESC Care Tool. Setting: At UVMCH, opioid exposed infants are routinely monitored on Labor and Delivery and the Newborn Nursery …

The Impact of COVID-19 Infection on Labor and Delivery, Newborn Nursery, and Neonatal Intensive Care Unit: Prospective Observational Data from a Single Hospital System.

Objective Since its emergence in late 2019, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the novel coronavirus that causes novel coronavirus disease 2019 (COVID-19), has spread globally. Within the United States, some of the most affected regions have been New York, and Northern New Jersey. Our objective is to describe the impact of COVID-19 in a large delivery service in Northern New Jersey, including its effects on labor and delivery (L&D), the newborn nursery, and the neonatal intensive care unit (NICU). Materials and Methods Between April 21, 2020 and May 5, 2020, a total of 78 mothers (3.6% of deliveries) were identified by screening history or examination to either be COVID-19 positive or possible positives (persons under investigation). Of the mothers who were tested after admission to L&D, 28% tested positive for SARS-CoV-2. Discussion Isolation between mother and infant was recommended in 62 cases, either because the mother was positive for SARS-CoV-2 or because the test was still pending. Fifty-four families (87%) agreed to isolation and separation. The majority of infants, 51 (94%), were initially isolated on the newborn nursery. Six needed NICU admission. No infants had clinical evidence of symptomatic COVID-19 infection. Fourteen infants whose mothers were positive for SARS-CoV-2, and who had been separated from the mother at birth were tested for SARS-CoV-2 postnatally. All were negative. Results COVID-19 posed a significant burden to mothers, infants, and staff over the 5-week study period. The yield from screening mothers for COVID-19 on L&D was high. Most families accepted the need for postnatal isolation and separation of mother and newborn. Conclusion Our study suggests that the transmission of SARS-CoV-2 from mother to her fetus/newborn seems to be uncommon if appropriate separation measures are performed at birth. Key Points The yield of targeted testing for SARS-CoV-2, on mothers on Labor and Delivery is high.Agreement to separation of mothers and infants to reduce transmission of SARS-CoV-2 was high.The incidence of symptomatic COVID-19 in newborns is low, if appropriate separation occurs at birth.

Early Extended Neonatal Screening for Congenital Cytomegalovirus Infection: A Quality Improvement Initiative

Identification of congenital cytomegalovirus (cCMV) infection in neonates is important for early diagnosis of sensorineural hearing loss. Therefore, a quality improvement project was designed with an aim to improve newborn CMV screening by 25% from a baseline rate of 22%. This project was conducted across two hospital sites at one medical center with two tertiary care newborn nurseries and neonatal intensive care units. Symptomatic neonates with suggestive findings of cCMV, who had failed the newborn hearing screen, who had not had a hearing screen performed by 10 days of age, or who were infants of HIV-positive mothers were screened for cCMV. Serial interventions (formalized teaching sessions using an algorithm and involving a nurse educator, creation of electronic medical record order sets, huddle board reminders, and regular audits) were conducted, and statistical process control p-charts were used to identify any signals and to determine if there was any special cause variation. Of 5,817 infants born in 2018, 903 were eligible for screening. Small for gestational age (46%) was the most common indication for screening. After multiple interventions, the median screening rate increased from a baseline of 22% in 2016 to 74% during the one-year study period. Four infants had positive CMV screen and received appropriate treatment as a result of these interventions. Multidisciplinary quality improvement initiatives can improve newborn screening for cCMV infection in a tertiary care environment.

Variation in Management of Cutaneous Lumbosacral Findings in Newborns.

Cutaneous lumbosacral findings in neonates are common in the newborn nursery but may also be associated with occult spinal dysraphism. Variation in management of lumbosacral findings by neonatal clinicians has not been previously described. Clinicians in the Better Outcomes through Research for Newborns (BORN) Network were invited to participate in an electronic survey. Participants reviewed 18 photographs of lumbosacral findings in asymptomatic neonates and selected 1 or more initial management step(s): routine care, watchful waiting, imaging, and/or subspecialty consultation. Additional data collected include ease of access to imaging and subspecialty consultants and characteristics of respondents. Of 407 BORN Network clinicians, 206 (51%) completed the survey. Respondents were in >90% agreement in initial management approach of 8 of 18 cases. The most common initial actions were spinal ultrasound (53%), neurosurgery evaluation (18%), and MRI (13%). Anomalies of the gluteal crease had the lowest proportion of agreement. In 2 cases, there were differences in respondents' choice to image or consult a subspecialist depending on their percent clinical full time equivalent spent taking care of neonates <1 month of age: (1) coccygeal hair (P = .02) and (2) deviated gluteal crease (P = .02). Variation in initial management of neonatal lumbosacral findings by clinicians in the BORN Network was seen most often for deviations of the gluteal crease, flat vascular macules, and coccygeal hair.

Evaluation of the Period of PURPLE Crying: An Abusive Head Trauma Prevention Programme

Abusive head trauma (AHT) in infants is thought to be triggered by caregiver frustration with persistent crying. The Period of PURPLE Crying (POPC) is designed to educate parents about normal infant crying, strategies to use when infants cry and the dangers of shaking in an effort to decrease AHT. Studies evaluating the POPC have measured changes in parent knowledge and behaviour regarding infant crying. Our objective was to evaluate the POPC's effect on caregiver frustration with infant crying compared to standard discharge information (SDI). We taught paediatric interns and medical students rotating in the newborn nursery to deliver the POPC and discuss infant crying. New parents were pseudo‐randomised to receive SDI or the POPC plus SDI. Parents were contacted five‐to‐eight weeks after discharge and asked knowledge questions about infant crying as well as the number of times that they were frustrated by their infant's crying in the preceding week. Of 271 parents who consented to participate, 164 (61%) completed the survey. The POPC group answered two of the knowledge questions correctly more often than the control group (score differences: 17%, 95% confidence interval (CI) 3–32% and 21%, 95% CI 7–36%). However, parents reported frustration due to infant crying at similar rates between the control (55/80, 69%) and POPC (60/84, 71%) groups. Our results support previous findings that the POPC improves caregiver knowledge concerning infant crying. The POPC does not appear to affect caregiver frustration with crying.‘Our objective was to evaluate the POPC's effect on caregiver frustration with infant crying compared to standard discharge information’Key Practitioner Messages Instructing new parents about normal infant crying and the dangers of shaking an infant remains an important part of anticipatory guidance. The POPC is not more effective at reducing caregiver frustration with infant crying than standard discharge instructions. Future investigations should specifically aim to include male caregivers as recipients of the programme.

Pacifiers: A Cause for Confusion.

Pacifier avoidance is recommended in the newborn nursery to optimize exclusive breast-feeding rates according to the Baby-Friendly Hospital Initiative. There are many reasons why parents may choose to provide a pacifier to their infant, particularly due to the association between pacifier use with sleep and risk reduction for sudden infant death syndrome. Early use of a pacifier does not likely cause direct harm to infants or lead to difficulty breast-feeding. Pediatricians should partner with families to share a clear message in support of establishing exclusive breast-feeding, ideally before introduction of a pacifier. [Pediatr Ann. 2020;49(5):e204-206.].

The impact on the exclusive breastfeeding rate at 6 months of life of introducing supplementary donor milk into the level 1 newborn nursery.

This study explored whether donor-milk supplementation increases breastfeeding exclusivity at 6 months of life. In 10/2015, we implemented donor milk for breastfed newborns who needed nutritional supplements for hypoglycemia, hyperbilirubinemia, and >8% weight loss at 40 h of life. We conducted a retrospective chart review on 122 qualified neonates admitted to newborn nursery at University of Florida Jacksonville 4 months before donor-milk implementation and 6 months after. 73 (60%) of the neonates received formula and 49 (40%) received donor milk. 39 (54%) in the formula group and 33 (46%) in the donor-milk group were surveyed after 6 months of life. Multivariate logistic regression showed that newborns who received donor milk had five times greater odds of being exclusively breastfed at 6 months of life. Donor milk as feeding supplementation for newborns is associated with increased exclusive breastfeeding at 6 months of life.

Maxillary Frenulum in Newborns: Association with Breastfeeding.

To relate maxillary and lingual frenulum configuration to breastfeeding success. Cross-sectional study. Newborn nursery in tertiary care academic hospital. Newborns were observed between 24 and 72 hours after birth. Mothers were asked a series of questions relating to their breastfeeding experience. The maxillary and lingual frenula were examined and scored. Corresponding LATCH scores were recorded. A total of 161 mothers with newborns participated. The mean gestational age of newborns was 38.81 weeks (95% CI, 38.65-38.98); 82 (50.9%) male and 79 (49.1%) female newborns were included. In sum, 70.8% had the maxillary frenulum attached to the edge of the alveolar ridge; 28.6%, attached to the fixed gingiva; and 0.6%, attached to mobile gingiva. In addition, 3.7% had anterior ankyloglossia, and 96.3% had no obvious anterior ankyloglossia. There was no significant correlation between maxillary frenulum scores or lingual frenulum scores and LATCH scores (P > .05). Of the mothers included in the study, 56.5% were first-time mothers. Overall, 43.5% of the mothers had other biological children, with 70.0% of those mothers having previously breastfed. Experienced mothers who had breastfed for >3 months had significantly higher LATCH scores. Those who had previously breastfed had a mean LATCH score of 9.16 (95% CI, 8.80-9.52), as compared with those who had not, with a mean of 8.14 (95% CI, 7.43-8.85). We did not find that maxillary frenulum configuration correlated with LATCH scores. Mothers experienced with breastfeeding had better LATCH scores. Attention toward breastfeeding education, particularly in new mothers, should precede maxillary frenotomy in neonates with breastfeeding difficulties.

Effect of an Alternative Newborn Naming Strategy on Wrong-Patient Errors: A Quasi-Experimental Study.

Newborns are often assigned temporary names at birth. Temporary newborn names-often a combination of the mother's last name and the newborn's gender-are vulnerable to patient misidentification due to similarities with other newborns or between a mother and her newborn. We developed and implemented an alternative distinct naming strategy, and then compared its effectiveness on reducing the number of wrong-patient orders with the standard distinct naming strategy. This study was conducted over a 14-month period in the newborn nursery and neonatal intensive care units of three hospitals that were part of the same health care system. We used a quasi-experimental study design using interrupted time series analysis to compare the differences in wrong-patient orders (an indicator of patient misidentification) before and after the implementation of the alternative distinct naming strategy. Overall, there were 25 wrong-patient errors per 10,000 orders during entire study period (36.8 per 10,000 before and 19.6 per 10,000 after). However, there was no statistically significant change in the rate of wrong-patient ordering errors after the transition from the distinct to the alternative distinct naming strategy (β = 0.832, 95% confidence interval [CI] = -0.83 to 2.49, p = 0.326). We also found that, overall, 1.7% of the clinicians contributed to 62% of the wrong-patient errors. Although we did not find statistically significant differences in wrong-patient errors, the alternative distinct naming approach provides pragmatic advantages over its predecessors. In addition, the localization of wrong-patient errors within a small set of clinicians highlights the potential for developing strategies for delivering training to clinicians.

Neonatal intensive care unit admissions before and after the adoption of the baby friendly hospital initiative

Background The Baby Friendly Hospital initiative (BFHI) is a global initiative of the World Health Organization developed in 1991 to promote and support successful breastfeeding. It has led to increased rates of exclusive breastfeeding. Exclusive breastfeeding may increase risk for hypoglycemia, hyperbilirubinemia, and dehydration requiring higher level of neonatal care. Objective To determine if there was a change in admissions to the Neonatal Intensive Care Unit (NICU) from the newborn nursery after the adoption of BFHI in a large urban hospital. Methods This is a retrospective analysis of all neonates admitted to the NICU from the newborn nursery between January 2007 and December 2016 at Thomas Jefferson University Hospital, in Philadelphia, PA, USA. Demographics, clinical characteristics and primary diagnosis for admission were compared between those admitted before (January 2007 to December 2011) and after (January 2012 to December 2016) the initiation of BFHI. Results A total of 20,124 infants were born and 3,684 infants (18.3%) were admitted to NICU. 570 infants (2.8% of live birth) were admitted to the NICU from the newborn nursery, 282 (49.5%) were born before and 288 (50.5%) born after BFHI. There was no significant difference in the number of infants admitted from the newborn nursery either as a percentage of total deliveries (2.8 versus 2.9%, p = .6) or percentage of total NICU admissions (15.5 versus 15.5%, p = 1.0) before and after the BFHI. Additionally, there was no difference in number of infants admitted with a diagnosis of possible sepsis, hypoglycemia, neonatal abstinence syndrome (NAS) and hyperbilirubinemia between the two groups. However, significantly more infants admitted with hypoglycemia required IV fluids for hypoglycemia after the initiation of BFHI (8 out of 27 versus 21 out of 28, p .001). The age of admission was higher and the duration of NICU stay was shorter in infants admitted after the initiation of the BFHI. Conclusions The BFHI has not led to a significant change in the number of infants admitted to NICU from the newborn nursery or reasons for their admissions. However, since its adoption, there has been an increase in the use of IV fluids for treatment of hypoglycemia. These findings suggest a role for additional treatments other than formula to prevent IV fluid use, such as glucose gel. Change in NICU guidelines for the management of possible sepsis and NAS may have impacted the duration of hospitalization in infants born after BFHI.

Improving the Bilirubin Management Program in the Newborn Nursery: Background, Aims, and Protocol

Background: Practices to detect and manage hyperbilirubinemia in newborn nurseries are highly variable. American Academy of Pediatrics guidelines in 1999, 2004, and 2009 have generated, perhaps unintentionally, divergent practices that might not all be of equivalent value. Evidence-based progress is needed to define less invasive, less expensive, uniform, and safe methods to reduce ER visits and hospital readmissions for jaundice treatment and bilirubin encephalopathy. Objectives: This research briefing is intended to inform readers of a new prospective quality improvement program aimed at testing the value of specific changes in newborn nursery hyperbilirubinemia detection and management. This new program includes predetermined means of assessing those specific changes, which relate to diagnosis, safety, outcomes, and cost. Methods: In this briefing, we present the perceived problems in our present bilirubin management system, as voiced by stakeholders. We report our proposed means to test minimization of those problems utilizing already acquired data on approximately 400,000 well babies in the Intermountain Healthcare system of hospitals in the western USA. We then describe our methods of assessing specific outcomes in a pre- versus postpractice change analysis. Results and Conclusions: The University of Utah Newborn Nursery will implement a quality improvement project in bilirubin management during 2020 to test the feasibility and effectiveness of several changes to our current bilirubin management program. We maintain that the improved understanding generated by this project will be a step toward new evidence-based strategies for reducing ER visits and hospital readmissions for jaundice treatment and preventing bilirubin encephalopathy.

The Parental Experience of Newborns With Neonatal Abstinence Syndrome Across Inpatient Care Settings: A Qualitative Study.

Understanding the experience of parents with newborns hospitalized with neonatal abstinence syndrome (NAS) across all inpatient settings is important in optimizing their involvement as part of the care team. A descriptive qualitative study design was utilized to understand the parental experience and identify barriers to parent involvement in care of newborns with NAS care. Semistructured one-on-one interviews were conducted with parents of a convenience sample of fifteen infants admitted for NAS in the newborn nursery and level II/III neonatal intensive care unit within a tertiary care center in Northern New England. Interviews were analyzed using thematic content analysis. Sixty percent of mothers were treated with buprenorphine during pregnancy, and 60% of infants required pharmacological treatment for NAS symptoms. The predominant themes of parental experience included preparation/education for hospitalization, communication with providers, NAS management, family resources, physical hospital environment, and maternal guilt. The parental experience of care for NAS is negatively affected by lack of standardized NAS education in the prenatal and postnatal settings, inconsistent communication with providers, the Finnegan scoring system, lack of provider sensitivity to parental substance use disorder, and maternal guilt. This study also highlights the parental desire to be more involved in the care of newborns with NAS.

Association between phototherapy and serum calcium levels in newborns: A institutional cross-sectional study

Introduction: Hyperbilirubinemia is one of the most prevalent problems in neonates. Phototherapy is one of the routine methods for management of hyperbilirubinemia. AIM: The aim of this study is to evaluate significant change in serum calcium level in term newborns who are undergoing phototherapy and to find out the association between effect of phototherapy on serum calcium levels in newborns. Methods: 60 newborns with neonatal hyperbilirubinemia admitted in newborn nursery were selected for the study. Serum calcium estimation was done before phototherapy. All newborns were subjected to double surface phototherapy. After 48 hours of phototherapy serum calcium was estimated and compared with earlier value. Results: Mean serum bilirubin level and mean serum calcium levels before phototherapy were 15.2 1.25 mg/dl and 9.2 1.2 mg/dl respectively. While after phototherapy we observed that mean serum bilirubin level and mean serum calcium levels were 11.2 2.6 mg/dl and 8.11 0.54 mg/dl respectively. The difference of these before and after phototherapy were also found to be statistically significant (p=

599: Isolated neonatal acidemia: What is the long-term outcome?

Fetal acidemia has been associated with Hypoxic Ischemic Encephalopathy (HIE) and delayed development (DD). Criteria for pathologic acidemia have been primarily derived through consensus with little evidence to support routine measurement of cord gases at birth. Further, the appropriate management for full or near-term newborns who are clinically stable with normal APGAR scores but cord gas evidence of acidemia (pH< 7.10, base deficit (BD)< -11.0) is not known. We sought to determine whether isolated fetal acidemia is associated with DD milestones. We hypothesize that these neonates have a similar incidence of DD when compared to non-acidemic neonates. Retrospective case control study of newborns with acidemia (pH< 7.10, BD< -11.0), born 2015-2019, at ≥36 weeks gestational age (GA) at a tertiary referral center with universal cord gas collection. Cases were paired with controls matched by date of birth, birth weight, GA, and NICU or nursery admission. The primary outcome was DD milestones as defined by diagnosed speech/motor delay by a specialist up to 24 months after birth. 148 neonates were matched with controls of whom 46% were female, 38% non-Hispanic Caucasian, full or near term (39 ± 1.4w), and of normal weight (3270±560g). 80 were admitted to the newborn nursery. Eleven cases had DD. There was no significant difference in incidence of DD milestones between the acidemic and control groups (p=0.58 for nursery admission, p=0.69 for NICU admission). Neonates with DD did not have any significant difference in arterial or venous pH or BD (p≥0.16), however the 5 min Apgar scores were significantly lower for DD babies in both acidemic (7.3 vs 8.3) and control (7.7 vs 8.7) groups (p≤0.01). Category II/III Fetal Heart Tracings were significantly associated with incidence of acidemia (p≤0.01) but not DD (p≥0.33). Isolated fetal acidemia with a 5 min Apgar ≥7 is not associated with short term delayed developmental milestones. Future studies should include a prospective analysis of acidemic babies with later assessment of developmental data.

Identification of Key Determinants of Staphylococcus aureus Vaginal Colonization.

Staphylococcus aureus is an important pathogen responsible for nosocomial and community-acquired infections in humans, and methicillin-resistant S. aureus (MRSA) infections have continued to increase despite widespread preventative measures. S. aureus can colonize the female vaginal tract, and reports have suggested an increase in MRSA infections in pregnant and postpartum women as well as outbreaks in newborn nurseries. Currently, little is known about specific factors that promote MRSA vaginal colonization and subsequent infection. To study S. aureus colonization of the female reproductive tract in a mammalian system, we developed a mouse model of S. aureus vaginal carriage and demonstrated that both hospital-associated and community-associated MRSA isolates can colonize the murine vaginal tract. Immunohistochemical analysis revealed an increase in neutrophils in the vaginal lumen during MRSA colonization. Additionally, we observed that a mutant lacking fibrinogen binding adhesins exhibited decreased persistence within the mouse vagina. To further identify novel factors that promote vaginal colonization, we performed RNA sequencing to determine the transcriptome of MRSA growing in vivo during vaginal carriage at 5 h, 1 day, and 3 days postinoculation. Over 25% of the bacterial genes were differentially regulated at all time points during colonization compared to laboratory cultures. The most highly induced genes were those involved in iron acquisition, including the Isd system and siderophore transport systems. Mutants deficient in these pathways did not persist as well during in vivo colonization. These results reveal that fibrinogen binding and the capacity to overcome host nutritional limitation are important determinants of MRSA vaginal colonization.IMPORTANCEStaphylococcus aureus is an opportunistic pathogen able to cause a wide variety of infections in humans. Recent reports have suggested an increasing prevalence of MRSA in pregnant and postpartum women, coinciding with the increased incidence of MRSA infections in neonatal intensive care units (NICUs) and newborn nurseries. Vertical transmission from mothers to infants at delivery is a likely route of MRSA acquisition by the newborn; however, essentially nothing is known about host and bacterial factors that influence MRSA carriage in the vagina. Here, we established a mouse model of vaginal colonization and observed that multiple MRSA strains can persist in the vaginal tract. Additionally, we determined that MRSA interactions with fibrinogen and iron uptake can promote vaginal persistence. This study is the first to identify molecular mechanisms which govern vaginal colonization by MRSA, the critical initial step preceding infection and neonatal transmission.

Improving the Accuracy of Newborn Weight Classification

PurposeThe purpose of this project was to improve the accuracy of newborn weight classification using a regional newborn growth reference (Olsen), an evidence-based method, to determine SGA, AGA and LGA in term infants compared to the current growth reference (Lubchenco). DesignQuality improvement methods using Lewin's Change Theory guided the process. Setting/local problemAt an academic medical center term infants were evaluated for weight-for-gestational age using the Lubchenco growth reference as well as other growth references based on provider preference. PatientsAll term newborns (N = 314) admitted to the newborn nursery during one month following a 3-months implementation of the practice change. Intervention/measurementsNewborn nursery nursing staff and provider staff were provided education and training on using and interpreting the new growth reference. ResultsUse of the Olsen regional growth reference identified more infants as small and fewer infants as large for gestational age. Post hoc analysis with a more global growth reference (Fenton) also identified more infants as small and fewer infants as large for gestational age. There was no statistically significant difference between the Olsen or Fenton growth references. ConclusionUse of either of these two updated growth references more accurately classifies infant weight for gestational age compared to the Lubchenco growth reference, potentially decreasing newborn health risks such as hypoglycemia.

Newborn Nursery Reach Out and Read

Newborn Nursery Reach Out and Read

1528. Rates of Peripheral Blood Culture Contamination in an Urban Children’s Hospital

BackgroundPositive peripheral blood culture results are essential in guiding antimicrobial therapy in patients with bacteremia. However, false-positive results may frequently pose diagnostic issues in interpreting the test. These results can lead to increased costs and patient harm through the administration of unnecessary antibiotics and prolongation of hospital stay. The maximum acceptable contamination rate for peripheral blood cultures as suggested by the College of American Pathologists is 3%.MethodsWe initiated a longitudinal quality improvement project to monitor peripheral blood contamination rates at our children’s hospital in Brooklyn, NY. We reviewed positive blood culture results on a monthly basis and assessed whether they represented true infections vs. contamination based on review of patient charts. Residents and nurses in the pediatric emergency department (ED), neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), inpatient unit, and newborn nursery were educated on proper skin sterilization techniques using video demonstration; the importance of avoiding palpating the venipuncture site after sterilization and the importance of cleaning the port on the blood culture bottle were reinforced.ResultsThe pediatric ED and the PICU had the highest contamination rates in 2018 at 4.38% and 3.82%, respectively. The newborn nursery had the lowest contamination rate, at 0%. The NICU and pediatric inpatient units had contamination rates that met the goal as well, at 1.25% and 0.72%, respectively.ConclusionThe departments in need of targeted interventions are the pediatric ED and the PICU, both of which had contamination rates greater than the 3% goal rate set for our project. Future interventions currently being considered include re-education of nursing and resident staff as well as the creation of equipment bundles to facilitate adequate skin preparation prior to venipuncture. Disclosures All authors: No reported disclosures.

Quality Improvement Learning Collaborative Improves Timely Newborn Follow-Up Appointments

American Academy of Pediatrics guidelines indicate that newborns should follow up with their primary care providers within three days of discharge from the newborn nursery. Many barriers exist to achieving timely follow-up, with potential implications on a newborn's health. The goal of this project was to improve rates of timely newborn follow-up through a nine-month quality improvement learning collaborative (QILC). Timely newborn follow-up was defined as an appointment scheduled within three days of newborn discharge. Both inpatient hospitalist and outpatient pediatric practices were eligible to participate. Inpatient and outpatient practices aimed to have 75% of newborns scheduled appropriately by six months into the project. In addition, outpatient practices aimed to have 60% of newborns seen appropriately by their provider. All practices aimed to have their progress sustained at conclusion of the QILC. Practices submitted data at baseline and nine subsequent phases. Monthly webinars featured a quality improvement didactic, data review, and discussion of practices' changes, successes, and challenges. Eleven practices and 24 physicians participated in the QILC. Aggregate data from the practices showed continual improvement in all measured newborn scheduling metrics throughout the nine-month learning collaborative, with sustainment of progress over the last three months of the QILC. A QILC is successful for increasing timely newborn follow-up for both the newborn hospitalist and outpatient pediatrician. Pediatric providers can learn from others' strategies and successes to incorporate meaningful changes in their practice.