NICU Discharge Research Articles

VALIDATION OF INDIA EBUS AMONG PROFESSIONALS PRACTICING IN NICU

Background-INDIA EBUS is a cloud-based software aimed at supporting optimal neurodevelopmental outcomes in NICU. INDIA is an acronym for Individual New-born Developmental Intervention Application which is based on the available evidence. It includes various aspects like Neurodevelopmental, Neurophysiological, Neurobehavioral, developmentally supportive and Trauma informed care, Splinting, Occupational Therapy intervention, etc., which helps in clinical assistance, interpretation and documentation for professionals. The objective of the study was to check the content validity of the INDIA EBUS. Prospective online survey was used. Methods- The professionals were contacted and a letter of request was sent to them. An online process was used to select the participants. For the online survey, 30 people were chosen using a convenient sampling method. Request letter was sent to the professionals. After that investigator briefly introduced the INDIA EBUS. Later software access was given for seven to ten days to the participant. After sending google form online recruitments of the participants, if they click to I agree as per google form, data was collected. The main inclusion criteria were that the participants had at least one year of clinical experience in the NICU. Results-INDIA EBUS uses the combination of different models aimed at neuroprotection by the multidisciplinary team in NICU and post discharge follow up as a theoretical framework. The literature review & expert-based panel supported the Content Validity of the INDIA EBUS. Content Validity Index for the Components relating to the Developmentally supportive care and neuromotor assessment was 0.87. The neurodevelopmental assessment and intervention had a CVI greater than or equal to 0.78. For the Trauma informed care, chest physiotherapy, and neurobehavioral assessment, it was below 0.50. The health care workers confirmed the understandability, completeness & credibility of the INDIA EBUS. The different stakeholders in the study considered the software would be helpful for the brain-oriented care in NICU (neuroprotection) & beneficial for neurodevelopment. Negative ratings referred to the time required for the use of data entry and the use of digital devices. Conclusion- There was substantial evidence supporting the content validity of the INDIA EBUS. Despite the substantial length & time requirement, software was considered helpful for comprehensive neurodevelopmental care in NICU. Further research on psychometric qualities, implementation and effectiveness is needed.

Factor that mothers of children with severe medical needs experience when considering NICU discharge

Factor that mothers of children with severe medical needs experience when considering NICU discharge

58 Relationship Between Early Laboratory Measures and Neurological Injury in Neonates Undergoing Therapeutic Hypothermia

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Hypoxic-ischemic encephalopathy (HIE) is a major contributor to morbidity and mortality. Therapeutic hypothermia (TH) is the standard of care for neonates with moderate to severe HIE. Brain magnetic resonance imaging (MRI) is the imaging modality of choice for confirmation of HIE, assessment of injury severity, and prognostication. Reliable, inexpensive and widely available laboratory measures for early identification of risk for neurological injury can play a critical role in the optimal management of neonatal HIE, especially in the resource-limited setting. Our study examined whether derangements in early routine laboratory measures (acid-base, haematological, metabolic) were worse in neonates with MRI findings of neurological injury. Objectives Primary objective: To evaluate the role of early laboratory measures in predicting neurological injury as detected by MRI at 72 hours. Secondary objective: To evaluate the role of early laboratory measures in predicting survival to NICU discharge in patients with HIE. Design/Methods This single-centre, retrospective cohort study included neonates ≥ 35 weeks gestation with moderate to severe HIE, who had undergone therapeutic hypothermia. Based on findings of brain MRI completed within 72 hours of life, our cohort was divided into 2 groups: neonates with, and without, evidence of neurological injury consistent with HIE. Baseline characteristics, as well as laboratory measures, were compared between groups, and a receiver operating characteristic (ROC) curve analysis was conducted to determine the cut-off for prediction of neurological injury based on the highest sensitivity and specificity values. Results 104 neonates were analyzed. Baseline characteristics (Table 1) were similar between both groups, except for cord venous pH and base excess (BE), which were significantly lower in the abnormal MRI group (p = 0.02). In bivariate analysis, pH (at 1 h of age, p = 0.027), BE (at 1 h, p = 0.001, and 6 h of age, p = 0.004), ionized calcium (at 6 h of age, p = 0.02), and platelets (at 1 h of age, p = 0.004) were significantly different in neonates with abnormal MRI. In ROC curve analysis, BE at 1 h of life was the best predictor of abnormal MRI (AUC = 0.71, p = 0.002), with a cut-off value of ≤ -14.95, sensitivity of 67% and specificity of 66% (Figure 1). Conclusion Among neonates with HIE undergoing TH, early laboratory measures such as acid-base status, ionized calcium, and platelet count were worse in neonates with abnormal MRI, in comparison to neonates with normal MRI. Base excess at 1 h of life is a good predictor of abnormal MRI. Future prospective studies to validate these findings are needed

NEOage clocks - epigenetic clocks to estimate post-menstrual and postnatal age in preterm infants.

Epigenetic clocks based on DNA methylation (DNAm) can accurately predict chronological age and are thought to capture biological aging. A variety of epigenetic clocks have been developed for different tissue types and age ranges, but none have focused on postnatal age prediction for preterm infants. Epigenetic estimators of biological age might be especially informative in epidemiologic studies of neonates since DNAm is highly dynamic during the neonatal period and this is a key developmental window. Additionally, markers of biological aging could be particularly important for those born preterm since they are at heightened risk of developmental impairments. We aimed to fill this gap by developing epigenetic clocks for neonatal aging in preterm infants.As part of the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) study, buccal cells were collected at NICU discharge to profile DNAm levels in 542 very preterm infants. We applied elastic net regression to identify four epigenetic clocks (NEOage Clocks) predictive of post-menstrual and postnatal age, compatible with the Illumina EPIC and 450K arrays. We observed high correlations between predicted and reported ages (0.93 – 0.94) with root mean squared errors (1.28 - 1.63 weeks).Epigenetic estimators of neonatal aging in preterm infants can be useful tools to evaluate biological maturity and associations with neonatal and long-term morbidities.

Developing an audio-based communication tool for NICU discharge of Latino families with limited English proficiency

ObjectiveResearch shows NICU Latino parents with limited English proficiency (LEP) feel less comfortable asking questions and participating in medical decision-making, which may negatively affect transition to community healthcare. Question prompt lists (QPL), suggested questions sometimes drawn from families and providers, can improve family-centered communication. We explored clinician and parent perceptions to inform development of and pilot a NICU discharge QPL. MethodsFocus groups with NICU and primary care providers explored perceived educational needs of Latino parents LEP and barriers to effective transition to community healthcare. Semi-structured interviews with Latino parents LEP explored perceptions of knowledge gaps and recommendations to improve the transition process. A Spanish audio QPL for parents and an English written version for providers were developed and pilot tested for acceptability. ResultsProvider focus groups (n = 27) and parent interviews (n = 19) identified themes: decreased parent activation, knowledge gaps, limited-use interpreters, unfamiliarity with healthcare system, and social isolation as barriers to smooth NICU-to-home transition. Providers (n = 11) and parents (n = 10) favored QPL introduction early in NICU admission, finding it useful to improve communication and transition processes for families. ConclusionOur QPL may address challenges faced by Latino parents LEP when transitioning home. Practice implicationsQPLs may improve Latino NICU infants’ healthcare outcomes.

Association of outborn versus inborn birth status on the in-hospital outcomes of neonates treated with therapeutic hypothermia: A propensity score-weighted cohort study

ObjectiveTo compare the risk of in-hospital mortality and morbidity between outborn and inborn neonates treated with whole body hypothermia. MethodsThe association of outborn birth status with in-hospital mortality and morbidity, prior to NICU discharge or transfer, was assessed in a large historical cohort of neonates who had therapeutic hypothermia initiated on the day of birth. The cohort was restricted to neonates born at ≥35 weeks gestational age from 2007 to 2018. Since the sample was non-random, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalance in baseline maternal and neonatal characteristics between outborn and inborn neonates. Cox proportional hazards regression was used to assess the association between outborn status and in-hospital mortality. ResultsThere were 4447 neonates included in the study (2463 outborn). Outborn status was not significantly associated with an increased risk of in-hospital mortality in the unadjusted cohort (HR = 1.17, 95% CI 0.97–1.42, p = 0.10) or IPW cohort (HR = 1.09, 95% CI 0.95–1.26, p = 0.22). However, in the IPW cohort, outborn neonates were significantly more likely to have seizures (28% vs 24%, p = 0.006), anticonvulsant exposure (46% vs 41%, p = 0.002), and gastrostomy tube placement (5.8% vs 3.8%, p = 0.009) during their newborn hospitalization. ConclusionOutborn status was not significantly associated with increased in-hospital mortality among neonates treated with whole body hypothermia. However, outborn neonates were more likely to have seizures, receive anticonvulsant treatment, and undergo gastrostomy tube placement. Further study is needed to better understand the etiologies of these outcome disparities and potential implications for long-term neurodevelopmental outcomes.

Erythropoietin is not a risk factor for severe retinopathy of prematurity among high risk preterm infants

BackgroundRetinopathy of prematurity (ROP) is a developmental retinal vaso-proliferative disease and a leading cause of blindness in children. Early gestational age, low birth weight and unregulated oxygen exposure are the main risk factors for the development of ROP.There are conflicting reports of a possible association between recombinant Erythropoietin (rhEPO) use and an increased risk for the development of ROP. ObjectiveTo determine whether rhEPO is an independent risk factor for the development of severe ROP among preterm infants with a gestational age of 23 to 32 weeks and a birth weight <1500 g. MethodsWe performed a retrospective study of risk factors for ROP on a cohort of 1762 premature infants born between 2009 and 2014, half of whom received rhEPO. To examine the association between treated ROP and rhEPO, a propensity score (PS) analysis was performed using the inverse probability of treatment weighted (IPTW) approach. ResultsThe incidence of treated ROP was 7.3% (129/1762). PS analysis did not show an association between rhEPO and severe ROP needing treatment or ROP stage 2 or higher, in either the whole population or in the subgroup of babies born at 23 to 28 weeks gestation, in whom the incidence of severe ROP was the highest. Of 117 patients treated for Type 1 or worsening stage 3 ROP, 17 were first diagnosed after NICU discharge. ConclusionOur study showed no association between Erythropoietin use and severe ROP and highlights the importance of Ophthalmology follow up after hospital discharge.

Improving the Life Chances of NICU Graduates.

* Abbreviations: FBBH — : Following Baby Back Home RCT — : randomized clinical trial Although the rates of mortality among extremely preterm and/or low birth weight newborns have been declining for decades, addressing the ongoing health and developmental needs of NICU graduates continues to be of considerable importance, given their increased susceptibility to neurodevelopmental impairments, other health problems, and mortality over the life course.1 In the current issue of Pediatrics , McKelvey et al2 report on a propensity-matched study of a home-visiting program designed to support parents in addressing their infants’ needs after NICU discharge. The program, known as Following Baby Back Home (FBBH), is delivered by nurse–social-worker teams who focus on helping parents meet their children’s medical and developmental needs, including supporting adherence to medical appointments, linking families with other health and human services, and promoting infants’ growth and development. The program continues through child age 3. Using a carefully crafted propensity-matched design, the authors found that compared with those in the control group ( n = 485), infants enrolled in FBBH ( n = 485) had higher rates of health … Address correspondence to David Olds, PhD, Prevention Research Center for Family and Child Health, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13121 E 17th Ave, Room 5317, Aurora, CO 80045. E-mail: david.olds{at}cuanschutz.edu

Preterm and writhing movements: is it possible to predict fidgety movements in preterm infants?

Preterm infants who do not have fidgety movements at 3 months of corrected age have up to ten times greater risk of developing cerebral palsy or other alterations in motor development, compared to infants who exhibit such movements. The General Movements Assessment (GMA) is a validated tool that may predict the fidgety movement period. This study aimed to describe the trajectory of the General Movements Assessment (GMA) during the preterm and writhing movements periods in preterm infants and determine the best time point to predict the fidgety movements period. Fifty-two preterm newborns were evaluated by the GMA method. GMA assessment at the age of 5 weeks post term was found the most predictive of neuromotor development disorders in at-risk newborns, with a sensitivity and specificity of 86% and 58%, respectively, and a high negative predictive value (92%) and increased hit ratio (69% accuracy). Preterm infants with ≤34 weeks of gestational age have a high prevalence of poor repertoire classifications on the GMA and one single assessment with GMA near the time of NICU discharge seems to be the best time to determine infants who need to be followed more carefully, but the best time point to predict the fidgety movements period was 5 weeks post term.

Hearing Screening in Pediatric Primary Care.

1. Jordan K. Yoeli, MD*,† 2. Daniel Nicklas, MD*,† 1. *Children’s Hospital Colorado, Aurora, CO 2. †University of Colorado, Aurora, CO Screening for congenital and acquired deafness and hearing loss (HL) represents a significant responsibility for clinicians in all newborn units and medical homes. Approximately 1 to 3 infants of 1,000 born in a well infant nursery setting and 2 to 4 of 100 born in a NICU have significant bilateral HL. Outcomes in various developmental domains depend on the early recognition and subsequent intervention for HL. Developmental delay is present in 30% to 40% of children with HL; the goal of hearing screening (HS) and prompt intervention is to optimize a child’s language acquisition, cognitive development, literacy, social-emotional maturity and academic success. This article reviews the most up-to-date standards and practices to aid medical providers in the early detection and intervention for pediatric HL. In the United States, universal screening begins in the neonatal period. According to the American Academy of Pediatrics (AAP) Joint Commission on Infant Hearing (JCIH), all infants should be screened for congenital HL before 1 month of age. Most infants are screened in nursery or NICU settings, except for those born outside of a medical facility. For the latter population or for infants with no documented HS, screening should be completed by the medical home before 1 month of age. In a well nursery setting, most HSs are performed by otoacoustic emission (OAE) testing. During an OAE screen, a sensitive microphone in the ear canal records the cochlear responses (“acoustic emissions”) to acoustic stimuli, thereby testing the peripheral auditory system from the outer/middle ear (conduction zones) to the cochlear outer hair cells (sensory organ). A “pass” indicates that hearing is functional to the level of …

Achievement of maturational milestones among very low birth weight infants.

Very low birth weight (VLBW) infants must achieve several maturational milestones to be discharged home from the NICU. Describe the timing of maturational milestones in VLBW infants and the impact of clinical variables and milestone achievement on postmenstrual age (PMA) at discharge. For VLBW infants without severe lung disease discharged home from a level IV NICU, we assessed PMA at the achievement of thermoregulation, cardiorespiratory stability, feeding, and discharge. In 400 infants (median GA 28.4 weeks), lower birth weight, white race, and having multiple comorbidities of prematurity predicted later discharge PMA. The most common milestone sequence was CPAP discontinuation, caffeine discontinuation, thermoregulation, apnea resolution, and full oral feeds. PMA at apnea resolution and full oral feeds correlated highly with discharge PMA. In a single-center VLBW cohort, comorbidities of prematurity impacted the timing of NICU discharge through delay in oral feeding and cardiorespiratory stability.

Barriers and facilitators to breastfeeding support practices in a neonatal intensive care unit in Colombia.

Objective.To assess breastfeeding support practices and related barriers and facilitators in a large Intensive Care Unit, Neonatal (NICU) in Medellín, Colombia, as part of a broader quality improvement initiative to enhance breastfeeding support.Methods.A mixed-methods descriptive design was used to collect data on care practices and outcomes related to NICU breastfeeding support. Data sources included the Neo-BFHI’s self-assessment questionnaire of breastfeeding policies and practices, clinical observations, and a retrospective review of 51 patient charts.Results.Of the 51 charts reviewed, 98% of the infants received breastmilk during their hospitalization but the majority (84%) also received formula and only 8% of infants were exclusively breastfed at the time of NICU discharge. All NICU staff received education on mother and baby-friendly care, and the unit complied with the International Code of Marketing of Breast-milk substitutes. However, resources to support lactation (e.g., access to breastfeeding specialists, breast pumps, written teaching materials for parents) were limited, and infants were only allowed to consume milk expressed within the hospital. Mother-infant separation, as well as staff beliefs and care routines, also limited important breastfeeding support practices such as skin-to-skin care and early initiation of direct breastfeeding.Conclusion.The self-assessment questionnaire and observations revealed a high value for breastfeeding and a family-centered approach to care in the NICU. Key challenges to sustaining breastfeeding in the NICU included a lack of facilities for supporting parental presence, barriers to expression and provision of mother’s milk, and a high rate of bottle-feeding with formula.

Randomized trial of azithromycin to eradicate Ureaplasma respiratory colonization in preterm infants: 2-year outcomes

BackgroundTo assess the potential impact of azithromycin treatment in the first week following birth on 2-year outcomes in preterm infants with and without Ureaplasma respiratory colonization who participated in a double-blind, placebo-controlled randomized controlled trial.MethodsRespiratory morbidity was assessed at NICU discharge and at 6, 12, and 22–26 months corrected age using pulmonary questionnaires. Comprehensive neurodevelopmental assessments were completed between 22 and 26 months corrected age. The primary and secondary composite outcomes were death or severe respiratory morbidity and death or moderate–severe neurodevelopmental impairment, respectively, at 22–26 months corrected age.ResultsOne hundred and twenty-one randomized participants (azithromycin, N = 60; placebo, N = 61) were included in the intent-to-treat analysis. There were no significant differences in death or serious respiratory morbidity (34.8 vs 30.4%, p = 0.67) or death or moderate–severe neurodevelopmental impairment (47 vs 33%, p = 0.11) between the azithromycin and placebo groups. Among all trial participants, tracheal aspirate Ureaplasma-positive infants experienced a higher frequency of death or serious respiratory morbidity at 22–26 months corrected age (58%) than tracheal aspirate Ureaplasma-negative infants (34%) or non-intubated infants (21%) (p = 0.028).ConclusionsWe did not observe strong evidence of a difference in long-term pulmonary and neurodevelopment outcomes in preterm infants treated with azithromycin in the first week of life compared to placebo.ImpactNo strong evidence of a difference in long-term pulmonary and neurodevelopment outcomes was identified at 22–26 months corrected age in infants treated with azithromycin in the first week of life compared to placebo.The RCT is the first study of 2-year pulmonary and neurodevelopmental outcomes of azithromycin treatment in ELGANs.Provides evidence that ELGANs with lower respiratory tract Ureaplasma have the most frequent serious respiratory morbidity in the first 2 years of life, suggesting that a Phase III trial of azithromycin to prevent BPD targeting this population is warranted.

Electroencephalogram Background Predicts Time to Full Oral Feedings in Hypoxic-Ischemic Encephalopathy.

Infants with a history of neonatal hypoxic-ischemic encephalopathy (HIE) are at risk for oral motor dysfunction. Previous studies have associated the need for gastrostomy tube at neonatal intensive care unit discharge with brainstem injury on magnetic resonance imaging (MRI). However, the factors associated with time to full oral feeds in this population have not been previously described. This study aimed to study factors associated with time to full oral feeds in this population. This is a single-center, retrospective study that examined these factors using Cox regression. A total of 150 infants who received therapeutic hypothermia from 2011 to 2017 were included in this study. The single clinical factor significantly associated with time to full oral feeds was the severity of background abnormality on electroencephalogram in the first 24 hours of age (severe vs. mild 95% confidence interval [CI]: 0.34-0.74; moderate vs. mild 95% CI: 0.19-0.45). Brainstem injury on MRI was the factor most highly associated with need for gastrostomy tube placement (p = 0.028), though the overall incidence of need for gastrostomy tube feeds in this population was low (5%). These findings may help clinicians counsel families on what to expect in neonates with HIE and make decisions on the need for and timing to pursue gastrostomy tube in this population. · The overall incidence of the need for assisted feeding at NICU discharge is low in this population.. · MRI brainstem injury was most highly associated with need for gastrostomy tube placement.. · Worsening severity of background abnormality on EEG was associated with longer time to oral feeds..

Predictive Models of Neurodevelopmental Outcomes After Neonatal Hypoxic-Ischemic Encephalopathy.

To develop predictive models for death or neurodevelopmental impairment (NDI) after neonatal hypoxic-ischemic encephalopathy (HIE) from data readily available at the time of NICU admission ("early") or discharge ("cumulative"). In this retrospective cohort analysis, we used data from the Children's Hospitals Neonatal Consortium Database (2010-2016). Infants born at ≥35 weeks' gestation and treated with therapeutic hypothermia for HIE at 11 participating sites were included; infants without Bayley Scales of Infant Development scores documented after 11 months of age were excluded. The primary outcome was death or NDI. Multivariable models were generated with 80% of the cohort; validation was performed in the remaining 20%. The primary outcome occurred in 242 of 486 infants; 180 died and 62 infants surviving to follow-up had NDI. HIE severity, epinephrine administration in the delivery room, and respiratory support and fraction of inspired oxygen of 0.21 at admission were significant in the early model. Severity of EEG findings was combined with HIE severity for the cumulative model, and additional significant variables included the use of steroids for blood pressure management and significant brain injury on MRI. Discovery models revealed areas under the curve of 0.852 for the early model and of 0.861 for the cumulative model, and both models performed well in the validation cohort (goodness-of-fit χ2: P = .24 and .06, respectively). Establishing reliable predictive models will enable clinicians to more accurately evaluate HIE severity and may allow for more targeted early therapies for those at highest risk of death or NDI.

Related Factors of Discontinue Kangaroo Mother Care at Home for Low Birth Weight Infant after NICU Discharge

LBW infant suffered a health problem in the early days after birth and continue after hospital discharge. Continued KMC implementation is needed to enhance neonatal survival. This study is aimed to know the description and the influence factors in KMC implementation at home after hospital discharge. A descriptive study with cross sectional approach was used. 49 mothers of LBW infant were participated in this study using a convenience sampling method during the study period August 2018 to March 2019 on one largest hospital in one city in Indonesia. Several significant factors that influenced a continuing KMC implementation at home in the first day after hospital discharge were mother KMC skill competency before discharge (p 0.006 and OR 6.250), Infant discharge weight (p 0.001 and OR 8.914) and length of hospital stay (p 0.015 and OR 4.433). Several stop reason by 36 mothers on 14 days after hospital discharge included baby uncomfortable and fussy 8 (16.33%), the baby weight enhanced 9 (18.37%), the baby health going well 2 (4.1), busy 9 (18.37%), and never did KMC since at hospital 8 (16.33%). The education, health care provider support and continue follow-up at home are needed for enhanced the mother’s responsibility and awareness to doing KMC at home.

PEDIATRIC NURSES' PERCEPTION AND PRACTICES REGARDING NEONATAL DISCHARGE FROM NEONATAL INTENSIVE CARE UNITS

Background: Today's, the neonatal discharge planning care has been an indispensable component of neonatal intensive care. However, this comes with various challenges. So, pediatric nurses must be able to provide effective nursing care and to be awareof their roles, to achieve successful discharge of baby from Neonatal Intensive Care Unit.Aim: to assess pediatric nurses’perception and practices regarding neonatal discharge from Neonatal Intensive Care Units. Study Design: a descriptive design was utilized in this study. Setting:The study wascarried out in NeonatalIntensive Care Units, at general hospitals in Port-Said Governorate, Egypt.Subjects andMethod: Sixty pediatricnurseswere included in the present study. Data were collected using NICU discharge practices questionnaire, andNICU discharge perception scale. Results: Themain finding of thisstudy revealed that all pediatric nurses hadpoor neonatal discharge practices, while the majority of them had good perception regarding neonatal discharge.Conclusion: There waspositive statistical significant correlation between pediatric nurses' practices andtheir perception regarding neonatal discharge.Recommendation:Continuous trainingprogramwas recommended for pediatric nurses to enhance their perception and improve their skills toward neonatal discharge.

Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units.

Very low birth weight (VLBW; <1500 g birth weight) infants are substantially more likely to be born to black than to non-black mothers, predisposing them to potentially preventable morbidities that increase the risk for costly lifelong health problems. Mothers’ own milk (MOM) may be considered the ultimate “personalized medicine” since milk composition and bioactive components vary among mothers and multiple milk constituents provide specific protection based on shared exposures between mother and infant. MOM feedings reduce the risks and associated costs of prematurity-associated morbidities, with the greatest reduction afforded by MOM through to NICU discharge. Although black and non-black mothers have similar lactation goals and initiation rates, black VLBW infants are half as likely to receive MOM at NICU discharge in the United States. Black mothers are significantly more likely to be low-income, single heads of household and have more children in the home, increasing the burden of MOM provision. Although rarely considered, the out-of-pocket and opportunity costs associated with providing MOM for VLBW infants are especially onerous for black mothers. When MOM is not available, the NICU assumes the costs of inferior substitutes for MOM, contributing further to disparate outcomes. Novel strategies to mitigate these disparities are urgently needed.Impact Mother’s own milk exemplifies personalized medicine through its unique biologic activity.Hospital factors and social determinants of health are associated with mother’s own milk feedings for very low-birth-weight infants in the neonatal intensive care unit. Notably, out-of-pocket and opportunity costs associated with providing mother’s own milk are borne by mothers. Conceptualizing mother’s own milk feedings as an integral part of NICU care requires consideration of who bears the costs of MOM provision—the mother or the NICU?

Comparison of outcomes of infants with giant omphaloceles over two decades.

The purpose of this study was to compare the outcomes of infants with giant omphalocele (GO) born in two different epochs over two decades at a single institution. Specifically, it examined whether the utilization of selective pulmonary vasodilators and extracorporeal membrane oxygenator (ECMO) in the management of pulmonary hypertension in the second epoch were associated with improved outcomes. The medical records of all patients diagnosed with GO at a large children's hospital from January 1, 1996 to December 31, 2016 were reviewed and divided into two epochs. Patients were classified as having an isolated GO or GO with minor or major associated anomalies. GO was defined as a defect more than or equal to 5 cm in size and/or liver in the sac. During the study period, 59 infants with GO were identified. The duration of invasive mechanical ventilation was significantly shorter among the survivors from the second epoch (p = 0.03), with none greater than seven days. There were no significant differences in the outcomes of survival to NICU discharge and length of stay (LOS) between infants in the two epochs. Infants with GO who required invasive mechanical ventilation for more than seven days did not survive in the second epoch. Survival did not improve with use of selective pulmonary vasodilators and ECMO. This information could be shared with families during prenatal and postnatal counselling to facilitate informed decision making regarding goals of care.

Association of nucleated red blood cell count with mortality among neonatal intensive care unit patients

Nucleated red blood cells (nRBCs) are associated with adverse outcomes for pediatric and adult intensive care patients. The association between nRBC count and mortality was examined in an observational cohort of patients admitted to the neonatal intensive care unit from December 2015-December 2018. Among the 1059 patients with at least one nRBC count obtained, 45 infants (4.2%) experienced in-hospital mortality prior to NICU discharge, the primary outcome measured in this study. Infants with any nRBC count >0 had a significantly higher risk of mortality (5.3% [45/849] vs. 0% [0/351], p<0.001 by Fisher exact), and time to mortality decreased with higher nRBC counts (Spearman correlation -0.59, p<0.001). The association between nRBC count and mortality remained significant even when restricting only to infants who were older than 7 days at time of nRBC count. Among neonatal intensive care unit patients, including those >7 days old, nRBCs are associated with significantly elevated mortality risk. A prospective study to better characterize clinical co-variants is necessary to better establish the use of nRBCs as a predictor of mortality.