Spanish Neonatal Intensive Care Units Research Articles

Inspired oxygen fraction thresholds to accurately predict surfactant administration in neonatal RDS is gestational age strata: A pragmatic, multi‐center study

AbstractObjectiveCurrent international guidelines on neonatal respiratory distress syndrome (RDS) recommend continuous positive airway pressure (CPAP) stabilization as primary treatment. Some guidelines recommend surfactant replacement for babies requiring FiO2 > 0.3 regardless of gestational age (GA). We explore the accuracy of alternative inspired oxygen fraction (FiO2) thresholds as early predictors of surfactant replacement in babies stratified by GA.Study DesignPragmatic, observational study in 12 Italian and Spanish neonatal intensive care units. This is a secondary analysis of data from two cohorts of preterm babies with RDS, stratified by GA (25°− 276; 28°−306; 31°−336) and stabilized on CPAP. FiO2 was collected soon after stabilization and its accuracy to predict subsequent surfactant administration by a rigorously masked physician was assessed.ResultsWe enrolled 412 preterm infants. FiO2 was collected within 2 h of life of life. A cut off of FiO2 > 0.30 failed to identify 50.3% of infants who were later given surfactant by a masked physician. A FiO2 = 0.29 threshold improved sensitivity values to 0.85, 0.79, and 0.61 for the three GA ranges while maintaining specificity of ≥85%. A FiO2 = 0.26 threshold gave sensitivity = 0.83 specificity = 0.79 with GA dependent differences (250−276 sensitivity = 0.90 specificity = 0.80; 280−306 sensitivity = 0.84 specificity = 0.78; 310−336 sensitivity = 0.73 specificity = 0.80).ConclusionsFiO2 is a GA dependent predictor of early surfactant administration. Its accuracy increases when used at lower levels than currently recommended by international guidelines (236 words).

Drug compatibility in neonatal intensive care units: gaps in knowledge and discordances.

In this work, we reviewed the compatibility data of drug combinations frequently administrated in nine Spanish neonatal intensive care units (NICUs) and analyzed the degree of agreement among three highly used databases (Micromedex, King Guide to Parenteral Admixtures, and Stabilis) through Cohen's kappa coefficient statistical analysis. Among 1945 drug combinations analyzed, 283 were compatible, 421 were potentially compatible, 216 were incompatible, 139 were controversial, and there was no data for 886 combinations. In general, the three databases showed a strong degree of agreement: Micromedex vs. King Guide (κ = 0.746; p < 0.001), King Guide vs. Stabilis (κ = 0.743; p < 0.001), and Micromedex vs. Stabilis (κ = 0.691; p < 0.001). However, in 6 of 648 (Micromedex vs. King Guide), 3 of 357 (King Guide vs. Stabilis), and 32 of 606 (Micromedex vs. Stabilis) comparisons, drug pairs were compatible according to the first database and incompatible according to the second, indicating discordances among databases.Conclusion: There is a gap in knowledge about physical compatibility of a great number of drug combinations commonly used in NICUs. Although the three databases showed strong concordance, for some drug combinations, important discrepancies were found. Thus, there is a need for further studies on drug compatibility to increase safety of intravenous administration. What is Known: •Y site-administration in NICUs is very common and some administration errors are related to the lack of information on the compatibility of intravenousdrugs. •Physical compatibility data of drugs frequently used in NICUs is still very limited. What is New: •Physical compatibility data of drug combinations commonly used in Spanish NICUs was reviewed in three highly used admixture databases: Micromedex,King Guide to Parenteral Admixtures and Stabilis, and our results showed a strong degree of agreement between them, however for some drugcombinations, important discrepancies were found. •Our results indicated that there is still a large gap in knowledge about physical compatibility of a great number of drug combinations commonly used in NICUs..

Analysis of standard concentrations of continuous infusions in nine Spanish neonatal intensive care units

ObjectivesThe aim of this study was to describe the use of standard concentrations for continuous infusion drugs in Spanish neonatal intensive care units (NICUs).MethodsWe conducted an observational multicentre study based...

Intravenous drug use in neonatal intensive care units

ObjectivesIntravenous drug use in neonates is frequent and prone to medication errors. The aim of this study was to describe the intravenous drugs most frequently used in Spanish Neonatal Intensive...

Implementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants

BackgroundBloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. MethodsWe assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. ResultsOut of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. ConclusionsThe NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs.

Clinical assessment of pain in Spanish Neonatal Intensive Care Units

Abstract Introduction Clinical scales are currently the best method to assess pain in the neonate, given the impossibility of self-report in this age group. A study is designed with the aim of determining the current practices as regards the clinical assessment of pain in Spanish Neonatal Units and the factors associated with the use of clinical scales. Methods A prospective longitudinal observational study was conducted. A total of 30 Units participated and 468 neonates were included. Results Only 13 Units (43.3%) had pain assessment protocols. Pain was evaluated with a scale in 78 neonates (16.7%, 95% CI; 13.1–20.1) and the mean number of pain assessments per patient and per day was 2.3 (Standard Deviation; 4.8), with a median of 0.75. Of the total number of 7189 patient-days studied, there was at least one pain assessment in 654 (9.1%). No pain assessment was performed with a clinical scale on any patient in 20 (66.7%) Units. Among those that did, a wide variation was observed in the percentage of patients in whom pain was assessed, as well as in the scales used. The CRIES (C-Crying; R-Requires increased oxygen administration; I -Increased vital signs; E-Expression; S-Sleeplessness) scale was used in most Units. In the multivariate analysis, only invasive mechanical ventilation was associated with receiving a pain assessment with a scale (OR 1.46, P = .042). Discussion The majority of neonates admitted into Intensive Care in Spain do not receive a pain assessment. Many units still do not routinely use clinical scales, and there is a wide variation between those that do use them. These results could serve as a basis for preparing national guidelines as regards pain in the neonate.

Breastfeeding Support in Spanish Neonatal Intensive Care Units and the Baby-Friendly Hospital Initiative.

The Baby-Friendly Hospital Initiative (BFHI) has a positive effect on breastfeeding in maternity wards; however, few studies have examined to what degree it affects care in neonatal intensive care units (NICUs). Recently, the BFHI has been adapted to the NICUs (Neo-BFHI). This study aimed to compare breastfeeding support in Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited (group 1) with NICUs in hospitals that have not yet begun this initiative (group 2). A validated questionnaire on breastfeeding support was distributed to level II and III NICUs in Spanish public hospitals. A univariate analysis and an analysis adjusted for the number of beds in NICUs were conducted. The results of the analysis of 36 breastfeeding support measures are presented in accordance with the Ten Steps to Successful Breastfeeding adapted to NICUs. Of the 141 participating NICUs, 129 (91%) responded to the questionnaire: 38 NICUs from group 1 and 91 NICUs from group 2. Group 1 had implemented a higher number of breastfeeding support measures than group 2. There were significant differences in 18 measures related to steps 2, 4, 5, 7, and 8 of the Neo-BFHI. In addition, a comparison of NICUs in hospitals with full accreditation (7 of 129) with those in group 2 revealed significant differences in 7 measures pertaining to steps 2, 5, 8, and 9. The Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited have better implementation of practices to promote and support breastfeeding.

Strategies implementation to reduce medicine preparation error rate in neonatal intensive care units.

This study assessed the rate of errors in intravenous medicine preparation at bedside in neonatal intensive care units versus preparation error rate in a hospital pharmacy service before and after several strategies were implemented. We performed a prospective observational study during 2013-2015. Ten Spanish neonatal intensive care units and one hospital pharmacy service participated in the study. Two types of preparation errors were considered, calculation errors and accuracy errors. The study was carried out over three consecutive phases: (1) pre-intervention phase, when medicine preparation samples were collected from neonatal intensive care units and hospital pharmacy service according to their normal clinical practice; (2) intervention phase, when protocol standardisation and educational strategy took place; and (3) post-intervention phase, when new medicine samples were collected after strategy implementation. In neonatal intensive care units, 1.35% of samples registered calculation errors in pre-intervention phase; no calculation errors were registered in hospital pharmacy service samples. In post-intervention phase, no calculation errors were registered in either group. Accuracy error rate decreased both in neonatal intensive care units (54.7 vs 23%) and hospital pharmacy service (38.3 vs 14.6%). Calculation errors can disappear with good standardisation protocols. Decrease in accuracy error depends on good preparation technique and environmental factors. • Medication use is associated with a risk of errors and adverse events. Medication errors are more frequent and have more severe consequences in paediatric patients. • Lack of commercial drug formulations adapted to newborn infants makes medicine preparation process more prone to error. What is New: • Calculation errors are minimising using concentration standard protocols. Preparation rules are essential to ensure the accuracy process. • Environmental conditions affect the accuracy process.

Medicine preparation errors in ten Spanish neonatal intensive care units.

While calculation errors can be eliminated using protocols based on standard drug concentrations, accuracy error rates depend on several variables that affect both neonatal intensive care units and hospital pharmacy services. Medication use is associated with a risk of errors and adverse events. Medication errors are more frequent and have more severe consequences in paediatric patients. Lack of knowledge of drug pharmacokinetics and pharmacodynamics in relation to physiological immaturity makes neonates more vulnerable to medication errors. Calculation errors are avoided using concentration standard preparation protocols. Accuracy in the preparation process depends mainly on the degree to which commercial drug preparations meet current legal requirements and the syringes and preparation techniques used.

Sedation and analgesia practices among Spanish neonatal intensive care units

Introduction: Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. Method: A multicenter, observational, longitudinal and prospective study. Results: Thirty neonatal units participated and included 468 neonates. Of these, 198 (42.3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam.