scholarly journals Accuracy of Transcutaneous Carbon Dioxide Measurement in Premature Infants

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Marie Janaillac ◽  
Sonia Labarinas ◽  
Riccardo E. Pfister ◽  
Oliver Karam
Keyword(s):  
Carbon Dioxide ◽  
Partial Pressure ◽  
Premature Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Wide Limit ◽  
Cerebral Lesions ◽  
Carbon Dioxide Measurement

Background.In premature infants, maintaining blood partial pressure of carbon dioxide (pCO2) value within a narrow range is important to avoid cerebral lesions. The aim of this study was to assess the accuracy of a noninvasive transcutaneous method (TcpCO2), compared to blood partial pressure of carbon dioxide (pCO2).Methods.Retrospective observational study in a tertiary neonatal intensive care unit. We analyzed the correlation between blood pCO2and transcutaneous values and the accuracy between the trends of blood pCO2and TcpCO2in all consecutive premature infants born at <33 weeks’ gestational age.Results.248 infants were included (median gestational age: 29 + 5 weeks and median birth weight: 1250 g), providing 1365 pairs of TcpCO2and blood pCO2values. Pearson’sRcorrelation between these values was 0.58. The mean bias was −0.93 kPa with a 95% confidence limit of agreement of −4.05 to +2.16 kPa. Correlation between the trends of TcpCO2and blood pCO2values was good in only 39.6%.Conclusions.In premature infants, TcpCO2was poorly correlated to blood pCO2, with a wide limit of agreement. Furthermore, concordance between trends was equally low. We warn about clinical decision-making on TcpCO2alone when used as continuous monitoring.

Tracheostomy in the Extremely Premature Neonate: A Multi-Institutional Study

2020 ◽  
Vol 162 (4) ◽  
pp. 559-565
Author(s):  
Kevin D. Pereira ◽  
Kevin Shaigany ◽  
Karen B. Zur ◽  
Carolyn M. Jenks ◽  
Diego A. Preciado ◽  
...  
Keyword(s):  
Lung Disease ◽  
Premature Infants ◽  
Gestational Age ◽  
Chronic Lung Disease ◽  
Neonatal Intensive Care ◽  
Premature Neonate ◽  
Neurodevelopmental Outcomes ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
The Mean

Objective (1) To describe characteristics associated with tracheostomy placement and (2) to describe associated in-hospital morbidity in extremely premature infants. Study Design Pooled retrospective analysis of charts. Setting Academic children’s hospitals. Subjects and Methods The patient records of premature infants (23-28 weeks gestational age) who underwent tracheostomy between January 1, 2012, and December 31, 2017, were reviewed from 4 academic children’s hospitals. Demographics, procedural morbidity, feeding, respiratory, and neurodevelopmental outcomes at the time of transfer from the neonatal intensive care unit (NICU) were obtained. The contribution of baseline characteristics to mortality, neurodevelopmental, and feeding outcomes was also assessed. Results: The charts of 119 infants were included. The mean gestational age was 25.5 (95% confidence interval, 25.2-25.7) weeks. The mean birth weight was 712 (671-752) g. Approximately 50% was African American. The principal comorbidity was chronic lung disease (92.4%). Overall, 60.5% of the infants had at least 1 complication. At the time of transfer, most remained mechanically ventilated (94%) and dependent on a feeding tube (90%). Necrotizing enterocolitis increased the risk of feeding impairment ( P = .002) and death ( P = .03). Conclusions Tracheostomy in the extremely premature neonate is primarily performed for chronic lung disease. Complications occur frequently, with skin breakdown being the most common. Placement of a tracheostomy does not seem to mitigate the systemic morbidity associated with extreme prematurity.

scholarly journals Trends in Pediatric Candidemia: Epidemiology, Anti-Fungal Susceptibility and Patient Characteristics in a Children’s Hospital

2020 ◽  
Author(s):  
Anabel Piqueras ◽  
Lakshmi Ganapathi ◽  
Jane F. Carpenter ◽  
Thomas Rubio ◽  
Thomas J. Sandora ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Antifungal Agent ◽  
Neonatal Intensive Care ◽  
Clinical Decision Making ◽  
Species Distributions ◽  
Bloodstream Infections ◽  
Clinical Decision ◽  
The United States ◽  
Morbidity And Mortality ◽  
Susceptibility Patterns

Background. Candida bloodstream infections (CBSIs) have decreased among pediatric populations in the United States, but remain an important cause of morbidity and mortality. Species distributions and susceptibility patterns of CBSI isolates diverge widely between children and adults. Awareness of these patterns can inform clinical decision-making for empiric or pre-emptive therapy of children at risk for candidemia. Methods. CBSIs occurring from 2006-2016 among patients in a large children&rsquo;s hospital were analyzed for age specific trends in incidence rate, risk factors for breakthrough-CBSI and death, as well as underlying conditions. Candida species distributions and susceptibility patterns were evaluated in addition to antifungal agent use. Results. The overall incidence rate of CBSI among this complex patient population was 1.97/1,000 patient-days. About half of CBSI episodes occurred in immunocompetent children and 14% in Neonatal Intensive Care Unit (NICU) patients. Antifungal resistance was minimal: 96.7% of isolates were fluconazole-, 99% were micafungin-, and all were amphotericin susceptible. Liposomal amphotericin was the most commonly prescribed antifungal agent including for NICU patients. Overall CBSI-associated mortality was 13.7%; there were no deaths associated with CBSI among NICU patients after 2011. Conclusions. Pediatric CBSI characteristics differ substantially from those in adults. Improved management of underlying diseases and antimicrobial stewardship may further decrease morbidity and mortality from CBSI while continuing to maintain low resistance rates among Candida isolates.

scholarly journals “I can guess the month … but beyond that, I can’t tell” an exploratory qualitative study of health care provider perspectives on gestational age estimation in Rajasthan, India

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
K. Scott ◽  
S. Gupta ◽  
E. Williams ◽  
M. Arthur ◽  
U. V. Somayajulu ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Gestational Age ◽  
Age Estimation ◽  
Clinical Decision Making ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Provider Perspectives ◽  
Gestational Age Estimation ◽  
Age Estimates

Abstract Background Accurately estimating gestational age is essential to the provision of time-sensitive maternal and neonatal interventions, including lifesaving measures for imminent preterm birth and trimester-specific health messaging. Methods We explored healthcare provider perspectives on gestational age estimation in the state of Rajasthan, India, including the methods they use (last menstrual period [LMP] dating, ultrasound, or fundal height measurement); barriers to making accurate estimates; how gestational age estimates are documented and used for clinical decision-making; and what could help improve the accuracy and use of these estimates. We interviewed 20 frontline healthcare providers and 10 key informants. Thematic network analysis guided our coding and synthesis of findings. Results Health care providers reported that they determined gestational age using some combination of LMP, fundal height, and ultrasound. Their description of their practices showed a lack of standard protocol, varying levels of confidence in their capacity to make accurate estimates, and differing strategies for managing inconsistencies between estimates derived from different methods. Many frontline healthcare providers valued gestational age estimation more to help women prepare for childbirth than as a tool for clinical decision making. Feedback on accuracy was rare. The providers sampled could not offer ultrasound directly, and instead could only refer women to ultrasound at higher level facilities, and usually only in the second or third trimesters because of late antenatal care-seeking. Low recall among pregnant women limited the accuracy of LMP. Fundal height was heavily relied upon, despite its lack of precision. Conclusion The accuracy of gestational age estimates is influenced by factors at four levels: 1. health system (protocols to guide frontline workers, interventions that make use of gestational age, work environment, and equipment); 2. healthcare provider (technical understanding of and capacity to apply the gestational age estimation methods, communication and rapport with clients, and value assessment of gestational age); 3. client (time of first antenatal care, migration status, language, education, cognitive approach to recalling dates, and experience with biomedical services); and, 4. the inherent limitations and ease of application of the methods themselves.

Sex Difference in Mortality for Premature and Low Birth Weight Neonates: A Systematic Review

2017 ◽  
Vol 35 (08) ◽  
pp. 707-715 ◽  
Author(s):  
Corrine Dickinson ◽  
Yogavijayan Kandasamy ◽  
Huy Vu
Keyword(s):  
Systematic Review ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Sex Difference ◽  
Neonatal Intensive Care ◽  
Clinical Decision Making ◽  
Reference Lists ◽  
Clinical Decision ◽  
Male Mortality ◽  
Mortality Outcome

Objective Advances in neonatology have made possible the survival of neonates with lower gestational ages and birth weights. Nevertheless, findings remain of a sex difference in mortality for premature and low birth weight (LBW) neonates with male sex often associated with poorer outcome (the “male disadvantage”). Through literature review, this article will seek clarification of the existing evidence regarding the association between sex and mortality at discharge from neonatal intensive care units (NICUs) for premature and LBW neonates. Methods A systematic review was conducted in Medline and Google Scholar with subsequent search of study reference lists. Results The database search yielded 349 articles and an additional 11 were identified from study reference lists. A final 32 studies were reviewed. Of these, 26 studies demonstrated worse male mortality outcome and 6 studies reported no sex difference in mortality. Conclusion The majority of reviewed studies found poorer male mortality outcome. A small number of studies maintained a null association between sex and mortality. This indicates male premature and LBW neonates experience higher risk of mortality by discharge compared with females, an observation which may inform clinical decision making in the NICU.

scholarly journals Evaluation of Heart Rate Assessment Timing, Communication, Accuracy, and Clinical Decision-Making during High Fidelity Simulation of Neonatal Resuscitation

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Win Boon ◽  
Jennifer McAllister ◽  
Mohammad A. Attar ◽  
Rachel L. Chapman ◽  
Patricia B. Mullan ◽  
...  
Keyword(s):  
Decision Making ◽  
Heart Rate ◽  
Neonatal Intensive Care ◽  
Clinical Decision Making ◽  
Neonatal Resuscitation ◽  
Clinical Decision ◽  
High Fidelity ◽  
High Fidelity Simulation ◽  
Chi Square ◽  
Chi Square Analysis

Objective. Accurate heart rate (HR) determination during neonatal resuscitation (NR) informs subsequent NR actions. This study’s objective was to evaluate HR determination timeliness, communication, and accuracy during high fidelity NR simulations that house officers completed during neonatal intensive care unit (NICU) rotations.Methods. In 2010, house officers in NICU rotations completed high fidelity NR simulation. We reviewed 80 house officers’ videotaped performance on their initial high fidelity simulation session, prior to training and performance debriefing. We calculated the proportion of cases congruent with NR guidelines, using chi square analysis to evaluate performance across HR ranges relevant to NR decision-making: <60, 60–99, and ≥100 beats per minute (bpm).Results. 87% used umbilical cord palpation, 57% initiated HR assessment within 30 seconds, 70% were accurate, and 74% were communicated appropriately. HR determination accuracy varied significantly across HR ranges, with 87%, 57%, and 68% for HR <60, 60–99, and ≥100 bpm, respectively (P<0.001).Conclusions. Timeliness, communication, and accuracy of house officers’ HR determination are suboptimal, particularly for HR 60–100 bpm, which might lead to inappropriate decision-making and NR care. Training implications include emphasizing more accurate HR determination methods, better communication, and improved HR interpretation during NR.

scholarly journals Survival and incidence of hemorrhagic-ischemic cerebral lesions in premature infants of gestational age (GA) ≤ 28 weeks

1999 ◽  
Vol 45 (6) ◽  
pp. 919-919
Author(s):  
O Claris ◽  
J C Picaud ◽  
M Walther ◽  
E Basson ◽  
A Lapillonne ◽  
...  
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Cerebral Lesions

The assessment of bulging fontanel and splitting of sutures in premature infants: an interrater reliability study by the Hydrocephalus Clinical Research Network

2013 ◽  
Vol 11 (1) ◽  
pp. 12-14 ◽  
Author(s):  
John C. Wellons ◽  
Richard Holubkov ◽  
Samuel R. Browd ◽  
Jay Riva-Cambrin ◽  
William Whitehead ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Research ◽  
Premature Infants ◽  
Interrater Reliability ◽  
Clinical Decision Making ◽  
Clinical Signs ◽  
Clinical Decision ◽  
Research Network ◽  
Posthemorrhagic Hydrocephalus ◽  
Clinical Research Network

Object Previous studies from the Hydrocephalus Clinical Research Network (HCRN) have shown a great degree of variation in surgical decision making for infants with posthemorrhagic hydrocephalus, such as when to temporize, when to shunt, or when to convert. Since much of this clinical decision making is dictated by clinical signs of increased intracranial pressure (including bulging fontanel and splitting of sutures), the authors investigated whether there was variability in how these signs were being assessed by neurosurgeons. They wanted to answer the following question: is there acceptable interrater reliability in the neurosurgical assessment of bulging fontanel and split sutures? Methods Explicit written definitions of “bulging fontanel” and “split sutures” were agreed upon with consensus across the HCRN. At 5 HCRN centers, pairs of neurosurgeons independently assessed premature infants in the first 3 months of life for the presence of a split suture and/or bulging fontanel, according to the a priori definitions. Interrater reliability was then calculated between pairs of observers using the Cohen simple kappa coefficient. Institutional board review approval was obtained at each center and at the University of Utah Data Coordinating Center. Results A total of 38 infants were assessed by 13 different raters (10 faculty, 2 fellows, and 1 resident). The kappa for bulging fontanel was 0.65 (95% CI 0.41–0.90), and the kappa for split sutures was 0.84 (95% CI 0.66–1.0). No complications from the study were encountered. Conclusions The authors have found a high degree of interrater reliability among neurosurgeons in their assessment of bulging fontanel and split sutures. While decision making may vary, the clinical assessment of this cohort appears to be consistent among these physicians, which is crucial for prospective studies moving forward.

scholarly journals Gestational diabetes mellitus in women born small or premature: Systematic review and meta-analysis

2021 ◽  
Author(s):  
Yasushi Tsujimoto ◽  
Yuki KATAOKA ◽  
Masahiro Banno ◽  
Shunsuke Taito ◽  
Masayo Kokubo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Low Birthweight ◽  
Clinical Decision Making ◽  
Absolute Risk ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Increased Risk

ABSTRACT Background: Women born preterm or with low birthweight (LBW) have an increased future risk of gestational diabetes mellitus (GDM) during pregnancy; however, a quantitative summary of evidence is lacking. In this study, we aimed to investigate whether being born preterm, or with LBW or small for gestational age (SGA) are associated with GDM risk. Methods: We searched the MEDLINE, Embase, and CINAHL databases and study registries, including ClinicalTrials.gov and ICTRP, from launch until 29 October 2020 for observational studies examining the association between birth weight or gestational age and GDM were eligible. We pooled the odds ratios and 95% confidence intervals using the DerSimonian and Laird random-effects model. Results: Eighteen studies were included (N = 827,382). The meta-analysis showed that being born preterm, with LBW or SGA was associated with increased risk of GDM (pooled odds ratio = 1.84; 95% confidence interval: 1.54 to 2.20; I2 = 78.3%; τ2 = 0.07). Given a GDM prevalence of 2.0%, 10%, and 20%, the absolute risk differences were 1.6%, 7.0%, and 11.5%, respectively. The certainty of evidence was low due to serious concerns of risk of bias and publication bias. Conclusion: Women born prematurely, with LBW or SGA status, may be at increased risk for GDM. However, whether this should be considered in clinical decision-making depends on the prevalence of GDM.

scholarly journals Treatment status of extremely premature infants with gestational age < 28 weeks in a Chinese perinatal center from 2010 to 2019

2021 ◽  
Author(s):  
Wen-Wen Zhang ◽  
Yong-Hui Yu ◽  
Xiao-Yu Dong ◽  
Simmy Reddy
Keyword(s):  
Survival Time ◽  
Premature Infants ◽  
Active Treatment ◽  
Gestational Age ◽  
Real World ◽  
Neonatal Intensive Care ◽  
Total Mortality ◽  
Delivery Room ◽  
Real World Data ◽  
Perinatal Medicine

Abstract Background There is a paucity of studies conducted in China on the outcomes of all live-birth extremely premature infants (EPIs) and there is no unified recommendation on the active treatment of the minimum gestational age in the field of perinatal medicine in China. We aimed to investigate the current treatment situation of EPIs and to provide evidence for formulating reasonable treatment recommendations. Methods We established a real-world ambispective cohort study of all live births in delivery rooms with gestational age (GA) between 24+0 and 27+6 weeks from 2010 to 2019. Results Of the 1163 EPIs included in our study, 241 (20.7%) survived, while 849 (73.0%) died in the delivery room and 73 (6.3%) died in the neonatal intensive care unit. Among all included EPIs, 862 (74.1%) died from withholding or withdrawal of care. Regardless of stratification according to GA or birth weight, the proportion of total mortality attributable to withdrawal of care is high. For infants with the GA of 24 weeks, active treatment did not extend their survival time (P = 0.224). The survival time without severe morbidity of the active treatment was significantly longer than that of withdrawing care for infants older than 25 weeks (P < 0.001). Over time, the survival rate improved, and the withdrawal of care caused by socioeconomic factors and primary nonintervention were reduced significantly (P < 0.001). Conclusions The mortality rate of EPIs is still high. Withdrawal of care is common for EPIs with smaller GA, especially in the delivery room. It is necessary to use a multi-center, large sample of real-world data to find the survival limit of active treatment based on our treatment capabilities.

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