scholarly journals Cost of neonatal intensive care for extremely preterm infants in Canada

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Asaph Rolnitsky ◽  
Sharon L. Unger ◽  
David R. Urbach ◽  
Chaim M. Bell
Keyword(s):  
Intensive Care ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Regional variation in cost of neonatal intensive care for extremely preterm infants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Asaph Rolnitsky ◽  
David Urbach ◽  
Sharon Unger ◽  
Chaim M. Bell
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Preterm Infants ◽  
Gestational Age ◽  
Regional Variation ◽  
Neonatal Intensive Care ◽  
Cost Optimization ◽  
Program Cost ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Regional variation in cost of neonatal intensive care for extremely preterm infant is not documented. We sought to evaluate regional variation that may lead to benchmarking and cost saving. Methods An analysis of a Canadian national costing data from the payor perspective. We included all liveborn 23–28-week preterm infants in 2011–2015. We calculated variation in costs between provinces using non-parametric tests and a generalized linear model to evaluate cost variation after adjustment for gestational age, survival, and length of stay. Results We analysed 6932 infant records. The median total cost for all infants was $66,668 (Inter-Quartile Range (IQR): $4920–$125,551). Medians for the regions varied more than two-fold and ranged from $48,144 in Ontario to $122,526 in Saskatchewan. Median cost for infants who survived the first 3 days of life was $91,000 (IQR: $56,500–$188,757). Median daily cost for all infants was $1940 (IQR: $1518–$2619). Regional variation was significant after adjusting for survival more than 3 days, length of stay, gestational age, and year (pseudo-R2 = 0.9, p < 0.01). Applying the model on the second lowest-cost region to the rest of the regions resulted in a total savings of $71,768,361(95%CI: $65,527,634–$81,129,451) over the 5-year period ($14,353,672 annually), or over 11% savings for the total program cost of $643,837,303 over the study period. Conclusion Costs of neonatal intensive care are high. There is large regional variation that persists after adjustment for length of stay and survival. Our results can be used for benchmarking and as a target for focused cost optimization, savings, and investment in healthcare.

Factors affecting parents' presence with their extremely preterm infants in a neonatal intensive care room

2013 ◽  
Vol 102 (7) ◽  
pp. 695-702 ◽  
Author(s):  
Ann-Britt Heinemann ◽  
Lena Hellström-Westas ◽  
Kerstin Hedberg Nyqvist
Keyword(s):  
Intensive Care ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Factors Affecting ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Anna Bry ◽  
Helena Wigert
Keyword(s):  
Intensive Care ◽  
Preterm Infants ◽  
Premature Infants ◽  
Emotional Support ◽  
Neonatal Intensive Care ◽  
Psychosocial Support ◽  
Medical Condition ◽  
Qualitative Interview Study ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Extremely premature infants (those born before 28 weeks’ gestational age) are highly immature, requiring months of care at a neonatal intensive care unit (NICU). For parents, their child’s grave medical condition and prolonged hospitalization are stressful and psychologically disruptive. This study aimed at exploring the needs of psychosocial support of parents of extremely premature infants, and how the NICU as an organization and its staff meets or fails to meet these needs. Method Sixteen open-ended interviews were conducted with 27 parents after their infant’s discharge from the NICU. Inductive content analysis was performed. Results Four themes were identified: Emotional support (with subthemes Empathic treatment by staff, Other parents as a unique source of support, Unclear roles of the various professions); Feeling able to trust the health care provider; Support in balancing time spent with the infant and other responsibilities; Privacy. Parents of extremely premature infants needed various forms of emotional support at the NICU, including support from staff, professional psychological help and/or companionship with other patients’ parents. Parents were highly variable in their desire to discuss their emotional state with staff. The respective roles of nursing staff, social workers and psychologists in supporting parents emotionally and identifying particularly vulnerable parents appeared unclear. Parents also needed to be able to maintain a solid sense of trust in the NICU and its staff. Poor communication with and among staff, partly due to staff discontinuity, damaged trust. Parents struggled with perceived pressure from staff to be at the hospital more than they could manage and with the limited privacy of the NICU. Conclusions The complex and individual psychosocial needs of parents of extremely preterm infants present many challenges for the NICU and its staff. Increasing staffing and improving nurses’ competence in addressing psychosocial aspects of neonatal care would help both nurses and families. Clarifying the roles of different professions in supporting parents and developing their teamwork would lessen the burden on nurses. Communicating with parents about their needs and informing them early in their NICU stay about available support would be essential in helping them cope with their infant’s hospitalization.

scholarly journals Fathers’ experiences of feeding their extremely preterm infants in family-centred neonatal intensive care: a qualitative study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Evalotte Mӧrelius ◽  
Sofia Brogren ◽  
Sandra Andersson ◽  
Siw Alehagen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Shared Responsibility ◽  
Oral Feeding ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Feeding Process

Abstract Background Extremely preterm infants need advanced intensive care for survival and are usually not discharged before they reach the time of expected birth. In a family-centred neonatal intensive care unit both parents are involved at all levels of care including the feeding process. However, studies focusing on fathers in this situation are scarce. The purpose of this study was to explore the experiences of feeding extremely preterm infants in a neonatal intensive care unit from fathers’ perspectives. Methods The study adopts a qualitative inductive method, reported according to the COREQ checklist. Seven fathers of extremely preterm infants (gestational age 24–27 weeks) in neonatal intensive care in Sweden were interviewed by telephone after discharge in 2013–2014. The interviews were analysed using a qualitative content analysis and confirmed by triangulation in 2021. Results Six sub-categories and two generic categories formed the main category: “a team striving towards the same goal”. The fathers were equally involved and engaged members of the feeding team all hours of the day. The fathers shared responsibility and practical duties with the mothers, and they provided as much support to the mothers as they could. However, the fathers found it difficult to support and encourage the mothers to breastfeed and express breastmilk when the breastmilk production was low. The fathers experienced a loss when breastfeeding was not successful. Conclusions The findings indicate that fathers want to be involved with infant care, including night-time feeds, and long and demanding feeding processes. Fathers and staff need to collaborate to provide the best support to mothers during the feeding process. This study may inspire hospital staff to acknowledge and support fathers to become more involved in the oral feeding process when an infant is born extremely preterm.

scholarly journals Feasibility of automated insulin delivery guided by continuous glucose monitoring in preterm infants

2019 ◽  
Vol 105 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Kathryn Beardsall ◽  
Lynn Thomson ◽  
Daniela Elleri ◽  
David B Dunger ◽  
Roman Hovorka
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Preterm Infants ◽  
Glucose Control ◽  
Neonatal Intensive Care ◽  
Closed Loop ◽  
Glucose Monitoring ◽  
Insulin Delivery ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

ObjectiveClosed-loop systems have been used to optimise insulin delivery in children with diabetes, but they have not been tested in neonatal intensive care. Extremely preterm infants are prone to hyperglycaemia and hypoglycaemia; both of which have been associated with adverse outcomes. Insulin sensitivity is notoriously variable in these babies and glucose control is time-consuming, with management requiring frequent changes of dextrose-containing fluids and careful monitoring of insulin treatment. We aimed to evaluate the feasibility of closed-loop management of glucose control in these infants.Design and settingSingle-centre feasibility study with a randomised parallel design in a neonatal intensive care unit. Eligibility criteria included birth weight <1200 g and <48 hours of age. All infants had subcutaneous continuous glucose monitoring for the first week of life, with those in the intervention group receiving closed-loop insulin delivery in a prespecified window, between 48 and 72 hours of age during which time the primary outcome was percentage of time in target (sensor glucose 4–8 mmol/L).ResultsThe mean (SD) gestational age and birth weight of intervention and control study arms were 27.0 (2.4) weeks, 962 (164) g and 27.5 (2.8) weeks, 823 (282) g, respectively, and were not significantly different. The time in target was dramatically increased from median (IQR) 26% (6-64) with paper guidance to 91% (78-99) during closed loop (p<0.001). There were no serious adverse events and no difference in total insulin infused.ConclusionsClosed-loop glucose control based on subcutaneous glucose measurements appears feasible as a potential method of optimising glucose control in extremely preterm infants.

scholarly journals Bonding in neonatal intensive care units: Experiences of extremely preterm infants’ mothers

2018 ◽  
Vol 31 (4) ◽  
pp. 325-330 ◽  
Author(s):  
Isabel María Fernández Medina ◽  
José Granero-Molina ◽  
Cayetano Fernández-Sola ◽  
José Manuel Hernández-Padilla ◽  
Marcos Camacho Ávila ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Faiza Latheef ◽  
Hanna Wahlgren ◽  
Helene Engstrand Lilja ◽  
Barbro Diderholm ◽  
Mattias Paulsson
Keyword(s):  
Clinical Practice ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Significant Risk ◽  
Quality Register ◽  
Increased Risk ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Hyperosmolar Solutions

<b><i>Introduction:</i></b> Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. <b><i>Methods:</i></b> A retrospective cohort study in extremely preterm infants (gestational age &#x3c;28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. <b><i>Results:</i></b> A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. <b><i>Conclusion:</i></b> The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

scholarly journals Near-Infrared Spectroscopy in Extremely Preterm Infants

2021 ◽  
Vol 8 ◽  
Author(s):  
Leeann R. Pavlek ◽  
Clifford Mueller ◽  
Maria R. Jebbia ◽  
Matthew J. Kielt ◽  
Omid Fathi
Keyword(s):  
Infrared Spectroscopy ◽  
Preterm Infants ◽  
Near Infrared Spectroscopy ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Potential Applications

With advances in neonatal care, survival of premature infants at the limits of viability has improved significantly. Despite these improvement in mortality, infants born at 22–24 weeks gestation are at a very high risk for short- and long-term morbidities associated with prematurity. Many of these diseases have been attributed to abnormalities of tissue oxygenation and perfusion. Near-infrared spectroscopy utilizes the unique absorption properties of oxyhemoglobin and deoxyhemoglobin to provide an assessment of regional tissue oxygen saturation, which can be used to calculate the fractional tissue oxygen extraction. This allows for a non-invasive way to monitor tissue oxygen consumption and enables targeted hemodynamic management. This mini-review provides a brief and complete overview of the background and physiology of near-infrared spectroscopy, practical use in extremely preterm infants, and potential applications in the neonatal intensive care unit. In this mini-review, we aim to summarize the three primary application sites for near-infrared spectroscopy, disease-specific indications, and available literature regarding use in extremely preterm infants.

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