scholarly journals The Burden of Hypoxic Respiratory Failure in Preterm and Term/Near-term Infants in the United States 2011-2015

10.36469/9682 ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. 130-141
Author(s):  
Shivani Pandya ◽  
Onur Baser ◽  
George J. Wan ◽  
Belinda Lovelace ◽  
Jim Potenziano ◽  
...  
Keyword(s):  
United States ◽  
Respiratory Failure ◽  
Neonatal Intensive Care ◽  
The United States ◽  
Inpatient Setting ◽  
Index Hospitalization ◽  
Related Factors ◽  
Term Infants ◽  
Hypoxic Respiratory Failure ◽  
Near Term

Objectives: This study quantified the burden of hypoxic respiratory failure (HRF)/persistent pulmonary hypertension of newborn (PPHN) in preterm and term/near-term infants (T/NTs) by examining health care resource utilization (HRU) and charges in the United States. Methods: Preterms and T/NTs (≤34 and >34 weeks of gestation, respectively) having HRF/PPHN, with/without meconium aspiration in inpatient setting from January 1, 2011-October 31, 2015 were identified from the Vizient database (first hospitalization=index hospitalization). Comorbidities, treatments, HRU, and charges during index hospitalization were evaluated among preterms and T/NTs with HRF/PPHN. Logistic regression was performed to evaluate mortality-related factors. Results: This retrospective study included 504 preterms and 414 T/NTs with HRF/PPHN. Preterms were more likely to have respiratory distress syndrome, neonatal jaundice, and anemia of prematurity than T/NTs. Preterms had significantly longer inpatient stays (54.1 vs 29.0 days), time in a neonatal intensive care unit (34.1 vs 17.5 days), time on ventilation (4.7 vs 2.2 days), and higher total hospitalization charges ($613,350 vs $422,558) (all P<0.001). Similar rates were observed for use of antibiotics (96.2% vs 95.4%), sildenafil (9.5% vs 8.2%), or inhaled nitric oxide (93.8% vs 94.2%). Preterms had a significantly higher likelihood of mortality than T/NTs (odds ratio: 3.6, 95% confidence interval: 2.3-5.0). Conclusions: The findings of more severe comorbidities, higher HRU, hospitalization charges, and mortality in preterms than in T/NTs underscore the significant clinical and economic burden of HRF/PPHN among infants. The results show significant unmet medical need; further research is warranted to determine new treatments and real-world evidence for improved patient outcomes.

scholarly journals Cost-benefit analysis of VKA versus NOAC treatment in German patients with atrial fibrillation utilizing patient self-testing

10.36469/9774 ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. 142-159
Author(s):  
Roland Diel ◽  
Niklas Lampenius
Keyword(s):  
Neonatal Intensive Care ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
The United States ◽  
Inpatient Setting ◽  
Index Hospitalization ◽  
Related Factors ◽  
Term Infants ◽  
Near Term ◽  
New Treatments

Objectives: This study quantified the burden of hypoxic respiratory failure (HRF)/persistent pulmonary hypertension of newborn (PPHN) in preterm and term/near-term infants (T/NTs) by examining health care resource utilization (HRU) and charges in the United States. Methods: Preterms and T/NTs (≤34 and >34 weeks of gestation, respectively) having HRF/PPHN, with/without meconium aspiration in inpatient setting from January 1, 2011-October 31, 2015 were identified from the Vizient database (first hospitalization=index hospitalization). Comorbidities, treatments, HRU, and charges during index hospitalization were evaluated among preterms and T/NTs with HRF/PPHN. Logistic regression was performed to evaluate mortality-related factors. Results: This retrospective study included 504 preterms and 414 T/NTs with HRF/PPHN. Preterms were more likely to have respiratory distress syndrome, neonatal jaundice, and anemia of prematurity than T/NTs. Preterms had significantly longer inpatient stays (54.1 vs 29.0 days), time in a neonatal intensive care unit (34.1 vs 17.5 days), time on ventilation (4.7 vs 2.2 days), and higher total hospitalization charges ($613,350 vs $422,558) (all P<0.001). Similar rates were observed for use of antibiotics (96.2% vs 95.4%), sildenafil (9.5% vs 8.2%), or inhaled nitric oxide (93.8% vs 94.2%). Preterms had a significantly higher likelihood of mortality than T/NTs (odds ratio: 3.6, 95% confidence interval: 2.3-5.0). Conclusions: The findings of more severe comorbidities, higher HRU, hospitalization charges, and mortality in preterms than in T/NTs underscore the significant clinical and economic burden of HRF/PPHN among infants. The results show significant unmet medical need; further research is warranted to determine new treatments and real-world evidence for improved patient outcomes.

Inhaled Nitric Oxide Therapy in the Near-Term or Term Neonate with Hypoxic Respiratory Failure

2004 ◽  
Vol 23 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Leslie Williams ◽  
Thomas Shaffer ◽  
Jay Greenspan
Keyword(s):  
Nitric Oxide ◽  
Respiratory Failure ◽  
Vascular Reactivity ◽  
Minute Ventilation ◽  
Strong Relationship ◽  
Inhaled Nitric Oxide ◽  
Term Infants ◽  
Arterial Blood ◽  
Hypoxic Respiratory Failure ◽  
Near Term

Inhaled nitric oxide (iNO) has altered the management strategy for treating near-term and term infants with hypoxic respiratory failure (HRF) There is a strong relationship between HRF and persistent pulmonary hypertension of the newborn (PPHN). PPHN is characterized by elevated pulmonary resistance, pulmonary vasoconstriction, and altered vascular reactivity. The resulting high pulmonary pressure may lead to HRF, which is defined as a relative deficiency of oxygen in arterial blood and insufficient minute ventilation. iNO improves oxygenation and decreases the need for extracorporeal membrane oxygenation. Although iNO therapy is effective, its efficacy can depend on the fine points of its use and on other care the infant is receiving. Even in NICUs that do not have iNO available, those who care for term infants with HRF must be familiar with its use and know when and how to transfer these infants and how to help families through this difficult period. Because iNO therapy will probably be used more frequently in nurseries over the next few years, more information on the safety and efficacy of its use in the broader neonatal population needs to be available.

Cost-Effectiveness of Inhaled Nitric Oxide in the Treatment of Neonatal Respiratory Failure in the United States

PEDIATRICS ◽  
2003 ◽  
Vol 112 (6) ◽  
pp. 1351-1360 ◽  
Author(s):  
D. C. Angus ◽  
G. Clermont ◽  
R. S. Watson ◽  
W. T. Linde-Zwirble ◽  
R. H. Clark ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
United States ◽  
Cost Effectiveness ◽  
Respiratory Failure ◽  
The United States ◽  
Inhaled Nitric Oxide

Epidemiology and Outcomes of Acute Respiratory Failure in Hospitalized Patients in the United States, 2001 - 2009

CHEST Journal ◽  
2012 ◽  
Vol 142 (4) ◽  
pp. 727A
Author(s):  
Mihaela Stefan ◽  
Penelope Pekow ◽  
Meng-Shiou Shieh ◽  
Michael Rothberg ◽  
Jay Steingrub ◽  
...  
Keyword(s):  
United States ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
The United States ◽  
Hospitalized Patients

scholarly journals Hypoxic Respiratory Failure in Term and Near Term Newborns: Perspective from the Neonatal Transfer Service

2011 ◽  
Vol 70 ◽  
pp. 505-505
Author(s):  
S Davidson ◽  
N Ratnavel ◽  
S Mohinuddin ◽  
M F Hird ◽  
A Sinha
Keyword(s):  
Respiratory Failure ◽  
Hypoxic Respiratory Failure ◽  
Term Newborns ◽  
Near Term

Limitation of Private Attending Pediatricians' Neonatal Intensive Care Privileges in Level III Institutions Throughout the United States

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 190-193
Author(s):  
Rita G. Harper ◽  
Concepcion G. Sia ◽  
Regina Spinazzola ◽  
Raul A. Wapnir ◽  
Shahnaz Orner ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Health Care Providers ◽  
Curriculum Design ◽  
Neonatal Intensive Care ◽  
District Of Columbia ◽  
The United States ◽  
Geographic Region ◽  
Neonatal Intensive Care Units ◽  
Care Providers

Objective. To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States. Design. A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States. Results. Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and &gt;9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (≤10) as well as large (≥60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged. Conclusions. The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.

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