Pragmatic Expansion of a Neonatal Antibiotic Stewardship Program in a Community Health Care System.

BACKGROUND: Previously published neonatal antibiotic stewardship efforts have been primarily implemented in single centers. Piedmont Athens Regional began work to decrease antibiotic use in the NICU with spread to the newborn nursery (NBN) and, subsequently, 13 other NICUs and NBNs throughout a health care system over a 4-year period. METHODS: This quality improvement initiative was conducted in the context of a multicenter learning collaborative from 2016 to 2019. The primary aim was a 10% reduction in antibiotic days per 1000 patient days (antibiotic utilization rate [AUR]) among newborns in the NICU and NBN at each hospital by December 2018. Change ideas were implemented by using plan-do-study-act cycles. The primary outcome measure was AUR with a balancing measure of antibiotic restarts. RESULTS: Piedmont Athens Regional decreased the NICU AUR by 46% and NBN AUR by 83%. Piedmont Healthcare decreased the NICU AUR by 40% and NBN AUR by 74%. Seven of 8 NICUs and 5 of 7 NBNs achieved a >10% reduction in AUR and 8 of 8 intervention hospitals showed a sustained drop in AUR in the NBN, NICU, or both during the 1.5-year postobservation period. Decreases in antibiotic initiation resulted in 335 fewer antibiotic courses in the NICU and 189 fewer infants started on antibiotics in the NBN in 2020 versus 2017. CONCLUSIONS: This initiative achieved reductions in AUR across multiple hospitals in the network. The system-wide approach facilitated information technology (IT) and electronic health record modifications. Common drivers of NICU improvement were involvement for at least 2 years, multidisciplinary teams, and the highest baseline AUR. The common driver of nursery improvement was the implementation of a neonatal sepsis risk calculator.

Perinatal exposure to alcohol: implications for lung development and disease.

In utero alcohol exposure dramatically increases the risk of premature delivery. However, the majority of premature and term newborns exposed to alcohol remain undetected by medical caregivers. There is a desperate need for reliable and accurate biomarkers of alcohol exposure for the term and premature newborn population. The inability to identify the exposed newborn severely limits our understanding of alcohol's pathophysiological effects on developing organs such as the lung. This chapter will review potential advancements in future biomarkers of alcohol exposure for the newborn population. We will discuss alcohol's effects on redox homeostasis and cellular development of the neonatal lung. Finally, we will present the evidence describing in utero alcohol's derangement of innate and adaptive immunity and risk for infectious complications in the lung. Continued investigations into the identification and understanding of the mechanisms of alcohol-induced alterations in the premature lung will advance the care of this vulnerable patient population.

A jet impingement investigation of osteoblastic cell adhesion.

When designing dental and orthopedic implants, it is important to consider phenomena occurring at the microscopic level, particularly at the bone-implant interface. The presence of hard tissue at this interface is essential to implant viability. The integrity of this tissue-biomaterial interface is dependent on appropriate osteoblast functions (adhesion, matrix deposition, etc.) in the immediate area. Researchers have modified various materials with cell-adhesive peptides with the ultimate goal of controlling osteoblast functions. This study used microjet impingement to compare the strength of adhesion of osteoblastic cells (at varying populations) and fibroblasts to peptide-modified substrates in the presence and absence of fetal bovine serum. In the presence of the serum, there was no significant difference in cellular adhesion strength between substrates. In the absence of serum, all cells tested adhered more strongly to underlying substrates, and the strength of cellular adhesion was greater on modified surfaces than on plain glass surfaces. In the absence of serum, second-passage osteoblastic cells generally adhered to substrates more strongly than first-passage osteoblastic cells; fibroblasts adhered similarly to second-passage osteoblastic cells. Fundamental studies such as the present increase the understanding of cell adhesion to various substrates--knowledge that may be ultimately useful in creating an optimal bone-implant interface.