Effect of an Alternate Definition for a Clinically Significant Cardiopulmonary Event on Discharge.

OBJECTIVE: To evaluate a precise definition of a clinically significant cardiopulmonary event (CSCPE) on the hospital length of stay (LOS), medical provider satisfaction, and discharge complications. STUDY DESIGN: This is a single-center, observational study that included 139 infants before and 134 infants after the new definition was implemented in December 2017. Retrospective data collected November 2015 to November 2017 (before) was compared with prospective data from June 2018 to July 2020 (after). Outcome measures were the proportion of infants waiting to outgrow CSCPE, LOS, provider satisfaction with the definition, and discharge complications. Multivariate regression modeling was used to evaluate variables on LOS and postmenstrual age at discharge. RESULTS: The proportion waiting to outgrow CSCPE decreased from 68.4% to 31.7% (P < .0001). The LOS was similar between groups; however, multivariate analysis correcting for gestational age and reason awaiting discharge estimated 3.5 days (95% CI, 1.4-5.8 days; P = .0017) decrease in LOS, and 0.92 weeks (95% CI, 0.29-1.56; P = .005) younger postmenstrual age at discharge in the after group. There was no difference in the number of readmissions or emergency room visits for apnea or deaths. Provider satisfaction improved with discharge planning after the implementation of the definition. CONCLUSIONS: We developed an alternate definition for a CSCPE that decreased the proportion of infants waiting to outgrow a CSCPE but not LOS. There was no difference in the number of readmissions or emergency room visits for apnea or deaths, and provider satisfaction in management and discharge planning was greater. CLINICAL TRIAL REGISTRATION INFORMATION: This study was registered under the ClinicalTrial.gov Protocol ID: 5892S-15. "The effect of standardizing the definition and approach to a clinically significant cardiopulmonary event in infants less than 30 weeks on length of stay." Recorded Nov 2017.

Incidence of Nasogastric and Gastrostomy Tube at Discharge Is Reduced after Implementing an Oral Feeding Protocol in Premature (< 30 weeks) Infants.

Objective Reduce the number of infants requiring home tube feeds by initiating an oral feeding protocol (OFP). Study Design All infants < 30 weeks' gestation were eligible. The OFP involved four steps: encourage non-nutritive suck before 30 weeks, oral motor exercises starting as early as 30 weeks, swallowing exercises as early as 31 weeks, and an infant-driven oral feeding pathway as early as 32 weeks. Results The study included 129 infants before the protocol (January 2010 to December 2011) and 141 infants after the protocol (March 2013 to May 2015). Between the study periods, a multidisciplinary committee took 8 months to create the OFP, followed by a 3-month orientation of the protocol to the nursing and medical staff. The incidence of home tube feeds for 23 to 29 weeks was 26% before and 15% after the protocol (p = 0.03). Oral feeds were started sooner (p < 0.001), and full oral feedings were achieved earlier after the protocol was initiated (p < 0.001). Conclusion After introducing an OFP, oral feedings were started earlier, full oral feedings were achieved sooner, and the incidence of home tube feeds at discharge was reduced.

Etiologies of NICU deaths.

BACKGROUND AND OBJECTIVES: Infant mortality is an indicator of overall societal health, and a significant proportion of infant deaths occur in NICUs. The objectives were to identify causes of death and to define potentially preventable factors associated with death as areas for quality improvement efforts in the NICU. METHODS: In a prospectively defined study, the principal investigator in 46 level III NICUs agreed to review health care records of infants who died. For each infant, the principal investigator reviewed the medical record to identify the primary cause of death and to look for preventable factors associated with the infant's death. Infants born at ≥22 weeks estimated gestational age who were born alive were included. Stillborn infants were excluded. RESULTS: Data were collected on 641 infants who died. At lower gestational ages, mortality was most commonly due to extreme prematurity and the complications of premature birth (respiratory distress progressing to respiratory failure, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis). With increasing gestational age, the etiology of mortality shifted to hypoxic-ischemic encephalopathy and genetic or structural anomalies. Reviewers of clinical care identified 197 (31%) infants with potentially modifiable factors that may have contributed to their deaths. CONCLUSIONS: The factors associated with death in infants admitted for intensive care are multifactorial and diverse, and they change with gestational age. In 31% of the deaths, potentially modifiable factors were identified, and these factors suggest important targets for reducing infant mortality.

Peripherally inserted central catheter using the saphenous vein: importance of two-view radiographs to determine the tip location.

Two cases are described in which a peripherally inserted central catheter tip in the saphenous vein appeared to be in the inferior vena cava by an anteroposterior abdominal radiograph, but a lateral view revealed the catheter tip to be outside the inferior vena cava. The actual location of the catheter tip placement may be misleading with a single radiograph. Two-view radiographs should be considered to assure the proper catheter tip placement.