ABSTRACT
OBJECTIVE: To evaluate the association between hypercarbia in the first 24 h of life and clinical outcomes in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN: Retrospective review of patients entered into the CDHSG registry between 2007-2014. Half of the identified patients were analyzed to identify the PaCO2 value most predictive of mortality. Prediction models for outcomes of death, ECMO, and respiratory support at 30 days of life (DOL) were developed using PaCO2. Remaining half of data was used for validation of study findings. RESULTS: 1878 and 1875 patients were analyzed in the testing and validation groups. Lowest PaCO2≥60 mmHg in the first DOL is highly predictive of death prior to discharge. Prediction models including this variable demonstrate good discrimination for outcomes of death, ECMO, and respiratory support (AUC 0.8808, 0.8279, 0.8065). CONCLUSION: Lowest PaCO2 in the first DOL is an independent risk factor of mortality and morbidity in CDH.
Subject(s)
Carbon Dioxide/blood , Hernias, Diaphragmatic, Congenital/mortality , Hernias, Diaphragmatic, Congenital/therapy , Extracorporeal Membrane Oxygenation/mortality , Female , Hernias, Diaphragmatic, Congenital/blood , Humans , Infant, Newborn , Logistic Models , Male , Morbidity , Multivariate Analysis , Predictive Value of Tests , Registries , Retrospective Studies , Risk Factors , Severity of Illness Index , Texas/epidemiologyABSTRACT
OBJECTIVES: To identify teamwork behaviors associated with improving efficiency and quality of simulated resuscitation training. METHODS: Secondary analysis of a randomized controlled trial of trainees undergoing neonatal resuscitation training was performed. Trainees at a large academic center (n = 100) were randomized to receive standard curriculum (n = 36) versus supplemental team training curriculum (n = 62). A 2-hour team training session focused on communication skills, and team behaviors served as the intervention. Outcomes of interest included resuscitation duration, time required to complete a simulated newborn resuscitation, and performance score, determined by evaluation of each of the team's steps during simulated resuscitation scenarios. RESULTS: The teamwork behaviors assertion and sharing information were associated with shorter resuscitation duration and higher performance scores. Each additional use of assertion (per minute) was associated with a duration reduction of 41 s (95% confidence interval [CI], -71.5 to -10.2) and an increase in performance score of 1.6% (95% CI, 0.4-2.7). Each additional use of sharing information (per minute) was associated with a 14-second reduction in duration (95% CI, -30.4 to 2.9) and a 0.8% increase in performance score (95% CI, 0.05-1.5). CONCLUSIONS: Teamwork behaviors of assertion and sharing information are 2 important mediators of efficiency and quality of resuscitations.
Subject(s)
Academic Medical Centers/organization & administration , Inservice Training/organization & administration , Patient Care Team/organization & administration , Resuscitation/methods , Clinical Competence , Communication , Humans , Infant, Newborn , Internship and Residency , Interprofessional Relations , Randomized Controlled Trials as TopicABSTRACT
We compared the rates of medical closure of patent ductus arteriosus (PDA) and complications (renal dysfunction, necrotizing enterocolitis, spontaneous intestinal perforation, and intraventricular hemorrhage) between infants treated with indomethacin and infants treated with ibuprofen. We performed a retrospective comparative cohort study of infants treated with indomethacin or ibuprofen for symptomatic PDA at Duke University Medical Center between November 2005 and November 2007. We identified 65 infants who received indomethacin and 57 who received ibuprofen. The rate of survival without surgical ductal ligation was 62% (40/65) in the indomethacin group and 58% (33/57) in the ibuprofen group (p = 0.71). The rate of the composite of complications (death, necrotizing enterocolitis, or intestinal perforation) was 40% (26/65) in the indomethacin group and 32% (18/57) in the ibuprofen group (p = 0.35). There was no significant difference between groups in elevation of serum creatinine during treatment. In clinical practice, ibuprofen appears to be as effective as indomethacin for closure of patent ductus arteriosus with similar complication rates. The decision to use one agent over the other should be based on dose schedule preference and the currently published clinical trials until more safety and effectiveness data are available.
