Readmission Reduction for Hyperbilirubinemia in Infants ≥ 35 Weeks Estimated Gestational Age Using a Standardized Protocol.

BACKGROUND: Most newborns experience hyperbilirubinemia. Monitoring and treatment must be balanced with the risk of unintended harm, including readmission to the birth hospital. From January 2019 to April 2021, the average rate of inborn readmission for all causes was 2.09% at the study hospital; hyperbilirubinemia accounted for 91% of these readmissions. The aim of this project was to decrease readmission rate for hyperbilirubinemia by 60% within eight months of protocol implementation. METHODS: The Lean system of quality improvement was used to assess root causes and implement countermeasures. A hyperbilirubinemia protocol was developed, and phototherapy equipment was upgraded. Monthly readmission rates were the main outcome measure. Process measures included hour of life for initial transcutaneous bilirubin measurement. Balance measures included number of serum bilirubin labs obtained per 100 infants, percentage treated with phototherapy, mean length of phototherapy treatment, and length of hospital stay. Statistical process control charts were used to measure changes in quality over time. RESULTS: Baseline data showed a monthly readmission rate for hyperbilirubinemia of 1.9%. Following countermeasure implementation, there was a clinically significant downward shift in the monthly readmission rate to 0.64%, representing a 66% decrease from baseline. CONCLUSION: Implementation of the project protocol was associated with a clinically significant decrease in readmissions for hyperbilirubinemia with no concurrent clinically significant changes in the number of labs drawn, number of infants started on phototherapy, or average length of hospital stay. For military treatment facilities or institutions with similar staffing models, this protocol may offer a model for improvement.

Evaluating the effects of a neonatal hypoglycemia bundle on NICU admission and exclusive breastfeeding.

OBJECTIVE: Early feeding, skin-to-skin contact, and dextrose gel have been independently shown to promote breastfeeding and decrease NICU admission for neonatal hypoglycemia. We combined these interventions to decrease NICU admissions for asymptomatic hypoglycemia and increase exclusive breastfeeding rates. PROJECT DESIGN: The IHI Model for Improvement was used to design a bundle including feeding within 1 h of birth, 1 h of uninterrupted skin-to-skin within 2 h of birth, and administration of buccal 40% dextrose gel for hypoglycemic infants. RESULTS: Utilization of dextrose gel was 94% following implementation. There were no trends in exclusive breastfeeding at discharge or NICU admissions for asymptomatic hypoglycemia. Post hoc multivariate analysis identified cesarean delivery as an independent risk factor for compliance failure and failure of exclusive breastfeeding but not for NICU admission. CONCLUSIONS: Despite high compliance with dextrose gel utilization, there was no change in exclusive breastfeeding at discharge or NICU admission rates for asymptomatic hypoglycemia.

Novel D: -erythro N-octanoyl sphingosine analogs as chemo- and endocrine-resistant breast cancer therapeutics.

PURPOSE: Resistance to endocrine and chemotherapies remains the primary cause of breast cancer treatment failure. We have synthesized four novel D: -erythro N-octanoyl sphingosine analogs and catalogued their activity in drug-sensitive (MCF-7), endocrine-resistant (MDA-MB-231) and chemoresistant (MCF-7TN-R) breast cancer cells. METHODS: 3-(4,5-Dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to determine cell viability; colony assay was performed to determine effects on clonogenic survival and (1)H NMR, (13)C NMR, HPLC spectra and elemental analytical data analyses were used to determine analog identity and purity. RESULTS: All four analogs inhibited both viability and clonogenic survival, with analog C exhibiting a log-fold improvement in anti-survival activity compared to the parent compound. CONCLUSION: With resistance to current breast cancer chemotherapies on the rise, the development of novel therapeutic targets is of growing importance. Our results show that lipid analogs have therapeutic potential in treating chemo- and endocrine-resistant breast cancer.