Early Skin-to-Skin Care with a Polyethylene Bag for Neonatal Hypothermia: A Randomized Clinical Trial.

OBJECTIVE: To determine whether early polyethylene bag use with skin-to-skin care compared with skin-to skin care alone reduce hypothermia among infants born at term in resource-limited settings. STUDY DESIGN: Infants born at term in the tertiary referral center in Lusaka, Zambia, were randomized using sequentially numbered sealed opaque envelopes in 2 phases: after birth (phase 1) and at 1 hour after birth (phase 2) to either skin-to-skin care with polyethylene bags or skin-to-skin care alone. Infant and maternal temperatures were recorded at birth, 1 hour, and every 4 hours until discharge or 24 hours. RESULTS: We enrolled 423 infants from May 2017 to August 2017. The rate of moderate-severe hypothermia (temperature <36.0°C) at 1 hour was 72 of 208 (34.6%) in the skin-to-skin care with a polyethylene bag group compared with 101 of 213 (47.4%) in the skin-to-skin care alone group (relative risk, 0.71; 95% CI 0.56-0.90; P < .01; number needed to treat = 8). phase 1 treatment assignment significantly modified the effect of phase 2 treatment (P = .02 for interaction effect). Among infants randomized to skin-to-skin care with a polyethylene bag in phase 1, the risk of moderate-severe hypothermia was decreased in infants randomized to continue this intervention until discharge compared with infants randomized to skin-to-skin care alone. The rates of severe hypothermia, hyperthermia, and other adverse events did not differ significantly between groups. CONCLUSIONS: Low-cost polyethylene bags started after birth in combination with skin-to-skin care reduced moderate or severe hypothermia at 1 hour and at discharge among infants born at term in a resource-limited setting compared with skin-to-skin care alone. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03141723.

Surgery Grand Rounds: Perspectives of the 21st Century Attendee.

BACKGROUND: Grand rounds is an important and traditional academic medical institution. With generational changes in learning and the advancement of technology, it is difficult to know if the current method of grand rounds remains relevant and is meeting its audience's needs. Furthermore, surgeons may have different educational needs for grand rounds than other fields of healthcare. This study evaluates the needs of attendees and their attitudes toward modern surgical grand rounds through focus groups. MATERIALS AND METHODS: Independent focus groups were conducted in the department of surgery at a large academic institution. In total, 19 individuals (five professors, three associate professors, three assistant professors, seven senior residents, and one junior resident) participated in the focus groups. Thematic analysis was conducted through a process of independent coding and defining of themes followed by joint revision until consensus was reached. RESULTS: Four major themes arose from the discussion: current design and format of grand rounds, audience attitudes and needs, perceived barriers to meaningful grand rounds, and suggestions and improvements to grand rounds. Further subthemes also emerged. These themes were present in both faculty and resident responses, with 115 individual data pieces coded in total. CONCLUSIONS: Grand rounds is an opportunity for social interaction, networking, professional and personal identity formation, and learning meaningful and relevant content. Audience diversity, desire for more audience engagement, and changes in the modern learning environment provide the largest challenges to meaningful grand rounds. This first and interesting research into surgery grand rounds provides insight on how to best meet attendee needs in the 21st century.

Higher- or Usual-Volume Feedings in Infants Born Very Preterm: A Randomized Clinical Trial.

OBJECTIVE: To determine whether higher-volume feedings improve postnatal growth among infants born very preterm. STUDY DESIGN: Randomized clinical trial with 1:1 parallel allocation conducted from January 2015 to June 2018 in a single academic medical center in the US. In total, 224 infants with a birth weight 1001-2500 g born at <32 weeks of gestation were randomized to higher-volume (180-200 mL/kg/d) or usual-volume (140-160 mL/kg/d) feedings after establishing full enteral feedings (≥120 mL/kg/d). The primary outcome was growth velocity (g/kg/d) from randomization to study completion at 36 weeks of postmenstrual age or hospital discharge if earlier. RESULTS: Growth velocity increased among infants in the higher-volume group compared with the usual-volume group (mean [SD], 20.5 [4.5] vs 17.9 [4.5] g/kg/d; P < .001). At study completion, all measurements were higher among infants in the higher-volume group compared with the usual-volume group: weight (2365 [324] g, z score -0.60 [0.73] vs 2200 [308] g, z score -0.94 [0.71]; P < .001); head circumference (31.9 [1.3] cm, z score -0.30 [0.91] vs 31.4 [1.3] cm, z score -0.53 [0.84]; P = .01); length (44.9 [2.1] cm, z score -0.68 [0.88] vs 44.4 [2.0], z score -0.83 [0.84]; P = .04); and mid-arm circumference (8.8 [0.8] cm vs 8.4 [0.8] cm; P = .002). Bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, or other adverse outcomes did not differ between groups. CONCLUSIONS: In infants born very preterm weighing 1001-2500 g at birth, higher-volume feedings increased growth velocity, weight, head circumference, length, and mid-arm circumference compared with usual-volume feedings without adverse effects. TRIAL REGISTRATION: ClinicalTrials.gov; NCT02377050.