An EBP to Promote Early Skin-to-Skin Care Intervention and Mother's Own Milk Feedings in the Extremely Low Birth Weight Population.

PURPOSE: Describe an evidence-based process (EBP) to promote early skin-to-skin care (SSC) intervention and increase mother's-own-milk (MOM) feedings at discharge among extremely low birth weight (ELBW) infants. DESIGN: This EBP aimed to address the following clinical question: Among ELBW infants, does early SSC &#ξ2264;16 days of life (DOL), compared to SSC >16 DOL, result in more infants receiving MOM feedings at discharge? SAMPLE: A retrospective chart review of 199 ELBW infants. MAIN OUTCOME VARIABLE: Early SSC intervention among ELBW infants and MOM at discharge. RESULTS: Early SSC intervention increased from 46 to 73 percent among ELBW infants over the EBP period. Frequency of SSC intervention was associated with year of EBP and MOM at discharge (p = <.05). ELBW infants in the early SSC intervention group received more MOM at discharge.

Central versus Low-Lying Umbilical Venous Catheters: A Multicenter Study of Practices and Complications.

OBJECTIVES: Conventional neonatology practice is to place umbilical venous catheters (UVCs) in central position and to limit the use of low-lying catheters. Our objectives were to describe the practices and complications associated with UVCs and to evaluate the type of infusates used with either UVC position. STUDY DESIGN: A retrospective chart review was performed at four neonatal intensive care units to identify neonates who underwent UVC placement over a 2-year period. Infant demographics, UVC position, catheter days, fluid and medication characteristics, and specific complications were extracted. RESULTS: A total of 2,011 neonates who underwent UVC placement were identified during the 2-year period. Of these, 641 UVCs (31.9%) were identified in the low-lying position. Centrally positioned UVCs were associated with lower gestational age and were left in situ for a longer duration than low-lying UVCs. Infusions of hyperosmolar solutions and vasopressors were significantly higher in central UVCs, though they were used in a significant number of low-lying UVCs. Complications, while not statistically different, were three times higher in low-lying UVCs. CONCLUSION: Despite conventional teaching, low-lying UVCs were used in nearly one-third of infants in this cohort. Parenteral nutrition, antibiotics, and vasopressors were infused through central and low-lying UVCs. There was no statistically significant difference in complication rates between UVC positions.

Neonatal Abstinence Syndrome Due to Maternal Kratom Use.

Neonatal abstinence syndrome (NAS) is increasing in incidence and most commonly associated with maternal opioid use during pregnancy. Nonopioid alternatives to treat opioid dependence are highly sought after in the country's current opioid epidemic. Whether Kratom, a legal, widely available herbal supplement, should be classified as an opioid is contentious. Although the US Food and Drug Administration has recently addressed this controversy, Kratom continues to be marketed as a nonopioid remedy for opioid withdrawal. Its use is increasing in the United States. We describe an infant with NAS born to a mother with daily Kratom tea ingestion to self-treat opioid dependence. Pediatricians and parents should be aware of the risk of NAS due to Kratom use during pregnancy.

Outcomes of Lung Transplantation for Infants and Children with Genetic Disorders of Surfactant Metabolism.

OBJECTIVE: To compare outcomes of infants and children who underwent lung transplantation for genetic disorders of surfactant metabolism (SFTPB, SFTPC, ABCA3, and NKX2-1) over 2 epochs (1993-2003 and 2004-2015) at St Louis Children's Hospital. STUDY DESIGN: We retrospectively reviewed clinical characteristics, mortality, and short- and long-term morbidities of infants (transplanted at <1 year; n = 28) and children (transplanted >1 year; n = 16) and compared outcomes by age at transplantation (infants vs children) and by epoch of transplantation. RESULTS: Infants underwent transplantation more frequently for surfactant protein-B deficiency, whereas children underwent transplantation more frequently for SFTPC mutations. Both infants and children underwent transplantation for ABCA3 deficiency. Compared with children, infants experienced shorter times from listing to transplantation (P = .014), were more likely to be mechanically ventilated at the time of transplantation (P < .0001), were less likely to develop bronchiolitis obliterans post-transplantation (P = .021), and were more likely to have speech and motor delays (P ≤ .0001). Despite advances in genetic diagnosis, immunosuppressive therapies, and supportive respiratory and nutritional therapies, mortality did not differ between infants and children (P = .076) or between epochs. Kaplan-Meier analyses demonstrated that children transplanted in epoch 1 (1993-2003) were more likely to develop systemic hypertension (P = .049) and less likely to develop post-transplantation lymphoproliferative disorder compared with children transplanted in epoch 2 (2004-2015) (P = .051). CONCLUSION: Post-lung transplantation morbidities and mortality remain substantial for infants and children with genetic disorders of surfactant metabolism.