Successful Implementation of the Eat Sleep Console Model of Care for Infants With NAS in a Community Hospital.

BACKGROUND: Opioid use across the United States is increasing. The concomitant rise in the incidence of neonatal abstinence syndrome (NAS) has made care of infants with this disease process a top priority for pediatric centers across the country. There is growing evidence that the Eat Sleep Console (ESC) model of care is superior to the established Finnegan Neonatal Abstinence Scoring System model. OBJECTIVES: We aimed to improve the care of infants with NAS by transitioning from the Finnegan Neonatal Abstinence Scoring System model to the ESC model of care. Our goal was to decrease the average length of stay from 11.77 to 5.94 days without having an increase in readmissions. METHODS: A multidisciplinary team was created. Education about NAS and ESC was created and distributed. Patients were admitted to the inpatient unit, and outcomes were observed. Standard quality improvement methodology was used for this intervention. RESULTS: After implementation of the ESC care model, average length of stay decreased to 5.94 days, with 0 patients readmitted or transferred for NAS-related complications. We saw a 48% reduction in average variable cost per patient. In addition to these reductions and savings, total per patient morphine exposure was reduced from 2.25 to 0.45 mg/kg, a 79% reduction in use. CONCLUSIONS: The ESC model of care was successfully implemented at our institution with resultant cost savings, decreased length of stay, and decreased medication use. Our work further supports the adoption of this new model of care for infants with NAS.

Epidemiology of bacteremia in febrile infants in the United States.

BACKGROUND: Fever in infants is a common clinical dilemma. The objective of this study was to present data from hospital systems across the northeast, southeast, mid-west, and western United States to identify the pathogens causing bacteremia in febrile infants admitted to general care units. METHODS: This was a retrospective review of positive blood culture results in febrile infants aged ≤90 days admitted to a general care unit across 6 hospital systems. Data were collected from January 1, 2006 through December 31, 2012 from emergency departments and general inpatient units. Cultures from ICUs, central lines, or infants who had complex comorbidities were excluded, as were repeat cultures positive for the same bacteria. Common contaminants were considered pathogens if they were treated as such. RESULTS: We identified 181 cases of bacteremia in 177 infants. The most common pathogen was Escherichia coli (42%), followed by group B Streptococcus (23%). Streptococcus pneumoniae was more likely in older infants (P = .01). Non-low-risk bacteremic infants were more likely to have E. coli or group B Streptococcus than low-risk bacteremic infants. We identified no cases of Listeria monocytogenes. Variation between sites was minimal. CONCLUSIONS: This is the largest and most geographically diverse study to date examining the epidemiology of bacteremia in infants. We suggest E. coli is the most common cause of bacteremia in previously healthy febrile infants admitted to a general inpatient unit. We identified no cases of L monocytogenes and question whether empirical therapy remains necessary for this pathogen.