RESUMO
BACKGROUND: Healthcare spending is expected to grow faster than the economy over the next decade, and the cost of prematurity increases annually. The aim of this study was to investigate the frequency of intervention after routine laboratory testing in preterm infants. METHODS: This was a retrospective study of preterm infants (≤34 weeks) admitted to the NYU Langone Health NICU from June 2013 to December 2014. Data collected included demographics, results of laboratory tests, and resulting interventions. Intervention after a hemogram was defined as a blood transfusion. Intervention after a hepatic panel was defined as initiation or termination of ursodiol or change in dose of vitamin D. Subjects were stratified into 3 groups based on gestation (<28 weeks, 28-31 6/7 weeks, 32-34 weeks). Chi-square analysis was used to compare the frequency of intervention between the groups. RESULTS: A total of 135 subjects were included in the study. The frequency of intervention after a hemogram was 8.4% in infants <28 weeks, 4.6% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks; this difference was found to be statistically significant (pâ=â0.02). The frequency of intervention after a hepatic panel was 4.2% in infants <28 weeks, 5.7% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks, which was not found to be a statistically significant different. CONCLUSION: No interventions were undertaken post-routine laboratory testing in any infant 32-34 weeks and routine testing in this population may be unnecessary. Further studies are needed to elucidate if routine testing affects neonatal outcomes.
Assuntos
Anemia/diagnóstico , Conservadores da Densidade Óssea/administração & dosagem , Doenças Ósseas Metabólicas/diagnóstico , Colagogos e Coleréticos/uso terapêutico , Colestase/diagnóstico , Testes Diagnósticos de Rotina/métodos , Fosfatase Alcalina/sangue , Anemia/sangue , Anemia/terapia , Bilirrubina/sangue , Doenças Ósseas Metabólicas/sangue , Doenças Ósseas Metabólicas/tratamento farmacológico , Colestase/sangue , Colestase/tratamento farmacológico , Colestase/etiologia , Testes Diagnósticos de Rotina/economia , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Idade Gestacional , Custos de Cuidados de Saúde , Gastos em Saúde , Hematócrito/economia , Hematócrito/métodos , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Testes de Função Hepática/economia , Testes de Função Hepática/métodos , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Nutrição Parenteral Total/efeitos adversos , Seleção de Pacientes , Estudos Retrospectivos , Ácido Ursodesoxicólico/uso terapêutico , Vitamina D/administração & dosagemRESUMO
Pertussis infections in the United States are increasing as a consequence of waning immunity and increased surveillance. Those most at-risk of mortality include infants less than 6 months of age and premature infants. The 2006 immunization schedule emphasizes an adolescent pertussis booster at 12 years of age. However, of concern is the current generation of parents and grandparents who will still be un-immunized and therefore, available vectors of pertussis to vulnerable neonates. Given the proximity of parents to medical care in the Neonatal Intensive Care Unit (NICU), and the potential for severe disease in their children, NICU personnel should consider administration of acellular pertussis vaccine to parents of hospitalized infants.
