Comparison of Time to First Dose of Oral Morphine in the Treatment of Neonatal Abstinence Syndrome.

OBJECTIVE: To compare time to first dose of oral morphine used in the treatment of neonatal abstinence syndrome (NAS) in a neonatal intensive care unit (NICU) versus a special care nursery (SCN) setting. METHODS: A retrospective chart review was completed of patient data from two community hospitals in a single health network. Infants born at either facility between January 2013 and August 2015 were eligible for inclusion in the study if treated for NAS with a course of oral morphine. The primary outcome was time from birth to first dose of oral morphine. Secondary outcomes included details about the morphine treatment course, length of stay, and complications from NAS. RESULTS: A total of 54 patients (19 NICU patients and 35 SCN patients) fulfilled inclusion criteria for the study. The primary outcome of median time from birth to first dose of oral morphine did not differ between the two groups (42.5 hrs [NICU] vs 43 hrs [SCN], p=0.53). No significant differences were found between the morphine regimens used in the two units. The median length of hospital stay (27 days [NICU] vs 26 days [SCN], p=0.66) and median length of NICU/SCN stay (26 days [NICU] vs 23 days [SCN], p=0.75) were not statistically significantly different. Time between transfer to the NICU or SCN and administration of the first dose of oral morphine was significantly shorter in the SCN setting (28 hrs [NICU] vs 4 hrs [SCN], p=0.009). CONCLUSIONS: This study found that infants treated for NAS had similar treatment in an NICU and an SCN. No difference was observed in time from birth to initiation of medication therapy. In addition, no differences were seen in all but one marker for quality of care including length of stay and cumulative morphine dose. Infants treated for NAS, whether in an NICU or SCN setting, can receive similar treatment and comparable outcomes.

Egreso neonatal precoz en una unidad de alojamiento conjunto / Early newborn discharge in a rooming in area

El alta precoz del recién nacido antes de las 48 horas del nacimiento se ha convertido en una práctica clínica rutinaria, a pesar de que tal conducta puede estar asociada a complicaciones en algunos neonatos. Definir las características demográficas de los recién nacidos que egresan de forma precoz en una unidad de Alojamiento Conjunto. En un estudio observacional, descriptivo, de diseño transversal se analizaron 1557 recién nacidos de edad gestacional entre 35 y 40 semanas. De esta población total, el 60% egresó antes de las 48 horas. En un subgrupo de 108 niños menores de 2500 gramos, 38 (35,2%) fueron dados de alta antes de 48 horas. A medida que la edad gestacional decreció, la incidencia del alta precoz se redujo: 24,2%, 45,6% y 65,6% para prematuros tardíos, neonatos a término precoces y neonatos mayores de 39 semanas, respectivamente. Sin embargo, 188 (46,3%) de los 406 recién nacidos menores de 39 semanas, incluyendo 8 prematuros tardíos, egresaron antes de 48 horas. En la población analizada el egreso precoz prevalece sobre el alta más tardía. Este procedimiento parece aplicarse sin mayor consideración de factores individuales de riesgo como el bajo peso al nacer y la edad gestacional por debajo de 39 semanas. Es factible que se precisen criterios particulares de alta neonatal que se puedan aplicar en grupos bien seleccionados de esta población

Early newborn discharge has progressively become a common clinical practice in many institutions, despite the fact of potential complications when it is applied collectively. To define demographic variables associated with early discharge of newborn infants in a rooming-in area. Methods: The design of the study was descriptive, observational and cross-sectional.1557 infants between 35 and 40 weeks’ gestational age were included. Overall, 60% of the total sample was discharged before 48 hours, including 38 (35.2%) out of 108 low-birth-weight infants. Incidence of early discharge was inversely related to gestational age; 24.2%, 45.6% and 65.6% for late preterm, early term and late term newborns, respectively. Nevertheless, 188 (46,3%) out of 406 infants below 39 weeks, including 8 late preterm newborns, were discharged before 48 hours. Early newborn discharge is highly prevalent in our institution. This policy seems to be routinely applied regardless of high risk situations defined by low birth weight or short gestational age. Formulation of particular criteria adjusted to the demographic and behavioral characteristics of this population seems mandatory

Single-room infant care: future trends in special care nursery planning and design.

For the past several years, health care providers specializing in the treatment of neonates have been working steadily to improve the environment for premature and sick neonates in order to optimize outcomes. They have also begun to recognize that involving the family in every aspect of care not only has positive value for the family, but can improve outcomes for neonates as well. This article examines how the staff at one hospital closely utilized and married these two concepts, developmentally supportive care and family-centered care, to design a Level II special care nursery that embraces parents as partners in treatment. Each phase of design development is described, including space programming, schematic design, environmental design, and design development, as well as the successful use of a multidisciplinary team.

Early discharge after delivery. A study of safety and risk factors.

The increased frequency of early discharge of newborns has led to questions of its safety. Most studies have looked at mortality and rehospitalization, not all missed diagnoses. The purpose of this study was to determine diagnoses in newborn infants that would have been missed if the infant had been discharged in <24 h. The design was a cohort study at Rabin Medical Center-Beilinson Campus (average monthly deliveries 1996 [250], 1997 [500]), a university-affiliated community hospital with all in-born term (> or = 37 weeks) infants born September through November 1996 and June 1997. The main outcome measures were medical diagnoses (except trivial physical descriptions) noted at discharge (generally at > or =48 h) exam, not noted on admission exam (<24 h). The results showed that 54 infants (5.1%) had diagnoses that were not detected before the infant was 24 h of age. The leading diagnosis was hyperbilirubinemia. Other potentially missed diagnoses included congenital heart disease (n = 10), morbidity of birth trauma (n = 9), metabolic disturbances (n = 2), hip dislocation (n = 1), suspected sepsis (n = 2), excessive weight loss (n = 2), polycythemia (n = 2), inguinal hernia (n = 1), and abducens paresis (n = 1). It is concluded that diagnoses can be missed by discharging infants in 24 h or less. These diagnoses have the potential for adverse sequela. Even if early discharge is felt to be cost effective, parents should be counseled that it is not risk free. Better mechanisms should be put in place for assuring the safety of such infants.

La hospitalización pediátrica infantil: los espacios lúdicos / Pediatric hospitalizacion: play spaces

Objetivo: El objetivo del presente trabajo es estudiar las características de los espacios dedicados a actividades lúdicas en el área de pediatría de los hospitales españoles, con la finalidad de conocer si sus características son las necesarias para la implementación de programas de preparación psicológica a través del juego. Métodos: Para ello se elaboró el "Cuestionario de la Utilización del Juego en los Hospitales Infantiles" que fue cumplimentado por los hospitales que realizan atención pediátrica y están situados en las capitales de las provincias españolas; (N=115). Resultados: Los resultados obtenidos ponen de manifiesto que las; personas encargadas de las actividades lúdicas en los hospitales públicos son principalmente los maestros y los voluntarios, pero no personal especializado, existiendo juguetes de uso común. En los hospitales privados no están presentes estas prestaciones. El lugar donde se realizan las actividades lúdicas es, principalmente, la habitación, aunque exista sala de juego en el hospital. La higiene de los juguetes forma parte de la limpieza que se realiza en el resto de dependencias del hospital. Conclusiones: Por lo que podemos concluir que, las caracteristicas del hospital (crivado-público) condiciona las prestaciones del área de pediatría de los hospitales españoles. El juego forma parte de La actividad del niño en el hospital pero no tiene una finalidad terapéutica. Por lo que sería necesario sensibilizar a los hospitales españoles (áreas de pediatría; de la importancia de los programas que incorporan actividades lúdicas como técnica terapéutica (AU)

Influencias dos diferentes tipos de alojamento sobre recem-nascidos na pratica do aleitamento materno / Influence of the different types of room on newborns during breastfeeding

O presente estudo foi realizado no Centro Medico Socialde Vila Lobato, que e um servico ambulatorial primario para criancas e gestantesda Faculdade de Medicina de Ribeirao Preto - FMRPUSP, no periodo de 1 de janeirode 1980 a 31 de dezembro de 1984, abrangendo 132 criancas. O estudo foi longitudinal e retrospectivo, tendo sido possivel constituir dois grupos distintos de criancas, diferindo de acordo com sua permanencia hospitalar no periodo pos-parto,em Alojamento Conjunto e bercario tradicional. Apos a analise estatistica de todas as variaveis envolvidas no estudo, o unico dado que diferencia os dois gruposera o local de internacao no periodo pos-parto. Embora exista uma tendencia a maior amamentacao no grupo que utilizou o Alojamento Conjunto, a analise estatistica mostrou que essa diferenca nao e significativa, devendo-se, porem, consideraro papel importante desempenhado pelo CMSCVL no estimulo a pratica do aleitamentomaterno, o que pode ter homogenizado os dois grupos. O tempo mediano de desmame,encontrado para a populacao estudada de 132 criancas foi de dez meses e para as que ficaram no bercario tradicional, oito meses. Foram identificadas tambem as causas de desmame para a populacao estudada, que se mostraram semelhantes as referidas em outros trabalhos publicados

Breast-feeding policies and routines among Arizona hospitals and nursery staff: results and implications of a descriptive study.

In 1988, Arizona's 61 hospitals providing obstetrical services were canvased with regard to hospital routines that favor either breast-feeding or bottle-feeding. Forty-five hospitals provided responses that were used in the survey. Practices favoring breast-feeding, which were reported by a majority of the hospitals (more than 50%), were demand feeding, staff assessment for "latch-on" (the action of nipple presentation and sucking initiation) and positioning, "rooming-in" (the practice of minimal mother-infant separation), and information about follow-up support services. Hospital practices suggested to promote bottle-feeding were the provision of pacifiers and supplemental water or glucose, issuance of formula packs at discharge, and a first feed of sterile water. A positive significant relationship was identified for policies advocating breast-feeding and the prevalence of breast-feeding encouragement from professional staff. Of 44 respondents, 41 indicated that their hospital's policies endorse breast-feeding as the ideal method of feeding healthy newborns. Hospital staff perceived that they encourage mothers to breast-feed and offer support to those who initiate breast-feeding. On the basis of this information, we conclude that dietetics practitioners should evaluate current breast-feeding practices and integrate policies supportive of breast-feeding into the health care system.

An intermediate care nursery at Christchurch Women's Hospital: the first year.

Following the Sheldon report (UK 1971) the proportion of newborn infants admitted to neonatal units in England and Wales rose to 20% of live births. Admission policies in Christchurch have followed Sheldon's recommendations and by 1981, 37% of all infants born in Christchurch Women's Hospital were admitted to the neonatal unit. Admission criteria were reviewed in 1982 with the result that most infants with a birth weight greater than 2.5 kg are no longer admitted to the unit. In addition an intermediate nursery was opened to admit healthy but low birth weight (1.8 to 2.5 kg) infants together with their mothers. In 1983 only 9.7% of inborn infants were admitted to the neonatal unit. Data relating to the operation of the intermediate nursery are presented.

Assessing trends in perinatology.

Hospital administrators must respond as the medical profession renews its efforts to reduce newborn mortality rates. Technological changes in the case of obstetric and newborn patients, pressures for the regionalization of service, and consumer demands for a more humane birth environment are factors the administrator must consider.