Disparities in Perinatal Quality Outcomes for Very Low Birth Weight Infants in Neonatal Intensive Care

ObjectiveTo determine if hospital-level disparities in very low birth weight (VLBW) infant outcomes are explained by poorer hospital nursing characteristics.ConclusionsPoorer nursing characteristics contribute to disparities in VLBW infant outcomes in two nurse-sensitive perinatal quality standards. Improvements in nursing have potential to improve the quality of care for seven out of ten black VLBW infants who are born in high-black hospitals in this country.     

Neonatal RBC transfusions: Do benefits outweigh risks?

Preterm neonates represent one of the most transfused categories of patients. Their target hematocrits, however, are mainly based on expert opinion. The risk of transfusions are very high in the smallest preterm baby with a weak immune response, immature antioxidant ability, fragile germinal matrix and impaired cerebral autoregulation, yet red cell transfusions remain the only life saving measure in the baby with symptomatic anemia.Minimizing phlebotomy losses, following a restrictive transfusion policy and using screened, leukocyte depleted, irradiated, single donor blood remain the best means of avoiding the possible risks while maximizing the benefits of red cell transfusions in the preterm newborn.     

Is Endocan a Novel Diagnostic Marker for the Severity of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants?

IntroductionEndocan levels were found to be associated with severity and mortality of the respiratory system diseases.ObjectiveWe aimed to figure out whether endocan was an important marker for the diagnosis, severity and follow-up of bronchopulmonary dysplasia (BPD).Materials and methodsInfants with moderate/severe BPD, and who required hydrocortisone treatment were included in the study group. Infants without BPD were allocated in the control group. Endocan levels were compared between the control group and the study group, and before and after the treatment in the study group.ResultsA total of 148 infants, 74 infants in the control group and 74 infants in the BPD group, were included. The endocan level was higher in the BPD group than in the control group (P = .001). Endocan levels before treatment in the BPD group was found to be higher than endocan level after treatment (P = .021).ConclusionOur study found that endocan levels increased in moderate/severe BPD. Serum endocan levels may be a safe and novel indicator for the follow-up of response to treatment and the prognosis of the severity of the disease.     

Hemodynamically significant PDA: An echocardiographic and clinical assessment of incidence,natural history,and outcome in very low birth weight infants maintained in negative fluid balance

Summary Fifty very low birth weight (VLBW) infants (750–1500 g, 27–33 weeks gestational age) were assigned at random to one of two groups of negative fluid balance and underwent prospective clinical and echocardiographic examinations during the first month of life. The purpose was to determine: (a) the effect of fluid restriction on the incidence of ductal shunting, (b) the reliability of the physical examination in diagnosing significant ductal shunting, and (c) the relationship between significant ductal shunting and outcome in such infants. None of the infants had manipulations to close the ductus during the first week of life. Using routine structural and functional echocardiographic indices as criteria for the diagnosis of hemodynamically significant ductal shunting (hsPDA), we found that the two fluid-balance groups (8%–10% weight loss vs 13%–15% weight loss) did not significantly differ in incidence of hsPDA, duration of ventilation, or development of BPD. These two groups were then combined for further analysis: 32 (64%) of 50 VLBW infants had hsPDA during the first week of life. The group of infants with hsPDA did not differ significantly from that without hsPDA in birth weight or gestational age, but had a significantly lower Apgar score (P<0.04) and was significantly more likely to require ventilator support for RDS (P<0.01). Although when present a typical ductal murmur was specific for the development of significant ductal shunting, no murmur was heard in 21 (66%) of 32 infants with early hsPDA. Of the infants requiring ventilator support for RDS, the group with early hsPDA needed ventilation for 13.8±9.4 days, significantly longer than the group without early hsPDA (3.2±2.6 days,P<0.001), and had a higher incidence of BPD and death than the group without early hsPDA (P<0.04). In our study of a large group of prospectively identified VLBW infants, we did not find that significant ductal shunting was altered by more stringent fluid restriction, but we did find that such shunting was frequently inapparent clinically, and was associated with significantly increased morbidity and mortality.This research was supported in part by Children's Hospital Research Foundation; DHHS-USPHS, MCH grant 000174; American Heart Association, SWOC; and by DRR CLINFO grant RR00068-18-52, General Clinical Research Center.     

Fluconazole prophylaxis prevents invasive fungal infection in high-risk, very low birth weight infants

OBJECTIVES: To evaluate the benefit of fluconazole prophylaxis in preventing invasive fungal infection in very low birth weight (VLBW) infants with central vascular access. STUDY DESIGN: A 3-year baseline period (1998 to 2000) was compared with a subsequent 3-year period (2001 to 2003) during which a different protocol for preventing invasive fungal infection was used. All infants with a birth weight < 1500 g and with central vascular access were eligible for the study. Fluconazole (Diflucan R) was administered for 28 days at a dose of 6 mg/kg every third day during the first week and daily after the first week. RESULTS: There were no significant differences between the baseline and the fluconazole groups in demographic characteristics or risk factors for fungal infection. Fungal infection developed in 9 of the infants in the baseline group and in none of those in the fluconazole group (P=.003). A trend of decreasing mortality rate between the 2 groups (12.6% vs 8.1%; P=.32) was observed but was not statistically significant. No adverse effects of fluconazole therapy were documented. CONCLUSIONS: Fluconazole prophylaxis appeared to be beneficial in preventing invasive fungal infection in VLBW infants.     

Feasibility of and delay in obtaining pulse oximetry during neonatal resuscitation

Application of the sensor to newly born infants before connection to a pulse oximeter increases the reliability and speed with which data are displayed. Data are available in most infants within 90 seconds of birth. Oximetry may be useful in guiding interventions during resuscitation.     

Trends in severe bronchopulmonary dysplasia rates between 1994 and 2002

OBJECTIVE: To examine temporal trends in the rates of severe bronchopulmonary dysplasia (BPD) between 1994 and 2002. STUDY DESIGN: In a retrospective cohort study, all infants with a gestational age (GA) <33 weeks in a large managed care organization were identified. Annual rates of BPD (defined as an oxygen requirement at 36 weeks corrected GA), severe BPD (defined as respiratory support at 36 weeks corrected GA), and death before 36 weeks corrected GA were examined. RESULTS: Of the 5115 infants in the study cohort, 603 (12%) had BPD, including 246 (4.9%) who had severe BPD. There were 481 (9.5%) deaths before 36 weeks corrected GA. Although the decline in BPD in this period was not significant, the rates of severe BPD declined from 9.7% in 1994 to 3.7% in 2002. Controlling for gestational age, the odds ratio (95% CI) for annual rate of decline in severe BPD was 0.890 (0.841-0.941). Controlling for gestational age, deaths before 36 weeks corrected GA also declined, with the odds ratio (CI) for the annual decline being 0.944 (0.896-0.996). CONCLUSIONS: In this study population, the odds of having of BPD remained constant after controlling for GA. However, the odds of having severe BPD declined on average 11% per year between 1994 and 2002.