The Maryland State Intensive Care Neonatal Program (MSICNP) laboratory utilization in a neonatal intensive care unit (part 6 and conclusion).
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Humans↗
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Results for “neonatal intensive care”
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The psychosocial impact of tertiary care: neonatal intensive care and the social worker.
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Anxiety↗
Reduction of cerebral palsy by neonatal intensive care.
Neonatal mortality has declined since the advent of intensive care. The incidence of cerebral palsy has likewise decreased in spite of increased survival of low birth weight infants.
Cerebral Palsy↗
Osteomyelitis in a neonatal intensive care unit.
Neonatal osteomyelitis presents with few clinical signs despite multiple sites of involvement. Four cases of osteomyelitis due to Staphylococcus aureus or Candida albicans were encountered in a neonatal intensive care unit. Three were unsuspected clinically and were detected as incidental radiologic findings. The fourth presented with soft-tissue abscesses. Long bone metaphyses were most frequently affected. Other sites included iliac bones, clavicles, and spine. On follow-up the bones healed, but one patient was left with hip deformity secondary to destruction of the cartilaginous femoral heads and another patient developed obstructive hydrocephalus due to Candida ventriculitis. Complete skeletal survey is indicated in any infant with osteomyelitis at one site to seek additional silent areas of involvement.
Abscess↗
Intensive care for sick neonates, the earlier the better: improved survival rate of IRDS children, referred by means of a mobile neonatal intensive care unit.
A mobile intensive care unit has been used since september 1976 in the region referring sick neonates to the two University Hospital NICU's of Amsterdam. The present study compares two groups of neonates (suffering from the I.R.D.S.) i.e. a group that had been referred by non specialized transport teams (N S T-group) and a group admitted after institution of the neonatal-transport service (S. T.-group). Significant difference is found in the temperature on admission (S T group greater than N S T group). In the N S T-and the S T-group the need for ventilatory assistance was not significantly different but in the S T-group it was started significantly earlier. Survival after institution of ventilatory assistance and overall-survival are significantly better in the S T-group. These conclusions point to the fact that administering intensive care to sick neonates as early as possible and transportation of this group by means of special "neonatal"-transport services increases their survival rates.
Humans↗
Staff nurse turnover in neonatal intensive care units.
The turnover rate and patterns in Neonatal Intensive Care Units (NICUs) were assessed and compared with adult Intensive Care Units (ICUs) and General Infant Care Units at the same hospitals for the year 1976. Thirty-five hospitals with NICUs participated in the study. The findings of this study disagree with the previous literature in three major ways: 1 The turnover rate of staff nurses was less than half that estimated by The National Commission on Nursing for 1970. 2 The turnover rates in ICUs and NICUs were not significantly higher than that for staff nurses in Non-Intensive Care Units. In addition, the pattern of turnover among leavers is identical for all three major types of unit. The variability pattern for neonatal units, however, is statistically significant; this is not so with the other units studied. 3 There is no evidence for a stabilization of turnover following the usual 'induction crisis period' (the first 3 to 6 months).
Evaluation Studies as Topic↗
The Clinician-reported Genetic Testing Utility InDEx for Neonatal Intensive Care (C-GUIDE NICU): Quantifying genome-wide sequencing utility in the NICU.
PURPOSE: Use of genomic sequencing (GS) in neonatal intensive care units (NICUs) has increased with improved diagnostic yield. However, uncertainty persists regarding when and for whom GS is most useful. Because a standardized approach to assessing utility is lacking, we developed a novel version of the Clinician-reported Genetic testing Utility InDEx (C-GUIDE) to quantify the utility of GS in NICUs. METHODS: Informed by a scoping review, we developed a draft C-GUIDE NICU tool to quantify utility, which underwent iterative revisions through feedback from clinician interviews and questionnaires on item relevance, comprehensibility, and comprehensiveness. We finalized the expert-informed C-GUIDE NICU using an international Delphi consensus process. RESULTS: Scoping review (n = 25 articles) and interviews (n = 21) revealed key themes of utility. Guided by qualitative feedback and item scoring, C-GUIDE was iteratively reduced to include 21, 18, and 14 items. The Delphi consensus process with 22 experts achieved item consensus and stability, yielding a final 10-item tool. CONCLUSION: Using a rigorous process, we developed a consensus-based standardized method for capturing the clinical utility of GS in NICUs. C-GUIDE NICU can be used by clinicians, researchers, and payers to assess GS value to patient care and will be available for licensed use following reliability and validity testing.
Humans↗
Postneonatal infant mortality in infants to a neonatal intensive care unit.
The postneonatal infant mortality (PNIM) of 2,205 infants admitted to a neonatal intensive care unit from January 1971 to December 1974 was 44 in 1,000 infants who survived to age 28 days. This rate is approximately ten times that of the general population. Congenital malformations (59%), infections (12%), sudden infant death syndrome (10%), and asphyxial brain damage (10%) were the most common causes of death. One third (26) of the infants remained in the hospital whereas two thirds (52) had been dismissed prior to death. All who remained in the hospital plus 36 who had been dismissed died of severe illnesses that were incompatible with prolonged survival. The remaining PNIM was 10 in 1,000 neonatal survivors. This rate is still twice that of the general population. These deaths occurred in infants who were apparently well at the time of dismissal and subsequent examinations. Sudden infant death syndrome and infections constituted the largest portion of this mortality. Factors contributing to mortality in this group were poor socioeconomic status and low birth weight. Maternal age, race, marital status, and neonatal illnesses including apnea were not significantly related. Factors that appear to be important in the birth of high-risk infants continued to be operative in the postneonatal period, and contribute to a high mortality in apparently normal infants dismissed from the neonatal intensive care unit.
Abnormalities, Multiple↗
Neonatal intensive care and radiation.
Radiography plays an important role in a neonatal intensive care nursery. Diagnostic radiation was measured in 96 newborns. Mean exposure per neonate was 68.1 milliroentgens (mR) (SD = 132.7) with a median exposure per neonate of 28 mR. Radiation received by neonates was low, but further studies are needed to show the safety of radiation or its delayed effects. The measurement of radiation is simple, and routine radiation recording can prove useful in future evaluations of this high-risk population.
Critical Care↗
Outcome of infants of very low birthweight treated in neonatal intensive care unit.
The neonatal survival rate of 500 VLBW (less than or equal to 1 500 g) treated in the neonatal unit of the Departement of Paediatrics in Lausanne (C.H.U.V.) was studied according to changing patterns of nursing and medical care occurring in four successive periods (1961 IX-1963, X-1963 - 1965, 1966-1968, IV-1971-1973). The survival rate at 28 days increased from 35.5% to 47.7% between 1961 and 1965. Earlier start of feeding, intravenous fluid therapy, better control of ambient temperature and better oxygenotherapy are the main changes during this period. Further improvement in neonatal care did not affect the 28-day survival rate. 213 VLBW out of 500 (42.6%) survived at 28 days, 13 (6.1%) out of these died within the first two years of life, 36 (16.9%) were lost for the follow-up. The remaining 164 VLBW were followed until ages between 18 months and 8 years. The improvement in neonatal care was associated with a decrease in the incidence of major neurological sequels from 21.1% to 12.2% between 1961 and 1973. Cerebral palsy and epilepsy are responsible for this decrease. The incidence of mental retardation (DQ or IQ less than 80) also decreased from 17.5% to 4.9% during the same period. However, the incidence of retrolental fibroplasia remained stable. The outlook for VLBW infants is now much more encouraging. Further improvement in perinatal care is likely to further reduce the incidence of major handicaps. but it is not clear whether they will affect the incidence of minor problems such as learning difficulties or poor school performances. More prospective studies are necessary to clarify these points and to ensure early detection of these developmental problems.
Central Nervous System Diseases↗
Implementing customized genomic sequencing reports to empower providers in safety-net neonatal intensive care units.
PURPOSE: Through our implementation study providing rapid genomic sequencing (rGS) in safety-net neonatal intensive care units (NICUs), we investigated the feasibility and perceived usefulness of customized "clinical interpretive reports" (CIRs) to help neonatal providers with interpreting, disclosing, and managing care based on rGS results. METHODS: Enrolled infants received rGS through a clinically accredited vendor. We developed 5 CIR types to provide customized interpretation of rGS results and link results to clinical management considerations, research opportunities, and resources. We developed workflows to triage, create, and deliver CIRs within 3 business days. Providers received the vendor reports and CIRs, disclosed results, and completed post-disclosure surveys. We analyzed summary statistics for the first 100 cases. RESULTS: We delivered 97 of 100 CIRs (97%) within our goal time frame (average 1.3 days) and provided clinical management recommendations in 40 of 100 (40%). Neonatal providers completed the post-disclosure surveys for 86 of 100 disclosures (86%). Most reported using the CIR before disclosure (80/86, 93%) and found it helpful at providing useful information beyond the vendor report (79/80, 99%). CONCLUSION: It is feasible and useful to develop customized rGS reports to assist non-genetics providers in safety-net NICU settings. Similar approaches may hold promise for equitably advancing genomic care in non-NICU settings.
Humans↗
The risks of umbilical vessel catheterization in a neonatal intensive care unit.
Five hundred and fourteen high-risk neonates who had indwelling umbilical catheters at the neonatal intensive care unit of the University of Benin Teaching Hospital were studied. of these 514 neonates, 122 (23.8%) had their catheters in-situ for longer than 24 h. Of the 122, fifty-four (44%) had positive bacterial cultures from their catheter tips. Seven (5.7%) and four (3.2%) of the 122 neonates studied developed septicaemia and necrotizing enterocolitis respectively. Catheterization for periods in excess of 48 h significantly increased the risk of bacterial colonization. Malposition of umbilical catheter tips include: insertion into the right portal vein (thirty-six cases); superior mesenteric vein (three cases) and the left atrium (four cases). The complications related specifically to the malposition were: air collection in the hepatic venous system (two cases); cardiac arrest (one case); necrotising enterocolitis (one case) and a case of blanching of the abdominal wall. Because of these complications, the indications for catheterization should be restricted to carefully selected patients and strict aseptic technique be adhered to during the procedure.
Catheterization↗
The large private hospital and neonatal intensive care.
The experiences of the Methodist Hospital of Indiana in integrating family physicians into neonatal intensive care are related, and some useful organizational innovations in neonatal nursing are suggested.
Economics, Hospital↗
Outbreak of influenza in a neonatal intensive care unit.
An outbreak of influenza A/Victoria/3/75 (H3N2) involving five infants in a neonatal intensive care unit is described. The clinical signs and symptoms were indistinguishable from those seen in bacterial sepsis. There was no evidence of meningoencephalitis. All infants recovered without any sequelae.
Antibodies, Viral↗
Prevention of bacterial neonatal sepsis by contamination in an intensive care neonatal unit (lecture).
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Anti-Bacterial Agents↗
Two outbreaks of Flavobacterium meningosepticum type E in a neonatal intensive care unit.
Two separate outbreaks due to Flavobacterium meningosepticum type E occurred in a neonatal intensive care unit in March-April and July 1975. The first outbreak involved all five infants in the unit. Two infants developed meningitis, one had bacteremia, and two were colonized. During the second outbreak, five of seven infants were colonized but none developed disease. The upper respiratory tract was colonized first in most instances, and the organism persisted at this site for a mean of 17.3 days. Duration of colonization was more prolonged in infants receiving antibiotics than in untreated infants. Extensive environmental surveillance failed to demonstrate a reservoir, however, F. meningosepticum was recovered from three nasoendotracheal tubes and from an aerosol tube before colonization of four infants. The organism was resistant to most antimicrobial colonization of four infants. The organism was resistant to most antimicrobial agents tested and developed resistance to others during the treatment course of one infant. Although F. meningosepticum was not recovered from cultures of transport vehicles, several other gram-negative bacteria were isolated and were also resistant to multiple antibiotics.
Anti-Bacterial Agents↗
Otitis media in the neonatal intensive care unit.
Thirty-eight of 125 premature infants who were hospitalized in a neonatal intensive care unit (NICU) had abnormal tympanic membrane mobility compatible with otitis media. Twenty-five of these 38 had received antibiotics within one week of otoscopic examination and were considered to have either serous otitis or partially treated bacterial otitis media; tympanocentesis was not performed in them. Tympanocentesis was performed in the remaining 13 infants who had not received antibiotics. Bacterial otitis media was confirmed in ten of the 13. Either staphylococcal (six cases) or Gram-negative enteric organisms (four cases) were isolated in cultures obtained by tympanocentesis in these cases. The four cases of Gram-negative infections occurred in infants within six weeks of birth. Nasotracheal intubation for more than seven days was significantly correlated with impaired tympanic membrane mobility compatible with otitis media. Otitis media occurs frequently among premature infants who are hospitalized in an NICU, and it should be looked for in any infant in whom sepsis is clinically suspected.
Cross Infection↗
Regional organisation of neonatal intensive care in the North-west.
From January 1976 to July 1978, 234 ill neonates were transported to the regional neonatal intensive care unit (ICU) of St Mary's Hospital, Manchester, from 26 maternity hospitals three to 120 miles (4.8-193.1 km) away. Ninety per cent were transferred from 15 hospitals within a 30-mile (48.3 km) radius of the ICU. Most referring hospitals had more than 2000 births a year and offered good nursing supervision of high-risk neonates in conventional special care baby units (SCBUs). In 200 of the 234 babies respiratory symptoms precipitated referral, hyaline membrane disease being the most common final diagnosis. Altogether 143 babies received definitive mechanical ventilation, and most of them were ventilated in the ambulance en route to the ICU. The neonatal survival rates for all babies and for those who received mechanical ventilation were 61% and 45% respectively. Lethal inoperable malformations and tentorial tears accounted for 23 of the 92 deaths.A crisis-orientated referral service directed towards the treatment of babies with impending or actual respiratory failure needs close collaboration between the regional ICU and referring SCBUs, with parallel development of their facilities and skills. A complementary but distinct pattern of referral is necessary to cater for those high-risk but not critically ill babies who are born in hospitals that lack staff and facilities to provide the vigilant and anticipatory care that is so necessary.
Critical Care↗