The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study.

Background: In this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates.

Methods: This study employed a qualitative study design using inductive thematic discourse analysis of 'naturally occurring data' in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital.

Improving the Timeliness and Efficiency of Discharge From the NICU.

Background: Discharge from the NICU is a highly complex process. Multidisciplinary survey results and chart audits identified gaps in the timeliness and efficiency of discharge in our NICU. Using the define-measure-analyze-improve-control quality improvement framework, we aimed to increase the percentage of patients discharged before 11:00 am from a baseline mean of 9.

Profound Hypotonia and Respiratory Failure due to Suspected Nemaline Myopathy in a Preterm Infant.

Congenital myopathies, such as nemaline myopathy, may present with hypotonia and respiratory failure in the neonatal period. Respiratory function can be further compromised in affected infants by the development of chylous effusions. We present the case of a preterm male infant born at 32 weeks' gestation, who was profoundly hypotonic and required intubation at birth.

Uncertainty at the Limits of Viability: A Qualitative Study of Antenatal Consultations.

Background And Objectives: Antenatal consultation between a neonatologist and expectant parent(s) may determine if resuscitation is provided for or withheld from neonates born in the gray zone of viability. In this study, we sought to gain a deeper understanding of uncertainties present and neonatologists' communication strategies regarding such uncertainties in this shared decision-making.

Methods: A prospective, qualitative study using transcriptions of audio-recorded antenatal consultations between a neonatologist and expectant parent(s) was conducted.

Proposed Plasma Ammonia Reference Intervals in a Reference Group of Hospitalized Term and Preterm Neonates.

Background: Plasma ammonia is commonly measured in the diagnostic evaluation of hospitalized newborns, but reference values are not well defined.

Methods: We prospectively enrolled newborns admitted to the level III/IV neonatal intensive care unit and level II intermediate special care nursery from January 2017 to January 2018. Infants with inborn errors of metabolism or liver disease were excluded.

Universal Electrocardiographic Screening for Long QT Syndrome in Hospitalized Neonates.

Objective: Long QT syndrome (LQTS) is a known cause of unexpected death, leading some to recommend routine neonatal electrocardiographic (ECG) screening. We used continuous electronic heart rate corrected QT interval (QTc) monitoring to screen for interval prolongation in a cohort of hospitalized neonates to identify those at a risk of having LQTS. We hypothesized that this screening method would yield an acceptable positive predictive value (PPV).