A New Approach to Recognize Neonatal Impaired Kidney Function.

Introduction: Previous studies in term newborns with hypoxic ischemic encephalopathy showed that the rate of serum creatinine (SCr) decline during the first week of life could be used to identify newborns with impaired kidney function (IKF) who are missed by standard definitions of neonatal acute kidney injury (nAKI).

Methods: Retrospective review of the medical records of 329 critically ill newborns ≥27 weeks of gestational age (GA) admitted to a level 4 neonatal intensive care unit (NICU). We tested the hypothesis that the rate of SCr decline combined with SCr thresholds provides a sensitive approach to identify term and preterm newborns with IKF during the first week of life.

Risk Factors for Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation.

Objective: This study aimed to assess the association of clinical risk factors with severity of magnetic resonance imaging (MRI) brain injury in neonatal extracorporeal membrane oxygenation (ECMO) patients.

Study Design: This is a single-center retrospective study conducted at an outborn level IV neonatal intensive care unit in a free-standing academic children's hospital. Clinical and MRI data from neonates treated with ECMO between 2005 and 2015 were reviewed.

Impact of decolonization on methicillin-resistant transmission and infection in a neonatal intensive care unit.

Background: The value of decolonization as a strategy for preventing methicillin-resistantStaphylococcus aureus (MRSA) in the neonatal intensive care unit (NICU) remains to be determined.

Objective: After adding decolonization to further reduce MRSA transmission in our NICU, we conducted this retrospective review to evaluate its effectiveness.

Method: The review included patients who were admitted to our NICU between April 2015 and June 2018 and were eligible for decolonization including twice daily intranasal mupirocin and daily chlorhexidine gluconate bathing over 5 consecutive days.

Reduction in Unintended Extubations in a Level IV Neonatal Intensive Care Unit.

Objectives: Unintended extubations (UEs) lead to significant morbidity in neonates. A quality improvement project was initiated in response to high rates in our level IV NICU. We targeted creating and sustaining UE rates below the published standard of 1 per 100 ventilator days.

Reassessing the need for active surveillance of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the neonatal intensive care population.

Objective: To determine the continued need for active surveillance to prevent extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) transmission in a neonatal intensive care unit (NICU).

Design: This retrospective observational study included patients with ESBL-E colonization or infection identified during their NICU stay at our institution between 1999 and March 2018. Active surveillance was conducted between 1999 and March 2017 by testing rectal swab specimens collected upon admission and weekly thereafter.

The association of type of surgical closure on length of stay among infants with gastroschisis born≥34 weeks' gestation.

Background/purpose: The optimal surgical approach in infants with gastroschisis (GS) is unknown. The purpose of this study was to estimate the association between staged closure and length of stay (LOS) in infants with GS.

Design/methods: We used the Children's Hospital Neonatal Database to identify surviving infants with GS born ≥34 weeks' gestation referred to participating NICUs.

High surgical burden for infants with severe chronic lung disease (sCLD).

Background/purpose: Infants with severe chronic lung disease (sCLD) may require surgical procedures to manage their medical problems; however, the scope of these interventions is undefined. The purpose of this study was to characterize the frequency, type, and timing of operative interventions performed in hospitalized infants with sCLD.

Methods: The Children's Hospital Neonatal Database was used to identify infants with sCLD from 24 children's hospital's NICUs hospitalized over a recent 16-month period.

Perioperative hypothermia in NICU infants: its occurrence and impact on infant outcomes.

Infants admitted to the neonatal intensive care unit (NICU) often require surgical intervention and maintaining normothermia perioperatively is a major concern. In our preliminary study of 31 normothermic infants undergoing operative procedures in the operating room (OR), 58% (N = 18) returned hypothermic while all 5 undergoing procedures in the NICU remained normothermic (P = .001).

Postnatal weight gain in preterm infants with severe bronchopulmonary dysplasia.

Objectives: To characterize postnatal growth failure (PGF), defined as weight < 10th percentile for postmenstrual age (PMA) in preterm (≤ 27 weeks' gestation) infants with severe bronchopulmonary dysplasia (sBPD) at specified time points during hospitalization, and to compare these in subgroups of infants who died/underwent tracheostomy and others.

Study Design: Retrospective review of data from the multicenter Children's Hospital Neonatal Database (CHND).

Results: Our cohort (n = 375) had a mean ± standard deviation gestation of 25 ± 1.

Improving hand hygiene compliance in health care workers: Strategies and impact on patient outcomes.

Background: We described a systematic process for improving hand hygiene (HH) compliance in health care providers and assessed the impact of HH on patient outcomes.

Methods: This retrospective cohort study was conducted between July 2008 and September 2011 in a children's hospital. We employed failure mode effectiveness analysis to identify barriers for complying with HH requirements and instituted improvement measures.

Heparin inhibits angiotensin II-induced vasoconstriction on isolated mouse mesenteric resistance arteries through Rho-A- and PKA-dependent pathways.

Heparin is commonly used to treat intravascular thrombosis in children undergoing extracorporeal membrane oxygenation or cardiopulmonary bypass. These clinical circumstances are associated with elevated plasma levels of angiotensin II (Ang II). However, the mechanisms by which heparin modulates vascular reactivity of Ang II remain unclear.

The impact of ethnic population dynamics on neonatal ECMO outcomes: a single urban institutional study.

Introduction: Neonatal extracorporeal membrane oxygenation ECMO has been clinically used for the last 25 y. It has been an effective tool for both cardiac and non cardiac conditions. The impact of ethno-demographic changes on ECMO outcomes however remains unknown.

Survival in congenital diaphragmatic hernia: use of predictive equations in the ECMO population.

Background: Equations have been proposed by the Wilford Hall/Santa Rosa (WHSR) and Congenital Diaphragmatic Hernia Study Group (CDHSG) for predicting survival in patients with CDH. The CDHSG stratifies risk based on a logistic regression equation incorporating birth weight and 5-min Apgar score, while the WHSR group uses the difference between maximum pO(2) and maximum pCO(2) as an index of risk. These models have not been applied specifically to the CDH ECMO (extracorporeal membrane oxygenation) population, a group at highest mortality risk.

Therapeutic hypothermia for neonatal encephalopathy and extracorporeal membrane oxygenation.

This case series describes the clinical management of 5 infants who underwent whole-body cooling during extracorporeal membrane oxygenation (ECMO). In all 5 infants, systemic hypothermia was maintained during ECMO with acceptable clinical outcomes.

Clinical and economic impact of methicillin-resistant Staphylococcus aureus colonization or infection on neonates in intensive care units.

Objective: The rising incidence and mortality of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in children has become a great concern. This study aimed to determine the clinical and economic impact of MRSA colonization or infection on infants and to measure excess mortality, length of stay, and hospital charges attributable to MRSA.

Design: This is a retrospective cohort study.

A tale of two bridges: effect of the bloodless bridge on renal function and blood pressure in neonates managed with venoarterial extracorporeal membrane oxygenation.

Objective: To investigate if a change in bridge design of the extracorporeal membrane oxygenation (ECMO) circuit had an impact on renal function and blood pressure in neonates requiring venoarterial ECMO support.

Design: : Retrospective chart review.

Setting: A tertiary care neonatal intensive care unit and ECMO center.

Role of sensory C fibers in hypoxia/reoxygenation-impaired myogenic constriction of cerebral arteries.

Objective: Hypoxia/reoxygenation (H/R) associated with extracorporeal membrane oxygenation disrupts cerebral autoregulation. However, the underlying mechanisms remain poorly understood. The present study was designed to investigate the role of sensory C-fibers in myogenic responsiveness of cerebral arteries.

Rho-kinase contributes to hypoxia/reoxygenation-induced cerebral endothelial dysfunction.

Hypoxia/reoxygenation (H/R) in vitro induced cerebral endothelial dysfunction is mediated by superoxide production. However, the intracellular pathways involved remain unclear. The present study was designed to investigate the involvement of Rho-kinase and its interaction with nitric oxide (NO) in cerebral endothelial dysfunction after H/R.

Summary proceedings from the cardiology group on cardiovascular instability in preterm infants.

The appropriate determination of adequate tissue perfusion and the best approach to treatment of perceived abnormalities in blood pressure in the neonate remain controversial. There is no consensus regarding the actual definition of hypotension in the neonate or how best to raise perceived low blood pressure. In addition, there is no direct and prospectively collected information available on the result of treatment of a "low" blood pressure on neonatal morbidity and mortality.

Altered cerebrovascular responses after exposure to venoarterial extracorporeal membrane oxygenation: role of the nitric oxide pathway.

Background: Previous studies in our laboratory on newborn lambs have shown cerebral autoregulation impairment after exposure to venoarterial extracorporeal membrane oxygenation (VA ECMO), with additional studies showing an altered cerebrovascular response to NG-nitro-L-arginine methyl ester in lamb cerebral vessels in this same model.

Objective: To further study the mechanisms involved in altered cerebrovascular responses in vessels exposed to VA ECMO.

Design: Prospective study.

Validation of the CAS neonatal NIRS system by monitoring vv-ECMO patients: preliminary results.

The CAS neonatal NIRS system determines absolute regional brain tissue oxygen saturation (SnO2) and brain true venous oxygen saturation (SnvO2) non-invasively. Since NIRS-interrogated tissue contains both arterial and venous blood from arterioles, venules, and capillaries, SnO2 is a mixed oxygen saturation parameter, having values between arterial oxygen saturation (SaO2) and cerebral venous oxygen saturation (SvO2). To determine a reference for SnO2, the relative contribution of SvO2 to SaO2 drawn from a brain venous site vs.