Neonatal Intensive Care Unit Resource Use for Infants at 22 Weeks' Gestation in the US, 2008-2021.

Importance: During the past decade, clinical guidance about the provision of intensive care for infants born at 22 weeks' gestation has changed. The impact of these changes on neonatal intensive care unit (NICU) resource utilization is unknown.

Objective: To characterize recent trends in NICU resource utilization for infants born at 22 weeks' gestation compared with other extremely preterm infants (≤28 weeks' gestation) and other NICU-admitted infants.

Longitudinal Survey of COVID-19 Burden and Related Policies in U.S. Neonatal Intensive Care Units.

Objective: This study aimed to determine the prevalence of confirmed novel coronavirus disease 2019 (COVID-19) disease or infants under investigation among a cohort of U.S. neonatal intensive care units (NICUs).

Ten-year trends in infant neuroimaging from US Neonatal Intensive Care Units.

Objective: To identify patterns of neuroimaging (NI), including cranial ultrasounds (CUS) and magnetic resonance imaging (MRI), among a large cohort of United States NICU infants.

Study Design: The retrospective cohort study of the Pediatrix Clinical Data Warehouse for infants discharged between 2008 and 2017.

Results: From the 863,863 infants during the study period, 204,197 (24%) had at least one NI study.

Does quality improvement work in neonatology improve clinical outcomes?

Purpose Of Review: Quality improvement initiatives in neonatology have been promoted as an important way of improving outcomes of newborns. The purpose of this review is to examine the effectiveness of recent quality improvement work in improving the outcomes of infants requiring neonatal intensive care.

Recent Findings: Quality improvement collaboratives and single-center projects demonstrate improvement of clinical processes and outcomes in neonatology that impact both preterm and term infants.

Stronger and More Vulnerable: A Balanced View of the Impacts of the NICU Experience on Parents.

For parents, the experience of having an infant in the NICU is often psychologically traumatic. No parent can be fully prepared for the extreme stress and range of emotions of caring for a critically ill newborn. As health care providers familiar with the NICU, we thought that we understood the impact of the NICU on parents.

Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants.

 To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants.  We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group,  = 313) to infants born in the 2 years after (post-ASO,  = 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours.

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign.

Background And Objective: Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the "100,000 Babies Campaign."

Methods: Key drivers of neonatal morbidity and mortality were identified.

Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants.

Background And Objective: Central venous catheters in the NICU are associated with significant morbidity and mortality because of the risk of central line-associated bloodstream infections (CLABSIs). The purpose of this study was to determine the effect of catheter dwell time on risk of CLABSI.

Methods: Retrospective cohort study of 13,327 infants with 15,567 catheters (93% peripherally inserted central catheters [PICCs], 7% tunneled catheters) and 256,088 catheter days cared for in 141 NICUs.

The Pediatrix BabySteps® Data Warehouse--a unique national resource for improving outcomes for neonates.

The Pediatrix Medical Group Clinical Data Warehouse represents a unique electronic data capture system for the assessment of outcomes, the management of quality improvement (CQI) initiatives, and the resolution of important research questions in the neonatal intensive care unit (NICU). This system is described in detail and the manner in which the Data Warehouse has been used to measure and improve patient outcomes through CQI projects and research is outlined. The Pediatrix Data Warehouse now contains more than 1 million patients, serving as an exceptional tool for evaluating NICU care.

Serum tocopherol levels in very preterm infants after a single dose of vitamin E at birth.

Objective: Our aim was to examine the impact of a single enteral dose of vitamin E on serum tocopherol levels. The study was undertaken to see whether a single dose of vitamin E soon after birth can rapidly increase the low α-tocopherol levels seen in very preterm infants. If so, this intervention could be tested as a means of reducing the risk of intracranial hemorrhage.

Individual and center-level factors affecting mortality among extremely low birth weight infants.

Objective: To examine factors affecting center differences in mortality for extremely low birth weight (ELBW) infants.

Methods: We analyzed data for 5418 ELBW infants born at 16 Neonatal Research Network centers during 2006-2009. The primary outcomes of early mortality (≤12 hours after birth) and in-hospital mortality were assessed by using multilevel hierarchical models.

A national survey of neonatal peripherally inserted central catheter (PICC) practices.

Purpose: The purpose of this study was to assess and describe the practices involved in the insertion and maintenance of peripherally inserted central catheters (PICCs) in neonates in level III neonatal intensive care units (NICUs) in the United States and to compare the findings with current recommendations and evidence.

Subjects: The study included responses from 187 nurses, nurse practitioners, and neonatologists who place PICCs in NICUs representing 43 states.

Methods: A 90-question, multiple-choice survey of a variety of PICC practices was sent to NICU directors and nursing staff responsible for PICC insertion.

A quality improvement approach to optimizing medication use in the neonatal intensive care unit.

Despite many years of heavy use in premature and critically ill newborns, surprisingly few medications have been rigorously tested in neonatal multicenter randomized clinical trials. Little is known about the pharmacology of these drugs at various birth weights, gestational ages, and chronologic ages. This article describes a quality improvement approach to evaluating and improving neonatal intensive care unit (NICU) medication use, with an emphasis on adaptation of drug use to the specific clinical NICU context and use of system-based changes to minimize harm and maximize clinical benefit.

Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity: the pediatrix experience.

Comprehensive oxygen management, focused on avoiding hyperoxia and repeated episodes of hypoxia-hyperoxia in very low birth weight infants, has been successfully used for the reduction of retinopathy of prematurity. Building on this experience, the Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity quality improvement initiative was developed to facilitate the spread and refinement of these techniques. The initiative focused on staff education and evaluation and redesign of the processes and practices involving oxygen use.

A primer on quality improvement methodology in neonatology.

This article provides a systematic and pragmatic approach to quality improvement in the neonatal intensive care unit setting. The "model for improvement" serves as the foundation for the approach, and is based on three core questions, followed by cycles of testing: What are we trying to accomplish? How will we know that a change represents an improvement? What changes can we make that will result in continuous improvement? This article reviews these questions in detail and provides specific examples to highlight the practical use of this methodology.

The Pediatrix BabySteps Data Warehouse and the Pediatrix QualitySteps improvement project system--tools for "meaningful use" in continuous quality improvement.

The Pediatrix BabySteps Clinical Data Warehouse (CDW) is a rich and novel tool allowing unbiased extraction of information from an entire neonatal population care by physicians and advanced practice nurses in Pediatrix Medical Group. Because it represents the practice of newborn medicine ranging from small community intensive care units to some of the largest neonatal intensive care units in the United States, it is highly representative of scope of practice in this country. Its value in defining outcome measures, quality improvement projects, and research continues to grow annually.

Crossing the quality chasm in neonatal-perinatal medicine.

The "Quality Chasm" exists in neonatal intensive care. Despite years of clinical research in neonatology, therapies continue to be underused, overused, or misused. A key concept in crossing the quality chasm is system redesign.

Controversy surrounding the use of home oxygen for premature infants with bronchopulmonary dysplasia.

Objective: To determine the criteria used in the current practice of neonatology for the initiation of home oxygen therapy in premature infants with bronchopulmonary dysplasia and to compare these criteria with the available literature regarding the use of home oxygen therapy.

Study Design: Participants in the December 2000 meeting of the Vermont Oxford Network were surveyed regarding their current use of home oxygen therapy for infants with bronchopulmonary dysplasia.

Results: Surveys were returned by 181 out of 297 participants.

Inhibition of sympathetic responses at birth in sheep by lesion of the paraventricular nucleus.

Birth is characterized by a surge in sympathetic outflow, heart rate (HR), mean arterial blood pressure (MABP) and circulating catecholamines. The paraventricular nucleus (PVN) of the hypothalamus is an important central regulatory site of sympathetic activity, but its role in the regulation of sympathoexcitation at birth is unknown. To test the hypothesis that the PVN regulates sympathetic activity at birth, experiments were performed in chronically instrumented near-term (137- to 142-day gestation, term 145 days) sheep before and after delivery by cesarean section.

An evidence-based multidisciplinary protocol for neonatal circumcision pain management.

Pain experienced in infancy may have effects later in life. Neonatal circumcision is a common painful procedure. In addition to dorsal penile nerve block, interventions that may have a role in minimizing pain and distress in neonatal circumcision include use of a sucrose pacifier, buffered lidocaine, small needles, acetaminophen, swaddling, and environmental modification.

Optimization of high-frequency oscillatory ventilation for the treatment of experimental pneumothorax.

Objective: To determine the effect of frequency, amplitude, inspiratory time, and mean airway pressure on gas flow through a chest tube in an animal model of pneumothorax treated with high-frequency oscillatory ventilation (HFOV).

Design: Observational study.

Setting: Animal laboratory.