Clinical Characteristics of Necrotizing Enterocolitis Diagnosed by Independent Adjudication of Abdominal Radiographs, Laparotomy, or Autopsy in Preterm Infants in the "Connection Trial".

Objective:  Necrotizing enterocolitis (NEC) classically is diagnosed by radiographic demonstration of pneumatosis intestinalis/portal venous gas (PI/PVG). This study examines clinical characteristics of NEC confirmed by independent evaluation of abdominal radiographs, taken for clinical signs of NEC, or by pathologic findings at laparotomy or autopsy (confirmed NEC [cNEC]).

Study Design:  The investigated cohort included 1,382 extremely low birth weight (BW) infants (BW range: 500-1,000 g) with median 27 weeks (range: 23-32) gestational age (GA) at birth.

Systemic corticosteroids for the prevention of bronchopulmonary dysplasia, a network meta-analysis.

Background: Despite considerable improvement in outcomes for preterm infants, rates of bronchopulmonary dysplasia (BPD) remain high, affecting an estimated 33% of very low birthweight infants, with corresponding long-term respiratory and neurosensory issues. Systemic corticosteroids can address the inflammation underlying BPD, but the optimal regimen for prevention of this disease, balancing of the benefits with the potentially meaningful risks of systemic corticosteroids, continues to be a medical quandary. Numerous studies have shown that systemic corticosteroids, particularly dexamethasone and hydrocortisone, effectively treat or prevent BPD.

Clinical and Cost Impact Analysis of a Novel Prognostic Test for Early Detection of Preterm Birth.

 The objective of this study was to evaluate the potential impact to the U.S. health care system by adopting a novel test that identifies women at risk for spontaneous preterm birth.

Should we believe in transfusion-associated enterocolitis? Applying a GRADE to the literature.

Numerous observational studies appear to demonstrate an association between packed red blood cell (pRBC) transfusions and necrotizing enterocolitis (NEC). However, the limited numbers of randomized controlled trials (RCTs) do not support a causal relationship between pRBC transfusion and NEC. We sought to determine the quality of the evidence behind transfusion-associated necrotizing enterocolitis (TANEC), and to formulate a GRADE-based recommendation regarding transfusion practices to reduce the risk of TANEC.

Evidence, Quality, and Waste: Solving the Value Equation in Neonatology.

Rising health care costs challenge governments, payers, and providers in delivering health care services. Tremendous pressures result to deliver better quality care while simultaneously reducing costs. This has led to a wholesale re-examination of current practice methods, including explicit consideration of efficiency and waste.

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value.

Background: The use of unnecessary tests and treatments contributes to health care waste. The "Choosing Wisely" campaign charges medical societies with identifying such items. This report describes the identification of 5 tests and treatments in newborn medicine.

A risk-adjusted, composite outcomes score and resource utilization metrics for very low-birth-weight infants.

Importance: It is difficult for neonatal intensive care units (NICUs) to determine the overall efficacy of multiple continuous quality improvement (CQI) projects aimed at reducing very low-birth-weight (VLBW) infant morbidities. It is challenging to know whether a NICU is becoming more proficient, and it is not usually apparent whether concurrent resource use is changing.

Objective: To develop a risk-adjusted composite score of the major morbidities in VLBW infants and a companion metric that accounts for resource use to enhance the ability to measure overall progress in CQI and to identify proficient NICUs.

Baby-MONITOR: a composite indicator of NICU quality.

Background And Objectives: NICUs vary in the quality of care delivered to very low birth weight (VLBW) infants. NICU performance on 1 measure of quality only modestly predicts performance on others. Composite measurement of quality of care delivery may provide a more comprehensive assessment of quality.

Nurse-to-patient ratios and neonatal outcomes: a brief systematic review.

Background: Higher patient-to-nurse ratios and nursing workload are associated with increased mortality in the adult intensive care unit (ICU). Most neonatal ICUs (NICUs) in the United Kingdom do not meet national staffing recommendations. The impact of staffing on outcomes in the NICU is unknown.

Correlation of neonatal intensive care unit performance across multiple measures of quality of care.

Objectives: To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance.

Design: We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input.

Prospective economic evaluation of a peer support intervention for prevention of postpartum depression among high-risk women in Ontario, Canada.

Objective: A previous multisite, randomized, controlled trial of peer support compared with usual care for prevention of postpartum depression demonstrated a reduction in depression symptoms at 12 weeks postbirth. Our objective was to determine the cost-effectiveness of this intervention.

Study Design: Prospectively planned economic evaluation alongside the clinical trial to determine the cost per case of postpartum depression averted, using individual patient data (n = 610) and societal perspective.

Variations in definitions of mortality have little influence on neonatal intensive care unit performance ratings.

Objective: To measure the influence of varying mortality time frames on performance rankings among regional neonatal intensive care units (NICUs) in a large state.

Study Design: We performed a cross-sectional data analysis of very low birth weight infants receiving care at 24 level 3 NICUs. We tested the effect of 4 definitions of mortality: (1) death between admission and end of birth hospitalization or up to 366 days; (2) death between 12 hours of age and the end of birth hospitalization or up to 366 days; (3) death between admission and 28 days; and (4) death between 12 hours of age and 28 days.

Do transfusions cause necrotizing enterocolitis? The complementary role of randomized trials and observational studies.

A systematic review and a meta-analysis of the published literature on the association between transfusions in newborns and the occurrence of transfusion-associated necrotizing enterocolitis were performed. We discuss the differences between findings in randomized trials, and the results of observational studies that first explored this putative link. We suggest the following framework: where observational studies play a hypothesis generating- role for therapies and harm, and randomized studies allow an acid test of that hypothesis.

Neonatal intensive care unit discharge preparedness: primary care implications.

Objective: To investigate specific post-neonatal intensive care unit (NICU) discharge outcomes and issues for families.

Study Design: The authors prospectively surveyed family's discharge preparedness at the infant's NICU discharge. In the weeks after the infant was discharged, families were interviewed by telephone for self-reported utilization of health services as well as any infant-associated problems or issues.

Development and pretesting of a decision-aid to use when counseling parents facing imminent extreme premature delivery.

Objective: To develop and pretest a decision-aid to help parents facing extreme premature delivery during antenatal counseling regarding delivery room resuscitation.

Study Design: Semistructured interviews with 31 clinicians and with 30 parents of children born <26 weeks' gestation were conducted following standard methods of qualitative research. These characterized perceptions of prenatal counseling to identify information that parents value when making decisions regarding delivery room resuscitation.

Economic evaluation alongside the Premature Infants in Need of Transfusion randomised controlled trial.

Background: The Premature Infants in Need of Transfusion (PINT) Outcome Study showed no significant difference in the primary outcome of death or neurodevelopmental impairment (NDI) in extremely low birthweight (ELBW) infants. However, a post-hoc analysis expanding the definition of NDI to include borderline intellectual functioning (Mental Development Index (MDI) <85) found an improvement in outcomes in the group maintained at higher haemoglobin levels.

Objective: To determine the cost effectiveness of more frequent red blood cell transfusions (high-Hb threshold) compared with less frequent transfusions (low-Hb threshold) in ELBW infants.

Health state preferences associated with weight status in children and adolescents.

Background: Childhood obesity is a substantial public health problem. The extent to which health state preferences (utilities) are related to a child's weight status has not been reported. The aims of this study were (1) to use a generic health state classification system to measure health related quality of life and calculate health utilities in a convenience sample of children and adolescents and (2) to determine the extent to which these measures are associated with weight status and body mass index (BMI).

Prematurity: an overview and public health implications.

The high rate of premature births in the United States remains a public health concern. These infants experience substantial morbidity and mortality in the newborn period, which translate into significant medical costs. In early childhood, survivors are characterized by a variety of health problems, including motor delay and/or cerebral palsy, lower IQs, behavior problems, and respiratory illness, especially asthma.

Variation in diagnosis of apnea in moderately preterm infants predicts length of stay.

Objective: Apnea of prematurity is one of the most common diagnoses in the NICU. Because resolution of apnea is a usual precondition for discharge from the hospital, different monitoring practices might affect length of stay for premature infants. Our objective was to compare the proportion of 33 to 34 weeks' gestational age infants diagnosed with apnea in different NICUs and to assess whether variability in length of stay would be affected by the rate of documented apnea.

Clinical benefits, costs, and cost-effectiveness of neonatal intensive care in Mexico.

Background: Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.

Economic evaluation of caffeine for apnea of prematurity.

Objective: To determine the cost-effectiveness of treatment with caffeine compared with placebo for apnea of prematurity in infants with birth weights less than 1250 g, from birth through 18 to 21 months' corrected age.

Methods: We undertook a retrospective economic evaluation of the cost per survivor without neurodevelopmental impairment by using individual-patient data from the Caffeine for Apnea of Prematurity clinical trial (N = 1869). We included direct medical costs either to the insurance payer or the hospital but excluded costs to parents and society, such as lost productivity.

Patient-to-nurse ratios and outcomes of moderately preterm infants.

Objective: Moderately preterm infants (30-34(6/7) weeks' gestational age) represent the largest population of NICU residents. Whether their clinical outcomes are associated with differences in NICU nurse-staffing arrangements has not been assessed. The objective of this study was to test the influence of patient-to-nurse ratios (PNRs) on outcomes of care provided to moderately preterm infants.

Economic evaluation of inhaled nitric oxide in preterm infants undergoing mechanical ventilation.

Objective: In the previously reported Nitric Oxide for Chronic Lung Disease (NO CLD) trial, ventilated preterm infants who received a course of inhaled nitric oxide (iNO) between 7 and 21 days of life had a significant improvement in survival without bronchopulmonary dysplasia (BPD), as well as a shorter duration of admission and ventilation. However, the price for the drug may be a barrier to widespread use. We sought to estimate the incremental cost-effectiveness of iNO therapy to prevent BPD in infants of <1250 g birth weight.

Are we satisfied with the way we review an article?

Nurses and other healthcare professionals must read professional journals on a regular basis to provide evidence-based care. Because authors often provide little detail on their methodology, it may be difficult to determine whether we should incorporate the conclusions of a study into our clinical practice. In addition, authors and readers may have a limited understanding of statistical analysis.