28 NICUs participating in a quality improvement collaborative targeting early-onset sepsis antibiotic use.

Objective: There is widespread overuse of antibiotics in neonatal intensive care units (NICUs). The objective of this study was to safely reduce antibiotic use in participating NICUs by targeting early-onset sepsis (EOS) management.

Study Design: Twenty-eight NICUs participated in this statewide multicenter antibiotic stewardship quality improvement collaborative.

National Healthcare Safety Network 2018 Baseline Neonatal Standardized Antimicrobial Administration Ratios.

Background: The microbiologic etiologies, clinical manifestations, and antimicrobial treatment of neonatal infections differ substantially from infections in adult and pediatric patient populations. In 2019, the Centers for Disease Control and Prevention developed neonatal-specific (Standardized Antimicrobial Administration Ratios SAARs), a set of risk-adjusted antimicrobial use metrics that hospitals participating in the National Healthcare Safety Network's (NHSN's) antimicrobial use surveillance can use in their antibiotic stewardship programs (ASPs).

Methods: The Centers for Disease Control and Prevention, in collaboration with the Vermont Oxford Network, identified eligible patient care locations, defined SAAR agent categories, and implemented neonatal-specific NHSN Annual Hospital Survey questions to gather hospital-level data necessary for risk adjustment.

Choosing wisely for the other 80%: What we need to know about the more mature newborn and NICU care.

Although neonatal intensive unit (NICU) care is envisioned as the care of very immature infants, more than 95% of births and 80% of NICU admissions are of more mature newborns-infants born at 34 or more weeks' gestation. In spite of the size of this population there are important gaps in the understanding of their needs and optimal management as reflected by remarkably large unexplained variation in their care. The goal of this article is to describe what is known about the more mature, higher birth weight newborn population's use of NICU care and highlight important gaps in knowledge and obstacles to research.

Newborn Antibiotic Exposures and Association With Proven Bloodstream Infection.

Objectives: To estimate the percentage of hospital births receiving antibiotics before being discharged from the hospital and efficiency diagnosing proven bloodstream infection.

Methods: We conducted a cross-sectional study of 326 845 live births in 2017, with a 69% sample of all California births involving 121 California hospitals with a NICU, of which 116 routinely served inborn neonates. Exposure included intravenous or intramuscular antibiotic administered anywhere in the hospital during inpatient stay associated with maternal delivery.

Using NHSN's Antimicrobial Use Option to Monitor and Improve Antibiotic Stewardship in Neonates.

Background: The Antimicrobial Use (AU) Option of the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) is a surveillance resource that can provide actionable data for antibiotic stewardship programs. Such data are used to enable measurements of AU across hospitals and before, during, and after stewardship interventions.

Methods: We used monthly AU data and annual facility survey data submitted to the NHSN to describe hospitals and neonatal patient care locations reporting to the AU Option in 2017, examine frequencies of most commonly reported agents, and analyze variability in AU rates across hospitals and levels of care.

Variations in Neonatal Antibiotic Use.

Objectives: We sought to identify whether and how the NICU antibiotic use rate (AUR), clinical correlates, and practice variation changed between 2013 and 2016 and attempted to identify AUR ranges that are consistent with objectively determined bacterial and/or fungal disease burdens.

Methods: In a retrospective cohort study of >54 000 neonates annually at >130 California NICUs from 2013 to 2016, we computed nonparametric linear correlation and compared AURs among years using a 2-sample test of proportions. We stratified by level of NICU care and participation in externally organized stewardship efforts.

Comparison of Collaborative Versus Single-Site Quality Improvement to Reduce NICU Length of Stay.

Background: There is unexplained variation in length of stay (LOS) across NICUs, suggesting that there may be practices that can optimize LOS.

Methods: Three groups of NICUs in the California Perinatal Quality Care Collaborative were followed: (1) collaborative centers participating in an 18-month collaborative quality improvement project to optimize LOS for preterm infants; (2) individual centers aiming to optimize LOS; and (3) nonparticipants. Our aim in the collaborative project was to decrease postmenstrual age (PMA) at discharge for infants born between 27 + 0 and <32 weeks' gestational age by 3 days.

Association Between Neonatal Intensive Care Unit Admission Rates and Illness Acuity.

Importance: Most neonates admitted to a neonatal intensive care unit (NICU) are born at gestational age (GA) of 34 weeks or more. The degree of uniformity of admission criteria for these infants is unclear, particularly at the low-acuity end of the range of conditions warranting admission.

Objectives: To describe variation in NICU admission rates for neonates born at GA of 34 weeks or more and examine whether such variation is associated with high illness acuity or designated facility level of care.

Estimating Length of Stay by Patient Type in the Neonatal Intensive Care Unit.

Objective Develop length of stay prediction models for neonatal intensive care unit patients. Study Design We used data from 2008 to 2010 to construct length of stay models for neonates admitted within 1 day of age to neonatal intensive care units and surviving to discharge home. Results Our sample included 23,551 patients.

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.

Neonatal intensive care unit antibiotic use.

Background And Objectives: Treatment of suspected infection is a mainstay of the daily work in the NICU. We hypothesized that NICU antibiotic prescribing practice variation correlates with rates of proven infection, necrotizing enterocolitis (NEC), mortality, inborn admission, and with NICU surgical volume and average length of stay.

Methods: In a retrospective cohort study of 52,061 infants in 127 NICUs across California during 2013, we compared sample means and explored linear and nonparametric correlations, stratified by NICU level of care and lowest/highest antibiotic use rate quartiles.

Referral of very low birth weight infants to high-risk follow-up at neonatal intensive care unit discharge varies widely across California.

Objectives: To determine rates and factors associated with referral to the California Children's Services high-risk infant follow-up (HRIF) program among very low birth weight (BW) infants in the California Perinatal Quality of Care Collaborative.

Study Design: Using multivariable logistic regression, we examined independent associations of demographic and clinical variables, neonatal intensive care unit (NICU) volume and level, and California region with HRIF referral.

Results: In 2010-2011, 8071 very low BW infants were discharged home; 6424 (80%) were referred to HRIF.

The effectiveness of flow cytometric sorting of human sperm (MicroSort®) for influencing a child's sex.

Background: Flow cytometric sorting can be used to separate sperm based on sex chromosome content. Differential fluorescence emitted by stained X- vs. Y-chromosome-bearing sperm enables sorting and collection of samples enriched in either X- or Y-bearing sperm for use to influence the likelihood that the offspring will be a particular sex.

Evidence-based approach to preventing central line-associated bloodstream infection in the NICU.

Aim: To review care practices and methods of implementation that reduce the risk of central line-associated bloodstream infection (CLABSI).

Methods: Medical and quality improvement-oriented literature was reviewed.

Results: Although effective catheter practices, equipment and staff training methods are available to reduce CLABSI, their implementation is often difficult.

Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists.

Objective: In 2008, all 18 regional referral NICUs in New York state adopted central-line insertion and maintenance bundles and agreed to use checklists to monitor maintenance-bundle adherence and report checklist use. We sought to confirm whether adopting standardized bundles and using central-line maintenance checklists reduced central-line-associated bloodstream infections (CLABSI).

Methods: This was a prospective cohort study that enrolled all neonates with a central line who were hospitalized in any of 18 NICUs.

Neonatal intensive care unit collaboration to decrease hospital-acquired bloodstream infections: from comparative performance reports to improvement networks.

This two-part article provides a general guide to thinking about data-driven clinical performance evaluation and describes two statewide improvement networks anchored in such comparisons. Part 1 examines key ideas for making fair comparisons among providers. Part 2 describes the development of a data-driven collaborative that aims to reduce central line associated bloodstream infections in neonatal ICUs across New York State, and a more mature collaborative in California that has already succeeded in reducing these infections; it provides sufficient detail and tools to be of practical help to others seeking to create such networks.

Poststroke upper-limb rehabilitation using 5 to 7 inserted microstimulators: implant procedure, safety, and efficacy for restoration of function.

Objective: To investigate the feasibility of implanting microstimulators to deliver programmed nerve stimulation for sequenced muscle activation to recover arm-hand functions.

Design: By using a minimally invasive procedure and local anesthesia, 5 to 7 microstimulators can be safely and comfortably implanted adjacent to targeted radial nerve branches in the arm and forearm of 7 subjects with poststroke paresis. The microstimulators' position should remain stable with no tissue infection and can be programmed to produce effective personalized functional muscle activity with no discomfort for a preliminary 12-week study.

A 1000+ channel bionic communication system.

The wireless electronic nervous system interface known as the functional electrical stimulation-battery powered bion system is being developed at the Alfred Mann Foundation. It contains a real-time propagated wave micro-powered multichannel communication system. This system is designed to send bi-directional messages between an external master controller unit (MCU), and each one of a group of injectable stimulator-sensor battery powered bion implants (BPB).

Discovering how to think about a hospital patient information system by struggling to evaluate it: a committee's journal.

Parallel to the monumental problem of replacing paper-and-pen-based patient information management systems with electronic ones is the problem of evaluating the extent to which the change represents an improvement. All clinicians must grapple with this daunting challenge; those with little or no informatics expertise may be particularly surprised by the attendant difficulties. To do so successfully, they must be able to explicitly conceptualize the daily clinical work-a prerequisite for appreciating and reasonably evaluating it.

Further comment on the House of Commons' report Human Reproductive Technologies and the Law.

The Fifth Report by the Science and Technology Committee of the House of Commons advances majority positions which often are highly supportive of reproductive liberty. This was, however, achieved with considerable difficulty and involved numerous compromises with a minority favouring intrusion by the state into reproductive matters. The report identifies examples of regulatory overreach in such areas as gender selection and gamete donation.

Scientific aspects of preconception gender selection.

Although numerous methods have been promoted as having an influence on the gender of offspring, most lack credible scientific evidence of effectiveness. Preconception gender selection has an important application in reducing the risk of having children with X-linked disease. A preconception, flow cytometric sperm sorting method of gender selection (MicroSort) is based upon the detection of differential fluorescence emitted by fluorescently stained X and Y chromosome-bearing spermatozoa.

Zirconia to Ti-6Al-4V braze joint for implantable biomedical device.

A strong, hermetic, reliable, and biocompatible ceramic-to-metal seal is essential for many implantable medical devices. Yttria-stabilized tetragonal zirconia polycrystals (Y-TZPs) and a titanium alloy Ti-6Al-4V were selected as the ceramic and metal components of the seal because both materials have excellent mechanical properties and favorable biocompatibility. A brazing method using titanium nickel (TiNi)-clad braze filler material is presented to bond the components together forming a seal.

An attempted suppression of liberty.

The Human Fertilisation and Embryology Authority (HFEA) report on gender selection is a presumptuous, biased, and misguided attempt to provide a basis on which to deny the freedom to make their own reproductive choices to citizens of Great Britain. The report should be soundly rejected.

NICU Notes: A Palm OS and Windows database software product and process to facilitate patient care in the newborn intensive care unit.

This is a database software application for information a neonatologist routinely considers in the newborn intensive care unit (NICU). Users enter data at the point of care on a handheld device that also encrypts the data. Data management follows synchronization via an ODBC DSN to a secure Microsoft Access application.