Improving Time to Goals of Care Discussions in Invasively Ventilated Preterm Infants.

Background And Objectives: The challenge of identifying preterm infants with bronchopulmonary dysplasia (BPD) that need tracheostomy placement may delay goals of care (GOC) discussions. By identifying infants with a low probability of ventilation liberation, timely GOC discussions may reduce the time to tracheostomy. Our SMART aim was to reduce the postmenstrual age (PMA) of GOC discussions by 20% in infants with BPD and prolonged invasive ventilatory requirement by October 2020.

A Quality Improvement Bundle to Improve Outcomes in Extremely Preterm Infants in the First Week.

Objectives: Our objective with this quality improvement initiative was to reduce rates of severe intracranial hemorrhage (ICH) or death in the first week after birth among extremely preterm infants.

Methods: The quality improvement initiative was conducted from April 2014 to September 2020 at the University of Alabama at Birmingham's NICU. All actively treated inborn extremely preterm infants without congenital anomalies from 22 + 0/7 to 27 + 6/7 weeks' gestation with a birth weight ≥400 g were included.

Higher- or Usual-Volume Feedings in Infants Born Very Preterm: A Randomized Clinical Trial.

Objective: To determine whether higher-volume feedings improve postnatal growth among infants born very preterm.

Study Design: Randomized clinical trial with 1:1 parallel allocation conducted from January 2015 to June 2018 in a single academic medical center in the US. In total, 224 infants with a birth weight 1001-2500 g born at <32 weeks of gestation were randomized to higher-volume (180-200 mL/kg/d) or usual-volume (140-160 mL/kg/d) feedings after establishing full enteral feedings (≥120 mL/kg/d).

Oxygen saturation histogram monitoring to reduce death or retinopathy of prematurity: a quality improvement initiative.

Objectives: Maintaining preterm infants within a goal oxygen saturation range challenges care providers. Through periodic assessment of saturation trends on infants' bedside histogram reports, our initiative aimed to (1) increase time spent at goal saturations and (2) reduce death or severe retinopathy of prematurity.

Study Design: The initiative integrated histogram monitoring into provider, respiratory, and nursing care.

Early-Onset Neonatal Sepsis with Extended Spectrum Beta-Lactamase Producing in Infants Born to South and South East Asian Immigrants: A Case Series.

Extended-spectrum -lactamase (ESBL)-producing Enterobacteriaceae represent a major worldwide threat. We present three cases of early onset ESBL sepsis in infants born to families from South and Southeast Asia to inform the practitioner community about this emerging threat. Infants with suspected sepsis, whose mother is from Asia or Southeast Asia, should be suspected of having an infection with an ESBL-producing organism, and practitioners should strongly consider adding a carbapenem to their usual initial antibiotic regimen.

Quality Improvement Project to Reduce Delayed Vaccinations in Preterm Infants.

Background: Preterm infants are especially vulnerable to infectious diseases. Although vaccinations are a safe and effective measure to protect preterm infants from vaccine-preventable diseases, delays in vaccinations are not uncommon.

Purpose: The goal of this quality improvement project was to improve on time vaccinations of preterm infants hospitalized in the neonatal intensive care unit.

A ferret model of COPD-related chronic bronchitis.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the US. The majority of COPD patients have symptoms of chronic bronchitis, which lacks specific therapies. A major impediment to therapeutic development has been the absence of animal models that recapitulate key clinical and pathologic features of human disease.

A case report of midgut atresia and spontaneous closure of gastroschisis.

We report a case in which a neonate with a prenatal diagnosis of gastroschisis was born with midgut atresia and the mummified remains of the midgut arising from a spontaneously closed abdominal wall defect. As our ability to prenatally diagnose abdominal wall defects has improved, we have gained some insight into the prenatal natural history of this pathological process. We present a case in which an abdominal wall defect spontaneously closed and was associated with an apparent in utero midgut vascular accident.