Research

18 pages, 2634 KiB

Open AccessEditor’s ChoiceArticle

Lessons Learned from a Collaborative to Develop a Sustainable Simulation-Based Training Program in Neonatal Resuscitation: Simulating Success

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Children 2021, 8(1), 39; https://doi.org/10.3390/children8010039 - 12 Jan 2021

Cited by 9 | Viewed by 3785

Abstract

Newborn resuscitation requires a multidisciplinary team effort to deliver safe, effective and efficient care. California Perinatal Quality Care Collaborative’s Simulating Success program was designed to help hospitals implement on-site simulation-based neonatal resuscitation training programs. Partnering with the Center for Advanced Pediatric and Perinatal [...] Read more.

Newborn resuscitation requires a multidisciplinary team effort to deliver safe, effective and efficient care. California Perinatal Quality Care Collaborative’s Simulating Success program was designed to help hospitals implement on-site simulation-based neonatal resuscitation training programs. Partnering with the Center for Advanced Pediatric and Perinatal Education at Stanford, Simulating Success engaged hospitals over a 15 month period, including three months of preparatory training and 12 months of implementation. The experience of the first cohort (Children’s Hospital of Orange County (CHOC), Sharp Mary Birch Hospital for Women and Newborns (SMB) and Valley Children’s Hospital (VCH)), with their site-specific needs and aims, showed that a multidisciplinary approach with a sound understanding of simulation methodology can lead to a dynamic simulation program. All sites increased staff participation. CHOC reduced latent safety threats measured during team exercises from 4.5 to two per simulation while improving debriefing skills. SMB achieved 100% staff participation by identifying unit-specific hurdles within in situ simulation. VCH improved staff confidence level in responding to neonatal codes and proved feasibility of expanding simulation across their hospital system. A multidisciplinary approach to quality improvement in neonatal resuscitation fosters engagement, enables focus on patient safety rather than individual performance, and leads to identification of system issues. Full article

(This article belongs to the Special Issue Neonatal Health Care)

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14 pages, 835 KiB

Open AccessArticle

Association between Regional Tissue Oxygenation and Body Temperature in Term and Preterm Infants Born by Caesarean Section

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Marlies Bruckner

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Lukas P. Mileder

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Alisa Richter

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Nariae Baik-Schneditz

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Bernhard Schwaberger

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Corinna Binder-Heschl

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Berndt Urlesberger

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Gerhard Pichler

Children 2020, 7(11), 205; https://doi.org/10.3390/children7110205 - 29 Oct 2020

Cited by 3 | Viewed by 1535

Abstract

Body temperature (BT) management remains a challenge in neonatal intensive care, especially during resuscitation after birth. Our aim is to analyze whether there is an association between the BT and cerebral and peripheral tissue oxygen saturation (crSO₂/cTOI and prSO₂), [...] Read more.

Body temperature (BT) management remains a challenge in neonatal intensive care, especially during resuscitation after birth. Our aim is to analyze whether there is an association between the BT and cerebral and peripheral tissue oxygen saturation (crSO₂/cTOI and prSO₂), arterial oxygen saturation (SpO₂), and heart rate (HR). The secondary outcome parameters of five prospective observational studies are analyzed. We include preterm and term neonates born by Caesarean section who received continuous pulse oximetry and near-infrared spectroscopy monitoring during the first 15 min, and a rectal BT measurement once in minute 15 after birth. Four-hundred seventeen term and 169 preterm neonates are included. The BT did not correlate with crSO₂/cTOI and SpO₂. The BT correlated with the HR in all neonates (ρ = 0.210, p < 0.001) and with prSO₂ only in preterm neonates (ρ = −0.285, p = 0.020). The BT was lower in preterm compared to term infants (36.7 [36.4–37.0] vs. 36.8 [36.6–37.0], p = 0.001) and prevalence of hypothermia was higher in preterm neonates (29.5% vs. 12.0%, p < 0.001). To conclude, the BT did not correlate with SpO₂ and crSO₂/cTOI, however, there was a weak positive correlation between the BT and the HR in the whole cohort and a weak correlation between the BT and prSO₂ only in preterm infants. Preterm neonates had a statistically lower BT and suffered significantly more often from hypothermia during postnatal transition. Full article

(This article belongs to the Special Issue Neonatal Health Care)

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11 pages, 1760 KiB

Open AccessArticle

A Neonatal Intensive Care Unit’s Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative

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Children 2020, 7(11), 202; https://doi.org/10.3390/children7110202 - 29 Oct 2020

Cited by 6 | Viewed by 3871

Abstract

Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and [...] Read more.

Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality. In Simulating Success, a 15-month quality improvement (QI) project, the Center for Advanced Pediatric and Perinatal Education (CAPE) and California Perinatal Quality Care Collaborative (CPQCC) provided outreach and training on neonatal simulation and debriefing fundamentals to individual teams, including community hospital settings, and assisted in implementing a sustainable program at each site. The primary Aim was to conduct two simulations a month, with a goal of 80% neonatal intensive care unit (NICU) staff participation in two simulations during the implementation phase. While the primary Aim was not achieved, in-situ simulations led to the identification of latent safety threats and improvement in system processes. This paper describes one unit’s QI collaborative experience implementing an in-situ neonatal simulation and debriefing program. Full article

(This article belongs to the Special Issue Neonatal Health Care)

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10 pages, 1974 KiB

Open AccessFeature PaperArticle

Non-Contact Video-Based Neonatal Respiratory Monitoring

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Scott L. Rossol

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Jeffrey K. Yang

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Caroline Toney-Noland

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Children 2020, 7(10), 171; https://doi.org/10.3390/children7100171 - 06 Oct 2020

Cited by 19 | Viewed by 3076

Abstract

Respiratory rate (RR) has been shown to be a reliable predictor of cardio-pulmonary deterioration, but standard RR monitoring methods in the neonatal intensive care units (NICU) with contact leads have been related to iatrogenic complications. Video-based monitoring is a potential non-contact system that [...] Read more.

Respiratory rate (RR) has been shown to be a reliable predictor of cardio-pulmonary deterioration, but standard RR monitoring methods in the neonatal intensive care units (NICU) with contact leads have been related to iatrogenic complications. Video-based monitoring is a potential non-contact system that could improve patient care. This iterative design study developed a novel algorithm that produced RR from footage analyzed from stable NICU patients in open cribs with corrected gestational ages ranging from 33 to 40 weeks. The final algorithm used a proprietary technique of micromotion and stationarity detection (MSD) to model background noise to be able to amplify and record respiratory motions. We found significant correlation—r equals 0.948 (p value of 0.001)—between MSD and the current hospital standard, electrocardiogram impedance pneumography. Our video-based system showed a bias of negative 1.3 breaths and root mean square error of 6.36 breaths per minute compared to standard continuous monitoring. Further work is needed to evaluate the ability of video-based monitors to observe clinical changes in a larger population of patients over extended periods of time. Full article

(This article belongs to the Special Issue Neonatal Health Care)

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6 pages, 727 KiB

Open AccessArticle

Randomized Longitudinal Study Comparing Three Nasal Respiratory Support Modes to Prevent Intermittent Hypoxia in Very Preterm Infants

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Children 2020, 7(10), 168; https://doi.org/10.3390/children7100168 - 05 Oct 2020

Cited by 1 | Viewed by 1732

Abstract

Nasal continuous positive airway pressure (NCPAP) devices using variable (vf-) and continuous (cf-) flow or synchronized nasal intermittent positive pressure ventilation (s-NIPPV) are used to prevent or treat intermittent hypoxia (IH) in preterm infants. Results concerning which is most effective vary. We aimed [...] Read more.

Nasal continuous positive airway pressure (NCPAP) devices using variable (vf-) and continuous (cf-) flow or synchronized nasal intermittent positive pressure ventilation (s-NIPPV) are used to prevent or treat intermittent hypoxia (IH) in preterm infants. Results concerning which is most effective vary. We aimed to investigate the effect of s-NIPPV and vf-NCPAP compared to cf-NCPAP on the rate of IH episodes. Preterm infants with a gestational age of 24.9–29.7 weeks presenting with IH while being treated with cf-NCPAP were monitored for eight hours, then randomized to eight hours of treatment with vf-NCPAP or s-NIPPV. Data from 16 infants were analyzed. Due to an unexpectedly low sample size, the results were only reported descriptively. No relevant changes in the rate of IH events were detected between cf- vs. vf-NCPAP or between cf-NCPAP vs. s-NIPPV. Although limited by its small sample size, s-NIPPV, vf- and cf-NCPAP seemed to be similarly effective in the treatment of IH in these infants. Full article

(This article belongs to the Special Issue Neonatal Health Care)

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10 pages, 1149 KiB

Open AccessFeature PaperArticle

Learning from Wildfire Disaster Experience in California NICUs

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Amy L. Ma

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Ronald S. Cohen

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Henry C. Lee

Children 2020, 7(10), 155; https://doi.org/10.3390/children7100155 - 01 Oct 2020

Cited by 3 | Viewed by 3175

Abstract

Wildfires have been affecting California greatly, and vulnerable patients in neonatal intensive care units (NICUs) are not exempt. Our aim was to learn how personnel working in NICUs of California hospitals handled issues of neonatal transfer during wildfire disasters in recent years, with [...] Read more.

Wildfires have been affecting California greatly, and vulnerable patients in neonatal intensive care units (NICUs) are not exempt. Our aim was to learn how personnel working in NICUs of California hospitals handled issues of neonatal transfer during wildfire disasters in recent years, with an ultimate goal to share lessons learned with healthcare teams on disaster preparedness. We identified California fires through newspaper articles and the CalFire.gov list. We determined which hospitals were affected and contacted members of the healthcare team through connections via the California Perinatal Quality Care Collaborative (CPQCC) database. We audio recorded interviews over phone or remote conferencing software or by written survey. We coded and analyzed transcripts and survey responses. While describing disaster preparedness, equipment (such as bassinets and backpacks), ambulance access/transport and documentation/charting were noted as important and essential. Teamwork, willingness to do other tasks that are not part of typical job descriptions, and unconventional strategies contribute to the success of keeping NICU babies safe when California wildfire strikes. Healthcare teams developed ingenious and surprising ways to evacuate NICU babies. Full article

(This article belongs to the Special Issue Neonatal Health Care)

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Review

Jump to: Research, Other

11 pages, 732 KiB

Open AccessReview

Examining the Relationship between Cost and Quality of Care in the Neonatal Intensive Care Unit and Beyond

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Lauren Culbertson

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Dmitry Dukhovny

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Wannasiri Lapcharoensap

Children 2020, 7(11), 238; https://doi.org/10.3390/children7110238 - 19 Nov 2020

Cited by 2 | Viewed by 2150

Abstract

There is tremendous variation in costs of delivering health care, whether by country, hospital, or patient. However, the questions remain: what costs are reasonable? How does spending affect patient outcomes? We look to explore the relationship between cost and quality of care in [...] Read more.

There is tremendous variation in costs of delivering health care, whether by country, hospital, or patient. However, the questions remain: what costs are reasonable? How does spending affect patient outcomes? We look to explore the relationship between cost and quality of care in adult, pediatric and neonatal literature. Health care stewardship initiatives attempt to address the issue of lowering costs while maintaining the same quality of care; but how do we define and deliver high value care to our patients? Ultimately, these questions remain challenging to tackle due to the heterogeneous definitions of cost and quality. Further standardization of these terms, as well as studying the variations of both costs and quality, may benefit future research on value in health care. Full article

(This article belongs to the Special Issue Neonatal Health Care)

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8 pages, 1038 KiB

Open AccessReview

The Denominator Matters! Lessons from Large Database Research in Neonatology

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Veeral N. Tolia

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Reese H. Clark

Children 2020, 7(11), 216; https://doi.org/10.3390/children7110216 - 07 Nov 2020

Cited by 1 | Viewed by 1802

Abstract

Observational studies from large datasets are becoming more common in neonatology. In this review, we highlight the importance of the denominator in study design and interpretation including examples of bias from source data, weight-based categories, age-related bias, and diagnosis-based denominators. Full article

(This article belongs to the Special Issue Neonatal Health Care)

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Other

Jump to: Research, Review

12 pages, 1480 KiB

Open AccessCommentary

Building the First Statewide Quality Improvement Collaborative, the CPQCC: A Historic Perspective

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Jeffrey B. Gould

Children 2020, 7(10), 177; https://doi.org/10.3390/children7100177 - 12 Oct 2020

Cited by 4 | Viewed by 2149

Abstract

The California Perinatal Quality Improvement Collaborative (CPQCC), founded in 1997, was the country’s first statewide perinatal quality improvement collaborative. Our goal was to improve the quality and outcomes of perinatal healthcare in California by developing a collaborative network of public and private obstetric [...] Read more.

The California Perinatal Quality Improvement Collaborative (CPQCC), founded in 1997, was the country’s first statewide perinatal quality improvement collaborative. Our goal was to improve the quality and outcomes of perinatal healthcare in California by developing a collaborative network of public and private obstetric and neonatal providers, insurers, public health professionals, and business groups to support a system for benchmarking and performance improvement activities for perinatal care. In this presentation, we describe how viewing the CPQCC as a complex value-driven organization, committed to identifying and addressing the needs of both its stakeholder partners and neonatal intensive care unit (NICU) members, has shaped the course of its development. Full article

(This article belongs to the Special Issue Neonatal Health Care)

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