Perspectives on developing and sustaining a small baby program

Delivery Room Resuscitation of Infants with Congenital Diaphragmatic Hernia: Lessons Learned through Video Review

INTRODUCTION

Delivery room (DR) interventions for infants with congenital diaphragmatic hernia (CDH) are not well described. This study sought to describe timing and order of DR interventions and identify system factors impacting CDH DR resuscitations using a human factors framework.

METHODS

Single center observational study of video recorded CDH DR resuscitations documenting timing and order of interventions. The team used the Systems Engineering Initiative for Patient Safety (SEIPS) model to identify system factors impacting DR resuscitations and time to invasive ventilation.

RESULTS

We analyzed 31 video recorded CDH resuscitations. We observed variability in timing and order of resuscitation tasks. The 'Internal Environment' and 'Tasks' components of the SEIPS model were prominent factors affecting resuscitation efficiency; significant room and bed spatial constraints exist, and nurses have a significant task burden. Additionally, endotracheal tube preparation was a prominent barrier to timely invasive ventilation.

CONCLUSION

Video review revealed variation in event timing and order during CDH resuscitations. Standardization of room set-up, equipment, and event order and reallocation of tasks facilitate more efficient intubation and ventilation, representing targets for CDH DR improvement initiatives. This work emphasizes the utility of rigorous human factors review to identify areas for improvement during DR resuscitation.

A unit's experience with hybrid NICU design: description of care model and implications for patients, families, and professionals

As the first extra-uterine setting for hospitalized infants, the neonatal intensive care unit (NICU) environment can make a lasting impact on their long-term neurodevelopment. This impact is likely mediated through both specific characteristics of the physical design of the care environment, as well as the experiences that occur within this environment. Recent studies document many established benefits of single-family rooms (SFRs). However, there is concern that infants who spend a prolonged time in SFRs without their parents being intimately involved in their care have reduced opportunities for meaningful experiences, with possible adverse consequences. The purpose of this report is to share an example of an application of the family-centered developmental care model through a hybrid NICU design, inclusive of both SFRs and semi-private bays. In this paper, we empirically describe the physical and operational considerations of a hybrid model, outline the strengths and challenges of this approach, and discuss implications for patients, families, and professionals.

Neonatal Golden Hour: a review of current best practices and available evidence

PURPOSE OF REVIEW

Recommendations made by several scientific bodies advocate for adoption of evidence-based interventions during the first 60 min of postnatal life, also known as the 'Golden Hour', to better support the fetal-to-neonatal transition. Implementation of a Golden Hour protocol leads to improved short-term and long-term outcomes, especially in extremely premature and extreme low-birth-weight (ELBW) neonates. Unfortunately, several recent surveys have highlighted persistent variability in the care provided to this vulnerable population in the first hour of life.

RECENT FINDINGS

Since its first adoption in the neonatal ICU (NICU) in 2009, published literature shows a consistent benefit in establishing a Golden Hour protocol. Improved short-term outcomes are reported, including reductions in hypothermia and hypoglycemia, efficiency in establishing intravenous access, and timely initiation of fluids and medications. Additionally, long-term outcomes report decreased risk for bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP).

SUMMARY

Critical to the success and sustainability of any Golden Hour initiative is recognition of the continuous educational process involving multidisciplinary team collaboration to ensure coordination between providers in the delivery room and beyond. Standardization of practices in the care of extremely premature neonates during the first hour of life leads to improved outcomes.

VIDEO ABSTRACT

http://links.lww.com/MOP/A68 .

Placental perfusion using intravoxel incoherent motion MRI combined with Doppler findings in differentiating between very low birth weight infants and small for gestational age infants

INTRODUCTION

Abnormalities in placental morphology and function can lead to small for gestational age infants (SGA) and very low birth weight infants (VLBWI). In this study, we explored the value of intravoxel incoherent motion (IVIM) histogram parameters, MRI morphological parameters, and Doppler findings of the placenta in differentiating between VLBWI and SGA.

METHODS

Thirty-three pregnant women who were diagnosed with SGA and met the inclusion criteria were enrolled in this retrospective study and divided into two groups: 22 with non-VLBWI and 11 with VLBWI. The IVIM histogram parameters (perfusion fraction (f), true diffusion coefficient (D), and pseudo-diffusion coefficient (D*)), MRI morphological parameters, and Doppler findings were compared between groups. The diagnostic efficiency was compared by receiver operating characteristic (ROC) curve analysis.

RESULTS

The D_mean, D_90th, D*_90th, f_max, and placental area of the VLBWI group were significantly lower than those of the non-VLBWI group (p < 0.05). The values of umbilical artery pulsatility index, resistance index (RI), and peak systolic velocity/end-diastolic velocity were significantly higher in the VLBWI group than in the non-VLBWI group (p < 0.05). D_90th, placental area, and umbilical artery RI had the highest areas under the curve (AUCs) of the ROC curves, at 0.787, 0.785, and 0.762, respectively. A combined predictive model (D_90th, placental area, and umbilical artery RI) improved the performance in differentiating between VLBWI and SGA compared with the single model (AUC = 0.942).

DISCUSSION

IVIM histogram (D_90th) and MRI morphological (placental area) parameters and a Doppler finding (umbilical artery RI) may be sensitive indicators for differentiating between VLBWI and SGA.