A quality improvement initiative to reduce antibiotic use in transient tachypnea of the newborn

To retrospectively study the use of antibiotics among neonates with a gestational age of ≥ 35 weeks experiencing respiratory distress, and to identify the risk factors associated with antibiotic use

BackgroundRespiratory distress is a common reason for NICU admission among late preterm and term neonates. Antibiotic use is prevalent among these neonates requiring respiratory support. This study investigates antibiotic use and its associated risk factors.MethodsA retrospective study was conducted at Al Wakra Hospital, Qatar, from January to December 2022. Neonates born at 35 weeks gestation or more, admitted to the NICU with respiratory distress, and requiring respiratory support were included based on specific criteria.ResultsOf the 1194 neonates admitted to the NICU, 1062 were 35 weeks or more gestational age. Among these, 485 neonates developed respiratory distress requiring respiratory support, with 442 included in the final analysis. Antibiotics were used in 56.1% (248/442) of cases. Factors such as maternal age, parity, rupture of membranes, chorioamnionitis, group B streptococci, antenatal prophylactic antibiotics, mode of delivery, sex, fetal distress, meconium-stained amniotic fluid, need for resuscitation, Apgar score ≤7 at 5 minutes, age at NICU admission, duration of NICU admission, maximum respiratory support, and duration of respiratory support were significantly associated with antibiotic use. Regression analysis identified parity, gestational age, sex, meconium-stained amniotic fluid, and duration of respiratory support as significant predictors of antibiotic use.ConclusionsRespiratory distress leads to frequent NICU admissions among late preterm and term neonates, with 56.1% receiving antibiotics. To mitigate potential harm from antibiotic exposure, strategies to reduce use without increasing neonatal sepsis risk are essential.

Applying quality improvement methods to reduce antibiotic use in neonates: a systematic review and meta-analysis

BACKGROUND

This study aims to explore effective interventions and observation indicators for reducing antibiotic use in neonates through quality improvement (QI) methods, while quantitatively analysing whether these methods increase the risk of neonatal mortality and serious adverse outcomes.

METHODS

By 27 August 2024, we reviewed all pertinent literature. A descriptive statistical analysis was conducted on all intervention measures, outcome indicators, process indicators, and balance indicators. The group utilizing QI interventions was designated as the intervention group, with the baseline period serving as the control group. The mortality rates and incidence of serious adverse outcomes were treated as dichotomous variables. The risk ratio (RR) and 95% CIs were effect indicators.

RESULTS

In total, 57 studies published between 2016 and 2024 were included. All studies were uncontrolled before-and-after studies. The most studied country was the United States of America. From these 57 studies, 27 effective intervention measures were identified, and all observation indicators and main results were presented in tabular form. According to the meta-analysis, the mortality rate in the intervention group decreased by 30% compared with the control group (RR = 0.7; 95% CI: 0.604-0.81; P < 0.001), while there was no statistically significant difference in the risk of serious adverse outcomes between the two groups.

CONCLUSIONS

QI methods can safely and effectively reduce the use of antibiotics in neonates, highlighting their potential for clinical applications.

Quality improvement bundles to decrease hypothermia in very low/extremely low birth weight infants at birth: a systematic review and meta-analysis

Background

Numerous studies have demonstrated that hypothermia in preterm infants correlates with increased morbidity and mortality, especially among those with very low or extremely low birth weights (VLBW/ELBW). An increasing number of healthcare facilities are implementing quality improvement (QI) bundles to lower the incidence of hypothermia at birth in this vulnerable population. However, the effectiveness and safety of these interventions have yet to be fully assessed. A meta-analysis is necessary to evaluate the efficacy and safety of QI bundles in reducing hypothermia at birth among VLBW/ELBW infants.

Methods

We searched PubMed, Embase, the Cochrane Library and Web of Science through April 22nd, 2024. Study selection, data extraction, quality evaluation and risk bias assessment were performed independently by two investigators. Meta-analysis was performed using Review Manager 5.4.1.

Results

A total of 18 studies were included for qualitative analysis and 12 for meta-analysis. For VLBW infants, meta-analysis revealed a reduction in hypothermia and an increase in hyperthermia following the introduction of QI bundles (mild hypothermia, OR 0.22, 95% CI [0.13-0.37]; moderate hypothermia, OR 0.18, 95% CI [0.15-0.22]; hyperthermia, OR 2.79, 95% CI [1.53-5.09]). For ELBW infants, meta-analysis showed a decrease in hypothermia but no increase in hyperthermia after implementing QI bundles (mild hypothermia, OR 0.46, 95% CI [0.26-0.81]; moderate hypothermia, OR 0.21, 95% CI [0.08-0.58]; hyperthermia, OR 1.10, 95% CI [0.22-5.43]).

Conclusion

QI bundles effectively reduce hypothermia in VLBW/ELBW infants, but they may also increase hyperthermia, especially in VLBW infants.

Thoracic fluid content (TFC) using electrical cardiometry versus lung ultrasound in the diagnosis of transient tachypnea of newborn

This study aimed to evaluate TFC by EC versus lung ultrasound (LUS) findings for diagnosing and follow-up of TTN in late preterm and term neonates. This prospective observational study was conducted on 80 neonates with gestational age ≥ 34 weeks. TTN group included 40 neonates diagnosed with TTN, and no lung disease (NLD) group included 40 neonates without respiratory distress. LUS and EC were performed within the first 24 h of life and repeated after 72 h. There was a statistically significant increase in TFC in TTN group on D1 [48.48 ± 4.86 (1 KOhm-1)] compared to NLD group [32.95 ± 4.59 (1 KOhm-1)], and then significant decrease in TFC in D3 [34.90 ± 4.42 (1 KOhm-1)] compared to D1 in the TTN group. There was a significant positive correlation between both TFC and LUS with Downes' score, TTN score, and duration of oxygen therapy in the TTN group.   Conclusion: Both LUS and TFC by EC provide good bedside tools that could help to diagnose and monitor TTN. TFC showed a good correlation with LUS score and degree of respiratory distress. What is Known: • Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns. • TTN is a diagnosis of exclusion, there are no specific clinical parameters or biomarker has been identified for TTN. What is New: • Thoracic fluid content (TFC) by electrical cardiometry is a new parameter to evaluate lung fluid volume and could help to diagnose and monitor TTN and correlates with lung ultrasound score.