Current Practice of Neonatal Resuscitation Documentation in North America: A Multi-Center Retrospective Chart Review

Background To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal documentation. Methods Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant’s record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified. Results Charts of 263 infants were reviewed. The mean gestational age was 28.4 weeks, and the mean birth weight 1050 g. Of the infants, 69 % were singletons, and 74 % were delivered by Cesarean section. A mean of 13.2 (SD 3.5) of the 29 Resuscitation Data Items were registered for each birth. Items most frequently present were; review of obstetric history (98 %), Apgar scores (96 %), oxygen use (77 %), suctioning (71 %), and stimulation (62 %). In our model adjusted for measured covariates, the institution was significantly associated with documentation. Conclusions Neonatal resuscitation documentation is not standardized and has significant variation. Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics. Understanding this variation may lead to efforts to standardize documentation of neonatal resuscitation

Reducing Peripherally Inserted Central Catheter Tip Migration in Neonates: A Proactive Approach to Detection and Repositioning

Objective: Peripherally Inserted Central Catheter (PICC) tip migration often occurs after placement despite efforts to position the tip centrally. This study aimed to quantify PICC tip migration within 3–7 h post-insertion and evaluate the effectiveness of manual adjustments for repositioning. Methods: This single-centre retrospective study evaluated the impact of a proactive approach following PICC placement, which included standardized body positioning during X-rays, defined target PICC tip locations, radiological surveillance at 4–6 h post-insertion, and guided manual adjustments. We included all infants receiving PICCs during a five-year period; trained nurses and physicians in vascular access performed the insertions. Results: Of 712 infants included, the median gestational age was 30 weeks, and the median birth weight was 1386 g. PICC tip migration occurred in 211 infants (30%) within 3–7 h post-insertion, with 81% of cases involving inward migration into the cardiac silhouette. Migration was more common in upper limb PICCs (82%). Manual adjustments achieved satisfactory repositioning in 191 infants (83%). None of the infants experienced pericardial effusion. Conclusions: A proactive approach that standardized imaging protocols, timing, and PICC tip positioning detected migration in 30% of infants and successfully facilitated repositioning in 83% of cases

31 Strengthening care for infants with medical complexity during the transition from the neonatal intensive care unit to the community

Abstract Background With advances in technology and innovative medical treatments, infants who previously would have died in early infancy are living longer. These infants have significant needs in the medical system and pose challenges in coordinating care from multiple providers, especially after discharge from NICU. Objectives To engage neonatal-to-early-childhood care-transition stakeholders in implementing system-level change to champion the successful transition of infants with medical complexity into early childhood. We believe this engagement activity will spark action amongst stakeholders to adopt best practices leading to improvements in care for this vulnerable patient population. Design/Methods We explored four key care transition related questions: We organized journey mapping and focus groups with NICU alumni families whose children have medical complexity. We conducted a literature review to identify evidence-based interventions. We compiled this information to create evidence briefs that were presented to an interprofessional group of senior stakeholders using the deliberative dialogue approach. Following presentation of the evidence briefs surveys were administered to measure stakeholder intention to act on solutions presented. Results Twenty-five opportunities for improving transitions between hospital and community care teams were identified through engagement with families and project team members (graphic A). These opportunities focused on facilitating clinical navigation, navigating community services, and improving parental mental health. Forty-two stakeholders representing a children’s and women’s hospital, families, community care providers, and provincial bodies were engaged in this project. A rapid review of the literature was carried out using multiple databases searches to ensure comprehensiveness and flexible search strategies to ensure literature was found for all issues. This included a broader search of NICU discharges and nine targeted searches with medical complexity populations. Proposed solutions from stakeholders were further validated through comparisons with the literature and ultimately thirty-five papers were included in the evidence briefs. Specific care interventions were recommended to key healthcare decision makers, such as providing post-discharge care coordination in a specialized complex care clinic, implementing patient-oriented discharge summaries, and facilitating access to mental health resources. Using a seven point Likert scale the majority of stakeholders agreed that both the evidence briefs and deliberative dialogues were very successful in achieving their aim. Stakeholder intention to act on solutions presented in evidence briefs and deliberative dialogues were rated as very likely. Conclusion </jats:sec

Standardizing Umbilical Catheter Usage in Preterm Infants

BACKGROUND AND OBJECTIVE: Absence of guidelines on umbilical arterial catheter (UAC) and umbilical venous catheter (UVC) use and inability to predict the hospital course may sway the frontline staff to overuse umbilical catheters in preterm infants. Our objective was to evaluate the feasibility of implementing guidelines standardizing the use of umbilical catheters and its impact on the incidence of sepsis and resource use. METHODS: All inborn infants delivered at &amp;lt;33 weeks’ gestation and admitted to the NICU were included in this quality improvement study. The primary outcome was proportion of infants receiving umbilical catheters. Secondary outcomes were central venous catheter (CVC) use and central line–associated bloodstream infection (CLABSI). RESULTS: The proportion of infants receiving UACs and UVCs was significantly lower in postintervention (sustainment) phase than in the preintervention phase (93 [42.3%] vs 52 [23.6%], P = .0001) and (137 [62.6%] vs 93 [42.3%], P = .0001), respectively. There was no corresponding increase in the proportion of infants receiving peripherally inserted central catheters (PICCs) or surgical CVCs (SCVCs) during the sustainment phase. There was a significant reduction in the proportion of infants receiving CVCs (UVC, PICC, and SCVC) in the sustainment phase. The incidence of CLABSI was similar in the preintervention and sustainment phases. CONCLUSIONS: Implementation of guidelines standardizing the use of umbilical catheters in the NICU is feasible. Fewer infants were exposed to the risk of UVC or UAC, and fewer resources were used. </jats:sec