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Angela Tamayo - One of the best experts on this subject based on the ideXlab platform.
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reduction in the incidence of Chronic Lung Disease in very low birth weight infants results of a quality improvement process in a tertiary level neonatal intensive care unit
Pediatrics, 2009Co-Authors: Howard J Birenbaum, Abby Dentry, Jane Cirelli, Sabah Helou, Maria A Pane, Karen P Starr, Clifford F Melick, Linda Updegraff, Cynthia Arnold, Angela TamayoAbstract:OBJECTIVE. Our objective was to reduce the incidence of Chronic Lung Disease by introducing potentially better practices in our delivery room and NICU. METHODS. We compared the incidences of Chronic Lung Disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain). RESULTS. There was a significant reduction in our incidence of Chronic Lung Disease, from 46.5% in 2002 to 20.5% in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4% in 2002 to 4.1% in 2005. The overall relative risk reduction for Chronic Lung Disease in 2005, compared with 2002, was 55.8%. CONCLUSIONS. By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of Chronic Lung Disease in infants with birth weights of
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reduction in the incidence of Chronic Lung Disease in very low birth weight infants results of a quality improvement process in a tertiary level neonatal intensive care unit
Pediatrics, 2009Co-Authors: Howard J Birenbaum, Abby Dentry, Jane Cirelli, Sabah Helou, Maria A Pane, Karen P Starr, Clifford F Melick, Linda Updegraff, Cynthia Arnold, Angela TamayoAbstract:OBJECTIVE. Our objective was to reduce the incidence of Chronic Lung Disease by introducing potentially better practices in our delivery room and NICU. METHODS. We compared the incidences of Chronic Lung Disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain). RESULTS. There was a significant reduction in our incidence of Chronic Lung Disease, from 46.5% in 2002 to 20.5% in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4% in 2002 to 4.1% in 2005. The overall relative risk reduction for Chronic Lung Disease in 2005, compared with 2002, was 55.8%. CONCLUSIONS. By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of Chronic Lung Disease in infants with birth weights of <1500 g in 2005, in comparison with 2002. These results have persisted to date. There were no significant short-term complications.
Howard J Birenbaum - One of the best experts on this subject based on the ideXlab platform.
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Chronic Lung Disease in very low birth weight infants persistence and improvement of a quality improvement process in a tertiary level neonatal intensive care unit
Journal of neonatal-perinatal medicine, 2016Co-Authors: Howard J Birenbaum, Abby Dentry, Sabah Helou, Maria A Pane, Linda Updegraff, Cynthia Arnold, E R Pfoh, G A Marinkovich, S Liverman, H CawmanAbstract:OBJECTIVE: We previously demonstrated a significant reduction in our incidence of Chronic Lung Disease in our NICU using potentially better practices of avoiding delivery room endotracheal intubation and using early nasal CPAP. We sought to demonstrate whether these improvements were sustained and or improved over time. STUDY DESIGN: We conducted a retrospective, cross-sectional analysis of infants 501-1500 grams born at our hospital between 2005 and 2013. Infants born during the 2005-2007, 2008-2010 and 2011-2013 epochs were grouped together, respectively. Descriptive analysis was conducted to determine the number and percent of maternal and neonatal characteristics by year grouping. Chi-squared tests were used to determine whether there were any statistically significant changes in characteristics across year groupings.. Two outcome variables were assessed: a diagnosis of Chronic Lung Disease based on the Vermont Oxford Network definition and being discharged home on supplemental oxygen. RESULTS: There was a statistically significant improvement in the incidence of Chronic Lung Disease in infants below 27 weeks' gestation in the three year period in the 2011-2013 cohort compared with those in the 2005-2007 cohort. We also found a statistically significant improvement in the number of infants discharged on home oxygen with birth weights 751-1000 grams and infants with gestational age less than 27 weeks in the 2011-2013 cohort compared to the 2005-2007 cohort. CONCLUSIONS: We demonstrated sustained improvement in our incidence of CLD between 2005 and 2013. We speculate that a multifaceted strategy of avoiding intubation and excessive oxygen in the delivery room, the early use of CPAP, as well as the use of volume targeted ventilation, when needed, may help significantly reduce the incidence of CLD.
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reduction in the incidence of Chronic Lung Disease in very low birth weight infants results of a quality improvement process in a tertiary level neonatal intensive care unit
Pediatrics, 2009Co-Authors: Howard J Birenbaum, Abby Dentry, Jane Cirelli, Sabah Helou, Maria A Pane, Karen P Starr, Clifford F Melick, Linda Updegraff, Cynthia Arnold, Angela TamayoAbstract:OBJECTIVE. Our objective was to reduce the incidence of Chronic Lung Disease by introducing potentially better practices in our delivery room and NICU. METHODS. We compared the incidences of Chronic Lung Disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain). RESULTS. There was a significant reduction in our incidence of Chronic Lung Disease, from 46.5% in 2002 to 20.5% in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4% in 2002 to 4.1% in 2005. The overall relative risk reduction for Chronic Lung Disease in 2005, compared with 2002, was 55.8%. CONCLUSIONS. By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of Chronic Lung Disease in infants with birth weights of
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reduction in the incidence of Chronic Lung Disease in very low birth weight infants results of a quality improvement process in a tertiary level neonatal intensive care unit
Pediatrics, 2009Co-Authors: Howard J Birenbaum, Abby Dentry, Jane Cirelli, Sabah Helou, Maria A Pane, Karen P Starr, Clifford F Melick, Linda Updegraff, Cynthia Arnold, Angela TamayoAbstract:OBJECTIVE. Our objective was to reduce the incidence of Chronic Lung Disease by introducing potentially better practices in our delivery room and NICU. METHODS. We compared the incidences of Chronic Lung Disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain). RESULTS. There was a significant reduction in our incidence of Chronic Lung Disease, from 46.5% in 2002 to 20.5% in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4% in 2002 to 4.1% in 2005. The overall relative risk reduction for Chronic Lung Disease in 2005, compared with 2002, was 55.8%. CONCLUSIONS. By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of Chronic Lung Disease in infants with birth weights of <1500 g in 2005, in comparison with 2002. These results have persisted to date. There were no significant short-term complications.
Heather E Jeffery - One of the best experts on this subject based on the ideXlab platform.
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intrauterine inflammation neonatal sepsis and Chronic Lung Disease a 13 year hospital cohort study
Pediatrics, 2009Co-Authors: Monica M Lahra, Philip J Beeby, Heather E JefferyAbstract:OBJECTIVE. To determine the impact of intrauterine inflammation of maternal (chorioamnionitis) and fetal (umbilical vasculitis) origin and neonatal sepsis on the development of neonatal Chronic Lung Disease in preterm infants. METHODS. This study was conducted at Royal Prince Alfred Hospital in Sydney, Australia. All infants born at RESULTS. There were 798 eligible infants born during the study period, and 761 (95.4%) had placental examination. The mean gestational age was 27.4 ± 1.5 weeks. Antenatal maternal steroids were given to 94.4%. Regression analysis showed that chorioamnionitis with umbilical vasculitis and increasing gestation were associated with reduced odds of Chronic Lung Disease. Chorioamnionitis without umbilical vasculitis showed a trend to reduced odds of Chronic Lung Disease. Birth weight at CONCLUSIONS. A fetal inflammatory response is protective for Chronic Lung Disease. Neonatal sepsis is strongly associated with Chronic Lung Disease, and the infecting organism is important. Coagulase-negative staphylococcal infection confers a risk for Chronic Lung Disease similar to that of other bacteremias. Candidemia confers the greatest risk of Chronic Lung Disease.
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intrauterine inflammation neonatal sepsis and Chronic Lung Disease a 13 year hospital cohort study
Pediatrics, 2009Co-Authors: Monica M Lahra, Philip J Beeby, Heather E JefferyAbstract:UNLABELLED OBJECTIVE To determine the impact of intrauterine inflammation of maternal (chorioamnionitis) and fetal (umbilical vasculitis) origin and neonatal sepsis on the development of neonatal Chronic Lung Disease in preterm infants. METHODS This study was conducted at Royal Prince Alfred Hospital in Sydney, Australia. All infants born at <30 weeks' gestation, admitted to the NICU, and surviving to 36 weeks' corrected gestation during 1992-2004 were eligible. Infants with major congenital abnormalities and those without placental examination were excluded. Antenatal and perinatal data extracted from hospital databases were correlated with the independent, central neonatal database and diagnostic laboratory reports. Neonatal sepsis was categorized according to blood culture isolates into 3 groups: coagulase-negative staphylococci, other bacteria, and Candida species. RESULTS There were 798 eligible infants born during the study period, and 761 (95.4%) had placental examination. The mean gestational age was 27.4 +/- 1.5 weeks. Antenatal maternal steroids were given to 94.4%. Regression analysis showed that chorioamnionitis with umbilical vasculitis and increasing gestation were associated with reduced odds of Chronic Lung Disease. Chorioamnionitis without umbilical vasculitis showed a trend to reduced odds of Chronic Lung Disease. Birth weight at <3rd percentile and neonatal sepsis were associated with increased odds of Chronic Lung Disease. CONCLUSIONS A fetal inflammatory response is protective for Chronic Lung Disease. Neonatal sepsis is strongly associated with Chronic Lung Disease, and the infecting organism is important. Coagulase-negative staphylococcal infection confers a risk for Chronic Lung Disease similar to that of other bacteremias. Candidemia confers the greatest risk of Chronic Lung Disease.
Marianne Moore - One of the best experts on this subject based on the ideXlab platform.
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chorioamnionitis mechanical ventilation and postnatal sepsis as modulators of Chronic Lung Disease in preterm infants
The Journal of Pediatrics, 2002Co-Authors: Linda J Van Marter, Alan Leviton, Elizabeth N Allred, Marcello Pagano, Marianne Moore, Olaf Dammann, Camilia R MartinAbstract:Abstract Objective: This case-control study of Chronic Lung Disease (CLD) evaluated the hypothesis that chorioamnionitis promotes CLD and interacts with other risk factors for CLD, including mechanical ventilation and postnatal infection. Study design: We identified a population of 193 infants who met our case criteria for CLD whose birth weights were ≤1500 g. These infants were matched 1:1 with control infants for gestational age and hospital of birth. Results: Univariable analyses revealed decreased CLD risk associated with histologic chorioamnionitis and increased risk associated with mechanical ventilation >7 days and culture-documented sepsis. In multivariable analyses, infants were at greatest risk for CLD when they had exposure to both chorioamnionitis and either mechanical ventilation >7 days (odds ratio, 3.2; 95% confidence interval, 0.9-11) or postnatal infection (odds ratio, 2.9; 95% confidence interval, 1.1-7.4). Conclusions: We conclude that prolonged mechanical ventilation or postnatal infection increases the risk of CLD among surviving preterm infants and that these 2 factors interact with antenatal infection to further increase the risk of CLD. (J Pediatr 2002;140:171-6)
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clinical markers of barotrauma and oxygen toxicity and inter hospital variation in rates of Chronic Lung Disease among surviving very low birth weight infants
Pediatric Research, 1999Co-Authors: L Van Marter, Alan Leviton, Elizabeth N Allred, Marcello Pagano, Ulana Sanocka, Richard B Parad, Marianne MooreAbstract:Clinical Markers of Barotrauma and Oxygen Toxicity and Inter-Hospital Variation in Rates of Chronic Lung Disease Among Surviving Very Low Birth Weight Infants
Andrew F Nelson - One of the best experts on this subject based on the ideXlab platform.
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the health and economic benefits associated with pneumococcal vaccination of elderly persons with Chronic Lung Disease
JAMA Internal Medicine, 1999Co-Authors: Kristin L Nichol, Leslie Baken, Janet Wuorenma, Andrew F NelsonAbstract:Background More than 50% of the elderly population has not received pneumococcal vaccination. Uncertainty regarding the benefits of immunization, particularly for noninvasive Disease, may contribute to the underuse of pneumococcal vaccine. Objective To assess the health and economic benefits associated with pneumococcal vaccination. Methods We conducted a 2-year retrospective cohort study among all elderly members of a staff-model managed care organization who had a baseline diagnosis of Chronic Lung Disease. The study outcomes were assessed over 2 years, from November 15, 1993, through November 14, 1995, and included hospitalizations for pneumonia and influenza, death, and hospitalization costs. Using administrative data, we compared these outcomes for vaccinated and unvaccinated subjects using multivariate models to control for subjects' baseline demographic and health characteristics. The additive benefits of combined influenza and pneumococcal vaccination were also assessed for the 2 influenza seasons included in the study. Results There were 1898 subjects. Pneumococcal vaccination was associated with significantly lower risks for pneumonia hospitalizations (adjusted risk ratio [RR], 0.57; 95% confidence interval [CI], 0.38-0.84;P=.005) and for death (adjusted RR, 0.71; 95% CI, 0.56-0.91;P=.008). For the control outcome of all nonpneumonia hospitalizations, rates did not differ significantly between the 2 groups (adjusted RR, 0.91; 95% CI, 0.77-1.07;P=.24). During the influenza seasons included in the study, the benefits of pneumococcal and influenza vaccinations were additive, with an adjusted RR of 0.28 (95% CI, 0.14-0.58;P Conclusions Pneumococcal vaccination of elderly persons with Chronic Lung Disease was associated with fewer hospitalizations for pneumonia, fewer deaths, and direct medical care cost savings.
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relation between influenza vaccination and outpatient visits hospitalization and mortality in elderly persons with Chronic Lung Disease
Annals of Internal Medicine, 1999Co-Authors: Kristin L Nichol, Leslie Baken, Andrew F NelsonAbstract:For elderly persons with Chronic Lung Disease, influenza is associated with significant adverse health effects and influenza vaccine is associated with substantial health benefits. Among these bene...