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Eric C Eichenwald - One of the best experts on this subject based on the ideXlab platform.

  • no change in the incidence of ampicillin resistant neonatal early onset sepsis over 18 years
    Pediatrics, 2010
    Co-Authors: Karen M Puopolo, Eric C Eichenwald
    Abstract:

    OBJECTIVE: The objective of this study was to assess the effect of maternal antibiotic exposure on neonatal early-onset sepsis (EOS) rates over an 18-year period. METHODS: A review was performed of infant and maternal records for all culture- proven cases of EOS in infants delivered at the Brigham and Women9s Hospital (Boston, MA) in 1990–2007. RESULTS: Data were analyzed from 335 EOS cases over periods that differed with respect to Hospital Policy for intrapartum antibiotic prophylaxis against group B Streptococcus (GBS): 1990–1992 (no prophylaxis); 1993–1996 (risk-based); and 1997–2007 (screening-based). The overall incidence of EOS decreased over these periods (3.70 vs 2.23 vs 1.59 cases per 1000 live births; P CONCLUSIONS: Predominant use of penicillin G for GBS prophylaxis resulted in decreased incidence of EOS. No change in the incidence of ampicillin-resistant EOS was observed, but resistant cases were associated with peripartum ampicillin exposure. These findings suggest that obstetricians should consider preferential use of penicillin G for GBS prophylaxis.

  • no change in the incidence of ampicillin resistant neonatal early onset sepsis over 18 years
    Pediatrics, 2010
    Co-Authors: Karen M Puopolo, Eric C Eichenwald
    Abstract:

    OBJECTIVE: The objective of this study was to assess the effect of maternal antibiotic exposure on neonatal early-onset sepsis (EOS) rates over an 18-year period. METHODS: A review was performed of infant and maternal records for all culture- proven cases of EOS in infants delivered at the Brigham and Women9s Hospital (Boston, MA) in 1990–2007. RESULTS: Data were analyzed from 335 EOS cases over periods that differed with respect to Hospital Policy for intrapartum antibiotic prophylaxis against group B Streptococcus (GBS): 1990–1992 (no prophylaxis); 1993–1996 (risk-based); and 1997–2007 (screening-based). The overall incidence of EOS decreased over these periods (3.70 vs 2.23 vs 1.59 cases per 1000 live births; P P = .0001). Overall peripartum antibiotic use increased during the study period primarily because of increased use of penicillin G and clindamycin, with no significant change in the use of ampicillin. CONCLUSIONS: Predominant use of penicillin G for GBS prophylaxis resulted in decreased incidence of EOS. No change in the incidence of ampicillin-resistant EOS was observed, but resistant cases were associated with peripartum ampicillin exposure. These findings suggest that obstetricians should consider preferential use of penicillin G for GBS prophylaxis.

Karen M Puopolo - One of the best experts on this subject based on the ideXlab platform.

  • no change in the incidence of ampicillin resistant neonatal early onset sepsis over 18 years
    Pediatrics, 2010
    Co-Authors: Karen M Puopolo, Eric C Eichenwald
    Abstract:

    OBJECTIVE: The objective of this study was to assess the effect of maternal antibiotic exposure on neonatal early-onset sepsis (EOS) rates over an 18-year period. METHODS: A review was performed of infant and maternal records for all culture- proven cases of EOS in infants delivered at the Brigham and Women9s Hospital (Boston, MA) in 1990–2007. RESULTS: Data were analyzed from 335 EOS cases over periods that differed with respect to Hospital Policy for intrapartum antibiotic prophylaxis against group B Streptococcus (GBS): 1990–1992 (no prophylaxis); 1993–1996 (risk-based); and 1997–2007 (screening-based). The overall incidence of EOS decreased over these periods (3.70 vs 2.23 vs 1.59 cases per 1000 live births; P CONCLUSIONS: Predominant use of penicillin G for GBS prophylaxis resulted in decreased incidence of EOS. No change in the incidence of ampicillin-resistant EOS was observed, but resistant cases were associated with peripartum ampicillin exposure. These findings suggest that obstetricians should consider preferential use of penicillin G for GBS prophylaxis.

  • no change in the incidence of ampicillin resistant neonatal early onset sepsis over 18 years
    Pediatrics, 2010
    Co-Authors: Karen M Puopolo, Eric C Eichenwald
    Abstract:

    OBJECTIVE: The objective of this study was to assess the effect of maternal antibiotic exposure on neonatal early-onset sepsis (EOS) rates over an 18-year period. METHODS: A review was performed of infant and maternal records for all culture- proven cases of EOS in infants delivered at the Brigham and Women9s Hospital (Boston, MA) in 1990–2007. RESULTS: Data were analyzed from 335 EOS cases over periods that differed with respect to Hospital Policy for intrapartum antibiotic prophylaxis against group B Streptococcus (GBS): 1990–1992 (no prophylaxis); 1993–1996 (risk-based); and 1997–2007 (screening-based). The overall incidence of EOS decreased over these periods (3.70 vs 2.23 vs 1.59 cases per 1000 live births; P P = .0001). Overall peripartum antibiotic use increased during the study period primarily because of increased use of penicillin G and clindamycin, with no significant change in the use of ampicillin. CONCLUSIONS: Predominant use of penicillin G for GBS prophylaxis resulted in decreased incidence of EOS. No change in the incidence of ampicillin-resistant EOS was observed, but resistant cases were associated with peripartum ampicillin exposure. These findings suggest that obstetricians should consider preferential use of penicillin G for GBS prophylaxis.

Andrew M. Courtwright - One of the best experts on this subject based on the ideXlab platform.

  • Experience with a Revised Hospital Policy on Not Offering Cardiopulmonary Resuscitation
    HEC Forum, 2020
    Co-Authors: Andrew M. Courtwright, Emily Rubin, Kimberly S. Erler, Julia I. Bandini, Mary Zwirner, M. Cornelia Cremens, Thomas H. Mccoy, Ellen M. Robinson
    Abstract:

    Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate (DNR) status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation (CPR) despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics consult outcomes were analyzed. In 42 of the 116 cases (36.2%), the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 (97.3%) of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 (79.2%) of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying (p = 0.007). The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients.

  • experience with a Hospital Policy on not offering cardiopulmonary resuscitation when believed more harmful than beneficial
    Journal of Critical Care, 2015
    Co-Authors: Andrew M. Courtwright, Sharon Brackett, Wendy Cadge, Eric L Krakauer, Ellen M. Robinson
    Abstract:

    Abstract Purpose This study investigated the impact of age, race, and functional status on decisions not to offer cardiopulmonary resuscitation (CPR) despite patient or surrogate requests that CPR be performed. Methods This was a retrospective cohort study of all ethics committee consultations between 2007 and 2013 at a large academic Hospital with a not offering CPR Policy. Results There were 134 cases of disagreement over whether to provide CPR. In 45 cases (33.6%), the patient or surrogate agreed to a do-not-resuscitate (DNR) order after initial ethics consultation. In 67 (75.3%) of the remaining 89 cases, the ethics committee recommended not offering CPR. In the other 22 (24.7%) cases, the ethics committee recommended offering CPR. There was no significant relationship between age, race, or functional status and the recommendation not to offer CPR. Patients who were not offered CPR were more likely to be critically ill (61.2% vs 18.2%, P Conclusions There was no association between age, race, or functional status and the decision not to offer CPR made in consultation with an ethics committee. Orders to withhold CPR were more common among critically ill patients.

Ellen M. Robinson - One of the best experts on this subject based on the ideXlab platform.

  • Experience with a Revised Hospital Policy on Not Offering Cardiopulmonary Resuscitation
    HEC Forum, 2020
    Co-Authors: Andrew M. Courtwright, Emily Rubin, Kimberly S. Erler, Julia I. Bandini, Mary Zwirner, M. Cornelia Cremens, Thomas H. Mccoy, Ellen M. Robinson
    Abstract:

    Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate (DNR) status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation (CPR) despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics consult outcomes were analyzed. In 42 of the 116 cases (36.2%), the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 (97.3%) of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 (79.2%) of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying (p = 0.007). The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients.

  • experience with a Hospital Policy on not offering cardiopulmonary resuscitation when believed more harmful than beneficial
    Journal of Critical Care, 2015
    Co-Authors: Andrew M. Courtwright, Sharon Brackett, Wendy Cadge, Eric L Krakauer, Ellen M. Robinson
    Abstract:

    Abstract Purpose This study investigated the impact of age, race, and functional status on decisions not to offer cardiopulmonary resuscitation (CPR) despite patient or surrogate requests that CPR be performed. Methods This was a retrospective cohort study of all ethics committee consultations between 2007 and 2013 at a large academic Hospital with a not offering CPR Policy. Results There were 134 cases of disagreement over whether to provide CPR. In 45 cases (33.6%), the patient or surrogate agreed to a do-not-resuscitate (DNR) order after initial ethics consultation. In 67 (75.3%) of the remaining 89 cases, the ethics committee recommended not offering CPR. In the other 22 (24.7%) cases, the ethics committee recommended offering CPR. There was no significant relationship between age, race, or functional status and the recommendation not to offer CPR. Patients who were not offered CPR were more likely to be critically ill (61.2% vs 18.2%, P Conclusions There was no association between age, race, or functional status and the decision not to offer CPR made in consultation with an ethics committee. Orders to withhold CPR were more common among critically ill patients.

Benbow Emily - One of the best experts on this subject based on the ideXlab platform.

  • The PLANES study : a protocol for a randomised controlled feasibility study of the placental growth factor (PlGF) blood test informed care versus standard care alone for women with a small for gestational age fetus at or after 32+0 weeks’ gestation
    'Springer Science and Business Media LLC', 2020
    Co-Authors: Gent Joanna, Bullough Sian, Harrold Jane, Jackson Richard, Woolfall Kerry, Andronis Lazaros, Kenny Louise, Cornforth Christine, Heazell Alexander E. P., Benbow Emily
    Abstract:

    Background: Stillbirth remains a major concern across the globe and in some high-resource countries, such as the UK, efforts to reduce the rate have achieved only modest reductions. One third of stillborn babies are small for gestational age (SGA) and these pregnancies are also at risk of neonatal adverse outcomes and lifelong health problems, especially when delivered preterm. Current UK clinical guidance advocates regular monitoring and early term delivery of the SGA fetus however; the most appropriate regimen for surveillance of these babies remains unclear and often leads to increased intervention for a large number of these women. This pilot trial will determine the feasibility of a large-scale trial refining the risk of adverse pregnancy outcome in SGA pregnancies using biomarkers of placental function sFlt-1/PlGF, identifying and intervening in only those deemed at highest risk of stillbirth. Methods: PLANES is a randomised controlled feasibility study of women with an SGA fetus that will be conducted at two tertiary care Hospitals in the UK. Once identified on ultrasound, women will be randomised into two groups in a 3:1 ratio in favour of sFlt-1/PlGF ratio led management vs standard care. Women with an SGA fetus and a normal sFlt-1/PlGF ratio will have a repeat ultrasound and sFlt-1/PlGF ratio every 2 weeks with planned birth delayed until 40 weeks. In those women with an SGA fetus and an abnormal sFlt-1/PlGF ratio we will offer birth from 37 weeks, or sooner if there are other concerning features on ultrasound. Women assigned to standard care will have an sFlt-1/PlGF ratio taken but the results will be concealed from the clinical team and the woman’s pregnancy will be managed as per the local NHS Hospital Policy. This integrated mixed method study will also involve a health economic analysis and a perspectives work package exploring trial feasibility through interviews and questionnaires with participants, their partners and clinicians. Discussion: Our aim is to determine feasibility through the assessment of our ability to recruit and retain participants to the study. Results from this pilot study will inform the design of a future large randomised controlled trial that will be adequately powered for adverse pregnancy outcome. Such a study would provide the evidence needed to guide future management of the SGA fetus

  • The PLANES study: a protocol for a randomised controlled feasibility study of the placental growth factor (PlGF) blood test-informed care versus standard care alone for women with a small for gestational age fetus at or after 32 + 0 weeks' gestation.
    'Springer Science and Business Media LLC', 2020
    Co-Authors: Gent Joanna, Bullough Sian, Harrold Jane, Jackson Richard, Woolfall Kerry, Andronis Lazaros, Kenny Louise, Cornforth Christine, Alexander Ep Heazell, Benbow Emily
    Abstract:

    BackgroundStillbirth remains a major concern across the globe and in some high-resource countries, such as the UK; efforts to reduce the rate have achieved only modest reductions. One third of stillborn babies are small for gestational age (SGA), and these pregnancies are also at risk of neonatal adverse outcomes and lifelong health problems, especially when delivered preterm. Current UK clinical guidance advocates regular monitoring and early term delivery of the SGA fetus; however, the most appropriate regimen for surveillance of these babies remains unclear and often leads to increased intervention for a large number of these women. This pilot trial will determine the feasibility of a large-scale trial refining the risk of adverse pregnancy outcome in SGA pregnancies using biomarkers of placental function sFlt-1/PlGF, identifying and intervening in only those deemed at highest risk of stillbirth.MethodsPLANES is a randomised controlled feasibility study of women with an SGA fetus that will be conducted at two tertiary care Hospitals in the UK. Once identified on ultrasound, women will be randomised into two groups in a 3:1 ratio in favour of sFlt-1/PlGF ratio led management vs standard care. Women with an SGA fetus and a normal sFlt-1/PlGF ratio will have a repeat ultrasound and sFlt-1/PlGF ratio every 2 weeks with planned birth delayed until 40 weeks. In those women with an SGA fetus and an abnormal sFlt-1/PlGF ratio, we will offer birth from 37 weeks or sooner if there are other concerning features on ultrasound. Women assigned to standard care will have an sFlt-1/PlGF ratio taken, but the results will be concealed from the clinical team, and the woman's pregnancy will be managed as per the local NHS Hospital Policy. This integrated mixed method study will also involve a health economic analysis and a perspective work package exploring trial feasibility through interviews and questionnaires with participants, their partners, and clinicians.DiscussionOur aim is to determine feasibility through the assessment of our ability to recruit and retain participants to the study. Results from this pilot study will inform the design of a future large randomised controlled trial that will be adequately powered for adverse pregnancy outcome. Such a study would provide the evidence needed to guide future management of the SGA fetus.Trial registrationISRCTN58254381 . Registered on 4 July 2019