Emma McCall

Reducing nosocomial infections in neonatal intensive care.

Background. Nosocomial infection is a common problem in neonatal intensive care. A pilot quality improvement initiative focussing on hand hygiene and aimed at reducing nosocomial infection in very low birth weight (VLBW) infants was introduced in five Neonatal Intensive Care Units. Methods. Line associated laboratory confirmed bloodstream infection (LCBSI) and ventilator associated pneumonia (VAP) were chosen as main outcome measures. Results. In VLBW infants, the rate of line associated LCBSI per 1000 central venous catheter days fell by 24%. The rate of VAP per 1000 ventilator days in VLBW infants fell by 38%. Pre- and post-intervention questionnaires showed a statistically significant increase in use of alcohol-based gels and increased knowledge of hand hygiene.

Socioeconomic inequalities in neonatal intensive care admission rates

Objective: To examine socioeconomic inequalities in neonatal intensive care (NIC) admissions relating to preterm birth, intrauterine growth restriction (IUGR), multiple births and other conditions. Methods: Retrospective review of all NIC admissions from 1996 to 2001 throughout a geographically defined region. Area deprivation indices were grouped into quintiles from least (1) to most (5) deprived. Admissions were classified by predefined hierarchical criteria. Results: The rate of admissions was 31.4 per 1000 births. There was a J-shaped relation with socioeconomic group (28.1 NIC admissions per 1000 in quintile 1, 34.0 in quintile 5 and below 28 in the other quintiles). The most deprived areas had a rate 19% above the regional average. The relation with socioeconomic group differed significantly according to primary reason for admission. The rates of admissions with significant prematurity (34% of all admissions) and IUGR as primary reason were highest in quintile 5 (18% and 41% above the regional average, respectively). This contrasted with the rate of admission for multiple birth which was highest in quintile 1 (45% above average). These differences provided the main explanation for the J-shaped overall curve. Conclusions: Measures to alleviate deprivation and to improve the preterm birth and IUGR rates in deprived groups would have the greatest potential to reduce inequality in need for NIC admission. Efforts to achieve targets for reduction in infant mortality need to take account of the different effects of socioeconomic inequalities for different conditions and groups of infants.

Improvement in neonatal intensive care in Northern Ireland through sharing of audit data

Problem: Ten percent of infants born will require admission to a neonatal facility. Coordinated activity to monitor and improve the quality of care for this high risk, high cost group of infants is considered a high priority. At the time of initiation of this project no system for collection and analysis of neonatal data existed in Northern Ireland. Design: In 1994 an ongoing prospective centralised data collection system was implemented to facilitate quality improvement and research in neonatal care. We aim to ascertain if there has been a demonstrable improvement in the quality of care provided since the initiation of this system. Setting: All nine Northern Ireland neonatal intensive care units returned prospectively collected socioeconomic, obstetric and neonatal episode data. Key measures for improvement: Achievement of the agreed quality indicators relating to transfer patterns, thermoregulation, antenatal steroid administration, and timing of administration of surfactant during the period 1 April 1999 to 31 March 2000 were compared with data for the period 1 April 1994 to 31 March 1996. Strategies for change: Monitoring included audit and annual feedback of timely clear and relevant data where results were provided confidentially as standardised reports, together with anonymised comparisons with other similar sized units. Draft recommendations were made at regional level and units were asked to adopt finalised consensus guidelines at the local level and to implement changes to clinical practice. Effects of change: The proportion of transfers taking place in utero increased from 26% to 42% and antenatal steroid administration from 68% to 82%. Normothermia on first admission improved from 66% to 71% for inborn infants. The proportion of infants receiving surfactant where the first dose was given within an hour of birth increased from 13% to 66%. Lessons learnt: A multiprofessional regional care network can facilitate the development of agreed standards and a culture of regular evaluation leading to quality improvement.

Improving survival for infants of <26 weeks' gestation, 1995-2005.

For infants born at extremely low gestations there is significant morbidity and mortality with wide variation in reported outcomes.1 2 The EPICure study has informed perinatal decision-making at gestations of <26 weeks in the UK and Ireland for the last decade but, as it reflects the outcome of infants born in 1995, it may no longer be appropriate.3 The aim of this study was to determine outcomes for infants born at 22+0–25+6 weeks’ gestation in 2005 in Northern Ireland compared with 1995. Anonymised data for infants born in 2005 were obtained retrospectively from (1) the NICORE (Neonatal Intensive Care Outcomes, Research and Evaluation) database, (2) CEMACH (Confidential Enquiry into Maternal and …

Online information for parents caring for their premature baby at home: A focus group study and systematic web search

Online resources are a source of information for parents of premature babies when their baby is discharged from hospital.

Modelling the development of late onset sepsis and length of stay using discrete conditional survival models with a classification tree component

This paper introduces a discrete conditional survival model (DC-S) with a classification component for predicting patient outcome and survival component for predicting length of stay in hospital. The DC-S model consists of two components; the conditional component which utilises a classification tree and the survival component which models the survival distribution. The survival component of the model is conditioned on the discrete conditional component, the classification tree. The DC-S model with classification tree is applied to a healthcare scenario where the length of stay of babies in neonatal wards in Northern Ireland (United Kingdom) is modelled using the baby characteristics known on the first day of admission. The resulting model can accurately predict length of stay of babies and thus has the potential to be used in bed planning. Hospitals could use such good estimates for the length of stay of patients (determined on the day of arrival) to plan ahead to make the correct provisions available during their stay. Not only does this have resource implications, it can also help patient families. The resulting model can also predict the occurrence (or otherwise) of late onset sepsis, which has implications on a patients stay.