Martha Caprio

Administration of Inactivated Trivalent Influenza Vaccine to Parents of High-Risk Infants in the Neonatal Intensive Care Unit

OBJECTIVE. Infants who are younger than 6 months and have influenza demonstrate significant morbidity and mortality. Trivalent inactivated influenza vaccine is indicated for parents and household contacts of these infants; however, the influenza vaccination rate in this population is estimated at 30%. The objective of this study was to determine the feasibility of trivalent inactivated influenza vaccine administration to parents in a tertiary-care, level III NICU and measure the effect of this program on vaccination rates among parents of this high-risk population. METHODS. For a 4-month period during influenza season, all parents of admitted patients were informed of the risks and benefits of trivalent inactivated influenza vaccine by placing an information letter at their infants bedside. All staff were educated about the dangers of influenza and instructed to reinforce the need to obtain vaccination. Parents were screened, provided medical consent, and, when eligible, were immunized at their infants bedside. RESULTS. During the study period, 158 children (273 parents) were admitted to the NICU with gestational ages ranging from 24 to 41 weeks; 220 parents (130 infants) were offered the vaccine, and 40 parents received the vaccine from their obstetrician. Overall vaccination rate was 95% (209 parents). A total of 23% of the parent population had never received trivalent inactivated influenza vaccine, despite having previous indications for immunization (smoking, asthma, or other children younger than 23 months, the indicated age for parental vaccination at the time of this study); 75% of the population received trivalent inactivated influenza vaccine for the first time. The 28 infants whose parents were not offered vaccine spent <72 hours in the NICU. CONCLUSIONS. Administration of trivalent inactivated influenza vaccine in the NICU is an effective means of increasing vaccination rates in parents of this population. In addition, the improved access and convenience allow for an increase in first-time vaccination of parents who were previously eligible to receive trivalent inactivated influenza vaccine but were never immunized.

Availability of Trivalent Inactivated Influenza Vaccine to Parents of Neonatal Intensive Care Unit Patients and Its Effect on the Healthcare Worker Vaccination Rate

BACKGROUND Trivalent inactivated influenza vaccine (TIV) is indicated for healthcare workers (HCWs); however, the vaccination rate in this population is estimated at 35%. We implemented a program for the administration of TIV, targeted at parents of neonatal intensive care unit (NICU) patients. OBJECTIVE To determine the effect of availability of TIV to parents in the NICU on HCW vaccination rates. DESIGN Questionnaire survey after an intervention-based study. SETTING Tertiary-care neonatal intensive care unit. PARTICIPANTS Physicians, nurses, and other NICU-based staff. METHODS For the 2005-2006 influenza season, parents of NICU patients were screened and administered TIV, if informed consent was obtained. As a consequence, TIV was available 20 hours/day to all staff. Previous vaccination history and comorbidities in HCWs were also assessed. RESULTS Of 120 neonatal HCWs, 112 (93%) were screened during the 2005-2006 season; 80 (67%) were vaccinated, compared with 49 (41%) prior to the implementation of this program (P < .03, by Students t test); 54 (45% of the study population, which includes senior neonatologists, fellow and resident physicians, nurses, respiratory therapists, X-ray technicians and clerical staff) received TIV in the NICU, compared with the 17 (14%) of 120 HCWs the previous year; and 20 (46%) of 43 HCWs of the nursing staff were vaccinated in the NICU, whereas only 3 (7%) of 43 HWCs were vaccinated outside the unit. Attending physicians had the lowest vaccination rate, and most cited efficacy and/or side effects in their deferral. Nurses most often refused influenza vaccination because they had a fear of injection. CONCLUSIONS Administration of TIV in the NICU is an effective means of increasing the vaccination rate among neonatal HCWs. To increase compliance with vaccination, educational efforts for nurses should emphasize the possibility of viral transmission to neonates as motivation for vaccination. Physician-directed efforts should include tolerability of vaccine side effects. Live attenuated influenza vaccine, administered intranasally, should be considered to increase vaccination rates among NICU nurses.

Evacuation of a Neonatal Intensive Care Unit in a Disaster: Lessons From Hurricane Sandy

NICU patients are among those potentially most vulnerable to the effects of natural or man-made disaster on a medical center. The published data on evacuations of NICU patients in the setting of disaster are sparse. In October of 2012, New York University Langone Medical Center was evacuated during Hurricane Sandy in the setting of a power outage secondary to a coastal surge. In this setting, 21 neonates were safely evacuated from the medical center’s NICU to receiving hospitals within New York City in a span of 4.5 hours. Using data recorded during the evacuation and from staff debriefings, we describe the challenges faced and lessons learned during both the power outage and vertical evacuation. From our experience, we identify several elements that are important to the functioning of an NICU in a disaster or to an evacuation that may be incorporated into future NICU-focused disaster planning. These include a clear command structure, backups (personnel, communication, medical information, and equipment), establishing situational awareness, regional coordination, and flexibility as well as special attention to families and to the availability of neonatal transport resources.

Quantification of impulse experienced by neonates during inter- and intra-hospital transport measured by biophysical accelerometery.

Abstract Background: Transport of premature infants incurs transfer-related morbidity, including intraventricular hemorrhage, a contributing factor to cerebral palsy. The force transmitted to the neonate during transport as a consequence of motion may be implicated in the increased morbidity in this population. Morbidity may occur via direct concussive force to a vulnerable germinal matrix, induction of an inflammatory reaction, or via transient desaturation via extubation. This transmitted force, measured as accelerations per unit time (impulse), is not well characterized. Any modification of a neonatal transporter which increases the time for a neonate in motion to come to rest may decrease the impulse experienced by the infant. Objective: The objective of the study was to quantify the magnitude of impulse experienced by neonates during inter- and intra-hospital transport using a novel biophysical model and determine whether a specialized air-foam mattress can reduce the transmitted impulse on the neonate. Methods: Five roundtrip trials were conducted for a transported neonate using a standard medical ambulance and transport isolette outfitted with an air-foam mattress. During the trials, measurements were made per second in the X (front-to-back), Y (side-to-side), and Z (up-and-down) planes using a computerized accelerometer attached to a neonatal resuscitation mannequin. Results were integrated over the trial time in each dimension to yield a measure of impulse (acceleration-per-unit-time). Total impulse for the trial was calculated. A second design included five trials from the delivery room to the NICU utilizing four different transport configurations with a standard neonatal isolette outfitted with a gel pillow, air-foam mattress, and air-foam mattress with gel pillow. Results: Mean impulse for the transport model was statistically greater than at rest. In the X and Z dimensions, the mean impulse was significantly lower using the air-foam mattress. The impulse of the Z dimension with the air-foam mattress did not differ from that experienced by the experimental model at rest. For the intra-hospital trial, all experimental set-ups produced significantly less cumulative impulse than the standard isolette, though in each specific dimension, no significant differences were noted. For cumulative impulse, no significant differences between any of the three experimental designs were observed. A trend toward decreased transport time was seen with the addition of the air-foam mattress and gel pillow. Conclusions: The mechanical trauma induced by transport can be measured and quantified using this system. Neonates transported with the air-foam mattress experienced less impulse in the front-to-back and up-and-down dimensions. For transports between the delivery room and NICU, neonates transported using the air-foam mattress and gel pillow experienced significantly less total impulse.

Rationale for the administration of acellular pertussis vaccine to parents of infants in the neonatal intensive care unit.

Pertussis infections in the United States are increasing as a consequence of waning immunity and increased surveillance. Those most at-risk of mortality include infants less than 6 months of age and premature infants. The 2006 immunization schedule emphasizes an adolescent pertussis booster at 12 years of age. However, of concern is the current generation of parents and grandparents who will still be un-immunized and therefore, available vectors of pertussis to vulnerable neonates. Given the proximity of parents to medical care in the Neonatal Intensive Care Unit (NICU), and the potential for severe disease in their children, NICU personnel should consider administration of acellular pertussis vaccine to parents of hospitalized infants.

Demonstration of communication between alveolus and interstitium in persistent interstitial pulmonary emphysema: case report.

ABSTRACT Persistent interstitial pulmonary emphysema (PIPE) is an uncommon complication of premature infants suffering from hyaline membrane disease who have been treated with mechanical ventilation. The presumed mechanism for the development of the disease is via a break in the bronchioalveolar system that allows air to escape into the interstitium. We report a case of a 9-week-old child who developed the localized form of the disease and underwent a lobectomy. Immunohistochemical stains helped to demonstrate the communication between the airway system and interstitium. This report strengthens the theory that the disease develops from airway rupture at the alveolar level.

Virtual radiology rounds: adding value in the digital era

BackgroundTo preserve radiology rounds in the changing health care environment, we have introduced virtual radiology rounds, an initiative enabling clinicians to remotely review imaging studies with the radiologist.ObjectiveWe describe our initial experience with virtual radiology rounds and referring provider impressions.Materials and methodsVirtual radiology rounds, a web-based conference, use remote sharing of radiology workstations. Participants discuss imaging studies by speakerphone. Virtual radiology rounds were piloted with the Neonatal Intensive Care Unit (NICU) and the Congenital Cardiovascular Care Unit (CCVCU). Providers completed a survey assessing the perceived impact and overall value of virtual radiology rounds on patient care using a 10-point scale. Pediatric radiologists participating in virtual radiology rounds completed a survey assessing technical, educational and clinical aspects of this methodology.ResultsSixteen providers responded to the survey; 9 NICU and 7 CCVCU staff (physicians, nurse practitioners and fellows). Virtual radiology rounds occurred 4–5 sessions/week with an average of 6.4 studies. Clinicians rated confidence in their own image interpretation with a 7.4 average rating for NICU and 7.5 average rating for CCVCU. Clinicians unanimously rated virtual radiology rounds as adding value. NICU staff preferred virtual radiology rounds to traditional rounds and CCVCU staff supported their new participation in virtual radiology rounds. Four of the five pediatric radiologists participating in virtual radiology rounds responded to the survey reporting virtual radiology rounds to be easy to facilitate (average rating: 9.3), to moderately impact interpretation of imaging studies (average rating: 6), and to provide substantial educational value for radiologists (average rating: 8.3). All pediatric radiologists felt strongly that virtual radiology rounds enable increased integration of the radiologist into the clinical care team (average rating: 8.8).ConclusionVirtual radiology rounds are a viable alternative to radiology rounds enabling improved patient care and education of providers.

Respiratory syncytial virus as a cause of pulmonary hemorrhage in a low birth weight infant - strategies for protection and prevention: a case report

IntroductionRespiratory Syncytial Virus is a common neonatal pathogen. Here we present a case of a premature, low birth weight infant who contracted respiratory syncytial virus and developed a severe pulmonary hemorrhage.Case presentationA 12-day-old Asian male, former 30-week premature infant with a birth weight of 1025 grams presented with nasal secretions, episodes of desaturations and increased work of breathing. The infant developed a pulmonary hemorrhage. Secretions during tracheal lavage were positive for respiratory syncytial virus on rapid fluorescence assay. After supportive care, the patient improved. Isolation, cohorting techniques and reinforcement of strict hand-washing guidelines prevented and outbreak to other infants.ConclusionThis original case report presents an uncommon presentation of respiratory syncytial virus infection, a common pediatric pathogen. Neonatologists should consider evaluating patients with pulmonary hemorrhage for respiratory syncytial virus if preceding symptoms are consistent with that infectious illness.

Efficacy of Survanta Treatment in Ventilated Infants with Meconium Aspiration 1666

The presence of meconium in the airway can lead to atelectasis, airway obstruction, pneumothorax, inflammation and surfactant inactivation. We sought to investigate if infants who required intubation and mechanical ventilation for meconium aspiration might improve their respiratory status with surfactant treatment (Survanta, Ross). Methods: Infant admitted to the NICU who required intubation and mechanical ventilation for meconium aspiration were treated with survanta (4cc/kg). Time of treatment and subsequent doses was at the discretion of the Attending Neonatologist. Age at diagnosis of respiratory compromise, oxygenation index, age at treatment of survanta and age of extubation were documented. Results:

Sensory Processing In Premature Infants With The Test Of Sensory Function In Infants (TSFI) † 978

Sensory Processing In Premature Infants With The Test Of Sensory Function In Infants (TSFI) † 978