Michael Feldman

THE INCIDENCE OF BIRTHMARKS IN ISRAELI NEONATES

Background. Several studies have documented cutaneous findings in neonates of various racial groups. Our purpose was to determine the frequency of birthmarks in Israeli neonates of Jewish and Arabic origin.

Paracetamol treatment of patent ductus arteriosus in preterm infants

Objective:To determine the effectiveness of paracetamol in closing patent ductus arteriosus (PDA) in preterm infants of our population.Study Design:Infants with symptomatic PDA who failed or could not get ibuprofen treatment, and who were candidates for surgical ligation, were administered oral paracetamol 15 mgkg–1 every 6h, for up to 7 days and were monitored for clinical, echocardiographic and laboratorial courses.Result:Seven infants, between 24–27 weeks’ gestation, were included. In four the DA was closed while treated by paracetamol—in one of them the DA reopened, treated with paracetamol again, and closed. In one infant, the DA almost closed, symptoms disappeared, and the DA subsequently closed spontaneously later. Two needed surgical ligation. There were no hematologic or biochemical abnormalities.Conclusion:Although there is the possibility that PDA may have closed spontaneously, it is proposed that paracetamol could contribute to the closure of PDA in preterm infants.

Late better than early elective term Cesarean section.

Aim:  Caesarean section (CS) deliveries have increased, mostly because of patient/obstetrician preference. Although CS decreases the risk of delivery‐related injuries, it increases the risk for respiratory and neurological complications. Complication rates are reportedly higher for elective CSs for term infants performed at 37–38 gestational weeks than later. We investigated this difference in an Israeli cohort.

ISO 9001 in a neonatal intensive care unit (NICU)

PURPOSE The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. DESIGN/METHODOLOGY/APPROACH The process started with the department heads decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. FINDINGS In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. RESEARCH LIMITATIONS/IMPLICATIONS The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. PRACTICAL IMPLICATIONS The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ORIGINALITY/VALUE ISO 9001 is becoming a recommended tool to improve clinical service quality.

Service Management of Special Care Units: Lessons Learned in Manufacturing

Special care units express an increasing interest in adopting methods for quality management, previously developed and implemented in manufacturing firms. The paper examines the analogy between service management in special care units and the management of manufacturing processes. This paper is based on the authors’ implementation of ISO 9001:2000 in a neonatal intensive care unit. It maps the major processes and entities that create the treatment outcome, conducting a focused comparison between healthcare organizations/special care units and manufacturing organizations. To verify the performance of various major processes in healthcare the authors recommend the use of the Yield performance measurement. The literature review shows that a comparison between manufacturing and service organizations is both useful and valid even though service organizations differ from manufacturing organizations. Despite the complexities of treating humans and the level of uncertainty that goes hand in hand with health care decision making, strict product and/or customer treatment identification and specifications can raise the level of success in achieving positive results.

Rehospitalization Through Childhood and Adolescence: Association with Neonatal Morbidities in Infants of Very Low Birth Weight

Objective To evaluate the impact of major neonatal morbidities on the risks for rehospitalization in children and adolescents born of very low birth weight. Study design An observational study was performed on data of the Israel Neonatal Network linked together with the Maccabi Healthcare Services medical records. After discharge from the neonatal intensive care unit, 6385 infants of very low birth weight born from 1995 to 2012 were registered with Maccabi Healthcare Services and formed the study cohort. Multivariable negative binomial regression models were calculated to estimate the adjusted relative risk (aRR) and 95% CI for hospitalization. Results Up to 18 years following discharge, 3956 infants were hospitalized at least once. The median age of follow‐up was 10.7 years with total of follow‐up of 67 454 patient years and 10 895 hospitalizations. The risks for rehospitalization were increased significantly for each of the neonatal morbidities: surgical necrotizing enterocolitis (NEC), aRR 2.71 (95% CI 2.08–3.53), intraventricular hemorrhage grades 3–4, 2.13 (1.85–2.46), periventricular leukomalacia (PVL), 1.83 (1.58–2.13), bronchopulmonary dysplasia, 1.94 (1.72–2.17), and retinopathy of prematurity stages 3–4, 1.59 (1.36–1.85). During the first 4 years, children with surgically treated NEC, intraventricular hemorrhage, PVL, or bronchopulmonary dysplasia had 1.5‐ to 2.5‐fold greater risks for hospitalization compared with those without the specific morbidity. In the 11th‐14th and 15th‐18th years, respectively, surgically treated NEC was associated with a 3.05 (1.32–7.04) and 3.26 (0.99–10.7) aRR for hospitalization, and PVL was associated with a 2.67 (1.79–3.97) and 3.47 (2.03–5.92) aRR for hospitalization. Conclusions Specific major neonatal morbidities as well as the number of morbidities were associated with excess risks of rehospitalization through childhood and adolescence.

Neonatal Chest Wall Rhabdomyosarcoma

An infant was born at term with a huge chest mass diagnosed as rhabdomyosarcoma. Treatment consisted of surgical resection and chemotherapy. We describe this very rare congenital mass and the problematic therapeutic management of such a tumor in a newborn.

PO-0678 Satisfaction Questionnaire In A Neonatal Intensive Care Unit: Our 5 Years’ Experience

Objective To compile and analyse the replies to questionnaires on patient satisfaction as a major parameter of quality assessment in the setting of a single neonatal intensive care unit (NICU) over a 5-year period. Methods The NICU of Hillel Yaffe Medical Centre (Hadera, Israel) has utilised the ISO 9001:2008 standard for quality management system since 2007. The responses of the neonates’ parents to a satisfaction questionnaire throughout a 5-year period were retrieved and analysed. Results The responses to a total of 1223 satisfaction questionnaire were available for analysis. Most of the parents were satisfied with the service, and some of them suggested improvements in features whose shortcomings were unknown to us and could easily be remedied for the most part. Conclusions The replies to the questionnaire identified components of care that parents found to be satisfactory and others that they wished could be changed. A satisfaction questionnaire is an easy tool for the improvement of service, and the use of the one we constructed and describe is recommended to guide the enhancement of quality medical care in an NICU.

PO-0780 Postnatal Follow-up Of Newborns With Prenatal Diagnosis Of Hydronephrosis

Background Prenatal Hydronephrosis is diagnosed in 1–5% of pregnancies worldwide. The diagnosis of antenatal hydronephrosis (ANH) causes stress to the parents and dilemmas to the paediatrician. Objectives To examine the correlation between the degree of the renal pelvic dilatation (RPD) detected by the first 2–5 days of life and the postnatal outcome. To investigate the correlation between bilateral hydronephrosis and the nephrologic outcome. To discuss the possibility of decreasing the postnatal examinations of these healthy babies. Methods During a period of two years, we enrolled 143 term newborns with ANH. These babies had an ultrasound at the age of 2–5 days and a second ultrasound at the age of 4–6 weeks. After the examinations they were referred to our nephrologist. Results Out of 8370 live-births, 143 infants had ANH. Six babies never completed the exam. At the first exam 69 babies were normal, 62 babies had mild, 3 babies had moderate and 3 babies had severe RPD. On their second ultrasound 76 had normal findings, 36 had mild, 8 had moderate and 12 had severe RPD. 132 babies completed both of the examinations. Bilateral hydronephrosis was detected in 33 cases during their first ultrasound while on the second only 27. There were 11 infants with UPJ obstruction 9 of them with severe RPD. We found 10 babies with VUR. Six babies needed surgical intervention. Conclusions There seems to be a correlation between the degree of RPD and the presence of postnatal pathology. Bilateral hydronephrosis probably carries increased risk for postnatal pathology.