Title The impact of changes in neonatal intensive care practices on short-term outcomes of premature infants Title (croatian) Utjecaj promjene prakse intenzivnog liječenja na kratkoročne ishode nedonoščadi Author Anna Mara Hrgetić Vitols Mentor Ruža Grizelj (mentor)Committee member Boris Filipović-Grčić (predsjednik povjerenstva)Committee member Marija Jelušić (član povjerenstva)Committee member Ruža Grizelj (član povjerenstva)Granter University of Zagreb Defense date and country 2018-07-13, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract OBJECTIVE: To assess the changes in neonatal care practices at the NICU-UHC Zagreb and their impact on short-term morbidity of a cohort of premature infants. A comparison between two epochs was performed, the periods before and after changes in respiratory support, healthcare professionals' attitudes and practices in supporting and promoting the breastfeeding, and laboratory phlebotomy reduction was introduced. ----- METHODS: We performed a retrospective study to investigate short-term morbidity of infants born at GA ≤32 weeks and/or BW ≤1500 g and transferred to UHC Zagreb from local Zagreb hospitals or remote areas in Croatia in the first week of life in the years 2013 and 2017. Continuous data was represented as mean ± SD, or median (minimum-maximum) values for continuous variables, and frequency percentages for categorical variables. Characteristics were compared between groups using the 2- sample t-test, Chi square test, or Fisher’s exact test. In all cases 2-tailed P values <0.05 were considered statistically significant. ----- RESULTS: The use of nCPAP as primary respiratory support increased from 25% to 72% (P<0.001) and surfactant use decreased from 69% to 33% (P=0.002) between the two time periods. The overall incidence of comorbidities was lower in 2017; rate of severe BPD (3 v. 42%, P<0.001), severe ROP (0% v. 14%, P=0.025), IVH ≥ 3 (11% v. 33%, P=0.023). The median duration of invasive MV was reduced from 31 days in 2013 to 6 days in 2017 (P<0.001), as well as LOS from 74 days in 2013 to 57 days in 2017 (P=0.001). Amount of phlebotomy blood loss and total number of PRBC transfusions were markedly reduced (from 1128 ml to 564 ml; P=0.004, and form 92 to 36; P=0.009, respectively). Incidence of surgical NEC, time to reach full enteral feed, and breastfeeding on discharge remained unchanged. ----- CONCLUSION: Changes in care protocols at the hospital since 2013 have improved the outcome of premature neonates. There was a marked improvement in most of the morbidity of very low birth weight infants over time, most likely due to provision of nCPAP as primary respiratory support. Usage of nCPAP as primary ventilation support and better policies on blood diagnostic
procedures have lowered the incidence of comorbidities and decreased hospital stays.
Abstract (croatian) CILJ: Ispitati utjecaj promjene prakse intenzivnog liječenja u Zavodu za neonatologiju i neonatalnu intenzivnu medicinu KBC-a Zagreb na kratkoročni morbiditet (do otpusta iz bolnice) kohorte nedonoščadi. Usporedili smo ishode nedonoščadi u periodu prije i poslije promjene načina provođenja respiratorne potpore, stavova zdravstvenih radnika i prakse u podupiranju i promicanju dojenja te smanjenja jatrogenog gubitka krvi. ----- METODE: Provedena je retrospektivna analiza
kratkoročnih ishoda nedonoščadi GD ≤32 tjedana i/ili RM ≤1500 g koja su premještena u KBC Zagreb iz lokalnih zagrebačkih bolnica ili udaljenih područja Hrvatske u prvom tjednu života tijekom 2013. i 2017. god. Kontinuirane varijable prikazane su kao aritmetička sredina i standardna devijacija ili medijan (najmanja-najveća vrijednost), a kategorijske varijable kao postotak. Za usporedbu karakteristika bolesnika u dva perioda korišten je t-test na temelju dvaju uzoraka, Χ2-test, a po potrebi i Fisherov egzaktni test. U svim slučajevima P vrijednosti <0.05 smatrale su se statistički značajnima. ----- REZULTATI: Primjena nCPAP-a kao primarne respiratorne potpore porasla je s 25% tijekom 2013. god. na 72% u 2017. god. (P<0.001) uz istodobno smanjenje supstitucije surfaktanta s 69% na 33% (P=0.002). Incidencija komorbiditeta je bila manja u 2017. god. nego u 2013. god.; stopa teških oblika BPD-a (3 v. 42%, P<0.001), teškog ROP-a (0% v. 14%, P=0.025), IVH ≥ 3 (11% v. 33%, P=0.023). Trajanje mehaničke ventilacije je skraćeno s 31 dan u 2013. god. na 6 dana u 2017. god. (P<0.001), kao i duljina hospitalizacije (sa 74 na 57 dana; P=0.001). Značajno je smanjena i količina gubitaka krvi zbog laboratorijskog uzorkovanja (od 1128 ml u 2013. god. na 564 ml u 2017. god.; P=0.004) te ukupan broj primijenjenih transfuzija koncentrata eritrocita (s 92 na 36; P=0.009). Incidencija NEK-a koji je zahtijevao kiruršku intervenciju, vrijeme do uspostave potpunog enteralnog unosa i učestalost dojenja se nisu značajno mijenjali. ----- ZAKLJUČAK: Promjene prakse poboljšale su ishode liječene nedonoščadi tijekom vremena, što se ogleda u značajno manjem pobolijevanju u gotovo svim morbiditetnim kategorijama. Primjena nCPAP-a kao primarne respiratorne potpore i bolja kontrola gubitaka krvi zbog laboratorijskog uzorkovanja smanjile su incidenciju komorbiditeta i skratile vrijeme liječenja.
Keywords
very low birth weight infants
respiratory support
red blood cell transfusion
bronchopulmonary dysplasia
intraventricular hemorrhage
retinopathy of prematurity
Keywords (croatian)
nedonoščad vrlo male rodne mase
respiratorna potpora
transfuzija eritrocita
bronhopulmonalna displazija
intraventrikularno krvarenje
retinopatija nedonoščadi
Language english URN:NBN urn:nbn:hr:105:207208 Study programme Title: Medicine (in English language) Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2019-04-29 12:11:36
