IMPROVING THE QUALITY OF CARE FOR INFANTS: A CLUSTER RANDOMIZED CONTROLLED TRIAL
Lee SK, Aziz K, Singhal N, et al. CMAJ. 2009;181(8):469-476.
A prospective cluster randomized controlled trial was conducted to evaluate the efficacy of the Evidence-Based Practice for Improving Quality method to reduce nosocomial infection and bronchopulmonary dysplasia among infants admitted to Canadian Neonatal Network hospitals.
There were 12 hospitals that participated in the study over a 36-month period. Infants from neonatal intensive care units were assigned to 1 of 3 groups: (1) infection group, (2) pulmonary group, and (3) comparison group. Practice changes were implemented in the infection group and pulmonary group through the use of evidence from the literature, data from participating hospitals regarding practices, and the use of a national network.
In the infection group, there was a significant decrease in the incidence of nosocomial infections from baseline to last quarter (P < .01). In the pulmonary group, there was a significant decrease in bronchopulmonary dysplasia from baseline to last quarter (P < .01). There was also a significant decrease in nosocomial infection in the pulmonary group from baseline to last quarter (P < .01).
The researchers note the Evidence-Based Practice for Improving Quality method has shown to be effective in reducing nosocomial infection and bronchopulmonary dysplasia in neonatal intensive care units. They add that this method may be generalizable to other areas of healthcare.
A SCORING SYSTEM FOR EARLY PROGNOSTIC ASSESSMENT AFTER NEONATAL SEIZURES
Pisani F, Sist L. Pediatrics. 2009;124:e580-e587.
This instrumentation development study was designed to create and test and scoring system to aid in predicting neurological outcome at onset of neonatal seizures.
A total of 70 newborns with neonatal seizures admitted to the neonatal intensive care unit at a university hospital in Italy were prospectively followed up, with neurological outcome assessment at age 24 months. A retrospective analysis was conducted on this group to determine 6 important variables to include as risk factors for adverse outcomes for a scoring system: birth weight, Apgar score at 1 minute, neurological exam at onset of seizure, cerebral ultrasound, efficacy of anticonvulsants, and presence of status epilepticus.
A scoring system was developed in which each of the 6 variables was scored from 0 to 3, representing a range of "normal" to "severely abnormal." A total score was computed by adding each variable raw score, thus ranging from 0 to 12. It was determined that a cutoff score of 4 or greater provided the greatest sensitivity and specificity as a prognostic indicator of an unfavorable outcome.
Researchers emphasize the scoring system should not be used in decisions regarding discontinuation of care. Rather, it can be implemented as a simple, useful tool for neonatologists to guide treatment and follow-up of neonates with seizures.