Thursday, January 20, 2022
#190 Genetic associations with preeclampsia, intrauterine growth restriction, and spontaneous preterm birth
AL Baranoff1*
A Paquette1,2
1Seattle Children’s Research Institute, Seattle, WA
2University of Washington School of Medicine, Seattle, WA
Purpose of Study
Pregnancy-related conditions are attributable to a combination of factors and may increase one’s risk for later disease. Three of the most common conditions are preeclampsia (PE), intrauterine growth restriction (IUGR), and spontaneous preterm birth/delivery (SPTB/SPTD). The genetic basis of these conditions is illustrated through the findings that women who experience SPTB/D are at increased risk of subsequent SPTB/D of the same gestational age, and women who experienced PE or IUGR are also more likely to experience these same complications in subsequent pregnancies. We investigated the genetic profiles of each outcome and analyzed which maternal and fetal genomic variants are most associated with multiple pregnancy complications. This knowledge will increase our ability to better treat and/or prevent adverse pregnancy outcomes by identifying persons who may be at higher risk of complications prior to their manifestation in disease.
Methods Used
We conducted a literature review of studies that assessed the association between fetally and/or maternally-based single nucleotide polymorphisms (SNPs) and PE, IUGR, and SPTB/D. We selected genetic variants that were significantly associated with these pregnancy outcomes in an initial candidate gene study, genome-wide association study (GWAS), or summarized in a meta-analysis (MA). The significance of association between SNP and pregnancy outcome was reported at either a study-wide significance level (for GWAS and MA studies) or p < 0.05 for candidate gene studies.
Summary of Results
Our search yielded 103 articles, of which 59 investigated genetic associations in PE, 27 in IUGR, and 18 in SPTB. We identified five variants found in both PE and IUGR: rs1918975, rs10774624, rs3184504, rs4769612, rs1884082 which were in regulatory regions of four genes: FLT1, SERPINA3, MECOM, and SH2B3. We identified no variants found in both IUGR and SPTB. We identified five genes that contained SNPs in both IUGR and SPTB (ADCY5, WNT4, IGF1R, EBF1, IGF1), although none of the SNPs overlapped. No genetic variations or gene profiles were found to be shared amongst all adverse pregnancy outcomes.
Conclusions
We identified five genetic variants associated with both PE and IUGR which correlated to four genes as well as five genes associated with both IUGR and SPTB. Several of these gene variants are also risk factors for the development of diseases that impact health throughout life, such as cardiovascular and kidney disease as well as neurological delay, revealing that adverse pregnancy outcomes and adult disease have shared and complex genetic risk factors. The contribution of the identified shared genetic variants in the pathogenesis of PE, IUGR, and SPTB/D should be the focus of future studies.
#191 Factors associated with hypothermia and hypoglycemia on admission in very low birth weight infants
C Marquez*
K Ramm
Y Shao
NS Nanduri
A Hisey
L Barton
R Ramanathan
M Biniwale
LAC + USC Medical Center, Los Angeles, CA
Purpose of Study
Maintaining temperature and glucose in preterm infants are vital as these abnormalities can predispose them to many undesirable complications in early neonatal period. The present study was conducted to identify the factors associated with hypothermia and hypoglycemia in very low birth weight (VLBW) preterm infants.
Methods Used
The data consisting of VLBW infants born at our hospital was collected retrospectively from 2009 through 2021. Maternal factors, delivery room events and early neonatal morbidities were analyzed against infant’s first temperature and glucose done on admission to NICU. Hypothermia was defined as temperature <36.5 C. Hypoglycemia was defined as blood glucose <45 mg/dl on admission checked by point of care testing. IRB approval was obtained to review the data from electronic medical records. SPSS version 28 statistical software was used to analyze the data.
Summary of Results
From all VLBW infants born during this period 152/642 (23.7%) had temperature below 36.5 C on admission to NICU while 104/652 (15.9%) were diagnosed to have hypoglycemia. Birth weight or gestational age had no impact on either hypothermia or hypoglycemia on NICU admission. Infants needing resuscitation including chest compressions and epinephrine administration were at highest risk for hypothermia. These infants were also noted to have metabolic acidosis and low 5 min apgar scores. Infants presented with hypoglycemia were small for gestational age (37% vs 24% p=0.009). Maternal medical conditions including diabetes did not put these infants at additional risk for hypoglycemia. Hypoglycemia on admission was also associated with additional risk of requiring higher ventilation as well as oxygen requirement in the first 24 hours of NICU stay.
Conclusions
VLBW Infants needing resuscitation in the delivery room are at risk for hypothermia. These infants may present with metabolic acidosis on admission to NICU. Hypoglycemia on admission may predispose VLBW infants for more respiratory support.
#192 The effect of SARS-CoV-2 on the rates of breastfeeding in the newborn nursery
J Wang1*
AF Ahmed2
R Ramanathan2
A Yeh2
1LAC+USC Medical Center/USC, Los Angeles, CA
2LAC+USC Medical Center, Keck School of Medicine of USC, LA, CA
Purpose of Study
Exclusive breastfeeding for the first six months of life is recommended by the American Academy of Pediatrics and the Centers for Disease Control for its benefits to infant immunity, maternal-child bonding, and long-term health. While these benefits are well studied, the SARS-CoV-2 pandemic raises questions about the safety of breastfeeding among SARS-CoV-2-positive mothers. In addition, the pandemic’s effects on hospital staffing, patient-provider facetime, and healthcare access may impact breastfeeding rates. This study aims to explore the effect of the SARS-CoV-2 pandemic on breastfeeding in the newborn nursery.
Methods Used
This is a retrospective cohort study comparing breastfeeding rates between neonates at LAC+USC Medical Center Newborn Nursery from January 2019 to April 2021. We defined the pre-SARS-CoV-2 group as all neonates born prior to April 2020, and the during-SARS-CoV-2 group as those born from April 2020 to April 2021. Maternal data gathered included gravidity and parity, ethnicity, age, mode of delivery, and pregnancy complications. Infant data gathered included gestational age, birth weight, sex, and hyperbilirubinemia requiring intensive phototherapy. Newborns with maternal contraindications to breastfeeding, such as positive toxicology screen, positive HIV status, incarceration, and placement in foster care were excluded. Rates of exclusive breastfeeding and any breastfeeding were calculated for each month within this time period and compared using T-test. P-value less than 0.05 was considered significant.
Summary of Results
Of the 964 newborns screened in the pre-SARS-CoV-2 cohort, 913 were included. Of the 800 screened during-SARS-CoV-2 cohort, 763 newborns were included. There were no significant differences in the demographics between the two cohorts (table 1). We found a 11% decrease in the rate of exclusive breastfeeding (p <0.05) and a 4% decrease in any breastfeeding (p <0.05) during the SARS-CoV-2 period (Image 1).
Maternal and neonatal demographics and characteristics
Breastfeeding rate at LAC+USC medical center before and during SARS-CoV-2
Conclusions
The SARS-CoV-2 pandemic had a negative impact on the rates of both exclusive breastfeeding and any breastfeeding among newborns in the normal nursery from a single center in Los Angeles. These results prompted the creation of a specific task force to counter the detrimental effect of the pandemic on breastfeeding. Prospective studies would be useful in assessing the long-term effects of the SARS-CoV-2 pandemic on breastfeeding rates and associated effects on infant immunity, maternal-child bonding, and long-term health.
#193 Expected growth trends in a large cohort of almost 7000 preterm infants from birth to eighteen years
J Barnard1,2*
A Defante2
J Ryu1,2
1University of California San Diego, La Jolla, CA
2Rady Children’s Hospital San Diego, San Diego, CA
Purpose of Study
Despite numerous studies about the growth of preterm infants (PI) postnatally, there is still no consensus on expected growth rates for PI through childhood. The standard of care is to correct for gestational age (GA) until age two years during which time PI are expected to ‘catch up.’ In addition to correcting for GA, there may be a need to account for growth restriction. There are conflicting studies on whether infants born small for gestational age (SGA) ‘catch up’ by age two years. However, to the best of our knowledge, there are no studies with this cohort size following the growth of SGA PI over 18 years.
Methods Used
This retrospective cohort study of 6916 followed infants born between 23–32 weeks over 18 years. Data was pulled from Rady Children’s Hospital electronic medical record system which includes specialists as well as over 30 general pediatrician offices. Being the main institution for follow up of premature infants in a very large catchment area allowed for longitudinal follow up of a large cohort. Infants were categorized as SGA if their birthweight was ≤ tenth percentile birthweight for their GA, AGA if tenth to ninetieth percentile and LGA if ≥ 90th percentile based on the WHO Fetal Growth Charts. Their weights and BMIs at ages two through 18 years were categorized as below the tenth percentile, between the tenth and ninetieth percentiles and above the ninetieth percentile by CDC standards.
Summary of Results
Using a Chi Squared test, preliminary results show statistically significant differences (p-values all < 0.001) in the counts of PI who are below the tenth percentile, between the tenth and ninetieth percentiles and above the ninetieth percentile by CDC standards at ages two through 18 years based on whether they were born SGA, AGA, or LGA. Those born SGA had more infants remain ‘small’ than those born AGA or LGA. But for all groups, we observed significantly more PI stay ‘small,’ less than the tenth percentile for weight, at ages two through 18 years than expected. This held true for BMI as well for ages two through 18 years for PI born SGA, AGA, or LGA with p-values all <0.001.
Conclusions
As more extremely premature and very low birth weight infants are surviving, there is a need for further assessment of this subpopulation’s expected postnatal growth. The observed distribution of PI over two through 18 years differed significantly by their size at birth. Infants born SGA may continue below the tenth percentile for weight for several years and this may not be ‘abnormal’ growth for them. These infants may be seen by various specialists for failure to thrive but might just need different standards. This study validates the need for different expectations of growth for infants born growth-restricted and very premature.
#194 General movement assessments in the surgical gastrointestinal neonatal population
S Bell
S Espinosa*
K Kesavan
KL Calkins
University of California Los Angeles, Los Angeles, CA
Purpose of Study
Infants with gastrointestinal disorders (GD) have increased survivorship with advances in neonatal medicine and surgery. GD infants are at risk for neurodevelopmental impairment; they require surgery and are at high risk for sepsis, growth failure, and prolonged hospital stays. There is evidence that the General Movement Assessment (GMA) is an early biomarker of motor delays, including cerebral palsy. Most studies have focused on extremely low birth weight infants (ELBWs) and have neglected GD infants.
Methods Used
In this retrospective single-site study, GD infants (i.e, gastroschisis, omphalocele, atresias) who underwent surgery within the first 90 days of life were compared to ELBWs (2/20/18 – 5/01/2021). The primary outcome was GMA results during the writhing stage at 36–49 weeks corrected gestational age (normal or abnormal (poor repertoire (PR), cramped synchronous (CS), or chaotic)) and fidgety stage at 3–4 months corrected gestational age (normal or abnormal). Abnormal fidgety was defined as fidgety movements that were not observed or movements that have exaggerated amplitude, speed, or jerkiness.
Summary of Results
There were 55 GD infants; 31 (56%) had at least one GMA. There were 33 ELBWs; 28 (85%) with one GMA. Gestational age and birth weight were significantly different when the cohorts were compared. However, the number of surgeries were similar (1.5 (0.8) vs. 1.7 (0.9), p=0.3) for the GD an ELBW cohort, respectively (table 1). Of the GD infants, 60% had an abnormal writhing stage GMA (0% CS, 60% PR) and 20% had an abnormal fidgety stage GMA. Of the ELBW infants, 35% had abnormal writhing stage GMA (15% CS, 20% PR) and 22% had an abnormal fidgety stage GMA. Rates for abnormal GMAs were similar when the groups were compared (p= 0.1, 0.9).
Characteristics of GD and ELBW infants
Conclusions
In this study, GD and ELBW infants were at high risk for abnormal GMAs. GMAs maybe a helpful tool to ensure that GD infants receive long-term follow-up and resources required to reach their developmental potential. Further longitudinal research is required to determine the accuracy of GMAs in the GD population.
#195 Abnormal blood gas and oxygen requirements in first 24 hours of life as indicators of morbidity in very low birth weight infants
NS Nanduri1,2*
A Hisey1,3
Y Shao1
K Ramm1
L Barton1
R Ramanathan1
M Biniwale1
1Los Angeles County University of Southern California Medical Center, Los Angeles, CA
2Drexel University College of Medicine, Philadelphia, PA
3Loyola University Chicago Stritch School of Medicine, Maywood, IL
Purpose of Study
Oxygen requirement as well as abnormal blood gas values have often been used as indicators of morbidity in the premature neonate, however, there is mixed evidence regarding its utility to predict short and long term morbidity. This study aims to assess the impact of abnormal pCO2, pH, and FiO2 values in the first 24 hours of life of very low birth weight (VLBW) infants on short and long term outcomes.
Methods Used
Data on all VLBW infants was retrospectively gathered from the electronic medical record between the years of 2009 and 2021. IRB approval was obtained prior. For blood gas levels, significance was calculated based on pH of 7.15 and CO2 of 50 mm Hg. FiO2 was considered significant if the infant required 50% in the first 24 hours of life. Each category was statistically analyzed against common neonatal outcomes including intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP).
Summary of Results
Of 564 VLBW infants studied 46.6% had an abnormal pCO2 and 53.4% had a normal pCO2. 78.7% of these infants had an abnormal pH and 19.5% had a normal pH. 87.2% had a normal FiO2 and 12.8% had an abnormal FiO2. Infants with elevated pCO2, decreased pH, and high FiO2 were significantly more likely to need intubation in the delivery room, emergently, remained intubated at 24 hours and had significantly higher days of invasive mechanical ventilation (table 1). These infants were more likely to need surfactant and had higher mortality (table 1). Lastly, these infants were at increased risk of IVH and ROP (table 1). BPD was correlated with higher FiO2 as well as low pH. Neonates with abnormal FiO2 also showed an increased risk for having abnormal MRI before discharge (51.6% vs 69.0% p = 0.034).
Conclusions
Abnormal blood gas and higher FiO2 in the first 24 hours of life is associated with increased need for intubation as well as invasive mechanical ventilation in the delivery room and NICU. VLBW infants showed increased likelihood of developing long term complications including BPD, severe IVH, and severe ROP.
#196 Intubation in the first 24 hours as an indicator of neonatal morbidity
N Nanduri1*
A Hisey1,2
Y Shao1
K Ramm1
C Marquez1
L Barton1
R Ramanathan1
M Biniwale1
1Los Angeles County University of Southern California Medical Center, Los Angeles, CA
2Loyola University Chicago Stritch School of Medicine, Maywood, IL
Purpose of Study
Delivery room intubation in the premature neonate has been previously correlated with an increased risk for neonatal morbidities such as bronchopulmonary dysplasia (BPD). Invasive ventilation for longer duration also puts these infants at similar risk . This study further assessed relationships between infants needing invasive ventilation at 24 hours of life and short term neonatal outcomes.
Methods Used
Retrospective data of preterm VLBW infants born between 2009 and 2021 at LAC + USC Medical Center was evaluated for invasive ventilation at 24 hours of life and common neonatal morbidities. Institutional IRB approval was obtained. Maternal factors, delivery room interventions and standard neonatal outcomes were analyzed.
Summary of Results
Out of the 313 infants meeting inclusion criteria, 136 (43.5%) required invasive ventilation beyond 24 hours of life. Infants born to mothers with histologic chorioamnionitis were more likely to need invasive respiratory support at 24 hours. These infants had lower birth weight as well as lower gestational age. Resuscitation in the delivery room including intubation and chest compressions were also strongly correlated. These infants had a higher incidence of patent ductus arteriosus (PDA) as well as severe intraventricular hemorrhage (IVH). Bronchopulmonary dysplasia (BPD), severe retinopathy of prematurity (ROP) and MRI abnormalities by term gestation were also more often seen.
Factors associated with intubation at 24 hours
Conclusions
VLBW infants who had invasive ventilation in the first 24 hours of life were more likely to have BPD, PDA, abnormal brain MRIs, and severe ROP during their NICU stay.
#197 Characterizing risk factors and investigating testing at birth for congenital hepatitis C virus infection
H Ko1*
M Dodd2
T Borunda2
K Page1
I Cervantes3
J Maxwell1
RO Castillo1
1University of New Mexico Health Sciences Center, Albuquerque, NM
2Rhodes Group, Albuquerque, NM
3University of New Mexico School of Medicine, Albuquerque, NM
Purpose of Study
Hepatitis C virus (HCV) is the leading cause of blood-borne infection globally with an associated increase from the ongoing opioid epidemic. Current recommendations call for antibody screening of HCV-exposed infants after 18 months of age or RNA testing after 2 months of age, however, studies have shown low compliance. We hypothesize that many women with HCV do not receive appropriate screening during pregnancy resulting in gaps in infant care. We seek to identify factors associated with suboptimal pediatric HCV screening that could improve screening and subsequent treatment in perinatally exposed and chronically infected children.
Methods Used
A retrospective chart review was completed using data obtained by Tricore Laboratories. The data assessed the yearly proportion of HCV in pregnant women who were tested from 2014–2019 at our institution, characterize their demographic and health information, and identify their infants and HCV testing status. Demographics of mothers and infants with HCV testing were compared to those without testing to determine if certain demographics portend a greater probability of follow up care for infants with possible congenital HCV infection.
Summary of Results
From 2014–2019, a total of 14,709 women delivered at our institution with 63% (n=9,310) receiving HCV testing. Of these women, 139 (1.5%) were antibody positive; 107 mother-infant pairs were included in our analysis. Only 29 infants (27%) had antibody testing and 4 infants (3.7%) received viral load testing. One child was found to be antibody and viral load positive. The majority of these infants (n=81) were discharged to their birth parent from the nursery or neonatal ICU regardless of testing status. Mean infant gestational age, mothers’ gravida/parity, liver enzyme levels, time between initial positivity of the mother and birth of infant, and maternal viral load at prenatal care onset did not differ significantly between the infant groups. However, urine positivity for opioid replacement therapy (ORT; methadone or buprenorphine) appeared to approach significance (p=0.08) for mothers whose infants were tested. Maternal and infant ALT levels showed a 0.34 correlation.
Conclusions
Mothers receiving ORT were more likely to have infant testing completed. This could be partly due to involvement of these mothers in programs which subsequently screen their infants. Additionally, a correlation between maternal and infant ALT levels seemed to exist however it is known that LFTs can fluctuate in those with HCV and in newborns. Thus, we are unable to conclude that this finding was clinically significant especially given the small number of infants who had LFT testing.
#198 Paid family leave and very low birthweight infant health outcomes
J Feister1*
H Lee1
L Greenberg2
M Parker3
M Rossin-Slater4
E Edwards2
1Lucile Salter Packard Children’s Hospital at Stanford, Palo Alto, CA
2Vermont Oxford Network, Burlington, VT
3Boston University School of Medicine, Boston, MA
4Stanford University, Stanford, CA
Purpose of Study
Paid family leave (PFL) is associated with improved infant health, potentially through increased breastfeeding. Little is known regarding the effects of PFL on very low birthweight (VLBW) infants, a population in which human breast milk (HBM) is critical. California (CA) was the first state to implement PFL in 2004. The primary aim of this study was to determine the impact of California’s PFL program on use of HBM at discharge, necrotizing enterocolitis (NEC), and in-hospital mortality in VLBW infants.
Methods Used
We conducted a quasi-experimental study by employing a difference-in-differences design using data from Vermont Oxford Network. PFL was defined as the intervention with CA as the exposed group and the rest of the Western U.S. (WUS) as the unexposed group . Singleton infants with birthweight <1500g cared for at VON participant hospitals in CA & rest of the WUS from 2001–2010 were included. Infants with early mortality or congenital anomalies were excluded. Relative risk (RR) and adjusted RR (aRR) of each outcome for infants born pre 2004 and post 2004 (the year of PFL implementation) were calculated using multivariate regression models, controlling for maternal race/ethnicity, birthweight, mode of delivery, and antenatal steroids. Trends pre/post PFL in CA vs. the WUS were compared to identify the effect of PFL on the outcomes of interest.
Summary of Results
Of 41,633 infants who met inclusion criteria, both CA and WUS infants were more likely to receive HBM at discharge post vs pre PFL enactment in CA (CA RR 1.19 [95% CI 1.15–1.23], aRR 1.17 [1.11–1.24]); WUS RR 1.03 [0.99–1.07], aRR 1.04 [0.98–1.10]). Both groups had higher incidence of NEC post vs pre PFL (CA RR 1.32 [1.18–1.47], aRR 1.29 [1.15–1.45]); WUS RR 1.43 [1.25–1.64], aRR 1.43 [1.24–1.64]). Incidence of NEC was lower in CA compared to WUS throughout the study period. There were no significant differences in mortality in either group pre vs post PFL. There was a trend of increasing use of HBM at discharge in CA but not WUS both pre and post PFL. Trends in NEC and mortality did not differ between CA and WUS. Overall, no statistically significant effect of PFL on the outcomes of interest was found when comparing difference in differences.
Conclusions
Implementation of PFL legislation in CA did not have a clear, significant impact on use of HBM at discharge, NEC, and mortality in VLBW infants. Inadequate duration or utilization of PFL may account for the lack of observed impact. PFL may also not be sufficient for families who spend long periods for NICU hospitalizations. Further research investigating individual level effects of PFL on VLBW infants and patterns of PFL utilization by families with infants in the NICU is warranted.
#199 Telemedicine exposure and training in neonatal-perinatal medicine fellowship programs: a national survey of fellowship directors
J Rajkumar1*
K Lund2
T Hyunh1
A Hoffman1
W Lapcharoensap1
1Oregon Health and Science University, Portland, OR
2University of Utah Health, Salt Lake City, UT
Purpose of Study
To describe the prevalence of Neonatal-Perinatal Medicine (NPM) fellow exposure to telemedicine, and the amount and type of telemedicine training fellows receive.
Methods Used
This study is a cross-sectional national survey of NPM fellowship training program directors. The survey was distributed electronically via the Organization of Neonatal-Perinatal Medicine Training Program Directors (ONTPD) listserv and answers were collected using Qualtrics.
Summary of Results
21 individuals responded to the survey with 18 total completed surveys. 8 (47.37%) programs had a neonatal telemedicine program. Of these, the types of consultation offered (number of programs in parentheses) included general neonatal consults (7), resuscitation guidance (3), counseling for fetal conditions or anomalies (4), perinatal viability counseling (3), remote rounding (1), and NICU follow-up (2). One program noted during the COVID pandemic, intrahospital consultations, rounds and parental visitation were being conducted via telemedicine. NPM fellows conducted the telemedicine consultations in 3 programs (37.5%). One program started fellow consultations during the first year, and two started in the second year. One program provided real-time fellow oversight by an attending during the first year of training and the other 2 indicated none was required. No programs had specific training or curriculum for fellows conducting telemedicine consultations. The overall perception of telemedicine and fellowship telemedicine training is described in table 1. Programs were generally in agreement that telemedicine is important in modern NICU practice, that fellows would likely encounter it in their careers, and that telemedicine training should be provided during fellowship.
Perception of telemedicine and fellow telemedicine training
Conclusions
Telemedicine has a rapidly expanding presence in neonatology. There appears to be minimal involvement of fellows throughout NPM fellowship programs. Further studies describing fellowship telemedicine training (including platform capabilities, demonstration of proficiency, communication techniques, documentation, medicolegal aspects, and simulated encounters) as well as the impact of such training on telemedicine program effectiveness are needed. Furthermore, development of expectations and curricula for telemedicine education in NPM fellowship should be standardized and widely adopted.
#200 Infant and maternal factors associated with developing necrotizing enterocolitis in very low birth weight infants
MA Sacks1*
YS Mendez1
FA Khan1
G Gollin2
A Radulescu1
1Loma Linda University Adventist Health Sciences Center, Loma Linda, CA
2Rady Children’s Hospital San Diego, San Diego, CA
Purpose of Study
The purpose of this study was to understand the relationship between maternal and infant risk factors associated with developing necrotizing enterocolitis in premature infants.
Methods Used
Following Institutional Review Board (IRB) approval (#5190190), this prospective study was performed at two large academic Neonatal Intensive Care Units (NICU) in southern California. Our recruitment targeted mothers of very low birth weight infants(<1500 grams). After informed consent, they completed a questionnaire including demographics, health, substance usage and socioeconomic status. The infant data was collected from birth until NICU discharge and monitored if the development of NEC.
Descriptive statistics and quatitative analysis were performed as appropiate. P values <0.05 were considered statistically significant.
Summary of Results
Seventy infants were enrolled: 37(57.9%) male and 33(47.1%) female. Only 12(17.1%) developed NEC ≥ Bell stage 2. NEC infants had a lower gestational age than infants without NEC 25.9 vs. 29.0 weeks (*p<0.05), and lower birth weight at 752.8 vs. 1082.3 grams (*p<0.05). There were no significant differences in mechanical ventilation, vasopressors, intracranial hemorrhage, infection, or feed initiation.
Mothers of NEC infants reported, on average, more overall stressors 1.5 vs 0.5 and specifically more emotional stressors 10/12 (83.3%) vs. 20/58 (35.7%) during pregnancy (*p<0.05) (table 1). Other maternal factors were not significantly associated with NEC: age at conception, pregnancy complications, smoking history, alcohol and drug usage, household income, education level, first born child and family history of prematurity.
Conclusions
Very low birth weight infants (<1500 grams) with necrotizing enterocolitis (NEC) were smaller and born earlier. Our findings suggest that specifically emotional stressors and overall number of maternal stressors during pregnancy may be risk factors for developing necrotizing enterocolitis.
#201 Evaluating the effects of breastfeeding versus bottle feeding on the preterm infants’ microbiome and metabolome
K Schulkers Escalante1,2*
SS Bai-Tong1,2
M Thoemmes1
K Weldon1
S Hansen1
D Motazavi1,2
J Kitsen1,2
S Jin Song1
J Gilbert1
P Dorrestein1
R Knight1
S Leibel1,2
SL Leibel1,2
1University of California San Diego, La Jolla, CA
2Rady Children’s Hospital San Diego, San Diego, CA
Purpose of Study
Breast milk provides numerous benefits to preterm infants including decreasing the risk of necrotizing enterocolitis and sepsis. Providing breast milk via direct breastfeeding versus a bottle has been shown to improve long term outcomes in term infants. As preterm infants transition from tube to oral feeds, the impact of the route of oral feeds on the infants’ microbiome and metabolome is unknown. The purpose of this study is to determine if direct breastfeeding changes the preterm infants’ oral and gut microbiome and metabolome versus exclusive bottle feeding.
Methods Used
This study proposes using stool, saliva and milk samples collected from a cohort of preterm infants from the study: ‘The Association Between Milk Feedings, the Microbiome and Risk of Atopic Disease in the Preterm Population (MAP) Study’ (NCT04835935). This study recruited 46 babies <34 weeks gestational age. Their clinical data was collected as well as weekly samples of their milk feeds, saliva and stool until discharge. Stool samples were analyzed for microbiome and metabolomic profiles in a subcohort of 18 infants. For each subject, 3 longitudinal stool samples were analyzed (at birth, 2 weeks of age, and 4–6 weeks of age). Fifty-four stool samples, including 18 meconium samples, were analyzed. Metabolites were analyzed by untargeted gas chromatography-mass spectrometry and Kruskal-Wallis H test was used for statistical analysis. Bacterial compositions were analyzed by shotgun metogenomic. Differences in bacterial community composition were compared using a permutational multivariate analysis of variance (PERMANOVA).
Summary of Results
Forty-two (91%) infants experienced at least one episode of breastfeeding during their NICU stay. Only 17 infants (40%) were discharged home primarily receiving maternal breast milk. Analysis of the 54 stool samples showed there was a strong differentiation in bacterial community composition after the initiation of bottle (p = 0.014) and breast feeding (p = 0.014). This indicated changes to the stool microbiome at the onset of oral feeding following full enteral feeds via a nasogastric tube based on shotgun analysis. Metabolomic analysis showed a trend toward differentiation in the stool after initiation of bottle feeds (p = 0.07) but did not show significant difference after the initiation of breastfeeding (p = 0.31).
Conclusions
While analysis of stool samples has demonstrated microbiome and metabolomic changes after the initiation of breast versus bottle feeds in a subcohort of preterm infants, the future direction is to analyze all of the stool, saliva and breast milk samples for distinct microbiome and metabolome signatures of preterm infants who were exclusively bottle fed versus breastfed.
#202 Variations in parent participation in nursing care sessions in the NICU by medicaid status
S Takamatsu*
AM Cunningham
J Dempsey
J Kelleher
AG Dempsey
University of Colorado – Anschutz Medical Campus, Aurora, CO
Purpose of Study
Parents are faced with the challenge of navigating other external responsibilities (e.g., parenting of other children, work) while their infant is hospitalized in the NICU. Families may have financial barriers impacting stability of housing, childcare, and transportation. As a result, increasing and stabilizing engagement is a common research interest, as it is influential in skill development and caregiver efficacy. Cares sessions with nursing occur in the NICU throughout the day, offering a structured time to observe and partake in the care of the infant. Participation in cares lends itself to demonstration of skills, explanation of care, and can be helpful for parents to feel competent interacting and caring for their baby. The present study collected data on the frequency of parents’ attendance of cares sessions in the NICU. To begin to understand differences in potential social barriers to engagement, differences were compared based on mother’s Medicaid status.
Methods Used
Our sample included 122 premature infants in the NICU who were part of a larger quality improvement study to enhance family engagement. Attendance of four or more cares sessions with nursing per seven days was set as the target goal. Bedside nurses entered data into the infant’s medical record. A X2 test was performed to detect a difference in goal attainment by Medicaid status.
Summary of Results
A X2 test of independence showed the relation between these variables (e.g., goal attainment and Medicaid status) was significant, X2 (1, N = 122) = 21.5, p = .000. Infants with mothers with commercial insurance were more likely than infants with mothers with Medicaid to attend 4 or more cares sessions per week.
Difference in goal attainment by mediciad status
Conclusions
The data show a difference in participation in cares sessions at least 4 times per week or more when compared by insurance status of the mother, a proxy of socioeconomic status. Further exploration is needed to fully understand barriers to parental engagement. Assessment of potentially related factors to Medicaid status (e.g., other family demands, distance from hospital, transportation difficulties) is recommended. The findings highlight the need for NICU providers to be cognizant of social determinants to bedside engagement and consider virtual options for parents to engage in care.
#203 Prevalence of neonatal intesnive care unit admisison among patients with genetic testing
SB Zoucha*
J Jensen
JL Bonkowsky
University of Utah Health, Salt Lake City, UT
Purpose of Study
Genetic disease is estimated to affect many critically ill neonates, but an unbiased determination of genetic disease prevalence in Neonatal Intensive Care Units (NICU) has been unclear. Since rapid and extensive genetic testing is increasingly available and practical and can impact outcomes, there is a need for identifying best clinical practices for genetic testing use. We hypothesized that a history of NICU admission is more common in patients with known or presumed genetic disease; and that neonatal NICU characteristics can guide best use of genetic testing.
Methods Used
We performed a retrospective population-based cohort analysis of children on whom genetic testing was performed at a tertiary children’s hospital. The hospital and specialists are the only providers of pediatric sub-specialty care in a 500-mile radius. We analyzed the cohort for a history of NICU admission, and clinical characteristics of the admission. We identified 3894 patients with a history of genetic testing with birthdates between 1/1/09 and 6/1/21 to identify a final cohort of 1611 patients.
Summary of Results
Of this cohort, 132 patients with a history of NICU admissions were identified (8.2% of the cohort). Of patients with a history of NICU admission; 36% had a positive (diagnostic) genetic test result, 30% had a negative test, and 34% had an uncertain (VUS) result. Compared to children without a history of NICU admission; 38% had a positive test result, 26% negative, and 36% uncertain; differences between these groups was not significant (p 0.34). The age at testing was lower in those with a history of NICU admission (3.4 years vs 4.6 years; p < 0.001).
Conclusions
Our study suggests that a genetic condition is present in a minority of children with a history of NICU admission. Further work into clinical characteristics of NICU children in whom genetic diagnoses are considered will help prioritize use of genetic testing.
#204 What is the evidence for an association between first trimester vaginal microbiota abnormalities and preterm birth?
N Holden1*
N Field2
1Western University of Health Sciences, Pomona, CA
2University College London, London, UK
Purpose of Study
Contemporary research has increasingly explored the possibility that preterm births (PTBs), the livebirth of babies prior to 37 weeks of completed pregnancy, are associated with first trimester vaginal microbiota abnormalities; yet the association between the two remains unclear.
Methods Used
A systematic literature review was conducted to assess current evidence for the role of first trimester vaginal microbiota abnormalities driving PTBs. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 guidelines, scientific databases, including Medline, Embase, and the Maternity & Infant Care Database (MIDIRS), were searched from January 2009 to March 2019. The search terms used were (vagina* microb* OR vagina* bacteria OR vagina* flora OR vagina* microflora* OR vaginal dysbiosis OR bacterial vaginosis) AND (preterm OR pre term OR premature OR early term OR early birth). Details on population/sample, study design, method of microbiota determination, measures of microbiota associations with PTBs, and Lactobacillus prevalence were extracted.
Summary of Results
Thirteen studies (nine cohort, four randomized control trial) were included in the review. The results provided strong evidence for an association between abnormal first trimester vaginal microbiota and PTBs. Specifically, low-Lactobacillus, high-diversity microbial econiches were found to be associated with an increased likelihood of PTB outcomes. Notably, two studies reported contradictory findings showing a negative association between first trimester AVF and PTBs, and three studies reported no significant association. Possible explanations for the negative association reported in Farr et al., 2015 include regional bias and inclusion of women with chronic conditions. Selection bias was also of concern in Koumans et al., 2010, which also reported a negative association, as participant recruitment was not randomized, possibly shifting the baseline health demographic of recruited women. No definite taxa-specific trends associated with PTB were identified; however, different studies reported Mycoplasma and Ureaplasma parvum increase the odds of PTB manifestation.
Conclusions
Associations were largely consistent and strong, suggesting vaginal flora measurements might hold the potential to enable early prediction of PTBs. It is important to note that causality and a biological mechanism for AVF-associated PTBs is not yet proven, with more research being recommended.
#205 Implementing screening for neonatal delirium in the NICU at rady children’s hospital
M Karmarkar1,2*
M Speziale2
W Jenkins2
D Heath2
J Kang2
J Suvak2
P Grimm2
L Moyer2
1University of California San Diego, La Jolla, CA
2Rady Children’s Hospital San Diego, San Diego, CA
Purpose of Study
Delirium is defined as fluctuating changes in awareness and cognition occurring in the setting of a medical illness, and is associated with adverse neurodevelopmental outcomes. Although delirium is recognized in pediatric ICUs, it is not commonly diagnosed in the neonatal population. The NICU at Rady Children’s Hospital is comprised of medically complex patients that are often on multiple medications for pain and sedation. Early recognition and treatment of delirium in the NICU may be helpful in improving clinical outcomes. We conducted a QI project to implement screening for neonatal delirium in high-risk patients. Our objective is to increase delirium screening (RASS/CAPD scores) from 0% to 85% in eligible NICU patients by 10/2021. Inclusion criteria are defined as NICU patients > or = 38 weeks corrected gestational age who are mechanically ventilated > 7 days and who are receiving any sedatives or opiates.
Methods Used
Multiple interdisciplinary meetings were initiated with key stakeholders to develop an algorithm for the evaluation of neonatal delirium. Completion of the RASS (Richmond Agitation and Sedation Scale) and age-adjusted CAPD (Cornell Assessment of Pediatric Delirium) scores were used as the objective tool for delirium screening. Weekly nursing compliance with RASS/CAPD score documentation (figure 1) is the primary process measure. Outcome measures include child psychiatry consultations and a diagnosis of delirium.
Summary of Results
Implementation of screening and data collection began in October 2020. After implementation, data from 10/2020 through 2/2021 showed an average weekly screening compliance of 76%. Our data shows a sustained shift with an average compliance of 88%, placing us above our goal of 85% compliance. Targeted future interventions to sustain our goal include: creation of an order set in the medical record and required documentation.
Conclusions
Through this QI project, we have increased awareness of neonatal delirium as a diagnosis in our NICU. Our expectation is that early recognition of delirium in our chronic patients will lead to more timely management of symptoms and decreased use of narcotic and sedative medications. This early recognition will be important to these patients’ overall recovery.
#206 Improving electrolyte and mineral homestasis in extremely premature infants
S Markee
J Fuller
A Yaroslaski*
E Shenk
J Maxwell
University of New Mexico Hospital, Albuquerque, NM
Purpose of Study
Infants ≤ 28 weeks gestational age (GA) are at increased risk for developing electrolyte and mineral abnormalities due to reduced baseline bone mineral content. ~80% of fetal calcium stores are obtained in the third trimester and ~54% of extremely preterm infants have metabolic bone disease. These infants rely heavily on early parenteral nutrition (PN) to provide appropriate electrolytes, but there is limited evidence on how to optimize calcium and phosphorus. Our primary outcome is to improve calcium and phosphorus by day of life (DOL) 7 in infants ≤ 28 weeks GA.
Methods Used
This Quality Improvement project is currently in the fourth Plan-Do-Study-Act (PDSA) cycle. We reviewed electrolyte and PN data in infants ≤ 28 weeks GA in 2019 (cohort 0; n=16). In March 2020, we obtained daily serum calcium and phosphorus levels in infants ≤ 28 weeks GA during the first postnatal week (n=13). Upon review, a custom PN form was designed for the next cohort (n=9), introducing calcium and phosphorus in PN earlier. In our third PDSA cycle we implemented new stock fluids, which included calcium gluconate 0.5 mEq/dL, dextrose, and amino acids for immediate use following birth for those born ≤ 28 weeks GA (n=10). A comparison was made between all three prospective cohorts. Additionally, serum creatinine and ionized calcium (ical) levels were compared. A Grubb’s analysis was used followed by a student’s t-test.
Summary of Results
Mean serum calcium on DOL1 between cohort 1 and 2 were similar (6.57 ± 0.25 mg/dL and 6.74 ± 0.12 mg/dL, respectively (p=0.6)). In cohort 3, the calcium level was noted to be lower on DOL3 compared to cohort 0, (9.6 ± 0.24 mg/dL and 9.03 ± 0.09 mg/dL, respectively (p=0.08)). Interestingly, mean serum creatinine on DOL1 nearly significantly decreased in cohort 2 (0.76 mg/dL ± 0.05 mg/dL), compared to cohort 1 (0.90 mg/dL ± 0.05 mg/dL), p=0.07. Mean serum creatinine remained < 1 mg/dL throughout the first week of life for infants in cohorts 2 and 3, while it trended higher in cohorts 0 and 1 over the first week of life.
Conclusions
The new PN allowed a more consistent and gradual increase in serum calcium levels, while remaining in normal limits, during the first postnatal week. Additionally, creatinine levels were lower and ical levels remained in goal range, requiring less therapeutic intervention. Addition of calcium gluconate to stock fluids for infants ≤ 28 weeks GA on DOL0, as seen in cohort 3, augmented the improvement and stabilization of serum calcium and creatinine levels. Surprisingly, we have found that although we have been unable to show an improvement in our serum phosphorus for this patient population, we have seen improvement in calcium and creatinine levels in the first postnatal week.
#207 Implementation of a neonatal massive transfusion protocol
H Ko1*
JR Griggs1
J Raval1
T Zamora2
1University of New Mexico Health Sciences Center, Albuquerque, NM
2Regents of the University of Minnesota, Minneapolis, MN
Purpose of Study
A Massive Transfusion Protocol (MTP) is an institutional plan created to facilitate communication, ensure timely lab monitoring and reduce delays/errors when ordering multiple blood products. Though adult and pediatric (MTPs) exist, they are ill-suited for use in the neonatal population. Given the unique nature of neonates, this population could benefit from a neonatal-specific MTP.
Methods Used
A pre-implementation survey was sent out to physicians, nurse practitioners, physician assistants, and nurses in the NICU. A multi-disciplinary team was then put together, involving clinical staff from the NICU, transfusion medicine, and the transfusion committee in order to develop a neonatal-specific MTP.
Summary of Results
Fifty responses were recorded to 5 questions. 64% were aware of MTPs in general. Almost all participants (96%) correctly identified that MTPs were generally used for any patients requiring large blood volume replacements and/or multiple blood products. Forty-six percent responded that they had previously experienced a clinical situation in which there was difficulty obtaining blood products. Of the 46% who experienced difficulty getting blood products, 67% identified that the delay was mostly attributed to waiting for blood products to arrive.
Conclusions
Our multi-disciplinary group collectively developed a neonatal-specific MTP to allow for a safer, timelier, and standardized approach to administering multiple blood products. Massive transfusions are rare but high-risk events in the NICU setting thus this study will hopefully improve patient outcomes related to transfusions. Our pre-implementation survey shows educational and practical barriers exist when attempting to order multiple blood products and further work will need to be done to address these barriers.
#208 Hospital variation in extremely preterm birth
GP Goldstein*
P Kan
C Phibbs
E Main
GM Shaw
H Lee
Stanford University, Stanford, CA
Purpose of Study
To assess between-hospital variation in extremely preterm birth (EPTB) frequency when stratifying by hospital level of care, and determine the proportion of variance explained by differences in maternal and hospital factors.
Methods Used
We assessed 7,072,562 births in California from 1997 to 2011, using hospital discharge, birth and death certificate data. We estimated the association between maternal and hospital factors and EPTB using multivariable regression, calculated hospital-specific EPTB frequencies and estimated between-hospital variances, intra-class coefficients, and median odds ratios stratified by hospital level of care.
Summary of Results
Hospital frequencies of EPTB ranged from 0.01% to 3.0%. Between-hospital EPTB frequencies varied substantially, despite stratifying by hospital level of care and accounting for confounding factors. This variation appeared to be related to differences in a collection of hospital, maternal sociodemographic and medical factors, and other factors not accounted for in our study, such as barriers to maternal transfer prior to delivery.
Hospital frequencies of extremely preterm birth (EPTB) among hospitals with level 1, 2 and 3A NICUs and by hospital rank
Conclusions
Our results demonstrate differences in EPTB frequency among hospitals when stratifying by hospital level of care. Proportion of EPTBs at level 1 and 2 NICUs should be further investigated and considered as a hospital quality measure.
#209 Perceived motivations and barriers of neonatal nurse practitioners in fellow evaluation: a pilot case study
N Dyess*
University of Colorado Denver School of Medicine, Aurora, CO
Purpose of Study
Fellowship programs must provide objective performance evaluations of trainees that are formative and come from multiple evaluators including nonphysicians. The utility of multisource feedback has been well demonstrated in the literature; however, it is difficult to ensure nonphysician staff fill out evaluations. The purpose of this study is to elucidate the neonatal nurse practitioner’s (NNP’s) perceived motivations and barriers to completing fellow evaluations. As a pilot study, an additional purpose was to assess feasibility and refine methods.
The research questions guiding this study are: how do NNPs view their role in the trainee evaluation process, what motivates NNPs to fill out evaluations, what are the self-perceived barriers to evaluations, and how can we increase NNP evaluation of trainees.
Methods Used
I performed a pilot study of a phenomenological, qualitative case study of NNPs at the University of Colorado. A convenience sample of 3 NNPs, selected via purposive sampling, participated in semi-structured, one-on-one interviews to explore the perceived motivations and barriers to evaluating fellows. A constructivist epistemological framework guided the study. The data was viewed through a theoretical framework inspired by Maslow’s motivation theory. Interview transcripts were coded inductively via the constant comparative method and then clustered into emergent themes using phenomenological reduction, horizontalization, imaginative variation, and thematic analysis.
Summary of Results
A conceptual framework emerged from the data, consisting of five themes of driving and restraining forces to completing evaluations which interact in a process akin to a neuronal cell’s action potential. The framework describes the implicit weighing of these forces to determine if a threshold for activation is reached to complete an evaluation. Themes are supported by Maslow’s motivation theory, with each of Maslow’s levels of need equating to a NNP’s level of need for completion of fellow evaluations.
The Fellow Characteristics theme describes how extremes of behavior, repetitive behavior, and a fellow’s value of feedback affect evaluation completion. The NNP-Fellow Relationship theme describes how increased exposure and knowledge of fellow repercussion affect evaluation completion. The Evaluation Characteristics theme illustrates how anonymity, specificity, feasibility, and timeliness affect evaluation completion. The NNP-Evaluation Relationship theme describes how knowledge of evaluator role/value and the evaluation process is critical to evaluation completion. The NNP Characteristics theme describes how alignment with preferred feedback strategies and seniority affect evaluation completion.
Themes of driving and restraining forces and representative quotes
Conclusions
The conceptual framework provides insights into the motivations and barriers to completion of fellow evaluations by NNPs that can inform measures to increase completion rates of trainee evaluations by nonphysicians.
#210 Evaluating a neonatal opioid withdrawal syndrome currriculum to improve care in rural hospitals
J Patel1*
S Sanders2
H Brakey2
T Ozechowski2
A Sussman2
A Kong2
H Pratt-Chavez2
1University of New Mexico School of Medicine, Albuquerque, NM
2University of New Mexico Health Sciences Center, Albuquerque, NM
Purpose of Study
The incidence of neonatal opiate withdrawal syndrome (NOWS) in the US has grown dramatically over the past two decades. Many rural hospitals are not equipped with resources and materials to manage best practices of these patients resulting in transfers to hospitals in bigger cities. The purpose of this study is to evaluate a curriculum we created to support rural hospitals to keep healthy infants with NOWS for observation instead of transferring them.
Methods Used
The curriculum was used for quality improvement at a rural hospital and shared with providers in another state that expressed interest. To evaluate the curriculum, we conducted pre- and post-surveys of NOWS knowledge, attitudes, and care practices, plus post-curriculum interviews and focus groups.
Summary of Results
Fourteen participants completed both pre- and post-curriculum surveys. They indicated an increase in knowledge and care practices, and a decrease in belief that infants with NOWS should be cared for in a critical care environment. Most respondents agreed with positively worded attitude items pre-test and post-test. Although few respondents expressed negative attitudes about mothers of infants with NOWS at pre-test, the training curriculum appeared to have no impact on such attitudes at post-test. Sixteen participants participated in focus groups or interviews. Qualitative data reinforced quantitative results, plus the need to reduce stigma and improve provider/staff interactions with patients.
Conclusions
This curriculum has strong positive impacts on NOWS knowledge and care practices. Incorporating focus on core concepts of trauma-informed care and self-regulation in future iterations of the curriculum may strengthen the opportunity to change attitudes and address the needs expressed by participants and improve care and well-being of families and babies with NOWS.
#211 Effects of postnatal glucocorticoids on brain structure in preterm infants, a scoping review
I Robles*
MA Eidsness
HM Feldman
SE Dubner
Stanford University School of Medicine, Stanford, CA
Purpose of Study
Postnatal GCs (GC) are given for many indications in infants, including for the reduction in incidence and severity of bronchopulmonary dysplasia, a major risk factor for morbidity, mortality, and neurodevelopmental disability in children born preterm. Variation exists in medication, dosing, timing, and reported outcomes. Clinical neurodevelopmental outcomes after GC administration may be due, in part, to GC induced alterations in neonatal brain development. The objective of this scoping review is to identify what is known about the effects of GC treatment on brain structural development in preterm human infants in order to identify potential mechanisms by which GCs may affect later clinical neurodevelopmental outcomes and to identify gaps in the literature.
Methods Used
A search query was developed to search online databases for original research on human infants, GCs, and brain structure. Potential article titles and abstracts were screened by two reviewers to identify papers for full text review.
Summary of Results
6565 titles were identified based on the search query for title and abstract review. Inclusion and Exclusion criteria are shown in the table. 70 were included for full text review. Multiple imaging modalities and outcomes were reported.
Inclusion and exclusion criteria for title and abstract review
Conclusions
GC effects on brain are of interest to a wide audience of researchers across the lifespan and across many clinical conditions. Relatively few human studies have directly assessed the effect of this intervention on early brain structural development. This study highlights the need for additional research on neonatal GCs and their potential effects on brain development.
#212 Does maternal age impact feeding outcomes in preterm infants?
A Patel1*
C Bradley2
1University of California Irvine School of Medicine, Irvine, CA
2University of California Irvine Department of Pediatrics, Irvine, CA
Purpose of Study
For preterm infants in the Neonatal Intensive Care Unit (NICU), successful and safe oral feeding is a requirement for discharge from the hospital. There are a variety of factors that contribute to feeding outcomes as neonates learn to coordinate breathing during oral feeding. While studies have detailed the effects of advanced maternal age on various neonatal morbidities, there is a dearth of literature exploring the association between maternal age and feeding outcomes in neonates. This analysis sought to examine whether a correlation exists between maternal age at delivery and feeding outcomes in preterm infants.
Methods Used
A retrospective chart review was conducted for 12 healthy infants born at less than 37 weeks gestational age who were admitted to the NICU and were transitioning from gavage to bottle feeding. Data was collected on maternal age at delivery, rate of milk transfer (in milliliters per minute), oral feeding performance (in percentage of milliliters taken during the feeding per milliliters prescribed), and feeding proficiency (in percentage of milliliters taken during the first five minutes of the feeding per milliliters prescribed). A correlation matrix was then developed via a linear regression model using these, and other, maternal and infant health factors to assess for possible correlations.
Summary of Results
Maternal age showed a moderately positive correlation with two of the three feeding outcomes studied. The Pearson correlation coefficient (R) for the association between maternal age and feeding performance was +0.66. The R for the association between maternal age and feeding proficiency was +0.48. Maternal age was not associated with rate of milk transfer, with an R of +0.04.
Conclusions
This preliminary analysis shows that increased maternal age may serve as a protective factor for the complex oral feeding process that is challenging for preterm infants due to immature neurodevelopment. Maternal age at delivery may be valuable to consider in studying progression to full oral feeding, and ultimately discharge from the NICU, in this population. While the power of this exploratory study is limited due to small sample size and potential for confounding, this warrants further research that examines the association of maternal age at delivery on various feeding outcome measures.
#213 Wee nuzzle: a quality initiative to promote non-nutritive breast feeding in order to increase breastmilk at discharge for preterm infants in the neonatal intensive care unit
K Schulkers Escalante1,2*
J Barnard1,2
E Clemens1
R Hammer1
C Ritter1
K Ko1
J Wood1
S Freeman1
J Cook1
K Weiss1,2
SL Leibel1,2
1University of California San Diego, La Jolla, CA
2Rady Children’s Hospital San Diego, San Diego, CA
Purpose of Study
Reduced opportunities for preterm infants to practice oral feeding can contribute to issues such as delayed hospital discharge and oral aversion. Furthermore, a lack of opportunity for direct latching may discourage mothers and reduce breastmilk feeding at discharge. The NICU at Jacobs Medical Center, University of California, San Diego has a low rate of non-nutritive breast feeding (NNBF) in preterm infants due to: 1) varying practices and comfort levels, especially for preterm infants on non-invasive respiratory support (NRS), 2) lack of formal guidelines, and 3) NNBF not frequently integrated into medical team’s daily discussions or documented by bedside staff. The goals of this QI project are to support early introduction to the breast to promote latching and ultimately milk transfer, promote maternal-infant bonding, and facilitate early positive oral experiences. Our SMART AIM is to increase eligible preterm infants attempting at least one session of NNBF at least once weekly from a baseline of 0% to ≥ 50% by July 2022.
Methods Used
To support the development of oral feeding skills, called Wee Feeds, in premature infants, a multidisciplinary team was developed that included providers, occupational and respiratory therapists, lactation consultants, nurses, and parents. A new pathway called ‘Wee Nuzzle’ was created as a pre-feeding developmental pathway primarily focusing on promoting breast feeding by encouraging Skin-to-Skin, Milk Drops, and NNBF. Premature infants’ ≥ 30 weeks are included if they are receiving enteral breast milk, are on NRS or room air, and the parent desires to do NNBF. Infants are excluded if they were intubated or within a week of extubation, have an umbilical arterial catheter, and/or have significant congenital or neurological abnormalities making it unsafe to attempt NNBF. Education for NICU staff has occurred at department meetings, nurse staff meetings and huddles, nursing fair skills day, and via multiple emails over the past 6 months. The primary process measure is percentage of eligible infants attempting at least one NNBF session per week. Outcome measures include the number of preterm infants discharged home on breastmilk and time to discharge from start of Wee Nuzzle. Balancing measures include an increase in respiratory support within 24 hours of NNBF without another explanation.
Summary of Results
Implementation of our project is currently ongoing. We plan to measure data monthly and implement PDSA cycles as needed.
Conclusions
The oral feeding pathway, Wee Feeds, has been widely accepted and supported by all levels of staff in our NICU and we hope to gain the same support for Wee Nuzzle. We will continue education, data collection and analysis with the hope to achieve our measures and aims.
