EVALUATION OF TRANSCUTANEOUS BILIRUBINOMETRY IN PRETERM NEONATES
Schmidt ET, Wheeler CA, Jackson GI, Engle WD. J Perinatol. 2009:1-6.
The purpose of this correlational study was to determine the accuracy and precision of transcutaneous bilirubin (TcB) measurements in preterm infants in comparison to total serum bilirubin (TSB).
Because jaundice is a potential problem in preterm neonates, it is necessary to monitor bilirubin levels of susceptible patients. Because TSB requires blood draws, which may be painful, the researchers posit it would be beneficial to have an alternate method for monitoring bilirubin levels.
A total of 90 infants in a neonatal intensive care unit were divided into 3 groups based on gestational age. The researchers discovered that agreement between TcB and TSB was comparable among the 3 groups, with a tendency for the TcB result to underestimate the TSB value. This underestimation tended to be less at higher bilirubin levels, when therapeutic interventions would be more likely to be initiated.
The researchers conclude that there is acceptable precision and agreement between TcB and TSB. This use of TcB may decrease the number of painful blood draws needed for some neonates, particularly those more mature neonates who have less frequently scheduled blood draws.
VENTILATOR-ASSOCIATED PNEUMONIA IN THE PEDIATRIC INTENSIVE CARE UNIT: CHARACTERIZING THE PROBLEM AND IMPLEMENTING A SUSTAINABLE SOLUTION
Bigham MT, Amato R, Bondurrant P, et al. J Pediatric. 2009;154:582-587.
A pretest/posttest design was used to examine ventilator-associated pneumonia (VAP) rates before and after a pediatric VAP prevention bundle was implemented in a 25-bed pediatric intensive care unit.
A multidisciplinary task force at a pediatric academic hospital developed a pediatric-specific VAP bundle. Implementation of each element of the bundle was led by a pediatric intensive care unit respiratory therapist. Staff were educated regarding implementation of the bundle.
The infection rate per 1000 mechanically ventilated days at baseline (rate = 5.6) decreased during the post-implementation phase (rate = 0.3; P < .0001). Similarly, the number of infections per 1,000 mechanically ventilated days was 5.6% at baseline and 0.3% after implementation (P < .0001).
Researchers conclude that a multidisciplinary quality improvement team can implement a sustainable pediatric-specific VAP prevention bundle, which can result in a decreased rate of VAP. This can decrease morbidity and mortality for those pediatric patients who require mechanical ventilation.