Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of ‘spell-free’ observation on interprovider variability and readmission rates
Objective: To study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on length of stay (LOS) and readmission rates. Study design: A protocol to standardize the duration of in-hospi...
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| Veröffentlicht in: | Journal of perinatology 2018-01, Vol.38 (1), p.86-91 |
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| creator | Chandrasekharan, P Rawat, M Reynolds, A M Phillips, K Lakshminrusimha, S |
| description | Objective:
To study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on length of stay (LOS) and readmission rates.
Study design:
A protocol to standardize the duration of in-hospital observation for preterm infants with apnea, bradycardia and desaturation spells who were otherwise ready for discharge was implemented in December 2013. We evaluated the impact of this protocol on the LOS and readmission rates of very low birth weight infants (VLBW). Data on readmission for apnea and an apparent life-threatening event (ALTE) within 30 days of discharge were collected. The pre-implementation epoch (2011 to 2013) was compared to the post-implementation period (2014 to 2016).
Results:
There were 426 and 368 VLBW discharges before and after initiation of the protocol during 2011 to 2013 and 2014 to 2016, respectively. The LOS did not change with protocol implementation (66±42 vs 64±42 days before and after implementation of the protocol, respectively). Interprovider variability on the duration of observation for apneic spells (
F
–8.8,
P
=0.04) and bradycardia spells (
F
–17.4,
P |
| doi_str_mv | 10.1038/jp.2017.174 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1962432218</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A523707287</galeid><sourcerecordid>A523707287</sourcerecordid><originalsourceid>FETCH-LOGICAL-c489t-d0278b5ceb4afffd10e5f17543425cbbe6c84ac6c75a0eb14e19b13b3cab90dc3</originalsourceid><addsrcrecordid>eNptks9q3DAQxk1pabZpT70XQaEUGm8lW17ZuYXQfxDopT2bkTTKarEtV5IX9pbHaB-lr5MnqZzdhKQEHYTm-83HzGiy7DWjS0bL-uNmXBaUiSUT_Em2YFys8qri5dNsQQUv87rkq6PsRQgbSmdRPM-OioYVlFd0kf09GweEEyI96J0Cry0QGDTRGCBOHqJ1Awkjdl0gdiCjx36OY3oYGGI4JbYfQUXiDIEku-iU64hxnsQ1En1rkeTrq983RrnxiNdXf4iTAf32oA_JMaJPDlur0ZMteAvSdjbubgryCLq3Icxw8sTwMntmoAv46nAfZz8_f_px_jW_-P7l2_nZRa543cRc00LUslIoORhjNKNYGSbSgHhRKSlxpWoOaqVEBRQl48gayUpZKpAN1ao8zt7vfVNpvyYMsU1lqNQHDOim0LJmVfCyKFid0Lf_oRs3-SFVl6i6bsqyST92R11Ch22ao4se1GzanlVFKagoapGo5SNUOhp7q9yAxqb4g4R39xLWCF1cB9dN83jDQ_DDHlTeheDRtKO3Pfhdy2g7b1S7Gdt5o9q0UYl-c-hpkj3qO_Z2hRJwsgdCkoZL9PeafsTvH3Ef2Xo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1988933910</pqid></control><display><type>article</type><title>Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of ‘spell-free’ observation on interprovider variability and readmission rates</title><source>SpringerLink Journals - AutoHoldings</source><creator>Chandrasekharan, P ; Rawat, M ; Reynolds, A M ; Phillips, K ; Lakshminrusimha, S</creator><creatorcontrib>Chandrasekharan, P ; Rawat, M ; Reynolds, A M ; Phillips, K ; Lakshminrusimha, S</creatorcontrib><description>Objective:
To study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on length of stay (LOS) and readmission rates.
Study design:
A protocol to standardize the duration of in-hospital observation for preterm infants with apnea, bradycardia and desaturation spells who were otherwise ready for discharge was implemented in December 2013. We evaluated the impact of this protocol on the LOS and readmission rates of very low birth weight infants (VLBW). Data on readmission for apnea and an apparent life-threatening event (ALTE) within 30 days of discharge were collected. The pre-implementation epoch (2011 to 2013) was compared to the post-implementation period (2014 to 2016).
Results:
There were 426 and 368 VLBW discharges before and after initiation of the protocol during 2011 to 2013 and 2014 to 2016, respectively. The LOS did not change with protocol implementation (66±42 vs 64±42 days before and after implementation of the protocol, respectively). Interprovider variability on the duration of observation for apneic spells (
F
–8.8,
P
=0.04) and bradycardia spells (
F
–17.4,
P
<0.001) decreased after implementation of the protocol. The readmission rate for apnea/ALTE after the protocol decreased from 12.1 to 3.4% (
P
=0.01).
Conclusion:
Implementing an institutional protocol for VLBW infants to determine the duration of apnea/bradycardia/ desaturation spell-free observation period as recommended by the American Academy of Pediatrics clinical report did not prolong the LOS but effectively reduced interprovider variability and readmission rates.</description><identifier>ISSN: 0743-8346</identifier><identifier>EISSN: 1476-5543</identifier><identifier>DOI: 10.1038/jp.2017.174</identifier><identifier>PMID: 29120450</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>692/1807 ; 692/700 ; Apnea ; Birth weight ; Bradycardia ; Cardiac arrhythmia ; Care and treatment ; Desaturation ; Design standards ; Health aspects ; Hospital admission and discharge ; Infants ; Low birth weight ; Management ; Medicine ; Medicine & Public Health ; Newborn babies ; original-article ; Pediatric Surgery ; Pediatrics ; Premature babies ; Premature infants ; Variability</subject><ispartof>Journal of perinatology, 2018-01, Vol.38 (1), p.86-91</ispartof><rights>Nature America, Inc., part of Springer Nature. 2018</rights><rights>COPYRIGHT 2018 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Jan 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-d0278b5ceb4afffd10e5f17543425cbbe6c84ac6c75a0eb14e19b13b3cab90dc3</citedby><cites>FETCH-LOGICAL-c489t-d0278b5ceb4afffd10e5f17543425cbbe6c84ac6c75a0eb14e19b13b3cab90dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/jp.2017.174$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/jp.2017.174$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29120450$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chandrasekharan, P</creatorcontrib><creatorcontrib>Rawat, M</creatorcontrib><creatorcontrib>Reynolds, A M</creatorcontrib><creatorcontrib>Phillips, K</creatorcontrib><creatorcontrib>Lakshminrusimha, S</creatorcontrib><title>Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of ‘spell-free’ observation on interprovider variability and readmission rates</title><title>Journal of perinatology</title><addtitle>J Perinatol</addtitle><addtitle>J Perinatol</addtitle><description>Objective:
To study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on length of stay (LOS) and readmission rates.
Study design:
A protocol to standardize the duration of in-hospital observation for preterm infants with apnea, bradycardia and desaturation spells who were otherwise ready for discharge was implemented in December 2013. We evaluated the impact of this protocol on the LOS and readmission rates of very low birth weight infants (VLBW). Data on readmission for apnea and an apparent life-threatening event (ALTE) within 30 days of discharge were collected. The pre-implementation epoch (2011 to 2013) was compared to the post-implementation period (2014 to 2016).
Results:
There were 426 and 368 VLBW discharges before and after initiation of the protocol during 2011 to 2013 and 2014 to 2016, respectively. The LOS did not change with protocol implementation (66±42 vs 64±42 days before and after implementation of the protocol, respectively). Interprovider variability on the duration of observation for apneic spells (
F
–8.8,
P
=0.04) and bradycardia spells (
F
–17.4,
P
<0.001) decreased after implementation of the protocol. The readmission rate for apnea/ALTE after the protocol decreased from 12.1 to 3.4% (
P
=0.01).
Conclusion:
Implementing an institutional protocol for VLBW infants to determine the duration of apnea/bradycardia/ desaturation spell-free observation period as recommended by the American Academy of Pediatrics clinical report did not prolong the LOS but effectively reduced interprovider variability and readmission rates.</description><subject>692/1807</subject><subject>692/700</subject><subject>Apnea</subject><subject>Birth weight</subject><subject>Bradycardia</subject><subject>Cardiac arrhythmia</subject><subject>Care and treatment</subject><subject>Desaturation</subject><subject>Design standards</subject><subject>Health aspects</subject><subject>Hospital admission and discharge</subject><subject>Infants</subject><subject>Low birth weight</subject><subject>Management</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Newborn babies</subject><subject>original-article</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Premature babies</subject><subject>Premature infants</subject><subject>Variability</subject><issn>0743-8346</issn><issn>1476-5543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNptks9q3DAQxk1pabZpT70XQaEUGm8lW17ZuYXQfxDopT2bkTTKarEtV5IX9pbHaB-lr5MnqZzdhKQEHYTm-83HzGiy7DWjS0bL-uNmXBaUiSUT_Em2YFys8qri5dNsQQUv87rkq6PsRQgbSmdRPM-OioYVlFd0kf09GweEEyI96J0Cry0QGDTRGCBOHqJ1Awkjdl0gdiCjx36OY3oYGGI4JbYfQUXiDIEku-iU64hxnsQ1En1rkeTrq983RrnxiNdXf4iTAf32oA_JMaJPDlur0ZMteAvSdjbubgryCLq3Icxw8sTwMntmoAv46nAfZz8_f_px_jW_-P7l2_nZRa543cRc00LUslIoORhjNKNYGSbSgHhRKSlxpWoOaqVEBRQl48gayUpZKpAN1ao8zt7vfVNpvyYMsU1lqNQHDOim0LJmVfCyKFid0Lf_oRs3-SFVl6i6bsqyST92R11Ch22ao4se1GzanlVFKagoapGo5SNUOhp7q9yAxqb4g4R39xLWCF1cB9dN83jDQ_DDHlTeheDRtKO3Pfhdy2g7b1S7Gdt5o9q0UYl-c-hpkj3qO_Z2hRJwsgdCkoZL9PeafsTvH3Ef2Xo</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Chandrasekharan, P</creator><creator>Rawat, M</creator><creator>Reynolds, A M</creator><creator>Phillips, K</creator><creator>Lakshminrusimha, S</creator><general>Nature Publishing Group US</general><general>Nature Publishing Group</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7RV</scope><scope>7T5</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20180101</creationdate><title>Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of ‘spell-free’ observation on interprovider variability and readmission rates</title><author>Chandrasekharan, P ; Rawat, M ; Reynolds, A M ; Phillips, K ; Lakshminrusimha, S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-d0278b5ceb4afffd10e5f17543425cbbe6c84ac6c75a0eb14e19b13b3cab90dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>692/1807</topic><topic>692/700</topic><topic>Apnea</topic><topic>Birth weight</topic><topic>Bradycardia</topic><topic>Cardiac arrhythmia</topic><topic>Care and treatment</topic><topic>Desaturation</topic><topic>Design standards</topic><topic>Health aspects</topic><topic>Hospital admission and discharge</topic><topic>Infants</topic><topic>Low birth weight</topic><topic>Management</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Newborn babies</topic><topic>original-article</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Premature babies</topic><topic>Premature infants</topic><topic>Variability</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chandrasekharan, P</creatorcontrib><creatorcontrib>Rawat, M</creatorcontrib><creatorcontrib>Reynolds, A M</creatorcontrib><creatorcontrib>Phillips, K</creatorcontrib><creatorcontrib>Lakshminrusimha, S</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection (ProQuest)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of perinatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chandrasekharan, P</au><au>Rawat, M</au><au>Reynolds, A M</au><au>Phillips, K</au><au>Lakshminrusimha, S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of ‘spell-free’ observation on interprovider variability and readmission rates</atitle><jtitle>Journal of perinatology</jtitle><stitle>J Perinatol</stitle><addtitle>J Perinatol</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>38</volume><issue>1</issue><spage>86</spage><epage>91</epage><pages>86-91</pages><issn>0743-8346</issn><eissn>1476-5543</eissn><abstract>Objective:
To study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on length of stay (LOS) and readmission rates.
Study design:
A protocol to standardize the duration of in-hospital observation for preterm infants with apnea, bradycardia and desaturation spells who were otherwise ready for discharge was implemented in December 2013. We evaluated the impact of this protocol on the LOS and readmission rates of very low birth weight infants (VLBW). Data on readmission for apnea and an apparent life-threatening event (ALTE) within 30 days of discharge were collected. The pre-implementation epoch (2011 to 2013) was compared to the post-implementation period (2014 to 2016).
Results:
There were 426 and 368 VLBW discharges before and after initiation of the protocol during 2011 to 2013 and 2014 to 2016, respectively. The LOS did not change with protocol implementation (66±42 vs 64±42 days before and after implementation of the protocol, respectively). Interprovider variability on the duration of observation for apneic spells (
F
–8.8,
P
=0.04) and bradycardia spells (
F
–17.4,
P
<0.001) decreased after implementation of the protocol. The readmission rate for apnea/ALTE after the protocol decreased from 12.1 to 3.4% (
P
=0.01).
Conclusion:
Implementing an institutional protocol for VLBW infants to determine the duration of apnea/bradycardia/ desaturation spell-free observation period as recommended by the American Academy of Pediatrics clinical report did not prolong the LOS but effectively reduced interprovider variability and readmission rates.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>29120450</pmid><doi>10.1038/jp.2017.174</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0743-8346 |
| ispartof | Journal of perinatology, 2018-01, Vol.38 (1), p.86-91 |
| issn | 0743-8346 1476-5543 |
| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | 692/1807 692/700 Apnea Birth weight Bradycardia Cardiac arrhythmia Care and treatment Desaturation Design standards Health aspects Hospital admission and discharge Infants Low birth weight Management Medicine Medicine & Public Health Newborn babies original-article Pediatric Surgery Pediatrics Premature babies Premature infants Variability |
| title | Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of ‘spell-free’ observation on interprovider variability and readmission rates |
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