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Background: Timely central venous access is essential in the care of critically ill neonates. Peripherally inserted central catheters (PICCs) are the preferred form of central venous access when umbilical venous catheters cannot be placed or are discontinued. However, time delays increase risk for injury from peripheral intravenous lines and may contribute to inconsistent delivery of necessary fluids and medications.Purpose: The aim of this quality improvement project was to decrease wait times for PICC placement in the neonatal intensive care unit (NICU).Methods: A unit-based PICC team was developed consisting of NICU nurses and attending neonatologists and implemented in 2 phases. Data were collected from chart reviews before, during, and after implementation of the team. We tracked time between PICC order and placement and number of attempts. Hospital metrics on peripheral intravenous line infiltrations and central line-associated blood stream infection were also monitored. At the end of the project, we continued tracking outcomes to determine whether gains would be sustained past the project period.Results: Implementation of a unit-based interdisciplinary specialty team led to a 50% reduction in mean PICC wait times from 1.2 days to 0.58 days. Benefits of the initiative were sustained past the initial project period.Implications For Practice: The development of a dedicated, local team played a key role in improving vascular access in the NICU.Implications For Research: Proximity of specialized teams provides a solution to address gaps in care in the NICU. [ABSTRACT FROM AUTHOR]

The Apgar score is a standardized tool for evaluating newborns in the delivery room. Despite its long history and widespread use, debate remains over its reliability of predicting neonatal outcomes, especially in extremely low-birth-weight premature infants. The aim of the study was to examine the relationship between the 5-minute Apgar score of extremely low-birth-weight infants, as it relates to survival and morbidities associated with prematurity and length of hospital stay. A retrospective query of the Alere neonatal database from 2001 to 2011 examined all infants less than 32 weeks' gestation and less than 1000-g birth weight. The 5-minute Apgar score was divided into 2 groups, score of 4 or greater or less than 4. The study compared results of the 5-minute Apgar score and associated morbidities in surviving infants. Statistical analyses included chi-square, Fisher exact test, t test, and multivariate regression. The sample consisted of 3898 infants with an 86.4% (n = 3366) survival rate. Controlling for gestational age and birth weight, surviving infants with a 5-minute Apgar score of less than 4 were more likely to demonstrate nonintact survival. Infants with a low 5-minute Apgar score have greater risk for mortality and morbidities associated with prematurity. [ABSTRACT FROM AUTHOR]

We studied 12 consecutive neonates placed on venoarterial extracorporeal membrane oxygenation (ECMO) in 2004-2005. Activated clotting times (ACT) and anti-factor Xa levels were measured, and the corresponding heparin drip rate was noted. The mean heparin drip rate was 42.2 +/- 10.9 (SD) U/kg/hour (range 20.0-69.5 U/kg/hour). There were 55 simultaneous ACT and anti-factor Xa samples drawn. The mean ACT was 167 +/- 20 seconds (range 128-227 seconds). There was no correlation between ACT levels and heparin dose (r = 0.21; p = 0.12). The mean anti-factor Xa activities were 0.73 +/- 0.19 U/ml (range 0.1-1.0 U/ml). There was a correlation (r = 0.75; p < 0.0001) between anti-factor Xa and heparin dose. We also examined the effect of day on ECMO on heparin drip rate, ACT, and anti-factor Xa. There was no correlation between day on ECMO and either heparin drip rate (r = 0.21, p = 0.12) or ACT (r = 0.002, p = 0.99). However, there was a positive correlation (r = 0.46, p < 0.0005) between day on ECMO and anti-factor Xa activities. In these neonatal patients on venoarterial ECMO, ACT was not a reliable indicator of heparin effect. Furthermore, the increase in anti-factor Xa levels with time on ECMO suggests that heparin accumulates and/or that anti-thrombin III levels decrease with time on ECMO.