Purpose: To assess the effect of a quality improvement (QI) bundle on improving breast milk output among very low birth weight (VLBW) mothers. Design: Before and after nonrandomized QI project. Sample: Mothers who delivered a VLBW infant in October and November 2015 were the prospective cohort. Those who delivered a VLBW infant in August and September 2015 were the retrospective cohort. The QI bundle consisted of early expression of milk, use of breast pumps, frequent expressions, videos, and regular counseling. This bundle was done for the prospective cohort. Outcomes measures: Quantity of expressed breast milk on day 7. Results: There were 13 mothers in the retrospective cohort and 18 mothers in the prospective one. The mean birth weight (1297.80 and 1207.70 g, p = .19) and gestation (32.5 and 31.5 wk, p = .27) were similar. There was a significant increase in the milk output on day 7 in the prospective group 113.6 ± 45 vs 182 ± 63 mL (p = .001).
Background: Frank liver failure is incompatible with life. Severity of liver disease is reflected in clinical signs or biochemical alterations. Hepatic dysfunction indicates poor outcome in critically ill patients, but no large systematic investigation into its exact incidence and prognostic relevance has been performed in different population groups.Methods: All PICU admissions during the study period were included. Pattern of admission LFT (Liver Function Tests) was reported. Relationship between clinical events and patient outcome with the LFT panel on day 1 and day 3 were reported. Association between final outcome and day 7 LFT was explored.Results: Deranged AST (Aspartate Transaminase), ALT (Alanine Transaminase), Bilirubin, Albumin, PT (Prothrombin time) and INR (International Normalized Ratio) on Day1 and 3 had significant association with increased requirement of inotropic and ventilatory support as well with increased mortality. LFT parameters on day 7 showed significant correlation between normal AST, ALT, bilirubin, PT and INR with improved survival.Conclusions: LFT's should be essential part of biochemical profile and doctors caring for sick patients in peripheral hospitals should consider for early referral of patients to higher centers based on LFT parameters for the advanced care they deserve.
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