Prevention of severe brain injury in very preterm neonates: A quality improvement initiative

Shukla, Vivek V.; Klinger, Andrew; Yazdi, S. M. Zaki R.; Rahman, A K M Fazlur; Wright, Sydney; Barganier, Angela; Ambalavanan, Namasivayam; Carlo, Waldemar A.; Ramani, Manimaran

doi:10.1038/s41372-022-01437-y

Cited by 3 publications

(2 citation statements)

References 48 publications

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“…[60] Few plant origin natural products Suksdorfin (Lee et al, 1994) [61] from Lomatium suksdorfii, circulin A and B macrocylic peptides, [62] pine cone, [63] Hyssop officinalis extracts, [64] Dandelion extract, [65] coumarins and xanthone, and inophyllums from Calophyllum inophyllum Linn inhibit HIV-1 RT activity. [66,67] Similarly, chlorogenic acids, compounds with cinnamoyl functional groups, and quinic acid were the most prominent compounds in the Helichrysum species with anti-HIV activity [68] [Table 1 and Figure 1].…”

Section: Plant Derived Anti-hiv Agentsmentioning

confidence: 99%

Untitled

2023

IJGP

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Present article explains human immunodeficiency virus (anti-HIV) activity of various bioorganic components isolated from various plant species. Plants possess enormous potential to fight against viruses and other microbial pathogens. Medicinal plants are large depository of antiretroviral agents which could be used for treatment of sexually transmitted diseases. Diseases caused by viruses are showing new trends in virulence, with high infectivity, morbidity, and mortality. Due to climatic effect and drug resistance and new mutations in pathogens, disease burden has been exacerbated enormously at global level. In the present article, plant-derived anti-HIV bioorganic constituents which display reverse transcriptase, protease, and integrase inhibition and obstruct virus cycle inside host have been highlighted with their activity. These plant origin drugs can be produced easily and inexpensively in developing countries and become affordable to poor people. This article suggests the use of natural products from medicinal plants to replace costly antiretroviral chemical drugs which cause cellular toxicity and impose multidrug resistance in viruses. There is an immense need to have most appropriate and highly effective plant origin organic and heterocyclic compound to suppress HIV progression in human cells. Present review article tries to explore new possibilities of HIV control by suggesting important plant natural products which can be used for discovery and design of new drug candidates.

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Section: Plant Derived Anti-hiv Agentsmentioning

confidence: 99%

Untitled

2023

IJGP

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“…7 The American Academy of Pediatrics (AAP) recommends limiting noise in the NICU to <45 dB and states that exposure to higher noise levels can have deleterious effects on high-risk newborns. 3,6,13,14 Preterm infants have impaired autoregulation of cerebral perfusion [15][16][17] and are susceptible to cognitive and motor neurodevelopmental delays based on gestational age, degree of respiratory compromise, and the presence of environmental stressors that affect cerebral blood flow. Noise triggers fluctuations in blood pressure, heart rate, and respiratory rate, which can alter cerebral blood flow and may precipitate an intraventricular hemorrhage and cerebral ischemia.…”

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Reducing Noise in the NICU

Gennattasio,

Carter,

Maffei

et al. 2024

Advances in Neonatal Care

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Background: In the neonatal intensive care unit (NICU), elevated noise negatively impacts the neurodevelopmental environment, interrupts sleep, and can affect brain development in neonates. The American Academy of Pediatrics recommends that noise levels in the NICU should not exceed 45 dB. Purpose: The project aims were to: (1) decrease average noise level by 10% from baseline and (2) decrease exposure to severe noise (>65 dB) to <5% of the time. Methods: This quality improvement project was conducted during 2021-2022 as a pre/post observational design in a Level IV NICU in New York City. We monitored sound levels for 20-24 h, 5 d/wk. Quality improvement interventions included: novel approaches to staff education, visual cues for when noise thresholds were exceeded, parent education, including access to personal decibel meters, technical improvements to vital sign monitors and entry doors, and defined quiet times (HUSH) for 2 h each 12-hour shift. Results: Education efforts and technical improvements successfully reduced median noise levels within the stepdown unit (P < .001), though not in the acute care NICU. In contrast, the implementation of 2-hour periods of enforced “quiet time” every 12 h effectively reduced both median noise levels and the incidence of severe noise (>65 dB) in both locations. Implications for practice and research: The HUSH strategy may be a sustainable way to decrease noise in the NICU. Future projects should prioritize education and dedicated quiet times to align with recommended standards, while research should explore the long-term developmental impacts of excessive noise levels on neonatal growth.

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Quality Improvement Interventions to Prevent Intraventricular Hemorrhage: A Systematic Review

Edwards,

Ehret,

Cohen

et al. 2024

Pediatrics

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OBJECTIVES: Quality improvement may reduce the incidence and severity of intraventricular hemorrhage in preterm infants. We evaluated quality improvement interventions (QIIs) that sought to prevent or reduce the severity of intraventricular hemorrhage. METHODS: PubMed, CINAHL, Embase, and citations of selected articles were searched. QIIs that had reducing incidence or severity of intraventricular hemorrhage in preterm infants as the primary outcome. Paired reviewers independently extracted data from selected studies. RESULTS: Eighteen quality improvement interventions involving 5906 infants were included. Clinical interventions in antenatal care, the delivery room, and the NICU were used in the QIIs. Four of 10 QIIs reporting data on intraventricular hemorrhage (IVH) and 9 of 14 QIIs reporting data on severe IVH saw improvements. The median Quality Improvement Minimum Quality Criteria Set score was 11 of 16. Clinical intervention heterogeneity and incomplete information on quality improvement methods challenged the identification of the main reason for the observed changes. Publication bias may result in the inclusion of more favorable findings. CONCLUSIONS: QIIs demonstrated reductions in the incidence and severity of intraventricular hemorrhage in preterm infants in some but not all settings. Which specific interventions and quality improvement methods were responsible for those reductions and why they were successful in some settings but not others are not clear. This systematic review can assist teams in identifying potentially better practices for reducing IVH, but improvements in reporting and assessing QIIs are needed if systematic reviews are to realize their potential for guiding evidence-based practice.

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Prevention of severe brain injury in very preterm neonates: A quality improvement initiative

Cited by 3 publications

References 48 publications

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Reducing Noise in the NICU

Quality Improvement Interventions to Prevent Intraventricular Hemorrhage: A Systematic Review

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