Use of technology as an evaluation tool of clinical care in preterm newborns

Mendes, Izabel; Carvalho, Manoel de; Almeida, Rosimary T.; Moreira, Maria Elizabeth Lopes

doi:10.2223/jped.1535

Cited by 5 publications

(11 citation statements)

References 14 publications

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“…Foi escolhido esse período porque, em um estudo brasileiro sobre a aplicação do Neonatal Therapeutic Intervention Scoring System (NTISS) como instrumento de comparação de prá-ticas assistenciais em UTIN, foi mostrado padrão de queda gradual e progressivo até o 31º dia de internação 10 . O NTISS é um índice de intensidade de utilização de tecnologias resultante da combinação de oito dimensões de tipos de assistência: respiratória, monitorização, cardiovascular, medicamentosa, metabólica/nutricional, procedimentos, transfusão e acesso vascular.…”

Section: Métodosunclassified

Use of off-label and unlicensed drugs in the neonatal intensive care unit and its association with severity scores

Carvalho

Ribeiro²,

Bonilha³

et al. 2012

J Pediatr (Rio J)

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Objective: To analyze the frequency of unlicensed (UL) and offlabel (OL) prescriptions in neonates admitted to the neonatal intensive care unit of a tertiary care hospital and to determine their association with patients' severity. Methods:Observational cohort study including drugs prescribed during hospitalization of neonates over a 6-week period between July and August 2011. The drugs were classified as UL and OL for dose, frequency, presentation, age group, or indication, according to an electronic list of drugs approved by the Food and Drug Administration. Patients were followed until hospital discharge or 31 days of hospitalization, with daily records of the Neonatal Therapeutic Intervention Scoring System (NTISS). Results:We identified 318 prescription items for 61 patients (average of five items/patient); there were only 13 patients with appropriate use of medications (21%). A prevalence of 7.5% was identified for UL prescriptions and 27.7% for OL, and the most prevalent OL use was that related to age group -19.5%. Fifty-seven medications were computedone patient received 10 UL/OL drugs during hospitalization. The prevalence of OL uses was higher in preterm infants < 35 weeks and in those with higher severity scores (p = 0.00). Conclusions:The prevalence of neonates exposed to UL/OL drugs during hospitalization was high, especially for those with higher NTISS scores. Although there is general appreciation that neonates, especially preterm infants, have a high rate of drug use, an assessment including different cultures and countries is still needed to prioritize areas for future research in the pharmacotherapy of this vulnerable population.J Pediatr (Rio J). 2012;88(6):465-70: Drugs, drug labeling, injury severity score, neonatology. ResumoObjetivo: Avaliar a frequência da prescrição de medicamentos de uso não licenciado (UL) e off-label (OL) em recém-nascidos internados em unidade de tratamento intensivo neonatal de hospital de nível terciário e verificar a associação do seu uso com a gravidade dos pacientes.Métodos: Estudo observacional de coorte dos medicamentos prescritos no período de 6 semanas da internação de neonatos, entre julho e agosto de 2011. Os medicamentos foram classificados em UL e OL para dose, frequência, apresentação, faixa etária e indicação, de acordo com bulário eletrônico aprovado pela Food and Drug Administration. Os pacientes foram acompanhados até alta hospitalar ou 31 dias de internação, com registro diário do Neonatal Therapeutic Intervention Scoring System. Resultados:Foram identificados 318 itens de prescrição para 61 pacientes (média de cinco itens/paciente) e apenas 13 pacientes com uso de medicamentos adequados (21%). Identificaram-se prevalên-cias de 7,5% para prescrições UL e de 27,7% para OL. O uso OL mais prevalente foi para medicamentos não padronizados para faixa etária -19,5%. Computaram-se 57 medicações -um paciente recebeu 10 fármacos UL/OL na internação. A prevalência de usos OL foi maior em prematuros < 35 semanas e nos com escores de gravidade mais ele...

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Section: Métodosunclassified

Use of off-label and unlicensed drugs in the neonatal intensive care unit and its association with severity scores

Carvalho

Ribeiro²,

Bonilha³

et al. 2012

J Pediatr (Rio J)

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“…Entretanto, a diferença do grau de gravidade dos RN admitidos em UTIN requer uma avaliação de sua condição clínica e da mensuração das tecnologias e intervenções adotadas durante sua internação. Esse conhecimento pode subsidiar a estimativa do prognóstico de cada RN, o planejamento da assistência de enfermagem, o dimensionamento de pessoal e da carga de trabalho da equipe de enfermagem, as aquisições de equipamentos, medicamentos e materiais, visando aperfeiçoar a alocação de recursos diante dos custos operacionais (3,4,5,6) .…”

Section: Introductionunclassified

“…Pesquisadores (3) observaram 96 RN de duas UTIN, uma pública e outra privada do Rio de Janeiro, e contabilizaram diariamente a utilização de tecnologias aplicando o NTISS e a gravidade dos pacientes no momento da admissão pela aplicação do Score for Neonatal Acute Physiology, Perinatal Extension, Version II (SNAPPE-II). O acompanhamento periódico do índice de utilização de tecnologias permitiu a detecção de variações nas práticas assistenciais que refletem em custos operacionais e podem orientar a alocação de recursos em terapia intensiva neonatal.…”

Section: Introductionunclassified

Scoring system for neonatal therapeutic intervention: a descriptive study

Curan

Rossetto

2014

Online Brazilian Journal of Nursing

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“… + + ? Mendes,2006 [ 36 ] - - + + + + Rojas,2011 [ 37 ] - - + + + ? Oygur,2012 [ 38 ] + - + + + - Shah,2015 [ 32 ] + - + + ?…”

Section: Resultsmentioning

confidence: 99%

“…Oygur et al also had individual treatments as separate parameters but did not specify the type of model used to predict in-hospital mortality [ 38 ]. In contrast, the other six studies summated the treatments to give a single score which was then used in subsequent analyses as a single parameter [ 33 , 34 , 36 , 37 , 39 , 40 ]. This is the same approach used by Gray et al in developing the NTISS [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of neonatal treatment intensity scores and their potential application in low-resource setting hospitals for predicting mortality, morbidity and estimating resource use

et al. 2017

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BackgroundTreatment intensity scores can predict mortality and estimate resource use. They may therefore be of interest for essential neonatal care in low resource settings where neonatal mortality remains high. We sought to systematically review neonatal treatment intensity scores to (1) assess the level of evidence on predictive performance in predicting clinical outcomes and estimating resource utilisation and (2) assess the applicability of the identified models to decision making for neonatal care in low resource settings.MethodsWe conducted a systematic search of PubMed, EMBASE (OVID), CINAHL, Global Health Library (Global index, WHO) and Google Scholar to identify studies published up until 21 December 2016. Included were all articles that used treatments as predictors in neonatal models. Individual studies were appraised using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). In addition, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used as a guiding framework to assess certainty in the evidence for predicting outcomes across studies.ResultsThree thousand two hundred forty-nine articles were screened, of which ten articles were included in the review. All of the studies were conducted in neonatal intensive care units with sample sizes ranging from 22 to 9978, with a median of 163. Two articles reported model development, while eight reported external application of existing models to new populations. Meta-analysis was not possible due heterogeneity in the conduct and reporting of the identified studies. Discrimination as assessed by area under receiver operating characteristic curve was reported for in-hospital mortality, median 0.84 (range 0.75–0.96, three studies), early adverse outcome and late adverse outcome (0.78 and 0.59, respectively, one study).ConclusionExisting neonatal treatment intensity models show promise in predicting mortality and morbidity. There is however low certainty in the evidence on their performance in essential neonatal care in low resource settings as all studies had methodological limitations and were conducted in intensive care. The approach may however be developed further for low resource settings like Kenya because treatment data may be easier to obtain compared to measures of physiological status.Systematic review registrationPROSPERO CRD42016034205Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0649-6) contains supplementary material, which is available to authorized users.

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Use of technology as an evaluation tool of clinical care in preterm newborns

Cited by 5 publications

References 14 publications

Use of off-label and unlicensed drugs in the neonatal intensive care unit and its association with severity scores

Use of off-label and unlicensed drugs in the neonatal intensive care unit and its association with severity scores

Scoring system for neonatal therapeutic intervention: a descriptive study

A systematic review of neonatal treatment intensity scores and their potential application in low-resource setting hospitals for predicting mortality, morbidity and estimating resource use

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