RESUMEN
Objective: The aim of this study was to examine effects of the 2022 infant formula shortage as experienced by neonatal intensive care units (NICUs) in the United States, a previously unreported perspective. Methods: A mixed-method approach was utilized. Data were collected using an online survey of NICU medical directors. Quantitative data were analyzed with descriptive statistics and Student's t test. Thematic analysis was utilized to make sense of patterns within the qualitative data. Results: Responses from 139 medical directors were received. Both academic (41.7%) and community (58.3%) NICUs were represented among respondents. Thirty-nine percent of NICU medical directors reported an impact on their unit by the infant formula shortage. Within the qualitative data four themes were revealed as follows: alterations to discharge planning, policy modifications, suboptimal solutions, and extraordinary measures. These themes may inform strategies for mitigation of future infant formula shortages. Conclusions: NICUs were significantly impacted by the infant formula shortage with likely lasting effects. From the reported experiences, clear recommendations have been formed to minimize effects of future infant formula shortages.
RESUMEN
Gastrointestinal bleeding (GIB) is a relatively uncommon presentation in the NICU. GIB in neonates includes a broad spectrum of disease morbidity, from minor reflux symptoms and growth failure to severe, clinically significant anemia requiring critical care resuscitation. Over the last several years, multiple diagnostic tools including fecal calprotectin and bedside ultrasonography have emerged and demonstrated utility in the early recognition of sources for GIB in neonates. Further evidence has continued to show that traditional medical therapy with intravenous proton pump inhibitors is well-tolerated, and that upper endoscopy has limited diagnostic and therapeutic value. Finally, additional research and quality improvement investigations are warranted to determine how best to prevent, recognize, and manage GIB in critical neonates.
Asunto(s)
Hemorragia Gastrointestinal , Resucitación , Recién Nacido , Humanos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Insuficiencia de Crecimiento , Mejoramiento de la CalidadRESUMEN
To better understand the controls on the opportunistic human pathogen Vibrio vulnificus in warm tropical waters, we conducted a year-long investigation in the Ala Wai Canal, a channelized estuary in Honolulu, HI. The abundance of V. vulnificus, as determined by quantitative PCR (qPCR) of the hemolysin gene (vvhA), varied spatially and temporally by nearly 4 orders of magnitude (≤3 to 14,000 mL-1). Unlike in temperate and subtropical systems, temperatures were persistently warm (19 to 31°C) and explained little of the variability in V. vulnificus abundance. Salinity (1 to 36 ppt) had a significant, but nonlinear, relationship with V. vulnificus abundance with the highest vvhA concentrations (>2,500 mL-1) observed only at salinities from 7 to 22 ppt. V. vulnificus abundances were lower on average during the summer dry season, when waters were warmer but more saline. The highest canal-wide average abundances were observed during a time of modest rainfall, when moderate salinities and elevated concentrations of reduced nitrogen species and silica suggested a groundwater influence. Parallel quantification of the vcgC gene suggested that C-type strains, which are responsible for most human infections, comprised 25% of the total V. vulnificus on average, but their relative contribution was greater at higher salinities, suggesting a broader salinity tolerance. Generalized regression models suggested that up to 67% of sample-to-sample variation (n = 202) in log-transformed V. vulnificus abundance was explained using the measured environmental variables, and up to 97% of the monthly variation in canal-wide average concentrations (n = 13) was explained with the best subset of four variables. IMPORTANCE Our data illustrate that, in the absence of strong seasonal variation in water temperature in the tropics, variation in salinity driven by rainfall becomes a primary controlling variable on V. vulnificus abundance. There is thus a tendency for a rainfall-driven seasonal cycle in V. vulnificus abundance which is inverted from the temperature-driven seasonal cycle at higher latitudes. However, stochasticity in rainfall and its nonlinear, indirect effects on V. vulnificus concentration means that high abundances can occur at any location in the canal at any time of year, making it challenging to predict concentrations of this pathogen at a high temporal or spatial resolution. Much of the variability in canal-wide average concentrations, on the other hand, was explained by a few variables that reflect the magnitude of freshwater input to the system, suggesting that relative risk of exposure to this pathogen could be predicted as an average for the system.