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Objective: To evaluate plasma clearance of lipid injectable emulsions packaged in either glass or plastic containers in neonates from 2 7-month periods, 1 year apart. Study design: Clinical records from June 1 to December 31, 2003 (glass [G] period) and the same months in 2004 (plastic [P] period) were assessed. Neonates who received lipid injectable emulsions were studied. Lipid container (glass vs plastic) was the independent variable. Results: Of the 197 patients studied, 122 (G, 50/81; P, 72/116) had evaluable triglyceride (TG) levels, for an overall rate of 62%. Only birth weight (G, 1.09 ± 0.32 kg vs P, 1.23 ± .45 kg) and birth length (G, 36.4 ± 3.5 cm vs P, 37.9 ± 3.5 cm) were significantly different between the 2 groups (P = .047 and .028, respectively). There were no differences in the day of life on which lipid injection was started, the lipid dose, or the timing of TG measurements. The incidence of hypertriglyceridemia was significantly higher in the P period (G, 3/50 vs P, 19/72; P = .004). Conclusions: Administration of the same lipid formulation in plastic bags compared with glass containers is associated with higher rates of hypertriglyceridemia. The poorer clearance of lipids could be due to a higher proportion of large-diameter fat globules in plastic bags compared with those in glass containers. [Copyright &y& Elsevier]

Although neonatal intensive unit (NICU) care is envisioned as the care of very immature infants, more than 95% of births and 80% of NICU admissions are of more mature newborns—infants born at 34 or more weeks' gestation. In spite of the size of this population there are important gaps in the understanding of their needs and optimal management as reflected by remarkably large unexplained variation in their care. The goal of this article is to describe what is known about the more mature, higher birth weight newborn population's use of NICU care and highlight important gaps in knowledge and obstacles to research. Research priorities are identified: including (1) the need for birth population based rather than NICU based studies, and (2) population specific data elements. Summary: More mature newborns—infants of 34 or more weeks' gestation—account for most NICU admissions. There are large gaps in the understanding of their needs and optimal management as reflected by large unexplained variation in their care. We enumerate these gaps in current knowledge and suggest research priorities to address them. [ABSTRACT FROM AUTHOR]

Frontline providers of neonatal care have a moral imperative to enhance value and inform senior administrators of how to most efficiently spend healthcare dollars. This article argues that the frontline is the ideal setting to pursue these efforts, offers recommendations for how to measure value, and describes five simple yet effective concrete tools that can improve value. It concludes with tips on advancing a value-added agenda through the Model for Improvement and advice for teams on ways of approaching senior leaders to help align unit-level aims with system-level goals and mission. Armed with these instruments, multidisciplinary teams can help ensure that neonatal care remains at the forefront of high-value healthcare. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe infection control practices for influenza in mother and newborn units in United States hospitals in the context of the 2009 H1N1 pandemic. We conducted surveys of neonatal intensive care unit directors in February and November 2010 and requested information on infection control practices during the 2009 and 2010 influenza seasons. We received 111 responses to the initial survey and 48 to the follow-up survey. In 2009, 58% of respondents restricted breastfeeding by mothers with influenza-like illness; 42% did not. Ninety percent of the respondents maintained physical separation between an ill mother and her newborn infant, although the approaches to this separation varied. Eighty percent of postpartum units and 89% of neonatal intensive care units restricted access by children. In 2010, fewer hospitals restricted mother-infant contact and children visitation compared with 2009. Infection control practices for influenza in mother and newborn units vary considerably in US hospitals, particularly regarding contact between an ill mother and her newborn infant. The identification of this variation may inform best practices in this area, as well as future investigations and future guideline development. [Copyright &y& Elsevier]