Caitlin Bradley

Background: Medical home (MH) is a financially viable, all‐inclusive primary care model that can enhance communication, improve care coordination and support patients, families and healthcare providers. No standard screening tool exists for use by hospital‐based healthcare providers to identify children with medical complexity (CMC), which can result in inconsistent MH referrals. The purpose of this research was to develop and validate a screening tool for use in identifying CMC who would benefit most from early MH referrals prior to hospital discharge home. Methods: This mixed‐methods research utilized e‐Delphi methodology and retrospective chart review to develop and validate a screening tool for MH referrals. Results: Twenty‐three nurses, nurse practitioners, physicians, social workers and case managers participated in four e‐Delphi rounds to develop the Pediatric Medical Home Screening Tool (PMHST). The PMHST consists of four sections and 20 criteria. Reliability testing of the PMHST revealed 82% agreement with medical complexity categorization of infants and young children. Conclusion: The PMHST may enhance future care transitions, improve quality of care and reduce the risks of safety events. The PMHST was validated in a sample of infants and young children and will be tested with a broader sample of children in the future.

Background: Despite advances in medical care, the incidence and severity of bronchopulmonary dysplasia (BPD) among infants born at less than 32 weeks’ gestation have not decreased. Also, BPD prediction tools have been criticized for containing too few variables, not being validated beyond their initial development, and having a lack of generalizability. To develop a comprehensive prediction tool for postnatal use, a broad evaluation of BPD risk factors is needed. Objectives: To examine risk factors for the development of BPD among a sample of preterm infants. Method: This research was a retrospective cohort study examining preterm infants (n = 455) treated at a level IV neonatal intensive care unit. Binary logistic regression was used to examine the relationship between BPD and 15 risk factors that were identified through a comprehensive review of the literature. Multinomial regression was used to examine the relationship between risk factors and the severity of BPD. Results: Risk factors for BPD that were identified included birth weight, surfactant administration, and mechanical ventilation. When examined by severity, other risk factors identified were gestational age, infections, and the presence of a patent ductus arteriosus. Discussion: The variables most frequently included in contemporary BPD prediction tools include gestational age, birth weight, sex, and early respiratory status. The findings of this research demonstrate that the addition of multiple surfactant doses, infections, and patent ductus arteriosus as BPD risk factors might strengthen BPD prediction tools. Moreover, a number of blood transfusions and weights deserve further evaluation in future research as potential BPD risk factors.

Refeeding syndrome (RS) is a condition characterized by electrolyte derangements, thiamin deficiency, and organ dysfunction after the provision of nutrition to an individual who had been deprived of nutrients. Published guidelines outlining the recognition and definition of RS exist for adult and children, but there are limited newborn‐specific guidelines because of a paucity of available literature and variation in reporting. We describe a small‐for‐gestational‐age, full‐term newborn with neonatal encephalopathy who underwent therapeutic hypothermia. Electrolyte derangements and lactic acidosis developed and persisted after the introduction of intravenous nutrition. After the exclusion of other etiologies, neonatal RS was suspected, and the newborn was treated with thiamin. We provide a brief review of the current literature on neonatal RS, present a case report consistent with neonatal RS, and provide suggestions for the utility of thiamin replacement in newborns with suspected neonatal RS.