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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
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Variations in Neonatal Antibiotic Use.

Joseph Schulman1, Jochen Profit2,3,4, Henry C Lee2,3,4

  • 1California Children's Services, California Department of Health Care Services, Sacramento, California; joseph.schulman@dhcs.ca.gov.

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|September 5, 2018
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Summary
This summary is machine-generated.

Antibiotic use in NICUs decreased significantly, but unexplained use persists. Current clinical factors do not explain high antibiotic use rates above 14.4%.

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Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Healthcare Quality Improvement

Background:

  • Antibiotic use in Neonatal Intensive Care Units (NICUs) is a significant concern due to potential for resistance and adverse effects.
  • Understanding trends and drivers of antibiotic use rates (AUR) is crucial for optimizing patient care and antimicrobial stewardship.

Purpose of the Study:

  • To evaluate changes in NICU antibiotic use rate (AUR), clinical correlates, and practice variation between 2013 and 2016.
  • To identify AUR ranges associated with bacterial or fungal infection burdens in neonates.

Main Methods:

  • Retrospective cohort study of over 54,000 neonates annually across more than 130 California NICUs from 2013 to 2016.
  • Analysis included nonparametric linear correlation and two-sample proportion tests to compare AURs over time, stratified by NICU level and stewardship program participation.

Main Results:

  • Overall NICU AUR declined by 21.9% by 2016, representing over 42,000 fewer antibiotic days.
  • NICUs in stewardship programs showed a greater AUR decline (28.7%) compared to others (16.2%).
  • The 2016 AUR did not correlate with proven infection or necrotizing enterocolitis but correlated with surgical volume, mortality, and length of stay, particularly in high-AUR NICUs.

Conclusions:

  • While unexplained antibiotic use in NICUs has decreased, it remains a challenge.
  • Current clinical correlates do not adequately explain AUR values exceeding the 14.4% lower quartile threshold.