%0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e66401 %T Exploring Stress and Stress-Reduction With Caregivers and Clinicians in the Neonatal Intensive Care Unit to Inform Intervention Development: Qualitative Interview Study %A Ginsberg,Kristin Harrison %A Alsweiler,Jane %A Rogers,Jenny %A Ross,Phoebe %A Serlachius,Anna %K neonatal intensive care unit %K NICU %K parents %K preterm infants %K stress %K stress reduction %K intervention development %K digital %K neonatology %K pediatric %K infants %K babies %K neonatal %K toddler %K children %K caregiver %K telemedicine %K telehealth %K virtual care %K virtual health %K virtual medicine %K remote consultation %K qualitative study %D 2025 %7 2.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Parents and caregivers with preterm babies in the neonatal intensive care unit (NICU) experience high levels of distress and are at an increased risk of anxiety, depression, and acute stress disorders. Effective interventions to reduce this distress are well described in the literature, but this research has been conducted primarily in Europe and North America. To our knowledge, few interventions of this sort have been developed in Australasia, and none have been developed or tested in Aotearoa New Zealand. Objective: The primary aims of this study were to explore sources of stress with caregivers and clinicians in a NICU in Aotearoa New Zealand and gather participant ideas on ways to reduce caregiver stress to inform intervention development. Methods: This qualitative design used an essentialist and realist methodology to generate findings aimed at future intervention development. Overall, 10 NICU clinicians (neonatologists, nurses, and mental health clinicians) and 13 caregivers (mothers, fathers, and extended family members) of preterm babies, either currently admitted or discharged from the NICU within the last 12 months, were recruited to participate in interviews exploring stress and stress-reduction in the NICU. Results: The 23 participants included 10 clinicians (all female, with an average of 15 years of experience in the NICU) and 13 parents and caregivers (majority of them were female; 10/13, 77%) of preterm babies. We identified 6 themes relevant to intervention development. Three themes focused on caregiver stress: the emotional “rollercoaster” of NICU; lack of support, both culturally and emotionally; and caregivers feeling “left out” and confused. Three themes focused on participant-proposed solutions to reduce stress: caregiver empowerment, improving emotional support, and communication on “my” terms (ie, digitally). Conclusions: Participants reported high levels of caregiver stress in the NICU, and they proposed a range of stress-reducing solutions, including increasing caregiver empowerment and improving emotional and cultural support. Clinicians and caregivers also strongly agreed on providing more information for caregivers in digital, mobile-friendly formats. %R 10.2196/66401 %U https://pediatrics.jmir.org/2025/1/e66401 %U https://doi.org/10.2196/66401 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63483 %T Preventing Premature Family Maladjustment: Protocol for a Multidisciplinary eHealth Study on Preterm Parents’ Well-Being %A Decataldo,Alessandra %A Paleardi,Federico %A Lauritano,Giacomo %A Figlino,Maria Francesca %A Russo,Concetta %A Novello,Mino %A Fiore,Brunella %A Ciuffo,Giulia %A Ionio,Chiara %+ Dipartimento di Sociologia e Ricerca Sociale, Università degli Studi Milano-Bicocca, Piazza dell'Ateneo 1, Milano, 20126, Italy, 39 0264487418, alessandra.decataldo@unimib.it %K preterm birth %K parental well-being %K sociology of health %K digital-based monitoring %K mixed methods research %K eHealth %D 2025 %7 18.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The consequences of preterm birth extend beyond the clinical conditions of the newborn, profoundly impacting the functioning and well-being of families. Parents of preterm infants often describe the experience of preterm birth and subsequent admission to the neonatal intensive care unit (NICU) as a disruptive event in their lives, triggering feelings of guilt, helplessness, and fear. Although various research examines changes in parents’ well-being and perception of self-efficacy during the stay in the NICU, there is a lack of research analyzing what happens in the transition phase at home after the baby’s discharge. Recently, scholars have advocated for the use of web-based support programs to monitor and prevent preterm family maladjustment and assist parents. Objective: This interdisciplinary research will develop a sociopsychological model focused on assessing the well-being of parents of premature infants during and after their stay in a NICU. Specifically, the study aims to (1) monitor the mental health of parents of premature infants both at the time of the child’s discharge from the NICU and in the first 6 months after discharge to prevent family maladjustment, (2) deepen our understanding of the role of digital tools in monitoring and supporting preterm parents’ well-being, and (3) study the potential impact of the relationship with health care professionals on the overall well-being of parents. Methods: This project combines mixed methods of social research and psychological support with an eHealth approach. The well-being of parents of premature infants will be assessed using validated scales administered through a questionnaire to parents of preterm infants within 6 NICUs at the time of the child’s discharge. Subsequently, a follow-up assessment of parental well-being will be implemented through the administration of the validated scales in a web application. In addition, an ethnographic phase will be conducted in the NICUs involving observation of the interaction between health care professionals and parents as well as narrative interviews with health care staff. Finally, interactions within the digital environment of the web application will be analyzed using a netnographic approach. We expect to shed light on the determinants of well-being among parents of premature infants in relation to varying levels of prematurity severity; sociodemographic characteristics such as gender, age, and socioeconomic status; and parental involvement in NICU care practices. With the follow-up phase via web application, this project also aims to prevent family maladjustment by providing psychological support and using an eHealth tool. Results: The results are expected by October 2025, the expiration date of the Project of Relevant National Interest. Conclusions: The eHealth Study on Preterm Parents’ Well-Being aims to improve preterm parents’ well-being and, indirectly, children’s health by reducing social costs. Furthermore, it promotes standardized neonatal care protocols, reducing regional disparities and strengthening collaboration between parents and health care staff. International Registered Report Identifier (IRRID): PRR1-10.2196/63483 %M 40101208 %R 10.2196/63483 %U https://www.researchprotocols.org/2025/1/e63483 %U https://doi.org/10.2196/63483 %U http://www.ncbi.nlm.nih.gov/pubmed/40101208 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60944 %T Call for Decision Support for Electrocardiographic Alarm Administration Among Neonatal Intensive Care Unit Staff: Multicenter, Cross-Sectional Survey %A Tang,Xiaoli %A Yang,Xiaochen %A Yuan,Jiajun %A Yang,Jie %A Jin,Qian %A Zhang,Hanting %A Zhao,Liebin %A Guo,Weiwei %+ Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong New Area, Shanghai, 200127, China, 86 18930830578, guoweiwei@scmc.com.cn %K ECG alarm %K electrocardiographic %K perception %K practice %K decision-making %K neonatal intensive care unit %K health care providers %K cross-sectional survey %K nationwide %D 2024 %7 20.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have shown that electrocardiographic (ECG) alarms have high sensitivity and low specificity, have underreported adverse events, and may cause neonatal intensive care unit (NICU) staff fatigue or alarm ignoring. Moreover, prolonged noise stimuli in hospitalized neonates can disrupt neonatal development. Objective: The aim of the study is to conduct a nationwide, multicenter, large-sample cross-sectional survey to identify current practices and investigate the decision-making requirements of health care providers regarding ECG alarms. Methods: We conducted a nationwide, cross-sectional survey of NICU staff working in grade III level A hospitals in 27 Chinese provinces to investigate current clinical practices, perceptions, decision-making processes, and decision-support requirements for clinical ECG alarms. A comparative analysis was conducted on the results using the chi-square, Kruskal-Wallis, or Mann-Whitney U tests. Results: In total, 1019 respondents participated in this study. NICU staff reported experiencing a significant number of nuisance alarms and negative perceptions as well as practices regarding ECG alarms. Compared to nurses, physicians had more negative perceptions. Individuals with higher education levels and job titles had more negative perceptions of alarm systems than those with lower education levels and job titles. The mean difficulty score for decision-making about ECG alarms was 2.96 (SD 0.27) of 5. A total of 62.32% (n=635) respondents reported difficulty in resetting or modifying alarm parameters. Intelligent module–assisted decision support systems were perceived as the most popular form of decision support. Conclusions: This study highlights the negative perceptions and strong decision-making requirements of NICU staff related to ECG alarm handling. Health care policy makers must draw attention to the decision-making requirements and provide adequate decision support in different forms. %M 39705688 %R 10.2196/60944 %U https://www.jmir.org/2024/1/e60944 %U https://doi.org/10.2196/60944 %U http://www.ncbi.nlm.nih.gov/pubmed/39705688 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56247 %T Digital Health as a Mechanism to Reduce Neonatal Intensive Care Unit Admissions: Retrospective Cohort Study %A Brinson,Alison K %A Jahnke,Hannah R %A Henrich,Natalie %A Moss,Christa %A Shah,Neel %K digital health %K education %K gestational conditions %K Maven Clinic %K mental health management %K neonatal %K NICU admissions %K neonatal intensive care unit %K mobile phone %D 2024 %7 16.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Admission to the neonatal intensive care unit (NICU) is costly and has been associated with financial and emotional stress among families. Digital health may be well equipped to impact modifiable health factors that contribute to NICU admission rates. Objective: The aim of the study is to investigate how the use of a comprehensive prenatal digital health platform is associated with gestational age at birth and mechanisms to reduce the risk of admission to the NICU. Methods: Data were extracted from 3326 users who enrolled in a comprehensive digital health platform between January 2020 and May 2022. Multivariable linear and logistic regression models were used to estimate the associations between hours of digital health use and (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission. Multivariable logistic regression models estimated the associations between (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission and the likelihood of a NICU admission. All analyses were stratified by the presence of any gestational conditions during pregnancy. Results: For users both with and without gestational conditions, hours of digital health use were positively associated with gestational age at birth (in weeks; with gestational conditions: β=.01; 95% CI 0.0006-0.02; P=.04 and without gestational conditions: β=.01; 95% CI 0.0006-0.02; P=.04) and mechanisms that have the potential to reduce risk of a NICU admission, including learning medically accurate information (with gestational conditions: adjusted odds ratio [AOR] 1.05, 95% CI 1.03-1.07; P<.001 and without gestational conditions: AOR 1.04, 95% CI 1.02-1.06; P<.001), mental health management (with gestational conditions: AOR 1.06, 95% CI 1.04-1.08; P<.001 and without gestational conditions: AOR 1.03, 95% CI 1.02-1.05; P<.001), and understanding warning signs during pregnancy (with gestational conditions: AOR 1.08, 95% CI 1.06-1.11; P<.001 and without gestational conditions: AOR 1.09, 95% CI 1.07-1.11; P<.001). For users with and without gestational conditions, an increase in gestational age at birth was associated with a decreased likelihood of NICU admission (with gestational conditions: AOR 0.62, 95% CI 0.55-0.69; P<.001 and without gestational conditions: AOR 0.59, 95% CI 0.53-0.65; P<.001). Among users who developed gestational conditions, those who reported that the platform helped them understand warning signs during pregnancy had lower odds of a NICU admission (AOR 0.63, 95% CI 0.45-0.89; P=.01). Conclusions: Digital health use may aid in extending gestational age at birth and reduce the risk of NICU admission. %R 10.2196/56247 %U https://pediatrics.jmir.org/2024/1/e56247 %U https://doi.org/10.2196/56247 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 8 %N %P e52468 %T Assessment of Skin Maturity by LED Light at Birth and Its Association With Lung Maturity: Clinical Trial Secondary Outcomes %A Neves,Gabriela Silveira %A Reis,Zilma Silveira Nogueira %A Romanelli,Roberta %A Batchelor,James %+ Faculty of Medicine, Universidade Federal de Minas Gerais, 190, Professor Alfredo Balena Avenue, Belo Horizonte, 30130-100, Brazil, 55 31995150401, neves.gabriela87@gmail.com %K newborn infant %K prematurity %K neonatal respiratory distress syndrome %K skin physiological phenomena %K photometer %K gestational age %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Clinicians face barriers when assessing lung maturity at birth due to global inequalities. Still, strategies for testing based solely on gestational age to predict the likelihood of respiratory distress syndrome (RDS) do not offer a comprehensive approach to addressing the challenge of uncertain outcomes. We hypothesize that a noninvasive assessment of skin maturity may indicate lung maturity. Objective: This study aimed to assess the association between a newborn’s skin maturity and RDS occurrence. Methods: We conducted a case-control nested in a prospective cohort study, a secondary endpoint of a multicenter clinical trial. The study was carried out in 5 Brazilian urban reference centers for highly complex perinatal care. Of 781 newborns from the cohort study, 640 were selected for the case-control analysis. Newborns with RDS formed the case group and newborns without RDS were the controls. All newborns with other diseases exhibiting respiratory manifestations were excluded. Skin maturity was assessed from the newborn's skin over the sole by an optical device that acquired a reflection signal through an LED sensor. The device, previously validated, measured and recorded skin reflectance. Clinical data related to respiratory outcomes were gathered from medical records during the 72-hour follow-up of the newborn, or until discharge or death, whichever occurred first. The main outcome measure was the association between skin reflectance and RDS using univariate and multivariate binary logistic regression. Additionally, we assessed the connection between skin reflectance and factors such as neonatal intensive care unit (NICU) admission and the need for ventilatory support. Results: Out of 604 newborns, 470 (73.4%) were from the RDS group and 170 (26.6%) were from the control group. According to comparisons between the groups, newborns with RDS had a younger gestational age (31.6 vs 39.1 weeks, P<.001) and birth weight (1491 vs 3121 grams, P<.001) than controls. Skin reflectance was associated with RDS (odds ratio [OR] 0.982, 95% CI 0.979-0.985, R2=0.632, P<.001). This relationship remained significant when adjusted by the cofactors antenatal corticosteroid and birth weight (OR 0.994, 95% CI 0.990-0.998, R2=0.843, P<.001). Secondary outcomes also showed differences in skin reflectance. The mean difference was 0.219 (95% CI 0.200-0.238) between newborns that required ventilatory support versus those that did not and 0.223 (95% CI 0.205-0.241) between newborns that required NICU admission versus those that did not. Skin reflectance was associated with ventilatory support (OR 0.996, 95% CI 0.992-0.999, R2=0.814, P=.01) and with NICU admission (OR 0.994, 95% CI 0.990-0.998, R2=0.867, P=.004). Conclusions: Our findings present a potential marker of lung immaturity at birth using the indirect method of skin assessment. Using the RDS clinical condition and a medical device, this study demonstrated the synchrony between lung and skin maturity. Trial Registration: Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-3f5bm5; https://tinyurl.com/9fb7zrdb International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-027442 %M 38875690 %R 10.2196/52468 %U https://biomedeng.jmir.org/2023/1/e52468 %U https://doi.org/10.2196/52468 %U http://www.ncbi.nlm.nih.gov/pubmed/38875690 %0 Journal Article %@ 2561-6722 %I %V 6 %N %P e53120 %T Pediatric Delirium Educational Tool Development With Intensive Care Unit Clinicians and Caregivers in Canada: Focus Group Study %A Wood,Michael %A Gandhi,Kavi %A Chapman,Andrea %A Skippen,Peter %A Krahn,Gordon %A Görges,Matthias %A Stewart,S Evelyn %K pediatric delirium education %K pediatric ICU %K focus groups, prototyping %K end users %K users %K education %K educational %K educational tool %K tool %K development %K caregiver %K Canada %K PICU %K pediatric intensive care unit %K quality of life %K child %K children %K family resource %K cognition %K clinical utility %K intensive care unit %D 2023 %7 11.12.2023 %9 %J JMIR Pediatr Parent %G English %X Background: Pediatric intensive care unit (PICU)–associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited. Objective: This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child’s PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources. Methods: Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design. Results: In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers. Conclusions: Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary. %R 10.2196/53120 %U https://pediatrics.jmir.org/2023/1/e53120 %U https://doi.org/10.2196/53120 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43602 %T Canadian Pediatric Intensive Care Adaptations for Critically Ill Adults During the COVID-19 Pandemic: Survey Study %A Parchomchuk,Evan %A Holt,Tanya %A Hansen,Gregory %+ Jim Pattison Children's Hospital, Pediatric Intensive Care Unit, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada, 1 306 844 1068, gregory.hansen@usask.ca %K Canada %K COVID-19 pandemic %K delivery of health care %K pediatrics %K population health %K health care %K intensive care %K patient care %D 2023 %7 10.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic overwhelmed Canadian hospitals with adult admissions. A large number of adult patients required critical care therapies, placing significant strain on hospital resources. In order to decompress adult intensive care units, pediatric intensive care units (PICUs) introduced adapted models of traditional care to lessen these burdens. Objective: We aimed to evaluate how PICUs across Canada adapted care for the high volumes of critically ill adults. Methods: A survey containing 40 questions was sent to the medical directors of 14 Canadian PICUs where English was the primary clinical language. The survey was designed to gain perspective on the various adaptations that PICUs instituted during the COVID-19 pandemic. Results: Of the 13 PICUs that returned survey responses (response rate: 13/14, 93%), 10 (77%) participated in at least one adaptation to support the influx of admitted adults with COVID-19. The key challenges included disorganization, loss of autonomy, and compromised patient care. The significant advantages of these adaptations included a sense of learning and comradery. Conclusions: Our study highlighted an unpreparedness in critical care surge capacity. During the COVID-19 pandemic, adaptations rapidly emerged in Canada that involved PICUs with adult care. In the future, preplanned adaptations for optimizing robust critical care services should be developed based on what has been learned from the COVID-19 pandemic. %M 36724349 %R 10.2196/43602 %U https://pediatrics.jmir.org/2023/1/e43602 %U https://doi.org/10.2196/43602 %U http://www.ncbi.nlm.nih.gov/pubmed/36724349 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e36229 %T Continuous Versus Intermittent Nutrition in Pediatric Intensive Care Patients: Protocol for a Randomized Controlled Trial %A Veldscholte,Karlien %A Cramer,Arnout B G %A de Jonge,Rogier C J %A Eveleens,Renate D %A Joosten,Koenraad F M %A Verbruggen,Sascha C A T %+ Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Postbus 2060, Rotterdam, 3000 CB, Netherlands, 31 107032770, s.verbruggen@erasmusmc.nl %K pediatric intensive care unit %K PICU %K pediatric critical illness %K time-restricted feeding %K intermittent fasting %K feeding intolerance %K ketones %K circadian rhythm %D 2022 %7 23.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intermittent fasting is a time-restricted feeding strategy with proven health benefits, which is based on multiple metabolic and endocrine changes, in several patient populations and healthy participants. In the pediatric intensive care unit (PICU), artificial feeding is usually administered 24 hours a day, although solid evidence supporting this practice is lacking. This discards the potential benefits of fasting in this population. We hypothesize that intermittent nutrition with a focus on an overnight feeding interruption (intermittent fasting), as compared with 24-hour continuous nutrition, is a feasible and safe strategy, with potential benefits, for critically ill children. Objective: The aim of the Continuous versus Intermittent Nutrition in Pediatric Intensive Care randomized controlled trial (RCT) is to investigate a strategy of intermittent nutrition with a focus on an overnight feeding interruption period versus 24-hour nutrition during the first 14 days in the PICU. Methods: The Continuous versus Intermittent Nutrition in Pediatric Intensive Care study is an investigator-initiated RCT in a tertiary referral PICU. Critically ill children (term newborn to 18 years), expected to stay in the PICU for ≥48 hours, and dependent on artificial nutrition, are eligible for inclusion. This study will randomize critically ill children (n=140) to a continuous versus intermittent nutrition strategy. In both groups, similar daily caloric targets will be prescribed. In the continuous group (control), nutrition will be administered 24 hours a day, with a maximum interruption period of 2 hours. In the intermittent group (intervention), nutrition will be interrupted during an age-dependent overnight fasting period. The study intervention will last until admission day 14, initiation of oral intake, or discharge from the PICU, whichever comes first. The primary outcome is the difference in ketosis between the groups under the condition of noninferiority regarding caloric intake. Secondary outcomes are feeding intolerance; the proportion of severe and resistant hypoglycemic events and severe gastrointestinal complications; and additional observed effects on nutritional intake, circadian rhythm, and clinically relevant outcome measures of the intermittent feeding strategy compared with continuous nutrition. Results: The study was approved by the Dutch national ethical review board in February 2020. The first patient was enrolled on May 19, 2020. By May 2022, a total of 132 patients had been included in the study. Recruitment of the last patient is expected in Q3 2022. Conclusions: Although intermittent fasting has been proven to have many health benefits in both animal and human studies, the feasibility and safety of this strategy in a PICU setting must be investigated. This RCT will help physicians gain more insight into the feasibility, safety, and potential clinical effects of intermittent feeding with overnight fasting in critically ill children. Trial Registration: Netherlands Trial Register NL7877; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7877 International Registered Report Identifier (IRRID): DERR1-10.2196/36229 %M 35737448 %R 10.2196/36229 %U https://www.researchprotocols.org/2022/6/e36229 %U https://doi.org/10.2196/36229 %U http://www.ncbi.nlm.nih.gov/pubmed/35737448 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27261 %T Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study %A Mannering,Hannah %A Yan,Chao %A Gong,Yang %A Alrifai,Mhd Wael %A France,Daniel %A Chen,You %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1475, Nashville, TN, 37203, United States, 1 6153431939, you.chen@vanderbilt.edu %K neonatal intensive care unit %K collaboration %K health care organization structures %K intensive care %K length of stay %K discharge dispositions %K electronic health records %K network analysis %K COVID-19 %K temporal network analysis %D 2021 %7 20.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post–COVID-19 era. Objective: This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre– to the intra–COVID-19 era. Methods: In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre–COVID-19, n=386; intra–COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre–COVID-19 as the period of September-December 2019 and intra–COVID-19 as the period of March-June 2020. These 2 groups were compared using patients’ clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians’ actions committed to the patients’ EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre– and intra–COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician’s leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95% CI). Results: Collaboration difficulty increased from the pre– to intra–COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre– and intra–COVID-19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Conclusions: Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU. %M 34637393 %R 10.2196/27261 %U https://www.jmir.org/2021/10/e27261 %U https://doi.org/10.2196/27261 %U http://www.ncbi.nlm.nih.gov/pubmed/34637393 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30582 %T Pediatric Chronic Critical Illness: Protocol for a Scoping Review %A Zorko,David %A McNally,James Dayre %A Rochwerg,Bram %A Pinto,Neethi %A Couban,Rachel %A O’Hearn,Katie %A Choong,Karen %+ Department of Pediatrics, McMaster University, Room 3E20, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada, 1 905 521 2100 ext 76651, david.zorko@medportal.ca %K pediatrics %K critical care %K intensive care units %K chronic critical illness %K research design %D 2021 %7 1.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Improvements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at a significant risk of recurrent and prolonged critical illness, with higher morbidity and mortality, making them a unique population described as having chronic critical illness (CCI). To date, pediatric CCI has been understudied and lacks an accepted consensus case definition. Objective: This study aims to describe the protocol and methodology used to perform a scoping review that will describe how pediatric CCI has been defined in the literature, including the concept of prolonged PICU admission and the methodologies used to develop any existing definitions. It also aims to describe patient characteristics and outcomes evaluated in the included studies. Methods: We will search four electronic databases for studies that evaluated children admitted to any PICU identified with CCI. We will also search for studies describing prolonged PICU admission, as this concept is related to pediatric CCI. Furthermore, we will develop a hybrid crowdsourcing and machine learning (ML) methodology to complete citation screening. Screening and data abstraction will be performed by 2 reviewers independently and in duplicate. Data abstraction will include the details of population definitions, demographic and clinical characteristics of children with CCI, and evaluated outcomes. Results: The database search, crowd reviewer recruitment, and ML algorithm development began in March 2021. Citation screening and data abstraction were completed in April 2021. Final data verification is ongoing, with analysis and results anticipated to be completed by fall 2021. Conclusions: This scoping review will describe the existing or suggested definitions of pediatric CCI and important demographic and clinical characteristics of patients to whom these definitions have been applied. This review’s results will help inform the development of a consensus case definition for pediatric CCI and set a priority agenda for future research. We will use and demonstrate the validity of crowdsourcing and ML methodologies for improving the efficiency of large scoping reviews. International Registered Report Identifier (IRRID): DERR1-10.2196/30582 %M 34596576 %R 10.2196/30582 %U https://www.researchprotocols.org/2021/10/e30582 %U https://doi.org/10.2196/30582 %U http://www.ncbi.nlm.nih.gov/pubmed/34596576 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 8 %P e24079 %T An Artificial Neural Network–Based Pediatric Mortality Risk Score: Development and Performance Evaluation Using Data From a Large North American Registry %A Ghanad Poor,Niema %A West,Nicholas C %A Sreepada,Rama Syamala %A Murthy,Srinivas %A Görges,Matthias %+ Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Rm V3-324, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 6048752000 ext 5616, mgorges@bcchr.ubc.ca %K artificial intelligence %K risk assessment %K decision support techniques %K intensive care unit %K pediatric %K decision making %K computer-assisted %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the pediatric intensive care unit (PICU), quantifying illness severity can be guided by risk models to enable timely identification and appropriate intervention. Logistic regression models, including the pediatric index of mortality 2 (PIM-2) and pediatric risk of mortality III (PRISM-III), produce a mortality risk score using data that are routinely available at PICU admission. Artificial neural networks (ANNs) outperform regression models in some medical fields. Objective: In light of this potential, we aim to examine ANN performance, compared to that of logistic regression, for mortality risk estimation in the PICU. Methods: The analyzed data set included patients from North American PICUs whose discharge diagnostic codes indicated evidence of infection and included the data used for the PIM-2 and PRISM-III calculations and their corresponding scores. We stratified the data set into training and test sets, with approximately equal mortality rates, in an effort to replicate real-world data. Data preprocessing included imputing missing data through simple substitution and normalizing data into binary variables using PRISM-III thresholds. A 2-layer ANN model was built to predict pediatric mortality, along with a simple logistic regression model for comparison. Both models used the same features required by PIM-2 and PRISM-III. Alternative ANN models using single-layer or unnormalized data were also evaluated. Model performance was compared using the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPRC) and their empirical 95% CIs. Results: Data from 102,945 patients (including 4068 deaths) were included in the analysis. The highest performing ANN (AUROC 0.871, 95% CI 0.862-0.880; AUPRC 0.372, 95% CI 0.345-0.396) that used normalized data performed better than PIM-2 (AUROC 0.805, 95% CI 0.801-0.816; AUPRC 0.234, 95% CI 0.213-0.255) and PRISM-III (AUROC 0.844, 95% CI 0.841-0.855; AUPRC 0.348, 95% CI 0.322-0.367). The performance of this ANN was also significantly better than that of the logistic regression model (AUROC 0.862, 95% CI 0.852-0.872; AUPRC 0.329, 95% CI 0.304-0.351). The performance of the ANN that used unnormalized data (AUROC 0.865, 95% CI 0.856-0.874) was slightly inferior to our highest performing ANN; the single-layer ANN architecture performed poorly and was not investigated further. Conclusions: A simple ANN model performed slightly better than the benchmark PIM-2 and PRISM-III scores and a traditional logistic regression model trained on the same data set. The small performance gains achieved by this two-layer ANN model may not offer clinically significant improvement; however, further research with other or more sophisticated model designs and better imputation of missing data may be warranted. %M 34463636 %R 10.2196/24079 %U https://medinform.jmir.org/2021/8/e24079 %U https://doi.org/10.2196/24079 %U http://www.ncbi.nlm.nih.gov/pubmed/34463636 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 2 %P e28210 %T Examining the Feasibility of Early Mobilization With Virtual Reality Gaming Using Head-Mounted Display and Adaptive Software With Adolescents in the Pediatric Intensive Care Unit: Case Report %A Lai,Byron %A Powell,Maegen %A Clement,Anne Grace %A Davis,Drew %A Swanson-Kimani,Erin %A Hayes,Leslie %+ Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294, United States, 1 2056389790 ext 8 9725, byronlai@uab.edu %K physical activity %K active video gaming %K exergaming %K early mobility %K rehabilitation %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Early rehabilitative mobilization for adolescents is safe and feasible. However, there is a lack of published rehabilitation strategies and treatments that can maximize engagement and outcomes among adolescents in the pediatric intensive care unit (PICU). Virtual reality (VR) gaming using a head-mounted display (HMD) and adaptive software can allow active and nonactive gameplay at the bedside for people with limited arm mobility, making it a potentially inclusive and enjoyable treatment modality for adolescents in the PICU. Objective: The purpose of this brief case study is to report on the preliminary feasibility of incorporating adaptive VR gaming using an HMD with 2 adolescents who received early mobility treatment within the PICU. Methods: This study was a mini-ethnographic investigation of 2 adolescents (a 15-year-old male and a 13-year old male) in the PICU who underwent VR gaming sessions as part of their early mobilization care, using an Oculus Rift HMD and adaptive software (WalkinVR) that promoted full gameplay in bed. The Rift was plugged into a gaming laptop that was set up on a table within the patient’s room before each session. The intervention was delivered by an adapted exercise professional and supervised by a physical therapist. Patients had access to a variety of active games (eg, boxing, rhythmic movement to music, and exploratory adventure) and nonactive games (eg, racing and narrative adventure). Gaming sessions were scheduled between usual care, when tolerable and requested by the participant. The interventionist and therapists took audio-recorded and written notes after completing each gaming session. These data were analyzed and presented in a narrative format from the perspective of the research team. Results: Case 1 participated in 4 gaming sessions, with an average of 18 minutes (SD 11) per session. Case 2 participated in 2 sessions, with an average of 35 minutes (SD 7) per session. Both cases were capable of performing active gaming at a moderate level of exercise intensity, as indicated by their heart rate. However, their health and symptoms fluctuated on a daily basis, which prompted the gameplay of adventure or nonactive games. Gameplay appeared to improve participants’ affect and alertness and motivate them to be more engaged in early mobilization therapy. Gameplay without the WalkinVR software caused several usability issues. There were no serious adverse events, but both cases experienced symptoms based on their condition. Conclusions: The findings of this study suggest that VR gaming with HMDs and adaptive software is likely a feasible supplement to usual care for adolescents within the PICU, and these findings warrant further investigation. Recommendations for future studies aimed at incorporating VR gaming during early mobilization are presented herein. %M 34042602 %R 10.2196/28210 %U https://rehab.jmir.org/2021/2/e28210 %U https://doi.org/10.2196/28210 %U http://www.ncbi.nlm.nih.gov/pubmed/34042602 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e22948 %T Extreme Prematurity and Pulmonary Outcomes Program in Saitama: Protocol for a Prospective Multicenter Cohort Study in Japan %A Namba,Fumihiko %A Tanaka,Kosuke %A Omori,Sayu %A Ikeda,Kazushige %A Kawabata,Ken %A Sato,Hiroaki %A Honda,Masakazu %A Ichikawa,Tomonori %A Minosaki,Yoshihiro %A Michikawa,Takehiro %A Oka,Shuntaro %A Kabe,Kazuhiko %+ Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Saitama, 350-8550, Japan, 81 49 228 3727, nambaf@saitama-med.ac.jp %K prematurity %K preterm infant %K bronchopulmonary dysplasia %K respiratory outcome %D 2021 %7 5.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Because of the improvements in survival rates for preterm infants, not only the rates of bronchopulmonary dysplasia (BPD) but also those of long-term respiratory complications of premature birth are increasing, resulting in financial and health burdens in developed countries. Thus far, the risk factors of respiratory morbidities in extremely preterm infants remain unknown. Furthermore, the definition and the predictive ability of BPD for long-term respiratory outcomes are yet to be determined. Objective: The objective of our study, Extreme Prematurity and Pulmonary Outcomes Program in Saitama, is to develop the diagnostic criteria for BPD and to determine the prognostic factors contributing to the long-term pulmonary outcomes manifesting in extremely preterm infants. Methods: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama is an observational prospective cohort study performed by a consortium of six neonatal intensive care units (NICUs) in Saitama, Japan. The subjects included in this study are infants (from each clinical center) with gestational ages 22 to 27 weeks. The target is 400 subjects. This study aims to determine the definition of BPD and other perinatal factors that accurately predict the long-term pulmonary outcomes in survivors of extreme prematurity. Moreover, the association between BPD and postprematurity respiratory disease will be investigated using generalized linear models. Results: The protocol and consent forms were evaluated and approved on September 5, 2019, by the Ethics Committee of Saitama Medical Center, Saitama Medical University. Enrollment began on April 1, 2020. It is expected to end on March 31, 2023. The follow-up for 1 year corrected age is expected to continue through the middle of 2024. Conclusions: The Extreme Prematurity and Pulmonary Outcomes Program in Saitama incorporates aspects of neonatal care in secondary- and tertiary-level NICUs to develop existing research studies on the definition of BPD, objective biomarkers, and outcome measures of respiratory morbidity in extremely preterm infants beyond NICU hospitalization, thereby leading to a novel understanding of the nature and natural history of BPD and potential mechanistic and therapeutic targets in at-risk subjects. International Registered Report Identifier (IRRID): DERR1-10.2196/22948 %M 33666556 %R 10.2196/22948 %U https://www.researchprotocols.org/2021/3/e22948 %U https://doi.org/10.2196/22948 %U http://www.ncbi.nlm.nih.gov/pubmed/33666556 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e25991 %T Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis %A Kowalski,Rebecca L %A Lee,Laura %A Spaeder,Michael C %A Moorman,J Randall %A Keim-Malpass,Jessica %+ School of Nursing, University of Virginia, PO Box 800782, Charlottesville, VA, 22908, United States, 1 2433961, jesskeim@gmail.com %K pediatric intensive care unit %K cardiorespiratory monitoring %K hospital transfer %K clinical deterioration %K monitoring %K ICU %K intensive care unit %K pediatric %K retrospective %K detection %K deterioration %K child %K accuracy %K cohort %D 2021 %7 22.2.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer. Objective: The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation. Methods: We conducted a retrospective cohort study of patients ≤21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer. Results: During the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness. Conclusions: This analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer. %M 33547772 %R 10.2196/25991 %U https://pediatrics.jmir.org/2021/1/e25991 %U https://doi.org/10.2196/25991 %U http://www.ncbi.nlm.nih.gov/pubmed/33547772