Day 1 :
Jaipur Golden Hospital, India
Keynote: To evaluate the effi cacy of probiotics in reducing the incidence and severity of necrotizing enterocolitis in very low birth weight infants
Time : 09:40-10:20
Sandeeep Rawal is MD in (Paediatrics), Fellowship in Neonatology (IAP). Presently he is working as a Senior Consultant in the Department of Neonatology and Paediatrics, Jaipur Golden Hospital, Delhi, India. He is In-charge of Neonatal fellowship program of the hospital run under the aegis of Indian Academy of Paediatrics and National Neonatology Forum. He is also a faculty of Post-graduate teaching program (DNB) of National Board of Examinations under Ministry of Health, India. He is a National trainer of Advanced NRP course in India and has conducted many workshops. He has been the Faculty to many conferences and CMEs. His interests include Pain Management in NICU, Asepsis in NICU, KMC and Nutrition in Preterm. He has been guide to many post-graduates dissertations in neonatology (central lines and nosocomial sepsis, role of probiotics in preventing NEC, transcutaneous bilirubinometry, late preterm, and kangaroo mother care). He has many publications to his credit in esteemed Journals of Paediatrics and Neonatology.
Aim: To evaluate the efficacy of probiotics in reducing the incidence and severity of necrotizing enterocolitis in very low birth weight infants.
Study: Prospective double blind randomized controlled trial.
Setting: NICU of Jaipur Golden Hospital, Rohini, Delhi.
Methods: A prospective, double blind randomized controlled study was conducted in infants with gestational age ≤34 weeks and birth weight ≤1500 g. The study group received probiotics supplementation, and the control group did not. The primary outcomes were death or NEC (Bell’s stage ≥2), and secondary outcomes were feeding intolerance and clinical or culture proven sepsis.
Results: The results indicated that total of 151 infants were enrolled in the study, 76 in the study group and 75 in the control group. There was significant difference in the incidence of NEC (0.0% vs 6.7%; p=0.028) and feeding intolerance (22.4% vs. 44.0%, 95%; p=0.005) between the groups. However, the incidence of death and clinical or culture proven sepsis were non-significant between the groups.
Conclusions: Probiotic mixture containing the commonly used probiotics Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum, along with Saccharomyces boulardii; at the dose of 2.5x109 live cells; reduce the incidence of necrotizing enterocolitis and feed intolerance in very low birth weight infants.
Emory University School of Medicine, Georgia
Eva Lee is Virginia C. and Joseph C. Mello Chair and Professor in the School of Industrial and Systems Engineering, and Director of the Center for Operations Research in Medicine and HealthCare, a center established through funds from the National Science Foundation and the Whitaker Foundation. She is a Distinguished Scholar in Health Systems, Health System Institute at Georgia Tech and Emory University School of Medicine. She is also the Co-Director of the Center for Health Organization Transformation, an NSF Industry/University Cooperative Research Center. She has made major contributions in advances to business operations transformation, biomedicine and clinical research, emergency response and disaster preparedness, and healthcare operations. Lee has received multiple prestigious analytics and practice excellence awards including INFORMS Franz Edelman award, Daniel H Wagner prize for novel cancer therapeutics, bioterrorism emergency response and mass casualty mitigation, personalized disease management, transforming clinical workflow and patient care, vaccine immunity prediction, and reducing hospital acquired conditions. Dr. Lee is an INFORMS Fellow. She has received patents on innovative medical systems and devices.
Congenital heart defects (CHDs) are the most common birth defect and occur in around 1% of births. They are the most common cause of infant deaths due to birth defects, and survivors often face health issues into adulthood. This project describes the transformation that can happen when advanced analytics and operations research is applied to improve the outcome of CHD surgeries in a coordinated effort involving multiple pediatric heart hospitals. Working with the Pediatric Heart Network (PHN), we devised a customizable model and decision support framework that combines systems modeling, simulation-optimization decision analytics, clustering, and machine learning within a collaborative learning paradigm to help hospitals pinpoint key factors on practice variation, and design clinical practice guidelines (CPGs) for rapid implementation to improve the outcomes of CHD surgeries. The project involved the implementation of an early extubation CPG (removal of the breathing apparatus) for patients in five large pediatric heart hospitals. The post implementation results in all sites were positive; early extubation rates increased from 12% to 67%, the median duration of postoperative (post-op) intubation decreased from 21.2 hours to 4.5 hours, and the length of stay (LOS) for patients in intensive care units decreased from 68.5 hours to 51.0 hours. Overall, the five hospital sites experienced LOS reductions ranging from 12% to 35%, decreased time to oral feeds (37%), and an earlier discontinuation of IV analgesics (37% to 55% depending on drug type). This CPG has since become routine practice. Earlier resumption of normal feeding and reduction in analgesics lessen risks of medical complications. Fewer analgesics reduce risks of cognitive impairment and impaired brain development in children. And shorter mechanical ventilation time and LOS for patients reduce their exposure to critical care therapies and indwelling devices, which subsequently reduce the risk of hospital-acquired infections. The implementation resulted in cost savings of approximately 27%, amounting to $13,500 per surgical procedure, on average. It reduced clinical care cost by 65%, pharmacy costs by 46%, laboratory costs by 44%, and imaging costs by 32%.