AMC Emma Childrens Hospital

Amsterdam, Netherlands

AMC Emma Childrens Hospital

Amsterdam, Netherlands
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Latour J.M.,Erasmus Medical Center | Van Goudoever J.B.,Erasmus Medical Center | Van Goudoever J.B.,VU University Amsterdam | Van Goudoever J.B.,AMC Emma Childrens Hospital | And 9 more authors.
Pediatric Critical Care Medicine | Year: 2011

Objective: To explore similarities and differences in perceptions on pediatric intensive care practices between parents and staff by using data from two studies. Design: A two-round Delphi method among nurses and physicians followed by an empiric survey among parents. Settings: Pediatric intensive care units at eight university medical centers. Subjects: Parents whose child has been admitted to a pediatric intensive care unit, nurses, and physicians. Interventions: None. Measurements and Main Results: Outcome measures were 74 satisfaction-with-care items divided into five domains: 1) information; 2) care and cure; 3) organization; 4) parental participation; and 5) professional attitude. The Delphi study was completed by 218 nurses and 46 physicians and the survey by 559 of 1042 (54%) parents. Parents rated 31 items more important than the professionals based on the standardized mean difference (Cohen's d, 0.21-1.18, p < .003). Ten of these were related to information provision. Information on the effects of medication had the largest effect size (Cohen's d 1.18, p = .001). Correct medication administration by professionals was also rated significantly more important by parents (Cohen's d 0.64, p = .001). The professionals rated 12 items more important than the parents (Cohen's d -0.23 to -0.73, p < .005), including three about multicultural care. Significant differences remained on two of the three multicultural care items when the Dutch (n = 483) and non-Dutch parents (n = 76) were separately compared with professionals. On the domain level, parents rated the domains information and parental participation more important than the professionals (Cohen's d 0.36 and 0.26, p = .001). Conclusions: Compared with the parents' perceptions, nurses and physicians undervalued a substantial number of pediatric intensive care unit care items. This finding may reflect a gap in the understanding of parental experiences as well as incongruity in recognizing the needs of parents. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Verbruggen S.C.,Erasmus MC Sophia Childrens Hospital | Landzaat L.J.,Erasmus MC Sophia Childrens Hospital | Reiss I.K.M.,Erasmus MC Sophia Childrens Hospital | Van Goudoever J.B.,Erasmus MC Sophia Childrens Hospital | And 3 more authors.
Neonatology | Year: 2012

Background: A large single-center randomized trial showed that treating hyperglycemia in critically ill children improved outcome, despite an increased incidence of hypoglycemia, especially in infants. Objectives: We evaluated the efficacy and incidence of hypoglycemia using a tight glucose protocol in critically ill term neonates. Methods: Term hyperglycemic (>8 mmol·l -1; >144 mg·dl -1) neonates treated with a tight glucose protocol during a 3.5-year period in a tertiary pediatric intensive care unit were retrospectively analyzed. Results: Seventy-three term hyperglycemic neonates [age 0 days (0-6), weight 3.2 ± 0.8 kg, PRISM 16 (11-20)] were included for analysis. Eighteen neonates died (25%). The initial mean (range) glucose level was 11.1 mmol·l -1 [9.6-15.2; 200 mg·dl -1 (173-274)], and normoglycemia (<8 mmol·l -1; <144 mg·dl -1) was reached within 5.3 h (1-25) with an overall treatment duration of 27 h (10-57). Seven hypoglycemic incidents (5 times ≤2.2 mmol·l -1; 40 mg·dl -1, and 2 times <1.7 mmol·l -1; 31 mg·dl -1) occurred in 5 (6.7%) infants, without severe clinical signs. Three hypoglycemic incidents were directly explained due to a protocol violation. One hypoglycemic incident occurred with the onset of sepsis, while no apparent cause was identified for three hypoglycemic incidents. Conclusions: Our glucose protocol was effective, but hypoglycemia occurred more frequently than in older children reported previously. Potential differences in glucose and insulin metabolism in term neonates appear to justify additional safety approaches, while awaiting further studies assessing the benefits of tight glucose protocols in this population. Meanwhile, we have decreased the initial insulin starting doses in our protocol. Copyright © 2011 S. Karger AG.

Simons S.H.P.,Erasmus MC Sophia Childrens Hospital | Van Der Lee R.,AMC Emma Childrens Hospital | Reiss I.K.M.,Erasmus MC Sophia Childrens Hospital | Van Weissenbruch M.M.,Medical Center Amsterdam
Acta Paediatrica, International Journal of Paediatrics | Year: 2013

Aim To determine the effects of propofol for endotracheal intubation in neonates in daily clinical practice. Methods We prospectively studied the pharmacodynamic effects of intravenous propofol administration in neonates who needed endotracheal intubation at the neonatal intensive care unit. Results Propofol was used for 62 intubations in neonates with postmenstrual ages ranging from 24 + 3 weeks to 44 + 5 weeks and bodyweights ranging from 520 to 4380 g. A 2 mg/kg bodyweight propofol starting dose was sufficient in 37% of patients; additional propofol was needed less often on the first postnatal day. The mean amount of propofol used was 3.3 (±1.2) mg/kg. The success rate of intubation depended on the experience of the physician and was related to the total administered amount of propofol. Hypotension occurred in 39% of patients and occurred more often at the first postnatal day. In 15% of procedures, propofol mono therapy was insufficient. Conclusion This study shows that high doses of propofol are needed to reach effective sedation in neonates for intubation, with hypotension as a side effect in a considerable percentage of patients. Further research in newborn patients needs to identify optimal propofol doses and risk factors for hypotension. ©2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.

Latour J.M.,Erasmus MC Sophia Childrens Hospital | Duivenvoorden H.J.,Erasmus MC Sophia Childrens Hospital | Hazelzet J.A.,Erasmus MC Sophia Childrens Hospital | Van Goudoever J.B.,Erasmus MC Sophia Childrens Hospital | And 2 more authors.
Pediatric Critical Care Medicine | Year: 2012

OBJECTIVE: To develop and test the psychometric properties of the EMPATHIC-N (EMpowerment of PArents in THe Intensive Care-Neonatology) questionnaire measuring parent satisfaction. DESIGN: A psychometric study testing the reliability and validity of a parent satisfaction questionnaire by applying confirmatory factor analysis including standardized factor loadings and subsequently Cronbach's α reliability estimates across time, congruent validity, and nondifferential validity testing. SETTING: A 30-bed neonatal intensive care unit in a university hospital. PATIENTS: Two cohorts with a total of 441 parents whose child was admitted to the neonatal intensive care unit, January to December 2009. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In the first cohort, 220 of 339 (65%) parents responded; in the second cohort, 59 of 102 (58%) parents responded. Structural equation modeling and confirmatory factor analysis resulted in a sufficient model fit of 57 statements within five domains: Information, Care & Treatment, Organization, Parental Participation, and Professional Attitude. Standardized factor loading of these statements were between 0.58 and 0.91. Reliability measures, Cronbach's α, of the domains ranged from 0.82 to 0.95. Reliability across time showed no evidence of statistically significant differences between the domains. Congruent validity was confirmed by a good correlation (p = .01) between the domains and four general satisfaction questions. Nondifferential validity showed no significant effect sizes between the infants' characteristics and the domains, except between ventilated infants and parent participation statements and infants ≥30 wks gestational age and organizational statements. CONCLUSIONS: The EMPATHIC-N questionnaire is a valid quality performance indicator to measure the delivered care as perceived by parents. Copyright © 2012 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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