Faculty Bibliography

INTRODUCTION/UNASSIGNED:Newborn infants undergo multiple blood tests before hospital discharge, some of which are unnecessary due to outdated hospital policies and provider variability. Reducing nonevidence-based laboratory testing can improve healthcare value, and clustering of blood sampling can reduce pain for newborns. METHODS/UNASSIGNED:This quality improvement project aimed to reduce the weekly number of laboratory tests and blood draws per patient-day for newborns by 10% within 8 months. A multidisciplinary team developed and addressed key drivers with Plan-Do-Study-Act cycles. Interventions included high-value care education, implementation of the 2022 American Academy of Pediatrics hyperbilirubinemia clinical guidelines, and modification of the blood type and screen testing workflow. The balancing measures were to maintain the average length of stay less than 48 hours and a 7-day readmission rate less than 1.5%. Data were collected using electronic health record reports and analyzed with statistical process control charts. RESULTS/UNASSIGNED:The study included 7,749 newborn nursery patients during a 22-month period. Laboratory tests per patient-day decreased from 1.41 to 0.84 after implementation of the new American Academy of Pediatrics hyperbilirubinemia guidelines, and further decreased to 0.53 with changes to the type and screen workflow. The number of blood draws per patient-day decreased from 0.47 to 0.20 with implementation of the updated hyperbilirubinemia guidelines. Average length of stay increased from 47.4 to 50.7 hours, associated with unrelated hospital changes. Readmission rates were stable. CONCLUSIONS/UNASSIGNED:This quality improvement project exceeded the study goal, achieving a 62% reduction in laboratory tests and a 57% reduction in blood draws performed on newborns, thereby increasing value and decreasing pain without adverse effects.

The U.S. Global Change Research Program reports that the frequency and intensity of extreme heat are increasing globally. Studies of the impact of climate change on child health often exclude sleep, despite its importance for healthy growth and development. To address this gap in the literature, we studied the impact of unusually high temperatures in the summer of 2022 on infants' sleep. Sleep was assessed objectively using Nanit camera monitors in infants' homes. Generally, sleep was not impacted when temperatures stayed below 88° but was negatively impacted when temperatures reached over 100°. Compared to non-heatwave nights, infants had less total sleep, less efficient sleep, took longer to fall asleep, had more fragmented sleep, and parents' visits were more frequent during the night. Following peaks in temperature, sleep metrics rebounded to better than average compared to non-peak nights, suggesting that infants compensated for disrupted sleep by sleeping more and with fewer interruptions once the temperature dropped below 85°. Increased instances of disrupted sleep in infancy have important implications for psychological health and development. Climate disruptions such as heat waves that create occasional or ongoing sleep disruptions can leave infants vulnerable and unprepared for learning.