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Availability of trivalent inactivated influenza vaccine to parents of neonatal intensive care unit patients and its effect on the healthcare worker vaccination rate

Shah, Shetal I; Caprio, Martha
BACKGROUND: Trivalent inactivated influenza vaccine (TIV) is indicated for healthcare workers (HCWs); however, the vaccination rate in this population is estimated at 35%. We implemented a program for the administration of TIV, targeted at parents of neonatal intensive care unit (NICU) patients. OBJECTIVE: To determine the effect of availability of TIV to parents in the NICU on HCW vaccination rates. DESIGN: Questionnaire survey after an intervention-based study. SETTING: Tertiary-care neonatal intensive care unit. PARTICIPANTS: Physicians, nurses, and other NICU-based staff. METHODS: For the 2005-2006 influenza season, parents of NICU patients were screened and administered TIV, if informed consent was obtained. As a consequence, TIV was available 20 hours/day to all staff. Previous vaccination history and comorbidities in HCWs were also assessed. RESULTS: Of 120 neonatal HCWs, 112 (93%) were screened during the 2005-2006 season; 80 (67%) were vaccinated, compared with 49 (41%) prior to the implementation of this program (P < .03, by Student's t test); 54 (45% of the study population, which includes senior neonatologists, fellow and resident physicians, nurses, respiratory therapists, X-ray technicians and clerical staff) received TIV in the NICU, compared with the 17 (14%) of 120 HCWs the previous year; and 20 (46%) of 43 HCWs of the nursing staff were vaccinated in the NICU, whereas only 3 (7%) of 43 HWCs were vaccinated outside the unit. Attending physicians had the lowest vaccination rate, and most cited efficacy and/or side effects in their deferral. Nurses most often refused influenza vaccination because they had a fear of injection. CONCLUSIONS: Administration of TIV in the NICU is an effective means of increasing the vaccination rate among neonatal HCWs. To increase compliance with vaccination, educational efforts for nurses should emphasize the possibility of viral transmission to neonates as motivation for vaccination. Physician-directed efforts should include tolerability of vaccine side effects. Live attenuated influenza vaccine, administered intranasally, should be considered to increase vaccination rates among NICU nurses
PMID: 18462142
ISSN: 0899-823x
CID: 129065

Quantification of impulse experienced by neonates during inter- and intra-hospital transport measured by biophysical accelerometery

Shah, Shetal; Rothberger, Adina; Caprio, Martha; Mally, Pradeep; Hendricks-Munoz, Karen
BACKGROUND: Transport of premature infants incurs transfer-related morbidity, including intraventricular hemorrhage, a contributing factor to cerebral palsy. The force transmitted to the neonate during transport as a consequence of motion may be implicated in the increased morbidity in this population. Morbidity may occur via direct concussive force to a vulnerable germinal matrix, induction of an inflammatory reaction, or via transient desaturation via extubation. This transmitted force, measured as accelerations per unit time (impulse), is not well characterized. Any modification of a neonatal transporter which increases the time for a neonate in motion to come to rest may decrease the impulse experienced by the infant. OBJECTIVE: The objective of the study was to quantify the magnitude of impulse experienced by neonates during inter- and intra-hospital transport using a novel biophysical model and determine whether a specialized air-foam mattress can reduce the transmitted impulse on the neonate. METHODS: Five roundtrip trials were conducted for a transported neonate using a standard medical ambulance and transport isolette outfitted with an air-foam mattress. During the trials, measurements were made per second in the X (front-to-back), Y (side-to-side), and Z (up-and-down) planes using a computerized accelerometer attached to a neonatal resuscitation mannequin. Results were integrated over the trial time in each dimension to yield a measure of impulse (acceleration-per-unit-time). Total impulse for the trial was calculated. A second design included five trials from the delivery room to the NICU utilizing four different transport configurations with a standard neonatal isolette outfitted with a gel pillow, air-foam mattress, and air-foam mattress with gel pillow. RESULTS: Mean impulse for the transport model was statistically greater than at rest. In the X and Z dimensions, the mean impulse was significantly lower using the air-foam mattress. The impulse of the Z dimension with the air-foam mattress did not differ from that experienced by the experimental model at rest. For the intra-hospital trial, all experimental set-ups produced significantly less cumulative impulse than the standard isolette, though in each specific dimension, no significant differences were noted. For cumulative impulse, no significant differences between any of the three experimental designs were observed. A trend toward decreased transport time was seen with the addition of the air-foam mattress and gel pillow. CONCLUSIONS: The mechanical trauma induced by transport can be measured and quantified using this system. Neonates transported with the air-foam mattress experienced less impulse in the front-to-back and up-and-down dimensions. For transports between the delivery room and NICU, neonates transported using the air-foam mattress and gel pillow experienced significantly less total impulse
PMID: 18184102
ISSN: 0300-5577
CID: 135331

Administration of inactivated trivalent influenza vaccine to parents of high-risk infants in the neonatal intensive care unit

Shah, Shetal I; Caprio, Martha; Hendricks-Munoz, Karen
OBJECTIVE: Infants who are younger than 6 months and have influenza demonstrate significant morbidity and mortality. Trivalent inactivated influenza vaccine is indicated for parents and household contacts of these infants; however, the influenza vaccination rate in this population is estimated at 30%. The objective of this study was to determine the feasibility of trivalent inactivated influenza vaccine administration to parents in a tertiary-care, level III NICU and measure the effect of this program on vaccination rates among parents of this high-risk population. METHODS: For a 4-month period during influenza season, all parents of admitted patients were informed of the risks and benefits of trivalent inactivated influenza vaccine by placing an information letter at their infant's bedside. All staff were educated about the dangers of influenza and instructed to reinforce the need to obtain vaccination. Parents were screened, provided medical consent, and, when eligible, were immunized at their infant's bedside. RESULTS: During the study period, 158 children (273 parents) were admitted to the NICU with gestational ages ranging from 24 to 41 weeks; 220 parents (130 infants) were offered the vaccine, and 40 parents received the vaccine from their obstetrician. Overall vaccination rate was 95% (209 parents). A total of 23% of the parent population had never received trivalent inactivated influenza vaccine, despite having previous indications for immunization (smoking, asthma, or other children younger than 23 months, the indicated age for parental vaccination at the time of this study); 75% of the population received trivalent inactivated influenza vaccine for the first time. The 28 infants whose parents were not offered vaccine spent <72 hours in the NICU. CONCLUSIONS: Administration of trivalent inactivated influenza vaccine in the NICU is an effective means of increasing vaccination rates in parents of this population. In addition, the improved access and convenience allow for an increase in first-time vaccination of parents who were previously eligible to receive trivalent inactivated influenza vaccine but were never immunized
PMID: 17766502
ISSN: 1098-4275
CID: 129066

Computer-based multivariate economic analysis of neonatal-intensive-care-unit-based influenza vaccine administration to parents in a low-socio-economic, urban setting

Shah, Shetal I; Caprio, Martha; Sen, Alpana; Hendricks-Munoz, Karen
OBJECTIVE: Trivalent inactivated influenza vaccine has been shown to reduce the number of influenza-related outpatient visits and hospitalizations of children up to 24 months of age. The American Academy of Pediatrics, Centers for Disease Control, and Advisory Committee on Immunization Practices recommend that the influenza vaccine be administered to the first-person contacts of infants less than 6 months of age. However, the economic implications of increasing immunization rates by using the neonatal intensive care unit (NICU) as an arena to capture the parents of these infants has not been fully evaluated. We sought to examine the direct and indirect costs of a program to administer the influenza vaccine to parents in the NICUs of a cohort of tertiary-care units primarily serving a low socioeconomic population. METHODS: The probabilities of infants being hospitalized because of infection from contact and of the efficacy of prophylaxis used in the present study were based on published results where possible, with an estimated 10% reduction in hospitalization of patients whose parents had received the vaccine. Variables in the 3- and 4-tiered analyses included chronic lung disease status, estimation if patients had siblings, vaccination status of siblings, seroconversion rate of vaccine, and parental vaccination status. Two thousand six hundred and thirty-two patients were analyzed using 2003 admission data from the New York City Regional Perinatal Center, which encompasses 11 level III NICUs. Hospitalization costs, indirect costs, and outpatient costs were assessed using previously published standard calculations. RESULTS: On the basis of this computer model, costs were $188 per patient per influenza season, including $6.80 per patient in outpatient costs. Administration of an NICU-based influenza vaccine increased costs to $200 per patient per influenza season, but decreased outpatient costs to $1.40 per patient. For cost savings to equal costs of vaccine administration, there must be either a 20% reduction in influenza hospitalizations of NICU patients or an increase in the sample size per influenza season to 4000 patients. CONCLUSIONS: The cost of administration of the influenza vaccine to parents of NICU patients is higher than the financial burden of influenza in this population as long as the sibling immunization rate remains low. Cost savings do not occur until the treated cohort increases to 4000 patients or the incidence of lung disease in this population increases. Further studies are needed to validate the cost savings of this mode and more accurately assess the financial savings
PMID: 17549758
ISSN: 1553-5606
CID: 102608

Rationale for the administration of acellular pertussis vaccine to parents of infants in the neonatal intensive care unit

Shah, S; Caprio, M; Mally, P; Hendricks-Munoz, K
Pertussis infections in the United States are increasing as a consequence of waning immunity and increased surveillance. Those most at-risk of mortality include infants less than 6 months of age and premature infants. The 2006 immunization schedule emphasizes an adolescent pertussis booster at 12 years of age. However, of concern is the current generation of parents and grandparents who will still be un-immunized and therefore, available vectors of pertussis to vulnerable neonates. Given the proximity of parents to medical care in the Neonatal Intensive Care Unit (NICU), and the potential for severe disease in their children, NICU personnel should consider administration of acellular pertussis vaccine to parents of hospitalized infants
PMID: 17180125
ISSN: 0743-8346
CID: 70828

A computer-based multivariate, economic analysis of neonatal intensive-care-unit-based influenza vaccine administration to parents in a hospitalist setting [Meeting Abstract]

Shah SI; Caprio M; Hendricks-Munoz K
ORIGINAL:0005720
ISSN: 1553-5592
CID: 66851

Administration of inactivated trivalent influenza vaccine (TIV) to parents of high-risk infants in the neonatal intensive care unit (NICU): a novel strategy to increase vaccination rates [Meeting Abstract]

Shah SI; Caprio M; Hendricks-Munoz K
ORIGINAL:0005721
ISSN: 1553-5592
CID: 66852

Management of a full-term infant with hemolytic disease of the newborn due to an anti-Rh17 antibody in a mother with D-- phenotype [Letter]

Shah, Shetal I; Caprio, Martha; Strauss, Robert; Moskowitz, Naomi
PMID: 16138349
ISSN: 0361-8609
CID: 129068

Management of an allo-anti-Rh17: Mother and baby [Meeting Abstract]

Strauss, RA; Gajera, DA; Saladino, M; Patel, AB; Cai, G; Zhu, CC; Burgos, A; Velliquette, R; Afonja, O; Moskowitz, N; Shah, S; Caprio, M; Koklanaris, N; Tropper, P; Talebian, S; Lee, MJ
ISI:000223575600443
ISSN: 0041-1132
CID: 46467

Developmental care: the impact of Wee Care developmental care training on short-term infant outcome and hospital costs

Hendricks-Munoz KD; Prendergast CC; Caprio MC; Wasserman RS
This article explores the effect of a comprehensive developmental care training program on the medical outcome and cost of care for premature infants. Premature infants less than 34 weeks' gestation admitted to 2 regional neonatal intensive care units were prospective studies 6 months before and after implementation of the Wee Care program (Children's Medical Ventures, Norwell, MA). Environment, medical outcome, and hospital charges were recorded. The sample consisted of 242 infants (139 pre- and 103 postintervention). Although the medical outcomes of chronic lung disease, infection rate, mild retinopathy of prematurity, and intraventricular hemorrhage were significantly decreased, there was no change in incidence of severe retinopathy of prematurity. Hospital stay and hospital costs were significantly decreased. The authors conclude that a multidisciplinary, structured program in developmental care can lead to alterations in the neonatal intensive care unit environment associated with improved medical outcome, decreased length of hospitalization, and decreased cost of care.
CINAHL:2004030378
ISSN: 1527-3369
CID: 80322