2021
An Initiative to Decrease Laboratory Testing in a NICU
Klunk CJ, Barrett RE, Peterec SM, Blythe E, Brockett R, Kenney M, Natusch A, Thursland C, Gallagher PG, Pando R, Bizzarro MJ. An Initiative to Decrease Laboratory Testing in a NICU. Pediatrics 2021, 148: e2020000570. PMID: 34088759, DOI: 10.1542/peds.2020-000570.Peer-Reviewed Original ResearchMeSH KeywordsBilirubinBlood GlucoseBlood VolumeCarbon DioxideConnecticutHemorrhageHospitals, PediatricHumansInfant, NewbornIntensive Care Units, NeonatalLaboratories, HospitalMonitoring, PhysiologicPainPoint-of-Care TestingProcedures and Techniques UtilizationQuality ImprovementUnnecessary ProceduresConceptsExtreme laboratory valuesPatient daysLaboratory valuesOutcome measuresMultifaceted quality improvement projectSerum bilirubin testSecondary outcome measuresPrimary outcome measureHealthcare Improvement's ModelNotable adverse effectsLaboratory testingQuality improvement projectOrder of interventionsBlood lossNeurodevelopmental impairmentBlood glucoseSecondary measuresSustained reductionBilirubin testBlood volumeGuideline developmentLaboratory testsUnnecessary testsNICUAdverse effects
2015
Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit in the Decade following Implementation of an Active Detection and Isolation Program
Nelson MU, Bizzarro MJ, Baltimore RS, Dembry LM, Gallagher PG. Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit in the Decade following Implementation of an Active Detection and Isolation Program. Journal Of Clinical Microbiology 2015, 53: 2492-2501. PMID: 26019206, PMCID: PMC4508396, DOI: 10.1128/jcm.00470-15.Peer-Reviewed Original ResearchMeSH KeywordsDNA, BacterialEpidemiological MonitoringFemaleGenetic VariationGenotypeGenotyping TechniquesHumansInfantInfant, NewbornIntensive Care Units, NeonatalMaleMethicillin-Resistant Staphylococcus aureusMolecular EpidemiologyMolecular TypingRetrospective StudiesStaphylococcal InfectionsVirulence FactorsConceptsNeonatal intensive care unitMethicillin-resistant Staphylococcus aureusIntensive care unitMRSA colonizationMolecular epidemiologyCare unitStaphylococcal cassette chromosome mec type IIAccessory gene regulator (agr) groupsMRSA colonization rateToxic shock syndrome toxinAgr group 1Exfoliative toxin AStaphylococcus aureusPotential virulence factor genesVirulence factor genesMRSA infectionSignificant morbidityClinical differencesPatient daysPulsed-field gel electrophoresisToxin AUSA300 strainGroup 1Continued vigilanceInfection
2014
One size does not fit all: why universal decolonization strategies to prevent methicillin-resistant Staphylococcus aureus colonization and infection in adult intensive care units may be inappropriate for neonatal intensive care units
Nelson MU, Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG. One size does not fit all: why universal decolonization strategies to prevent methicillin-resistant Staphylococcus aureus colonization and infection in adult intensive care units may be inappropriate for neonatal intensive care units. Journal Of Perinatology 2014, 34: 653-655. PMID: 25010223, PMCID: PMC4152419, DOI: 10.1038/jp.2014.125.Peer-Reviewed Original ResearchMeSH KeywordsAdultChlorhexidineHumansInfant, NewbornInfant, Premature, DiseasesIntensive Care UnitsIntensive Care Units, NeonatalMethicillin-Resistant Staphylococcus aureusMupirocinStaphylococcal InfectionsConceptsNeonatal intensive care unitIntensive care unitAdult intensive care unitsCare unitUniversal decolonizationMethicillin-resistant Staphylococcus aureus (MRSA) colonizationMRSA-positive clinical cultureUnique patient populationLarge multicenter trialsStaphylococcus aureus colonizationLong-term safetyMupirocin applicationAdverse eventsPreterm infantsLarge multicenterMulticenter trialPatient populationAureus colonizationDecolonization strategiesClinical culturesDisease controlHealthcare ResearchTrialsTrial methodsWidespread implementationClinical and Laboratory Factors That Predict Death in Very Low Birth Weight Infants Presenting With Late-onset Sepsis
Levit O, Bhandari V, Li FY, Shabanova V, Gallagher PG, Bizzarro MJ. Clinical and Laboratory Factors That Predict Death in Very Low Birth Weight Infants Presenting With Late-onset Sepsis. The Pediatric Infectious Disease Journal 2014, 33: 143-146. PMID: 24418836, PMCID: PMC3917323, DOI: 10.1097/inf.0000000000000024.Peer-Reviewed Original ResearchMeSH KeywordsComorbidityConnecticutFemaleHumansInfant, NewbornInfant, Very Low Birth WeightIntensive Care Units, NeonatalMaleMultivariate AnalysisRetrospective StudiesRisk FactorsSepsisConceptsLate-onset sepsisLow birth weight infantsBirth weight infantsIndependent risk factorLaboratory factorsWeight infantsVLBW infantsRisk factorsCases of LOSEpisodes of LOSRisk of LOSFungal LOSNeonatal intensive care unitMultivariate logistic regression analysisSepsis-related deathsIntensive care unitOnset of illnessSepsis-associated mortalityGram-positive infectionsLogistic regression analysisOnset of diseasePresentation of illnessComposite risk profileLaboratory signsNecrotizing enterocolitis
2013
Concurrent Bloodstream Infections in Infants with Necrotizing Enterocolitis
Bizzarro MJ, Ehrenkranz RA, Gallagher PG. Concurrent Bloodstream Infections in Infants with Necrotizing Enterocolitis. The Journal Of Pediatrics 2013, 164: 61-66. PMID: 24139563, DOI: 10.1016/j.jpeds.2013.09.020.Peer-Reviewed Original ResearchConceptsBloodstream infectionsPost-NECNegative bacilliLate-onset bloodstream infectionConcurrent bloodstream infectionHospital course dataMean gestational ageCases of NECDiagnosis of NECOnset of diseaseMicrobiologic etiologyUnderappreciated complicationMicrobiologic dataNecrotizing enterocolitisGestational ageRetrospective reviewSingle centerSurgical interventionBirth weightRisk factorsHigher oddsInfantsNECEnterocolitisInfection
2012
Methicillin-Resistant Staphylococcus aureus in the Neonatal Intensive Care Unit
Nelson MU, Gallagher PG. Methicillin-Resistant Staphylococcus aureus in the Neonatal Intensive Care Unit. Seminars In Perinatology 2012, 36: 424-430. PMID: 23177801, PMCID: PMC3508470, DOI: 10.1053/j.semperi.2012.06.004.Peer-Reviewed Original ResearchMeSH KeywordsAnti-Bacterial AgentsBacterial Physiological PhenomenaClinical ProtocolsCommunity-Acquired InfectionsCost of IllnessCross InfectionHumansInfant, NewbornInfant, PrematureInfant, Premature, DiseasesInfection ControlIntensive Care Units, NeonatalMethicillin-Resistant Staphylococcus aureusPrevalenceRisk FactorsStaphylococcal InfectionsConceptsNeonatal intensive care unitMethicillin-resistant Staphylococcus aureusIntensive care unitCare unitCharacteristics of MRSAStaphylococcus aureusCertain infantsMRSA infectionNICU populationIll infantsRisk factorsEpidemiologic assessmentClinical interventionsInfectionFrequent sourceInfantsTransmission patternsInterventionAureusMolecular analysisAdditional factorsMorbidityNeonatesNumerous strategiesPrevention
2008
Matched Case-Control Analysis of Polymicrobial Bloodstream Infection In A Neonatal Intensive Care Unit
Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG. Matched Case-Control Analysis of Polymicrobial Bloodstream Infection In A Neonatal Intensive Care Unit. Infection Control And Hospital Epidemiology 2008, 29: 914-920. PMID: 18808341, DOI: 10.1086/591323.Peer-Reviewed Original ResearchMeSH KeywordsBacteremiaCase-Control StudiesFemaleFungemiaFungiGram-Negative BacteriaGram-Negative Bacterial InfectionsGram-Positive BacteriaGram-Positive Bacterial InfectionsHumansIncidenceInfant, Low Birth WeightInfant, NewbornInfant, PrematureInfant, Premature, DiseasesInfant, Very Low Birth WeightIntensive Care Units, NeonatalMaleRisk FactorsConceptsPolymicrobial bloodstream infectionsMonomicrobial bloodstream infectionSevere underlying conditionsBloodstream infectionsOnset of infectionUnderlying conditionRisk factorsMultivariate analysisIndwelling central venous catheterIntensive care unit patientsNeonatal intensive care unitMatched Case-Control AnalysisIndependent risk factorNewborn intensive care unit (NICU) patientsCare unit patientsCentral venous cathetersIntensive care unitNeonatal bloodstream infectionsMost risk factorsCase-control studyCase-control analysisCoagulase-negative staphylococciHospital NICUUnit patientsVenous catheters
2007
Case-control analysis of endemic Serratia marcescens bacteremia in a neonatal intensive care unit
Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG. Case-control analysis of endemic Serratia marcescens bacteremia in a neonatal intensive care unit. Archives Of Disease In Childhood Fetal & Neonatal 2007, 92: f120. PMID: 17088342, PMCID: PMC2675455, DOI: 10.1136/adc.2006.102855.Peer-Reviewed Original ResearchMeSH KeywordsBacteremiaBirth WeightCase-Control StudiesConnecticutCross InfectionDrug Resistance, BacterialEndemic DiseasesEscherichia coliEscherichia coli InfectionsFemaleHumansInfant, NewbornIntensive Care Units, NeonatalMaleMicrobial Sensitivity TestsPrognosisRisk FactorsSerratia InfectionsSerratia marcescensConceptsNeonatal intensive care unitIntensive care unitCare unitUninfected controlsHospital Neonatal Intensive Care UnitSerratia marcescens bacteremiaMedian gestational ageCentral vascular catheterEscherichia coli bacteremiaRecords of infantsCase-control studyHigher overall mortalityE coliOnset of infectionCase-control analysisTime of infectionHigh rateAssociated meningitisHospital courseColi bacteremiaOverall mortalityGestational agePremature infantsVascular cathetersBirth weightAntibiotic-Resistant Organisms in the Neonatal Intensive Care Unit
Bizzarro MJ, Gallagher PG. Antibiotic-Resistant Organisms in the Neonatal Intensive Care Unit. Seminars In Perinatology 2007, 31: 26-32. PMID: 17317424, DOI: 10.1053/j.semperi.2007.01.004.Peer-Reviewed Original ResearchMeSH KeywordsAnti-Bacterial AgentsBacterial InfectionsCross InfectionDrug Resistance, BacterialHumansInfant, NewbornIntensive Care Units, NeonatalConceptsNeonatal intensive care unitIntensive care unitCare unitMultidrug-resistant Gram-negative rodsStandard antimicrobial therapyMethicillin-resistant Staphylococcus aureusProper hand hygieneVancomycin-resistant EnterococcusAntibiotic-resistant organismsEmpiric treatmentProlonged courseUse of antimicrobialsAntimicrobial therapyAntibiotic exposureHand hygieneDecolonization strategiesGram-negative rodsResistant organismsBacterial infectionsStaphylococcus aureusBacterial acquisitionPotential reservoirsAntimicrobialsCohortingNeonates
2005
Seventy-Five Years of Neonatal Sepsis at Yale: 1928–2003
Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy-Five Years of Neonatal Sepsis at Yale: 1928–2003. Pediatrics 2005, 116: 595-602. PMID: 16140698, DOI: 10.1542/peds.2005-0552.Peer-Reviewed Original ResearchMeSH KeywordsBacteremiaBirth WeightCross InfectionFemaleHumansInfant, NewbornInfant, PrematureIntensive Care Units, NeonatalLength of StayMaleRisk FactorsSepsisTime FactorsConceptsYale-New Haven HospitalEpisodes of sepsisLate-onset sepsisRecords of infantsPositive blood culturesNeonatal sepsisPreterm infantsBlood culturesSepsis-related mortality rateEarly-onset sepsisProlonged mechanical ventilationCentral vascular catheterNeonatal sepsis casesPopulation of infantsGroup B streptococciPercentage of casesDays of ageParenteral nutritionSepsis casesMechanical ventilationVascular cathetersIntensive careS pyogenesB streptococciSepsis
2004
Conjunctival Colonization of Infants Hospitalized in a Neonatal Intensive Care Unit: A Longitudinal Analysis
Raskind CH, Sabo BE, Callan DA, Farrel PA, Dembry LM, Gallagher PG. Conjunctival Colonization of Infants Hospitalized in a Neonatal Intensive Care Unit: A Longitudinal Analysis. Infection Control And Hospital Epidemiology 2004, 25: 216-220. PMID: 15061413, DOI: 10.1086/502381.Peer-Reviewed Original Research
1999
Increasing incidence of Gram-negative rod bacteremia in a newborn intensive care unit
SHAH S, EHRENKRANZ R, GALLAGHER P. Increasing incidence of Gram-negative rod bacteremia in a newborn intensive care unit. The Pediatric Infectious Disease Journal 1999, 18: 591-595. PMID: 10440433, DOI: 10.1097/00006454-199907000-00005.Peer-Reviewed Original ResearchConceptsGNR bacteremiaCare unitNewborn Special Care UnitPercutaneous central venous cathetersNewborn intensive care unitYale-New Haven HospitalMaternal intrapartum antibioticsGram-negative rod bacteremiaDuration of hospitalizationCentral venous cathetersNegative rod bacteremiaIntensive care unitStepwise multivariate analysisSpecial care unitsNumber of admissionsIntrapartum antibioticsVenous cathetersRetrospective reviewOverall incidenceNeonatal careProspective studyPatient populationBacteremiaMultivariate analysisIncidence
1998
Complications of conjunctivitis caused by Pseudomonas aeruginosa in a newborn intensive care unit
SHAH S, GALLAGHER P. Complications of conjunctivitis caused by Pseudomonas aeruginosa in a newborn intensive care unit. The Pediatric Infectious Disease Journal 1998, 17: 97-102. PMID: 9493803, DOI: 10.1097/00006454-199802000-00004.Peer-Reviewed Original ResearchMeSH KeywordsConjunctivitisFemaleHumansInfant, NewbornIntensive Care Units, NeonatalMalePseudomonas aeruginosaPseudomonas InfectionsRetrospective StudiesConceptsSystemic complicationsMean birth weightEye diseaseCare unitGestational ageBirth weightEye infectionsLower mean birth weightNewborn Special Care UnitNewborn intensive care unitYale-New Haven HospitalAverage postnatal ageMean gestational ageOutcomes of infantsIntensive care unitSpecial care unitsP. aeruginosa infectionBrain abscessesPostnatal ageAeruginosa infectionComplicationsConjunctivitisInfantsInfectionEarly detection