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. 2024 Feb 8;11(2):217.
doi: 10.3390/children11020217.

A Multifunctional, Low Cost and Sustainable Neonatal Database System

Joaquim M B Pinheiro  1 , Marilyn Fisher  1 , Upender K Munshi  1 , Rubia Khalak  1 , Kate A Tauber  1 , James J Cummings  1 , Jennifer B Cerone  1 , Meredith Monaco-Brown  1 , Gina Geis  1 , Rehman Chowdhry  1 , Mary Fay  1 , Anshu A Paul  1 , Carolyn Levine  2 , Phillip Pan  2 , Michael J Horgan  1
Affiliations

A Multifunctional, Low Cost and Sustainable Neonatal Database System

Joaquim M B Pinheiro et al. Children (Basel). .

Abstract

Continuous improvement in the clinical performance of neonatal intensive care units (NICU) depends on the use of locally relevant, reliable data. However, neonatal databases with these characteristics are typically unavailable in NICUs using paper-based records, while in those using electronic records, the inaccuracy of data and the inability to customize commercial data systems limit their usability for quality improvement or research purposes. We describe the characteristics and uses of a simple, neonatologist-centered data system that has been successfully maintained for 30 years, with minimal resources and serving multiple purposes, including quality improvement, administrative, research support and educational functions. Structurally, our system comprises customized paper and electronic components, while key functional aspects include the attending-based recording of diagnoses, integration into clinical workflows, multilevel data accuracy and validation checks, and periodic reporting on both data quality and NICU performance results. We provide examples of data validation methods and trends observed over three decades, and discuss essential elements for the successful implementation of this system. This database is reliable and easily maintained; it can be developed from simple paper-based forms or used to supplement the functionality and end-user customizability of existing electronic medical records. This system should be readily adaptable to NICUs in either high- or limited-resource environments.

Keywords: NICU; data quality; data systems; databases; informatics; neonatology; quality improvement; research; trends.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Bubble plot of gestational age values in the NICU database versus corresponding values in the 1993–2006 cohort of the high-risk follow-up database (Follow-up). Bubble size is proportional to the number of patients in the data point; pink bubbles are discordant values.
Figure 2
Figure 2
Trends in patient characteristics by year of admission to the NICU. (A): Admissions who were inborn; (B): rates of cesarean section birth in infants admitted to the NICU.
Figure 3
Figure 3
Trends in the rates of cardiopulmonary resuscitation (CPR) in the delivery room for inborn (A) and outborn (B) neonates admitted to the NICU. Arrow indicates start of overnight in-hospital neonatologist coverage.
Figure 4
Figure 4
Mortality trends for deaths occurring within the delivery room (A), and in NICU proper (B). See text for details.
Figure 5
Figure 5
Percentage of annual NICU admissions of GA > 34 weeks diagnosed with meconium aspiration syndrome in relation to recommendations for the intrapartum and neonatal management of infants with meconium-stained amniotic fluid in various Neonatal Resuscitation Program (NRP) editions, and in the statement by the American College of Obstetricians and Gynecologists (ACOG).
Figure 6
Figure 6
Presumed (culture-negative) sepsis trends by year, as a percentage of NICU admissions. See text for details.
See this image and copyright information in PMC

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