Hospitals Enact Policies to Curb Early Childbirth

Goal is to reduce elective C-sections, inductions before 39 weeks, study says

By Mary Elizabeth Dallas

HealthDay Reporter

MONDAY, May 6 (HealthDay News) -- Hoping to curb elective Cesarean births and labor inductions, two-thirds of U.S. hospitals have implemented policies to eliminate medically unnecessary pre-term births, a new study reports.

Pre-term deliveries (before 39 weeks' gestation) carry an increased risk of neonatal respiratory distress and admission to neonatal intensive care units (NICU), researchers from the University of Pennsylvania Perelman School of Medicine said.

For the study, the researchers questioned nearly 2,400 hospitals about their policies on early deliveries that weren't necessary for medical reasons.

They found that 66.5 percent of the hospitals had a formal policy against the practice, and more than two-thirds of these hospitals had a "hard-stop" policy, or a strictly enforced rule, against elective deliveries before 39 weeks of gestation.

"There is reason to be encouraged that hospital policies are decreasing the frequency of this practice, and we expect that fewer elective deliveries prior to 39 weeks means fewer term babies going to the NICU," study leader Dr. Nathaniel DeNicola said in a news release from the American College of Obstetricians and Gynecologists.

Another one-third of hospitals had no policy on such deliveries, but 53 percent of those hospitals said medically unnecessary deliveries before 39 weeks were against their standard of care.

State initiatives to help inform the public about the risks associated with elective early deliveries have been effective in encouraging hospitals to adopt formal policies against these pre-term deliveries, the study authors added.

"We had a number of hospitals volunteer that they were following the state initiative," DeNicola said.

The findings are scheduled for presentation Monday at the annual clinical meeting of the American College of Obstetricians and Gynecologists in New Orleans.

A separate study conducted by researchers from Baystate Medical Center in Springfield, Mass., showed that by restricting elective deliveries, hospitals can reduce the number of Cesarean births. These policies also can cut the amount of time between when a woman is admitted to the hospital and when she delivers her baby.

"What we used to see here were some providers performing elective inductions in patients, many of whom were fewer than 39 weeks of gestation, with unfavorable cervices," said study leader Dr. Andrew Healy. These inductions could take two or three days, and often ended in a Cesarean delivery, he said.

"We don't see that anymore since implementing a policy restricting elective labor induction, which is terrific," he said. "The mothers are more likely to be able to take their baby home with them and, having had a vaginal birth, are less uncomfortable and better able to care for their child."

For this study, which also will be presented at the American College of Obstetricians and Gynecologists meeting, Healy's team analyzed records of more than 9,500 single births at Baystate before it implemented a policy that set restrictions on labor inductions. The researchers also examined more than 2,600 single births that occurred after the policy was established.

Specifically, the researchers considered time from admission to delivery, Cesarean rates, NICU admission rates and stillbirths.

Average time from hospital admission to delivery for elective inductions decreased by six hours -- from 17 hours to 11 -- after the policy was implemented, the study found. The Cesarean delivery rate for women who underwent elective inductions dropped from 16 percent to 7 percent after the policy was put into place, and the policy resulted in a 33 percent reduction in the admission of term babies to the NICU.

Data and conclusions presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

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'Nightmare' Bacteria Spreading in U.S. Hospitals, Nursing Homes: CDC

By Steven Reinberg

HealthDay Reporter

TUESDAY, March 5 (HealthDay News) -- A "nightmare" bacteria that is resistant to powerful antibiotics and kills half of those it infects has surfaced in nearly 200 U.S. hospitals and nursing homes, federal health officials reported Tuesday.

The U.S. Centers for Disease Control and Prevention said 4 percent of U.S. hospitals and 18 percent of nursing homes had treated at least one patient with the bacteria, called Carbapenem-Resistant Enterobacteriaceae (CRE), within the first six months of 2012.

"CRE are nightmare bacteria. Our strongest antibiotics don't work and patients are left with potentially untreatable infections," CDC Director Dr. Thomas Frieden said in a news release. "Doctors, hospital leaders and public health [officials] must work together now to implement the CDC's 'detect and protect' strategy and stop these infections from spreading."

"The good news," Frieden added at an afternoon teleconference, "is we now have an opportunity to prevent its further spread." But, he continued, "We only have a limited window of opportunity to stop this infection from spreading to the community and spreading to more organisms."

CRE are in a family of more than 70 bacteria called enterobacteriaceae, including Klebsiella pneumoniae and E. coli, that normally live in the digestive system.

In recent years, some of these bacteria have become resistant to last-resort antibiotics known as carbapenems.

Although CRE bacteria are not yet found nationwide, they have increased fourfold within the United States in the past decade, with most cases reported in the Northeast.

Health officials said they're concerned about the rapid spread of the bacteria, which can endanger the lives of patients and healthy people. For example, in the last 10 years, the CDC tracked one CRE from one health-care facility to similar facilities in 42 states.

One type of CRE, a resistant form of Klebsiella pneumoniae, has increased sevenfold in the past decade, according to the CDC's March 5 Vital Signs report.

"To see bacteria that are resistant is worrisome, because this group of bacteria are very common," said Dr. Marc Siegel, clinical associate professor of medicine at NYU Langone Medical Center in New York City.

Most CRE infections to date have been in patients who had prolonged stays in hospitals, long-term facilities and nursing homes, the report said.

The bacteria kill up to half the patients whose bloodstream gets infected and are easily spread from patient to patient on the hands of health-care workers, the CDC said.

Moreover, CRE bacteria can transfer their antibiotic resistance to other bacteria of the same type.

This problem is the result of the overuse of antibiotics, Siegel said. "The more you use an antibiotic, the more resistance is going to emerge," he said. "This is an indictment of the overuse of this class of antibiotic."

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Flu Stretches Hospitals, Drug Supplies Nationwide

Jan. 10, 2013 -- The early flu season has turned severe in some parts of the country, stretching health care providers and drug supplies.

According to the latest numbers from the CDC, there’s now widespread flu activity in 41 states. New York City and 29 states are reporting a high number of cases of flu-like illness.

So far this flu season, 2,257 people have been hospitalized with laboratory-confirmed flu. Eighteen children have died.

The number of deaths attributed to both pneumonia and the flu is still below epidemic levels.

How much worse will it get? When will it be over? No one can say.

“Seasonal flu is a big deal -- always. It’s always going to be a problem. This year may be a very big problem,” says William Hanage, PhD, an associate professor of epidemiology at the Harvard School of Public Health in Boston. “We don’t know yet.”

Most flu seasons last about 11 to 12 weeks. “We’re at about week five,” says Curtis Allen, a press officer at the CDC. “Even that 11 to 12 weeks is not a hard and fast number. The saying in the influenza world is that if you’ve seen one flu season, you’ve seen one flu season. Each one is different.”

Across the Northeast, emergency rooms have seen an influx of patients showing flu-like symptoms. In some cases, patients who come in coughing are being directed to other areas, including outside tents, to keep them from infecting others.

“We’re opening additional work spaces and areas to take care of patients,” says Robert Glatter, MD, an emergency doctor at Lenox Hill Hospital in New York City. “It’s almost as concerning as the 2009 outbreak of H1N1. We’re getting concerned about the severity, especially because of how ill people are.”

Since Christmas, Glatter says Lenox Hill has seen a spike in flu cases. Many of the victims are elderly and their symptoms tend to be severe: aches, chills, cough, fevers, dizziness, nausea, vomiting, and diarrhea.

Already, Boston has had 10 times as many confirmed cases as it had last year, prompting the city’s mayor to declare a public health emergency there. Health centers around the city are offering free flu shot clinics to those people who haven’t yet been vaccinated.

That offer may be good only while supplies last, however. The health department in Somerville, a Boston suburb, says it ran out of flu vaccine on Tuesday.

On Thursday, Sanofi SA, the largest flu vaccine manufacturer in the U.S., confirmed that it had sold out of four of the six formulations of Fluzone vaccine, including a dosage that’s given to children. Another manufacturer, GlaxoSmithKline, says it expects to have adequate doses of its vaccine for another month.

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