title: Oral colostrum priming shortens hospitalization without changing the immune-microbial milieu Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial Oropharyngeal Colostrum Administration in Very Low Birth Weight Infants: A Randomized Controlled Trial* Impact of Early Human Milk on Sepsis and Health Care Costs in Very Low Birth Weight Infants Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. Oropharyngeal Administration of Colostrum Increases Salivary Secretory IgA Levels in Very Low‐Birth‐Weight Infants Necrotizing enterocolitis - classification and two initial steps towards prevention. Randomized Controlled Trial of Oropharyngeal Colostrum Administration in Very-low-birth-weight Preterm Infants. Oropharyngeal Administration of Mother's Milk Prior to Gavage Feeding in Preterm Infants: A Pilot Randomized Control Trial. Role of Oropharyngeal Administration of Colostrum in Very-Low-Birth-Weight Infants for Reducing Necrotizing Enterocolitis: A Randomized Controlled Trial. A Pilot Randomized Control Trial
abstract: Objective : Oral colostrum priming ( OCP ) after birth in preterm infants is associated with improved weight gain and modification of the oral immunomicrobial environment . We hypothesized that OCP would modify salivary immune peptides and the oral microbiota in preterm infants . Study design : We conducted a prospect i ve , r and omized clinical trial to determine the effects of OCP on salivary immune peptide representation in preterm infants ( < 32 weeks completed gestation at birth ) .  Saliva sample s were collected before and after OCP . Salivary immune peptide representation was determined via mass spectroscopy . Oral microbiota representation was determined via sequencing of the 16S rRNA gene . Results : Neonates who received OCP ( n=48 ) had a 16-day reduction in the median length of hospitalization as compared with infants who did not receive OCP ( n=51 ) . No differences in salivary immune peptide sequence representation before OCP between groups were found . Longitudinal changes in peptides were detected ( lysozyme C , immunoglobulin A , lactoferrin ) but were limited to a single peptide difference ( α-defensin 1 ) between primed and unprimed infants after OCP . We found no difference in microbial diversity between treatment groups at any time point , but diversity decreased significantly over time in both groups . OCP treatment marginally modified oral taxa with a decline in abundance of Streptococci in the OCP group at 30 days of life . Conclusions : OCP had neither an effect on the salivary peptides we examined nor on overall oral bacterial diversity and composition . Infants who received OCP had a reduced length of hospitalization and warrants further investigation OBJECTIVE To determine the rates , characteristics , risk factors , and outcomes of ventilator-associated pneumonia ( VAP ) in extremely preterm neonates in a neonatal intensive care unit ( NICU ) . METHODS A prospect i ve cohort study was conducted at the St Louis Children 's Hospital on all patients who had birth weight < or=2000 g and were admitted to the NICU for > or=48 hours from October 2000 to July 2001 . Extremely preterm neonates were defined as neonates with estimated gestational age ( EGA ) < 28 weeks . The primary outcome was the development of VAP . Secondary outcomes were death and NICU length of stay ( LOS ) . Multiple logistic regression was performed to determine independent predictors for VAP and mortality . RESULTS A total of 229 patients were enrolled . Sixty-seven ( 29 % ) had EGA < 28 weeks . Nineteen episodes of VAP occurred in 19 ( 28.3 % ) of 67 mechanically ventilated patients . VAP rates were 6.5 per 1000 ventilator days for patients with EGA < 28 weeks and 4 per 1000 ventilator days for EGA > or=28 weeks . By multivariate analysis , bloodstream infection before VAP ( adjusted odds ratio : 3.5 ; 95 % confidence interval [ CI ] : 1.2 - 10.8 ) was an independent risk factor for VAP after adjustment for the duration of endotracheal intubation . Ventilator-associated pneumonia ( adjusted odds ratio : 3.4 ; 95 % CI : 1.2 - 12.3 ) was an independent predictor of mortality . A strong association between VAP and mortality was observed in neonates who stayed in the NICU > 30 days ( relative risk : 8.0 ; 95 % CI : 1.9 - 35.0 ) . Patients with VAP also had prolonged NICU LOS ( median : 138 vs 82 days ) . CONCLUSIONS VAP occurred at high rates in extremely preterm neonates and was associated with increased mortality . Additional studies are needed to develop interventions to prevent VAP in NICU patients Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Purpose To evaluate the potential preventive effect of probiotics on  ventilator-associated pneumonia ( VAP ) . Methods This was an open-label , r and omized , controlled multicenter trial involving 235 critically ill adult patients who were expected to receive mechanical ventilation for ≥48 h. The patients were r and omized to receive ( 1 ) a probiotics capsule containing live Bacillus subtilis and Enterococcus faecalis ( Medilac-S ) 0.5 g three times daily through a nasogastric feeding tube plus st and ard preventive strategies or ( 2 ) st and ard preventive strategies alone , for a maximum of 14 days . The development of VAP was evaluated daily , and throat swabs and gastric aspirate were cultured at baseline and once or twice weekly thereafter . Results The incidence of microbiologically confirmed VAP in the probiotics group was significantly lower than that in the control patients ( 36.4 vs. 50.4 % , respectively ; P = 0.031 ) . The mean time to develop VAP was significantly longer in the probiotics group than in the control group ( 10.4 vs. 7.5 days , respectively ; P = 0.022 ) . The proportion of patients with acquisition of gastric colonization of potentially pathogenic microorganisms ( PPMOs ) was lower in the probiotics group ( 24 % ) than the control group ( 44 % ) ( P = 0.004 ) . However , the proportion of patients with eradication PPMO colonization on both sites of the oropharynx and stomach were not significantly different between the two groups . The administration of probiotics did not result in any improvement in the incidence of clinical ly suspected VAP , antimicrobial consumption , duration of mechanical ventilation , mortality and length of hospital stay . Conclusion Therapy with the probiotic bacteria B. Subtilis and E. faecalis are an effective and safe means for preventing VAP and the acquisition of PPMO colonization in the stomach Objectives : Studies have confirmed the safety of oropharyngeal administration of colostrum in very low birth weight infants . However , the effect of oropharyngeal administration of colostrum on immune system is inconclusive . This study aims to evaluate the effect of oropharyngeal administration of colostrum on secretory immunoglobulin A and lactoferrin in very low birth weight infants . Design : R and omized controlled trial . Setting : Forty-bedded neonatal ICU in a university children ’s hospital in the People ’s Republic of China . Patients : Very low birth weight infants were allocated to the study group ( n = 32 ) and control group ( n = 32 ) . Intervention : The intervention was oropharyngeal administration of 0.2 mL of their mother ’s colostrum every 4 hours for 7 days . The control group received saline solution . Measurements and Main Results : Secretory immunoglobulin A and lactoferrin in urine and saliva were measured within 24 hours of life ( baseline ) and at 7 and 21 days . Primary outcomes were changes of secretory immunoglobulin A and lactoferrin in urine and saliva between baseline and at 7 and 21 days . Infant ’s clinical data were also collected during hospitalization . Change from baseline in lactoferrin in saliva at 7 days ( 5.18 ± 7.07 vs –1.74 ± 4.67 µg/mL ; p < 0.001 ) and 21 days ( 5.31 ± 9.74 vs –1.17 ± 10.38 µg/mL ; p = 0.02 ) shows statistic difference . No differences were found of lactoferrin in urine and also no differences of secretory immunoglobulin A in urine and saliva . There were also no differences between days to full enteral feeding , occurrence rate of clinical sepsis , proven sepsis , and necrotizing enterocolitis . Conclusions : Oropharyngeal administration of colostrum can increases the level of lactoferrin in saliva in very low birth weight infants . No effect could be documented of secretory immunoglobulin A and lactoferrin in urine . Larger trials are needed to better describe the benefit of oropharyngeal administration of colostrum , if any , in very low birth weight infants Objective : To study the incidence of sepsis and neonatal intensive care unit ( NICU ) costs as a function of the human milk ( HM ) dose received during the first 28 days post birth for very low birth weight ( VLBW ) infants . Study design : Prospect i ve cohort study of 175 VLBW infants . The average daily dose of HM ( ADDHM ) was calculated from daily nutritional data for the first 28 days post birth ( ADDHM-Days 1–28 ) . Other covariates associated with sepsis were used to create a propensity score , combining multiple risk factors into a single metric . Result : The mean gestational age and birth weight were 28.1±2.4 weeks and 1087±252 g , respectively . The mean ADDHM-Days 1–28 was 54±39 ml kg−1 day−1 ( range 0–135 ) . Binary logistic regression analysis controlling for propensity score revealed that increasing ADDHM-Days 1–28 was associated with lower odds of sepsis ( odds ratio 0.981 , 95 % confidence interval 0.967–0.995 , P=0.008 ) . Increasing ADDHM-Days 1–28 was associated with significantly lower NICU costs . Conclusion : A dose – response relationship was demonstrated between ADDHM-Days 1–28 and a reduction in the odds of sepsis and associated NICU costs after controlling for propensity score . For every HM dose increase of 10 ml kg−1 day−1 , the odds of sepsis decreased by 19 % . NICU costs were lowest in the VLBW infants who received the highest ADDHM-Days 1–28 OBJECTIVE : To determine the immunologic effects of oropharyngeal colostrum administration in extremely premature infants . METHODS : We conducted a double-blind , r and omized , placebo-controlled trial involving 48 preterm infants born before 28 weeks ’ gestation . Subjects received 0.2 mL of their mother ’s colostrum or sterile water via oropharyngeal route every 3 hours for 3 days beginning at 48 to 96 hours of life . To measure concentrations of secretory immunoglobulin A , lactoferrin , and several immune substances , urine and saliva were obtained during the first 24 hours of life and at 8 and 15 days . Clinical data during hospitalization were collected . RESULTS : Urinary levels of secretory immunoglobulin A at 1 week ( 71.4 vs 26.5 ng/g creatinine , P = .04 ) and 2 weeks ( 233.8 vs 48.3 ng/g creatinine , P = .006 ) , and lactoferrin at 1 week ( 3.5 vs 0.9 μg/g creatinine , P = .01 ) were significantly higher in colostrum group . Urine interleukin-1β level was significantly lower in colostrum group at 2 weeks ( 55.3 vs 91.8 μg/g creatinine , P = .01 ) . Salivary transforming growth factor-β1 ( 39.2 vs 69.7 μg/mL , P = .03 ) and interleukin-8 ( 1.2 vs 4.9 ng/mL , P = .04 ) were significantly lower at 2 weeks in colostrum group . A significant reduction in the incidence of clinical sepsis was noted in colostrum group ( 50 % vs 92 % , P = .003 ) . CONCLUSIONS : This study suggests that oropharyngeal administration of colostrum may decrease clinical sepsis , inhibit secretion of pro-inflammatory cytokines , and increase levels of circulating immune-protective factors in extremely premature infants . Larger studies to confirm these findings are warranted OBJECTIVES To determine the rates , risk factors , and outcomes of  ventilator-associated pneumonia in pediatric intensive care unit ( PICU ) patients . METHODS A prospect i ve cohort study was conducted at the St Louis Children 's Hospital PICU on all patients who were admitted to the PICU from September 1 , 1999 , to May 31 , 2000 , except those who died within 24 hours , were > or = 18 years of age , or were neonatal intensive care unit patients on extracorporeal membrane oxygenation . The primary outcome measured was the development of ventilator-associated pneumonia . Secondary outcomes were death and hospital and PICU length of stay .  Multiple logistic regression analysis was performed to determine independent predictors for ventilator-associated pneumonia . RESULTS There were 34 episodes of ventilator-associated pneumonia in 30 patients of 911 admissions ( 3.3 % ) and 595 ( 5.1 % ) mechanically ventilated patients . The mean ventilator-associated pneumonia rate was 11.6/1000 ventilator days . By logistic regression analysis , genetic syndrome ( odds ratio [ OR ] : 2.37 ; 95 % confidence interval [ CI ] : 1.01 - 5.46 ) , reintubation ( OR : 2.71 ; 95 % CI : 1.18 - 6.21 ) , and transport out of the PICU ( OR : 8.90 ; 95 % CI : 3.82 - 20.74 ) independently predicted ventilator-associated pneumonia . CONCLUSIONS Ventilator-associated pneumonia occurs at significant rates among mechanically ventilated PICU patients and is associated with processes of care . Additional studies are necessary to develop interventions to prevent ventilator-associated pneumonia OBJECTIVES To characterize ventilator-associated pneumonia ( VAP ) in our pediatric intensive care unit ( PICU ) , implement an evidence -based pediatric VAP prevention bundle , and reduce VAP rates . STUDY DESIGN The setting is a 25-bed PICU in a 475-bed free-st and ing pediatric academic medical center . VAP was diagnosed according to Centers for Disease Control and National Nosocomial Infections Surveillance System definitions . A pediatric VAP prevention bundle was established and implemented . Baseline VAP rates were compared with implementation and post-bundle-implementation periods . RESULTS VAP is significantly associated with increased PICU length of stay , mechanical ventilator days , and mortality rates ( length of stay VAP 19.5+/-15.0 vs non-VAP 7.5+/-9.2 , P < .001 ; ventilator days VAP 16.3+/-14.7 vs non-VAP 5.3+/-8.4 , P < .001 ; mortality VAP 19.1 % vs non-VAP 7.2 % , P= .01 ) . The VAP rate was reduced from 5.6 ( baseline ) to 0.3 infections per 1000 ventilator days after bundle implementation ; P < .0001 . Subglottic/tracheal stenosis , trauma , and tracheostomy are significantly associated with VAP . CONCLUSIONS PICU VAP is associated with increased morbidity and mortality rates . A multidisciplinary improvement team can implement a sustainable pediatric-specific VAP prevention bundle , result ing in VAP rate reduction Aim Oropharyngeal administration of colostrum ( OAC ) has been proposed to provide mother 's early milk to very low‐birth‐weight ( VLBW ) infants in the first few days of life . The aim of this study was to test the hypothesis that OAC would increase salivary secretory IgA ( SsIgA ) . Patients and Methods Overall , 30 VLBW infants r and omized to receive OAC or sterile water  had salivary sampling for SsIgA on the day of life ( DOL ) 2 , 7 , and 14 . The incidence of late‐onset sepsis ( LOS ) and necrotizing enterocolitis ( NEC ) was determined prospect ively . Within and between‐group comparisons were made by paired and independent sample s t ‐tests . Results Baseline characteristics were similar between groups . SsIgA was higher in OAC versus the control group ( p < 0.05 ) on DOL 7 , but not subsequently on DOL 14 . There was no difference in LOS or NEC . Conclusion OAC  increased SsIgA at DOL 7 . A large , multicenter trial is needed to determine if OAC  decreases LOS or NEC in VLBW infants The premature infant suffers from immaturity of all organ systems , one of them being the gastrointestinal tract . When the infant is born , the immature gastrointestinal tract is exposed to milk and simultaneously colonized by high densities of bacteria . The combination of milk , microbiota and an immature gut , leaves the infant vulnerable to developing the dreaded intestinal emergency necrotizing enterocolitis ( NEC ) . NEC is often very aggressive and no cure exists , which means that prevention is an utmost important topic to research ers , physicians , parents - and infants . Despite immense research during the last decades , no specific test to determine if an infant suffers from NEC exists . Most neonatal units use Bell 's staging criteria , which are based on clinical and radiographic findings , as a diagnostic tool ; however the diagnosis given according to Bell 's stages has not been vali date d. In study I , we aim ed to determine the validity of the NEC diagnosis given at discharge . An expert panel consisting of a neonatologist , a paediatric surgeon and a paediatric radiologist served as the golden st and ard . We found that the diagnosis given at discharge had a poor validity which significantly affected the reported incidence of NEC in the neonatal department at Rigshospitalet , Denmark . The validity of the NEC diagnosis was worse than the validity of most other paediatric diagnoses that had been investigated . In studies II and III , we aim ed to explore possible means of NEC prevention . The role of nutrition in NEC development is well established with mother 's milk as the best option to avoid NEC in the preterm infant . Maternal milk is , however , most often not available in sufficient amounts during the first days of life , and preterm infant formula or human donor milk is used in its absence . Studies in preterm piglets showed that bovine colostrum equally to human donor milk protected against NEC compared to infant formula . Furthermore , bovine colostrum was superior to human donor milk in stimulating gut immunity and digestive functions . Hence , in study II we aim ed to design a pilot study of bovine colostrum used as a supplement to maternal milk in the first days of life and to determine if the study was feasible . In the paper , we present the protocol and the results of the first two phases of the Precolos study in which 12 infants were included and received pasteurized , spray-dried and reconstituted bovine colostrum during the first days of life as the first infants in the world . We found that the infants tolerated bovine colostrum without clinical adverse effects , but we also observed a transient hypertyrosinemia on day seven of life in five infants . The results were evaluated by a safety management board which encouraged us to continue the pilot study with the last phase , which was a r and omized controlled trial of 20 + 20 infants comparing supplementation with bovine colostrum to supplementation with st and ard nutrition . The r and omized trial has just finished recruitment . At last , we wanted to shed light on a possible microbiological angle of NEC prevention . Dysbiosis and bacterial translocation are believed to play a crucial role in the development of NEC as intestinal pneumatosis , which occurs when bacteria produce gas inside the intestinal wall , is a pathognomonic radiographic finding . In a quality improvement study from the US published in 2014 , NEC incidence was significantly reduced after the implementation of several quality improvement interventions . St and ardized weekly exchange of nasogastric feeding tubes was suggested as one of the potential NEC-reducing interventions . In the neonatal unit at Rigshospitalet , Denmark , preterm infants are fed 8 - 12 times daily through a resident nasogastric feeding tube which is exposed to body temperature , contains milk residuals from the last meal and is h and led by both parents and personnel . Since bacterial pollution of milk given through the nasogastric feeding tube might be NEC-inducing , we aim ed in study III to determine the bacterial load given to the infants when feeding them through a tube . We collected 92 used nasogastric feeding tubes and flushed them with one ml saline each to imitate a meal given through them . Eighty-nine percent of the tubes contaminated the meals with more than 1000 colony-forming units of bacteria and fifty-five percent contaminated the meals with the possible pathogens Enterobacteriaceae or Staphylococcus aureus . The concentration of bacteria in the saline flushed through the tubes was as high as 109 colony-forming units per ml ; however , neither the risk of contamination nor the concentration of bacteria in the flush was associated with the duration of use . Implementation of st and ardized weekly exchange of feeding tubes would therefore not prevent the contamination of meals . In conclusion , the studies included in this thesis serve as a base for future studies investigating the prevention of NEC . We found a poor validity of the NEC diagnosis given at discharge . This should be kept in mind when conducting epidemiological studies of NEC and especially when conducting interventional trials with NEC as an outcome . If the findings of the r and omized part of the Precolos study indicate a positive effect of bovine colostrum and do not give rise to concerns regarding feasibility , safety or tolerability , a large-scale r and omized controlled study with NEC as the primary outcome will be planned . Based on the high concentrations of bacteria found in the nasogastric feeding tubes , a r and omized controlled trial investigating whether the frequency of feeding tube exchange affects the early colonization has been commenced in the neonatal department at Rigshospitalet . Hopefully , the results of these studies will bring us closer to preventing NEC in the future OBJECTIVE The purpose of this study was to evaluate the effects of oropharyngeal colostrum administration in the incidence of late-onset clinical and proven sepsis and in concentrations of immunoglobulin A ( IgA ) in very-low-birth-weight ( VLBW ) infants . METHODS We conducted a double-blinded , r and omized , placebo-controlled trial and assigned 113 VLBW infants to receive 0.2 mL of maternal colostrum or sterile water ( placebo ) via oropharyngeal route every 2 hours for 48 hours , beginning in the first 48 to 72 hours of life . Neonates of both groups were fed breast milk from the first 3 days of life until a volume of at least 100 mL · kg · day . IgA was measured in serum and urine before and after treatment . Clinical data during hospitalization were collected . RESULTS We found no statistically significant differences between colostrum and placebo groups in the incidence of late-onset clinical sepsis ( odds ratio 0.7602 ; CI 95 % 0.3 - 1.6 ) and proven sepsis ( odds ratio 0.7028 ; CI 95 % 0.3 - 1.6 ) . The measurement of IgA was similar in serum before ( P value 0.87 ) and after treatment ( P value 0.26 day 4 and 0.77 day 18 ) . No differences were also observed in IgA in urine before ( P value 0.8 ) and after treatment ( P value 0.73 day 4 and 0.52 ) . CONCLUSIONS This study could not confirm the hypothesis that oropharyngeal administration of maternal colostrum to VLBW could reduce the incidence of late-onset sepsis and increase the levels of IgA. We believe that this finding can be justified by the practice of feeding VLBW infants exclusively with breast milk in the first days of life and reinforces the prior knowledge of the importance of early nutrition , especially , with human milk . It also suggests that oropharyngeal administration of colostrum should be reserved for neonates who can not be fed in first few days of life BACKGROUND Oropharyngeal administration of mother 's colostrum in early days has an immunoprotective effect in preterm infants . OBJECTIVES Our aim was to study the effect of oropharyngeal administration of mother 's milk ( OPAMM ) on decreasing the incidence of nosocomial sepsis . METHODS In a pilot prospect i ve r and omized study on preterm ( < 32 weeks gestation and 1500 g weight ) infants , we compared OPAMM practice ( applying 0.2 mL of mother 's colostrum or milk prior to gavage feeding until full oral feeding is reached ) with regular gavage feeding . The primary outcome was incidence of culture-proven nosocomial sepsis . Secondary outcomes included bacterial colonization of the gastrointestinal tract , feeding intolerance , time to reach full feeding , incidence of necrotizing enterocolitis , ventilator-associated pneumonia , duration of respiratory support , incidence of bronchopulmonary dysplasia ( BPD ) , length of hospital stay , and neonatal mortality . RESULTS The outcomes of 200 neonates ( 100 in each group ) were analyzed . OPAMM practice did not significantly reduce the incidence of culture proven nosocomial sepsis ( 8 % vs 13 % , P = 0.35 ) . Infants in the OPAMM group had a significantly lower growth of Klebsiella species in the oropharyngeal pouch , borderline lower incidence of ventilator-associated pneumonia , shorter duration of oxygen therapy , less episodes of feeding intolerance , reached full feeding earlier , and had a shorter length of hospital stay .  OPAMM practice did not affect the incidence of necrotizing enterocolitis , BPD , or neonatal mortality . CONCLUSION OPAMM prior to gavage feeding does not reduce the incidence of nosocomial sepsis but had beneficial effects on early achievement of feeding , and early hospital discharge in preterm very low-birth-weight infants AIM To study the role of oropharyngeal administration of colostrum ( OAC ) in very-low-birth-weight infants for reducing necrotizing enterocolitis ( NEC ) . STUDY DESIGN In this r and omized controlled trial , 117 infants were enrolled , 59 were r and omized to OAC group and 58 to routine care group . Infants with birth weight ≤ 1,250 g and /or gestational age ≤ 30 weeks were enrolled . Infants in OAC group received maternal colostrum ( 0.2 mL ) , 0.1 mL on either side , after 24 hours of postnatal life and were given every 2 hour for the next 72 hours irrespective of the enteral feeding status of the neonate . The primary outcome of the study was the incidence of NEC ( stage 2 or 3 ) . RESULTS Baseline characteristics were comparable between the two groups . There was no significant reduction in the incidence of NEC  in OAC group ( 0 [ 0 % ] vs. 3 [ 7.1 % ] ; p = 0.11 ) . There was significant reduction of 7 days of hospital stay  in OAC group ( 34.2 ± 5.7 vs. 41.5 ± 6.7 days ; p = 0.04).The incidence of early-onset sepsis , late-onset sepsis , blood culture positive sepsis , and ventilator-associated pneumonia were comparable between the two groups . CONCLUSION OAC  is safe and reduces the duration of hospital stay OBJECTIVE : People with multiple and persistent mental and physical health problems have high rates of transition failures when transferring from a hospital level of care to home . The transitional care model ( TCM ) is evidence -based and demonstrated to improve posthospital outcomes for elderly with physical health conditions , but it has not been studied in the population with serious mental illness . METHOD : Using a r and omized controlled design , 40 in patients from two general hospital psychiatric units were recruited and r and omly assigned to an intervention group ( n = 20 ) that received the TCM intervention that was delivered by a psychiatric nurse practitioner for 90 days posthospitalization , or a control group ( n = 20 ) that received usual care . Outcomes were as follows : service utilization , health-related quality of life , and continuity of care . RESULTS : The intervention group showed higher medical and psychiatric rehospitalization than the control group ( p = .054 ) . Emergency room use was lower for intervention group but not statistically significant . Continuity of care with primary care appointments were significantly higher for the intervention group ( p = .023 ) . The intervention group ’s general health improved but was not statistically significant compared with controls . CONCLUSIONS : A transitional care intervention is recommended ; however , the model needs to be modified from a single nurse to a multidisciplinary team with expertise from a psychiatric nurse practitioner , a social worker , and a peer support specialist . A team approach can best manage the complex physical/mental health conditions and complicated social needs of the population with serious mental illness
target: OC could significantly reduce the occurrence of VAP , and consequently , its routine use should be considered for VLBWs to prevent infectious diseases .
  OC  significantly reduces the occurrence of VAP and NEC in VLBW infants  .
  OC may reduce the incidence of VAP and NEC by increasing IgA levels .
  Early OC therapy for mechanical ventilation of low-weight infants may prevent the occurrence of VAP .
  OC significantly reduces the occurrence of VAP and NEC in VLBW infants .
  OC may reduce the incidence of VAP and NEC by increasing IgA levels .
  Early OC therapy for mechanical ventilation of low-weight infants may prevent the occurrence of VAP
background: Oropharyngeal colostrum ( OC ) is a novel feeding strategy to prevent complications of prematurity .
  A meta- analysis was conducted to investigate whether very low birth weight infants ( VLBWs ) can benefit from OC .