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Universal screening for postpartum mood and anxiety disorders (PMADs) has been recommended for all new parents at outpatient postpartum and well-child visits. However, parents of newborns admitted to the NICU are rarely able to access these services during their infant’s prolonged hospitalization. The objective of this study was to determine the prevalence of mental health screening and treatment programs for parents or other primary caregivers in NICUs across the country. In this cross-sectional study, US NICU medical directors were invited to complete an online survey about current practices in mental health education, screening, and treatment for primary caregivers of preterm and ill infants in the NICU. Comparative analyses using Fisher’s exact test were performed to evaluate differences in practices among various NICU practice settings. Survey responses were obtained from 75 out of 700 potential sites (10.7%). Of participating NICUs, less than half routinely provided caregivers with psychoeducation about mental health self-care (n = 35, 47%) or routinely screened caregivers for PPD or other mental health disorders (n = 33, 44%). Nearly one-quarter of the NICUs did not provide any PMAD screening (n = 17, 23%). Despite consensus that postpartum psychosocial care is essential, routine mental health care of primary caregivers in the NICU remains inadequate.

Objectives The authors sought to measure and compare practice preference variation in neonatal respiratory care within and between neonatal intensive care units (NICUs) using the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT). Study design Eleven NICUs completed the NSIGHT between 2019 and 2021. Net preference was measured by mean response; agreement was ranked by standard distribution of response values. Heat maps showed comparisons between NICUs and disciplines. Results NICUs and individuals agreed most often on use of pressure support with mandatory ventilation and on use of non-invasive positive pressure ventilation for apnea. High preference variation surrounded decisions for invasive ventilation versus continuous positive airway pressure for extremely low birth weight infants. Preference difference was most frequent between neonatologists and nurses. Conclusions Patterns of practice preference variation in neonatal respiratory care are specific to clinical scenario. Measuring preference variation may inform psychology of change and strengthen quality improvement efforts.

ObjectiveTo compare the efficacy of video-assisted self-directed neonatal resuscitation skills course with video-assisted facilitator-led course.MethodsThis multicenter, randomized, blinded, non-inferiority-controlled trial compared two methods of teaching basic neonatal resuscitation skills using mask ventilation. Groups of novice providers watched an instructional video. One group received instructor facilitation (Ins-Video). The other group did not (Self-Video). An Objective Structured Clinical Exam (OSCE) measured skills performance, and a written test gauged knowledge.ResultsOne hundred and thirty-four students completed the study. Sixty-three of 68 in the Self-Video Group (92.6%) and 59 of 66 in the Ins-Video Group (89.4%) achieved post-training competency in positive pressure ventilation (primary outcome). OSCE passing rates were low in both groups. Knowledge survey scores were comparable between groups and non-inferior.ConclusionsVideo self-instruction taught novice providers positive pressure ventilation skills and theoretical knowledge, but it was insufficient for mastery of basic neonatal resuscitation in simulation environment.

Professional reimbursement to neonatal providers is based on the level of Current Procedural Terminology (CPT®) coding in the NICU, newborn nursery and other areas where neonatal care is provided. Four levels of evaluation and management (E&M) care—critical, intensive, routine-hospital care or normal newborn care can be provided to neonates. The work relative value units (wRVUs) associated with these four levels of care vary widely. This manuscript provides a brief review of basic features associated with each of these four levels with a specific perspective on differences between critical and intensive care codes. Coding and billing are constantly evolving fields with significant variation in interpretation and readers are encouraged to review the current publications on CPT® coding and make an informed decision on the best codes to be used for their patients.

The duration of the majority of fellowships in pediatrics has been three-years. With increasing shortages of some outpatient-based pediatric subspecialists, shorter two-year fellowships are being considered for clinically oriented trainees not interested in a career based on research. Shortening the duration of fellowship may have some financial merits such as achieving a higher salary earlier after shorter training. However, we feel that continuing with a three-year duration for neonatology is more pragmatic at this time due to reductions in intensive care rotations during residency, time required to  achieve procedural excellence, the need for exposure to quality assurance methodology, proficiency in novel techniques such as bedside ultrasound, and to maintain the physician-scientist pipeline. The demand for neonatal fellowship continues to be high. Ongoing evaluation of the job market, training needs and fellowship curriculum is needed to determine if the duration of fellowship should be altered in the future.

Cutaneous T Cell Lymphoma (CTCL) is an increasingly prevalent condition that impacts patients of all skin types. The most common subtype of CTCL is Mycosis Fungoides (MF), an indolent non-Hodgkin lymphoma of T cell origin that primarily develops in the skin. Most patients with Stage IB MF receive phototherapy as a first-line treatment; however, some require additional systemic therapy. We conducted an institutional review board (IRB)-approved single-center retrospective study of 172 patients diagnosed with Stage IB MF at NYU Langone Health from January 1990 to April 2021. Our study identified demographic and clinical parameters that may indicate which Stage IB patients will require systemic therapy in order to guide clinical decision making and ensure that these treatments can be offered earlier in the disease course. Of 172 total patients enrolled, 129 (75.0&) received phototherapy only, 33 (19.2&) received phototherapy and a systemic agent, and 10 (5.8&) were excluded for lack of documented treatment modality. Univariate statistical analysis demonstrated that advanced age at diagnosis (p<0.005) and elevated LDH (p<0.001) were statistically significant markers in the systemic therapy group. There were no significant differences in anatomical regions involved for patients on systemic agents. Other variables including ethnicity, Fitzpatrick skin type, and health insurance status were not statistically significant predictors of receiving systemic therapy. These results suggest that clinicians should routinely order LDH upon diagnosis for all patients with Stage IB MF. If elevated, patients should be more closely monitored for earlier initiation of systemic agents. Patients with Stage IB MF with an advanced age of diagnosis are also at higher risk of requiring systemic therapy.