Development of the preterm infant gut and gastric residuals microbiome.

Underuse Versus Overuse of Neonatal Intensive Care: What Is the Right Amount?

Identifying Depression in Neonatal Intensive Care Unit Parents: Then What?

Routine monitoring of gastric residuals in preterm infants on gavage feeds is a common practice in many neonatal intensive care units and is used to guide the initiation and advancement of feeds. No guidelines or consensus is available on whether to re-feed or discard the aspirated gastric residuals. Although re-feeding gastric residuals may replace partially digested milk, gastrointestinal enzymes, hormones, and trophic substances that aid in digestion and promote gastrointestinal motility and maturation, re-feeding abnormal residuals may result in emesis, necrotising enterocolitis, or sepsis. To assess the efficacy and safety of re-feeding compared to discarding gastric residuals in preterm infants. The allocation should have been started in the first week of life and should have been continued at least until the baby reached full enteral feeds. The investigator could have chosen to discard the gastric residual in the re-feeding group, if the gastric residual quality was not satisfactory. However, the criteria for discarding gastric residual should have been predefined.To conduct subgroup analysis based on gestational age (≤ 27 weeks, 28 weeks to 31 weeks, ≥ 32 weeks), birth weight (< 1000 g, 1000 g to 1499 g, ≥ 1500 g), type of milk (human milk or formula milk), quality of the gastric residual (fresh milk, curded milk, or bile-stained gastric residual), volume of gastric residual replaced (total volume, 50% of the volume, volume of the next feed, or prespecified volume, irrespective of the volume of the aspirate, e.g. 2 mL, 3 mL), and whether the volume of gastric residual that is re-fed is included in or excluded from the volume of the next feed (see "Subgroup analysis and investigation of heterogeneity"). We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1), MEDLINE via PubMed (1966 to 19 February 2018), Embase (1980 to 19 February 2018), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 19 February 2018). We also searched clinical trial databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised and quasi-randomised controlled trials that compared re-feeding versus discarding gastric residuals in preterm infants. Two review authors assessed trial eligibility and risk of bias and independently extracted data. We analysed treatment effects in individual trials and reported the risk ratio and risk difference for dichotomous data, and the mean difference for continuous data, with respective 95% confidence intervals. We used the GRADE approach to assess the quality of evidence. We found one eligible trial that included 72 preterm infants. This trial was not blinded.We are uncertain as to the effect of re-feeding gastric residual on efficacy outcomes such as time to regain birth weight (mean difference (MD) 0.40 days, 95% confidence interval (CI) -2.89 to 3.69 days; very low quality evidence), time to reach enteral feeds ≥ 120 mL/kg/d (MD -1.30 days, 95% CI -2.93 to 0.33 days; very low quality evidence), number of infants with extrauterine growth restriction at discharge (risk ratio (RR) 1.29, 95% CI 0.38 to 4.34; very low quality evidence), duration of total parenteral nutrition (MD -0.30 days, 95% CI -2.07 to 1.47 days; very low quality evidence), and length of hospital stay (MD -1.90 days, 95% CI -25.27 to 21.47 days; very low quality evidence).Similarly, we are uncertain as to the effect of re-feeding gastric residual on safety outcomes such as incidence of stage 2 or 3 necrotising enterocolitis and/or spontaneous intestinal perforation (RR 0.71, 95% CI 0.25 to 2.04; very low quality evidence), number of episodes of feed interruption lasting ≥ 12 hours (RR 0.80, 95% CI 0.42 to 1.52; very low quality evidence), or mortality before discharge (RR 0.50, 95% CI 0.14 to 1.85; low-quality evidence). We are uncertain as to the effect of re-feeding gastric residual in the subgroups of human milk-fed and formula-fed infants. We found no data on other outcomes such as linear and head growth during hospital stay, postdischarge growth, number of infants with parenteral nutrition-associated liver disease, and neurodevelopmental outcomes. We found only limited data from one small unblinded trial on the efficacy and safety of re-feeding gastric residuals in preterm infants. The quality of evidence was low to very low. Hence, available evidence is insufficient to support or refute re-feeding of gastric residuals in preterm infants. A large, randomised controlled trial is needed to provide data of sufficient quality and precision to inform policy and practice.

To investigate, for preterm babies born between 27+0 and 31+6 weeks gestation in England, optimal place of birth and early care. Mixed methods. National Health Service neonatal care, England. To investigate whether birth and early care in neonatal intensive care units (tertiary units) compared to local neonatal units (non-tertiary units) influenced gestation-specific survival and other major outcomes, we analysed data from the National Neonatal Research Database, for 29,842 babies born between 27+0 and 31+6 weeks gestation and discharged from neonatal care between 1 January 2014 and 31 December 2018. We utilised an instrumental variable (maternal excess travel time between local neonatal units and neonatal intensive care units) to control for unmeasured differences. Sensitivity analyses excluded postnatal transfers within 72 hours of birth and multiple births. Outcome measures were death in neonatal care, infant mortality, necrotising enterocolitis, retinopathy of prematurity, severe brain injury, bronchopulmonary dysplasia, and receipt of breast milk at discharge. We also analysed outcomes by volume of neonatal intensive care activity. We undertook a health economic analysis using a cost-effectiveness evaluation from a National Health Service perspective and using additional lives saved as a measure of benefit, explored differences in quality of care in high compared with low-performing units and performed ethnographic qualitative research. The safe gestational age cut-off for babies to be born between 27+0 and 31+6 weeks and early care at either location was 28 weeks. We found no effect on mortality in neonatal care (mean difference -0.001; 99% confidence interval -0.011 to 0.010; p = 0.842) or in infancy (mean difference -0.002; 99% confidence interval -0.014 to 0.009; p = 0.579) (n = 18,847), including after sensitivity analyses. A significantly greater proportion of babies in local neonatal units had severe brain injury (mean difference -0.011; 99% confidence interval -0.022 to -0.001; p = 0.007) with the highest mean difference in babies born at 27 weeks (-0.040). Those transferred in the first 72 hours were more likely to have severe brain injury. For 27 weeks gestation, birth in centres with neonatal intensive care units reduced the risk of severe brain injury by 4.2% from 11.9% to 7.7%. The number needed to treat was 25 (99% confidence interval 10 to 59) indicating that 25 babies at 27 weeks would have to be delivered in a neonatal intensive care unit to prevent one severe brain injury. For babies born at 27 weeks gestation, birth in a high-volume unit (> 1600 intensive care days/year) reduced the risk of severe brain injury from 0.242 to 0.028 [99% confidence interval 0.035 to 0.542; p = 0.003; number needed to treat = 4 (99% confidence interval 2 to 29)]. Estimated annual total costs of neonatal care were £262 million. The mean (standard deviation) cost per baby varied from £75,594 (£34,874) at 27 weeks to £27,401 (£14,947) at 31 weeks. Costs were similar between neonatal intensive care units and local neonatal units for births at 27+0 to 29+6 weeks gestation, but higher for local neonatal units for those born at 30+0 to 31+6 weeks. No difference in additional lives saved were observed between the settings. These results suggested that neonatal intensive care units are likely to represent value for money for the National Health Service. However, careful interpretation of this results should be exercised due to the ethical and practical concerns around the reorganisation of neonatal care for very preterm babies from local neonatal units to neonatal intensive care units purely on the grounds of cost savings. We identified a mean reduction in length of stay (1 day; 95% confidence interval 1.029 to 1.081; p < 0.001) in higher-performing units, based on adherence to evidence- and consensus-based measures. Staff reported that decision-making to optimise capacity for babies was an important part of their work. Parents reported valuing their baby's development, homecoming, continuity of care, inclusion in decision-making, and support for their emotional and physical well-being. Birth and early care for babies ≥28 weeks is safe in both neonatal intensive care units and local neonatal units in England. For anticipated births at 27 weeks, antenatal transfer of mothers to centres colocated with neonatal intensive care units should be supported. When these inadvertently occur in centres with local neonatal units, clinicians should risk assess decisions for postnatal transfer, taking patient care requirements, staff skills and healthcare resources into consideration and counselling parents regarding the increased risk of severe brain injury associated with transfer. This study is registered as Current Controlled Trials NCT02994849 and ISRCTN74230187. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/70/104) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 12. See the NIHR Funding and Awards website for further award information.

The newborn care facilities, policies, and patient load in the perinatal care centers (PNCCs) in Saudi Arabia were assessed in 1985 as a first step toward providing data that would be needed in for...

In neonatal intensive care units, preterm infants are subjected to an average of two and up to fourteen painful procedures per day. Pain and infection are inextricably linked and always neonatal sepsis remains a feared cause of morbidity and mortality during the neonatal period. The study aimed to assess the effect of numbing needles pain with topical anaesthesia on preterms' exposure to neonatal sepsis. A quasi- experimental design was utilized. A purposive sample enrolled all premature infants (n=72) who admitted to the neonatal care department of Mansoura University Children Hospital. Four tools were used for data collection, namely preterm infants' profile, follow-up and clinical outcome assessment sheets, and Premature Infant Pain Profile. The study findings illustrated that there was statistically significant relation between frequency of applying topical anaesthesia and immunologic parameters presented by average of daily weight gain, number of culture-proven infections and negative C-reactive protein weekly profile, at p<.001, and p=.001 respectively. As well there was statistically significant relation between premature infants' calm state during needle painful events and their C-reactive protein weekly profile, at p<.001. Topical anaesthesia is recommended for procedural pain management in the neonatal care units to reduce the adverse effect of pain on preterm infants' immunity. Preterm infants, especially those born between 28-32 weeks of gestation (very premature) are exposed to repeated procedural pain-related stress, during a period of physiological vulnerability and rapid brain development, as part of their life-saving care in the neonatal intensive care unit (NICU). (1) Carbajal et al. (2) reported that neonates underwent an average of 10 painful procedures daily and 91% of these procedures were performed without specific analgesia, despite cutaneous receptive fields are large in the neonate, and peripheral sensory fibers are sensitive to tissue injury. (3) Assessment of neonatal pain is a pressing concern, especially within the context of neonatal intensive care where tiny infants may be exposed to prolonged and repeated pain during lengthy hospitalization. (4) For effective pain management, it is important to correctly identify the pain experienced by the newborns in time through the bedside nurse. Premature infant pain profile (PIPP) code a variety of behavioral and physiological responses (i.e. frown forehead, eye squeeze, naso-labial furrow, changes in heart rate, and oxygen saturation) in order to quantify pain in hospitalized neonates, who cannot self-reporting pain. (5 & 6) Nociception is the ability of peripheral afferent neurons to sense noxious stimuli. (7) Many studies reported that nociception and immune function exhibit a bidirectional relationship, in which each function affecting the other. (8-11) Two relevant literatures suggest applying effective analgesic strategies in the NICUs that may modulate immune function, and decrease the risk of neonatal infection. (12 & 13) Moreover, Vinall and Grunau (14) presented recent work supporting that, greater exposure to painful procedures in the NICU has been associated with the reprogramming of the stress hormone and immune systems among premature infants. Therefore, alleviation of pain caused by invasive procedures in neonates is important for humane reasons as well as for avoiding the acute physiological instability (e.g., metabolic, immune). Responses to neonatal pain vary based on gestational age, sleep-wake state, illness severity, as well as recency and duration of previous exposures to pain and non-invasive interventions. (15) Therefore, clinicians are faced with the difficult task of discriminating and appropriately managing pain in infants born premature. Every NICU should have a comprehensive approach to reduce pain for the admitted patients. Both non- pharmacological and pharmacological approaches play a role in the management of pain in the neonate, and while non-pharmacologic management is recommended as a first step, often invasive procedures in the NICU are still performed without support. (16) Unmanaged pain may have substantive effects on the developing brain, and stress systems of premature neonates; however, pain management remains a challenge. The use of swaddling, sucrose, pacifiers, and decreased environmental stimuli have shown limited therapeutic efficacy in treating mild to moderate painful stimuli. Local and systemic analgesia are often the treatment of choice for procedural pain, and specifically the various topical anesthetic agents including

World Prematurity Day: improving survival and quality of life for millions of babies born preterm around the world

The admission of a newborn infant to a neonatal intensive care unit (NICU) due to preterm birth or high-risk conditions, such as perinatal injury, sepsis, hypoxia, congenital malformation, or brain injury, is a stressful experience for mothers. There is currently a lack of research on maternal perceived stress and support in Egyptian NICUs and no validated Arabic tool to investigate this further. To determine the reliability and validity of the Arabic language versions of the Parental Stressor Scale: NICU (PSS:NICU) and the Nurse Parental Support Tool (NPST). Egyptian mothers completed the PSS:NICU and the NPST at the time of their infants' discharge from the NICU. Reliability was assessed with Cronbach α and Spearman-Brown coefficient. The multifactorial structure of the PSS:NICU Arabic version was tested. Associations with sociodemographic and clinical variables were explored with bivariate correlations and t tests. Sixty-eight mothers of preterm (PT) infants and 52 mothers of ill full-term (IFT) infants completed the study. Mothers of PT and IFT infants did not differ for sociodemographic variables. High internal consistency (α range between .93 and .96) emerged for both tools. Spearman-Brown coefficients ranged between 0.86 and 0.94. The multidimensional structure of the PSS:NICU was confirmed and 3 core dimensions explained up to 71.48% of the variance. Perceived nursing support did not diminish the effects of stress in mothers of infants admitted to the NICU, regardless of PT or IFT infants' status. A longer NICU stay was associated with greater stress in mothers of PT infants. The presence of comorbidities was significantly associated with stress of mothers of IFT infants. Future research is needed to develop evidence-based support for mothers whose infants are admitted to a NICU in Egypt. The availability of validated and reliable PSS:NICU and NPST scales in Arabic will facilitate cross-country and cross-cultural research on maternal stress in the NICU. Neonatal care nurses in Egypt will be able to increase their understanding of the stressors experienced by mothers of infants admitted to the NICU. This will in turn enable the introduction of neonatal care policies aimed at reducing specific stressors and provide improved maternal support.

Routine monitoring of gastric residuals in preterm infants on tube feeds is a common practice in neonatal intensive care units used to guide initiation and advancement of enteral feeding. There is a paucity of consensus on whether to re-feed or discard the aspirated gastric residuals. While re-feeding gastric residuals may aid in digestion and promote gastrointestinal motility and maturation by replacing partially digested milk, gastrointestinal enzymes, hormones, and trophic substances, abnormal residuals may result in vomiting, necrotising enterocolitis, or sepsis. To assess the efficacy and safety of re-feeding when compared to discarding gastric residuals in preterm infants. SEARCH METHODS: Searches were conducted in February 2022 in Cochrane CENTRAL via CRS, Ovid MEDLINE and Embase, and CINAHL. We also searched clinical trial databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs. We selected RCTs that compared re-feeding versus discarding gastric residuals in preterm infants. Review authors assessed trial eligibility and risk of bias and extracted data, in duplicate. We analysed treatment effects in individual trials and reported the risk ratio (RR) for dichotomous data and the mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. We found one eligible trial that included 72 preterm infants. The trial was unmasked but was otherwise of good methodological quality. Re-feeding gastric residual may have little or no effect on time to regain birth weight (MD 0.40 days, 95% CI -2.89 to 3.69; 59 infants; low-certainty evidence), risk of necrotising enterocolitis stage ≥ 2 or spontaneous intestinal perforation (RR 0.71, 95% CI 0.25 to 2.04; 72 infants; low-certainty evidence), all-cause mortality before hospital discharge (RR 0.50, 95% CI 0.14 to 1.85; 72 infants; low-certainty evidence), time to establish enteral feeds ≥ 120 mL/kg/d (MD -1.30 days, 95% CI -2.93 to 0.33; 59 infants; low-certainty evidence), number of total parenteral nutrition days (MD -0.30 days, 95% CI -2.07 to 1.47; 59 infants; low-certainty evidence), and risk of extrauterine growth restriction at discharge (RR 1.29, 95% CI 0.38 to 4.34; 59 infants; low-certainty evidence). We are uncertain as to the effect of re-feeding gastric residual on number of episodes of feed interruption lasting for ≥ 12 hours (RR 0.80, 95% CI 0.42 to 1.52; 59 infants; very low-certainty evidence). We found only limited data from one small unmasked trial on the efficacy and safety of re-feeding gastric residuals in preterm infants. Low-certainty evidence suggests re-feeding gastric residual may have little or no effect on important clinical outcomes such as necrotising enterocolitis, all-cause mortality before hospital discharge, time to establish enteral feeds, number of total parenteral nutrition days, and in-hospital weight gain. A large RCT is needed to assess the efficacy and safety of re-feeding of gastric residuals in preterm infants with adequate certainty of evidence to inform policy and practice.

The parents' presence and involvement in neonatal care is a promising approach to improve preterm infants' neurodevelopmental outcomes. We examined whether exposure to the parents' speech is associated with the preterm infant's social-cognitive development. The study included infants born before 32 gestational weeks in two neonatal units. Each infant's language environment was assessed from 16-hour recordings using Language Environment Analysis (LENA®). Parental presence was assessed with Closeness Diary for 14 days during the hospital stay. Attention to faces and non-face patterns was measured at the corrected age of seven months using an eye-tracking disengagement test. A total of 63 preterm infants were included. Infants were less likely to disengage their attention from faces (M = 0.55, SD = 0.26) than non-face patterns (M = 0.24, SD = 0.22), p < 0.001, d = 0.84. Exposure to the parents' speech during the neonatal period was positively correlated with the preference for faces over non-face patterns (rs = 0.34, p = 0.009) and with the preference for parents over unfamiliar faces (rs = 0.28, p = 0.034). The exposure to the parents' speech during neonatal hospital care is a potential early marker for later social development in preterm infants. The exposure to the parents' speech during neonatal intensive care is a potential early marker for optimal social-cognitive development in preterm infants. This is the first study to show an association between parental vocal contact during neonatal intensive care and early social development (i.e., face preference), measured at seven months of corrected age. Our findings suggest that we should pay attention to the parents' vocal contact with their child in the neonatal intensive care unit and identify need for tailored support for face-to-face and vocal contact.

Between the sheets - or how to keep babies warm.

Gastrectomy serves as a primary treatment for gastric cancer, a leading global malignancy, and affects significant physiological and anatomical changes in the digestive tract. Recent studies highlight the critical role of gastrointestinal microbiota in postoperative health following digestive tract surgeries, including gastrectomy. These alterations possibly impact the gut microbiota and affect patient health by influencing the bacterial environment in the gastrointestinal tract. However, the relationships between the gastrointestinal tract and the oral, gastric, and gut microbiota after gastrectomy are not clear. In this study, we aimed to characterize alterations in the gut microbiota due to gastrectomy and evaluate whether these alterations are associated with the oral and gastric microbiota. Saliva, gastric fluid, and stool samples were collected from patients diagnosed with primary gastric cancer who underwent gastrectomy at two time points, before and 6 months after gastrectomy. Next, 16S rRNA metagenomic analysis was performed. Diversity and linear discriminant analysis effect size (LEfSe) analyses of each microbiota were conducted before and after gastrectomy to compare alterations in the gut, oral, and gastric microbiota. The diversity of gut microbiota increased after gastrectomy compared to that before gastrectomy (Shannon index, p = 0.044), with LEfSe analysis showing increased abundance of Rothia and Lactobacillus in the gut microbiota. Additionally, the proportion of participants with Rothia in their gut microbiota increased, and this genus was present in the oral and gastric microbiota of almost all participants. Furthermore, a significant rise in Lactobacillus was observed in the gut, oral, and gastric microbiota of paired participants. We characterized gut microbiota alterations caused by gastrectomy and demonstrated their relationship with changes in oral and gastric microbiota, thereby elucidating interactions between the gastrointestinal tract microbiota in response to changes in the gastric environment.

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify, appraise and synthesize the best available studies exploring parents’ experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit. The review questions are: 1. How do parents describe their preparedness for bringing their infant(s) home? 2. How do the parents experience the event of discharge? 3. What issues do the parents describe as influencing their transition experiences when the infant is discharged from a NICU to home? INCLUSION CRITERIA Types of participants This review will consider studies that include mothers, fathers, step-parents or foster parents of infants who are hospitalized in a neonatal intensive care unit regardless of civil status, ethnicity or country of origin. Types of intervention(s)/phenomena of interest This review will include studies that investigate how parents experience the discharge of their infant from the Neonatal Intensive Care Unit. The included studies should describe parents’ experiences of being prepared for the discharge and the event of the discharge. Transition in this study is defined as: “a passage from one fairly stable state to another fairly stable state and it is a process triggered by a change”. The focus of this review is infants’ discharge from the Neonatal Intensive Care Unit. Context The context of this review is a Neonatal Intensive Care Unit defined as an intensive care unit of ill or premature and/or newborn infants. This review includes studies from all four classified levels for Neonatal Intensive Care Unit care TRUNCATED AT 250 WORDS

Effect of abdominal massage on feeding intolerance among premature baby with mechanical ventilation in neonatal intensive care unit in indonesia

ObjectiveTo explore parents’ needs and perceived gaps concerning communication with healthcare professionals during their preterm infants’ admission to the neonatal (intensive) care unit (NICU) after birth. MethodsSemi-structured, retrospective interviews with 20 parents of preterm infants (March 2020), admitted to a Dutch NICU (level 2–4) minimally one week, one to five years prior. The interview guide was developed using Epstein and Street’s Framework for Patient-Centered Communication. Online interviews were audio-taped and transcribed verbatim. Deductive and inductive thematic analysis was performed by two independent coders. ResultsCommunication needs and gaps emerged across four main functions of NICU communication: Building/maintaining relationships, exchanging information, (sharing) decision-making, and enabling parent self-management. Communication gaps included: lack of supportive physician communication, disregard of parents’ views and agreements, missing communication about decisions, and the absence of written (discharge) information. ConclusionThis study improves our understanding and conceptualization of adequate NICU communication by revealing persisting gaps in parent-provider interaction. Also, this study provides a steppingstone for further integration of parents as equal partners in neonatal care and communication. Practice implicationsThe results are relevant to practitioners in the field of neonatal and pediatric care, providing suggestions for tangible improvements in NICU care in the Netherlands and beyond.