Late Antibiotic Use Among Preterm Infants Admitted to the Neonatal Intensive Care Unit.

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

After completing this article, readers should be able to: 1. List the five epidemiologic truths that underlie ethical decision-making in the neonatal intensive care unit. 2. Describe how recent developments have altered some, but not all, of these epidemiologic observations. Progress in neonatology is generally portrayed as inexorable—doing better and better with smaller and smaller. For approximately the first 30 years of the specialty, this was true. A succession of manuscripts published between 1960 and 1990 bore witness to the success, with titles such as “1,500 g: How Small is Too Small?” that subsequently were followed by: 1,000 g:?, 800 g:?, and 500 g:?. By 1990, virtually all neonatal intensive care units (NICUs) had survival rates of 90% or greater for infants whose birthweights (BWs) were greater than 1,000 g. Consequently, for individual infants whose BWs were greater than 1 kg, parental refusal of intervention was precluded in the absence of other, nonBW-related circumstances. At the other end of a relatively narrow BW spectrum (approximately <450 g), survival was dismal. At a minimum, parental requests for nonresuscitation of infants who weighed less than this limit seemed supportable, under the broad rubric of futility. Thus, the ethical debate surrounding NICU care was played out along a birthweight dimension of roughly 1 lb. These epidemiologic truths were recognized by the early 1990s. However, much has changed in NICU care in the past decade. Exogenous surfactants are administered uniformly for respiratory distress. High-frequency oscillation and inhaled nitric oxide are widely available. Antenatal corticosteroids have become standard therapy for women in whom preterm delivery is threatened. In this brief article, we consider how these medical advances affected both the epidemiology and ethics of life and death for extremely low-birthweight (ELBW) infants in the NICU during the past 10 years. In parallel with Newton’s three laws for …

A higher level of care improves outcomes in extremely and very preterm infants, yet the impact of neonatal intensive care unit (NICU) level on moderate and late preterm (MLP) care quality is unknown. To examine the association between NICU type and care quality in MLP (30-36 weeks' gestation) and extremely and very preterm (25-29 weeks' gestation) infants. This cohort study was a prospective analysis of 433 814 premature infants born in 465 US hospitals between January 1, 2016, and December 31, 2020, without anomalies and who survived more than 12 hours and were transferred no more than once. Data were from the Vermont Oxford Network all NICU admissions database. NICU types were defined as units with ventilation restrictions without surgery (type A with restrictions, similar to American Academy of Pediatrics [AAP] level 2 NICUs), without surgery (type A) and with surgery not requiring cardiac bypass (type B, similar to AAP level 3 NICUs), and with all surgery (type C, similar to AAP level 4 NICUs). The primary outcome was gestational age (GA)-specific composite quality measures using Baby-Measure of Neonatal Intensive Care Outcomes Research (Baby-MONITOR) for extremely and very preterm infants and an adapted MLP quality measure for MLP infants. Secondary outcomes were individual component measures of each scale. Composite scores were standardized observed minus expected scores, adjusted for patient characteristics, averaged, and expressed with a mean of 0 and SD of 1. Between May 2021 and October 2022, Kruskal-Wallis tests were used to compare scores by NICU type. Among the 376 219 MLP (204 181 [54.3%] male, 172 038 [45.7%] female; mean [SD] GA, 34.2 [1.7] weeks) and 57 595 extremely and very preterm (30 173 [52.4%] male, 27 422 [47.6%] female; mean [SD] GA, 27.7 [1.4] weeks) infants included, 6.6% received care in type A NICUs with restrictions, 29.3% in type A NICUs without restrictions, 39.7% in type B NICUs, and 24.4% in type C NICUs. The MLP infants had lower MLP-QM scores in type C NICUs (median [IQR]: type A with restrictions, 0.4 [-0.1 to 0.8]; type A, 0.4 [-0.4 to 0.9]; type B, 0.1 [-0.7 to 0.7]; type C, -0.7 [-1.6 to 0.4]; P < .001). No significant differences were found in extremely and very preterm Baby-MONITOR scores by NICU type. In type C NICUs, MLP infants had lower scores in no extreme length of stay and change-in-weight z score. In this cohort study, composite quality scores were lower for MLP infants in type C NICUs, whereas extremely and very preterm composite quality scores were similar across NICU types. Policies facilitating care for MLP infants at NICUs with less complex subspecialty services may improve care quality delivered to this prevalent, at-risk population.

Nurses' Expectations of Using Music for Premature Infants in Neonatal Intensive Care Unit

The coronavirus disease 2019 (COVID-19) pandemic led to significant changes in neonatal intensive care unit (NICU) protocols, including restrictions on parental visitation and suspension of kangaroo mother care. These modifications likely impacted preterm infants' neurodevelopmental outcomes. While previous studies have examined the short-term developmental effects of the pandemic, the long-term neurodevelopmental consequences remain unclear. This study aimed to assess the impact of pandemic-related NICU care changes on the neurodevelopmental outcomes of preterm infants at 18 months corrected age in Japan. This retrospective, single-center study was conducted at a Japanese university hospital and included preterm infants born before and during the COVID-19 pandemic. Eligible infants were those with a gestational age of less than 32 weeks or a birth weight under 1,500 g, who subsequently underwent neurodevelopmental assessment at 18 months of corrected age using the Kyoto Scale of Psychological Development 2001 (KSPD). Infants were categorized into a prepandemic group (born before March 1, 2020) and a pandemic group (born on or after March 1, 2020). To compare demographic and clinical characteristics between the groups, the Mann-Whitney U test was employed for continuous variables and the chi-square test for categorical variables. All statistical analyses were performed using a predefined significance level of p < 0.05. A total of 44 preterm infants were included (22 per group). While there were no significant differences in birth weight or neonatal morbidities between the groups, the pandemic group had a significantly older gestational age (30 vs. 28 weeks, p = 0.04). KSPD assessments revealed that the pandemic group had significantly lower cognitive-adaptive (80 vs. 92, p = 0.01) and language-social (73 vs. 89, p = 0.04) developmental quotients (DQ) compared with the prepandemic group. Postural-motor DQ was lower in the pandemic group but did not reach statistical significance (82 vs. 98, p = 0.14). To account for potential confounders, an analysis of covariance was conducted, adjusting for gestational age, birth weight, and sex. The adjusted analysis remained consistent with the unadjusted findings, confirming significantly lower cognitive-adaptive DQ (F = 4.83, p = 0.03) and language-social DQ (F = 3.94, p = 0.04) in the pandemic group. Gestational age, birth weight, and sex were not significantly associated with any DQ scores. Preterm infants born during the COVID-19 pandemic exhibited significantly lower cognitive-adaptive and language-social DQs at 18 months corrected age than prepandemic infants. These findings suggest that pandemic-related restrictions on parental involvement in the NICU may have potentially influenced neurodevelopment. Further research is needed to explore long-term developmental trajectories and interventions to support optimal outcomes in this vulnerable population.

Genetic testing is an integral part of Neonatal Intensive Care Unit (NICU) care. There are reported disparities in both NICU care and genetic testing related to race and language spoken. Identifying characteristics associated with genetic testing in NICUs could help detect patients who may benefit from genetic testing, as well as any current disparities. We sought to analyze characteristics of NICU admits who had genetic testing in general and specific test categories. Characteristics were requested from the Children's Hospital Neonatal Consortium database for patients admitted to Primary Children's Hospital's NICU in 2022. Statistical analysis was performed to determine if characteristics were more likely to result in genetic testing and if differences between those with genetic testing and those without were significant. All genetic test types were more likely ordered with genetic consultations. Cytogenetic testing was more likely in patients with a cardiology consult or who were Spanish-speaking. Patients who were of Hispanic origin were more likely to have molecular testing ordered. The average number of specialty consults for a patient was higher for those with genetic testing. Premature and low birthweight infants had longer time to genetic test ordering. No disparities were identified, which could be due to a small, homogenous sample. The differences with Spanish-speaking patients and those with mothers of Hispanic origin could be due to many factors, including consenting practices. It may be difficult to identify infants who might need genetic testing when they are low birthweight and/or premature. It is important to continue monitoring for differences in ordering practice for this vulnerable population.

Family-centered care is a standard of practice in neonatal intensive care units (NICUs). The purpose of the study was to assess successes and opportunities for improvement with parents' experiences and involvement in their premature infants' care in NICUs. Researchers' surveyed 502 parents whose children were currently < or =30 months old, had been born at a gestational age < or =36 weeks and had gone through or were currently in NICUs. Most parents of premature infants were reasonably satisfied with the access, attention and information received from physicians and nurses in the NICU. However, approximately one-fourth were only moderately satisfied and nearly 10% were dissatisfied. While progress has been made in meeting the needs of parents in the NICU, more work needs to be carried out to improve family-centered care efforts. Specific attention should be given to providing more information and interaction opportunities for families, which may ultimately improve NICU outcomes.

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.

Preventing Postnatal Cytomegalovirus Infection in the Preterm Infant: Should It Be Done, Can It Be Done, and at What Cost?

BackgroundThe aim of this study was to review the effects of developmental care in neonatal intensive care unit (NICU) setting on mental and motor development of preterm infants.MethodWe searched PubMed, EMBASE, CINAHL, Scopus, Web of Science and Cochrane library until October 8th 2017, and included randomized controlled trials that assessed effects of developmental care in NICU on mental and motor development of preterm infants at 12 and 24 months of age, using the Bayley scale of infant development in this systematic review. In addition, data were pooled by random effects model and Standardized Mean Difference (SMD) with 95% confidence intervals (CI), calculated for meta-analysis.ResultsTwenty one studies were eligible to be included in this systematic review; however, only thirteen studies had data suitable for meta-analysis. According to statistical analysis, developmental care in NICU improved mental developmental index (MDI) (standardized mean difference [SMD] 0.55, 95% confidence interval [CI] 0.23–0.87; p < 0.05), and psychomotor developmental index (PDI) (SMD 0.33, [CI] 95% CI 0.08–0.57; p < 0.05) of BSID at 12 months of age and PDI at 24 months of age (SMD 0.15, 95% CI -0.02–0.32; p < 0.1) of preterm infants. However, the benefit was not detected at 24 months of age on MDI (SMD 0.15, 95% CI -0.05–0.35; p = 0.15).ConclusionCurrent evidence suggests that developmental care in only NICU setting could have significant effect on mental and motor development of preterm infants, especially at 12 months of age. However, because of clinical heterogeneity, more studies are needed to evaluate the effects of developmental NICU care in the development of preterm infants.

The stress of treatments in the neonatal intensive care unit (NICU) has been considered to affect autonomic nerve activity and motions in premature infants. In order to improve the treatments in NICU, we surveyed the actual environment in NICU, quantitatively. In this paper, we measured heart rate (HR) and motions of 8 premature infants at 4 types of stimuli according to the care in NICU. As the results, we clarified that physiological response was different depending on the kind of stimulation. We found that the motion by stimuli was different depending on the premature infants, from the analysis of motions. Therefore, motions by stimulation were different in each premature infant. Importance of treatment according to individual premature infants was suggested.

ObjectivesEarly and prolonged use of antibiotic therapy in preterm babies has been associated with adverse outcomes including increased incidence of necrotizing enterocolitis (NEC), bronchopulmonary dysplasia, and death.1–3 Efforts have been...

Between the sheets - or how to keep babies warm.

Introduction: Moderate and late preterm and early-term infants constitute a significant proportion of hospitalizations in neonatal intensive care units (NICU), yet have been perceived as low-risk groups. Their gestational age-specific data have been poorly studied, including respiratory morbidity and outcome. Objectives: The objectives of this study were to determine the respiratory morbidity among moderate and late preterm and early-term infants and to study their short-term outcomes. Materials and Methods: A longitudinal descriptive hospital-based study was conducted at a tertiary care hospital in Southern India, from January 2018 to June 2019. Newborns between 32 and &lt;39 completed weeks, after gestational age assessment, were observed until discharge and later followed up to 40 weeks of gestation. The outcome was recorded in terms of respiratory issues, length of hospital stay, and readmissions within a month. Results: Two hundred and fifty babies were included in the study. NICU care was required in 78%, 72%, and 9.2% of moderate preterm, late preterm, and early-term infants, respectively. Respiratory distress was noted in 78%, 66%, and 6% of moderate preterm, late preterm, and early-term infants, respectively. The association of respiratory distress with gestational age was highly significant (P &lt; 0.0001). Surfactant requirement was 12%, 6%, and 1.7% among the three groups. The average length of NICU stay was 7.8 days, 6.5 days, and 0.3 days among moderate and late preterms and early-term infants, respectively. Conclusion: Moderate and late preterms and early-term infants have significant morbidities. Gestational age has a substantial correlation with respiratory distress and neonatal outcomes. Knowledge about these issues can ensure improved outcome in these infants.

Introduction: Duration of appropriate antibiotic therapy for neonatal sepsis does not have evidence-based guidelines. The rationale and safety of these recommendations have never been scientifically evaluated. Such untested approaches could result in the unnecessary use of antibiotics leading to increased cost of care, unneeded intravenous cannulation, prolonged hospitalization, mother-infant separation, increased colonization by pathogenic organisms and emergence of drug resistant strains. So, our objective was to compare 3 days v/s. 7 days course of intravenous antibiotics for probable neonatal sepsis in order to determine the optimal length of antibiotic therapy so that infants with genuine infection would be adequately treated while those without infection would not be over-treated. Methods: Randomized controlled trial (computerized randomization) done in the Neonatal Intensive Care Unit in a Tertiary care Teaching Hospital, Mysuru. About 150 neonates who were admitted in NICU for probable sepsis (clinical signs of sepsis and positive septic screening), who were on antibiotic therapy, with sterile blood culture at 3rd day of admission were the participants. Neonates who fulfilled the inclusion criteria were randomly divided into two groups, i.e; those who received 3 days of antibiotics and those who received 7 day course of antibiotics. Successful therapeutic outcome was measured in terms of weight gain, no apparent signs of sepsis as ascertained by clinical examination & no re hospitalization for sepsis. Results: Among the 150 eligible neonates in the study, (75 each in Groups 1 and 2, which were comparable with regard to term/preterm population and also early and late onset neonatal sepsis), there was no statistically significant difference in the outcome between the two groups in terms of mean age at presentation, gestational age, mode of delivery, age of onset of sepsis at presentation and relapse rates. However, the duration of hospital stay in group 1 babies who received 3 days of antibiotics was significantly shorter than in group 2 babies who received 7 days of antibiotics. Conclusion: 3 day course of antibiotics is enough for culture sterile probable sepsis, in both term and preterm babies and also in both early and late onset neonatal sepsis.