Nurses’ knowledge, attitudes and practices regarding feeding of low and very-low birth weight infants: a cross-sectional study at tertiary referral hospitals in Rwanda

In order to know the response of the skin microcirculation to local warming, we determined changes in the skin blood volume (Vol), velocity (Vel) and flow (F) by using a new laser Doppler device on newborns. The study subjects were 39 infants whose gestational age was 34.1 +/- 2.8 weeks and birth weight was 2189 +/- 572 g. The study was performed from 8 h postnatally to 28 postnatal days. We measured skin blood volume, velocity and flow at 36 degrees C (Vol36, Vel36, F36), and each value at 5 min (Vol44-5, Vel44-5, F44-5) and 10 min (Vol44-10, Vel44-10, F44-10) after local warming was applied at 44 degrees C and the response curve of each parameter was obtained. Subsequently, serial changes in the response of skin microcirculation to local warming were investigated in nine very low birth weight (VLBW) infants (28.3 +/- 0.9 weeks, 1150 +/- 148 g) and 12 low birth weight (LBW) infants (32.8 +/- 1.3 weeks, 1971 +/- 292 g). The F36, the increment rate of blood volume (delta Vol) and the increment rate of blood velocity (delta Vel) were obtained within 24 h, from day 1 to day 7 and from day 8 to day 30 in both VLBW and LBW infants and from day 31 to day 60 and at more than 61 days in VLBW infants. The F36, delta Vol and delta Vel were compared during the study periods in VLBW and LBW infants. All results were expressed as mean +/- SD. The results showed that F36/F44-10 and F44-5/F44-10, Vol36/Vol44-10 and Vol44-5/Vol44-10, Vel36/Vel44-10 and Vel44-5/Vel44-10 were 0.25 +/- 0.09 and 0.74 +/- 0.17, 0.58 +/- 0.14 and 0.94 +/- 0.08, 0.42 +/- 0.12 and 0.79 +/- 0.15, respectively. Different modes of delivery did not have a significant effect on this response. The F36 in VLBW infants was high during the early neonatal period and gradually decreased with postnatal age. The delta Vol was low in VLBW infants during the neonatal period and gradually increased. The F36 in VLBW1-7 was significantly higher than in LBW1-7 (P < 0.01) and full-term controls (P < 0.001). The delta Vol in VLBW1-7 was 0.26 +/- 0.23, which is significantly lower than in LBW1-7 (0.57 +/- 0.17, P < 0.001) and full-term controls (0.77 +/- 0.21, P < 0.001). The delta Vel in VLBW1-7 and LBW1-7 was significantly higher than in controls (P < 0.05). The skin blood flow increased continuously when local warming was applied at 44 degrees C. This high blood flow and limited potential of vasodilatation are the characteristics of the skin microcirculation in VLBW infants during the neonatal period.

Background: In order to know the response of the skin microcirculation to local warming, we determined changes in the skin blood volume (Vol), velocity (Vel) and flow (F) by using a new laser Doppler device on newborns. Methods: The study subjects were 39 infants whose gestational age was 34.1~2.8 weeks and birth weight was 2189~572 g. The study was performed from 8 h postnatally to 28 postnatal days. We measured skin blood volume, velocity and flow at 36°C (Vol36, Vel36, F36), and each value at 5 min (Vol44–5, Vel44–5, F44–5) and 10 min (Vol44–10, Vel44–10, F44–10) after local warming was applied at 44°C and the response curve of each parameter was obtained. Subsequently, serial changes in the response of skin microcirculation to local warming were investigated in nine very low birth weight (VLBW) infants (28.3~0.9 weeks, 1150~148 g) and 12 low birth weight (LBW) infants (32.8~1.3 weeks, 1971~292 g). The F36, the increment rate of blood volume (ΔVol) and the increment rate of blood velocity (ΔVel) were obtained within 24 h, from day 1 to day 7 and from day 8 to day 30 in both VLBW and LBW infants and from day 31 to day 60 and at more than 61 days in VLBW infants. The F36, ΔVol and ΔVel were compared during the study periods in VLBW and LBW infants. All results were expressed as mean~SD. Results: The results showed that F36/F44–10 and F44–5/F44–10, Vol36/Vol44–10 and Vol44–5/Vol44-10, Vel36/Vel44-10 and Vel44–5/Vel44–10 were 0.25~0.09 and 0.74~0.17, 0.58~0.14 and 0.94~0.08, 0.42~0.12 and 0.79~0.15, respectively. Different modes of delivery did not have a significant effect on this response. The F36 in VLBW infants was high during the early neonatal period and gradually decreased with postnatal age. The ΔVol was low in VLBW infants during the neonatal period and gradually increased. The F36 in VLBW1–7 was significantly higher than in LBW1–7 (P<0.01) and full-term controls (P<0.001). The ΔVol in VLBW1–7 was 0.26~0.23, which is significantly lower than in LBW1–7 (0.57~0.17, P<0.001) and full-term controls (0.77~0.21, P<0.001). The ΔVel in VLBW1–7 and LBW1–7 was significantly higher than in controls (P<0.05). Conclusions: The skin blood flow increased continuously when local warming was applied at 44°C. This high blood flow and limited potential of vasodilatation are the characteristics of the skin microcirculation in VLBW infants during the neonatal period.

Timing of Caffeine Therapy in Very Low Birth Weight Infants

The surgical Apgar score (SAS) has demonstrated utility in predicting postoperative outcomes in a variety of surgical disciplines. However, there has not been a study validating the utility of the SAS in surgical patients in low-income countries. We conducted a prospective, observational study of patients undergoing laparotomy at a tertiary referral hospital in Rwanda and determined the ability of SAS to predict inpatient major complications and mortality. All adult patients undergoing laparotomy in a tertiary referral hospital in Rwanda from October 2014 to January 2015 were included. Data were collected on patient and operative characteristics. SAS was calculated and patients were divided into four SAS categories. Primary outcomes were in-hospital mortality and major complications. Rates and odds of in-hospital mortality and major complications were examined across the four SAS categories. Logistic regression modeling and calculation of c-statistics was used to determine the discriminative ability of SAS. 218 patients underwent laparotomy during the study period. One hundred and forty-three (65.6%) were male, and the median age was 34years (IQR 27-51years). The most common diagnosis was intestinal obstruction (97 [44.5%]). A high proportion of patients (170 [78%]) underwent emergency surgery. Thirty-nine (18.3%) patients died, and 61 (28.6%) patients had a major complication. In-hospital mortality occurred in 25 (50%) patients in the high-risk group, 12 (16%) in the moderate-risk group, 2 (3%) in the mild-risk group and there were no deaths in the low-risk group. Major complications occurred in 32 (64%) patients in the high-risk group, 22 (29%) in the moderate-risk group, 7 (11%) in the mild-risk group and there were no complications in the low-risk group. SAS was a good predictor of postoperative mortality (c-statistic 0.79) and major complications (c-statistic 0.75). SAS can be used to predict in-hospital mortality and major complications after laparotomy in a Rwandan tertiary referral hospital.

There have been significant advances in the provision of enteral nutrition support in the acute and community healthcare settings.[...].

Influence of increased survival in very low birth weight, low birth weight, and normal birth weight infants on the incidence of sudden infant death syndrome in the United States: 1985-1991.

Magnesium metabolism in preterm infants: Effects of calcium, magnesium, and phosphorus, and of postnatal and gestational age

Although pediatricians and neonatal nurses influence parents' treatment decisions, little is known about their attitudes toward active treatment of very low birth weight (VLBW) infants (less than 1500 g) and how they compare with parental attitudes. A survey of all 50 pediatricians in Newfoundland (72% response), all 53 neonatal intensive care nurses at the Janeway Child Health Centre (73.6% response), parents of all 144 traceable VLBW infants (72.2% response), and parents of 25 randomly selected normal term infants (60% response), born in Newfoundland between 1983 and 1987, revealed significant differences in attitudes among parents, nurses, and pediatricians about whether active treatment should be offered to potentially severely handicapped VLBW infants. Most parents of both VLBW and normal term infants (greater than 80%) agreed, pediatricians were divided, whereas most nurses (79.5%) objected. Both pediatricians and nurses tended to overestimate (P less than .05) the morbidity, mortality, and costs of care of VLBW infants. There was a direct correlation (P less than .05) between a negative attitude toward saving VLBW infants and a negatively false perception of neonatal morbidity, mortality, and costs. All groups favored a role for parents and physicians in treatment decisions and objected to a role for regulatory bodies. Pediatricians and nurses also favored a role for nurses and hospital ethics committees but parents disagreed. While most nurses (71%) believed it was unethical to save potentially severely handicapped infants, few pediatricians (36.9%) agreed. Only 27.8% of pediatricians and 10.3% of nurses would seek court intervention if they disagreed with a parental decision not to actively treat a potentially handicapped infant.(ABSTRACT TRUNCATED AT 250 WORDS)

Breastfeeding Trends Among Very Low Birth Weight, Low Birth Weight, and Normal Birth Weight Infants

Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants

Fungal infections in neonates, especially in Very Low Birth Weight (VLBW) infants, are mostly caused by Candida species and may lead to morbidity and mortality. A systematic review and a meta-analysis were conducted to determine the extent to which fluconazole, an antifungal prophylactic, was effective and safe to use in VLBW or premature infants in preventing Invasive Fungal Infection (IFI), by including Randomized Controlled Trials (RCTs) carried out worldwide. The investigation started with searching process through publication databases: MEDLINE, Cochrane, ScienceDirect, and Garuda, for Randomized Controlled Trials (RCTs) that compared the prophylactic effects of fluconazole and placebo on IFI in VLBW infants. The selected eight RCT studies indicated that, compared to placebo, fluconazole accounted for 68% risk reduction of overall fungal colonization (RR=0.32; 95% confidence interval [CI]=0.24-0.42, p=0.00001, I-square=0%) and 60% risk reduction of IFI (RR=0.40; 95%[CI]=0.22-0.72, I-square=56%, p=0.002). However, fluconazole did not significantly reduce mortality in VLBW infants (RR=0.79; 95%[CI]=0.60-1.03; p=0.08, I-square=0%). Also, regarding its safety, fluconazole prophylaxis did not result in significant elevations of SGOT/SGPT levels (RR=1.22; 95%[CI]=0.50-3.00, p=0.66, I-square=0%) nor cause intestinal perforation (RR=0.96; 95%[CI]=0.25-3.68, p=0.96, I-square=59%). Fluconazole is an effective prophylaxis agent against invasive fungal infection when given to preterm infants with birth weight &lt;1500, but not proven in reducing the mortality incidence in VLBW infants.

This study tested common assumptions that very low birth weight (VLBW) infants (less than 1500 g) adversely affected families and that if affected parents could choose again, they would prefer not to save potentially handicapped VLBW infants. A survey of parents, which used a validated impact-on-family questionnaire, was sent to families of all 144 traceable VLBW infants (72.2% response), and families of 25 randomly selected healthy term infants (60% response), born in Newfoundland between 1983 and 1987 (median age 36.5 months, range 12 to 71 months). This revealed that families with developmentally delayed VLBW infants perceived no worse impact on the family than those with healthy term infants. Families with developmentally normal VLBW infants perceived a more positive family impact than the other two groups (P less than .05). Most parents of both VLBW and healthy term infants supported saving all infants regardless of outcome (greater than 80%), believed that parents should be the principal decision makers regarding treatment decisions (greater than 92%), and supported the role of physicians (greater than 59%), but not nurses, ethics committees, or other regulatory bodies, in this decision. For the VLBW group, parental attitudes toward saving VLBW infants were related to their perceptions of family impact (P less than .05) but independent of sociodemographic factors or of the developmental normality of the infant. It is concluded that VLBW infants did not adversely affect these Newfoundland families or change their attitudes toward saving potentially handicapped infants. In the current debate about whether VLBW infants should be saved, cognizance must be taken of parental desires.

Comparison of the attitudes of health care professionals and parents toward active treatment of very low birth weight infants

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

Very low birth weight infants after discharge: What do parents describe?