Care Of High-risk Infants Research Articles

Kids+ Parent Infant Program (PIP): a community model for supporting partnerships in early developmental follow-up and support.

High-risk infants are discharged home from hospital with increased care needs and the potential for the emergence of developmental disabilities, contributing to high levels of parental stress and anxiety. To enable optimal outcomes for high-risk infants and their families, developmental follow-up programs need to continue following hospital discharge. However, current follow-up care for high-risk infants is variable in terms of type, access and equity, and there seems to be a gap in existing services such as supporting the transition home, parental support, and inclusion of all at-risk infants regardless of causality. Routine follow-up that identifies developmental delays or neuromotor concerns can facilitate timely referral and access to targeted intervention during critical periods of development. The Kids+ Parent Infant Program (PIP) is a unique model of developmental follow-up that shares some characteristics with established programs, but also includes additional key elements for a seamless, wrap-around service for all high-risk infants and their families living in a regional area of Australia. This community-based program provides integrated assessment and intervention of infants, alongside parent support and education, embracing a holistic model that accounts for the complexity and interrelatedness of infant, parent, medical and developmental factors. By prioritising the well-being of high-risk infants and their families, the Kids+ PIP paves the way for improved developmental outcomes and provides an innovative model for developmental follow-up, with the potential for reproduction in other healthcare settings.

Family-Centered Care for High-Risk Infants and the Roles of Healthcare Professionals

With an increasing trend toward low birth rates and premature births, the importance of managing the health of high-risk infants has received constant emphasis. It is necessary to establish a family-centered care culture in neonatal intensive care units where high-risk infants are hospitalized. This study is intended to examine the current status of family-centered care and the direction of the role played by healthcare professionals, focusing on the characteristics of high-risk infants and their families. Healthcare professionals should listen to the needs of the family and facilitate their involvement to improve the performance of family-centered care and systematic support. Specific guidelines are required to strengthen the competence and leadership of healthcare professionals. The paradigm shift toward family-centered care for high-risk infants is a challenge for healthcare professionals and parents, but it will serve as a vision and strategy to improve the health of high-risk infants and their families by including the family in the healthcare process.

Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal

ObjectivesTo assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and/or preterm) and neonatal mortality in rural Nepal.DesignThis is a secondary observational analysis to identify risk factors for...

A Cardiac Deep Learning Model (CDLM) to Predict and Identify the Risk Factor of Congenital Heart Disease.

Congenital heart disease (CHD) is a critical global public health concern, particularly when it comes to newborn mortality. Low- and middle-income countries face the highest mortality rates due to limited resources and inadequate healthcare access. To address this pressing issue, machine learning presents an opportunity to develop accurate predictive models that can assess the risk of death from CHD. These models can empower healthcare professionals by identifying high-risk infants and enabling appropriate care. Additionally, machine learning can uncover patterns in the risk factors associated with CHD mortality, leading to targeted interventions that prevent or reduce mortality among vulnerable newborns. This paper proposes an innovative machine learning approach to minimize newborn mortality related to CHD. By analyzing data from infants diagnosed with CHD, the model identifies key risk factors contributing to mortality. Armed with this knowledge, healthcare providers can devise customized interventions, including intensified care for high-risk infants and early detection and treatment strategies. The proposed diagnostic model utilizes maternal clinical history and fetal health information to accurately predict the condition of newborns affected by CHD. The results are highly promising, with the proposed Cardiac Deep Learning Model (CDLM) achieving remarkable performance metrics, including a sensitivity of 91.74%, specificity of 92.65%, positive predictive value of 90.85%, negative predictive value of 55.62%, and a miss rate of 91.03%. This research aims to make a significant impact by equipping healthcare professionals with powerful tools to combat CHD-related newborn mortality, ultimately saving lives and improving healthcare outcomes worldwide.

Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality

To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM). Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants. Interviews were audiotaped, professionally transcribed, and coded using NVivo software. In qualitative content analysis, researchers blinded to hospital performance identified emergent themes, highlighted illustrative quotes, and drew qualitative comparisons between hospital clusters. The following features distinguished high-performing facilities: 1) stronger commitment from hospital leadership to diversity, quality, and equity; 2) better access to specialist physicians and experienced nursing staff; 3) inclusion of nurses in developing clinical policies and protocols, and 4) acknowledgement of the influence of racism and bias in healthcare on racial-ethnic disparities. In both clusters, areas for improvement included comprehensive family engagement strategies, care standardization, and reporting of quality data by patient sociodemographic characteristics. Our findings suggest specific organizational and cultural characteristics, from hospital leadership and clinician perspectives, that may yield better patient outcomes, and demonstrate the utility of a positive deviance framework to center equity in quality initiatives for high-risk infant care.

The impact of Kaizen approach on neurodevelopmental follow-up of high-risk infants

ABSTRACT Kaizen methodology was implied as a tool for analyzing the current workflow, defining opportunities, developing a solution, and measuring the outcome. The current study aims to verify the early effect of a quality improvement study within the scope of the Kaizen approach to improve the quality of high-risk infant care. Initially, a value stream map was used to define the current follow-up plan. Then, a specific outpatient clinic was established with a standard follow-up schedule. The high-risk infants were evaluated with the same tools at the same corrected ages, and the multidisciplinary team performed appropriate family education. The early outcome was evaluated by Parents’ Satisfaction Levels with High-Risk Infant Care Questionnaire and Parenting Stress Index-Short Form. Thirty-four parents were included. The mean corrected age of the infants was 140.07 ± 146.55 days. Parents’ satisfaction scores were improved from 99.79 ± 17.17–121.61 ± 15.33 (P = 0.000), while perceived stress scores were decreased (98.03 ± 23.55 vs 86.18 ± 20.95), (P = 0.001). The main stages of the quality improvement process were described. The current research presents the preliminary results of a Kaizen implementation for neurodevelopmental follow-up of high-risk infants.

A pivotal moment in the evolution of neonatal care.

While extraordinary advances have been made in the medical care of critically ill newborns, understanding the need of even the smallest of these infants for early, extensive, intimate human contact and facilitating the family's role in the care of their baby has been much slower and inconsistent. There is abundant evidence for the essential role of nurturing parent-infant connections (bonding/attachment) for development of optimal physical, cognitive, and emotional health of all babies. It is time to leave behind the tradition of sensory deprivation and social isolation common in the care of high-risk infants. A paradigm shift is needed in neonatal care to acknowledge the critical importance of infant and family-centered developmental care and to remove any remaining constraints on a family's ability to become full partners in the nurture of their NICU newborn.

Analysis of the importance of nursing care and performance confidence perceived by nurses in the neonatal intensive care unit

Purpose: Neonatal nurses are expected to have clinical competency to provide qualified and safe care for high-risk infants. An educational intervention to enhance nurses’ clinical competence is often a priority in the nursing field. This study was conducted to explore nurses’ perceived importance and performance confidence of nursing care activities in neonatal intensive care units.Methods: One hundred forty-one neonatal nurses from seven hospitals across South Korea participated in the online survey study. The scale of neonatal nursing care activity consisted of 8 subdomains including professional practice (assessment, diagnosis, planning, intervention, evaluation, education, research, and leadership). The Importance-Performance Matrix was used to analyze the importance of and confident performance in each of the nursing subdomains.Results: Both importance and performance confidence increased as nurses’ age (p=.042 and p<.001) and clinical experience (p=.004 and p<.001). Participants scored relatively higher in importance and performance confidence in the professional practice subdomains (assessment, intervention, evaluation), but scored lower in the education and research subdomains.Conclusion: To provide evidence-based nursing care for high-risk infants in neonatal intensive care units, educational interventions should be developed to support nurses based on the findings of the research.

Neonatal Nurses' Perceptions of Palliative Care in the Neonatal Intensive Care Unit.

Neonatal palliative care is widely endorsed as an essential aspect of neonatal intensive care unit (NICU) practice, yet inconsistencies in its use continue to exist. We examined neonatal nurses' perceptions of barriers and facilitators to palliative care in their NICU setting. A cross-sectional design using the Neonatal Palliative Care Attitude Scale (NiPCAS™©) was administered using an online survey distributed to neonatal nurses through the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and National Association of Neonatal Nurses (NANN). Parametric statistical analyses were conducted to explore relationships between unit policy and neonatal palliative care (NPC) education, and the nurses' perceptions. Ninety-nine of 1,800 AWHONN members who identified as NICU nurses completed the survey, representing a response rate of 5.5% and 101 of 4,000 NANN members who subscribe to the MYNANN message boards completed the survey, reflecting a 2.5% response rate. N = 200 surveys were completed with minimal data missing, resulting in a final sample of 200. Exploratory factor analysis yielded these subconstructs: Unit Culture, Resources, and Perceived Inappropriate Care. Barriers identified were Perceived Inappropriate Care and Societal Understanding of NPC. A positive correlation was noted for NiPCAS™© scores and unit culture support (r(185) = .66, n = 187, p < .01), unit NPC policy (r(184) = .446, n = 186, p < .01), and NPC education (r(185) = .373, n = 187, p < .01). Nurses who work in a NICU with an NPC policy and who have received palliative care education demonstrated more favorable attitudes toward NPC. Policy and educational programs are important strategies to promote high-quality care for high-risk infants and their families.

Follow-through care for high-risk infants during the COVID-19 pandemic: lessons learned from the Vermont Oxford Network.

ObjectiveThe COVID-19 pandemic has altered the delivery of follow-up care for high-risk infants. We performed an audit to characterize programmatic responses in a quality improvement network.Study designWe audited 43 North American-based follow-up programs of the Vermont Oxford Network Extremely Low Birth Weight Follow-up Study Group in October, 2020. Our electronic survey included yes/no, agree/disagree, and free text response items.ResultThe response rate was 67.4%. Most programs altered capacity and the timing, frequency, or content of clinical assessments. Most perceived practice changes compromised their ability to ascertain infants’ medical and developmental needs. There was a rapid uptake of telemedicine services. Despite challenges with implementation, many endorsed improved connectedness with families.ConclusionPrograms adapted rapidly to meet the needs of high-risk infants during the pandemic. Clinical operations, assessment procedures, and quality metrics will also need to evolve. Quality improvement study group collaboratives are well-positioned to coordinate such work.

'Chimwemwe Mu'bereki' (Joyful Motherhood): Closing the Gap in Unmet Need for Home Based Nurse Midwifery Care in High Risk Infants and Postpartum Women in Malawi.

Although decreasing, maternal and infant mortality remain high in Malawi with and estimated 359 per 100,000 live births for maternal mortality ratios, and 22.4 per 1000 live births for infant mortality. Joyful Motherhood (JM), or Chimwemwe mu'bereki, is a Malawian nonprofit organization, founded by a US midwife in 2008, which provides home-based care to high-risk, critically ill postpartum women and infants in rural villages of Lilongwe, Malawi. JM employs 3 nurse-midwives who perform all community visits. Women served include, but are not limited to, those who experienced postpartum complications such as severe anemia, sepsis, eclampsia, or ruptured uterus, and complications related to HIV/AIDs. Infant clients include premature, low birth weight, multiples, and orphans who lost their mother in childbirth. All are enrolled for up to 2 years. The purpose of this mixed-methods descriptive study was to evaluate the home visit nurse-midwife programs of JM. There were 2 aims: (1) analyze descriptive data regarding clients served and (2) gain an understanding of the value of JM's services through the perspective of women and caregivers served. Research questions include: How many infants and women have been served since program inception? What are the infant and maternal mortality rates of JM's clients? How has JM's services benefitted clients served? Number of enrolled clients, annual visits made, and deaths were tracked by nurse-midwives providing care and transferred to Microsoft Excel on a monthly basis by the program manager. Cumulative numbers and rates were calculated. Qualitative data were collected via one-on-one interviews and focus groups using a Chichewa interpreter and were digitally audiorecorded and transcribed. From inception of program to July 2019, a total of 490 women and 1300 infants were served. Between October 2013 and July 2020, the infant mortality rate was 4.5% (46/1014) and maternal mortality rate was 1.4% (6/425). Twelve interviews and 2 focus groups were conducted to assess program effectiveness. Narratives revealed overwhelming gratitude for services provided. Participants expressed desperation when seeking care for family members unsuccessfully before being enrolled in JM. Many shared the infant visits were key in well-being and survival of their child into early childhood. Themes include: tough times; very grateful for these gifts; encouraging us to care; and advise others. JM's success for over 10 years demonstrates it is a viable model for unmet home care for high-risk infants and postpartum women in Malawi. Financial challenges prevent scaling up of services and expansion of clientele. Efforts to improve data collection are ongoing including future plans to launch a new mobile electronic record app to use on smart phones.

Cuidado e acompanhamento do lactente de alto risco no primeiro ano de vida

Objetivo: conhecer a percepção de familiares quanto ao cuidado e acompanhamento ao lactente de alto risco, pelos profissionais de saúde ao longo do primeiro ano de vida. Materiais e Método: estudo de natureza qualitativa, realizado com sete cuidadores familiares de lactentes estratificadas como alto risco, em um município do interior do Brasil. Os dados foram coletados por meio de entrevista audiogravadas no domicilio, no período de agosto a setembro de 2018. Posteriormente a transcrição, as falas foram submetidas a análise modalidade temática. Resultados: Os participantes apontaram que as orientações oferecidas no momento da alta, favoreceram a insegurança frente as ações de cuidados básicos. Ademais, o acompanhamento na Atenção Primária a Saúde foi referido como fator facilitador do cuidado, embora a visita domiciliar tenha se apresentado como uma lacuna de atuação dos profissionais. Conclusão: O cuidado ao lactente de alto risco trás desafios para a família e a necessidade da oferta de informações quanto a realização de cuidados básicos e a necessidade de acompanhamento pelos profissionais de saúde

To Individualize the Management Care of High-Risk Infants With Oral Feeding Challenges: What Do We Know? What Can We Do?

The increase in preterm infants' survival over the last 30 years has shed light over their inability to feed by mouth safely and efficiently. With adverse events such as increased risks for oxygen desaturation, bradycardia, penetration/aspiration, infants' hospitalization in neonatal intensive care units (NICUs) are understandably prolonged. Unfortunately, this leads to delayed mother-infant reunion, maternal stress, breastfeeding obstacles, and increased medical costs. Such impediments have stimulated clinicians and researchers to better understand the underlying causes and develop evidence-based solutions to assist these infants. However, it is notable that the research-to-practice translation of this knowledge has been limited as there are still no validated guidelines or protocols as how to best diagnose and care for these infants. This report revisits the immature physiologic functions at the root of these infants' oral feeding difficulties, the current practices, and the recent availability of evidence-based efficacious tools and interventions. Taking advantage of the latter, it presents a renewed perspective of how management strategies can be tailored to the specific needs of individual patients.

4107 Implementation and evaluation of a novel protocol that uses clinical biomarkers to promote early diagnosis and treatment of Neurodevelopmental Disabilities

OBJECTIVES/GOALS: Our objective was to establish a new protocol to evaluate new biomarkers to detect Neurodevelopmental Disabilities (NDD) in high-risk infants. As early intervention results in better outcomes, our goal was to implement the protocol to promote earlier NDD diagnosis and referral for treatment. METHODS/STUDY POPULATION: We implemented a new protocol using the General Movement Assessment (GMA), Hammersmith Infant Neurological Examination (HINE), and Capute Scales to evaluate infants who were at high risk of NDD. To determine the success of our protocol with these biomarkers, we studied former premature infants who were evaluated in follow-up clinic from 10/1/2018-10/1/2019. We defined our primary and secondary outcomes as the ages of neurodevelopmental diagnoses and referral to early intervention services before and after implementation of the new protocol, respectively. Our hypotheses were that infants who were evaluated with these biomarkers would be diagnosed with NDD and be referred for treatment at younger ages than their counterparts. RESULTS/ANTICIPATED RESULTS: Approximately 120 patients were evaluated during the time period that was defined. About half were evaluated prior to implementing the GMA and HINE, and the remainder were evaluated using GMA and other developmental measures. We anticipate that infants who underwent GMA will be diagnosed with NDD and referred for therapies at a younger age than their counterparts. DISCUSSION/SIGNIFICANCE OF IMPACT: Through our translational research, we will transform the standard of care for high-risk infants by incorporating clinical biomarkers into day-to-day clinical care for these infants. Implementation of this novel protocol will promote the early diagnosis and referral to treatment for NDD.

Optimizing High-risk Infant Follow-up in Nonresearch-based Paradigms: The New England Follow-up Network.

To establish the first regional quality improvement collaborative solely dedicated to follow-through care of high-risk infants after Neonatal intensive care unit (NICU) discharge and to characterize extremely low birth weight (ELBW) follow-up in New England. Eleven of 14 follow-up programs in New England partnered with the Vermont Oxford Network (VON) ELBW project for an initial data collection project. We collected information about the health status and developmental outcomes of infants born ≤1,000 g or younger than 28 weeks 2014-2016 at the 18-24 months corrected for gestational age (CGA) follow-up visit. VON collected and compiled the data. Of 993 eligible infants, 516 (52.0%) had follow-up visits. The rehospitalization rate was 33.9%, mostly respiratory illness. Ninety-six children (19.3%) had weight less than 10th percentile and 44 (8.9%) had weight less than third percentile at 18-24 months. Only 170 (61.4%) children had recommended hearing screening after NICU discharge. Forty-six (9.1%) had cerebral palsy; 81 of the 441 infants that completed all 3 sections of the Bayley Scales of Infant Development, third edition (18.4%) had any composite score less than 70. Over half of the social and demographic data were missing. Most quality initiatives in neonatology stop at NICU discharge. This first project by the New England Follow-up Network showed a low rate for clinical follow-up. It demonstrated many opportunities to improve postdischarge follow-through specific to NICU-based care. Future projects will aim to improve the quality of follow-through services through collaborative learning, data sharing, and comparative outcomes.

Reducing Invasive Care for Low-risk Febrile Infants Through Implementation of a Clinical Pathway.

Significant variation in management of febrile infants exists both nationally and within our institution. Risk stratification can be used to identify low-risk infants who can be managed as outpatients without lumbar puncture (LP) or antibiotics. Our objective was to reduce invasive interventions for febrile infants aged 29 to 60 days at low risk for serious bacterial infection (SBI) through implementation of a clinical pathway supported by quality improvement (QI). The evidence-based clinical pathway was developed and implemented by a multidisciplinary team with continuous-process QI to sustain use. Low-risk infants who underwent LP, received antibiotics, and were admitted to the hospital were compared pre- and postpathway implementation with SBI in low-risk infants and appropriate care for high-risk infants as balancing measures. Of 350 included patients, 220 were pre- and 130 were postpathway implementation. With pathway implementation in July 2016, invasive interventions decreased significantly in low-risk infants, with LPs decreasing from 32% to 0%, antibiotic administration from 30% to 1%, and hospital admission from 17% to 2%. Postimplementation, there were 0 SBIs in low-risk infants versus 29.2% in high-risk infants. The percentage of high-risk patients receiving care per pathway remained unchanged. Improvement was sustained for 12 months through QI interventions, including order-set development and e-mail reminders. Implementation of a clinical pathway by using QI methods resulted in sustained reduction in invasive interventions for low-risk febrile infants without missed SBIs. Clinical pathways and QI can be key strategies in the delivery of evidence-based care for febrile infants.

Characterizing Intervention Strategies Used in Community-Based Mental Health Care for Infants and Their Families.

Mental health interventions for infants typically target high-risk groups and can prevent long-term negative outcomes. Despite federal initiatives promoting early intervention, minimal research has examined usual care services for infants, which is important to improve routine care. The current study characterized usual care practices in infant mental health through the adaptation and administration of a provider survey. Providers (n = 126) reported using a wide range of intervention strategies and few intervention programs with varied evidence. Findings can inform future research to identify quality improvement targets of usual mental health care for high-risk infants and their families.

Assessing retention in care after 12\xa0months of the Pediatric Development Clinic implementation in rural Rwanda: a retrospective cohort study

BackgroundIn Africa, a high proportion of children are at risk for developmental delay. Early interventions are known to improve outcomes, but they are not routinely available. The Rwandan Ministry of Health with Partners In Health/Inshuti Mu Buzima created the Pediatric Development Clinic (PDC) model for providing interdisciplinary developmental care for high-risk infants in rural settings. As retention for chronic care has proven challenging in many settings, this study assesses factors related to retention to care after 12 months of clinic enrollment.MethodsThis study describes a retrospective cohort of children enrolled for 12 months in the PDC program in Southern Kayonza district between April 2014–March 2015. We reviewed routinely collected data from electronic medical records and patient charts. We described patient characteristics and the proportion of patients retained, died, transferred out or lost to follow up (LTFU) at 12 months. We used Fisher’s exact test and multivariable logistic regression to identify factors associated with retention in care.Results228 children enrolled in PDC from 1 April 2014–31 March 2015, with prematurity/low birth weight (62.2%) and hypoxic ischemic encephalopathy (34.5%) as the most frequent referral diagnoses. 64.5% of children were retained in care and 32.5% were LTFU after 12 months. In the unadjusted analysis, we found male sex (p = 0.189), having more children at home (p = 0.027), health facility of first visit (p = 0.006), having a PDC in the nearest health facility (p = 0.136), referral in second six months of PDC operation (p = 0.006), and social support to be associated (100%, p < 0.001) with retention after 12 months. In adjusted analysis, referral in second six months of PDC operation (Odds Ratio (OR) 2.56, 95% CI 1.36, 4.80) was associated with increased retention, and being diagnosed with more complex conditions (trisomy 21, cleft lip/palate, hydrocephalus, other developmental delay) was associated with LTFU (OR 0.34, 95% CI 0.15, 0.76). As 100% of those receiving social support were retained in care, this was not able to be assessed in adjusted analysis.ConclusionsPDC retention in care is encouraging. Provision of social assistance and decentralization of the program are major components of the delivery of services related to retention in care.

Implementation of safe sleep practices in Massachusetts NICUs: a state-wide QI collaborative.

To increase the use of safe sleep practices (SSP) among high-risk infants discharged from Massachusetts (MA) NICUs to 90% in 2 years. The Neonatal Quality Improvement Collaborative of MA (NeoQIC) is a consortium of neonatal providers that provides infrastructure to lead and manage state-wide quality improvement initiatives. The safe sleep initiative was started in July 2015 with participation of all 10 MA level III NICUs. Based upon the project algorithm, infants are eligible for two sleep practices: SSP or NICU therapeutic positioning (NTP) depending on their gestational age, weight, and clinical illness. Compliance with SSP is defined as: (1) supine positioning, (2) in a flat crib with no incline, (3) without positioning devices, and (4) without soft objects. NTP comprised usual NICU care. Local improvement teams devise intervention strategies, perform weekly crib audits for all NICU infants, and submit data on overall compliance and compliance with each SSP component on a monthly basis to NeoQIC. From July 2015 to June 2017, 7261 cribs were audited. Statistical process control charts showed significant improvement in the primary outcome of interest, overall compliance with SSP, for all participating NICUs. Compliance increased from 47.7% at the start of the project to 75.5% by the end of year 1 and to 81.0% by June 2017. This state-wide collaborative has improved SSP compliance in all level III MA NICUs and demonstrated that on a state-wide level, SSPs can be routinely integrated into the care of high-risk infants.

Menurunkan Skala Nyeri Bayi Prematur melalui Facilitated Tucking disertai ‘Hadir-Berbicara’ sebagai Upaya Penerapan Teori Comfort Kolcaba

&lt;em&gt;Premature infants had been experience of pain in neonatal ward that occur each day during treatment. Nurse need to do an intervention for reduce the scale of pain on premature infants. Pain management have to do at birth because of the repeated painful procedures in early life can affect the development of central nerve system permanently. The objective of this study was to describe the application of Kolcaba Comfort’s theory through facilitated tucking accompanied with ‘being with-talking to’ techniques in premature’s infant at high risk infant care. The method that used was case study by applying the four contexts of comfort’s experience associated with the three types of comfort based on Kolcaba Comfort’s theory in providing nursing care on five premature infants who have some painful procedures. The nursing intervention through facilitated tucking accompanied by ‘being with-talking to’ based on the principles of Kolcaba Comfort’s theory gave a positive result against premature infants’s comfort level. Four from five premature infants are in the level of transcendence which is a type of supreme comfort after the ease and relief. Kolcaba Comfort’s theory can be applied within the scope of neonatal care due in accordance with the developmental care of the infants and could reduce the scale of pain.&lt;/em&gt;