Neonatal Care Research Articles

Ethical considerations regarding the treatment of extremely preterm infants at the limit of viability: a comprehensive review.

Advancements in perinatal care have improved survival rates of extremely preterm infants born at 22 to 23weeks of gestation, thus introducing new ethical challenges associated with their treatment. Therefore, we reviewed the epidemiological prognosis, treatment evolution, and ethical considerations associated with the care of preterm infants at the limit of viability. We comprehensively searched PubMed to find relevant English-language articles published between January 2014 and July 2024. Survival rates of infants born at 22 to 23weeks of gestation have improved but remain low. Proactive treatment can result in survival rates exceeding 50% for infants born at 22weeks; however, these infants are at high risk for complications and neurodevelopmental impairment. Advancements in obstetric and neonatal care have contributed to improved outcomes. Ethical challenges include balancing survival with the disability risk, managing patients with uncertain prognoses, and considering parental wishes.Conclusion: The care of preterm infants at the limit of viability presents complex ethical dilemmas. Shared decision-making between healthcare providers and families as well as engaging in societal discourse are crucial to addressing these challenges.

The diagnostic accuracy of umbilical cord procalcitonin in predicting early-onset neonatal infection.

To determine the threshold of umbilical cord blood procalcitonin for early-onset neonatal infection diagnosis. This prospective study was conducted on 126 neonates in the neonatal care unit of Hue University of Medicine and Pharmacy Hospital, Vietnam, from June 01, 2023 to August 31, 2024. All neonates showed signs at birth or risk factors for early-onset infection (EOI) and were divided into two groups: EOI group and non-EOI group. Umbilical cord blood samples were collected for procalcitonin analysis immediately after birth. The median procalcitonin (PCT) levels in umbilical cord blood were significantly higher in the EOI group (0.154 ng/ml [0.092-0.197]) compared to the non-EOI group (0.097 ng/ml [0.082-0.134]; p < 0.001). Receiver operating characteristic (ROC) curve determined the optimal threshold value of PCT of 0.142 ng/ml with an AUC 0.751 (95% CI: 0.661-0.841, p<0.001) in the total population. At this cut-off, the Se, Sp, PPV, and NPV were 68.2%, 76.8%, 61.2%, and 81.8%, respectively. The optimal cut-off value for preterm neonates was 0.122 ng/ml (AUC: 0.785, 95% CI: 0.658-0.911, p<0.001) corresponding a Se of 79.2%, Sp of 74.1%, PPV of 73.1%, and NPV of 80.0%. In term group, the optimal cut-off value was 0.150 ng/ml (AUC: 0.726, 95% CI: 0.583-0.860, p<0.01), with a Se of 60.0%, Sp of 80.4%, PPV of 52.2%, and NPV of 84.9%. Umbilical cord blood PCT concentration were elevated in neonates with EOI. PCT could be a valuable marker for the early diagnosis of EOI.

PHOTOTHERAPY OUTCOMES AND BILIRUBIN ASSESSMENT TECHNIQUES IN PRETERM NEONATES: A TERTIARY CARE EXPERIENCE

Objective: Management of neonatal jaundice, particularly in preterm neonates, is a significant challenge in neonatal care, with phototherapy serving as the primary treatment modality. This study evaluates the outcomes of phototherapy and the efficacy of different bilirubin assessment techniques in a tertiary care environment. Methods: A hospital-based prospective observational study was conducted involving 100 preterm neonates. Transcutaneous (TcB) and total serum bilirubin (TSB) levels were measured before, during, and after phototherapy to assess correlations and differences. Results: Statistically significant correlations were found between TcB and TSB post-phototherapy (r-value = 0.8154, p-value&lt;0.0001) and during phototherapy (r-value = 0.6069, p-value&lt;0.0001). However, TcB tended to underestimate bilirubin levels compared to TSB post-phototherapy, with a mean difference of -0.42 mg/dl (p-value = 0.0117). Conclusion: Despite discrepancies with traditional serum bilirubin (TSB) measurements during and after phototherapy, TcB proves to be an effective tool in clinical practice. The findings suggest that with further refinement and adjustment for influencing factors, TcB can serve as an equivalent to serum assessments, reducing the need for invasive procedures in neonatal jaundice management.

Tadābīr-i-Navmawlūd (Child Health Care): A Holistic Framework in Unani System of Medicine for Child Well-Being

Infancy, the critical phase from birth to early childhood, holds immense importance, with each day contributing significantly to a child's development. Globally, approximately four million neonatal deaths occur annually, with 98% of these taking place in developing countries. In these regions, many newborns succumb to mortality at home, often under the care of mothers, family members, and traditional birth attendants. In Unani Medicine, this stage is associated with the temperament known as Mizāj Ḥārr Raṭb (hot and moist), highlighting a period of rapid growth and developmental milestones. Comprehensive neonatal and child care guidelines, referred to as Tadābīr-i-Navmawlūd, encompass various aspects, including newborn care, infant feeding, management of dentition, and therapeutic principles and treatments for children.Renowned Unani scholars such as Ibn Sīnā, Zakariyya Rāzī, Ali Ibn Abbas Majūsī, Ibn Rushd, and Ibn Hubal Baghdādī have extensively discussed these topics in classical Unani texts like Al-Qānūn fi’l Ṭibb, Kitāb al-Manṣūrī, Kāmil al-Ṣanāʻa, Kitāb al-Kulliyat, and Kitāb al-Mukhtārāt fi’l Ṭibb. Their writings outline regimens and medicinal practices aimed at promoting the health and well-being of newborns, infants, and children. Keywords: Unani medicine, Tadābīr-i-Navmawlūd, child health care, infancy, Amrāḍ-i-Aṭfāl.

Determinants of epilepsy among outpatients in public health institutions of Dawo district, South West Shoa Zone, Oromia, Ethiopia, 2023: an institutional-based unmatched case-control study

BackgroundGlobally, in ~50% of epilepsy cases, the underlying cause remains unknown, despite the fact that various disease pathways may contribute to the condition. Nearly 80% of people with epilepsy live in low- and middle-income countries and the risk of premature death in people with epilepsy is up to three times higher than that for the general population. Identifying the determinants of epilepsy is important for applying evidence-based interventions to achieve a better outcome. However, this information is scarce in a country with limited resources like Ethiopia.ObjectiveThis study aimed to assess the determinant of epilepsy among outpatients in Dawo public health institutions, from 29 February to 15 April 2023.MethodAn institution-based unmatched case-control study design was used, involving 61 cases and 122 control study subjects, who were selected using a consecutive sampling technique from public health institutions in Dawo. Data were collected using a pre-tested structured questionnaire. The data were coded, entered into EpiDATA version 3.1, and exported to SPSS version 20, for further analysis. Descriptive analysis was used to determine the percentages and frequency distributions. Logistic regression analysis was used to identify the determinants of epilepsy, and a variable with p &amp;lt; 0.05 was considered statistically significant.ResultsA total of 61 cases and 120 controls were included in the study, with an overall response rate of 98.90%. The majority of participants, 38 (62.3) of the cases and 63 (52.5) of the controls, were farmers by occupation. A family history of epilepsy (AOR = 13.71 95% CI 3.030–22.006), history of febrile seizure (AOR = 14.57 95% CI 2.930–24.522), history of head injury (AOR = 6.853 95% CI 1.780–16.402), and non-use of latrine were found to be determinants of epilepsy (AOR = 0.028 95% CI 0.008–0.040).Conclusion and recommendationsThe current study identified a family history of epilepsy, a history of febrile seizures, head injury, and unavailability of latrines as independent predictors of epilepsy in the study area. The information that adverse febrile seizures increase the risk of epilepsy suggests that a significant proportion of epilepsy cases in Dawo district could be prevented through improved maternal, neonatal, and child care. It is recommended that the Dawo Health Office, along with relevant stakeholders, focus on addressing this issue at various levels.

A Survey on the Organization and Operation of Level II/III Neonatal Intensive Care Units in Greece: A Comparison Between 2004 and 2022

Background/Objectives: Limited data exist on the organization and operation of Level II/III Neonatal Intensive Care Units (NICUs) in Greece; this retrospective cross-sectional survey explored their structure and functioning in 2004 and 2022. Methods: A structured questionnaire was utilized, along with demographic and perinatal data obtained from the Hellenic Statistical Authority. Results: Between 2004 and 2022, live births decreased by 28%, while the prematurity rate rose from 6.96% to 11.87% (p &lt; 0.001). Significant regional differences were observed in the number of NICUs (p = 0.033), live births (p &lt; 0.001), and NICUs per 10,000 live births (p = 0.025). In this survey, data from 20 Level III NICUs in 2004 and 22 NICUs (one Level II) in 2022 were analyzed. NICU admissions increased by 16.1% (p = 0.389), while the rate of admitted neonates/1000 live births increased from 13.5 to 21.8 (p &lt; 0.001). In 2022, premature infants constituted 40.2% of NICU admissions. The number of board-certified neonatologists increased by 21.8% between 2004 and 2022 (p = 0.795), along with a rise in the ratio of neonatologists per 10,000 live births (from 14.8 to 25, respectively, p &lt; 0.001). Conversely, there was a significant 17.2% reduction in the nursing staff by 2022 (p = 0.034). The number of available NICU beds also increased during the study period. The ratio of ventilators to intensive care beds significantly improved (p &lt; 0.001). In 2022, new treatment modalities, like therapeutic hypothermia, were introduced, and most NICUs reported offering long-term follow-up programs. Conclusions: This survey highlights significant advancements in Level II/III NICU infrastructure and care capabilities, while emphasizing demographic changes and a critical shortage of neonatal nursing staff. These factors should be carefully considered by health authorities in the development of future neonatal care strategic planning in the country.

Social Vulnerability and Pregnancy Option Counseling in the Setting of Periviable Delivery

Background/Objectives: According to the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, pregnant people facing periviable delivery should be counseled on expected neonatal outcomes and available pregnancy options. The objective of this study is to evaluate if rates of neonatology consultation and pregnancy option counseling for those facing periviable delivery differ based on social vulnerability factors or Social Vulnerability Index (SVI). Methods: This was a retrospective cohort study of patients who delivered at 22 0/7 weeks to 25 6/7 weeks of gestation at two academic medical centers with level III or IV neonatal intensive care units from 2019 to 2022. We analyzed the association between individual-level social vulnerability factors and census-tract-level SVI (released by the Center for Disease Control) and the rates of neonatology consultation and pregnancy option counseling. Results: In 138 periviable deliveries, 70.3% had a neonatology consultation, 92.0% were offered expectant management, 88.4% were offered neonatal full intervention, 41.3% were offered neonatal comfort care, and 44.9% were offered pregnancy termination. The rate at which neonatology consultations were completed and each pregnancy option was addressed did not differ by individual-level social vulnerability factors including race/ethnicity, government insurance, marital status, English proficiency, and parity, or by SVI. Conclusions: While these findings suggest that individual-level social vulnerability factors and SVI do not influence periviability counseling, we did identify gaps in comprehensive periviability counseling. Focus should be placed on increasing the rate of neonatology consultation and discussing the options of neonatal comfort care and pregnancy termination.

Effectiveness of Paracetamol in Treating Hemodynamically Significant Patent Ductus Arteriosus in Preterm Newborns

Background: Patent ductus arteriosus (PDA) is a common condition in preterm infants, often requiring medical intervention for closure. Traditional treatments such as indomethacin and ibuprofen are associated with adverse effects, prompting the exploration of alternative therapies. Paracetamol (acetaminophen) has emerged as a potential alternative with a favorable safety profile, but its efficacy in preterm infants remains under investigation. Aim: The aim of this study is to evaluate the efficacy of paracetamol in the management of hemodynamically significant PDA in preterm newborns, focusing on ductal closure rates, respiratory improvement, and the need for further interventions. Methods: This prospective observational study was conducted at Jawaharlal Nehru Medical College &amp; Hospital, enrolling 50 preterm infants diagnosed with hemodynamically significant PDA. Paracetamol (15 mg/kg iv every 6 hours) was administered for 120 hours. Clinical outcomes, including PDA closure, respiratory status, and the need for additional treatments, were monitored. Data were analyzed using SPSS version 23.0. Results: Out of 50 infants, 35 (70%) achieved complete PDA closure after 120 hours of paracetamol therapy. Respiratory improvement was observed in 28 (56%) infants, with a reduction in oxygen requirements. The mean duration of paracetamol treatment was 4.8 ± 0.9 days, and the mean NICU stay was 14.3 ± 3.2 days. No severe adverse events were noted, though 3 (6%) infants experienced mild transient liver enzyme elevation. Conclusion: Paracetamol was found to be an effective treatment for PDA in preterm infants, with high closure rates and a favorable safety profile compared to traditional treatments. It may serve as a viable alternative to indomethacin or surgical ligation in managing PDA. Recommendations: Paracetamol should be considered as a first-line pharmacological treatment for PDA in preterm infants, particularly in cases where traditional treatments are contraindicated or carry a high risk of adverse effects. Further studies with larger cohorts are needed to confirm these findings and assess long-term outcomes. Keywords: Paracetamol, Patent Ductus Arteriosus, Preterm Infants, Pharmacological Treatment, Neonatal Care.

Innovative Strategies in the Management of Hypoplastic Left Heart Syndrome: A Multidisciplinary and Translational Approach

Background: Hypoplastic Left Heart Syndrome (HLHS) represents one of the most severe congenital cardiac malformations, characterized by underdevelopment of left-sided heart structures, necessitating a complex surgical and medical management strategy. Despite advancements in staged palliation and neonatal care, outcomes remain suboptimal for a significant subset of patients. Recent progress in molecular biology, regenerative medicine, and surgical innovations offers novel approaches that may transform the clinical trajectory of these patients. Objectives: This article explores emerging strategies for HLHS management, including stem cell therapy, tissue engineering, genomic medicine, hybrid procedures, and long-term monitoring protocols facilitated by artificial intelligence (AI). Methods: A comprehensive review of contemporary literature was conducted, focusing on the translational application of novel therapies and their integration into current staged palliation frameworks. Results: Early-stage studies demonstrate promise for stem cell therapies and myocardial regeneration in improving ventricular function. Advances in 3D printing and bioengineering have facilitated patient-specific surgical planning and the development of biocompatible grafts. Furthermore, AI-driven algorithms provide personalized risk assessment and optimized perioperative management strategies. Conclusions: The integration of multidisciplinary and translational approaches offers an opportunity to redefine HLHS management, potentially improving survival and quality of life for affected individuals. However, further clinical trials and international collaboration are essential to establish these novel therapies as standard of care.

Editorial: What is new on the horizon in neonatology? Recent advances in monitoring, diagnostics, and therapeutics in neonatal care

Editorial: What is new on the horizon in neonatology? Recent advances in monitoring, diagnostics, and therapeutics in neonatal care

COMPARISON OF POISSON REGRESSION AND GENERALIZED POISSON REGRESSION IN MODELING THE NUMBER OF INFANT MORTALITY IN WEST JAVA 2022

In line with the Sustainable Development Goals (SDGs), the Infant Mortality Rate (AKB) is a very important health indicator, especially in neonatal and perinatal care. West Java Province consistently ranks third nationally in terms of infant mortality in 2020 and 2021. This study analyzes the factors influencing infant mortality in West Java in 2022 using secondary data from the 2022 West Java Provincial Health Profile. The response variable is the number of infant deaths, while the predictor variables include the percentage of K-4 coverage (X1), high-risk pregnancy (X2), family with PHBS (X3), exclusive breastfeeding (X4), and complete immunization coverage (X5). Given the count-based nature of the data, Poisson regression was used, which assumes equidispersion where the variance is equal to the mean. However, the analysis found overdispersion, where the variance significantly exceeds the mean, making Poisson regression unsuitable. To address this, Generalized Poisson Regression (GPR) was applied, as GPR introduces a dispersion parameter that accounts for overdispersion, thus better fitting the data. The initial Poisson regression results showed that X1, X2, X4, and X5 significantly influenced infant mortality, while the GPR model showed that only X2 and X3 were significant factors, with a dispersion parameter of -3.116. The GPR model shows that every additional one high-risk pregnancy increases the infant mortality rate by 1.00006, while an increase of one unit of clean and healthy living practices reduces the mortality rate by 2.66%. Model evaluation using AIC, BIC, and RMSE confirmed that the GPR model better described the relationship between predictor variables and infant mortality rates compared to Poisson regression. These findings emphasize the need to use GPR to model cases with overdispersion in count data, so as to provide more reliable information for policy and intervention strategies.

Content Validity for the Checklist of NICU Caregiver Behaviors.

To update and establish content validity for the Checklist of NICU Caregiver Behaviors. Structured literature review and Delphi analysis. Neonates born prematurely or who are sick in the NICU are frequently exposed to harmful stimuli that can affect brain development and result in adverse neurodevelopmental outcomes. In response to this risk, NICU caregiving now encompasses protecting and promoting neurodevelopment to affect long-term outcomes for neonates and their families. Developmentally supportive care (DSC) includes internationally recognized best practices for the care of neonates in the NICU. Implementation and operationalization of DSC is a priority for neonatology. Although evidence-supported guidelines exist for effective DSC strategies in the NICU, no validated tool exists to support implementation at the point of care. Nine expert reviewers from the United States and India including four occupational therapists, one nurse practitioner, one clinical nurse specialist, and three neonatal medicine specialists. The Checklist of NICU Caregiver Behaviors had been updated based on a structured review of the evidence. The updated checklist was then shared with a group of professionals with DSC expertise who provided further recommendations using a modified Delphi survey process. The project yielded the current NICU Caregiver Behavior Checklist. Expert reviewers provided 53 actionable recommendations in Round 1 and 18 actionable recommendations in Round 2 to support clarity and use of the tool. In response, the NICU Caregiver Behavior Checklist was reformatted as a collection of five checklists, each representing a core measure of DSC; the introduction section was expanded; language was broadened; and clarifications were provided to promote observations of target behaviors and allow for more site-specific recommendations and assessments. This evidence-based tool can be used as part of DSC education, as a self-assessment tool, and as a measure of NICU caregivers' use and quality of DSC.

The effect of an interactive mobile health intervention to improve community-based essential neonatal care practices among postpartum women in northeast Ethiopia: a cluster randomized controlled trial.

Despite global declines in child mortality rates, Africa's reduction is lagging behind other regions. Neonatal survival remains a key priority in the sustainable development agenda. Promoting neonatal care practices at the individual and community levels is essential, and technology-based interventions can effectively reach potential future mothers. This study aimed to evaluate the effect of an interactive mobile health intervention on improving community-based essential neonatal care practices among postpartum women in northeast Ethiopia. This study was conducted in Dessie and Kombolcha city zones, in northeast Ethiopia. A cluster randomized controlled trial was implemented among 743 participants (376 intervention and 367 control) from 2 January to 15 June 2023. Pregnant women at 30-weeks' gestation in selected clusters were enrolled and followed up to 45days after childbirth. Data were collected using Open Data Kit and analysed with Stata version 17. Structural equation modelling through confirmatory factor analysis was employed. Model fitness was evaluated using the χ2:degree of freedom ratio, root mean square error of approximation and standardized root mean square residual, indicating a good model fit. Statistical significance was declared at a level <0.05 with a 95% confidence interval. The study revealed high narrow birth-to-pregnancy intervals of <24 months in both groups (48.5% control, 49.5% intervention). Awareness of neonatal care increased markedly in the intervention group, increasing from 62.0% to 85.9%, compared with an increase from 57.8% to 67.6% in the control group. Disagreement regarding immediate newborn bathing was more prevalent in the intervention group (73.9%) than in the control group (58.9%). Initiating breastfeeding within 1h after birth was higher in the intervention group (85.4%) compared with the control group (74.4%). Postnatal visits to health facilities were more frequent in the intervention group (79.6%) than in the control group (54.8%). Mobile health intervention (β=0.393, p=0.007) and knowledge of neonatal care (β=0.347, p=0.012) had a significant positive effect on neonatal care practices. There were no significant indirect pathways between the variables analysed. Mobile health intervention and knowledge of neonatal care remain significant predictors with a total effect of β=0.382, p=0.009 and β=0.347, p=0.012, respectively, in enhancing neonatal care practices. This study underscores the significant role of mobile health interventions and maternal knowledge in enhancing neonatal care practices. These findings should inform the design and implementation of maternal and child health programs, emphasizing the integration of technology and education to improve neonatal outcomes in resource-limited settings. Protocol Registration and Results System Clinical Trial Registry, www.ClinicalTrials.gov, NCT05666050. Registered on 23 December 2022.

Living in a bubble with profound difficulties-parents' experiences of extremely preterm survivors.

To analyse the challenges faced by parents of extremely preterm infants born before 24 weeks of gestation and the potential buffering effect of perceived resources on the family's health continuum. The qualitative data were obtained from 70 parents of 70 infants born before 24 weeks of gestation, through open-ended questions in a survey. An inductive content analysis was conducted to identify themes and patterns in the parents' experiences. To enhance the understanding of the findings, salutogenic theory was incorporated to contextualise the emerging patterns of resources and deficits. Parents described the neonatal care as exemplary. However, the integrated results showed that parents reported profound difficulties characterised as 'living in a bubble' with comprehensive neonatal care and varied access to support and participation. In addition, the parents had to manage a preterm born child with medical complexities and encountered significant barriers between care levels. The findings highlight the need to improve support systems and address challenges for families of preterm born children. Enhancing collaboration between healthcare providers and families, identifying and overcoming barriers during care, and providing comprehensive support services are crucial. Addressing the parents' experienced deficits may mitigate potential adverse effects on family health outcomes.

Assessing neonatal nurses: transitioning preterm infants to oral feeding - a multicenter cross-sectional study

BackgroundIn Egypt, approximately 10% of preterm deliveries occur between 32 and fewer than 37 weeks, leading to high neonatal intensive care unit (NICU) admissions. Preterm infants often face oral feeding difficulties due to immature development, which can lead to extended hospital stays and increased health risks.AimTo assess neonatal nurses’ performance in terms of the transition to oral feeding in preterm infants, focusing on knowledge, practices, and attitudes.MethodsA descriptive, quantitative, multicenter, cross-sectional study was conducted across 16 hospitals in five governorates in Egypt from November 2023 to March 2024 involving 553 neonatal nurses. The data were collected through a self-administered questionnaire assessing knowledge and attitudes and through an observed checklist for nurses’ practices. The study used statistical methods, including binary logistic regression, to analyze the data.ResultsThe findings revealed significant knowledge gaps among nurses, particularly in terms of oro-motor function, suck-swallow-breathe patterns, and nonnutritive sucking. A total of 64.6% of the nurses had unsatisfactory knowledge, 58.6% had unsatisfactory practices, and 45% had a negative attitude toward the oral feeding transition. Key predictors of satisfactory practices included higher education levels, full-time employment, and positive attitudes.ConclusionThis study highlights critical gaps in neonatal nurses’ knowledge and practices regarding the transition to oral feeding in preterm infants. Addressing these gaps through targeted educational interventions and ongoing support is essential for improving care quality and outcomes for infants. The findings revealed that a substantial proportion of nurses lacked adequate knowledge of critical areas, such as oro-motor function, the suck-swallow-breathe pattern, and nonnutritive sucking. These knowledge deficits could hinder the ability of nurses to provide optimal care during this crucial transition.

Neurodevelopment in Preterm Neonates: A Comprehensive Approach to Quality of Life

Introduction: Prematurity constituted a significant challenge for world public health, being one of the main causes of neonatal mortality. The admission of preterm newborns (PNBs) to neonatal intensive care units (NICU) represented a crucial solution for their survival, although it implied separation from their families and exposure to adverse stimuli. In this context, Neurodevelopmental Centered Care (NCC) emerged as an innovative strategy that reorganized neonatal care towards a more humanized and patient-centered model.Development: NCC integrated practices such as the kangaroo method, non-pharmacological pain management and the active participation of families, promoting an environment that favored the neurodevelopment of the premature infant. These strategies demonstrated benefits such as reduced hospital stay and improved long-term neurological outcomes. However, their implementation was heterogeneous, facing barriers such as lack of specialized training, limited resources and resistance to change in health care teams. Models such as NIDCAP and the integrative approach of Altimier and Phillips offered effective frameworks to guide this care.Conclusions: The CCN was shown to be a key tool for improving the quality of life of RNP and their families. However, its mass adoption will require a coordinated effort that includes ongoing training, inclusive public policies, and adequate resources. The integration of families and an adapted NICU environment emerged as fundamental pillars for the success of this strategy

Outcomes Associated With Care Models for Neonates With Complex Medical Needs: A Scoping Review to Support Program Evaluation.

Neonates with complex medical needs (NCMNs) are a small proportion of neonatal intensive care unit admissions but are high healthcare utilizers. Since 2018, NCMNs at our hospital have been cared for by the Neonatal Complex Care Team. This model has yet to be evaluated. To inform the evaluation of our care model, we examined literature on care practices for the management of NCMNs and utilized that to define outcome measures. MEDLINE and Cumulated Index to Nursing and Allied Health Literature were searched. Inclusion dates: January 1, 1993, until July 15, 2023. The PRISMA extension for scoping reviews was used. The population was neonates in the neonatal intensive care unit, the concept was models of care, and the context was medical complexity. Two reviewers performed the title/abstract screening and full-text review. A total of 148 articles were screened, 17 fully reviewed, and 5 articles included. Data extraction was completed by one reviewer utilizing resources from the Joanna Briggs Institute. Care practices ranged from structured discharge meetings with families to an inpatient care model. Few reported new clinical models, and long-term health outcome data were limited. Multidisciplinary care teams emerged as crucial to in-hospital care and smooth discharge. Length of stay and readmission were identified as key outcomes for clinical program evaluation. There is limited literature on this topic; however, we identified themes and outcomes that are useful for clinical program evaluation. Long-term evaluation of novel models of care is needed.

Progression of serum creatinine and glomerular filtration rate in neonatal critical care patients during the first seven days of life.

Serum creatinine and estimated glomerular filtration rate (GFR) are key indicators of kidney function. This descriptive, retrospective study included neonatal patients admitted to a tertiary hospital's neonatal intensive care unit from January 2013 to December 2016. Data on kidney function were collected from birth to 7days of life. Patients were stratified into four gestational age groups: below 28weeks, 28-31weeks, 32-36weeks, and term neonates. Qualitative variables were expressed as percentages. Quantitative variables were assessed using the Kruskal-Wallis/Wilcoxon tests. Chi-square analysis was performed for categorical variables. Statistical analysis was conducted using SPSS (Version 22.0), with significance set at p < 0.05. Among 138 patients, 99 (71.7%) were premature. Term neonates showed a gradual postnatal decline in creatinine, while premature infants exhibited an initial rise followed by a decline, with values inversely proportional to gestational age (at seven days: 0.70 ± 0.19mg/dL in below 28weeks vs. 0.39 ± 0.08mg/dL in term, p < 0.001). Among the clinical-epidemiological variables of the included patients, seven significantly influenced serum creatinine. GFR decreased in premature neonates at 24h, then increased throughout the study. Term neonates demonstrated a progressive GFR increase, with higher values associated with greater gestational age (at seven days:16.8 ± 5.0ml/min/1.73m2 in below 28weeks vs. 41.8 ± 8.0ml/min/1.73m2 in term, p < 0.001). Evaluating kidney function in neonates, based on serum creatinine and GFR, requires special attention during the first days of life, particularly in critically ill neonates due to multiple physiological changes and clinical factors that may influence these parameters.

Relationship Between Clinical Decision-Making and Moral Distress in Neonatal Intensive Care Unit Nurses: A Multicenter Cross-Sectional Correlational Descriptive Study.

In the neonatal intensive care unit (NICU), nurses care for premature and critically ill neonates, interact with parents, and make clinical decisions regarding the treatment of neonates in life-threatening conditions. The challenges of managing unstable conditions and resuscitation decisions can cause moral distress in nurses. This study aims to determine the relationship between clinical decision-making and moral distress in NICU nurses. This cross-sectional, multicenter, descriptive correlational study involved 190 nurses working in 7 NICUs across hospitals in Khorramabad and Semnan in 2023. Data were collected using demographic questionnaires, the Clinical Decision-Making Laurie Scale (2001), and the Moral Distress Scale-Revised (MDS-R). All nurses in these NICUs were female. No significant correlation was found between clinical decision-making and moral distress (r=-0.03, P =.684). The moral distress score was low. In decision-making, 57.9% of nurses exhibited intuitive analysis (understanding without a rationale). Multiple linear regression analysis revealed that age, education level, and job position were significantly related to clinical decision-making; and being married and having children were inversely correlated with moral distress. 20% of nurses exhibited interpretive intuitive clinical decision-making, which involves care complexities, cognitive understanding, and task-based decisions. Nursing managers should focus on refining these decision-making strategies for NICU nurses. Given the importance of clinical decision-making in the NICU, future research should use quantitative and qualitative methods to explore the decision-making processes and moral distress in NICU nurses.

Research on the Demand for Postpartum Health Management and its Influencing Factors in Yulin

This study investigated mothers’ postpartum health management needs in Yulin City to study ways to improve maternal health management services. An electronic questionnaire survey was conducted on the postpartum follow-up of women in the First People’s Hospital of Yulin City, the Red Cross Hospital of Yulin City and the postpartum outpatient clinic of Guinan Hospital of Yulin City. The overall score of postpartum health management needs of the surveyed mothers was (4.34 ± 0.53) points. The average score of the required items was from high to low, which were (4.42 ± 0.56) points in the dimension of neonatal care needs, (4.33 ± 0.68) points in the dimensions of social support needs, and (4.27 ± 0.59) points in the dimensions of maternal physical and mental recovery needs. The main factors influencing the need for postpartum health management were education level, delivery experience, pregnancy complications/complications, and postpartum sleep (P &lt; 0.05).