Diaper Change Research Articles

Men changing nappies: Dismantling a key barrier to gender-diversifying the early years workforce

Currently the number of men working in early years education in England is very low at 2%. This stubbornly resistant workforce pattern matters because it perpetuates the entrenched gender stereotype of young children’s education and care as women’s work. It is extraordinary to find this corner of gender statis in a world that is supposedly in the grip of a gender revolution. This gender revolution does not appear to have impacted on, or even dented, the gendered nature of the early years workforce. This is all the more remarkable because early years staffing shortages have now reached crisis point in England (the country where the authors reside and where they have carried out the research referred to in this paper). The small minority of men that do take up work in this sector often work interchangeably with their female counterparts, adopting a range of roles and responsibilities including reading, rough and tumble, comforting and food preparation. The task of intimate care however, or more specifically ‘nappy changing’, remains an area of tension within men’s presence in early years settings, with parents or carers sometimes requesting that male practitioners do not change their child’s nappy or nursery managers removing men from this role. Although the Sex Discrimination and Equalities Act 2010 stipulates that no employee should be discriminated against because of their sex, a 2-year study into the recruitment and support of men in early years education in England (GenderEYE) shows that discriminatory practices around intimate care are very much alive.

Relationship between human behavior and indoor air quality of private room in a care facility for the elderly in Japan

In Japan, the number of elderly people in need of nursing care is increasing while the population of young people is decreasing, and the potential for labor shortages in the field of elder care is of great concern. This study aimed to estimate the behavior of the elderly by using sensors to monitor indoor air quality (IAQ), without placing undue burden on the elderly or their caregivers. Odor and carbon dioxide (CO2) concentrations were monitored in a private room of a nursing home in the Kanto Region of Japan, the behaviors of the resident and staff members were recorded, and the relationship between the two was analyzed. Both odor and CO2 concentrations were higher when the resident was present than when absent, indicating that the resident was one of the main sources of indoor odor and CO2. In addition, after the resident entered the room, the CO2 concentration increased and remained stable, whereas the odor concentration tended to vary after the resident entered the room, first increasing and later decreasing. This suggested that the increase or decrease in odor could be used to monitor the behavior of the resident and staff members. The relationship between the slopes of odor and CO2 in typical behavioral events suggest that if only odor increases and CO2 does not change, the likelihood of the event in which feces were observed during diaper changes is high. In addition, based on the behavior near the sensor, the rate of CO2 and odor emissions differed between the elderly resident and the younger staff members, suggesting that the ratio of odor slope to CO2 slope may be greater in the elderly than in younger people. Furthermore, the repeated number of increases and decreases in odor and CO2 suggested that multiple events could be distinguished. These results suggest that IAQ can be utilized to estimate the behavior of residents and staff in nursing care facilities for the elderly.

Nurses' Burden of Elimination Care: Sequential Explanatory Mixed-Methods Design.

Inpatients commonly experience problems with elimination due to incontinence, urinary retentions, and complications with indwelling catheters. Although elimination care (EC) is an important nursing area, few studies explore the burden of EC on nurses. To identify the burden on EC by analyzing nurses' opinions using sequential explanatory mixed method. This research was conducted using a sequential explanatory mixed-methods design. A total of 59 nurses at a tertiary hospital in South Korea participated in the study from January 1 to March 31, 2022. For quantitative analysis, information about number of delays of work due to EC, required time for serving bedpan or diaper changes, percentage of EC per shift, and percentage of patients who need EC was collected through a survey. For qualitative analysis, focus group interviews were conducted to identify factors that put a burden on EC. Important themes were derived by analyzing nurses' opinions on EC. For nurses in intensive care units, general wards, and integrated nursing care wards, the number of work delays due to EC was 3.6 ± 1.5, 2.3 ± 1.2, and 4.8 ± 2.4 (p<0.01), respectively. The mean percentage of EC work out of total nursing tasks per shift was 36.2 ± 19.0, 29.3 ± 14.4, and 43.8 ± 14.1 (p=0.02), respectively. The mean percentage of patients requiring EC out of patients a nurse cares was 85.4 ± 16.6, 41.3 ± 26.1, and 58.8 ± 21.9 (p<0.01), respectively. Following qualitative analysis, four themes related to nurses' EC burden were derived: physical burden, frequent care needs, delay of other jobs due to EC, and complications. Among them, frequent care needs were found to be the primary factor requiring consideration to reduce nurses' burden. This research found that EC is one of the most burdensome tasks that nurses want to avoid. To alleviate their burden, effective EC protocol or smart medical devices assisting with EC should be developed.

Impact of longer working hours on fathers' parenting behavior when their infants are 6 months old: The Japan Environment and Children's Study.

Long working hours have been suggested to affect fathers' parenting behavior, but previously reported findings have been inconsistent. This study examined the association between the working hours and parenting behavior of fathers while accounting for other factors related to their parenting behavior, using data from the Japan Environment and Children Study (JECS), a large cohort study in Japan. Data from 43,159 father-mother pairs were analyzed. The mother assessed the father's frequency of seven parenting behaviors at 6 months after delivery. Then, each behavior was classified into a high-engagement group (always and sometimes) or a low-engagement group (rarely and never). The father's weekly working hours was obtained from his responses and was classified into six levels. Logistic regression analysis showed that after adjustment for covariates, fathers' weekly working hours was inversely associated with the frequency of all parenting behaviors examined in this study (p for trend <0.0001). Compared with fathers working ≥0 to ≤40 h per week, those working >65 h per week showed the following adjusted odds ratios (95% confidence intervals) for low engagement in parenting behaviors: playing at home, 2.38 (2.08-2.72); changing diapers, 2.04 (1.89-2.20); and bathing the child, 2.01 (1.84-2.18). This study suggests that the greater time constraints imposed by longer working hours constitute a major factor that discourages fathers from engaging in childrearing behavior. Intervention targeting long working hours could contribute to measures aimed at promoting high-engagement parenting behaviors among fathers.

Joining actions through effort sounds: Mothers and infants in routine activities

This paper analyses the effort sounds made by caregivers in routine interactions with very young infants. Video recordings were made of 15 mother-infant dyads in Germany during nappy changing. The multimodal analysis of the interactions revealed that effort sounds were used when handling the infant’s body, such as dressing them or lifting them up, but also made to link to the sensations of the infant. The sounds achieved their meaning within sequences of actions and contextualised via temporality, phonetic variation and multimodality. With these vocalisations, I propose, parents can give infants’ sensations a voice, make them public, and thus achieve a co-ordination of experience.

Routine Diaper Change Alters Kidney Oxygenation in Premature Infants: A Non-A Priori Analysis.

Reduction in oxygen delivery to developing kidneys of premature infants may be an important source for acute kidney injury in premature infants. To describe changes in continuous kidney oxygenation (RrSO 2 ) measures before, during, and after routine diaper changes. Non-a priori analysis of a prospective cohort that received continuous measurement of RrSO 2 with near-infrared spectroscopy (NIRS) over the first 14 days of life demonstrating acute RrSO 2 drops surrounding diaper changes. In total, 26 of 38 (68%) infants (≤1800 g) from our cohort exhibited acute drops in RrSO 2 that temporally correlated with diaper changes. Mean (SD) RrSO 2 baseline prior to each diaper change event was 71.1 (13.2), dropped to 59.3 (11.6) during diaper change, and recovered to 73.3 (13.2). There was a significant difference between means when comparing baseline to diaper change ( P < .001; 95% CI, 9.9 to 13.8) and diaper change to recovery ( P < .001; 95% CI, -16.9 to -11.2). The mean decrease in RrSO 2 during diaper change averaged 12 points (17%) below 15-minute RrSO 2 mean prior to diaper change, with quick recovery to prediaper change levels. No decreases in SpO 2 , blood pressure, or heart rate were documented during the intermittent kidney hypoxic events. Routine diaper changes in preterm infants may increase the risk for acute reductions in RrSO 2 as measured by NIRS; however, the impact on kidney health remains unknown. Larger prospective cohort studies assessing kidney function and outcomes related to this phenomenon are needed.

“Oh, you’ve never done that before?!” Preservice teachers being ‘stirred in’ to unfamiliar practices with infants and toddlers

ABSTRACT Undertaking infant-toddler practicum during initial teacher education is critical to ensuring preservice teachers (PSTs) are well prepared for their future role as early childhood teachers. PSTs, however, can face challenges in infant-toddler practicum given the demands of this unique teaching and learning context. A knowledgeable, experienced educator as a guide is key to supporting PSTs’ learning during placement. This paper illuminates the practices of an infant-toddler educator who supported an international PST’s learning during her first nappy change on an infant-toddler practicum in an early childhood service in Australia. The paper addresses the scarce literature on PSTs’ experiences in infant-toddler settings, which can guide their relationships with colleagues. Drawing on the theory of practice architectures, we analyse a video vignette of the PST and educator during a nappy changing practice. We highlight the practices of both the educator and PST which helped the PST learn by being ‘stirred in’ to this common but unfamiliar practice for her and many other PSTs who may never have held a baby before. Implications call for cooperative and experienced educators who can support PSTs with pedagogical and practical elements of the practicum.

Mothers’ involvement in providing care for their hospitalised sick newborns in Kenya: a focused ethnographic account

IntroductionThere is growing evidence that parental participation in the care of small and sick newborns benefits both babies and parents. While studies have investigated the roles that mothers play in newborn units in high income contexts (HIC), there is little exploration of how contextual factors interplay to influence the ways in which mothers participate in the care of their small and sick newborn babies in very resource constrained settings such as those found in many countries in sub-Saharan Africa.MethodsEthnographic methods (observations, informal conversations and formal interviews) were used to collect data during 627 h of fieldwork between March 2017 and August 2018 in the neonatal units of one government and one faith-based hospital in Kenya. Data were analysed using a modified grounded theory approach.ResultsThere were marked differences between the hospitals in the participation by mothers in the care of their sick newborn babies. The timing and types of caring task that the mothers undertook were shaped by the structural, economic and social context of the hospitals. In the resource constrained government funded hospital, the immediate informal and unplanned delegation of care to mothers was routine. In the faith-based hospital mothers were initially separated from their babies and introduced to bathing and diaper change tasks slowly under the close supervision of nurses. In both hospitals appropriate breast-feeding support was lacking, and the needs of the mothers were largely ignored.ConclusionIn highly resource constrained hospitals with low nurse to baby ratios, mothers are required to provide primary and some specialised care to their sick newborns with little information or support on how undertake the necessary tasks. In better resourced hospital settings, most caring tasks are initially performed by nurses leaving mothers feeling powerless and worried about their capacity to care for their babies after discharge. Interventions need to focus on how to better equip hospitals and nurses to support mothers in caring for their sick newborns, promoting family centred care.

Prevalence of diaper need and diaper dermatitis and associated risk factors among children aged 1–24 months in a referral hospital in Ghana: A cross-sectional study

Abstract Objectives This research aimed to determine the prevalence of diaper need and diaper dermatitis (DD) and associated risk factors in children aged 1–24 months. Methods Data were collected through face-to-face exit interviews with 456 mothers at a Child Welfare Clinic. A chi-square, correlation, and multivariate logistic regression analyses at a significance level of p &lt; 0.05 were conducted. Results The prevalence of diaper need was found to be 53.5%, with lower odds observed in households with monthly incomes greater than $167 and in children on breastmilk only. Diaper need was higher in parents with no formal education and use of disposable diapers. The prevalence of DD was 27.4%, with lower odds observed in households with monthly incomes greater than $167 and in children less than 6 months old and on breastmilk only. There was a moderately positive correlation between diaper need and DD. Conclusion The researchers recommend affordable alternative diapering methods and educating parents on the importance of frequent diaper changes to improve the prevalence of diaper need and DD. Overall, this study highlights the significant prevalence of diaper need and DD among children and identifies the important associated risk factors.

Does the Implementation of Multidisciplinary Developmental Care Rounds Increase the Utilization of Developmental Caregiving Interventions in the Neonatal Unit?

The aims of this project were to improve the utilization of developmental care practices in the neonatal unit and to increase opportunities for parental involvement in the planning and provision of caregiving. This implementation project was conducted in a 79-bed neonatal tertiary referral unit in Australia. A pre/postimplementation survey design was utilized. A preimplementation survey was conducted to collect data on staff's perceived perception of developmental care practices. Following analysis of the data, a process for multidisciplinary developmental care rounds was developed and then implemented across the neonatal unit. A postimplementation survey was then conducted to evaluate whether staff perceived any changes in developmental care practices. The project was conducted over 8 months. A total of 97 surveys (pre: n = 46/post: n = 51) were received. Differences were demonstrated in staff's perceived perception of developmental care practices between the pre- and postimplementation periods in 6 themes of developmental care practice. Identified areas of improvement included the use of the 5-step dialogue, encouragement of parents to contribute to care planning, availability of a well-defined care plan for parents to visualize and document caregiving activities, increased use of swaddled bathing, side-lying position for nappy changes, consideration of infants sleep state before caregiving, and increased use of skin-to-skin therapy for management of procedural pain. Despite the majority of staff members who participated in both surveys acknowledging the importance of family-centered developmental care practice on neonatal outcomes, their use in clinical care is not always considered or practiced. Although it is reassuring to see improvements in several areas of developmental care postimplementation of the developmental care rounds, continued awareness and reinforcement of developmental neuroprotective caregiving strategies through initiatives such as a multidisciplinary care rounds are warranted.

An ensemble multi-stream classifier for infant needs detection

In this paper, we propose a novel multi-stream video classifier for infant needs detection. The proposed system is an ensemble-based system that combines several machine learning to improve the overall result of the state-of-the-art algorithms. It is a multi-stream in the sense that it combines the output predictions of both audio and images of infants from every single classifier employed in the system for a unified result. This produces better performance and results compared to the previous other research techniques, which relied on only one of these modalities. For training and testing the proposed system, from the Dunstan Baby Language video collection, we built three separate datasets for videos, images, and sounds encompassing the five primary infant needs that require predicting. These are: hunger, have wind, uncomfortable (require diaper change), wants to burp or tired, with a total of 3348 samples. We used four different ensemble algorithms for the best reachable performance. The proposed algorithm improves the overall accuracies of each single classifier from a low of 51% to a high of 99%. The proposed method also improves the accuracy of the classification process by about 9% compared to the state-of-the-art approaches, which was 90%.

Effects of routine procedures on salivary cortisol in mechanically ventilated neonates

Even though the stress secondary to invasive procedures has been investigated, less attention has been paid to the stimulation or pain caused by routine procedures on neonates. The changes in salivary cortisol concentration in mechanically ventilated NICU patients during routine procedures were monitored to provide reference and guidance for pain management. 80 mechanically ventilated neonates in the hospital from Sep 2021 to Mar 2022 were selected. The salivary cortisol levels of the neonates were monitored during nursing procedures and were categorized by their risk levels to the following groups: high-risk (endotracheal suctioning and arterial blood sampling), moderate-risk (gastric tube insertion, venipuncture), and low-risk (bedside bathing and diaper changes). The changes in heart rate were also recorded and compared. The concentration of cortisol in the saliva of the neonates was 1.5 ± 0.8 nmol/L during the sleeping state, 6.2 ± 1.3 nmol/L during endotracheal suctioning, 6.4 ± 1.4 nmol/L during arterial blood sampling, 6.1 ± 1.2 nmol/L during venipuncture, 4.4 ± 1.1 nmol/L during gastric tube insertion, 3.5 ± 0.8 nmol/L during bedside bathing, and 3.3 ± 0.9 nmol/L during a diaper change. The results revealed a statistically significant effect between routine procedures on salivary cortisol levels. Compared with the neonates in the control sleep state, there was a significant (P < 0.05) change in salivary cortisol concentration of infants undergoing high and moderate-risk nursing procedures. There was a small but significant (P < 0.05) change in salivary cortisol levels in infants who underwent low-risk procedures compared to infants in the control sleep state. Further, the fluctuation of salivary cortisol levels in routine procedures was more frequent compared with routine handling at night. The fluctuations of salivary cortisol concentration in high-risk procedures were larger than that of infants who underwent low-risk procedures, with the difference being statistically significant (P < 0.05). It was also determined that the top four influencing factors on the infants’ heart rate were arterial blood sampling venipuncture, intubation, endotracheal suctioning, and gastric tube insertion (P < 0.05). Monitoring the saliva cortisol concentration index and heart rates can reflect the impact of different routine procedures on newborns and can be used to manage neonatal pain in the future.

Effects of Early Toilet Training and Elimination Communication With Respect to Diaper Types.

To investigate effects of diaper-free times, elimination communication (EC) and early toilet training, a web-based survey was conducted for caregivers. The more diaper-free times an infant experienced during day, the earlier it was toilet trained (P < .001), which was enhanced by the usage of cloth diapers. The amount of diaper-free times significantly reduced the caregiver's continuous sleep, the occurrence of rashes and balm usage (P < .001) and lead to a more regular defecation frequency. Cloth diaper usage had no effect on rashes or balm usage, but on diaper change rate (P < .001). We could show that, although not as effective as full-time EC, part-time EC is more effective if cloth diapers are used, provided they are changed frequently. Furthermore, EC causes a more regular defecation in infants between 1 and 2 years.

SG-APSIC1159: Control of hospital-acquired carbapenemase-producing carbapenem-resistant Enterobacteriaceae colonization: A descriptive study

Objectives: Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are nosocomial pathogens, and control of CP-CRE transmission is one of the most important infection control issues healthcare organizations face today. Increasing colonization acquisition and clinical infections of CP-CRE occurred in our institution in 2019. In this observational study, we monitored CP-CRE acquisition following implementation of multimodal control measures, and we describe the impact of this intervention on clinical infections. Methods: Increased hospital-acquired CP-CRE colonization and clinical infections were observed in early 2019. Increased CP-CRE surveillance was implemented to include CP-CRE contacts, patients with lengths of stay &gt;7 days, patients with a recent history of hospitalization in other hospitals, and renal dialysis patients. The following interventions were also implemented: (1) isolation or placing CP-CRE patients in cohorts in a designated multidrug-resistant organism (MDRO) ward; (2) emphasis on hand hygiene and contact precautions; (3) mandatory use of gown and gloves for predefined ‘high-risk’ nursing activities, including diaper changing, toilet assistance, wound dressing, and handling urine or stool; (4) enhanced environmental and equipment cleaning; (5) regular audit and feedback regarding compliance; and (6) weekly feedback on ward-level CP-CRE acquisition. CP-CRE colonization cases and clinical infections were tracked by infection prevention and control nurses. Results: The hospital-acquired CP-CRE colonization rate was 4.39 per 10,000 patient days in 2019; it decreased slightly to 3.61 in 2020 and remained steady at 3.77 in 2021. The predominant CP-CRE genes were NDM, OXA-48–like, and KPC. There were 12 hospital-acquired CP-CRE infections in 2019, a rate of 0.37 per 10,000 patient days. This incidence decreased to 6 infections in 2020 and 3 infections in 2021, with corresponding infection rates of 0.19 and 0.09 per 10,000 patient days, respectively. Conclusions: Control of CP-CRE remains extremely challenging in hospitals with multibed open wards. A bundle approach to infection control showed a gradual reduction in CP-CRE cases, with a significant impact on the prevention of clinical infections.

The development of a nomogram model for the individualized prediction of diaper dermatitis risk in pediatric hospitalized children aged 1–36 months

Aims and objectiveTo develop a nomogram model for individualized prediction of diaper dermatitis in pediatric hospitalized infants and toddlers aged 1–36 months. BackgroundDiaper dermatitis is a common skin health problem in pediatrics, which brings pain and discomfort to the child. However, there is a scarcity of risk prediction tools for diaper dermatitis in infants and toddlers hospitalized in pediatrics. DesignA cross-sectional study. Methods210 cases each for caregivers and hospitalized children aged 1–36 months were selected as the research objects. A prediction nomogram model was established based on the risk factors according to the results of univariate analysis and multivariate logistic regression analysis. The predictive performance of the nomogram model was evaluated by discrimination and calibration. The clinical utility of the model was evaluated by decision curve analysis. This study was reported using the TRIPOD checklist. Results41 hospitalized children with diaper dermatitis with a prevalence of 19.52%. The risk factors included: age in months, diarrhea, history of diaper dermatitis, without prophylactic application of buttock protection products, frequency of diaper change per day ≤6.6 times, and the level of caregivers’ knowledge of infantile diaper dermatitis. The results showed that the C-index of the nomogram model was 0.891(95% CI: 0.832, 0.950), the calibration curve manifested a satisfactory consistency, and the net benefit was satisfactory. ConclusionsThe nomogram has a good predictive ability and satisfactory clinical utility, which is useful for pediatric medical staff screening high-risk patients with diaper dermatitis. Relevance to clinical practiceThe prediction nomogram model can help pediatric medical staff to calculate the risk probability of diaper dermatitis in pediatrics, formulate interventions timely, and optimize pediatric DD standardized care protocols. No patient or public contributionthe children's caregivers enrolled in this study only for the data collection.

Pencil-on-Paper Humidity Sensor Treated with NaCl Solution for Health Monitoring and Skin Characterization.

Although flexible humidity sensors are essential for human health monitoring, it is still challenging to achieve high sensitivity and easy disposal with simple, low-cost fabrication processes. This study presents the design and fabrication of highly reliable hand-drawn interdigital electrodes from pencil-on-paper treated with NaCl solution for highly sensitive hydration sensors working over a wide range of relative humidity (RH) levels from 5.6% to 90%. The applications of the resulting flexible humidity sensor go beyond the monitoring of respiratory rate and proximity to characterizations of human skin types and evaluations of skin barrier functions through insensible sweat measurements. The sensor array can also be integrated with a diaper to result in smart diapers to alert for an early diaper change. The design and fabrication strategies presented in this work could also be leveraged for the development of wearable, self-powered, and recyclable sensors and actuators in the future.

Parents' Knowledge of Genetic Care and UTI Events in Toddlers in the Children's Ward

Background: Infections of the urinary tract caused by bacterial invasion are known as urinary tract infections (UTI). The ability of parents to Genetalia’s care can be seen in how to clean Genetalia, cleaning during urinating or defecating, habits of disposable diaper changing, and habits of anal cleansing. This study aimed to investigate the correlation between the parents' ability to care for their children with the incidence of UTI in toddlers in the children's ward of Amelia Hospital Pare Kediri. Methods: The design used in this study was cross-sectional. There were 81 respondents in the research of toddlers who fulfilled inclusion criteria. This was done using purposive sampling. The independent variables were the parents' ability to take care of their children and the dependent variables were the incidence of UTI in their children. Data was collected using respondent observations. Results: The result showed that almost all respondents have a lack of parents' ability to care for their children (65.4%) and almost all toddlers have an incidence of urinary tract infection (63.3%). After analyzing the data with the cramers v contingency coefficient test and obtaining = 0.000, H1 was accepted and Ho was rejected, indicating that there was a relationship between family support and quality of life. r = 0 to 79. Conclusion: In order to prevent the increasing incidence of UTI, it is recommended that hospitals increase the preventive efforts of ISK events in infants by providing counseling to parents using media such as leaflets, brochures, or video screenings.

A new approach for measuring the air gap between diaper and baby skin

The air gap between baby skin and top sheet of disposable diapers is the main place where baby’s metabolic heat, perspiration, and moisture produced by evaporation of urine stay and transfer. Heat and moisture transfer underneath a diaper are greatly affected by the shape and size of the air gap, therefore, it is of significant importance to explore the air gap between diaper and baby skin for comfort and skin health of babies. Currently, it is still a big problem to accurately measure and characterize the air gap of diaper for scholars. In this article, a new approach to measure the air gap, combining three-dimensional scanning, liquid silicone rubber filling, and image processing methods, was proposed to obtain the shape and size of the air gap between diaper and baby skin by region, for quantitative research on heat and moisture transfer mechanism of diapers. In addition, several indicators, including air volume, air gap thickness, and contact area, as well as clothing area factor of the diaper, were chosen to quantify the air gap size and distributions. After verification of accuracy and repeatability, this new approach can effectively measure the size of the air gap underneath the diaper, and provide a feasible way for exploration on quantitative relationship between thermal and moisture comfort of diapers and their structural design, fit, and diapering habits. Furthermore, diaper designers and baby caregivers can obtain guidelines of diaper structural design, wearing and change to improve the microclimate in the diaper for baby comfort and skin health.

Newborn Cry Acoustics in the Assessment of Neonatal Opioid Withdrawal Syndrome Using Machine Learning

The assessment of opioid withdrawal in the neonate, or neonatal opioid withdrawal syndrome (NOWS), is problematic because current assessment methods are based on subjective observer ratings. Crying is a distinctive component of NOWS assessment tools and can be measured objectively using acoustic analysis. To evaluate the feasibility of using newborn cry acoustics (acoustics referring to the physical properties of sound) as an objective biobehavioral marker of NOWS. This prospective controlled cohort study assessed whether acoustic analysis of neonate cries could predict which infants would receive pharmacological treatment for NOWS. A total of 177 full-term neonates exposed and not exposed to opioids were recruited from Women & Infants Hospital of Rhode Island between August 8, 2016, and March 18, 2020. Cry recordings were processed for 118 neonates, and 65 neonates were included in the final analyses. Neonates exposed to opioids were monitored for signs of NOWS using the Finnegan Neonatal Abstinence Scoring Tool administered every 3 hours as part of a 5-day observation period during which audio was recorded continuously to capture crying. Crying of healthy neonates was recorded before hospital discharge during routine handling (eg, diaper changes). The primary exposure was prenatal opioid exposure as determined by maternal receipt of medication-assisted treatment with methadone or buprenorphine. Neonates were stratified by prenatal opioid exposure and receipt of pharmacological treatment for NOWS before discharge from the hospital. In total, 775 hours of audio were collected and trimmed into 2.5 hours of usable cries, then acoustically analyzed (using 2 separate acoustic analyzers). Cross-validated supervised machine learning methods (combining the Boruta algorithm and a random forest classifier) were used to identify relevant acoustic parameters and predict pharmacological treatment for NOWS. Final analyses included 65 neonates (mean [SD] gestational age at birth, 36.6 [1.1] weeks; 36 [55.4%] female; 50 [76.9%] White) with usable cry recordings. Of those, 19 neonates received pharmacological treatment for NOWS, 7 neonates were exposed to opioids but did not receive pharmacological treatment for NOWS, and 39 healthy neonates were not exposed to opioids. The mean of the predictions of random forest classifiers predicted receipt of pharmacological treatment for NOWS with high diagnostic accuracy (area under the curve, 0.90 [95% CI, 0.83-0.98]; accuracy, 0.85 [95% CI, 0.74-0.92]; sensitivity, 0.89 [95% CI, 0.67-0.99]; specificity, 0.83 [95% CI, 0.69-0.92]). In this study, newborn acoustic cry analysis had potential as an objective measure of opioid withdrawal. These findings suggest that acoustic cry analysis using machine learning could improve the assessment, diagnosis, and management of NOWS and facilitate standardized care for these infants.

Exploring Environmental Factors Contributing to Fluid Loss in Diapers Placed in Neonatal Incubators.

Assessing fluid output for infants in the neonatal intensive care unit is essential to understanding fluid and electrolyte balance. Wet diaper weights are used as standard practice to quantify fluid output; yet, diaper changes are intrusive and physiologically distressing. Less frequent diaper changes may have physiologic benefits but could alter diaper weights following extended intervals. This pilot study examined the impact of initial diaper fluid volume, incubator air temperature and humidity, and diaper brand on wet diaper weight over time. Baseline fluid volume was instilled, and then diapers were placed in a neonatal incubator. Wet diaper weight was assessed longitudinally to determine changes in fluid volume over time. A factorial design with repeated measures (baseline, 3 hours, and 6 hours) was used to explore the effects of diaper brand (brand 1 vs brand 2), baseline fluid volume (3 mL vs 5 mL), and incubator temperature (28°C vs 36°C) and humidity (40% vs 80%) on the trajectory of weight in 80 diapers. Wet diaper weight was significantly reduced over 6 hours ( P < .005). However, wet diaper weight increased in 80% humidity, but decreased in the 40% humidity over time ( P < .0001). Baseline fluid volume, incubator temperature, and diaper brand did not influence wet diaper weight over time (all P > .05). Understanding environmental factors that influence the trajectory of wet diaper weight may support clinicians in optimizing the interval for neonatal diaper changes to balance the impact of intrusive care with need to understand fluid volume loss.