Early Neonatal Intensive Care Unit Research Articles

Uni‐ and multimodal sensory‐supported interventions for very preterm and extremely preterm infants in the neonatal intensive care unit: An overview of systematic reviews and interventional studies

AbstractBackgroundVery and extremely preterm infants (VEPIs) experience sensory deprivation in the neonatal intensive care unit (NICU). While various sensory‐supported interventions might improve immediate physiological response, their impact on long‐term development remains unclear. Additionally, these interventions may pose challenges in the NICU environment due to complex treatments and monitoring requirements.AimsThis review aimed to understand the current evidence on sensory‐supported interventions in the NICU, identify the components of these interventions and determine their effects on the VEPIs.Study DesignA systematic search across nine electronic databases (PubMed, EBSCO, EMBASE, Web of Science, Scopus, Cochrane, Cochrane trial, IEEE Xplore DL and ACM DL) was conducted in December 2020 and updated in September 2022. The search gathers information on sensory‐supported interventions for VEPIs in the NICU.ResultsThe search yielded 23 systematic reviews and 22 interventional studies, categorized into auditory (19), tactile/kinesthetic (5), positional/movement support (7), visual (1) and multisensory (13) interventions. While unimodal and multimodal interventions showed short‐term benefits, their long‐term effects on VEPIs are indeterminate. Translating these findings into clinical practice remains a challenge due to identified gaps.ConclusionOur reviews indicate that sensory‐supported interventions have a transient impact, with intervention studies reporting positive effects. Future research should develop and test comprehensive, continuous multisensory interventions tailored for the early NICU stage.Relevance to Clinical PracticeMultimodal sensory interventions show promise for VEPIs, but long‐term effects need further study. Standardizing protocols for NICU integration and parental involvement is crucial. Ongoing research and collaboration are essential for optimizing interventions and personalized care.

Effect of maternal pre-pregnancy body mass index and gestational weight gain on birth weight and gestational age: An observational cross-sectional study

Background: Studies show that pre-pregnancy body mass index (ppBMI) and gestational weight gain (GWG) are associated with birth weight (BW), gestational age (GA), and neonatal morbidities. Higher BW leads to metabolic syndrome. Preterm and low BW (LBW) have short and long-term morbidities. Monitoring ppBMI and GWG is necessary as these are modifiable risk factors for obesity. In this study, we revisited these findings in an Indian scenario. Aims and Objectives: The primary objective is to study the association of BW and GA with ppBMI and GWG. The secondary objective is to study the association of ppBMI and GWG with cesarean section (CS), infant size, and early neonatal intensive care unit (NICU) requirement. Materials and Methods: This observational cross-sectional study was conducted over 1 year with 230 mothers, after Institutional Ethics Committee approval and informed consent. Data were collected using predesigned pro forma and analyzed by SPSS. Digital weighing scales, stadiometer, and fenton growth charts were used. Results: We found a positive linear correlation of ppBMI and GWG with BW. Obesity and excess GWG were associated with higher BW, large for GA, CS, and NICU stay. Overweight had more CS. Underweight and less GWG had a greater risk of LBW, preterm, and NICU stay. Less GWG had more small for GA. Conclusion: GWG and ppBMI are determinants of BW, GA, and neonatal morbidities. Further studies should focus on exercise and nutrition in pregnant and reproductive age women so that healthy babies with low-risk of obesity, metabolic syndrome, and neurodevelopmental disabilities are born.

Neurodevelopmental Outcomes following Preterm Birth and the Association with Postmenstrual Age at Discharge.

This study aimed to (1) define the prevalence of motor, cognitive, and language delays in preterm infants born <32 weeks estimated gestational age (EGA); and (2) identify the relationship between the timing of discharge from the neonatal intensive care unit (NICU) and neurodevelopmental outcome in early childhood. This retrospective study of 172 preterm infants born <32 weeks EGA and hospitalized in a level-IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1 to 2 years corrected age was conducted in the newborn follow-up clinic. At 1 to 2 years corrected age, the sample had an average Bayley Scales of Infant and Toddler Development (Bayley-III) cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for >28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. Higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, β = -1.1 (-1.6, -0.7)], poorer language outcome [p = 0.049, β = -0.5 (-0.9, -0.003)], and poorer motor outcome [p <0.001, β = -1.0 (-1.5, -0.5)]. For every additional week of hospitalization, scores were an average of 1.1 points lower in cognitive, 1.0 point lower in motor, and 0.5 points lower in language domains of the Bayley-III assessment. Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment in impacting developmental outcomes of infants hospitalized in the NICU. · There are high rates of developmental impairment among preterm infants born <32 weeks at 1 year to 2 years.. · The longer the infant is exposed to the NICU environment, the higher the risk of neurodevelopmental challenges.. · These findings provide increased motivation for optimizing the early NICU environment..

Rural community birth: Maternal and neonatal outcomes for planned community births among rural women in the United States, 2004-2009.

Approximately 22% of women in the United States live in rural areas with limited access to obstetric care. Despite declines in hospital-based obstetric services in many rural communities, midwifery care at home and in free standing birth centers is available in many rural communities. This study examines maternal and neonatal outcomes among planned home and birth center births attended by midwives, comparing outcomes for rural and nonrural women. Using the Midwives Alliance of North America Statistics Project 2.0 dataset of 18723 low-risk, planned home, and birth center births, rural women (n=3737) were compared to nonrural women. Maternal outcomes included mode of delivery (cesarean and instrumental delivery), blood transfusions, severe events, perineal lacerations, or transfer to hospital and a composite (any of the above). The primary neonatal outcome was a composite of early neonatal intensive care unit or hospital admissions (longer than 1day), and intrapartum or neonatal deaths. Analysis involved multivariable logistic regression, controlling for sociodemographics, antepartum, and intrapartum risk factors. Rural women had different risk profiles relative to nonrural women and reduced risk of adverse maternal and neonatal outcomes in bivariable analyses. However, after adjusting for risk factors and confounders, there were no significant differences for a composite of maternal (adjusted odds ratio [aOR] 1.05 [95% confidence interval {CI} 0.93-1.19]) or neonatal (aOR 1.13 [95% CI 0.87-1.46]) outcomes between rural and nonrural pregnancies. Among this sample of low-risk women who planned midwife-led community births, no increased risk was detected by rural vs nonrural status.

Early Neonatal Intensive Care Unit Therapy Improves Predictive Power for the Outcomes of Ventilated Extremely Low Birth Weight Infants

To assess the predictive value of early therapy for ventilated extremely low birth weight (ELBW) infants beyond information available at delivery. Prospective, single-center cohort analysis of 177 ventilated ELBW infants. We collected information known at delivery (gestational age, birth weight, singleton, sex, antenatal steroids) and additional information while infants were mechanically ventilated (head ultrasound scanning, clinician intuitions of death before discharge). An adverse outcome was defined as mortality or Bayley Mental Developmental Index or Psychomotor Developmental Index <70 at 2 years. We compared the predictive ability of clinical variables separately, in combination, and in addition to information available at delivery. A total of 77% of infants survived to follow-up; 56% of survivors had Bayley Mental Developmental Index and Psychomotor Developmental Index ≥ 70. A total of 95% of infants with both abnormal head ultrasound scanning results and predicted death before discharge had an adverse outcome, independent of gestational age. Conversely, 40% of infants with normal head ultrasound scanning results and no predicted death before discharge had an adverse outcome, independent of gestational age. After adjusting for variables known at birth, predicted death before discharge and abnormal head ultrasound scanning results added significantly to the ability to predict outcomes. Information gained early in the neonatal intensive care unit improves prediction of mortality or neurodevelopmental impairment in ventilated ELBW infants beyond information available in the delivery room.

Impact of Target Blood Gases on Outcome in Congenital Diaphragmatic Hernia (CDH)

Neonatal intensive care unit (NICU) stabilization strategies which normalize physiology according to predetermined blood gas targets may contribute to observed improved survival rates of patients with CDH. The purpose of our study was to compare risk-adjusted outcomes of CDH patients managed with or without blood gas targets established at NICU admission. Cases were collected from a national CDH network between May 2005 and November 2007. On NICU admission, the responsible neonatologist was asked to establish target ranges for pH, pCO (2), pO (2), and pre/post-ductal O (2) saturation. The outcomes analyzed were mortality, need for ECMO, days of mechanical ventilation/supplemental oxygen, and length of stay. Of 147 CDH infants, 63 had admission blood gas targets. Severity of illness and gestational age in both groups were comparable (SNAP-II score). Infants with blood gas targets had a significantly lower mortality than those without (Hazard ratio 0.27, p=0.006). Blood gas targets for the management of infants with CDH are associated with improved survival. Although the willingness to create and use stabilization targets to guide early NICU care may be a surrogate for other factors (experience, staffing, lack of interest), it is clearly associated with improved survival in CDH.

The Initial Maternal Cost of Providing 100 mL of Human Milk for Very Low Birth Weight Infants in the Neonatal Intensive Care Unit

Human milk (HM) feeding is associated with lower incidence and severity of costly prematurity-specific morbidities compared to formula feeding in very low birth weight (VLBW; <1,500 g) infants. However, the costs of providing HM are not routinely reimbursed by payers and can be a significant barrier for mothers. This study determined the initial maternal cost of providing 100 mL of HM for VLBW infants during the early neonatal intensive care unit (NICU) stay. This secondary analysis examined data from 111 mothers who provided HM for their VLBW infants during the early NICU stay. These data were collected during a multisite, randomized clinical trial where milk output and time spent pumping were recorded for every pumping session (n = 13,273). The cost analysis examined the cost of the breast pump rental, pump kit, and maternal opportunity cost (an estimate of the cost of maternal time). Mean daily milk output and time spent pumping were 558.2 mL (SD = 320.7; range = 0-2,024) and 98.7 minutes (SD = 38.6; range = 0-295), respectively. The mean cost of providing 100 mL of HM varied from $2.60 to $6.18 when maternal opportunity cost was included and from $0.95 to $1.55 when it was excluded. The cost per 100 mL of HM declined with every additional day of pumping and was most sensitive to the costs of the breast pump rental and pump kit. These findings indicate that HM is reasonably inexpensive to provide and that the maternal cost of providing milk is mitigated by increasing milk output over the early NICU stay.

Infections fongiques invasives du grand prématuré

Fungal infections were frequent in premature baby (<1500 g) and were associated with significant morbidity and mortality. In this paper we review the risk factors for invasive fungal infections and clinical settings. A better understanding of the mechanism of fungal infection in preterm infants is important in treatment and prevention. The early neonatal intensive care unit course favours colonization and proliferation of fungi since many preterm infants have central catheters and are exposed to broad spectrum antibiotics and parenteral nutrition. The majority of fungal infections in preterm neonates are due to Candida, with a small number due to other yeasts such as Malassezia. Candida is an opportunistic pathogen, which adheres to the skin, mucosal, and catheter surface. C. albicans account for 50% of cases of fungal sepsis. C. parapsilosis is the second most prevalent species in very low birth weight children; its frequency increased from 1995 to 2000. Risk factors for fungal colonization are: very low birth weight, exposure to broad spectrum antibiotics, parenteral nutrition and use of corticosteroids. Colonization of the skin, gastro-intestinal tract and respiratory tract and central vascular catheter precede infection. The majority of preterm infants with fungal infections develop thrombocytopenia, but this is a common feature shared with other sepsis. The evaluation of infants with fungal sepsis should include cerebrospinal fluid examination and culture of urine with surveillance for endocarditis, renal, liver and brain abscesses and endophthalmitis. The mortality rate can reach 30%, and is higher in very low birth weight infants.

Early NICU discharge of very low birth weight infants: a critical review and analysis

Early neonatal intensive care unit (NICU) discharge has been advocated for selected preterm infants to reduce both the adverse environment of prolonged hospital stay and to encourage earlier parental involvement by empowering parents to contribute to the ongoing care of their infant, and thereby reducing costs of care. Randomized trials and descriptive experiences of early discharge programs are critically reviewed over the last 30 years, and the key elements necessary for successful early discharge are reviewed and defined. Early discharge is clearly achievable for a large number of infants. Variations in neonatal care practices are reviewed since these variations have been documented to influence NICU stay. Management of apnea of prematurity and feeding practices is documented to significantly influence NICU length of stay, as is timing of discharge based on institutional factors. Developmentally centered care, use of nutritional supplements pre- and postdischarge, hearing screening programs, evaluation for retinopathy of prematurity, evaluation for apnea and bradycardia events, and cardiopulmonary stability while in a car seat all influence timing of discharge. Programs of early hospital discharge with home nursing and neonatologist support have been successful in lowering the length of NICU stay. However, trends in length of stay in NICUs indicate that for infants >750 g at birth over the last decade there have been insignificant reductions in length of hospital stay. Thus, because of the increase in the percentage of low birth weight infants in the US, there remain opportunities to improve on variations in care that will be translated to fewer NICU days in hospitals for selected infants. Several professional guidelines are summarized, and standards of care as related to discharge of premature infants are reviewed.

Fostering Behavioral Development of High-Risk Infants

Concerns exist regarding the impact of the early neonatal intensive care unit environment on preterm and other high-risk infants and the lack of stimulus geared to the infant's individual needs and status. The nurse, as the primary caregiver in the neonatal intensive care unit, plays a major role in determining the infant's environment and in modulating interactions between the infant and the environment. Considerations for planning and providing infant stimulation, and nursing actions to enhance and support the infant's developmental capabilities and to foster parent-infant interaction are discussed.