European Neonatal Intensive Care Units Research Articles

Red Blood Cell Transfusion in European Neonatal Intensive Care Units, 2022 to 2023

ImportanceRed blood cell (RBC) transfusions are frequently administered to preterm infants born before 32 weeks of gestation in the neonatal intensive care unit (NICU). Two randomized clinical trials (Effects of Transfusion Thresholds on Neurocognitive Outcomes of Extremely Low-Birth-Weight Infants [ETTNO] and Transfusion of Prematures [TOP]) found that liberal RBC transfusion thresholds are nonsuperior to restrictive thresholds, but the extent to which these results have been integrated into clinical practice since publication in 2020 is unknown.ObjectiveTo describe neonatal RBC transfusion practice in Europe.Design, Setting, and ParticipantsThis international prospective observational cohort study collected data between September 1, 2022, and August 31, 2023, with a 6-week observation period per center, from 64 NICUs in 22 European countries. Participants included 1143 preterm infants born before 32 weeks of gestation.ExposureAdmission to the NICU.Main Outcomes and MeasuresStudy outcome measures included RBC transfusion prevalence rates, cumulative incidence, indications, pretransfusion hemoglobin (Hb) levels, volumes, and transfusion rates, Hb increment, and adverse effects of RBC transfusion.ResultsA total of 1143 preterm infants were included (641 male [56.1%]; median gestational age at birth, 28 weeks plus 2 days [IQR, 26 weeks plus 2 days to 30 weeks plus 2 days]; median birth weight, 1030 [IQR, 780-1350] g), of whom 396 received 1 or more RBC transfusions, totaling 903 transfusions. Overall RBC transfusion prevalence rate during postnatal days 1 to 28 was 3.4 transfusion days per 100 admission days, with considerable variation across countries, only partly explained by patient mix. By day 28, 36.5% (95% CI, 31.6%-41.5%) of infants had received at least 1 transfusion. Most transfusions were given based on a defined Hb threshold (748 [82.8%]). Hemoglobin levels before transfusions indicated for threshold were below the restrictive thresholds set by ETTNO in 324 of 729 transfusions (44.4%) and TOP in 265 of 729 (36.4%). Conversely, they were between restrictive and liberal thresholds in 352 (48.3%) and 409 (56.1%) transfusions, respectively, and above liberal thresholds in 53 (7.3%) and 55 (7.5%) transfusions, respectively. Most transfusions given based on threshold had volumes of 15 mL/kg (470 of 738 [63.7%]) and were administered over 3 hours (400 of 738 [54.2%]), but there was substantial variation in dose and duration.Conclusions and RelevanceIn this cohort study of very preterm infants, most transfusions indicated for threshold were given for pretransfusion Hb levels above restrictive transfusion thresholds evaluated in recent trials. These results underline the need to optimize practices and for implementation research to support uptake of evidence.

Medication safety strategies in European adult, paediatric, and neonatal intensive care units: a cross-sectional survey

ObjectivesPatients in intensive care units (ICUs) are potentially more vulnerable to medication errors than patients admitted to general wards. However, little is known about medication safety strategies used in European...

Temporal evolution of electrographic seizures in newborn infants with hypoxic-ischaemic encephalopathy requiring therapeutic hypothermia: a secondary analysis of the ANSeR studies

Despite extensive research on neonatal hypoxic-ischaemic encephalopathy, detailed information about electrographic seizures during active cooling and rewarming of therapeutic hypothermia is sparse. We aimed to describe temporal evolution of seizures and determine whether there is a correlation of seizure evolution with 2-year outcome. This secondary analysis included newborn infants recruited from eight European tertiary neonatal intensive care units for two multicentre studies (a randomised controlled trial [NCT02431780] and an observational study [NCT02160171]). Infants were born at 36+0 weeks of gestation with moderate or severe hypoxic-ischaemic encephalopathy and underwent therapeutic hypothermia with prolonged conventional video-electroencephalography (EEG) monitoring for 10 h or longer from the start of rewarming. Seizure burden characteristics were calculated based on electrographic seizures annotations: hourly seizure burden (minutes of seizures within an hour) and total seizure burden (minutes of seizures within the entire recording). We categorised infants into those with electrographic seizures during active cooling only, those with electrographic seizures during cooling and rewarming, and those without seizures. Neurodevelopmental outcomes were determined using the Bayley's Scales of Infant and Toddler Development, Third Edition (BSID-III), the Griffiths Mental Development Scales (GMDS), or neurological assessment. An abnormal outcome was defined as death or neurodisability at 2 years. Neurodisability was defined as a composite score of 85 or less on any subscales for BSID-III, a total score of 87 or less for GMDS, or a diagnosis of cerebral palsy (dyskinetic cerebral palsy, spastic quadriplegia, or mixed motor impairment) or epilepsy. Of 263 infants recruited between Jan 1, 2011, and Feb 7, 2017, we included 129 infants: 65 had electrographic seizures (43 during active cooling only and 22 during and after active cooling) and 64 had no seizures. Compared with infants with seizures during active cooling only, those with seizures during and after active cooling had a longer seizure period (median 12 h [IQR 3-28] vs 68 h [35-86], p<0·0001), more seizures (median 12 [IQR 5-36] vs 94 [24-134], p<0·0001), and higher total seizure burden (median 69 min [IQR 22-104] vs 167 min [54-275], p=0·0033). Hourly seizure burden peaked at about 20-24 h in both groups, and infants with seizures during and after active cooling had a secondary peak at 85 h of age. When combined, worse EEG background (major abnormalities and inactive background) at 12 h and 24 h were associated with the seizure group: compared with infants with a better EEG background (normal, mild, or moderate abnormalities), infants with a worse EEG background were more likely to have seizures after cooling at 12 h (13 [54%] of 24 vs four [14%] of 28; odds ratio 7·09 [95% CI 1·88-26·77], p=0·0039) and 24 h (14 [56%] of 25 vs seven [18%] of 38; 5·64 [1·81-17·60], p=0·0029). There was a significant relationship between EEG grade at 12 h (four categories) and seizure group (p=0·020). High total seizure burden was associated with increased odds of an abnormal outcome at 2 years of age (odds ratio 1·007 [95% CI 1·000-1·014], p=0·046), with a medium negative correlation between total seizure burden and BSID-III cognitive score (rS=-0·477, p=0·014, n=26). Overall, half of infants with hypoxic-ischaemic encephalopathy had electrographic seizures and a third of those infants had seizures beyond active cooling, with worse outcomes. These results raise the importance of prolonged EEG monitoring of newborn infants with hypoxic-ischaemic encephalopathy not only during active cooling but throughout the rewarming phase and even longer when seizures are detected. Wellcome Trust, Science Foundation Ireland, and the Irish Health Research Board.

State of the Art of Probiotic Use in Neonatal Intensive Care Units in French-Speaking European Countries.

The effectiveness of probiotics in reducing the incidence of necrotizing enterocolitis has been supported by a very large number of studies. However, the utilization of probiotics in preterm infants remains a topic of debate. This study aims to assess the rate of probiotic use in European neonatal intensive care units (NICUs), compare administration protocols, and identify barriers and concerns associated with probiotic use. An online questionnaire was distributed via email to European NICUs between October 2020 and June 2021. Different questions related to the frequency of probiotic use were proposed. Data on probiotic administration protocols and reasons for non-utilization were collected. The majority of responses were from France and Switzerland, with response rates of 85% and 89%, respectively. A total of 21% of French NICUs and 100% of Swiss NICUs reported routine probiotic use. There was significant heterogeneity in probiotic administration protocols, including variations in probiotic strains, administration, and treatment duration. The main obstacles to routine probiotic use were the absence of recommendations, lack of consensus on strain selection, insufficient scientific evidence, and concerns regarding potential adverse effects. The rate of routine probiotic administration remains low in European NICUs, with heterogeneity among protocols. Further trials are necessary to elucidate optimal treatment modalities and ensure safety of administration.

Current pain management practices for preterm infants with necrotizing enterocolitis: a European survey

BackgroundNecrotizing enterocolitis (NEC) is a highly painful intestinal complication in preterm infants that requires adequate pain management to prevent short- and long-term effects of neonatal pain. There is a lack of international guidelines for pain management in NEC patients. Therefore, this study aims to describe current pain management for NEC patients in European neonatal intensive care units (NICUs).MethodsAn online survey was designed and conducted to assess current practices in pain management for NEC patients in European NICUs. The survey was distributed via neonatal societies, digital platforms, and professional contacts.ResultsOut of the 259 responding unique European NICUs from 36 countries, 61% had a standard protocol for analgesic therapy, 73% assessed pain during NEC, and 92% treated NEC patients with intravenous analgosedatives. There was strong heterogeneity in the used pain scales and initial analgesic therapy, which mainly included acetaminophen (70%), fentanyl (56%), and/or morphine (49%). A third of NICU representatives considered their pain assessment adequate, and half considered their analgesic therapy adequate for NEC patients.ConclusionsVarious pain scales and analgesics are used to treat NEC patients in European NICUs. Our results provide the first step towards an international guideline to improve pain management for NEC patients.ImpactThis study provides an overview of current pain management practices for infants with necrotizing enterocolitis (NEC) in European neonatal intensive care units.Choice of pain assessment tools, analgosedatives, and dosages vary considerably among NICUs and countries.A third of NICU representatives were satisfied with their current pain assessment practices and half of NICU representatives with their analgesic therapy practices in NEC patients in their NICU.The results of this survey may provide a first step towards developing a European pain management consensus guideline for patients with NEC.

Survey of transfusion practices in preterm infants in Europe

BackgroundPreterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in...

Assessing the impact of the COVID-19 pandemic on parental satisfaction in two European neonatal intensive care units

BackgroundNeonatal units across the world have altered their policies to prevent the spread of infection during the COVID-19 pandemic. Our aim was to report parental experience in two European neonatal...

Variations in Antibiotic Use and Sepsis Management in Neonatal Intensive Care Units: A European Survey.

Management of neonatal sepsis and the use of antimicrobials have an important impact on morbidity and mortality. However, there is no recent background on which antibiotic regimens are used in different European neonatal intensive care units (NICUs). Our study aimed to describe the use of antibiotics and other aspects of early- and late-onset sepsis (EOS and LOS, respectively) management by European NICUs. We conducted an online survey among NICUs throughout Europe to collect information about antibiotic stewardship, antibiotic regimens, and general aspects of managing neonatal infections. NICUs from up to 38 European countries responded, with 271 valid responses. Most units had written clinical guidelines for EOS (92.2%) and LOS (81.1%) management. For EOS, ampicillin, penicillin, gentamicin, and amikacin were the most commonly used antibiotics. Analysis of the combinations of EOS regimens showed that the most frequently used was ampicillin plus gentamicin (54.6%). For LOS, the most frequently used antibiotics were vancomycin (52.4%), gentamicin (33.9%), cefotaxime (28%), and meropenem (15.5%). Other aspects of the general management of sepsis have also been analyzed. The management of neonatal sepsis in European NICUs is diverse. There was high self-reported adherence to the local clinical guidelines. There was homogeneity in the combination of antibiotics in EOS but less in LOS.

Safety of in-neonatal intensive care unit administration of rotavirus vaccination among preterms

Abstract Background Rotavirus is among the most common vaccine preventable illness in children under 5 years old. Despite increased severity of rotaviral illness in early infancy, most neonatal intensive care units (NICUs) do not administer rotavirus vaccination. The present project aims to evaluate the safety of in-neonatal intenive care unit administration of the monovalent live, attenuated rotavirus vaccination to preterm newborns in Sicily. Methods From the first of March 2018 within the six most important NICUs of Sicily (three located in Palermo, two in Catania and one in Messina), and under the scientific coordination of the University of Palermo and of the Regional Health Department, rotavirus vaccination was administered to preterm newborns with gestational age ≥28 weeks. Vaccine administrations were performed both under hospital and outpatient settings, from 6 weeks of age and in accordance with the Sicilian Vaccination Schedule. Results At the end of December 2019, 449 preterm newborns were fully vaccinated (two dose completion) against rotavirus in the six Sicilian NICUs participating to the project. Average gestational age was 31.4 (SD ± 2.7) weeks. First dose of rotavirus vaccination was administered at 6.3 (SD ± 0.6) weeks. Average weight at first dose were 2.890 (SD ± 0.456) grams. Only 8% and 2% of vaccinated newborns reported abdominal colic and fever &amp;gt;38.5 °C in the 15 days after first dose, respectively. No one expected adverse event was observed in the 30 days after vaccination. Conclusions First data obtained from this study confirms the absolute safety of monovalent rotavirus vaccination also in preterm newborns with gestational age ≥28 weeks. Results could represent for public health physicians and for neonatologists a key tool for standardize rotavirus vaccination in very Italian NICU. Key messages Rotavirus vaccination is extremely safe in preterm newborns with gestational age ≥28 weeks. Rotavirus vaccination should be routinely implemented in Italian and European NICUs.

Differences for managing mother’s own milk for very preterm infants across 11 European countries

Abstract Background There is an ongoing debate about the best practices to handle mother's own milk (MOM) for infants born very preterm (VPT, ≤32 weeks of gestation), specifically to prevent the human cytomegalovirus (HCMV) transmission and bacterial contamination of expressed MOM. Thus, we aimed to compare practices for managing MOM for VPT infants in European neonatal intensive care units (NICUs). Methods Data were collected as part of the EPICE (Effective Perinatal Intensive Care in Europe) study which explored the use of evidence-based practices for the care of VPT infants in 11 European countries. Structured questionnaires were sent to the head of all participating NICUs with at least 10 VPT admissions. Of the eligible 135 NICUs, 134 replied. Results A written protocol for breastfeeding/human milk use was available in 91% of the NICUs. Overall, 34% used human bank milk for all VPT infants whose mothers did not express and 56% reported using fresh MOM without restrictions regarding minimum gestational age, birth weight or risk of HCMV transmission (country range: 0-100%). In 22% of units all VPT infants received MOM pasteurized (country range: 0-73%). HCMV serology on all mothers who express their milk was not required in 71% of units (country range: 7-100%). Among NICUs that performed HCMV serology, 3% provided untreated fresh MOM and 23.5% formula in the case of positive mothers. Systematic bacteriological analyses of MOM were not performed in 76% NICUs (country range: 29-100%) while less than 10% did it for the first milk feeding, 7% every week and 8% with another frequency. Conclusions There are large variations in managing MOM across countries, which could reflect differences in regulations or guidelines, and among the same country NICUs, revealing that different options can operate locally. This variability suggests substantial differences in attitudes about what constitutes best practices among European neonatologists. Key messages We found significant differences across and within European countries for managing MOM for VPT infants suggesting lack of strong recommendations at the international and national level. There is wide variation in what European neonatologists consider best practices. To guide practice and not jeopardise VPT infants from MOM we need strong evidence-based data.

Postnatal Corticosteroids Policy for Very Preterm Infants and Bronchopulmonary Dysplasia

Introduction: Postnatal corticosteroids (PNC) are effective for reducing bronchopulmonary dysplasia (BPD) in very preterm neonates but are associated with adverse effects including an increased risk of cerebral palsy. PNC use in Europe is heterogeneous across regions. This study aimed to assess whether European neonatal intensive care units (NICUs) with a low use of PNC or an explicit policy to reduce PNC use had higher risks of mortality or BPD. Methods: We included 3,126 infants in 105 NICUs born between 24 + 0 and 29 + 6 weeks’ gestational age in 19 regions in 11 countries in the EPICE cohort. First, we identified clusters of NICUs using hierarchical clustering based on PNC use and BPD prevalence and compared case mix and mortality between the clusters. Second, a multilevel analysis was performed to evaluate the association between a restrictive PNC policy and BPD occurrence. Results: There were 3 clusters of NICUs: 52 with low PNC use and a low BPD rate, 37 with low PNC use and a high BPD rate, and 16 with high PNC use and a medium BPD rate. Neonatal mortality did not differ between clusters (p = 0.88). A unit policy of restricted PNC use was not associated with a higher risk of BPD (odds ratio 0.68; 95% confidence interval: 0.45–1.03) after adjustment. Conclusion: Up to 49% of NICUs had low PNC use and low BPD rates, without a difference in mortality. Infants hospitalized in NICUs with a stated policy of low PNC use did not have an increased risk of BPD.

Medical Staffing in Neonatal and Pediatric Intensive Care Units - an European Survey

Recently, there is a growing scarcity of qualified personnel in German healthcare system. This can lead to problems especially in the highly specialized neonatal and pediatric intensive care. We conducted a survey to evaluate the staffing situation at 583 European neonatal and pediatric intensive care units (ICU). Response rate was 48.5%. As a main result our evaluation demonstrated a significant lower nurse-staffing in Germany compared to the other countries (90.4 vs. 95.8%, p<0.001). In addition, the average nurse-to-patient ratio was worse in German neonatal ICUs (3.0 vs. 2.3, p<0.001). The presence of senior doctors is also lower in German neonatal and pediatric ICUs compared to the other countries (on weekdays: 12.0 vs. 14.6 h, p=0.04; on weekends: 8.9 vs. 13.2 h, p=0.003). Our survey demonstrates that the nurse-staffing at neonatal and ICUs in Germany is worse than in other European countries. The resulting potential loss of quality is worsened due to lower presence of senior doctors at the ICUs. Possible consequences include increase of complications, impairment of treatment success, closure of intensive care beds, and mental and physical illness of the staff. Compared to other European countries, there is a lack of nurses at neonatal and pediatric ICUs in Germany. This study underlines the importance to take measures to counteract nursing crisis.

Effect of Needle Aspiration of Pneumothorax on Subsequent Chest Drain Insertion in Newborns

Treatment options for a symptomatic pneumothorax in newborns include needle aspiration (NA) and chest drain (CD) insertion. There is little consensus as to the preferred treatment, reflecting a lack of evidence from clinical trials. To investigate whether treating pneumothoraces diagnosed on chest radiography (CR) in newborns receiving respiratory support with NA results in fewer infants having CDs inserted within 6 hours of diagnosis. This randomized clinical trial was conducted from October 7, 2013, to December 21, 2016. The setting was 5 tertiary European neonatal intensive care units. Infants receiving respiratory support (endotracheal ventilation, continuous positive airway pressure, or supplemental oxygen >40%) who had a pneumothorax on CR that clinicians deemed needed treatment were eligible for inclusion. Infants were randomly assigned (1:1) to drainage using NA or CD insertion, stratified by center and gestation at birth (<32 vs ≥32 weeks). Caregivers were not masked to group assignment. For NA, a needle was inserted between the ribs to aspirate air and was removed once air was no longer aspirated. A CD was inserted if clinicians deemed that the response was inadequate. For CD insertion, a drain was inserted between the ribs and was left in situ. The primary outcome was whether a CD was inserted on the side of the pneumothorax within 6 hours of diagnosis. A total of 76 infants were randomly assigned, and 6 (4 assigned to NA and 2 to CD) were excluded because they met exclusion criteria at enrollment. Of the 70 remaining infants, 33 (16 male [48%]) were assigned to NA and 37 (22 male [59%]) to CD insertion. Their median (interquartile range [IQR]) gestational age was 31 (27-38) vs 31 (27-35) weeks, and their median (IQR) birth weight was 1385 (1110-3365) vs 1690 (1060-2025) g, respectively. Fewer infants assigned to NA had a CD inserted within 6 hours (55% [18 of 33] vs 100% [37 of 37]; relative risk, 0.55; 95% CI, 0.40-0.75) and during hospitalization (70% [23 of 33] vs 100% [37 of 37]; relative risk, 0.70, 95% CI, 0.56-0.87). Needle aspiration reduced the rate of CD insertion in symptomatic newborns with pneumothorax on CR. It should be used as the initial method of draining radiologically confirmed pneumothorax in symptomatic infants. isrctn.org Identifier: ISRCTN65161530.

Capacities and Competences for Drug Evaluation in European Neonatal Intensive Care Units: A Survey and Key Issues for Improvement.

Multicenter neonatal clinical trials aim to provide evidence-based drug evaluation, but recruiting neonates requires collaboration, standard procedures, and trained neonatologists. A questionnaire based on a previous Delphi study was sent to European neonatal intensive care units (NICUs) to collect their research experience and identify areas for improvement. Of 247 NICUs,79 (32%) responded: 69 were level III units and 10 were level II units. In level III centers, 62% had medical staff dedicated to research and 65% conducted regular in-house audits. Similarities were observed in the median number of trials per year (level II: 2; level III: 5), Good Clinical Practice training (level II: 78%; level III: 66%), and standard operating procedures (level II: 63%; level III: 71%). Most NICUs had access to scientific advice for trial design, conduct, data management, and regulatory aspects. Involvement of patient advocacy groups was more common in level II units (level II: 75%; level III: 59%). A "quality" score of 34 "quality" research items was calculated for all centers (mean: 23.2 ± 6.2; range: 6-34). Research experience and processes vary across Europe. Harmonizing research practices and setting standards will allow building a European neonatal network for effective, safe, and quality neonatal drug development.

Pulse oximeter saturation target limits for preterm infants: a survey among European neonatal intensive care units

The optimum range of pulse oximeter oxygen saturation (SpO2) for preterm infants remains controversial. Between November 2015 and February 2016, we conducted a web-based survey aimed to investigate the current and former practices on SpO2 targets in European neonatal intensive care units (NICUs). We obtained valid responses from 193 NICUs, treating 8590 newborns ≤28 weeks per year, across 27 countries. Forty different saturation ranges were reported, ranging from 82–93 to 94–99%. The most frequently utilized SpO2 ranges were 90–95% (28%), 88–95% (12%), 90–94% (5%), and 91–95% (5%). A total of 156 NICUs (81%) changed their SpO2 limits over the last 10 years. The most frequently reported former limits were 88–92% (18%), 85–95% (9%), 88–93 (7%), and 85–92% (6%). The NICUs that increased their SpO2 ranges expected to obtain a reduction in mortality. A 54% of the NICUs found the scientific evidence supporting their SpO2 targeting policy strong or very strong.Conclusion: We detected a high degree of heterogeneity in pulse oximeter SpO2 target limits across European NICUs. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned.What is Known:• For preterm infants requiring supplemental oxygen, the optimum range of pulse oximeter oxygen saturation (SpO2) to minimize organ damage, without causing hypoxic injury, remains controversial.What is New:• This survey highlights the lack of consensus regarding SpO2target limits for preterm infants among European neonatal intensive care units (NICUs). We detected 40 different SpO2ranges, and even the most frequently reported range (i.e., 90–95%) was used in only 28% of the 193 respondent NICUs.• A total of 156 NICUs (81%) changed their SpO2limits over the last 10 years. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned.

Association between the p.Thr1406Asn polymorphism of the carbamoyl-phosphate synthetase 1 gene and necrotizing enterocolitis: A prospective multicenter study.

The p.Thr1406Asn (rs1047891) polymorphism of the carbamoyl-phosphate synthetase 1 (CPS1) gene has been linked to functional consequences affecting the downstream availability of the nitric oxide precursor L-arginine. L-arginine concentrations are decreased in preterm infants with necrotizing enterocolitis (NEC). In this multicenter prospective study, we investigated the association of the p.Thr1406Asn polymorphism with NEC in 477 preterm infants (36 cases of NEC) from 4 European neonatal intensive care units (Maastricht, Las Palmas de Gran Canaria, Mantova, and Milan). Allele and genotype frequencies of the p.Thr1406Asn polymorphism did not significantly differ between the infants with and without NEC. In contrast, the minor A-allele was significantly less frequent in the group of 64 infants with the combined outcome NEC or death before 34 weeks of corrected gestational age than in the infants without the outcome (0.20 vs. 0.31, P = 0.03). In addition, a significant negative association of the A-allele with the combined outcome NEC or death was found using the dominant (adjusted odds ratio, aOR: 0.54, 95% CI 0.29–0.99) and the additive (aOR 0.58, 95% CI 0.36–0.93) genetic models. In conclusion, our study provides further evidence that a functional variant of the CPS1 gene may contribute to NEC susceptibility.

Parent and nurse perceptions on the quality of family-centred care in 11 European NICUs

BackgroundFamily-centred care (FCC) is a state-of-the-art practice in neonatal intensive care units (NICU) based on its shown benefits on the well-being of both infants and parents. However, there is no systematic knowledge about how FCC is implemented in different European contexts. ObjectivesTo describe parents’ presence and the quality of FCC from the perspectives of mothers, fathers and nurses in 11 European NICUs. MethodsA prospective survey was conducted in Finland, Sweden, Norway, Estonia, Spain and Italy. The perceived quality of FCC was measured using 8 text-message questions sent to the parents’ mobile phones, one question each day, during the infant's hospital stay. Nurses answered corresponding questions through a Web questionnaire during a 3-month period. The responses were rated on a 7-point Likert scale. Parents who were not present in the unit during the day used a “0” response. ResultsA total of 262 families of preterm infants born before 35 gestational weeks participated in the study. Mothers gave 5045 responses, fathers gave 3971 responses and nurses gave 11,132 answers. The mothers were present during 92.7% and the fathers during 77.9% of the study days. The mothers rated the quality of FCC slightly higher than the fathers did (5.8 [95% CI 5.7–5.9] vs. 5.7 [95% CI 5.6–5.8], mean difference of 0.12 [95% CI 0.05–0.2], p<0.001). There was wide variation in the parents’ presence and the quality of FCC between the units. The weakest aspects of FCC were emotional support, parents’ participation in decision-making and fathers’ participation in infant care. The perceived quality of FCC between the nurses and parents were comparable. ConclusionsThis study showed a high perceived quality of FCC in 11 European units, as indicated by both parents and nurses. The innovative data-collection method and instrument successfully quantified each unit's FCC profile for further quality improvement and should be trialled in other NICUs and countries.

Approaches to supporting lactation and breastfeeding for very preterm infants in the NICU: a qualitative study in three European regions

ObjectivesTo explore differences in approaches to supporting lactation and breastfeeding for very preterm infants in neonatal intensive care units (NICU) in 3 European regions.DesignQualitative cross-sectional study carried out by means...

NIDCAP and developmental care

Perinatal mortality in very low birth weight infants has dramatically decreased during the last decades. However, 15-25% of these infants will show neurodevelopmental impairment later on. The aim of implementing early developmental care (EDC), emerged as a new field in neonatology, is to create an intervention program designed to provide support for optimal neurobehavioral development during this highly vulnerable period of brain growth. The theoretical framework, which underlies the approach, is supported by research in different scientific fields, including neuroscience, psychology, medicine and nursing. EDC utilizes a range of medical and nursing interventions that aim to decrease the stress of preterm neonates in neonatal intensive care units (NICUs). The Neonatal Individualized Developmental Care Assessment Program (NIDCAP) is an integrated and holistic form of family-centered developmental care. Changing the traditional NICU towards an EDC-NICU includes training nursing and medical staff, investing in their quality and most importantly keeping parents in proximity to the infants. The new challenge of modern neonatology is to restore the mother-infant dyad applying “couplet care” starting at birth until discharge. Most of the European NICUs apply some elements of EDC, but it is more consistent in northern Europe. The development of NIDCAP training centers in Europe demonstrates the evolution of care. It is likely that future research and intervention programs will optimize our practices. Developmental care could prove to be an important recent step in improving outcome in extremely preterm neonates. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

O-103 Sedation And Analgesia For Neonates In Nicus Across Europe: The Europain Survey

<h3>Background</h3> Pain and stress induced by mechanical ventilation, invasive procedures, or painful diseases supports the use of sedation/analgesia (S/A) in newborns admitted to Neonatal Intensive Care Units (NICUs). To date, these practices have not been studied at a large scale. <h3>Objective</h3> To determine current clinical practices regarding the use of S/A drugs in NICUs across Europe. <h3>Methods</h3> This epidemiological observational study on bedside clinical practices regarding S/A collected data for all neonates in participating NICUs until the infant left the unit (discharge, death, transfer) or for up to 28 days. Data collection occurred via an online database for 1 month at each NICU. All neonates up to 44 weeks gestation were included. <h3>Results</h3> From October 2012 to June 2013, 243 NICUs from 18 European countries collected data on 6680 eligible neonates. Of these, 2142 received tracheal ventilation (TV), 1496 non-invasive ventilation (NIV) and 3042 only spontaneous ventilation (SV). The median (IQR) gestational age of TV, NIV and SV neonates were 32.1 (28.1–37.4), 33.6 (31.0–36.6) and 37.9 (35.0–39.9), respectively (p &lt; 0.001). Overall, more TV neonates [81.5% (n = 1746)] received S/A drugs than NIV neonates [17.8% (n = 266)] and SV neonates [9.3% (n = 282)]; p &lt; 0.001. Fig. shows the rate of S/A use by country; table shows S/A drugs used. <h3>Conclusions</h3> Most ventilated but few non-ventilated neonates (NIV and SV) receive S/A therapy in European NICUs. Wide variations in S/A use, drugs used, and mode of administration (continuous, bolus, or both) exist among countries.