Infant Care Centers Research Articles

Clinical features of 19 children infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 in Hangzhou, China

To study the clinical features of children infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The medical data of 19 children who were diagnosed with SARS-CoV-2 Omicron variant infection from January 28 to March 3, 2022 in Hangzhou were retrospectively reviewed. Among the 19 children, there were 7 boys (37%) and 12 girls (63%), and their age ranged from 6 months to 16 years, with a median age of 2 years and 1 month. Most of these children were infants and young children (aged ≤3 years, accounting for 53%). Among these children, 11 (58%) were unvaccinated with SARS-CoV-2 vaccine and 8 (42%) were vaccinated with SARS-CoV-2 vaccine, and 3 children (16%) had a history of underlying diseases. All 19 children had a clear history of close contact with persons infected with SARS-CoV-2, and 10 children (53%) were involved in the cluster outbreak in a maternal and infant care center. In terms of clinical classification, 13 children (68%) had mild coronavirus disease 2019 (COVID-19) and 6 (32%) had common COVID-19, with no severe cases of COVID-19. The most common clinical symptoms were cough (100%) and fever (63%). The children with a normal peripheral white blood cell count accounted for 84%, and those with a normal lymphocyte count accounted for 68%. There were no significant abnormalities in platelet count, procalcitonin, liver function parameters (alanine aminotransferase and aspartate aminotransferase), and renal function parameters (creatinine and urea). Six children (32%) had obvious signs of pneumonia on chest CT. All 19 children were given symptomatic treatment, and 12 children (63%) were given aerosol inhalation of interferon α. All children were cured and discharged. Children infected with Omicron variant strains are more common in infants and young children, with mild symptoms and good prognosis. Most of the children have a history of close contact with persons infected with SARS-CoV-2, and epidemic prevention and control should be strengthened in places with many infants and children, such as maternal and infant care centers.

40% Glucose Gel for the Treatment of Asymptomatic Neonatal Hypoglycemia.

The Mother Infant Care Center at Fort Belvoir Community Hospital (FBCH) recently revised its asymptotic neonatal hypoglycemia (ANH) protocol and adopted 40% glucose gel into its treatment pathway. The previous protocol used infant formula as the primary intervention. To evaluate the effectiveness of 40% glucose gel on exclusive human milk diet rates, time on protocol, level II Special Care Nursery (SCN) admission rates, length of stay (LOS), and total hospital costs for newborns with ANH at FBCH. Infants with ANH were treated with 40% glucose gel (n = 35) and compared with a historical group of infants with ANH (n = 29) who were treated with formula. Exclusive human milk diet rates increased by 33.6%. The mean time on protocol dropped by 1.13 hours. The SCN admission rates dropped by 2.4% in the postimplementation group. The mean LOS was more than 12 hours less in the postimplementation group. The mean total cost per patient was $1190.60 lower after implementation of 40% glucose gel. The use of 40% glucose gel is a patient-focused, less-invasive, and cost-effective treatment of ANH. More studies are needed to better define neonatal hypoglycemia. The use of 40% glucose gel is safe for use in infants with ANH; however, more studies are needed to examine its comprehensive benefits.

Does Patient-centered Care Change Genital Surgery Decisions? The Strategic Use of Clinical Uncertainty in Disorders of Sex Development Clinics.

Genital surgery in children with ambiguous or atypical genitalia has been marred by controversies about the appropriateness and timing of surgery, generating clinical uncertainty about decision making. Since 2006, medical experts and patient advocates have argued for putting the child's needs central as patient-centered care. Based on audio recordings of 31 parent-clinician interactions in three clinics of disorders of sex development, we analyze how parents and clinicians decide on genital surgery. We find that clinicians and parents aim for parent-centered rather than infant-centered care. Parents receive ambivalent messages about surgery: while clinicians express caution, they also present the surgery as beneficial. We examine how parents and clinicians reach agreement about surgery-differentiating parents who push strongly for surgery from parents who do not express any preconceived preferences about surgery and parents who resist surgery. We conclude that clinicians use clinical uncertainty about surgery strategically to direct parents toward perceived clinically appropriate decisions.

Occupancy and patient care quality benefits of private room relative to multi-bed patient room designs for five different children’s hospital intensive and intermediate care units

Prior research documents occupancy and patient care quality (OPCQ) benefits for private room (PR) relative to multi-bed (MB) designs in neonatal intensive care units (NICUs). To extend this research design to four additional types of children's hospital units: a cardiovascular care center (CVCC), an infant care center (ICC), a medical/surgical unit (Med/Surg), and a pediatric intensive care unit (PICU). Staff comments, task activities, patient care demands, and perceptual survey rankings for twelve major indicators of OPCQ were assessed with nursing staff on these units plus an NICU. With the PR designs, for 38 of 48 pairwise comparisons for the twelve major OPCQ indicators, CVCC staff rankings are significantly lower than those by staff on the other four units. For 47 of 48 pairwise comparisons for the twelve major OPCQ indicators, NICU, ICC, Med/Surg, and PICU staff rankings for PR designs do not differ significantly from those for MB designs. Comments by staff on all five units target numerous PR OPCQ defects. Design, operation and management of the patient care environments on the five different PR units evaluated in this research confront a challenge in realizing OPCQ benefits that match experience with PR NICU designs in other contexts.

Does quality of developmental care in NICUs affect health-related quality of life in 5-y-old children born preterm?

Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse experiences, which may affect health-related quality of life (HRQoL) even in the absence of prematurity-related morbidities. The aim of this multicenter longitudinal study was to examine the relation between quality levels of NICU Developmental Care (DC) and HRQoL at 60 mo in children who were born preterm. HRQoL of 102 very preterm (VPT) children from 20 NICUs and 110 full-term controls was assessed using TNO-AZL Preschool Children's Quality of Life Questionnaire (TAPQOL). In VPT children, we compared HRQoL by splitting NICUs into units with high- and low-quality of DC according to the following two factors: (i) the infant centered care (ICC), and (ii) the infant pain management (IPM). Compared to VPT children from NICUs with high-quality of ICC, VPT children from NICUs with low-quality in ICC scored lower in HRQoL component which resulted from the aggregation of lively, positive emotionality, social and motor functioning. No differences were found between VPT children from high-quality ICC NICUs and full-term children and for the IPM index. Findings suggest that higher quality of DC in NICU related to ICC might mitigate long-term negative quality of life outcomes.

Language outcomes at 36 months in prematurely born children is associated with the quality of developmental care in NICUs.

The aim of this study was to examine the relationship between the quality levels of NICU developmental care (DC) and language skills at 36 months in very preterm (VPT) children. Language skills of 78 VPT children from 19 NICUs and 90 full-term controls was assessed using a standardized language test. We compared children' language task performance by splitting NICUs into units with high- and low-quality of DC according to two main factors: (1) infant centered care (ICC), and (2) infant pain management (IPM). VPT children from low-care units with respect to ICC obtained lower scores in sentence comprehension, compared to children from high-care units. No differences were found between preterm children from high-quality ICC NICUs and full-term children. Findings suggest that higher quality of DC related to infant centered care can mitigate delays in language skills at 36 months in children born VPT.

Neonatal developmental care in infant pain management and internalizing behaviours at 18months in prematurely born children.

Very preterm infants are exposed to adverse stressful experiences, which may result in long-term behavioural outcomes. The developmental care practices, including pain management and environmental support, can minimize the effects of stress exposure. However, developmental care quality levels may vary among Neonatal Intensive Care Units (NICUs) and little is known about how differences in developmental care quality affect long-term behavioural outcomes. The aim of this study was to examine the relation between quality levels NICUs developmental care and behaviour problems at 18months corrected age in preterm children. The behaviour of 134 preterm children from 22 NICUs and 123 full-term controls was examined using the questionnaire Child Behaviour Checklist 1½-5. We compared the behavioural profile of children by splitting NICUs into units with high- and low quality of developmental care according to two main care factors: (1) infant centered care (ICC) index, and (2) infant pain management (IPM) index. Preterm children from low-care units in IPM group reported higher scores in Internalizing Problems, compared to children from high-care units. No differences were found between preterm children from high-care in IPM and full-term children. No significant IPM effect was found for externalizing problems. No significant ICC effect emerged both for internalizing and externalizing problems. Findings suggest that higher quality of developmental care related to infant pain management can mitigate behavioural problems at 18months in children born preterm, to such an extent that preterm children exhibit a behavioural profile similar to that displayed by full-term children.

Incomplete bladder emptying is associated with febrile urinary tract infections in infants

ObjectiveTo investigate lower urinary tract dysfunction in pre-toilet trained infants with and without history of febrile UTI (f-UTI). Materials and MethodsPre-toilet trained infants with f-UTI (Group 1) from pediatric nephrology and urology clinics, and those without f-UTI (Group 2) from infant-care centers were enrolled for the present study. Infants in Group 1 underwent four-hourly (4-H) observations for at least one month after treatment for UTI. Voided volume (VV) and post-void residual urine (PVR) were measured by weighting diaper and suprapubic ultrasound after finishing voiding, respectively. Average PVR was defined as the mean value of PVR during 4-H observation. Interrupted voiding was defined as two or three voidings within 10 min. Voiding efficiency was defined as VV/(VV + PVR). ResultsThe mean ages of Group 1 (n = 64) and Group 2 infants (n = 56) were 10.6 ± 7.5 months vs 10.2 ± 5.1 months, respectively (p = 0.70). Group 1 infants had significantly higher voiding frequency (3.0times ± 1.2 vs 2.6times ± 0.9, p = 0.04), average PVR (14.5 ml ± 14.2 vs 8.9 ml ± 8.8, p < 0.01) and lower voiding efficiency (71.2% ± 20.5 vs 80.2% ± 18.5, p = 0.01) than Group 2. ROC curve analysis showed that the optimal cutoff values for PVR and voiding efficiency to differentiate Group 1 and Group 2 infants were 10 ml and 80%, respectively. Group 1 infants had significantly more repeat elevated PVR (≧ 10 ml) and repeat low voiding efficiency (≦ 80%) than Group 2 (44.8% vs 22.4%, p = 0.03; 62.0% vs 28.6%, p < 0.01, respectively). ConclusionPre-toilet trained infants with f-UTI were associated with elevated PVR and lower voiding efficiency than normal controls.

Maternal stress and depressive symptoms associated with quality of developmental care in 25 Italian Neonatal Intensive Care Units: A cross sectional observational study

BackgroundParents of very preterm infants are at great risk for experiencing stress and depression. The so called developmental care oriented approach used in Neonatal Intensive Care Units have beneficial effects for parents. However the actual level of developmental care may vary among units and little is known about how the routine adoption of developmental care affects maternal stress and depression. ObjectivesTo investigate the extent to which level of quality of developmental care routinely carried out in 25 tertiary Neonatal Intensive Care Units across Italy affects maternal stress and depression. Participants178 mothers of healthy very preterm infants with gestational age ≤29wk and/or birth weight ≤1500g and without documented neurologic pathologies were recruited consecutively. 180 full-term mothers were recruited as the control group. MethodsTo distinguish the quality of developmental care level, each unit was assessed using a specifically developed questionnaire. We compared negative emotional states of mothers by splitting the 25 Neonatal Intensive Care Units into units with high-care and low-care based on median splits for two main care factors: (1) The Infant Centered Care index (consisting of measures of parent involvement, including ability to room in, frequency and duration of kangaroo care and nursing interventions aimed at decreasing infant energy expenditure and promoting autonomic stability). (2) The Infant Pain Management index (consisting of measures to decrease painful experiences including pharmacologic and nursing care practices). Maternal stress was assessed by the Parental Stressor Scale: Neonatal Intensive Care Unit questionnaire. Maternal depressive symptomatology was assessed by the Edinburgh Postnatal Depression Scale questionnaire. ResultsPreterm mothers from low-care units in the Infant Pain Management reported higher scores in their perception of stress associated with behavior and appearance of the infant than mothers from high-care units (p=0.05). Preterm mothers from high-care units in the Infant Pain Management reported a depressive symptomatology score average similar to that reported by full-term mothers. No significant Infant Centered Care effect was found both for maternal stress and depression. ConclusionsThe findings suggest that implementing more practices useful to reduce infants’ painful experience can mitigate the stress and depressive symptomatology of the preterm mothers.

Level of NICU Quality of Developmental Care and Neurobehavioral Performance in Very Preterm Infants

To examine the relation between the neurobehavior of very preterm infants and the level of NICU quality of developmental care. The neurobehavior of 178 very preterm infants (gestational age ≤29 weeks and/or birth weight ≤1500 g) from 25 NICUs participating in a large multicenter, longitudinal study (Neonatal Adequate Care for Quality of Life, NEO-ACQUA) was examined with a standardized neurobehavioral assessment, the NICU Network Neurobehavioral Scale (NNNS). A questionnaire, the NEO-ACQUA Quality of Care Checklist was used to evaluate the level of developmental care in each of the NICUs. A factor analyses applied to NEO-ACQUA Quality of Care Checklist produced 2 main factors: (1) the infant-centered care (ICC) index, which measures parents' involvement in the care of their infant and other developmentally oriented care interventions, and (2) the infant pain management (IPM) index, which measures the NICU approach to and the procedures used for reducing infant pain. The relations between NNNS neurobehavioral scores and the 2 indexes were evaluated. Infants from NICUs with high scores on the ICC evidenced higher attention and regulation, less excitability and hypotonicity, and lower stress/abstinence NNNS scores than infants from low-care units. Infants from NICUs with high scores on the IPM evidenced higher attention and arousal, lower lethargy and nonoptimal reflexes NNNS scores than preterm infants from low-scoring NICUs. Very preterm infant neurobehavior was associated with higher levels of developmental care both in ICC and in IPM, suggesting that these practices support better neurobehavioral stability.

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children’s hospital1

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.

Opening Our Doors for All Newborns: Caring for Displaced Neonates: Intrastate

Woman’s Hospital in Baton Rouge, Louisiana, one of the first women’s specialty hospitals in the nation, is a 225-bed, private, not-for-profit organization that delivers more than 8000 infants each year. Sick newborns and infants less than 1 year of age are cared for in the 83-bed Center for Newborn and Infant Care, comprised of a level III-C NICU,1 special care nursery (level II), developmental nursery, infant care center, and neonatal surgery center. A private physician group consisting of 9 neonatologists and 2 neonatal nurse practitioners (NNPs) provide in-house coverage on a 24/7 basis. The hospital employs 4 NNPs to serve as transport NNPs. The Louisiana Office of Emergency Preparedness (OEP) designated Woman’s Hospital as the referral center for high-risk obstetrical patients and neonates for both Hurricanes Katrina and Rita. In a period of 5 days, 87 neonates were transferred to Woman’s Hospital during Hurricane Katrina, and transports were arranged for an additional 34 infants to other facilities. Twenty-one neonates were transferred to Woman’s Hospital during Hurricane Rita. ### Peak Census: 61; Midnight Census: 56* Katrina, still in the Gulf of Mexico, became a category 2 hurricane, and by 11 pm, the landfall forecast was for just east of New Orleans, Louisiana.2 We knew Baton Rouge would experience some type of adverse weather. The Hospital Emergency Incident Command System contains 4 increasing states of storm readiness based on the type of tropical storm/hurricane watches and warnings issued for Baton Rouge. Level 2 was implemented, which included fueling of emergency power generator tanks, establishment of alternate communications, updating departmental emergency call lists, stocking of hospital linen, replenishment of emergency food and drinkable water supplies, battery charging on portable equipment, and an evaluation of current medication supplies in the pharmacy, with procurement of additional needed emergency medications. ### Peak Census: 59; Midnight Census: 54 Katrina became a category 3 hurricane. During the day, the … Address correspondence to Steven B. Spedale, MD, FAAP, PO Box 45171, Baton Rouge, LA 70895-4171. E-mail: steve.spedale{at}infamedics.com

Infant mortality and concepts of hygiene. Strategies and consequences in the Kaiserreich and the Weimar Republic: the example of Berlin

The fight against infant mortality followed the guidelines of “hygiene” and their modifications into social, racial, and national hygiene. In Berlin, the campaign to promote infant hygiene began in 1904, when the municipal authorities started to create infant care centers tentatively under the auspices of a charitable association. During and after the First World War, the authorities expanded this campaign to reflect a growing commitment to the principles of social and racial hygiene, which aimed both to improve social conditions that worked against the health of children and to strengthen the constitution of the race. While racial hygienists feared that social measures for the weak would promote degeneration by encouraging their survival, social hygienists argued that it was impossible to distinguish between “fit” and “unfit” in early childhood, and eugenics became increasingly important. Social hygiene as a means of prevention was reduced to a “systematical registration” of the more or less fit individuals. This development and the eugenic background of infant care created a link to the concept of selection in Nazi Germany.

A Model for Community Based Mother Infant Care Center: TMIC (transitional mother infant care center) using a Sanhujoriwon

A Model for Community Based Mother Infant Care Center: TMIC (transitional mother infant care center) using a Sanhujoriwon

Caregiver-Environment Scale: Assessing the Quality of Center-Based Infant Care

INTRODUCTION agree on presence of specified features of the infant’s milieu (e.g., environmental indicators), and (c) do indiDaily experiences have a profound effect on infant viduals affiliated with center-based infant care programs development. As the number of dual-parent employment perceive items on CES to be appropriate measures of rises, concurrent with an increase in single-parent famicaregiver–infant interactions and of an infant’s surlies, infant experiences increasingly occur in nonfamilial roundings? settings (Neugebauer, 1992). Accompanying this increase has been protracted debate over effects of nonfamilial infant care on children’s development (Belsky, METHOD 1986; Clarke-Stewart, 1988; Lamb & Sternberg, 1990), Subjects not as a homogeneous treatment but rather a complex experience influenced by many variables (Lamb & The CES examines both the characteristics of infant care personnel and the facility in which this center-based Sternberg, 1990). It appears that the quality of certain environmental and process variables affects later child care occurs. Participants in the study were 15 caregivers in nine private facilities providing care to infants. To be development. Yet, because environmental features are easier to assess, these are all too often the sole focus of included in the study, caregivers had to meet two criteria: (a) be a caregiver in a facility licensed by the Pennregulations and evaluations while more important process variables are neglected. Therefore, an instrument sylvania Department of Welfare, and (b) provide care to infants between the ages of 6 weeks and 12 months. that can identify many important factors and assesses their quality in infant care centers seems critical. An The physical context in which care occurred (i.e., center characteristics) was also assessed. overview of the development and field-testing of such an instrument, the Caregiver-Environment Scale (CES; Capone, Oren, & Neisworth, 1995) follows. Instrument and Observer’s Manual Development

Infants in Italy: An evaluation of other than mother care

As more and more women return to the work force while their children are but babies, other than mother care for infants outside their own home has become an issue of major import in this country. In Europe, however, more governments subsidize infant care for mothers who work outside the home. This paper reports on one such country, Italy. Italy has provided government sponsored infant care since 1925 and is currently in the process of remodeling the original infant care system. An overview of this delivery system was made, based on observation of 90 different infant care programs sponsored by the Italian government, ten private infant care centers and one training institution sponsored jointly by the Catholic Church and local government. These observations were made in large northern industrial cities as well as several small communities, and several large cities in central and southern Italy. Over 100 interviews included advisors, school administrators, city officials, pediatricians, psychiatrists, progr...

In an Infant Care Center

In an Infant Care Center

In an Infant Care Center

Severely ill babies receive the life-saving care they need in this specially designed, equipped, and staffed unit in a small community hospital.