Infants In Neonatal Intensive Care Unit Research Articles

Outcomes of a Breast Pump Combining Compression and Vacuum Technology in Exclusively Pumping Mothers of VLBW Infants in the NICU

Objective:To determine whether exclusively pumping mothers of very low birth weight (VLBW) neonatal intensive care unit (NICU) infants could achieve adequate milk production using the PJ’s Comfort®multiuser breast pump, with its compression and vacuum technology and flexible silicone breast cup.Methods:We employed a single-site, convenience sample, 24-month, prospective, nonexperimental, descriptive study in NICU mothers of VLBW infants who were asked to complete a pumping log for 15 days.Results:Of mothers with complete pumping logs (36/51), the mean time to first pumping was 9.5 hours and the mean number of pumping sessions was 7.4/24 hours. By day 15, 83% reached a milk volume of ≥350 mL/day, 66% reached ≥500 mL/day, and 29% reached ≥700 mL/day. Comments regarding the comfort, ease of use, and features of the pump were very favorable.Conclusions:Using current technologies, PJ’s Comfort®is a cost-effective option for establishing adequate milk production in mothers of VLBW infants in the NICU.

Acute Kidney Injury in Neonates: A Single-Center Experience

Background: Neonatal intensive care unit infants frequently experience acute kidney damage. Estimates of the prevalence of acute kidney vary depending on the definitions used. In Iraq, studies addressing the prevalence and risk factors of acute kidney injury in this age group are scarce, none of which has implicated the KDIGO diagnostic and staging criteria. Objectives: To describe the prevalence, demographics, risk factors, etiology, and staging of acute kidney injury using KDIGO criteria in the Neonatal intensive care unit and correlate these findings with patient outcomes. Methods: A retrospective study was conducted in the Neonatal Intensive Care Unit/ CWTH/ Medical City Complex/ Baghdad during the period from the 1st of August 2019 to the 15th of January 2020. All neonates diagnosed with acute kidney injury according to KDIGO –classification 2012 and admitted to the neonatal intensive care unit were included in this study. Demographics, clinical staging, and investigations were retrieved from patients' notes. Results: The prevalence of acute kidney damage was 7.2%. The mean gestational age of the patients was 36.8 ± 2.9 weeks, 58% of them were full-term, with a male-to-female ratio of 1.40:1. Stage I patients represented 35.1%, 43.2% were stage 2, and 21.6% had severe stage 3. Acute kidney injury-related mortality was 35.1%. The term female sex, high birth weight, and age younger than seven days at diagnosis predicted a bad prognosis. Vaginally delivered, stage III acute kidney injury-KDIGO, and peritoneal dialysis patients had the worst outcomes. Asphyxia was a major cause of acute kidney injury (P=0.001). High blood urea (P=0.01), low PH (P=0.009), low HCO3 (P=0.001), low WBC count (P=0.001), and low platelet count (0.001) were associated with unfavorable outcomes. Conclusions: The prevalence of acute kidney injury, according to KIDGO diagnostic and staging criteria, is 7.1%. Asphyxia, female gender, and vaginal deliveries are variables associated with poor prognosis in addition to advanced illness stage and laboratory indicators. Received: Dec. 2022 Accepted: Jun 2023 Published: Oct.2023

Evaluation of Occupational Therapy and Music Therapy Co-Treatment in the Neonatal Intensive Care Unit

Aims To examine co-treatment with music therapy and occupational therapy with infants in the neonatal intensive care unit (NICU). Methods A quasi-experimental design was used to study the effect of standard care occupational therapy (SCOT) vs co-treatment with music therapy (Co-Tx) on behavioral state and physiologic measures. 46 participants were enrolled in the study. Interventions were implemented in approximately 20-minute sessions. Physiologic measures, heart rate (HR) and oxygen saturation (SpO2), were collected using Sickbay. Behavioral measures were collected using The Face, Legs, Activity, Cry, and Consolability (FLACC) Pain Assessment Tool. Results Mean heartrates during Co-Tx (161.3 ± 15.4 BPM) did not differ significantly compared to SCOT (161.8 ± 15.7 BPM). In unadjusted comparisons, mean SpO2 levels were significantly higher during Co-Tx than SCOT (95.48 ± 3.43% vs. 95.12 ± 3.71%, p = 0.046). There was a significant decrease in pre- to post-test FLACC scores for Co-Tx when compared to SCOT (decrease of 0.97 ± 1.96 vs. 0.61 ± 1.65, p = 0.023). In adjusted comparisons, there were no statistically significant differences in physiological outcomes. Conclusions Co-treatment with music therapy may create a more stable and regulated environment for NICU infants. Further research is recommended on music therapy co-treatment with rehabilitative therapies.

A Pilot Study of Decellularized Cartilage for Laryngotracheal Reconstruction in a Neonatal Pig Model.

Severe subglottic stenosis develops as a response to intubation in 1% of the >200,000 neonatal intensive care unit infants per year and may require laryngotracheal reconstruction (LTR) with autologous hyaline cartilage. Although effective, LTR is limited by comorbidities, severity of stenosis, and graft integration. In children, there is a significant incidence of restenosis requiring revision surgery. Tissue engineering has been proposed to develop alterative grafting options to improve outcomes and eliminate donor-site morbidity. Our objective is to engineer a decellularized, channel-laden xenogeneic cartilage graft, that we deployed in a proof-of-concept, neonatal porcine LTR model. Meniscal porcine cartilage was freeze-thawed and washed with pepsin/elastase to decellularize and create microchannels. A 6 × 10-mm decellularized cartilage graft was then implanted in 4 infant pigs in an anterior cricoid split. Airway patency and host response were monitored endoscopically until sacrifice at 12 weeks, when the construct phenotype, cricoid expansion, mechanics, and histomorphometry were evaluated. The selective digestion of meniscal components yielded decellularized cartilage with cell-size channels. After LTR with decellularized meniscus, neonatal pigs were monitored via periodic endoscopy observing re-epithelization, integration, and neocartilage formation. At 12 weeks, the graft appeared integrated and exhibited airway expansion of 4 mm in micro-CT and endoscopy. Micro-CT revealed a larger lumen compared with age-matched controls. Finally, histology showed significant neocartilage formation. Our neonatal porcine LTR model with a decellularized cartilage graft is a novel approach to tissue engineered pediatric LTR. This pilot study sets the stage for "off-the-shelf" graft procurement and future optimization of MEND for LTR. NA Laryngoscope, 134:807-814, 2024.

Molecular characteristics and clinical features of Staphylococcus epidermidis healthcare-associated late-onset bacteremia among infants hospitalized in neonatal intensive care units

BackgroundThough Staphylococcus epidermidis was the most common pathogen of late-onset sepsis (LOS) in neonatal intensive care units (NICUs), there haves been scanty reports on molecular epidemiology of S. epidermidis isolates from infants stayed in NICU and on correlation of molecular characteristics with clinical features in these infants. MethodsWe collected and characterized S. epidermidis bloodstream isolates from infants hospitalized in NICU of a medical center in Taiwan between 2018 and 2020. Medical records of these infants were retrospectively reviewed. ResultsA total of 107 isolates identified from 78 episodes of bacteremia in 75 infants were included for analysis. Of the 78 isolates (episodes), 24 pulsotypes, 11 sequence types (STs), and 5 types of staphylococcal chromosomal cassette (type I–V) were identified. ST59 and its single locus variant ST1124 (37.2%) comprised the most common strain, followed by ST35 (14.1%), ST2 (11.5%), and ST89 (10.3%). All but 5 isolates (73/78, 93.6%) belonged to clonal complex (CC) 2. Comparing infants infected with genetically different strains, the patients with underlying immune disease were significantly associated with ST2 infection (P = 0.021), while no statistically significant differences were found in terms of clinical and laboratory characteristics. Only 3.8% of the isolates were susceptible to oxacillin. ConclusionsMore than 90% of S. epidermidis bloodstream isolates from infants in NICU in Taiwan were resistant to oxacillin. Though diverse, more than 90% of the isolates (episodes) belonged to CC2. No statistically significant differences were found in terms of clinical characteristics among the infants infected with genetically different strains.

Application of Trauma-Informed Care Principles to Care Needs Identified by Mothers of NICU-Hospitalized Children

Systematic uptake of family-centered care (FCC) interventions remains challenging and frequently suboptimal in many neonatal intensive care units (NICUs). Across NICUs in the United States, integrating family members as partners in infant caregiving and decision-making has not been well supported and routine screening and provision of psychological support for parents remains inadequate. Trauma-informed care (TIC) may offer a more comprehensive approach to NICU care which can encompass FCC principles and promote family recovery and resilience by recognizing and responding to the traumas experienced by NICU infants and families. The current paper aimed to understand needs identified by mothers of NICU-hospitalized children and reports a focused analysis of one-on-one interview data (n = 13 mothers) collected during a larger mixed methods study. Reflexive thematic analysis was used to understand needs identified by mothers and to explore how these needs aligned with TIC principles. Six themes were identified and subsequently examined in the context of the principles of TIC: I Just Had No Control, That Really Caught Us Off Guard, So Much Was Already Taken Away, We’re People and There Needs To Be More Support and Practices Which Helped. Mothers’ care needs were found to align with TIC principles. Findings suggest that implementation of TIC principles in NICU settings can support parental presence, participation in infant care, and mental health and support the potential of TIC as a more comprehensive approach to meeting the needs of NICU parents.

Time-domain Features of Angular-velocity Signals for Camera-based Respiratory RoI detection: A Clinical Study in NICU.

Camera-based measurement of respiratory rate (RR) is emerging for preterm infants monitoring in Neonatal Intensive Care Units (NICU). Accurate detection of respiratory region of interest (Resp-RoI), e.g. thorax and abdomen of infants, is essential for achieving a fully-automatic solution and for high-quality RR estimation. However, the application of fast Fourier transform (FFT) for detecting Resp-RoI in premature infants may not be appropriate due to their irregular breathing patterns. This study proposes a new method for detecting Resp-RoIs in premature infants that uses time-domain features of angular-velocity of respiration. By fusing respiratory motion on orthogonal directions, the proposed method is more robust to variations of infant posture in the incubator.. In addition, using inter-beat interval (IBI) features in the time domain helps to distinguish between Resp-RoI and background. The proposed method was validated on 20 preterm infants in NICU. It obtains a clear improvement on Resp-RoI detection (RoI correspondence = 0.74) and RR estimation (MAE = 3.62 bpm) against the benchmarked approaches (maxFFT: RoI correspondence = 0.45, MAE = 5.61 bpm).

Circumstances, causes and timing of death in extremely preterm infants admitted to NICU: The EPIPAGE-2 study.

To describe the circumstances, causes and timing of death in extremely preterm infants. We included from the EPIPAGE-2 study infants born at 24-26 weeks in 2011 admitted to neonatal intensive care units (NICU). Vital status and circumstances of death were used to define three groups of infants: alive at discharge, death with or without withholding or withdrawing life-sustaining treatment (WWLST). The main cause of death was classified as respiratory disease, necrotizing enterocolitis, infection, central nervous system (CNS) injury, other or unknown. Among 768 infants admitted to NICU, 224 died among which 89 died without WWLST and 135 with WWLST. The main causes of death were respiratory disease (38%), CNS injury (30%) and infection (12%). Among the infants who died with WWLST, CNS injury was the main cause of death (47%), whereas respiratory disease (56%) and infection (20%) were the main causes in case of death without WWLST. Half (51%) of all deaths occurred within the first 7 days of life, and 35% occurred within 8 and 28 days. The death of extremely preterm infants in NICU is a complex phenomenon in which the circumstances and causes of death are intertwined.

Neonatal Intraventricular Hemorrhage Presenting as Pyrexia of Newborn: A Case Report

Abstract: 
 Background Temperature instability is a relatively common presenting symptom in a Neonatal Intensive Care Unit (NICU) with sepsis being one of the major etiologies that need to be ruled out. However, an important differential diagnosis is a central fever. Many cases of Intracranial Hemorrhage/Intraventricular Hemorrhage (ICH/IVH) present with temperature dysregulation with no other clear associated symptoms, and cranial imaging for early identification and treatment of ICH/IVH is crucial. 
 Case report A 3-day-old male born at 33 weeks and four days of gestation who was admitted to the neonatal critical care unit due to prematurity and respiratory distress was noted to be febrile during the fourth hospital day. The septic screen was negative, and the patient continued to spike fever while on broad-spectrum antimicrobial treatment. Due to an unexplained drop in his hematocrit, cranial ultrasound was done, and grade III IVH was identified. The patient continued to improve clinically, but the exact etiology of his IVH was not identified. His fever resolved without interventions, and his IVH continued to decrease in size. Serial cranial imaging was done in NICU, and no neurosurgical interventions were warranted. He was referred to neurosurgery and neurology and followed in the infant’s high-risk clinic. 
 Discussion Sepsis is the top of differentials when managing a newborn infant in NICU. However, we must always keep our minds open to other differentials, including central hyperthermia. Extreme prematurity is a major risk factor for ICH/IVH in the neonatal period; nonetheless, other risk factors are identified, and many cases of ICH/IVH had no identified causative factor or even risk factors. 
 Conclusion Identifying clinical presentation and risk factors associated with ICH and IVH in NICU patients is crucial for early diagnosis and offers appropriate management. A high index of suspicion is required to promptly diagnose ICH/IVH resulting in central fever and avoid unnecessary workup and treatment.

Neonatal Intensive Care Unit Latent Profiles of Maternal Distress: Associations With 5-Year Maternal and Child Mental Health Outcomes

To examine profiles of distress of mothers of preterm infants in the neonatal intensive care unit (NICU) and relate profiles to maternal and child outcomes at child age 5 years. A racially and economically diverse sample of mothers (n= 94; 39% African American, 52% White) of preterm infants (≤30 weeks of gestation) completed validated questionnaires assessing depression, anxiety (state and trait), NICU stress, and life stress at NICU discharge of their infant. Mothers reported on their own and their children's symptomatology at child age 5. A latent profile analysis was conducted to categorize maternal symptomatology. Latent profile analysis yielded 4 distinct maternal profiles: low symptomatology, high NICU stress, high depression and anxiety, and high state anxiety. Social determinants of health factors including age, education, neighborhood deprivation, and infant clinical risk distinguished the profiles. Mothers in the high depression and anxiety profile reported more anxiety and life stress at follow-up and reported their children experienced more anxious/depressed symptoms. Existing literature has gaps related to examining multiple dimensions of NICU distress and understanding how patterns of mood/affective symptoms, life stressors, and related social determinants of health factors vary across mothers. In this study, one specific profile of maternal NICU distress demonstrated enduring risks for poorer maternal and child mental health outcomes. This new knowledge underscores sources of disparate health outcomes for mothers of preterm infants and the infants themselves. Universal screening is needed to identify at-risk dyads for poor health outcomes in need of individualized interventions that address both maternal and child well-being. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

Early pumping frequency and coming to volume for mother's own milk feeding in hospitalized infants.

To identify daily pumping frequencies associated with coming to volume (CTV: producing > 500 milliliters of milk per day by postnatal day 14) for mothers of infants in the neonatal intensive care unit (NICU). We compared demographics and daily pumping frequencies for mothers who did and did not experience CTV. Of 427 mothers who produced milk, 201 (50.1%) experienced CTV. Race, insurance, delivery type and birthweight were associated with CTV. For mothers who experienced CTV, average pumping episodes increased daily, stabilizing at 5 pumping episodes per day by postnatal day 5 (5 × 5). Women who experienced CTV were also more likely to have pumped between 0100 and 0500 (AM pumping). In multivariable analysis birthweight, 5 × 5 and AM pumping were each independently associated with CTV. Supporting mothers of NICU infants to achieve 5 or more daily pumping sessions by postnatal day 5 could improve likelihood of achieving CTV.

Self-Efficacy and Outcomes in Women with Diabetes: A Prospective Comparative Study.

Background: Breastfeeding is especially beneficial to women with diabetes and their infants, yet diabetic mothers frequently experience less favorable breastfeeding outcomes. Objectives: To identify facilitators and barriers to breastfeeding for women with diabetes by comparing cognitive and social factors, health and hospital-related factors, and breastfeeding outcomes between women with and without diabetes. Design/Methods: Women with any type of diabetes (n = 28) and without diabetes (n = 29) were recruited during pregnancy. Data were collected from the electronic medical record and maternal surveys at 24-37 weeks' gestation, birth hospitalization, and 4 weeks' postbirth. We compared differences in mother's regard for breastfeeding, breastfeeding intention, and birth hospital experience by diabetes status, and estimated odds ratios for exclusive breastfeeding (EBF) and unmet intention to breastfeed. Results: Women with and without diabetes had similar breastfeeding intentions, attitudes, and self-efficacy. Women with diabetes were less likely to EBF, and more likely to have unmet intentions to EBF at hospital discharge, compared to women without diabetes. At 4 weeks' postpartum, there was no difference in breastfeeding by diabetes status, although EBF at hospital discharge was strongly associated with EBF at 4 weeks. Infant neonatal intensive care unit (NICU) admission and hypoglycemia were significantly associated with diabetes status, reduced EBF rates, and unmet breastfeeding intentions. Conclusions: Despite having a strong intent to breastfeed, women with diabetes experienced less favorable early breastfeeding outcomes and were less likely to meet their own breastfeeding goals. These differences may be driven by neonatal complications, such as infant hypoglycemia and NICU admissions, rather than maternal cognitive and social factors.

Model-based subcutaneous insulin for glycemic control of pre-term infants in the neonatal intensive care unit

Hyperglycaemia is a common problem in neonatal intensive care units (NICUs). Achieving good control can result in better outcomes for patients. However, good control is difficult, where poor control and resulting hypoglycaemia reduces outcomes and confounds results. Clinically validated models can provide good control, and subcutaneous insulin delivery can provide more options for insulin therapy for clinicians. However, this combination has only been significantly utilised in adult outpatient diabetes, but could hold benefit for treating NICU infants. This research combines a well-validated NICU metabolic model with subcutaneous insulin kinetics models to assess the feasibility of a model-based approach. Clinical data from 12 very/extremely pre-mature infants was collected for an average study duration of 10.1 days. Blood glucose, interstitial and plasma insulin, as well as subcutaneous and local insulin were modelled, and patient-specific insulin sensitivity profiles were identified for each patient. Modelling error was low, where the cohort median [IQR] mean percentage error was 0.8 [0.3 3.4] %. For external validation, insulin sensitivity was compared to previous NICU cohorts using the same metabolic model, where overall levels of insulin sensitivity were similar. Overall, the combined system model accurately captured observed glucose and insulin dynamics, showing the potential for a model-based approach to glycaemic control using subcutaneous insulin in this cohort. The results justify further model validation and clinical trial research to explore a model-based protocol.

Pain responses in preterm infants and parental stress over repeated painful procedures: a randomized pilot trial

Objectives In this pilot study, the aims were to determine the feasibility of whether pain behavior in extremely and very preterm infants and perceived parental stress change when parents are involved in pain reducing measures, either actively, performing facilitated tucking or passively, observing the intervention, in comparison to the involvement of nurses only. In addition, the infant’s pain reactivity and parental stress over three time points of measurement was of interest. Methods Extremely and very preterm infants in need of subcutaneous erythropoietin were randomly assigned to the two intervention groups. The intervention encompassed that one parent of each infant was involved during the painful procedure: Either parents executed facilitated tucking themselves or stood by, observing the procedure. Usual care involved that nurse executed facilitated tucking. All infants received 0.5 ml of 30% oral glucose solution via cotton swab before the painful procedure. Infant pain was observed with the Bernese Pain Scale for Neonates (BPSN) and measured with the MedStorm skin conductance algesimeter (SCA) before, during, and after the procedure. Parents’ stress levels were measured before and after the painful procedure on the infant, using the Current Strain Short Questionnaire (CSSQ). Feasibility of a subsequent trial was determined by assessing recruitment, measurement and active parental involvement. Quantitative data collection methods (i.e. questionnaires, algesimeter) were employed to determine the number of participants for a larger trial and measurement adequacy. Qualitative data (interviews) was employed to determine parents’ perspectives of their involvement. Results A total of 13 infants (98% participation rate) were included along with their mothers. Median gestational age was 27 weeks (IQR 26-28 weeks), 62% were female. Two infants (12.5%) dropped out of the study as they were transferred to another hospital. Facilitated tucking turned out to be a good method to actively involve parents in pain reducing measures. No significant differences between the two intervention and control groups were found concerning parental stress and infant pain (p = .927). Power analysis indicated that at least N = 741 infants (power of 81%, α = .05) would be needed to obtain statistically significant results in a larger trial, as effect sizes were smaller than expected. Two of the three measurement tools – i.e. the BPSN and CSSQ) – proved easy to implement and were well accepted. owever, the SCA was challenging in this context. Measurements were also found to be time-consuming and resource-intense (i.e. health professionals as assistants). Conclusions Although the intervention was feasible and was readily accepted by parents, the study design was found to be challenging along with the SCA. In preparation of the larger trial, the study design needs to be revisited and adjusted. Thus, issues of time and resources may be resolved. In addition, national and international collaboration with similar neonatal intensive care units (NICU) needs to be considered. Thus, it will be possible to conduct an appropriately powered larger trial, which will yield important results to improve pain management in extremely and preterm infants in NICU.

The Effect of Gentle Touch on Cardiorespiratory Indices and Pain Behaviors Related to Venipuncture and Blood Sampling in Preterm Infants Under Intensive Care.

Infants undergo extremely painful procedures in a Neonatal Intensive Care Unit (NICU), which if left uncontrolled may cause complications. Therefore, this study was conducted to investigate gentle touch effect on cardiorespiratory indices and pain behaviors related to venipuncture and blood sampling in preterm infants. A quasi-experimental study was undertaken in gentle touch and control groups in three stages. The population included premature infants in NICU of Al-Zahra Hospital, Isfahan, Iran. Using convenience sampling, 52 infants were randomly selected and assigned to two groups (n = 26). Gentle touch technique and measurement of cardiorespiratory indices were performed 5 minutes before, during, and 5 minutes after procedure, and routine care was provided for control group. Neonatal pain and cardiorespiratory indices were assessed using the Neonatal Infant Pain Scale (NIPS) and an intensive care monitor. Data was analyzed using repeated measures ANOVA, independent t-test, and Chi-square test in SPSS software. The independent t-test revealed a significant difference between mean pain score of the infants in two groups during the procedures (t50 = -3.32, p = 0.002), but no significant different was between groups before and after the procedure (p > 0.05). However, the cardiorespiratory indices were not significantly different before, during, and after the procedure (p > 0.05). The results suggest that gentle touch reduced the infants' pain during venipuncture and blood sampling. Thus, it is recommended this method be applied to mitigate pain in premature infants.

Early Diagnosis of Late-Onset Neonatal Sepsis Using a Sepsis Prediction Score

Sepsis represents a common cause of morbidity in the Neonatal Intensive Care Unit (NICU). Our objective was to assess the value of clinical and laboratory parameters in predicting septicemia (positive blood culture) in NICU infants. In the first part of the present study (derivation cohort) we retrospectively reviewed the clinical files of 120 neonates with symptoms of suspected sepsis and identified clinical and laboratory parameters associated with proven sepsis on the day the blood culture was taken, as well as 24 h and 48 h earlier. These parameters were combined into a sepsis prediction score (SPS). Subsequently (validation study), we prospectively validated the performance of the SPS in a cohort of 145 neonates. The identified parameters were: temperature instability, platelet count < 150,000/mm3, feeding volume decrease > 20%, changes in blood glucose > 50%, CRP > 1 mg/dL, circulatory and respiratory deterioration. In the retrospective cohort, on the day the blood culture was obtained, a SPS ≥ 3 could predict sepsis with 82.54% sensitivity, 85.96% specificity, 5.88 PLR (Positive Likelihood Ratio), 0.20 NLR (Negative Likelihood Ratio), 86.67% PPV (Positive Predictive Value), 81.67% NPV (Negative Predictive Value) and 84.17% accuracy. In the prospective cohort, on the day the blood culture was obtained, a SPS ≥ 3 could predict sepsis with 76.60% sensitivity, 72.55% specificity, 2.79 PLR, 0.32 NLR, 83.72% PPV, 62.71% NPV and 75.17% accuracy. We concluded that this combination of clinical and laboratory parameters may assist in the prediction of septicemia in NICUs.

Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China

Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34+0 weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.

Effect of oral stimulation in improving feeding performance of pre-term infants in NICU: A systematic review

Aim: The Aim of this systematic review is to evaluate the effectiveness of oral stimulation techniques in improving feeding performance among pre-term infants in neonatal intensive care units (NICUs). Method: We conducted a comprehensive literature search of electronic databases, including PubMed, CINAHL, and Cochrane Library, from 2010-2021. Studies were included if they investigated the effect of oral stimulation on feeding performance outcomes such as time to full enteral feeding, weight gain, and length of hospital stay. Two reviewers independently assessed the quality of the studies using the Cochrane risk-of-bias tool and extracted data using a standardized data extraction form, and data were synthesized using a narrative approach due to heterogeneity in study design and outcome measures. Result: Our search identified 10 studies that met the inclusion criteria, consisting of randomized controlled trials, quasi-experimental studies, and case series. Eight studies reported significant improvements in feeding performance outcomes with the use of oral stimulation interventions compared to standard care or placebo. The remaining two studies reported mixed findings or no significant differences between groups. Overall, the quality of evidence was low to moderate due to methodological limitations and inconsistency in outcome reporting. Our findings suggest that oral stimulation techniques such as non-nutritive sucking, pacifier-activated device, and oral motor exercises are effective in improving feeding performance among pre-term infants in NICUs. These techniques were associated with reduced time to achieve full oral feeds, shortened hospital stay, and improved weight gain compared to control groups. Conclusion: The results of this systematic review suggest that oral stimulation may be an effective intervention for improving feeding performance in pre-term infants in NICUs. However, further research is needed to establish the optimal timing, frequency, and duration of oral stimulation interventions, as well as their long-term effects on growth and development. Future studies should also address methodological limitations, such as small sample sizes and lack of blinding, to improve the quality of evidence in this field. Significance of the study: Oral feeding is a difficult job for premature infants those who are admitted to NICU. Because of poor muscle tone, underdeveloped oral motor skills and reduced suck-swallow-breathe synchronization, they are unable to commence feeds from the bottle and breast immediately after birth, unlike full-term infants. As long as oral feeding is not developed, a number of non-oral feeding methods are employed which feeding methods can cause severe side effects 1. The primary barrier to oral feeding in infants with gestational age less than 34 weeks is the lack of coordination in sucking, swallowing, and breathing. Oral feeding in these infants can cause apnoea, decreased pulse oximetry, transient bradycardia, and aspiration. Therefore, in neonates those who do not reach the gestational age of 34 weeks for them bottle or breastfeeding are not considered, and developmental transition from gavage to oral feeding in a 28-week-old infant may take 6 weeks or longer. Several studies have shown that oral motor intervention on infants less than 34 weeks results in decreased transition time from gavage to oral feeding 2.

The effect of instructing mothers in attachment behaviors on short-term health outcomes of premature infants in NICU.

The birth of a pre-mature infant and subsequent hospitalization and separation from the family can impair maternal and neonatal attachment and quality of maternal care. This study aimed to assess the effect of instructing mothers in attachment behaviors on short-term health outcomes of pre-mature infants admitted to neonatal intensive care units (NICUs). In this quasi experimental study, 80 mothers of pre-mature infants who were admitted to NICUs at two referral health centers in northern Iran were studied in two groups in 2018. Attachment behaviors were taught to mothers in the test group during four consecutive sessions. Mother-infant attachment behaviors were evaluated at both the beginning and the end of this study using a checklist derived from Avant's Maternal Attachment Assessment Strategy. Moreover, infants' short-term health consequences were investigated in two groups. SPSS 18 statistical software was used for data analysis. On average, it took respectively 34.90 ± 12/65 and 31/15 ± 14/35 days for the infants in the control and the intervention group to reach full oral feeding and 38/5 (38/4-42/11) and 37 (31/85-42/14) days to gain the minimum weight required for discharge. Moreover, the mean length of stay for the infants in the control and the intervention group was 41/80 ± 13/86 and 39/02 ± 16/01 days, respectively (P > 0/05). Instructing mothers in attachment behaviors clinically improved short-term health-related outcomes. Hence, this intervention is recommended to be incorporated in the care program for mothers with pre-mature infants.

2315. Impact of MSSA Surveillance and Decolonization on Invasive Infection in the Neonatal ICU

Abstract Background Invasive methicillin-susceptible Staphylococcus aureus (MSSA) infections are an important cause of morbidity and mortality in neonatal intensive care unit (NICU) infants. MSSA colonization (asymptomatic carriage in the nose, skin, or gut) is a risk factor for subsequent invasive infection (e.g., pneumonia, bone infections, bloodstream infections, etc). Active surveillance programs coupled with decolonization measures for MSSA-colonized infants have been associated with decreased invasive MSSA infection rates in the NICU setting. Methods In June 2020, an active surveillance program was implemented to detect MSSA nasal colonization for infants admitted to the St. Louis Children’s Hospital NICU, a 140-bed quaternary NICU. MSSA-colonized infants were decolonized with a 7 day course of intranasal mupirocin twice daily plus topical chlorhexidine baths on days 1, 4, and 7 (for infants greater than 30 weeks postmenstrual age). MSSA bloodstream infection (BSI) rates were followed quarterly pre- (September 2018-May 2020) and post- (June 2020-March 2022) implementation of MSSA surveillance and decolonization. Mean MSSA BSI rates pre- and post-implementation were compared via paired T-test. The number of infants treated with mupirocin was calculated pre- and post-implementation. Results After implementing MSSA surveillance and decolonization there was no significant change in the mean MSSA BSI rate (Figure): 0.22 per 1000 patient-days pre-implementation, 0.16 per 1000 patient-days post-implementation (p=0.37). Since initiating MSSA decolonization in June 2020, the number of NICU infants exposed to mupirocin increased nearly fourfold: mean 10 infants treated per month pre-implementation, mean 38 infants treated per month post-implementation. Conclusion Implementing an MSSA surveillance and decolonization program in the NICU was not associated with a sustained decrease in invasive MSSA infections. However, mupirocin use in the NICU nearly quadrupled following implementation. Additional investigation is warranted to identify potential contributing factors for unchanged invasive MSSA infection rates despite active surveillance and decolonization (e.g., emerging mupirocin resistance). Disclosures All Authors: No reported disclosures.