Infants In NICU Research Articles

The Otoacoustic Emissions in the Universal Neonatal Hearing Screening: An Update on the European Data (2004 to 2024).

Background: The reported data on European universal neonatal hearing screening (UNHS) practices tend to be scarce, despite the fact that the European Union project, EUScreen, collected unofficial data from 38 collaborating European institutions. The objectives of this systematic review were as follows: (a) to identify the most recent (in a 20-year span) literature information about UNHS programs in Europe and (b) to provide data on the procedures used to assess the population, the intervention policies, and on the estimated prevalence of congenital hearing loss with emphasis on the bilateral hearing loss cases. Methods: Queries were conducted via the Pubmed, Scopus and Google Scholar databases for the time period of 2004-2024. The Mesh terms used were "OAE", "Universal Neonatal Hearing Screening", "congenital hearing loss" and "well babies". Only research articles and review papers of European origin were considered good candidates. The standard English language filter was not used, in order to identify information from non-English-speaking scientific communities and groups. Results: Very few data and reports were identified in the literature search. Eleven manuscripts were identified corresponding to eight UNHS programs. Except in Poland, most of the data refer to regional and not national programs. The screening coverage estimates of all programs exceed 90%; infants were mostly assessed by a three-stage protocol (TEOAE + TEOAE + AABR), followed by a clinical ABR test. The average prevalence (i.e., from well babies AND NICU infants) of bilateral hearing loss ranged from 0.5 to 20.94 per 1000 (Zurich sample). Infants presenting unilateral or bilateral hearing losses were first rehabilitated by hearing aids and consequently (>15 mo) by cochlear implants. Conclusions: Even though UNHS programs are well-established clinical practices in the European States, the amount of information in the literature about these programs is surprising low. The existing data in the timespan 2004-2024 corroborate the international UNHS data in terms of coverage and bilateral hearing loss prevalence, but there is a strong need to supplement the existing information with the latest developments, especially in the area of hearing loss rehabilitation.

NICU Warriors: Engaging and Promoting the Mental Health of Black Fathers

ABSTRACT Although newborn intensive care (NICU) research highlights the mental health and support needs of parents, a majority of the research and interventions focus on the needs of the mother. Engaging and partnering with male caregivers (like female caregivers) in the care of their NICU infants yields positive health outcomes for the infant and better mental health outcomes for the father. Yet there are few articles about male NICU caregiving experiences, and scant articles exploring the mental health and support needs of Black NICU fathers. Utilizing two case studies of Black fathers, this paper will identify their mental health needs. This article will outline and integrate the Recommendation for Psychosocial Support of NICU Families and existing literature to these case studies. Based on their unique needs, NICU providers must do more to engage Black fathers and explore alternative models of care that are culturally aware for psychosocial support.

Muscle growth and motor development in NICU graduates and infants at high-risk of adverse neurological outcome over the first year

Muscle growth and motor development in NICU graduates and infants at high-risk of adverse neurological outcome over the first year

The Effect of Video Calls Held Between Preterm Babies Hospitalized in the Neonatal Intensive Care Unit and Their Mothers on the Amount of Breast Milk: A Randomized Controlled Trial

Objective: In this study, it was aimed to investigate the effect of video calls held between preterm babies hospitalized in NICU and their mothers on the amount of breast milk. Methods: This study is a randomized controlled trial. This study was conducted in the NICU of Balıkesir Atatürk City Hospital between 15 April-01 October 2022. One hundred preterm infants and their mothers, 50 in video call and 50 in control groups, were included. Online video calls between the preterm infants and their mothers were held by using Zoom application as 10 minutes on every day of the week. The breast milk follow-up form was sent to the mothers over WhatsApp application and the mothers sent the form back to the researcher at the 7th day. As per the standard hospital protocol, mother who control group can visit their infants in NICU face-to-face two days a week and get information about their infants. Results: No statistically significant difference was determined between the video call group and the control group in terms of 7-day breastmilk amount; however, the breast milk of the mothers in the video call group increased more on the 7th day compared to the control group (p<.001). Conclusions: It was found that the amount of breast milk increased more in the mothers in the experimental group at the end of day 7 compared to the control group mothers. Preterm delivery is among the factors that lead to inadequate breast milk expression. NICU nurses can make use of virtual patient visit technology in order to increase the amount of breast milk in mothers.

The influence of infant characteristics on postpartum depression among mothers with hospitalized infant in NICU.

The purpose of the study to determine the prevalence of mother postpartum depression and to examine the association between infant characteristics and postpartum depression in the neonatal intensive care unit. A quantitative cross-sectional survey design was conducted in three government teaching hospitals in Jordan. A convenience sample of 188 mothers with hospitalized 188 infants in NICU was recruited. Questionnaires were used to collect the quantitative data, which include Infant Demographic Data Questionnaire, Mother Demographic Data Questionnaire and Edinburgh Postnatal Depression Scale (EPDS). The study revealed that infant characteristics such as gestational age, medical condition classification, and birth weight are found to be significant factors that influence depression among mothers. The results showed that mothers with infants admitted to NICU experience postpartum depression with a mean of 3.82 and median of 4.04. There were significant differences based on gestational age, birth weight, and classification of medical condition and mothers' postpartum depression. Knowing the relationship of certain infant's characteristics and postpartum depression can help to focus on relevant infant characteristics so that timely interventions to improve mothers' well-being can be developed.

Impact of Physician Characteristics on Late-Onset Sepsis (LOS) Evaluation in the NICU.

The threshold for a late-onset sepsis (LOS) evaluation varies considerably across NICUs. This unexplained variability is probably related in part to physician bias regarding when sepsis should be "ruled out". The aim of this study is to determine if physician characteristics (race, gender, immigration status, years of experience and academic rank) effect LOS evaluation in the NICU. This study includes a retrospective chart review of all Level III NICU infants who had a LOS evaluation over 54 months. Physician characteristics were compared between positive and negative blood culture groups and whether CBC and CRP were obtained at LOS evaluations. There were 341 LOS evaluations performed during the study period. Two patients were excluded due to a contaminant. Patients in this study had a birth weight of [median (Q1, Q3)]+ 992 (720, 1820) grams and birth gestation of [median (Q1, Q3)] 276/7 (252/7, 330/7) weeks. There are 10 neonatologists in the group, 5/10 being female and 6/10 being immigrant physicians. Experienced physicians were more likely to obtain a CBC at the time of LOS evaluation. Physician characteristics of race, gender and immigration status impacted whether to include a CRP as part of a LOS evaluation but otherwise did not influence LOS evaluation, including the likelihood of bacteremia.

Genomic testing and molecular diagnosis among infants with congenital heart disease in the neonatal intensive care unit.

To evaluate patterns of genetic testing among infants with CHD at a tertiary care center. We conducted a retrospective observational cohort study of infants in the NICU with suspicion of a genetic disorder. 1075 of 7112 infants admitted to BCH had genetic evaluation including 329 with CHD and 746 without CHD. 284 of 525 infants with CHD admitted to CMHH had genetic evaluation. Patterns of testing and diagnoses were compared. The rate of diagnosis after testing was similar for infants with or without CHD (38% [121/318] vs. 36% [246/676], p = 0.14). In a multiple logistic regression, atrioventricular septal defects were most high associated with genetic diagnosis (odds ratio 29.99, 95% confidence interval 2.69-334.12, p < 0.001). Infants with suspicion of a genetic disorder with CHD had similar rates of molecular diagnosis as those without CHD. These results support a role for genetic testing among NICU infants with CHD.

Real-Time Jaundice Detection in Neonates Based on Machine Learning Models

Introduction: Despite the many attempts made by researchers to diagnose jaundice non-invasively using machine learning techniques, the low amount of data used to build their models remains the key factor limiting the performance of their models. Objective: To build a system to diagnose neonatal jaundice non-invasively based on machine learning algorithms created based on a dataset comprising 767 infant images using a computer device and a USB webcam. Methods: The first stage of the proposed system was to evaluate the performance of four machine learning algorithms, namely support vector machine (SVM), k nearest neighbor (k-NN), random forest (RF), and extreme gradient boost (XGBoost), based on a dataset of 767 infant images. The algorithm with the best performance was chosen as the classifying algorithm in the developed application. The second stage included designing an application that enables the user to perform jaundice detection for a patient under test with the minimum effort required by capturing the patient’s image using a USB webcam. Results: The obtained results of the first stage of the machine learning algorithms evaluation process indicated that XGBoost outperformed the rest of the algorithms by obtaining an accuracy of 99.63%. The second-best algorithm was the RF algorithm, which had an accuracy of 98.99%. Following RF, with a slight difference, was the k-NN algorithm. It achieved an accuracy of 98.25%. SVM scored the lowest performance among the above three algorithms, with an accuracy of 96.22%. Based on these obtained results, the XGBoost algorithm was chosen to be the classifier of the proposed system. In the second stage, the jaundice application was designed based on the model created by the XGBoost algorithm. This application ensured it was user friendly with as fast a processing time as possible. Conclusion: Early detection of neonatal jaundice is crucial due to the severity of its complications. A non-invasive system using a USB webcam and an XGBoost machine learning technique was proposed. The XGBoost algorithm achieved 99.63% accuracy and successfully diagnosed 10 out of 10 NICU infants with very little processing time. This denotes the efficiency of machine learning algorithms in healthcare in general and in monitoring systems specifically.

"Light-Dark Cycle: Weight Gain and Reduction in Length of Stay in Premature NICU Infants"

"Light-Dark Cycle: Weight Gain and Reduction in Length of Stay in Premature NICU Infants"

Application and Research Progress of Hammock Position in Premature Infants in NICU

Application and Research Progress of Hammock Position in Premature Infants in NICU

Camera-Based Cardiorespiratory Monitoring of Preterm Infants in NICU

Camera-Based Cardiorespiratory Monitoring of Preterm Infants in NICU

Nurses' Performance Regarding Gravity Gavage Way Versus Injection Force on Gastric Residual Volume Among Preterm Infants in NICU

Nurses' Performance Regarding Gravity Gavage Way Versus Injection Force on Gastric Residual Volume Among Preterm Infants in NICU

Retracted: Readiness for Hospital Discharge and Its Correlation with the Quality of Discharge Teaching among the Parents of Premature Infants in NICU.

[This retracts the article DOI: 10.1155/2022/4924021.].

How NICU design and infant and family-centered developmental care act synergistically to support babies and families.

Recommended NICU Design Standards and Infant and Family Centered Developmental Care standards have complementary goals. Design standards focus on environmental modifications necessary to enhance NICU baby and family experiences and outcomes. Infant and Family Developmental Care Standards focus on the functional aspects of babies' and families' experience, including the caregiving environment. When applied in the NICU environment of care, both complementary evidence-based standards can function synergistically to promote better outcomes for babies and families.

Antibiotic Therapy for Pneumonia in the Neonatal Intensive Care Unit: Is 5 Days Enough?

Abstract Background Antibiotic therapy provided to infants in the NICU is associated with both short-and-long-term adverse consequences. In 2019, the Neonatal Antimicrobial Stewardship Program (NEO-ASP) at Nationwide Children’s Hospital (NCH), Columbus, OH, recommended a five-day antibiotic course with a time-out for treatment of pneumonia in the seven NCH network NICUs. Objective To determine the duration of antibiotic therapy for pneumonia after implementation of a 5-day antibiotic treatment course and describe its safety among infants in the NICU. Methods Prospective surveillance of antibiotic therapy provided to infants in 7 NCH NICUs (1, level 4; 5, Level 3; 1, level 2) who were diagnosed with pneumonia by the attending neonatologist based on clinical and radiographic abnormalities from 8/2020 to 4/2022. Pertinent clinical, laboratory, and microbiologic data were obtained from electronic health records. Infants were excluded if they had positive bacterial cultures of blood, urine, or cerebrospinal fluid. The length of therapy (LOT) was defined as any calendar day that the infant received ≥1 antibiotic while definitive treatment course was the duration of appropriate antibiotic therapy. Safety was defined a priori by re-initiation of antibiotic therapy within 14 days after discontinuation of the initial treatment and/or mortality (overall/sepsis-related). Results From 8/2020 to 4/2022, NICU infants (66% male) were diagnosed with 136 episodes of pneumonia at a median (IQR) age of 2 (1-20) days. 61 (45%) of episodes were late onset at ≥3 days of age. All infants had sterile cultures of blood, urine, and cerebrospinal fluid, if performed. Their median (IQR) birth weight and gestational age were 2780 (1090-3450) g and 36 (28-38) wk, respectively. At the time of pneumonia diagnosis, 44% of infants were receiving CPAP while 55% were on mechanical ventilation (11% high frequency oscillatory ventilation). The median (IQR) LOT was 6 (5-6) days and length of definitive treatment was 5 (5-5) days. Overall mortality was 5% (7/128) with 2% of deaths being sepsis-related (n=3; Table 1). The majority of pneumonia episodes (88%; n=120) were treated with 5 days of definitive antibiotic therapy and 22 (16%) episodes had antibiotics restarted within 14 days (Table 1). There was no significant difference in the composite safety outcome between ≤5 vs. 6-20 days of definitive antibiotic therapy (p=0.29). Table 1. Safety assessments of definitive antibiotic treatment for 136 pneumonia episodes in 128 infants Table 2. Underlying conditions, antibiotic duration, and cause of death among 7 infants in the NICU Conclusion(s) There was excellent adherence (88%) to the NEO-ASP recommendation of a 5-day definitive treatment course for pneumonia and in addition, the intervention seemed safe.

Impact of kangaroo father care in stable very low birth weight infants on father-infant bonding

Background and objectivesKangaroo Mother Care is an evidence-based low-cost intervention to improve infant survival, neurodevelopment, and the quality of mother-infant bonding. Similarly, Kangaroo Father Care(KFC) may promote bonding of fathers with their infants and make them feel less stressed. We planned this study to evaluate the impact of KFC on father-infant bonding using a self-administered Postpartum Bonding Questionnaire (PBQ). MethodsThis prospective observational before-after study was conducted in 30 fathers of stable very low birth weight infants in a tertiary NICU over 3 months. We evaluated the impact of KFC on father-infant bonding by administering the PBQ before and after 7 successive days of KFC. ResultsWe observed a statistically significant improvement in the scores for impaired bonding (p = 0.003), anger and rejection (p = 0.022) and anxiety about care (p = 0.005) after 7 days of KFC. ConclusionKFC for 7 days significantly increased bonding between father and infant and helped fathers who had impaired bonding, anger and anxiety towards care of their infant.

Serial neuroimaging of brain growth and development in very preterm infants receiving tailored neuropromotive support in the NICU. Protocol for a prospective cohort study.

Children born very preterm (VP) remain at risk for long-term neurodevelopmental impairment. Patterns of brain growth and injury, and how early neuropromotive therapies might mitigate developmental risk in VP infants remain insufficiently understood. This is a prospective cohort study of VP infants born at/before 32 weeks gestation. The study will enroll n = 75 consecutively-born VP infants in a level-III NICU. Exposed infants will be categorized into two groups (group 1: low-risk, n = 25 or group 2: high-risk, n = 25) based on the degree of neurological injury on early brain magnetic resonance imaging (MRI) at enrollment. Infants in the low-risk group (i.e., without significant injury defined as intraventricular hemorrhage with dilation, moderate or severe white matter injury, or cerebellar hemorrhage) will receive neurodevelopmental support utilizing the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, while infants in the high-risk group (with neurological injury) will receive more intensive neurorehabilitative support (SENSE-plus). Age-specific, tailored sensory experiences will be facilitated contingently, preferentially by the infant's family with coaching from NICU staff. VP infants in exposure groups will undergo a brain MRI approximately every 2 weeks from enrollment until term-equivalent to monitor brain growth and evolution of injury. Exposed infants will be compared with a reference group (group 3: n = 25), i.e. VP infants whose families decline initial enrollment in SENSE, and subsequently undergo a term-equivalent brain MRI for other purposes. The primary aim of this study is characterization of term-equivalent brain growth and development among VP infants receiving NICU-based neuropromotive interventions compared to VP infants receiving the standard of care. Secondary aims include defining the timing and factors associated with total and regional brain growth on serial brain MRI among VP infants, (Aim 2), and using early imaging to tailor developmental intervention in the NICU while exploring associations with outcomes in VP infants at discharge and at two years corrected age (Aim 3). This study will address gaps in understanding patterns of brain growth and injury drawing on serial MRI of hospitalized VP infants. These data will also explore the impact of intensive, tailored neuropromotive support delivered prior to term-equivalent on child and family outcomes.

64 Consensus Practice Recommendations Regarding Parental Presence in Canadian NICUs to Inform Ongoing and Post Pandemic Policies

Abstract Introduction/Background In March 2020, parental presence restriction policies were introduced in Canadian NICUs as institutions aimed to prevent COVID-19 transmission during the emerging global pandemic. However, parental presence in NICUs is necessary for maximizing parent and infant health outcomes, and there continues to be significant variation in parental restriction across Canadian NICUs. Objectives To identify the impact of parental restriction policies in Canadian NICUs on parents, infants, and healthcare providers and co-create practice recommendations for ongoing pandemic management and post-pandemic policies. Design/Methods A national survey was conducted to assess the impact of Canadian NICU restriction policies. Recommendations were developed through Delphi and Values and Preferences research methods. For the first Delphi survey, participants rated 50 items of importance from the national survey on a scale from 1 (very low importance) to 5 (very high). On the second Delphi survey, participants ranked the top 20 items from highest relative to lowest importance. A literature review was conducted for the top 10 items, and evidence of known benefits and harms was presented to the panel of decision-makers during the Values and Preferences consensus meetings. Participants voted on the inclusion of each item as a national recommendation and discussed additional caveats. A vote of 80% or more was deemed a consensus. Results Parents (n=426) and healthcare providers (n=205) completed a national survey, from which a list of reported impacts was derived. After two separate Delphi rounds (n=39, and n=20), a series of 10 recommendations with the highest rated importance were identified. A representative panel of decision-makers (n=20), including parents of NICU infants, NICU healthcare providers and managers, and infectious disease and public health policy-makers, took part in a Values and Preferences task. Items of importance included 7 strong recommendations (parents as essential caregivers, providing skin-to-skin contact, direct or mothers’ own expressed milk feeding, attending medical rounds, mental health and psychosocial services access, food and drink access, and inclusion of parent partners in pandemic response planning) and 6 conditional recommendations (providing hands-on care tasks, touch, two parents present at the same time, use of communication devices, and in-person access to medical rounds and mental health and psychosocial services). Consensus was reached on all items in favour of inclusion in national recommendations for Canadian NICUs. Conclusion These recommendations will guide ongoing and future pandemic management and policies with respect to parental presence and involvement in their infants’ care.

Trend and Predictors of Breastmilk Feeding among Very-Low-Birth-Weight Infants in NICU and at Discharge.

Mothers' own milk (MOM) for premature babies is considered a life-saving drug for its proven protective action against the complications of prematurity and for effects on outcome in the short and long term, especially neurological ones. We studied the use of MOM for infants weighing <1500 g for a period of 5 years, evaluating the trend over time and the impact of some variables on human milk feeding performance. Statistical comparisons concerned the rate of feeding with breast milk during a stay in an NICU and at discharge with respect to two types of variables: (1) maternal and neonatal characteristics (gestational age, birth weight, type of pregnancy (whether single or twin), maternal age) and (2) feeding characteristics (time of the start of minimal enteral feeding and availability of MOM, days until the achievement of full enteral feeding). Group comparisons were performed using ANOVA or t-test for continuous variables and Pearson chi-squared test or Fisher exact test for categorical variables. We observed an increase, between 2017 and 2021, in MOM use (p = 0.003). The availability of the own mothers' milk occurred, on average, on the fourth day of life and improved over the years. The start of minimal enteral feeding (MEF) with human milk averaged 1.78 days, and 54.3% of VLBWs received MEF with donor milk on the first day of life. The average percentage of feeding with the mothers' milk at discharge was 47.6%, with 36.1% of exclusive MOM and an increase from 45.8% in 2017 (33.3% exclusive) to 58.82% (41.18% exclusive) in 2021. The mean average daily growth of the weight improved (p < 0.001) during this period, and there was no statistical difference between infants fed with maternal milk and those fed with bank milk. Older maternal age, early-start feeding with maternal milk and low gestational age had a statistically significant impact on feeding with MOM at discharge.

Retrospective analysis of leukemoid reactions in extremely preterm infants in a tertiary NICU from 2018–2021

Background Neonatal leukemoid reaction is associated with higher risk of mortality, chronic lung disease and has been associated with chorioamnionitis. Literature on extremely low birth weight infants with leukemoid reaction is limited. Objectives The aim of our study was to characterize the maternal and placental factors associated with neonatal leukemoid reaction and to describe outcomes of these ELBW infants. Our objective was to assess if there were maternal factors that would assist the decision-making process regarding the delivery of preterm infants at risk of chorioamnionitis and the sequelae of this inflammatory process. Methods This was a retrospective case-control study performed in a single, tertiary Maternity Hospital in Dublin. Two matched controls were identified for each case based on gestation and year of birth and data was collected on both the infants and their mothers. Results 7 extremely preterm neonates were identified as having a leukemoid reaction, defined as a total white cell count of >50,000 or in the first seven days of life. Baseline characteristics between the groups were similar. The median gestational age in the cases group was 24 + 4 weeks and in the control group was 24 + 1. The mean birthweight was 650 g in the cases group vs. 655 g in the control group. There was a higher percentage of males in the control group, 42.9% vs 28.6% in the cases. The preterm infants with leukemoid reaction had a longer duration of ventilation with a median of 18 days (7.5–23.5 days) compared to 6.5 days (2.8–24.5 days) in the control group. More infants in the leukemoid reaction group required inotropes for hypotension in the first 72 h after delivery (42.9% vs 7.1% in the controls, p value .169). Death or Bronchopulmonary dysplasia (BPD) occurred in 85.7% of the cases identified with a leukemoid reaction vs 71.4% of the controls matched. Median maternal CRP was higher in cases prior to delivery vs the controls (66 vs 18.1 mg/L, p-value = .2151). There was histological evidence of maternal inflammatory response in all cases with fetal inflammatory response in 71% of cases. Conclusions Leukemoid reaction in ELBW infants with evidence of maternal and fetal inflammatory response syndrome on placental histology is associated with a longer duration of initial ventilation, increased need for inotropes in the first 72 h after birth, higher rates of death, and BPD. Prospective studies are required to identify potential biomarkers such as proinflammatory cytokines, IL-6, which might aid the decision-making process in delivery.