Level Neonatal Intensive Care Unit Research Articles

Relationship between osteopenia of prematurity and ABO blood groups

Amaç: Çalışmamızda çok düşük doğum ağırlıklı (ÇDDA) prematürelerde kan grupları ile prematüre osteopenisi (PO) arasındaki ilişkiye bakılması amaçlanmıştır. Gereç ve Yöntem: Çalışmamız retrospektif hasta veri kayıtlarından 1 Ocak 2013 - 31 Aralık 2018 tarihleri arasında 3. düzey yenidoğan yoğun bakım ünitesinde yapıldı. Çalışmaya gebelik haftası (GH) <32 hafta ve doğum ağırlığı (DA) <1500 g olan yenidoğanlar dahil edildi. Kan grupları O, A, B, AB olarak 4 ayrı gruba ayrıldı. Prematüre osteopenisi grubuna postanatal 1. ayda alkalen fosfataz düzeyleri > 700 IU / L olan bebekler dahil edildi.Bulgular: Çalışmaya toplam 1567 ÇDDA prematüre bebek dahil edildi. Genel PO oranı %14,6 olarak bulundu. Prematüre osteopenisi oranları O kan grubunda %14,3, A kan grubunda %14,7, B kan grubunda %15,3 ve AB kan grubunda %13,2 olarak bulundu. Dört kan grubu PO açısından karşılaştırıldığında istatistiksel olarak anlamlı fark tespit edilmedi (p=0,612).Sonuç: Çalışmamızda PO ile kan grubu arasındaki olası ilişkiye bakan ilk çalışma olup, PO için herhangi bir kan grubunun risk teşkil etmediği bulundu.

Improved Referral of Very Low Birthweight Infants to High-Risk Infant Follow-Up in California

To examine changes in referral rates of very low birthweight (birthweight <1500g) infants to high-risk infant follow-up in California and identify factors associated with referral before and after implementation of a statewide initiative in 2013 to address disparities in referral. We included very low birthweight infants born 2010-2016 in the population-based California Perinatal Quality Care Collaborative who survived to discharge home. We used multivariable logistic regression to examine factors associated with referral and derive risk-adjusted referral rates by neonatal intensive care unit (NICU) and region. Referral rate improved from 83.0% (preinitiative period) to 94.9% (postinitiative period); yielding an OR of 1.48 (95% CI, 1.26-1.72) for referral in the postinitiative period after adjustment for year. Referral rates improved the most (≥15%) for infants born at ≥33weeks of gestation, with a birthweight of 1251-1500g, and born in intermediate and lower volume NICUs. After the initiative, Hispanic ethnicity, small for gestational age status, congenital anomalies, and major morbidities were no longer associated with a decreased odds of referral. Lower birthweight, outborn status, and higher NICU volume were no longer associated with increased odds of referral. African American race was associated with lower odds of referral, and higher NICU level with a higher odds of referral during both time periods. Referral improved in many previously poor-performing NICUs and regions. High-risk infant follow-up referral of very low birthweight infants improved substantially across all sociodemographic, perinatal, and clinical variables after the statewide initiative, although disparities remain. Our results demonstrate the benefit of a targeted initiative in California, which may be applicable to other quality collaboratives.

Effectiveness of Hand Hygiene Promotional Program based on the WHO Multimodal Hand Hygiene Improvement Strategy, in Terms of Compliance and Decontamination Efficacy in an Indian Tertiary Level Neonatal Surgical Intensive Care Unit

AbstractBackground: The WHO Multimodal Hand Hygiene Improvement Strategy (MHHIS) has been proposed to improve the Hand Hygiene (HH) compliance of the WHO recommendations on HH.Therefore, the current study was planned in our neonatal unit with the objective of evaluating the effectiveness of a Hand Hygiene Promotional Program (HHPP) based on the WHO MHHIS, in terms of compliance and decontamination efficacy among the health-care workers (HCWs) in the unit. Objective: The objective of the study was to evaluate the effectiveness of the WHO MHHIS on HH compliance and decontamination efficacy. Methods: The HHPP was carried out in our neonatal surgical intensive care unit from July to August 2013. A pre-intervention phase consisted of assessment of ward infrastructure, HH knowledge and perception, determination of HH compliance and collection of hand rinse samples from the HCWs before and after handwashing. Intervention phase consisted of changing traditional to elbow-operated taps, display of posters and reminders, placement of soaps in water draining trays, autoclaved single-use paper towels for hand drying, availability of hand rubs and training sessions for health-care providers. In the post-intervention phase, all the assessments and observations of pre-intervention phase were repeated. Results: HHPP resulted in a significant increase in overall HH compliance from 26.6% (95% confidence interval [CI] 23.9–29.3) to 65.3% (95% CI 62.4–68.2) (P < 0.001) and reduction in load of microorganisms (P = 0.013). There was a significant improvement in HH knowledge (P < 0.001), and perception surveys revealed high appreciation of each strategy component by the participants. Conclusion: To the best of our knowledge, this is the first study about the effect of implementation of the WHO MHHIS from an Indian hospital. HHPP was found to be effective in terms of HH compliance and decontamination efficacy. Its implementation is highly recommended to promote HH in a developing country like India.

Aerosol therapy in relation to retinopathy of prematurity in mechanically ventilated preterm infants

BackgroundAerosol administration is increasingly being used as a therapeutic intervention for mechanically ventilated preterm infants. However, the effects of inhalation therapy on retinopathy of prematurity (ROP) have not yet been explored.MethodsA retrospective cohort study was conducted in a tertiary level neonatal intensive care unit (NICU) from 2011 to 2013. All preterm infants with a gestational age (GA) of 24~29 weeks receiving invasive intubation for more than 1 week in the NICU were included. Infants with severe congenital anomalies were excluded. ROP was defined as stage II or greater according to medical records by ophthalmologists. A multivariate logistic regression model was used to estimate the risk of ROP in relation to inhalation therapy after adjusting for confounders.ResultsIn total, 205 infants were enrolled in this study, including 154 with inhalation therapy and 51 without inhalation therapy. Univariate analyses showed an association of inhalation with the following characteristics: sex (p = 0.047), GA (p = 0.029), sepsis (p = 0.047), bronchopulmonary dysplasia (BPD) (p < 0.001), and ROP (p = 0.001). Furthermore, logistic regression analysis indicated that inhalation therapy was an independent risk factor for ROP (odds ratio (OR) = 2.639; 95% confidence interval (CI) = 1.050~6.615). In addition, infants with a GA of 24~25 weeks (OR = 6.063; 95% CI = 2.482~14.81) and 26~27 weeks (OR = 3.825; 95% CI = 1.694~8.638) were at higher risk of ROP than those with a GA of 28~29 weeks. Other factors – including sex, sepsis, BPD, and delivery mode – did not carry significant risk.ConclusionAerosol therapy with pure oxygen delivery is associated with ROP. Clinicians should exercise great caution when conducting aerosol therapy with excess oxygen in mechanically ventilated preterm infants.

Percutaneous Inserted Venous Catheter via Femoral Vein in Extremely Low-Birth-Weight Infants: A Single-Center Experience.

This study aimed to assess the applicability of the insertion of small diameter catheters through the femoral vein in extremely low-birth-weight (ELBW) infants. All femoral small diameter catheters (Silastic or femoral arterial catheter [FAC]) inserted in ELBW infants in a tertiary level neonatal intensive care unit were retrospectively reviewed. Success rate, dwelling time, and percutaneously inserted central venous catheter-related complications were recorded. Thirteen small diameter catheters were inserted in seven ELBW infants. Mean gestational age at birth was 25+3 weeks (standard deviation [SD] ± 2.12) and mean birth weight was 686 g (SD ± 204.9). Mean weight at the first time of insertion was 1,044 g (SD ± 376.3). In two occasions, a FAC was used instead of a Silastic. In most cases (11/13, 84.6%), the patient was intubated prior to the procedure. The mean dwelling time was 16.7 days (SD ± 9.8). Most of the inserted small diameter catheters were removed electively (8/12, 66.7%), except for one episode of clinical sepsis from coagulase-negative Staphylococcus and three cases of accidental line extravasation. No other complications were reported. The success rate was 92.3%. Femoral venous catheterization using small diameter catheters in ELBW infants may be promising when other routes have been exhausted. Our results support that it is a feasible technique that can be performed at the bedside with successful results when conducted by experienced personnel.

Turn Down the Volume: A Study of Excessive Sound Levels in the Neonatal Intensive Care Unit

Background: World Health Organization (WHO) guidelines recommend that environmental sound levels in the Neonatal Intensive Care Unit (NICU) should be an hourly average level (LAeq) <45 dB and maximum level (LAmax) <65 dB. While studies have shown that ambient sound in NICUs often exceed these levels, information is lacking regarding sound exposure at the bedside. Our purpose in this study was to determine sound levels of common medical interventions in the NICU and inside the bedsides of neonates under varying conditions and to determine the association, if any, between NICU design, ventilator, incubator and shift of day and sound …

Assessment and Management of Procedural Pain During the Entire Neonatal Intensive Care Unit Hospitalization

BackgroundDespite strong evidence that repeated pain exposure in neonates is associated with adverse outcomes, pain assessment and management continues to be less than optimal in most neonatal intensive care units (NICUs). AimsTo evaluate current pain assessment and management practices, and identify factors associated with optimal treatment throughout a cohort of preterm neonates over the entire hospital stay. DesignA secondary analysis of study data collected from 2012 to 2016 as part of a larger clinical trial and supplemental chart review. SettingsTertiary level neonatal intensive care unit. Participants/Subjects242 stable preterm neonates born at less than 37 weeks gestational age. MethodsData were analyzed quantitatively using R for statistics. ResultsThe 242 neonates underwent a total of 10,469 painful procedures (4,801 tissue breaking and 5,667 non–tissue breaking, with only 56.6% and 12.2% having a documented pain score using the Premature Infant Pain Profile, respectively). Average pain exposure was 43 with a median of 32(10-576) per entire hospital stay. Documented pain score and greater postnatal age were associated with higher use of a pain reducing intervention and lower gestational age, first day, first week, higher illness severity, non tissue breaking and night time procedures were associated with lower. Use of a pain relieving intervention was documented in 58.5% of procedures. Sucrose was most commonly used pharmacologic and non nutritive sucking the most common non pharmacologic interventions. ConclusionsIncreased efforts are needed to promote consistent pain assessment and management to ensure optimal outcomes for vulnerable at risk neonates.

Outcomes of infants born at 23 and 24 weeks' gestation with gut perforation

PurposeThe provision of neonatal intensive care to infants born at 23 or 24 weeks' gestation poses medical, surgical and ethical challenges. Gastrointestinal perforation is a well-recognized complication of preterm birth, occurring most often as a result of necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). Given the risk of morbidity and mortality in these ‘periviable’ infants, this complication may prompt transition from active management to palliative care. In our institution, the surgical care of periviable infants with gut perforation has not been dictated by gestational age. This study reports our outcomes. MethodsA retrospective cohort analysis of integrated neonatal medical and surgical care of all infants born between 23+0 and 24+6 weeks' gestation admitted to a tertiary level neonatal intensive care unit (NICU) during a 16 year period (2002–2017). ResultsA total of 198 periviable neonates (73 born at 23 weeks' gestation and 125 born at 24 weeks) were admitted during the 16-year period; most were inborn with only 26 retrieved from regional centers. Twenty-six of these infants developed gut perforation: 14 SIP, 8 NEC, 3 esophageal perforation and one after reduction of an incarcerated inguinal hernia. Twelve (46%) periviable infants with gut perforation survived to discharge home, seven of whom had no/mild disability at 2–3 years corrected gestational age. Of the 198 periviable infants admitted to NICU, 116 (58%) were alive at a corrected gestational age of 2–3 years and 29 of the 56 (51%) assessed had mild or no disability. ConclusionsIn the setting of combined medical and surgical care in a tertiary level NICU almost half of all periviable infants with a gut perforation survived, many with no/mild disability at 2–3 years corrected gestational age. Rigid protocols that rely on gestational age alone to guide treatment are not appropriate. These results support the contention that, when possible, extremely preterm infants should be born and cared for in units with combined medical and surgical expertise. Level of evidenceLevel III cohort study.

Influence of etiology on treatment choices for neonatal seizures: A survey among pediatric neurologists

BackgroundA targeted treatment approach is increasingly promoted in epilepsy management. AimTo investigate if etiology (both established or initially presumed) influences antiepileptic drug choice of experts in neonatal seizures. MethodsAn invitation to participate to a web-based questionnaire was sent to Italian pediatric neurologists affiliated to the Italian Society of Pediatric Neurology (SINP). Results19 pediatric neurologists from different centers, all consultants of third level Neonatal Intensive Care Units (NICUs) answered. As first-line drug phenobarbital was the most common choice, it was used in 79% of cases of acute symptomatic seizures, in 63% of structural epilepsy, in 42% of genetic epilepsies. As second-line drug phenytoin was used by 58% in acute symptomatic seizures, 37% in structural epilepsy, 5% in genetic epilepsy. Pyridoxine/pyridoxalphosphate was much more used in genetic epilepsy (as first-line in 26%, as second-line in 37%) than in the other two conditions.Long-term conventional EEG monitoring was suggested as important to verify efficacy of drugs in controlling seizures by 84% of interviewed neurologists, but EEG was available around the clock in only 53% of their centers. 1 to 3-channel aEEG/EEG (commonly named CFM) was often used instead of conventional EEG monitoring. ConclusionThis is the first survey looking at a targeted approach in treatment of neonatal seizures by pediatric neurologists consulted by NICUs. The treatment approach is similar to previous surveys in case of acute symptomatic seizures, but in case of other etiologies the choices are different, especially for the second-line option. Larger studies should address this topic.

Unexpected term NICU admissions: a marker of obstetrical care quality?

Unexpected admissions of term neonates to the neonatal intensive care unit and unexpected postnatal complications have been proposed as neonatal-focused quality metrics for intrapartum care. Previous studies have noted significant variation in overall hospital neonatal intensive care unit admission rates; however, little is known about the influence of obstetric practices on these rates or whether variation among unanticipated admissions in low-risk, term neonates can be attributed to systemic hospital practices. The objective of the study was to examine the relative effects of patient characteristics and intrapartum events on unexpected neonatal intensive care unit admissions and to quantify the between-hospital variation in neonatal intensive care unit admission rates among this group of neonates. We performed a retrospective cross-sectional study using data collected as part of the Consortium for Safe Labor study. Women who delivered term (≥37 weeks), singleton, nonanomalous, liveborn infants without an a priori risk for neonatal intensive care unit admission were included. The primary outcome was neonatal intensive care unit admission among this population. Multilevel mixed-effect models were used to calculate adjusted odds ratios for demographics (age, race, insurer), pregnancy characteristics (parity, gestational age, tobacco use, birthweight), maternal comorbidities (chronic and pregnancy-induced hypertension), hospital characteristics (delivery volume, hospital and neonatal intensive care unit level, academic affiliation), and intrapartum events (prolonged second stage, induction of labor, trial of labor after cesarean delivery, chorioamnionitis, meconium-stained amniotic fluid, and abruption). Intraclass correlation coefficients were used to estimate the between-hospital variance in a series of hierarchical models. Of the 143,951 infants meeting all patient and hospital inclusion criteria, 7995 (5.6%) were admitted to the neonatal intensive care unit after birth. In the fully adjusted model, the factors associated with the highest odds for neonatal intensive care unit admission included: nulliparity (adjusted odds ratio, 1.62 [95% confidence interval, 1.53-1.71]), large for gestational age (adjusted odds ratio, 1.59 [95% confidence interval, 1.47-1.71]), and small for gestational age (adjusted odds ratio, 1.60 [95% confidence interval, 1.47-1.73]). Induction of labor (adjusted odds ratio, 0.95 [95% confidence interval, 0.89-1.01]) was not associated with increased odds of neonatal intensive care unit admission compared with women who labored spontaneously. The events associated with higher odds of neonatal intensive care unit admission included: prolonged second stage (adjusted odds ratio, 1.66 [95% confidence interval, 1.51-1.83]); chorioamnionitis (adjusted odds ratio, 3.89 [95% confidence interval, 3.42-4.44]), meconium-stained amniotic fluid (adjusted odds ratio, 1.96 [95% confidence interval, 1.82-2.10]), and abruption (adjusted odds ratio, 2.64 [95% confidence interval, 2.16-.21]). Compared with women who did not labor, the odds of neonatal intensive care unit admission were lower for women who labored: adjusted odds ratio, 0.48 (95% confidence interval, 0.45-0.52) for women with no uterine scar and adjusted odds ratio, 0.83 (95% confidence interval, 0.73-0.94) for women with a uterine scar. There was significant variation in neonatal intensive care unit admission rates by hospital, ranging from 2.9% to 11.2%. After accounting for case mix and hospital characteristics, the between-hospital variance was 1.9%, suggesting that little of the variation was explained by the effect of the hospital. This study contributes to the currently limited understanding of term, neonatal intensive care unit admission rates as a marker of obstetrical care quality. We demonstrated that significant variation exists in hospital unexpected neonatal intensive care unit admission rates and that certain intrapartum events are associated with an increased risk for neonatal intensive care unit admission after delivery. However, the between-hospital variation was low. Unmeasured confounders and extrinsic factors, such as neonatal intensive care unit bed availability, may limit the ability of unexpected term neonatal intensive care unit admissions to meaningfully reflect obstetrical care quality.

Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect.

ObjectiveTo investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders.MethodsThis was an observational, prospective, single-center cohort study including all eligible neonates with GA < 35 weeks and/or birth weight ≤ 1500 g born at a 3rd level Neonatal Intensive Care Unit between 2011 and 2014. Pathological patterns of placenta, membranes and cord were classified according to Redline’s criteria. Multivariable linear and logistic regression models were applied, either including or not GA among the covariates.ResultsOf the 807 enrolled neonates, 134 (16.6%) had signs of IUI: among these, 54.5% showed just histological chorioamnionitis (HCA), 25.4% had HCA + funisitis (FUN) stage 1, and 20.1% had HCA + FUN stage 2–3. At univariate analysis, HCA increased the risk for retinopathy of prematurity (ROP) and bronchopulmonary dysplasia, while FUN (any stage) had a deleterious impact on all outcomes investigated. After adjustment for covariates not including GA, HCA was a risk factor only for ROP (OR = 2.8, CI: 1–7.8), while FUN (any stage) was still associated with increased ORs for all outcomes (p <0.01). Upon inclusion of GA in the regression model, the results differed remarkably. HCA was associated with lower risk for mechanical ventilation (OR = 0.3, CI: 0.1–0.7) and need for surfactant (OR = 0.5, CI: 0.2–0.9), while FUN (any stage) worsened clinical conditions at birth (p <0.05), increased the risk for early-onset sepsis (p <0.01), and increased the length of mechanical ventilation (FUN stage 2–3 only, RC = 6.5 days, CI: 2–11). No other outcome was affected.ConclusionsIUI, especially FUN, negatively impact most neonatal morbidities, but its effect is partially reverted adjusting for GA. Considered that GA is an intermediate variable interposed between prenatal causes of prematurity and outcomes, the appropriateness of adjusting for GA may be questionable.

Parental perceptions of neonatal therapeutic hypothermia; emotional and healing experiences

Introduction: Parents of infants who undergo therapeutic hypothermia experience emotional challenges that have not been fully characterized. Comprehensive understanding of the parental experience of hypothermia is needed to provide better care to the family of the infant. This study aimed to improve the understanding of the parental emotional experience of therapeutic hypothermia in the Neonatal Intensive Care Unit (NICU).Methods: Semistructured interviews were conducted in a group setting with parents matched into groups according to the severity of the infant’s presenting encephalopathy. The interviews were transcribed and coded into principal and additional subthemes.Results: Families of 15 infants, who were between 2 months and 2 years at the time of the interview, participated. Infants had a mean gestational age of 40.0 weeks and 11 (73%) were male. Eleven (73%) were transferred from other hospitals following birth and eight (53%) had seizures. Emotional Experiences was a principal theme and included subthemes of traumatic experiences, Loss of normalcy, and Separation of parent and infant. The birth was frequently described as traumatic with descriptions of chest compressions, excessive blood loss and infants not crying. Trauma was also described in the parental observations of the shivering hypothermic infant. Parents highlighted the loss of normalcy in terms of their expected birth narrative and the loss of the early opportunity to breastfeed and hold their infant. Parents reported that the physical separation imposed by hypothermia adversely impacted their ability to bond with their infant. Healing Experiences was the other principal theme with subthemes identified as Incorporation of parents into NICU care, Reclaiming parenthood and Support from other hypothermia families. Parents reported feeling a connection to their infant when they were involved in medical rounds and when asked to participate in routine care of their infant. Occasionally, parents strongly advocated for their own participation in a particular aspect of their infant’s care such as a diaper change and this was perceived as reinforcing their role as parent. Lastly, parents requested greater access to peer support from parents who had experienced therapeutic hypothermia.Conclusion: Parents of infants treated with hypothermia reported the experience of their unexpected adverse delivery and their baby subsequently being treated with therapeutic hypothermia as traumatic. This trauma can be compounded by the pale, still and shivering appearance of their newborn and the delay in bonding as a result of physical separation during hypothermia treatment. Parents described feeling connected to their infant in the context of performing routine care activities and desired greater access to peer support. The themes reported in this study could be used to inform high level NICU care and raise provider awareness of the parent experience.

Causes of death in a neonatal intensive care unit in southeast region of Turkey

Aim: Neonatal mortality rate is a good indicator to show the developmental status of a country. The aim was to assess mortality rate and causes of death in a tertiary level neonatal intensive care unit (NICU) at Sanliurfa Training and Research Hospital. Material and Methods: All infant deaths occurred in one year period between 2017 and 2018 at Sanliurfa Training and Research Hospital NICU were retrospectively reviewed and causes of death and mortality rate were examined. A total of 189 (9.4%) infants died in the study period. Most common cause of death was prematurity and associated conditions (49.2%) followed by perinatal asphyxia (16.4%) and congenital anomalies (12.7%). In term infants perinatal asphyxia (36.9%), congenital anomalies (16.9%) and acute bilirubin encephalopathy (12.3%) were the three leading causes of death. The median age of death was 3 (1-240) days. Most of the deaths (73%) occurred in the early neonatal period. Conclusion: Prematurity, perinatal asphyxia, congenital anomalies and severe hyperbilirubinemia are the leading causes of neonatal mortality in Sanliurfa. Measures for antenatal follow-up, diagnosis of antenatal risk factors, early neonatal follow-up and certification of health staff in delivery room would contribute for reduction of neonatal mortality in southeast region of Turkey.

264: Severe maternal morbidity associated with hospital NICU level in Washington State

Rising maternal mortality and severe maternal morbidity (SMM) rates have drawn increasing public health attention. In rural areas, complex maternal health needs are best served by regionally coordinated care; however, critical access hospitals may have to contend with obstetric emergencies when maternal transport is not feasible. We evaluated patterns of SMM across the Washington State Perinatal Regional Network, a system in which neonatal intensive care unit (NICU) levels should directly correlate with maternal level of care. We analyzed de-identified patient and hospital-level rates of SMM diagnoses and procedures for all women who delivered at 58 non-military hospitals in Washington State from 10/2015-9/2016. Data was obtained from the Washington State Comprehensive Hospital Abstract Reporting System (CHARS) which includes inpatient diagnosis with associated Present on Admission (POA) flags, procedure and discharge information derived from hospital billing systems. SMM was defined by CDC criteria. Deliveries were stratified by having or not having SMM. For deliveries with SMM diagnoses, POA rates were tabulated. Hospital SMM rates (all SMM, transfusion only, SMM excluding transfusion) were grouped according to their NICU Level of Care (Critical Access and 1-4). Odds ratios and 95% confidence intervals (CI) were calculated. Of 76,961 deliveries, 981 women (1.3%) had any SMM including 448 (0.58%) with SMM diagnoses/procedures and 533 (0.69%) with transfusion only. Level 1 and critical access hospitals had the highest transfusion rate (1.0%), while Levels 2,3 and 4 hospitals had progressively lower rates (Table; P<.001). Level 4 hospitals had the highest rate of SMM diagnoses/procedures (Table). Among those with SMM diagnoses, the percentage of women with diagnoses POA was highest in Level 4 NICU hospitals (Figure). SMM diagnoses occur most frequently at the centers providing the highest level of care in Washington State, likely attribiutable to the regional referral system. This is supported by the dose dependent relationship between POA and NICU levels. However, transfusion rates are increased in Level 1/critical access hospitals that may not be optimally equipped to handle maternal hemorrhage. Efforts to decrease SMM should focus on equipping Level 1 and critical access hospitals with tools to decrease maternal morbidity and improve referral systems.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Screening for retinopathy of prematurity by telemedicine in a tertiary level neonatal intensive care unit in France: Review of a six-year period

To analyze the prevalence and risk factors for retinopathy of prematurity (ROP) and severe (treatment-requiring) ROP. A retrospective study was conducted in a level III neonatal unit in Bordeaux, France, from 2009 to 2015. Four hundred and nineteen preterm infants who were screened for ROP exclusively by RetCam were included. ROP of any degree was diagnosed in 27.68% of infants. Stages 1, 2, 3 and 4 ROP was found in 44%, 46%, 9% and 1% of subjects, respectively. No stage 5 ROP was observed. 28/419 infants (6.6%) were treated exclusively with laser photocoagulation. No intravitreal anti-VEGF injections or surgical treatments were performed. No infants born at>31 weeks or with BW>1110g required ROP treatment. On multivariate analysis, risk factors for ROP development were low birth weight, low gestational age at birth, high duration of invasive mechanical ventilation, shock or use of vasopressors. On multivariate analysis, risk factors for severe, treatment-requiring ROP were male gender, gestational age≤27 weeks and Apgar score at 5minutes≤7. In our 6-year series, ROP was successfully identified on screening exclusively by telemedicine, and no surgical treatment was required. This study identifies known ROP risk factors, but the Apgar score at 5minutes as a risk factor for severe ROP requires further studies in order to be confirmed.

NOISE SOURCES AND ITS LEVELS DURING MORNING AND AFTERNOON SHIFT IN THE NEONATAL INTENSIVE CARE UNITS

Noisy environment is considered one important stress factors for newborn infants and nurses in the Neonatal Intensive Care Unit (NICU). It may be harmful to full term and preterm infants. The aim of this study is to compare noise sources and its levels during morning and afternoon shift in NICU. The study was a comparative descriptive design, was done on a convenient sample of 100 new born infants attending the NICU of El Manial University Hospital (Kasr Al Ainy) and Pediatric University Hospital (Al Monira). Neonatal assessment sheet and noise sources and its levels sheet were utilized for data collection. Sound level meter was used to measure the level of noise during morning and afternoon shift. Results of the study revealed statistically significant differences between morning and afternoon shift regarding noise sources and its levels. The mean of noise level during morning and afternoon shift were 71.61±5.14 decibels and 60.12±9.21 decibels respectively. Devices alarm in NICU was a higher source of noise in the afternoon shift (54%) and conversation/talking were recorded only in the morning shift (21%). The study concluded that noise levels were above the standard of AAP recommendations in NICU during morning and afternoon shift and devices alarm in NICU was a higher source of noise. The study recommended that noise sources and its levels in NICU should be evaluated routinely in different days of the week and an educational program is needed to raise awareness among nurses and other professionals about the resources of noise.

Réalisation d’une transfusion sanguine en néonatologie : état des lieux des pratiques en 2016 en France ; situations aiguës ou chirurgicales exclues

BackgroundBlood transfusion is common in neonatology, especially in preterm or low birth weight infants. Recommendations were proposed by the French National Authority of Health (HAS) in 2014 and 2015 for red blood cells and platelet transfusion respectively, but an heterogeneity of practical attitudes persist. The objective of this survey is to evaluate transfusion practices in neonatal intensive care units. MethodsInvestigation of practice of neonatal transfusion was organized among 68 neonatal intensive care unit (level 3) between September 2016 and May 2017, by mailing survey focused on systematic training of nurses, patient identification, immunohematology, information and technical aspects of blood components administration. ResultsTwenty-three neonatal intensive care units among the 68s answered the questionnaire. One thousand five hundred sixty seven neonates were transfused and 3382 blood products were administered. The results highlight a consensual attitude concerning the procedures of patient identification, immunohematology tests and blood products administration. However, heterogeneity remains concerning information of the parents or the person with parental authority, immediate and delayed follow-up and devices used for the transfusion. However HAS guidelines (2014 and 2015) appear to be well applied by clinicians for blood products, specifications and calcul of transfused volume based on gestational age and weight.

Early Hypophosphatemia in High-Risk Preterm Infants: Efficacy and Safety of Sodium Glycerophosphate From First Day on Parenteral Nutrition.

Early hypophosphatemia is common in premature infants ≤1250 g. The aim of this study was to assess the frequency and severity of hypophosphatemia after sodium glycerophosphate supplementation from first day of life in parenteral nutrition and to address the safety of this practice. Prospective cohort study of infants ≤1250 g birth weight born in a tertiary-care level neonatal intensive care unit and supplied with sodium glycerophosphate from the first day of life. Primary outcome was the presence of hypophosphatemia (<4 mg/dL) on the first week. Data were compared with our 2014 prospective subcohort of infants ≤1250 g receiving phosphate after 48 hours of life and morbidity with that of our 2016 retrospective cohort of ≤1250 g. Fifty-four neonates were included. The frequency of hypophosphatemia was 29.6%. Only 1 patient presented hypophosphatemia <2 mg/dL. Mild hypokalemia was found in 8 patients (50%). No cases of hypernatremia were observed. Patients with hypophosphatemia had significantly lower gestational age (27.4 vs 28.8 weeks, P = .032) and lower z-score birth weight (-1.68 vs -0.47; P = .001). When compared with the 2014 subcohort, we found a lower frequency of hypophosphatemia (29.6% vs 69.2%; P = .008) and a lower rate of samples with hypophosphatemia (20.4% vs 51.4%; P = .0002) and critical hypophosphatemia (0.68% vs 11.4%, P = .0005). No differences were found in morbidity or mortality. Sodium glycerophosphate supplementation in parenteral nutrition from the first day of life significantly decreased the frequency of hypophosphatemia. No adverse events were reported.

Knowledge of healthcare providers regarding breastfeeding preterm infants in mainland China

BackgroundSupport from healthcare professionals has been identified as an important variable affecting successful breastfeeding in preterm infants. This study aimed to explore the knowledge of healthcare providers regarding breastfeeding preterm infants in mainland China.MethodsAn online cross-sectional survey of healthcare providers from 9 tertiary level neonatal intensive care units across 4 districts in mainland China was conducted from May–November, 2017. A total of 187 healthcare providers responded to the survey. Data included demographic information and current and desired knowledge about breastfeeding preterm infants. Breastfeeding knowledge was evaluated using a researcher-developed questionnaire with six domains based on breastfeeding preterm infant guidelines.ResultsThe average percent of correctly answered questions was 53.73%. The domain with the highest mean percent was ‘indications and methods of breastfeeding’ (64.41%). The lowest scoring domain was ‘characteristics of premature human milk’ (38.83%). Knowledge score was related to the following factors: age, profession, professional title, education background and offspring amount by univariate analysis (p < 0.05). Multiple linear regression analysis found that healthcare provider breastfeeding knowledge was associated with profession (physician or nurse), professional title, sex and total offspring. In terms of training needs, 86.7% of healthcare providers reported insufficient knowledge about breastfeeding in the preterm infant population; 82.2% wanted more knowledge about indications and contraindications related to breastfeeding premature infant; and 71.7% considered expert lectures as the most effective way of acquiring additional breastfeeding knowledge.ConclusionThe knowledge about breastfeeding in the preterm infant population among NICU healthcare professionals in mainland China was limited. More targeted training is needed to improve NICU healthcare provider knowledge regarding breastfeeding preterm infants.

Factors that have an impact on knowledge, attitude and practice related to kangaroo care: National survey study among neonatal nurses.

To explore factors that impact nurses' knowledge, perceptions and practice related to kangaroo care in neonatal intensive care units in China. It is recognised extensively that kangaroo care is an effective intervention for improving the outcomes of preterm infants and has been recommended as a routine practice for neonatal care. However, this practice is uncommon in China and little is known about neonatal nurses' knowledge and attitude. A descriptive cross-sectional survey. An online questionnaire was completed by 830 neonatal nurses. Data were analysed using measures of central tendency, dispersion, ANOVA, t tests and the general linear model. A total of 48.2% of the participants reported practicing kangaroo care. Range of score for each scale was knowledge 0-16 (M=9.62), perceptions 28-103 (M=79.99), barriers 17-85 (M=65.40) and practice 11-55 (M=34.44). Experience in using kangaroo care was a primary factor for the scores of four scales. Particularly, experienced nurses had higher level of knowledge and perceived less barriers. Respondents' role in neonatal intensive care units considerably influenced perceptions and practice level. Nurses' highest education and neonatal intensive care unit level also influenced the knowledge and practice score, separately. A major barrier to practice was the reluctance of physicians, nurses and parents. Neonatal nurses' knowledge, attitude and practice levels related to kangaroo care were relatively low. Results suggested that leadership and knowledgeable practitioners could initiate education and clinical training to improve nurses' knowledge and awareness on the efficacy of kangaroo care. Moreover, initiatives and behaviours would be enhanced following increased knowledge and perceived value. Such barriers as the reluctance of medical staff may likewise be lowered or removed after experiencing kangaroo care. Neonatal nurses' knowledge and belief need to be improved for optimal practice of kangaroo care. Organisational support and clear guidelines are also in need for successful kangaroo care.