Neonatal Assessment Research Articles

Neonatal Assessment Manual Score: Is There a Role of a Novel, Structured Touch-Based Evaluation in Neonatal Intensive Care Unit?

Despite the technological improvements in monitoring preterm infants in the neonatal intensive care unit, routine care in the neonatal ward is primarily based on manual procedures. Although manual clinical procedures play a critical role in neonatology, little attention has been paid to palpation as a clinical assessment tool. Palpation is a clinical evaluation tool that relies mostly on the senses of touch and proprioception. Based on recent studies investigating the role and clinical effectiveness of touch in full-term and preterm babies, this paper proposes an evaluative touch-based procedure—the Neonatal Assessment Manual Score (NAME) model—that could be useful in the neonatal ward and describes its rationale. The operator applies gentle light pressures to the infant's body. In essence, the touch stimulates low-threshold afferent fibers that could influence the interoceptive cerebral network and the autonomic nervous system, thus altering the blood flow and breathing rhythm. These events could change how bodily fluids distribute among body segments and hence the body volume. The volume modification could be felt manually through haptic perception owing to the high sensitivity of the fingers. On the basis of their clinical conditions and stage of development, infants will respond differently to the applied pressures. Evaluating the infant's response, the operator produces a score of “bad,” “marginal,” or “good” for communicating quickly and clearly the infant's conditions to other professionals. Because the NAME model is intended for every professional who is used to touch-based procedures, if future studies confirmed its validity and reliability in clinical practice, the NAME model could become a part of the neonatal ward routine care for better assessing and managing the infant's conditions, even during emergencies.

Effect of combined pharmacological, behavioral, and physical interventions for procedural pain on salivary cortisol and neurobehavioral development in preterm infants: a randomized controlled trial.

Repeated procedural pain may lead to increased secretion of cortisol and future neurobehavioral development disorders in preterm infants. Changes in the cortisol level may mediate the effect of neonatal repetitive procedural pain on altered childhood neurobehavioral development in preterm infants. However, few studies have investigated the effect of combined pharmacological, behavioral, and physical interventions over repeated painful procedures on pain response, cortisol level, and neurobehavioral development. This study examined (1) the efficacy and safety of sucrose combined with massage, music, non-nutritive sucking, and gentle human touch to treat preterm infants with repeated procedural pain; (2) the cortisol level at discharge from the neonatal intensive care unit (NICU); (3) neurobehavioral development at 40 weeks' corrected gestational age; and (4) the potential mediating effect of the cortisol level in the combined interventions on neurobehavioral development. Stable preterm infants (n = 76) were randomized to receive routine care or combined interventions across repeated painful procedures throughout their NICU stay. The Premature Infant Pain Profile scores in the early, middle, and late periods of the NICU stay were measured, as were the basal salivary cortisol level at admission and discharge, the Neonatal Behavioral Neurological Assessment score at 40 weeks' corrected gestational age, and the incidence of adverse effects during the study period. Our findings indicated that the combined interventions remained efficacious and safe for reducing repeated procedural pain, decreased the cortisol level at discharge, and promoted early neurobehavioral development in preterm infants. This effect may have been mediated through decreased cortisol levels and reduced repeated procedural pain.

Adverse drug reactions and causality assessment in neonates

Adverse drug reactions and causality assessment in neonates

Assessment of Nurses Knowledge Toward Neonate with Birth Asphyxia at Neonatal Intensive Care Unit in Pediatric Hospitals at Babylon Governorate

Background: Birth asphyxia is neonates’ inability to activate and sustain breathing at conception .. It is also recognized as a condition that arises when blood gas delivery is compromised, contributing to hypoxemia and hypercapnia The combination of hypoxia and ischemia may contribute to a cascade of biochemical changes in the body contributing to neuronal brain loss and brain harm Objectives: In order the aim of study to Identify the demographic characteristic of sample , Identify knowledge of nurses in caring of neonate with birth asphyxia at NICU at pediatric hospitals in Babylon governorate , determine the relationship between nurses knowledge with birth asphyxia at NICU with certain of socio- demographic characteristics of sample Babylon, Iraq. Methodology: A comprehensive research is undertaken to investigate nurses’ understanding of Neonate with Birth Asphyxia in the Neonatal Intensive Care Unit at Babylon Governorate Pediatric Hospitals A randomized random sample of (62) nurse is chosen with the usage of the chance sampling method. The research group is spread in the Neonatal Intensive Care Unit at Babylon Governorate Pediatric Hospitals. The data was obtained using a built-in self-report questionnaire and evaluated using the concise statistical analysis method that involves “frequencies & percentages” and the Inferential statistical data analysis methodology used for the Chi-square test. Results: Results of the analysis show that the participants with excellent awareness served (66.1 percent), whereas those with bad information (33.9 percent) reflected nurses in the Neonatal Intensive Care Unit at the Babylon Governorate Pediatric Hospitals. In comparison, the mean age of experienced nurses is 32.73 ± 9.33 while those with bad awareness are 26.05 ± 5.86. Significant linkages exist between Education and awareness engagement, p = 0.015. Conclusions and recommendations : Around 66 per cent of nurses have experience of birth asphyxia, the study showed. Despite Born Asphyxia, about half of them have strong and optimistic disposition towards Neonate. Education will be deemed to improve nurses’ awareness of Neonate with Birth Asphyxia

Implementation of a Modified Neonatal Early-onset Sepsis Calculator in Well-baby Nursery: a Quality Improvement Study.

The use of sepsis risk scores (SRSs), calculated based on the neonatal early-onset sepsis (EOS) calculator, has been shown to limit the unwarranted sepsis evaluations and to reduce the empirical use of antibiotics in neonates.s. To reduce both the sepsis evaluation rate (SER) and antibiotic initiation rate (AIR) by 25% from baseline by incorporating conservative SRS cutoff values into the routine sepsis risk assessment of well-appearing neonates born at 34 weeks and older gestation. During a pre quality improvement (QI) period (June 2016-August 2016), a QI team calculated SRS on all newborn infants to determine safe SRS cutoff values. During the QI-study period (September 2016-November 2017), we implemented an EOS evaluation algorithm based on 2 SRS cutoff values, 0.05 (later increased to 0.1) for sepsis evaluation and 0.3 for the initiation of antibiotic therapy. Monthly SER and AIR were summarized and analyzed by using standard statistical tests and statistical process control charts. During the surveillance phase (January 2019-June 2019), we evaluated whether previously attained improvements in SER and AIR were sustained. During the pre-QI period, the mean (±SD) of monthly SER and monthly AIR were 23.8% (±5.7%) and 6.2% (±0.4%), respectively. During the QI-study period, the mean (±SD) of monthly SER and monthly AIR decreased to 15% (±4.7%), P = 0.01, and 3.2% (±1.5%), P = 0.005, respectively. During the surveillance period, both outcome measures were comparable with the QI-study period. The implementation of a modified EOS calculator-based EOS algorithm using a conservative approach was successful in reducing antibiotic exposure and the need for blood work in well-appearing neonates.

Comparison of correlation of various methods of gestational age assessment in term neonates

Knowledge of gestational age of newborn babies may modify the details of their care. Though gestational age is usually calculated from the date of mother’s last menstrual period this date is not known with certainty in large majority of pregnancy. In others there may be misleading information especially when the menstrual cycle is irregular, when conception is shortly after a previous pregnancy or when the mother was taking oral contraceptives shortly before conception. Hence the need of multiple modalities to confirm the gestational age and the reliability of modalities is a major concern. Our study is undertaken to compare the correlation of gestation age assessment by three methods viz., gestational age assessment by last menstrual period dates, gestational age assessment by last trimester ultrasound and gestational assessment by post-natal assessment of modified Ballard score. This study is a prospective study conducted in a rural medical college hospital. Total of 150 term babies were enrolled in the study. Duration of the study was two years. The gestational age of the neonates was calculated by all 3 methods and the correlation was assessed. The study concluded that the modified Ballard score overestimates the gestational age and the third trimester ultrasound underestimates the gestational age.

Smartphone app for neonatal heart rate assessment: an observational study

BackgroundHeart rate (HR) assessment is crucial in neonatal resuscitation, but pulse oximetry (PO) and electrocardiography (ECG) are rarely accessible in low-resource to middle-resource settings. This study evaluated a free-of-charge smartphone...

Aberrant expression of miR-199a in newborns with hypoxic-ischemic encephalopathy and its diagnostic and prognostic significance when combined with S100B and NSE.

Neonatal hypoxic-ischemic encephalopathy (HIE) is a disorder mainly due to asphyxia during the perinatal period, and late diagnosis leads to high mortality. In this study, the expression of microRNA-199a (miR-199a) in HIE newborns was investigated, as well as its clinical significance in HIE diagnosis and prognosis. Circulating levels of S100B and NSE in HIE newborns were measured using enzyme-linked immunosorbent assay, and the expression of miR-199a was analyzed using quantitative real-time PCR. The diagnostic value of miR-199a, S100B and NSE was evaluated using the receiver operating characteristic (ROC) analysis, and their prognostic value was assessed by the evaluation of Gesell intellectual development of the HIE newborns. HIE newborns possessed significantly increased levels of S100B and NSE and decreased miR-199a (all P < 0.01). The Neonatal Behavioral Neurological Assessment (NBNA) score of HIE newborns was negatively correlated with S100B and NSE, while was positively correlated miR-199a. The ROC analysis results showed the diagnostic value of serum miR-199a, and the combined detection of miR-199a, S100B and NSE could obtained the highest diagnostic accuracy in HIE newborns. miR-199a expression was lowest in newborns with severe HIE, and it had diagnostic potential to distinguish HIE cases with different severity. Regarding the prognosis of neonatal HIE, the correlation of miR-199a, S100B, NSE with Gesell intellectual development was found in HIE newborns. The decreased miR-199a in HIE newborns serves as a potential diagnostic biomarker and may help to improve the diagnostic and prognostic value of S100B and NSE in neonatal HIE.

Nurse-Led Neonatal Follow-Up Clinic: A New Emerging Concept in a Developing Country

Objective: To investigate the feasibility and acceptance of nurse-led neonatal follow-up clinic (NLNFC) in a tertiary care facility. Materials and Methods: In a prospective observational study, total 105 stable mother-neonate dyads were independently followed up in both nurse led and neonatologist run follow-up clinics. The outcome was measured in terms of agreement between the nurse and neonatologist in the domains of neonatal assessment, counselling mothers on essential newborn care (ENC) and giving advice ( P &lt; 0.05) and mothers’ acceptability for NLNFC. Results: Agreement between the trained neonatal nurse and neonatologist varied between 87 and 100%. The most unanimity was observed in neonatal assessment and counselling on ENC (93.3%-100%) followed by prescribing treatment (87%). The mean acceptability scores of the mothers for NLNFC was 33.13 ± 2.6 (25-35, maximum possible score 35). Conclusion: Establishing NLNFCs in developing countries is feasible. Nurses can be entrusted with the responsibility of following up stable neonates here and mothers will surely be satisfied with this type of clinic.

A clinical analysis of neurobehavioral development within one year after birth in preterm infants with bronchopulmonary dysplasia

To study the effect of bronchopulmonary dysplasia (BPD) on neurobehavioral development within one year after birth in preterm infants. A retrospective analysis was performed for the preterm infants with a gestational age of <34 weeks who were born from September 2017 to December 2019 and completed the follow-up assessments of neurobehavioral development at the corrected gestational ages of 40 weeks and 3, 6, and 12 months. According to their diagnosis, they were divided into a BPD group with 23 infants and a non-BPD group with 27 infants. The outcome of neurobehavioral development was compared between the two groups at different time points. There was no significant difference in the neonatal behavioral neurological assessment score between the BPD and non-BPD groups at the corrected gestational age of 40 weeks (P>0.05). Based on the Gesell Developmental Scale, compared with the non-BPD group, the BPD group had significantly lower global developmental quotient (DQ) and DQs of fine motor, adaptive behavior, and personal-social behavior at the corrected gestational ages of 3, 6, and 12 months (P<0.05). For both groups, the DQ of language at the corrected gestational age of 6 months was significantly higher than that at the corrected gestational age of 12 months (P<0.017), the DQ of personal-social behavior at the corrected gestational age of 6 months was significantly higher than that at the corrected gestational age of 3 months (P<0.017), and the DQ of adaptive behavior at the corrected gestational age of 12 months was significantly higher than that at the corrected gestational ages of 3 and 6 months (P<0.017). Based on the BSID-II scale, there were no significant differences in mental development index and psychomotor development index at each time point between the two groups (P>0.05). The mental development index at the corrected gestational age of 3 months was significantly higher than that at the corrected gestational ages of 6 and 12 months in both groups (P<0.001). Preterm infants with BPD have delayed neurodevelopment within one year after birth compared with those without BPD, which should be taken seriously in clinical practice.

Preventive Effects of Neuroprotective Agents in a Neonatal Rat of Photothrombotic Stroke Model.

Neonatal ischemic stroke has a higher incidence than childhood stroke. Seizures are the first sign for the need for clinical assessment in neonates, but many questions remain regarding treatments and follow-up modalities. In the absence of a known pathophysiological mechanism, only supportive care is currently provided. Stroke-induced microglia activation and neuroinflammation are believed to play a central role in the pathological progression of neonatal ischemic stroke. We induced a photothrombotic infarction with Rose Bengal in neonatal rats to investigate the effects of pre- and post-treatment with Aspirin (ASA), Clopidogrel (Clop), and Coenzyme Q10 (CoQ10), which are known for their neuroprotective effects in adult stroke. Pre-stroke medication ameliorates cerebral ischemic injury and reduces infarct volume by reducing microglia activation, cellular reactive oxygen species (ROS) production, and cytokine release. Post-stroke administration of ASA, Clop, and CoQ10 increased motor function and reduced the volume of infarction, and the statistical evidence was stronger than that seen in the pre-stroke treatment. In this study, we demonstrated that ASA, Clop, and CoQ10 treatment before and after the stroke reduced the scope of stroke lesions and increased behavioral activity. It suggests that ASA, Clop, and CoQ10 medication could significantly have neuroprotective effects in the neonates who have suffered strokes.

Hemorrhage Risk Assessment on Admission: Utility for Prediction of Maternal Morbidity.

Hemorrhage is a major cause of maternal morbidity and mortality prompting creation of innovative risk assessment tools to identify patients at highest risk. We aimed to investigate the association of hemorrhage risk assessment with maternal morbidity and to evaluate maternal outcomes after implementation of the risk assessment across hospital sites. We conducted a retrospective cohort analysis of a multicenter database including women admitted to labor and delivery from January 2015 to June 2018. The Association of Women's Health, Obstetric and Neonatal Nurses risk assessment tool was used to categorize patients as low, medium, or high risk for hemorrhage. Multivariate logistic regression was used to describe the association between hemorrhage risk score and markers of maternal morbidity and evaluate maternal outcomes before and after standardized implementations of the risk assessment tool. In this study, 14,861 women were categorized as low risk (26%), 26,080 (46%) moderate risk, and 15,730 (28%) high risk (N = 56,671 births). For women with high-risk scores, the relative risk (RR) ratio compared with low-risk women was 4.9 (RR: 95% confidence interval [CI]: 3.2-7.4) for blood transfusion and 5.2 (RR: 95% CI: 4.6-5.9) for estimated blood loss (EBL) ≥ 1,000 mL. For the second objective, 110,633 women were available for pre- and postimplementation analyses (39,027 and 71,606, respectively). A 20% reduction in rates of blood transfusion (0.5-0.4%, p = 0.02) and EBL ≥ 1,000 mL (6.3-5.9%, p = 0.014) was observed between pre- and postimplementations of the admission hemorrhage risk assessment tool. Women who were deemed high risk for hemorrhage using a hemorrhage risk assessment tool had five times higher risk for blood transfusion and EBL ≥ 1,000 mL compared with low-risk women. Given the low incidence of the outcomes explored, the hemorrhage risk assessment works moderately well to identify patients at risk for peripartum morbidity. · This study aimed to understand the utility of the AWOHNN hemorrhage risk assessment tool for predicting hemorrhage-related morbidity and to evaluate maternal outcomes before and after tool implementations.. · A high score using a hemorrhage risk assessment tool on admission is associated with five times higher risk for blood transfusion and/or estimated blood loss ≥ 1,000 mL, compared with a low score.. · Use of a hemorrhage risk assessment tool works moderately well to identify patients at highest risk for hemorrhage-related morbidity..

Evaluation of quality of recovery score in mothers and neonatal outcome assessment after surgery using preoperative dexamethasone for caesarean section

BackgroundQuality of recovery (QoR) after surgery is an essential measure of early postoperative health status of the patient. The incidence of caesarean section (CS) has increased in the last few decades. Numerous studies have been conducted for reduction of pain after CS but only a few on the effect of preoperative dexamethasone on QoR after CS. This study is designed to evaluate QoR with dexamethasone and neonate outcome assessment after CS. MethodsThis is a prospective, randomised study in which patients undergo CS under spinal anaesthesia (SA). Patients received either 8 mg (2 ml) of dexamethasone IV (group D, n = 30) or 2 ml of 0.9% normal saline (group C; n = 30) before SA. The QoR-40 and Apgar score, neonatal respiratory distress, haemodynamic response and ill effects were recorded. ResultsThe baseline haemodynamic (heart rate, mean arterial pressure (MRP), Respiratory rate (RR) and pulse oximetry) parameters were comparable in both the groups. The mean global score and each score in group D was better than that of group C (p < 0.001). The mean duration of block in group D (169.83 ± 9.05 min) was more than that in group C (163.33 ± 11.91 min) (p < 0.021). The incidence of neonatal respiratory distress, neonatal intensive care unit admission and Apgar score at 1 min and at 5 min of birth was comparable between the groups. ConclusionDexamethasone has a positive effect on early postoperative recovery of patients undergoing CS with a delay in regression of spinal block and without any significant adverse effects on neonatal outcomes.

Assessment of Neonate's Congenital Hypothyroidism Pattern Using Poisson Spatio-temporal Model in Disease Mapping under the Bayesian Paradigm during 2011-18 in Guilan, Iran

Background: Congenital Hypothyroidism (CH) is one of the reasons for mental retardation and defective growth in neonates. It can be treated if it is diagnosed early. The congenital hypothyroidism can be diagnosed using newborn screening in the first days after birth. Disease mapping helps to identify high-risk areas of the disease. This study aimed to evaluate the pattern of CH using the Poisson Spatio-temporal model in disease mapping under the Bayesian paradigm.Methods: The recorded data of all infants diagnosed with CH between 2011 and 2018 in Guilan, Iran were used in this study. The Poisson Spatio-temporal model under the Bayesian paradigm was run using the Markov Chain Monte Carlo method in Open BUGS software. Moreover, the maps of the towns in Guilan were prepared via Arc GIS software.Results: Out of 219800 live births in Guilan, Iran, the incidence of CH was 2:1000 in this time period. The pattern of disease mapping for the posterior mean of relative risk for CH was identical in this 7-year period. Furthermore, the pattern of disease mapping with spatial model excluding time dependence was similar to the maps of the Spatio-temporal model.Conclusion: The incidence rate of CH was approximately constant during this time, and disease mapping revealed no rising trends in this period. This probably can be due to resolving iodine deficiency as one of the main causes of CH incidence by consuming kinds of seafood and iodized salt in Guilan province.

The Neonatal Neurological Examination: Improving Understanding and Performance.

The neonatal neurological examination is a cornerstone in the assessment of a neonate's neurological function. Although current neuroimaging and neurophysiology techniques have markedly improved our ability to assess and diagnose neurologic abnormalities, the clinical neurological examination remains highly informative, cost-effective, and time efficient. Early recognition of abnormal findings can prevent delays in diagnosis and implementation of beneficial therapies. The intent of this article is to improve the understanding and performance of the neonatal neurological examination. A standardized approach to neonatal neurological examination is described, including examination techniques and normal and abnormal findings.

Developmental Support for Infants With Genetic Disorders.

As the technical ability for genetic diagnosis continues to improve, an increasing number of diagnoses are made in infancy or as early as the neonatal period. Many of these diagnoses are known to be associated with developmental delay and intellectual disability, features that would not be clinically detectable at the time of diagnosis. Others may be associated with cognitive impairment, but the incidence and severity are yet to be fully described. These neonates and infants with genetic diagnoses therefore represent an emerging group of patients who are at high risk for neurodevelopmental disabilities. Although there are well-established developmental supports for high-risk infants, particularly preterm infants, after discharge from the NICU, programs specifically for infants with genetic diagnoses are rare. And although previous research has demonstrated the positive effect of early developmental interventions on outcomes among preterm infants, the impact of such supports for infants with genetic disorders who may be born term, remains to be understood. We therefore review the literature regarding existing developmental assessment and intervention approaches for children with genetic disorders, evaluating these in the context of current developmental supports postdischarge for preterm infants. Further research into the role of developmental support programs for early assessment and intervention in high-risk neonates diagnosed with rare genetic disorders is needed.

Effect of Parenting Training on Neurobehavioral Development of Infants

BackgroundEarly interventions have been believed to have a positive influence on the neurodevelopment of infants. Our Child Health Center has carried out parenting training for parents of infants for several years to promote the neurobehavioral development of infants at an early stage.Material/MethodsWe enrolled 117 families with term infants age 0–3 months who had completed a parenting training class at the Child Health Center of the Department of Pediatrics, the Third Xiangya Hospital. Parenting training included 4 parts: nursing, intelligence, social contact, and physical ability. A nurse practitioner demonstrated procedures to parents, who then performed them at home for 1 month. The Neonatal Behavioral Neurological Assessment (NBNA) was used to evaluate infants before and 1 month after parenting training.ResultsIn the comparative analysis before and after parenting training, there was a significant increase in the NBNA scores. For the infants whose parents received parenting training, the NBNA scores in total score (33.74±0.19 before parenting training vs. 36.69±0.20 after 1 month), neonatal behavioral capacity (10.19±0.14 before parenting training vs. 11.26±0.10 after 1 month), passive muscle tension (7.28±0.07 before parenting training vs. 7.82±0.04 after 1 month), and initiative muscle tension (4.29±0.08 before the parenting training vs. 5.61±0.13 after 1 month) were significantly higher one month before (P<0.01).ConclusionsTerm infant neurobehavior was associated with participation in parenting training, suggesting that these practices of parenting training support better early neurobehavioral development of infants.

Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors.

Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates' pain responses and may lead to inaccurate pain assessment when not appropriately considered. We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN. We videotaped 154 full-term and preterm neonates of different GAs during 1-5 capillary heel sticks in their first 14days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models. Premature birth (b=-0.721), caffeine (b=-0.302), and the behavioural states quiet and awake (b=-0.283), active and asleep (b=-0.158), and quiet and asleep (b=-0.498) were associated with changes in behavioural pain scores. Premature birth (b=-0.232), mechanical ventilation (b=-0.196), and duration of the heel stick procedure (b=0.0004) were associated with changes in physiological pain scores. Premature birth (b=-0.907), Caffeine (b=-0.402), the behavioural states quiet and awake (b=-0.274), and quiet and asleep (b=-0.459), and duration of the heel stick procedure (b=0.001) were associated with changes in the modified BPSN total scores. Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates' pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs. We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population.

Use of the modified myocardial performance index for evaluating fetal cardiac functions in pregestational diabetic pregnancy babies

The aim of this study is assessment of importance of use of the modified myocardial performance index (Mod-MPI) for the evaluation of foetal cardiac function in foetuses of women with pregestational diabetes mellitus (PDM). In this study, data of 30 pregnant patients aged 18–45 years diagnosed with PDM and 30 pregnant women aged 18–45 years with normal pregnancy and their babies were evaluated. Foetal echocardiographic and doppler measurements, foetal biometric measurements, umbilical artery and ductus venosus pulsatility indexes were measured in both PDM and control groups. The Mod-MPI was significantly higher in foetuses of PDM women. Many influences especially cardiac and postpartum complications are observed in infants of PDM women. The Mod-MPI is a simple and useful method for assessing foetal ventricular function. Our study has shown that PDM is associated with foetal ventricular dysfunction. Impact statement What is already known on this subject? Although MPI is frequently used in routine clinical assessment of neonates, it is not used adequately in foetuses. Many influences especially cardiac and postpartum complications are observed in infants of PDM women. However, there are few studies focussed specifically on the assessment of foetal cardiac function in PDM. What do the results of this study add? MPI, which shows both diastolic and systolic functions is independent of ventricular anatomy and foetal heart rate, was found significantly higher in diabetic mother foetuses, can be said to be a valuable parameter in evaluating foetal cardiac functions globally. What are the implications of these findings for clinical practice and/or further research? Our study has shown that foetuses PDM are associated with foetal ventricular dysfunction. For this MPI measurement can be routinely performed at foetal cardiac measurements in foetuses of PDM mothers.

Assessement of Behavioral and Neurological Responses of Neonates with Jaundice undergoing Phototherapy

Abstract Background: Phototherapy has been the standard of care for the treatment of hyperbilirubinemia in neonates. It is generally safe procedure, although behavioral and neurological side-effects can occur. Aim of Study: To assess behavioral and neurological responses of neonates with jaundice undergoing phototherapy. Subjects and Methods: A descriptive exploratory research design was utilized on a convenient sample of sixty neonates with jaundice, total serum bilirubin level ranged from seven to twenty mg/dl and undergoing phototherapy at the NICU of El-Monera Pediatric Hospital, Cairo University. A neonatal characteristics assessment sheet, and Neonatal Behavioral Assessment Scale (NBAS) were used to collect data from September 2018 to February 2019. After written consent from parents, neonatal characteristics were recorded from the medical sheet and every neonate was assessed individually using (NBAS) two times, before starting and after stopping phototherapy. Results: The current study revealed that all neonates were full term and their mean weight was 2.86±0.53. Behavioral and neurological responses of neonates with jaundice were differed significantly after than before starting phototherapy on the NBAS. Conclusion: There were behavioral differences of studied neonates after phototherapy related to their habituation, social interactive, motor response, state organization, state regulation and reflexes. Recommendation: NBAS must be used as a tool in the routine care for neonates with jaundice undergoing photother-apy and establishment of health educational instruction for all working nurses in NICUs about appropriate nursing care to minimize the potential side effects and complications of phototherapy.