Neonatal Care Unit Research Articles

70 Purpose-built Catheters for Minimally Invasive Surfactant Therapy – Experience from a Canadian Tertiary Level Neonatal Intensive Care Unit

Abstract Background Surfactant delivery via a thin endotracheal catheter during spontaneous breathing (a technique called minimally invasive surfactant therapy [MIST]), is an increasingly popular alternative to intubation and surfactant administration. Procedural details among different centres vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multiaccess catheters and vascular catheters for this purpose. Recently, purpose-built catheters for MIST received regulatory approval in Canada and became available for use. Procedural differences and user experiences between such catheters have not been described. Objectives The aim of this study was to describe procedural success, procedural adverse effects and user experience pertaining to two different types of purpose-build catheters (BLEScath™ and Surfcath™) for surfactant administration. Design/Methods This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit (NICU) in Southwestern Ontario. Neonates who received MIST using purpose-built catheters between January 1, 2021 and March 31, 2022 were included. Two types of purpose-built catheters were used in this time period: Surfcath™ and BLEScath™. Relevant baseline characteristics and data on procedural details (premedication, type of catheter) were collected. The procedural success, number of attempts and adverse effects among neonates who received MIST via Surfcath™ and those who received surfactant via BLEScath™ were compared, using chi-square tests or Fisher’s tests, as appropriate. User experience was described using an ease-of-use scale. Descriptive reports of user experience were collected and explored for themes/patterns. P-values <0.05 were considered statistically significant. Results 37 neonates met eligibility criteria; 22 received MIST via Surfcath™, whereas 15 received MIST via BLEScath™. Success rates were 91% in SurfCath™ and 93% in BLES-Cath (P> 0.994). Failed attempts were lower in Surfcath™ (23%) compared with BLEScath™ (33%), but the difference was not statistically significant (p=0.708). Upon analyzing ease-of-use by operators, we found that 90% of operators found Surfcath™ very easy or relatively easy to use, compared with 43% of users reflecting the same degree of use with BLEScath™ (P=.021). Users described difficulty in ‘maneuvering’ the BLEScath™ and reported it to be ‘pliable/ flimsy’. There was no difference in adverse events between groups. Conclusion This is the first study in Canada to report the experience of MIST with purpose-built catheters. Overall success rate was equally high for both catheters. Users subjectively reported higher ease of use with SurfCath™. Commercially available purpose-built catheters should facilitate universal adaptation of the MIST method. Our reports regarding operator experience may help with optimizing future product design to improve ease-of-use.

87 Infant Malrotation with Midgut Volvulus Presenting in the Paediatric Emergency Department or the Neonatal Intensive Care Unit: A Retrospective Review for a Quality Improvement Initiative

Abstract Background In neonates, bilious vomiting is considered malrotation with midgut volvulus (MV) until proven otherwise, given its associated high morbidity and mortality. The diagnosis is time-critical, requiring prompt identification to avoid complications. Many of these patients are described as clinically well at time of presentation, possibly delaying definitive management. Objectives This study was a retrospective quality initiative aimed to evaluate the clinical presentation of infants and children with MV in a single paediatric tertiary care centre emergency department (ED) and neonatal intensive care unit (NICU). The study also aimed to identify delays in the management pathway. Design/Methods Patients with a final diagnosis of MV presenting to the ED/NICU were identified between January 2015 and May 2022. Patient demographics, signs and symptoms at presentation, initial laboratory studies, imaging, and surgical findings were recorded. The following time points were recorded: (1) first medical evaluation, (2) radiologic investigations (abdominal X-ray [AXR], ultrasound [US], upper gastrointestinal radiography [UGI]), (3) consultation with surgical team, and (4) time to surgery. Results During the study period, 29 paediatric patients presented a diagnosis of MV (ED: 21, NICU: 8). The median age at presentation was 7 days (3-13.5), with 27/29 (93%) being less than 3 months. From them, 21 patients (72%) were male. Bilious green (17/26) and/or yellow (13/26) vomiting was the most frequent presentation in 26/26 (100%), the three other patients had missing data. Five patients (17%) had a pH < 7.30 (with base deficit < -5) and seven (24%) patients had a glucose value > 7 mmol/L. Abdominal radiograph was performed in 17/29 (59%) patients. All (100%) had ultrasound (US) which was diagnostic in 24/29 (83%) cases. Six upper gastrointestinal series (UGI) were performed, being diagnostic in all cases (100%). The Ladd’s procedure was the standard treatment for every patient (100%). Median time between arrival and US was 151 minutes (71 – 243), UGI was 347 min (246 – 800) and surgery was 299 minutes (204-371). In the NICU specifically, six cases were referrals, with the median time between the first documented bilious vomit and the call from the referral centre being 660 minutes (335-1104). Of the 29 cases, 27 (93%) survived and from them, one suffered a short bowel complication. Conclusion Bilious (green/yellow) vomiting is a reliable clinical sign of MV in infants, being always aware that yellow may be bile. Ultrasound is a rapid test with more than 80% diagnostic accuracy. Delay for definitive surgery was considered slightly high. This quality initiative will help develop a clinical practice guideline and algorithm to reduce delays for infants presenting with MV.

Impact of Targeted Neonatal Echocardiography on Patent Ductus Arteriosus Management in a Canadian Tertiary Care Neonatal Unit: A Retrospective Cohort Study.

Comprehensive assessment of hemodynamic significance of a patent ductus arteriosus (PDA) is a common indication to perform targeted neonatal echocardiography (TNE). Impact of implementation of such an assessment on PDA management decisions remains to be reported. The objective of this study is to compare PDA-related hemodynamic information and PDA treatment decisions before and after introduction of TNE service. This was a retrospective cohort study at a tertiary level neonatal intensive care unit in Southwestern Ontario. We investigated two time periods: Epoch-1 (non-TNE 2013-2016) versus Epoch-2 (TNE 2018-2021). We included neonates < 32 weeks with PDA. Data on baseline clinical characteristics, PDA-related echocardiographic parameters, PDA treatment details, and relevant long-term outcomes were collected. Primary outcome was defined as PDA treatment rates and need for multiple courses. Secondary outcomes included availability of PDA hemodynamic data and neonatal mortality/morbidity (PDA-related) RESULTS: A total of 275 neonates were included. A total of 162 were assessed by conventional echocardiography in Epoch-1, whereas 113 were assessed by TNE in Epoch-2. Baseline clinical characteristics were similar. Epoch-2 had more echocardiographic assessments per patient of 2.7 (±1.8) versus 1.9 (± 1.3), p < 0.001 in Epoch1. The mean postnatal age at first echocardiographic assessment was higher in Epoch-2 (12.7 days [ ± 14.6]) than in Epoch-1 (7.9 days [ ± 10.4]), p < 0.001. Comprehensive hemodynamic assessment of PDA-related echocardiographic parameters such as PDA size, shunt pattern, effect on systemic circulation, and pulmonary circulation were higher in Epoch-2. Overall, PDA treatment rates were comparable in the two time periods. The use of multiple courses of treatment was higher in Epoch-1 than in Epoch-2 (47.8 vs. 31.7%, p = 0.047). In Epoch-1, neonates received PDA treatment earlier than in Epoch-2. With the implementation of the TNE service, increased echocardiographic evaluations per patient were completed with availability of more comprehensive hemodynamic information about PDA. PDA treatment rates were similar in the two epochs, but need for multiple courses were less in TNE era. · TNE allows comprehensive hemodynamic assessment of PDA.. · Implementation of dedicated TNE service led to increased use of echocardiography to assess PDA.. · Standardized hemodynamic assessment of PDA may allow improved individualization of treatment need..

XIII International Conference on Kangaroo Mother Care - Different opinions, experiences and related KMC issues: Good practices, stabilisation concept, nutrition and basic respiratory support.

This study aimed to summarise the views and experiences of the participants in the workshop of the XIII International Conference on Kangaroo Mother Care (KMC). The results of the discussions held during the workshop of the XIII International Conference on KMC were summarised. There were 152 participants from 47 countries. Four main KMC topics were discussed: good practices, immediate implementation, nutrition and basic ventilation. Several agreements were reached, namely that professional societies and governments should develop official recommendations to promote KMC as standard care for preterm and low birth weight infants and that parents should be involved as active caregivers in neonatal care units. Moreover, the criteria for referring community-born infants to KMC require standardisation. Important inequalities in resource availability among high-, middle- and low-income countries were recognised for all topics. Specific needs were identified for parenteral nutrition and fortifiers, nasal continuous positive airway pressure (nCPAP) and oxygen blenders, which are rarely available in low- and middle-income countries. Immediate implementation of KMC was discussed as a new concept. Its benefits were recognised, but its application has some variability. Adequate preterm care requires a basic neonatal package, including KMC, nCPAP, immediate management protocols and adequate nutrition and feeding strategies. The differences in resources among high-, middle- and low-income countries highlight the wide disparities in neonatal care according to the place of birth.

Modifications in family centered developmental care and in neonatal intensive care during the COVID-19 pandemic in a hospital in Spain: A qualitative study

IntroductionFamily centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC. ObjectivesTo understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19. MethodsA qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses’ narratives and discourses. ResultsThree open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1) changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2) changes in interpersonal relationships in the context of a pandemic, and 3) transition to normality. ConclusionsThe nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

Motor development in premature infants: Study protocol for an interdisciplinary hospital-home intervention.

Deviations occur in the neuropsychomotor development of premature infants; early interventions minimize delay motor. This study aimed to determine the effect of an interdisciplinary hospital-home intervention addressing motor development adaptation in premature infants in Colombia in comparison with traditional interventions. This study was based on a parallel design, with two groups, namely, experimental and control. The experimental group, hospital-home intervention (HHI) performed in two settings (i.e., hospital neonatal care units and homes), and the control group, traditional intervention, (TI) performed in institutions for premature infants. The sample will be composed of 130 randomly-allocated infants, 65 in the experimental group (HHI) and 65 in the control group (TI) of moderate to late preterm infants (gestational age between 34 and 37 weeks), weighing more than or equal to 1.800 g, who are hemodynamically stable and reside in the cities of Tunja and Bogotá-Colombia recruited between 2021 and 2022. For the pre- and post-intervention assessments, the TIMPSI and the CapDMP are the instruments used to assess motor development and the degree of parents' or caregivers' knowledge about motor development. The HHI is composed of 10 intervention strategies based on stimulation of motor development, performed twice a day for 10 min for two months, in combination with calls to a mobile device, using software (Baby Motor Skills) and an instant messaging system (WhatsApp). This hospital-home intervention program proposes an approach focused on the motor development of premature infants, based on sensory and motor stimulation strategies, in addition to follow-up performed at home with the use of a mobile application that improves the motor development of premature infants. Register Clinical Trial: NCT04563364. The HHI provides the opportunity to determine whether the individualized four-week from admission to follow up at home with parent training will improve the motor skills of premature infants.

Characteristics of pregnancy complicated with type 1 and type 2 diabetes.

Diabetes in pregnancy is a major risk factor for adverse perinatal outcomes such as congenital anomalies, hypertensive disorders of pregnancy (HDP), and macrosomia. For the mechanism of onset of type 1 and type 2 diabetes are different, we focused on the difference in perinatal outcomes between the type 1 and type 2 diabetes groups. We retrospectively reviewed 22 pregnancies with type 1 diabetes and 15 pregnancies with type 2 diabetes, who were managed in our single center, with regard to maternal diabetes conditions during pregnancy and neonatal birthweight and blood glucose level. Furthermore, we checked the effect of continuous glucose monitoring and continuous subcutaneous insulin injection in pregnancies with type 1 diabetes. Type 1 diabetes in pregnancy was less controllable and increased neonatal birth weight and neonatal hypoglycemia within 2h after birth after neonatal care unit admission. Continuous glucose monitoring and continuous subcutaneous insulin injection that are convenient to use, had a similar effect in the management of type 1 diabetes during pregnancy, compared with conventional diabetes treatment. In contrast, maternal BMI and HDP were increased in women with type 2 diabetes. In the management of pregnancy with diabetes, we should pay attention to the difference in pregnancy prognosis between type 1 and type 2 diabetes.

Modificaciones de los cuidados centrados en el desarrollo y la familia en cuidados intensivos neonatales durante la pandemia por COVID-19 en un hospital de España: un estudio cualitativo

IntroductionFamily centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC. ObjectivesTo understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19. MethodsA qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses’ narratives and discourses. ResultsThree open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1)changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2)changes in interpersonal relationships in the context of a pandemic, and 3)transition to normality. ConclusionsThe nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

Intestinal Obstruction by Meconium Ileus in the Newborn Revealing Cystic Fibrosis

Objective: To report a case of a preterm infant with meconium ileus at birth and cystic fibrosis. Background: The meconium ileus corresponds to the obstruction of the terminal ileum by an abnormally thick meconium; it is observed most often in neonates with cystic fibrosis. Case description: a female infant was born by cesarean delivery section on severe pre-eclampsia with oligohydramnios and intrauterine growth restriction, weighing 1230 g at 36 weeks of gestational age, with Apgar scores of 10/10. His mother was a 26-year-old G2P2 who had attended three prenatal consultations with negative serology for vertical infections. Immediately after birth, the newborn was referred to our neonatal critical care unit due to severe abdominal distension. the Newborn had a delay in meconium emission of more than 48 hours. an abdominal X-ray showed significant intestinal distension and a barium enema was performed showing meconium plugs with a colon of normal topography and caliber, initially put on antibiotic therapy with enema by gastroraphy twice a day, an etiological assessment was carried: A genetic study was conducted, revealing that the newborn is a carrier of a variant (c.1521-1523delCTT,p.Phe508del F50 del) associated with a classic form of cystic fibrosis in a homozygous state and the first immunoreactive trypsinogen (IRT) was &gt; 1300 ug/l (reference value &gt;1000 ug/l), in view of the non-improvement the newborn benefited from an ileostomy. Comments: This case illustrates the rapid evolution of CF in a premature patient with meconium ileus as the first clinical manifestation.

Causes, Timing, and Factors Related to Neonatal Death: A Descriptive Study

Background: Neonatal and pediatric health have a great share in global health programs. However, the neonatal mortality rate still shows unacceptable figures and statistics worldwide. Objectives: To investigate the timing and causes of neonatal death. Methods: In this retrospective descriptive study conducted in neonatal care units of Mahdiyeh Hospital in Tehran, Iran, the census sampling method was used to include all the medical records of the expired neonates during 2015-2020. Neonatal and maternal demographics and health complications were recorded. Descriptive statistics such as mean, standard deviation, frequency, and associations were analyzed to compare factors recorded as causes of neonatal death and its timing. A P-value of &lt; 0.05 was considered significant. Results: Out of 24049 live births, 755 neonates had expired (3.1%). The expired neonates' average birth weight was 1616 ± 905 grams, and 35.9% weighed under 1000 grams. Most (80.8%) expired neonates were preterm (30.9 ± 4.8 gestational weeks), and the most common causes of neonatal death were prematurity (23.6%), congenital anomaly (19.9%), respiratory distress syndrome or RDS (19.5%), sepsis (13.2%), and asphyxia (7%). Most (60.7%) neonates died between the second and seventh days of birth. The following conditions were associated with an early-period neonatal death rather than a later-period: multiple births (OR = 2.8), normal vaginal delivery (OR = 2.03), low-birth-weight, diabetic mothers, neonatal heart disease, neonatal neurological diseases, RDS, asphyxia, familial marriage, and intrauterine growth restriction (IUGR) (P &lt; 0.05). Being male (P = 0.005) or being multiple births (P &lt; 0.0001) were associated with a higher risk of death. While 57% of mothers delivered through Cesarean section, among the expired neonates, 66.9% were delivered through Cesarean section. In expired neonates, Apgar scores were low in the first (5.71) and fifth (7.27) minutes of birth. Conclusions: Our study showed that prematurity, congenital anomaly, RDS, sepsis, and asphyxia were the most prevalent causes of death among expired neonates, respectively. Preterm birth and low birth weight were prevalent among expired neonates. Conducting regular similar studies periodically is important to identify, manage, and reduce neonatal mortality rates as an indicator of health promotion in the country.

Time trends in perinatal outcomes among HIV-positive pregnant women in Northern Tanzania: A registry-based study.

Maternal HIV infection is associated with increased risk of having a preterm delivery, low birth weight baby, small for gestational age baby and stillbirth. Maternal use of combination antiretroviral treatment is also associated with preterm delivery and low birth weight, although the effects vary by the type of drugs and timing of initiation. To examine time trends in adverse perinatal outcomes among HIV-positive compared with HIV-negative women. Registry-based cohort study. Northern Tanzania, 2000-2018. Mother-baby pairs of singleton deliveries (n = 41 156). Perinatal outcomes of HIV-positive women were compared with HIV-negative women during time periods representing shifts in prevention of mother-to-child transmission guidelines. Monotherapy was used as first-line therapy before 2007 while combination antiretroviral treatment was routinely used from 2007. Log binomial and quantile regression were used to analyze the data. Preterm delivery, low birth weight, perinatal death, stillbirth, low Apgar score, transfer to neonatal care unit and small for gestational age. Overall, maternal HIV infection was associated with a higher risk of low birth weight and small for gestational age. Moreover, this pattern became more pronounced over time for low birth weight, the last time period being an exception. For other outcomes we found none or only a small overall association with maternal HIV infection, although a trend towards higher risk over time in HIV-positive compared with HIV-negative women was observed for preterm delivery and perinatal death. Quantile regression showed an increase in birth weight in babies born to HIV-negative women over time and a corresponding decline in birth weight in babies born to HIV-positive women. Unfavourable trends in some of the selected perinatal outcomes were seen for HIV-positive compared with HIV-negative women. Potential side-effects of combination antiretroviral treatment in pregnancy should be further explored.

The Relationship Between Hemoglobin Level and Mother-Child Medical History of Children with Anemia who are Under Five Years Old

Background: The prevalence of anemia is a global public health concern, affecting both developed and developing countries. The effects of childhood anemia are devastating, ranging from stunted growth and impaired cognitive and motor development to an increased risk of mortality. Objective: The study aims to determine the mother and child medical history associated with hemoglobin levels among under-five children in Kut City. Methods: A cross-sectional study with a convenience sample (non-probability) was conducted among 264 children admitted to hospitals in Kut City. From September 1st, 2022, to March 1st, 2023. Data were collected via questionnaires, and descriptive and inferential statistics were used to evaluate the data. Results: The total number of children participating in the study was 264, with 39.0% having mild anemia and 60.0% having moderate anemia, according to the WHO classification of anemia. The results showed that the children most at risk of developing anemia were born to mothers with prenatal medical problems. As well as the period of admission of the child to the hospital. Children who were partially immunized showed the lowest mean of hemoglobin. In contrast, children with a History of acute blood loss showed the lowest mean of hemoglobin. The degree of anemia was significantly associated with a long duration admission in pediatric word or neonatal care unit. Conclusions: According to the study, the most critical factors facing anemia were high significant with partially immunized and a history of blood loss.

Surgical repair of neonatal total anomalous pulmonary venous connection: A single institutional experience with 241 cases

ObjectiveChallenges persist in surgery for neonatal total anomalous pulmonary venous connection (neoTAPVC), with the high mortality risk not mitigated over time. MethodsA prospectively collected single-center database containing all neonates with TAPVC undergoing biventricular repair in 2012 to 2020 was retrospectively reviewed. The primary outcome was death or postoperative pulmonary venous obstruction (PPVO). Based on the preoperative admission location in our hospital, patients were classified into those being admitted to cardiac intensive care unit versus neonatal intensive care unit or general pediatric intensive care unit. Access to dedicated presurgical care (DPC) was defined as patients who were preoperatively admitted to the cardiac intensive care unit. ResultsOverall, 241 patients with a median age at surgery of 14 days (interquartile range [IQR], 9-21 days) were included. Anomalous return was supracardiac in 38.6%, cardiac in 26.1%, infracardiac in 28.6%, and mixed in 6.6%. Patients receiving DPC had better survival (96.3% vs 84.3%; P = .0028) and lower incidence of PPVO (15.2% vs 28.6%; P = .011) compared with those without DPC. Patients in the DPC group were less likely to undergo operation within 24 hours on presentation (27.1% vs 40.3%; P = .041), had improved lactate clearance (1.5 [IQR, 1.0-2.2] vs 2.8 [IQR, 1.8-4.1]; P < .001), and had lower incidence of postoperative pulmonary hypertension crisis (2.8% vs 18.7%; P < .001) compared with those in no-DPC group. After matching, no difference in PPVO could be observed in patients undergoing conventional versus sutureless repair (22.6% vs 12.9%; P = .29). ConclusionsAccess to DPC potentially improves outcomes in the neoTAPVC setting; freedom from PPVO were similar using conventional versus sutureless repair.

Extrauterine Growth Retardation—Incidence, Risk Factors, and Prediction Model in Tertiary Care Neonatal Intensive Care Unit in North India

Background With the increasing survival of preterm infants, their nutrition becomes an enormous challenge. Adequate nutrition plays an important role in good neurodevelopmental outcomes. Extrauterine growth retardation (EUGR) is defined as discharge weight below 10th percentile of the weight expected for that gestation after plotting on postnatal growth charts. Aims and Objective This study was conducted to assess the incidence of EUGR in preterm babies and its associated risk factors. Material and Methods This was a retrospective medical chart review of neonates admitted from January 2017 to November 2021 to a level III Neonatal Intensive Care Unit in Delhi, India. Eligible neonates were all preterm babies born at &lt;35 completed weeks’ gestation admitted in NICU within 24 hours of birth and survived for at least 7 days. Neonates who died during hospitalization or were born with a major congenital anomaly requiring surgery in immediate neonatal period or with any genetic syndrome were excluded. Results A total of 250 babies were enrolled in the study, out of which 45.2% neonates were EUGR. Factors significantly associated with EUGR status were long duration of hospital stay, lower birth weight, small for gestational age (SGA) at birth, male sex, persistent ductus arteriosus, sepsis, broncho-pulmonary dysplasia, use of total parenteral nutrition, long duration of mechanical ventilation, longer time to reach full feeds, and interruption of feeds. SGA was associated with highest odds of developing EUGR [OR-80.45 (16.96-1441.09), P&lt;0.001 followed by use of TPN [OR-2.86 (1.61-5.08), p&lt;0.001]. Risk of EUGR increased manifold as the number of risk factors increased. Future plans Strategies for prevention of EUGR should focus on prevention of various neonatal morbidities and risk factor reduction during the hospital stay.

Early social referencing predicts object mastery motivation in infancy: Social antecedents of object mastery motivation.

The researchers sought to understand the typical development of social referencing and object mastery motivation in infancy and to determine the relationship between social referencing and object mastery behaviors in infants from 7 to 22months of age. The study included 36 infants who were followed as part of a longitudinal study of at-risk infants but were not determined to need care in the neonatal intesive care unit at birth. Both mastery behaviors of persistence and success showed a statistically significant effect of age, while social behaviors remained stable from 7 to 22months. Social behaviors at 7 and 10months were correlated with persistence at 22months and success at 16 to 22months demonstrating that early social referencing predicts object mastery behaviors in later infancy. Further research should determine if this trend extends to early childhood.

Incidence of Neonatal Seizures in China Based on Electroencephalogram Monitoring in Neonatal Neurocritical Care Units

Neonatal seizures pose a significant challenge in critical care, and continuous video electroencephalography (cEEG) monitoring holds promise for early detection of seizures. However, large-scale data on the incidence of neonatal seizures and monitoring systems in China are lacking. To determine the incidence of neonatal seizures in infants with high risk in China. A large, cross-sectional multicenter study was conducted from January 2017 to December 2018 in the neonatal intensive care units (NICUs) of 7 tertiary medical centers in China. Neonates with high risk were included, and cEEG monitoring was conducted. Data were collected between January 1, 2017, and January 31, 2020. The data were analyzed between January 2021 and January 2022. The incidence of neonatal seizures, categorized by etiology, and seizure burden. A total of 20 310 neonates with high risk were included (10 495 [51.7%] male; mean [SD] postmenstrual age, 37.7 [3.7] weeks), and seizures were observed in 3423 infants (16.9%). The highest proportion of seizures was attributed to acute neonatal encephalopathy (1448 [42.3%]). The incidence of seizures decreased with postmenstrual age and birth weight, with the highest occurrence observed in neonates with postmenstrual age of less than 28 weeks (237 of 879 [27.0%]) or birth weight of less than 1.0 kg (269 of 914 [29.4%]). Preterm infants had a higher proportion of moderate and severe seizure burdens compared with full-term infants (moderate severity: 248 of 1199 [20.7%] vs 454 of 2224 [20.4%]), but no significant differences were observed in etiology. Seizure burden was highest with genetic syndromes (49 of 188 [26.1%]), central nervous system malformations (33 of 127 [26.0%]), and inborn errors of metabolism (27 of 113 [23.9%]). During hospitalization, 7.8% of neonates with seizures died (267 neonates), with 81.3% of these cases having a moderate or severe seizure burden (217 neonates). Mortality was generally higher in preterm vs full-term infants (98 of 1199 [8.2%] vs 169 of 2224 [7.6%]) and increased with the severity of seizure burden (217 of 267 neonates with moderate or severe burden [81.3%]). This cross-sectional study of neonatal seizures underscores the substantial burden seizures pose to high-risk infants with brain injury in China, particularly those who are born prematurely or who have congenital conditions.

Validation and Feasibility of the Postnatal Growth and Retinopathy of Prematurity Retinal Screening Criteria at a Level IV Tertiary Care Neonatal Intensive Care Unit.

Retinopathy of prematurity (ROP) is detected in preterm infants by standardized screening programs, but in general, they have poor sensitivity. The Postnatal Growth and Retinopathy of Prematurity (G-ROP) algorithm uses weight gain to predict ROP superior reported sensitivity. Our objectives are to (1) independently validate the sensitivity of G-ROP criteria for the detection of ROP in infants born at >28 weeks' gestation in a tertiary care unit in the United States and (2) to calculate the cost savings associated with a potential reduction in examinations. This is a retrospective analysis of retinal screening examination data, with post-hoc application of G-ROP criteria to determine whether G-ROP criteria had acceptable sensitivity and specificity in diagnosing Type 1 and Type 2 ROP. All infants born at >28 weeks who were screened by current American Academy of Pediatric Ophthalmologists/American Academy of Pediatrics guidelines at Oklahoma Children's Hospital at the University of Oklahoma Health Sciences Center, between 2014 and 2019, were included. Subset analysis of infants screened by second tier criteria was also performed. Potential cost savings were estimated by analyzing frequency of billing codes. And by calculating the number of infants who could have potentially been spared examination. The G-ROP criteria had 100% sensitivity in detecting type 1 and 87.6% sensitivity in detecting type 2 ROP, which would have reduced infants screened by 50%. All infants in the second tier who would require treatment were detected. A cost saving of 49% was projected. The G-ROP criteria are easy to apply in real-world setting, thus establishing feasibility. The algorithm identified all cases of type 1 ROP; however, some cases of type 2 ROP were not detected. The annual savings in hospital examination cost by using these criteria would be 50%. Therefore, G-ROP criteria can safely be used to screen for ROP and may reduce the number of unnecessary examinations. · The G-ROP screening criteria are safe and predict 100% of treatment warranted ROP.. · Adoption of G-ROP criteria is feasible for level IV NICUs.. · Adoption of G-ROP screening guidelines will result in significant cost savings..

Financial Implications for Families of Newborns Admitted in a Tertiary Care Neonatal Unit in Northern India

Background Admission of a newborn to neonatal intensive care unit is very stressful for family and poses significant financial burden. Aim To estimate the cost of neonatal care in a tertiary care level institution in northern India. Methods This prospective observational study was conducted over a period of 4 months at a 30-bedded level III neonatal unit in a tertiary care institute in north India. Data was collected from a self-written diaries by parents of all neonates admitted in the unit. The cost analysis included direct hospital cost and additional expenditure by families during entire hospital stay. Results A total of 135 newborns (86 males) were enrolled in this study. 60 babies required Neonatal intensive care unit (NICU) admission. The median total expenditure incurred in study cohort was US$172 (IQR 83.5–546.3); median duration of hospital stay was 7 (IQR 5–16) days. The total expenditure per day for babies with Neonatal intensive care unit stay was US$32.7 (IQR 23.5–48). The direct hospital charges amounted to approximately 3/4th of total expenditure, while rest 1/4th was additional cost incurred upon family. Conclusion The cost of care of a sick newborn in public sector hospital of India is substantial. Additional expenditure apart from direct cost of treatment contributes significantly to the financial burden.

Study of altered blood glucose levels in term neonate with sepsis

Neonatal hypoglycemia is common metabolic disorder. Hyperglycemia can also occur in other conditions like exogenous parenteral glucose administration, preterm, ELBW babies, stressed premature infants (requiring mechanical ventilation), hypoxia or neonatal diabetes mellitus. The major clinical problems associated with hyperglycemia are hyper osmolality and osmotic dieresis leading to alteration in cerebral auto regulation. Aim &amp; objective: To study the effect of hyperglycemia in term neonate with sepsis and compare it with hypoglycemia. It is a hospital based prospective observational study .The study was carried out in the special care neonatal unit and pediatric indoor of Department of Pediatrics, SCB Medical College, Cuttack and SVP Postgraduate Institute of Pediatrics, Cuttack during the period from September 2018 to August 2020. The number of cases of neonatal sepsis with normoglycemia hypoglycemia and hyperglycemia were, 90(44%), 67(32%), 52(24%) cases respectively. The total number of cases with proven sepsis (n=47) hyperglycemia accounts for 40.4%of cases followed by hypoglycemia 18 cases (38.3%) and normoglycemia seen in 10 cases (21.2%). Both hypoglycemia and hyperglycemia were associated with increased mortality rates at all thresholds but hyperglycemia was independently associated with increased odds of death in patients with neonatal sepsis compared to hypoglycemia.

Spanish adaptation and validation of the empowerment of parents in the intensive care-neonatology (EMPATHIC-N) questionnaire

IntroductionParental satisfaction is rarely measured in the neonatal intensive care unit due to a lack of specific assessment tools. The Empowerment of Parents in The Intensive Care-Neonatology (EMPATHIC-N) questionnaire is an instrument to assess satisfaction in relation to family-centred care that has been validated in several countries, but not Spain. ObjectivesTo perform the translation and cultural adaptation of the EMPATHIC-N to Spanish followed by its validation for the purpose of assessing satisfaction in parents with children admitted to the neonatal intensive care unit. Material and methodsThe questionnaire first underwent forward and backward translation and transcultural adaptation by a panel of experts through a standardized process based on the Delphi method, followed by a pilot study in 8 parents and then a cross-sectional study in the neonatal intensive care unit of a tertiary care hospital to assess the reliability and converging validity of the Spanish version. ResultsThe study proved the comprehensibility, validity, feasibility, applicability and usefulness of the Spanish version of the EMPATHIC-N in the field of paediatric health after being evaluated by 19 professionals and 60 parents. The content validity was found to be excellent (0.93). The reliability and convergent validity of the Spanish version of the EMPHATIC-N was analysed in a sample of 65 completed questionnaires. The Cronbach α for each domain was greater than 0.7, indicating a high internal consistency. We assessed validity by analysing the correlation of the 5 domains with the with the 4 general satisfaction items. The validity was found to be adequate (rs, 0.4−0.76; P < .01). ConclusionsThe Spanish version of the EMPATHIC-N questionnaire is a comprehensible, useful, valid and reliable instrument to measure satisfaction in the parents of children admitted to neonatal care units.