Neonatal Care Research Articles

Introducing a Resource to Support Neonatal Nurse Engagement in Clinical Research ©.

This paper introduces the Resource to Support Neonatal Nurse Engagement in Clinical Research © to educate and support engagement of nurses in study design and protocol review. The resource serves to promote collaboration between nurses and pharmaceutical researchers to advance the development of neonatal therapies. Neonates remain therapeutic orphans, underserved by the drug development community. Off-label use of drugs in neonates negatively impacts the evaluation of their safety and efficacy. Although NICU nurses' competencies are examples of expertise needed for well-designed clinical trials, nurses may have limited experience in providing insights. Resource development included a literature review and usability testing by multiple stakeholders. Usability testing indicated the resource was comprehensive and relevant to pharmaceutical and nonpharmaceutical studies. Reviewers commented resource prompts are beneficial in assessing study feasibility. Sponsors of research need nurse engagement to improve feasibility and flexibility and prevent protocol deviations in clinical trials. Leveraging the "Resource to Support Neonatal Nurse Engagement in Clinical Research © " can enhance research education and foster engagement of nurses in neonatal research. The resource has implications for the nursing profession, the pharmaceutical industry, and the advancement of new therapies. Individual nurses benefit from education and a framework for research engagement. The profession benefits from enhanced visibility through research collaboration. The pharmaceutical industry gains valuable insights on neonatal care, family dynamics, and NICU standard of care. A resource to foster collaboration in the study development process is an important step for advancing new therapies for neonates.

Multicentre external validation of the Neonatal Healthcare-associated infectiOn Prediction (NeoHoP) score: a retrospective case–control study

Background and objectivesNeonatal mortality due to severe bacterial infections is a pressing global issue, especially in low-middle-income countries (LMICs) with constrained healthcare resources. This study aims to validate the Neonatal...

Innovative Solutions in Neonatal Care: The Design and Implementation of a Multifunctional Incubator with Integrated Phototherapy for Enhanced Treatment of Hyperbilirubinemia in Newborns

Innovative Solutions in Neonatal Care: The Design and Implementation of a Multifunctional Incubator with Integrated Phototherapy for Enhanced Treatment of Hyperbilirubinemia in Newborns

Protocol to Support Skin-to-Skin Care and Closeness Between Parents and Neonates in the NICU

Skin-to-skin care (SSC) is essential, can help to prevent separation of parents and the neonate in the NICU, and should be a standard practice. It can safely be integrated into the routine care of preterm neonates, those who require surgery, and those who require all levels of intensive care. Years of experience with the provision of SSC in our NICU influenced our approach to care and resulted in practice guidelines for the safe provision of SSC. In this article, we present our clinical practical guidelines that support SSC and closeness between parents and the neonate to ensure the use of these practices for all neonates in the NICU.

Introducing a Tool to Support Neonatal Nurse Engagement in Clinical Research.

Introducing a Tool to Support Neonatal Nurse Engagement in Clinical Research.

Anesthetic considerations for fetal interventions

Fetal therapy is a well-established but rapidly evolving field discipline. Fetal interventions require a multidisciplinary team approach that emphasizes collaboration and communication. The success of a fetal therapy program relies on the availability of a comprehensive obstetric and neonatal care team, support services, and advanced imaging. Technological advancements in prenatal fetal imaging and genetic diagnosis have improved our understanding of various fetal anomalies. Surgical techniques and anesthetic management have also advanced, leading to better outcomes. Fetal anesthesia presents unique challenges as it involves managing both the mother and the fetus. Anesthetic management focuses on ensuring maternal safety and comfort, maintaining adequate uteroplacental perfusion, optimizing surgical conditions, and minimizing risks for both the mother and the fetus. This article reviews current anesthesia practices for fetal surgery, highlighting recent advances and future directions.

To Validate Use of Transmittance Sensor of Peripheral Pulse Oximeter for Forehead Pulse Oximetry in Newborns

Introduction Peripheral pulse oximeters with continuous monitoring of heart rate and saturation have revolutionized neonatal care. Motion artifacts, hypothermia, and poor perfusion are some of the barriers for reliable reading in the transmittance type of peripheral pulse oximeters. This study was planned to assess the effectiveness of transmittance sensors applied over the forehead for monitoring the heart rate and saturation. Material and Methods An observation study was conducted over a period of 1 month. Two pulse oximeters (Masimo RAD97) were applied simultaneously, one over the periphery (right hand/wrist) and the other over the forehead using an innovative headband. A total of 540 readings of heart rate and saturation (SpO2) from each site were recorded. A difference of more than 5 beats/minute in heart rate and 2% saturation were considered clinically significant. Results Forty-five neonates with mean gestational age of 35.3 ± 3.2 weeks and birth weight of 2109 ± 683 grams were enrolled. Forehead pulse oximeter could pick up the heart rate and SpO2 readings in all the babies. A statistically significant difference of 3.8 beats/minute in heart rate and 2.5% in SpO2 was noted ( p-value < 0.0001). The difference in heart rate was not clinically significant. Conclusion We propose that the transmittance type peripheral pulse oximeter sensors can be used over the forehead. It has the potential to avoid erroneous readings due to motion artifacts, hypothermia, or shock. Saturation nomograms for the forehead pulse oximetry need to be established before it can be used to monitor and manage the neonates for the same.

Prospective Observational Study Of The Outcome Of Pregnancies With Sonologically Detected Nuchal Cord At Term

Background: Nuchal cord refers to the condition where the umbilical cord wraps around the fetal neck, potentially leading to complications during pregnancy and delivery. The prevalence of nuchal cords at delivery ranges between 6% and 37%, with possible adverse outcomes including fetal asphyxia, hypoxia, and in severe cases, stillbirth. The current study aims to evaluate the impact of nuchal cord detection via ultrasound in fullterm pregnancies and assess its prognostic significance concerning perinatal outcomes. Materials and Methods: This prospective observational study involved a cohort of pregnant women at term (37- 42 weeks of gestation) with sonologically detected nuchal cords. Ultrasound evaluations were conducted to determine the presence and characteristics of nuchal cords, including the number of loops and tightness. The outcomes measured included the mode of delivery, fetal distress, Apgar scores, and neonatal complications such as hypoxic-ischemic encephalopathy (HIE) and meconium aspiration syndrome (MAS). Statistical analysis was performed to assess the correlation between nuchal cord characteristics and perinatal outcomes. Results: The study found that the presence of nuchal cords was associated with an increased rate of cesarean deliveries and a higher incidence of fetal distress during labor. However, the degree of tightness and the number of loops significantly influenced the severity of outcomes. Neonates with tightly looped nuchal cords showed a higher incidence of low Apgar scores and required more intensive neonatal care. The study also observed a slight increase in the occurrence of neonatal complications, including MAS and HIE, among those with multiple nuchal cord loops. Conclusion: The detection of nuchal cords at term via ultrasound is a valuable tool in predicting potential delivery complications. While many nuchal cords do not adversely affect perinatal outcomes, those with multiple loops or tight cords pose a higher risk of complications. This study emphasizes the importance of careful monitoring and tailored management strategies for pregnancies complicated by nuchal cords to optimize maternal and fetal outcomes.

Dairy farm management factors associated with auction sale price of young dairy calves sold at auction markets in Québec, Canada. A cross-sectional study

Each year around 150,000 surplus calves are sold at auction markets in Québec, Canada. Surplus calves (male or female not kept in the herd of origin) are sold at a young age, but these animals are at risk of receiving lower quality neonatal care than replacement heifers. Knowledge of factors associated with a higher selling price could help convince farmers to spend more resources in the care surplus calves. Our objective was to explore the associations between farm management practices and the median percentile of surplus calf selling price per farm at auction markets. The price (CAD/kg of body weight) and the individual identification number of surplus calves sold in 2 auction markets in Québec during 4 sales days in the summer 2019 and in the winter 2020 were recorded. The recorded price of each surplus calf was transformed as percentile for each breed and day of sale. Farmers managing the surplus calves were contacted and interviewed on farm management practices. The data from farmer's interviews were analyzed as potential variables associated with the median percentile of calves' selling price per farm (farm level dependent variable) in a multivariable linear regression model. A total of 509 farmers were contacted, of which 433 farmers agreed to participate, and 409 interviews were retained for statistical analysis. The farms enrolled in the study had sold a median of 2 calves (range 1-19 calves) during the sale days considered. The main breed of surplus calves sold were Holstein (82%) and Angus crossbred calves (9%). The results from the multivariable model showed that median percentile of calves' selling price was positively associated with farms with an average milk production per cow superior to 11,000 L/years (β 0.13, 95% confidence interval (95% CI): 0.045, 0.221) and farms with 3 or more workers available to take care of surplus calves (β 0.08, 95% CI: 0.005, 0.167). Those results indicate that farms having an average milk production per cow superior to 11,000 L/year increase the calves' selling price by 13 percentiles (i.e., from 50th to 63rd) and that farms having at least 3 caretakers increase their median percentile calves' selling price by 8 percentiles (i.e., from 50th to 58th). Median percentile of calves' selling price was negatively associated with farms that vaccinated cows for neonatal calf diarrhea (β -0.06, 95% CI:-0.127, -0.011), that do not disinfect the navel of newborn calves (β -0.07, 95% CI:-0.133, -0.012), that allow transporters to enter the farm's building (β -0.07, 95% CI:-0.130, -0.015) and that used wood shaving as bedding for surplus calves (β -0.08, 95% CI:-0.156, -0.021). Sensitivity analyses performed on farms that have sold 2 or more surplus calves did not show significant changes in the associations found. Despite the fact that the study was based on self-reported questionnaire answers and a small number of calves per farm, it provides insight on farm management practices associated with median percentile of surplus calf selling price at the auction markets. Taking these results in consideration, farmers could potentially improve the market value of their animals.

Lung Ultrasound in Neonates: A Narrative Review Along With Diagnostic Insights and Early Postnatal Applications.

Ultrasound (US) has become a useful, bedside, noninvasive imaging techniquein diagnosing pulmonary diseases, particularly in Neonatology, due to its non-invasive nature, lack of ionizing radiation, and high-quality imaging. This study explores current methodologies, applications, and benefits of thoracic US in neonatal care, highlighting its application in assessing pleural morphology, pulmonary consolidations, and diaphragmatic function. Key ultrasound findings, such as A-lines, B-lines, and the pleural sliding sign, are instrumental in diagnosing various lung conditions, including pneumothorax and respiratory distress syndrome. The present review emphasizes the growing importance of lung ultrasound (LUS) in predicting neonatal intensive care needs, reducing reliance on X-rays, and improving the early diagnosis of conditions like transient tachypnea of the newborn. The use of ultrasound scoring systems enhances diagnostic accuracy, making thoracic ultrasound a valuable addition to neonatal care protocols for real-time, radiation-free assessment from birth.

Healthcare Bundles are Potentially Important in Neonatal Care as Many Disorders are Temporally Clustered

Healthcare Bundles are Potentially Important in Neonatal Care as Many Disorders are Temporally Clustered

Racial and Ethnic Disparities in Neonatal Sepsis.

Sepsis is a significant health burden in the neonatal population. Although disparities in neonatal care have been reported, there are no data on racial/ethnic disparities in the context of sepsis. Therefore, we aimed to assess racial/ethnic disparities in the prevalence and outcomes of neonatal sepsis. The national inpatient Kids' Inpatient Database produced by the Healthcare Cost and Utilization Project was used for the year 2019. The International Classification of Diseases, 10th revision codes were used to identify the primary outcome of the neonates diagnosed with sepsis. The χ2 and Fisher tests were used to calculate odds ratios for categorical variables, and logistic regression was performed to calculate adjusted odds ratio (aOR) to account for confounders in neonatal sepsis. Of the total 3,512,817 patients, 202,103 patients with neonatal sepsis were identified across all racial and ethnic groups. Overall prevalence was statistically significant in Black [aOR, 1.13 (95% confidence interval [CI], 1.10-1.17)], Hispanic [aOR, 1.19 (95% CI, 1.15-1.22)], Asian/Pacific Islander [aOR, 1.10 (95% CI, 1.05-1.16)] and Native Americans [aOR, 1.17 (95% CI, 1.04-1.31)] compared with Whites. In Black infants, the OR for the overall mortality was 1.35 (95% CI, 1.28-1.42), and sepsis-related mortality was 1.20 (95% CI, 1.06-1.35) compared to Whites. Although the prevalence of sepsis is marginally higher in Hispanic infants compared with Whites, the overall and sepsis-related mortalities are the highest in Black infants compared with all races and ethnic groups.

Complete Pentalogy Of Cantrell: Case Report And Review Of Literature

Introduction: Pentalogy of Cantrell (POC) is a rare congenital anomaly with two sub-categories: complete or partial. Complete has all five defects (anterior diaphragmatic defect, ventral abdominal wall defect, pericardial defect, intracardiac anomalies, and lower sternal defect). The first documented case was described by Cantrell et al. in 1958. Both sporadic and genetic causes have been proposed for POC, with a reported incidence of 5 - 10 cases per one million live births and various clinical presentations. The prognosis of POC depends on the severity of the defects and the associated cardiac anomalies. This case report seeks to increase awareness of this condition, emphasize the need for appropriate counselling in our environment, and review the literature on previous reported cases’ outcomes. Case Presentation: A 5-hour-old term female neonate was referred to our Children Emergency Center with multiple defects (ectopia cordis, sternal cleft, omphalocele, and limb abnormalities) with dysmorphic facies. A diagnosis of POC was made, and multidisciplinary management was instituted. The eviscerated heart and epigastric omphalocele were dressed and evaluated for palliative surgical care. However, she developed complications with sepsis and electrolyte derangements and died from multi-organ failure before any surgical intervention could be carried out. Conclusion: Though rare, the Pentalogy of Cantrell in its classical form does occur in our environment. The presence of extracardiac and limb deformities worsens the outcome. Based on poor outcomes, there is a need to emphasize appropriate antenatal and postnatal assessments to provide effective counselling on termination, neonatal palliative care, and surgical repairs as appropriate.

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand–Myanmar border

BackgroundNeonatal hyperbilirubinaemia (NH) is a common problem worldwide and is a cause of morbidity and mortality especially in low-resource settings.MethodsA study was carried out at Shoklo Malaria Research Unit (SMRU)...

Assessment of neonatal glycaemic status and comorbidities in infants of diabetic mothers admitted to the neonatal care unit of Al-Ramadi Teaching Hospital for maternity and childhood, Iraq.

To assess neonatal and maternal characteristics, glycaemic status and comorbidities in the neonates of diabetic mothers. The cross-sectional study was conducted from October 2021 to May 2022 at the Department of Physiology, College of Medicine, University of Mustansiriyah, Baghdad, Iraq, and comprised healthy women. Samples were raised by simple random technique. Digital pulse waves were captured using a fingertip pulse wave transducer. Lab Chart Pro version 7.2 was used to automatically detect and quantify the amplitude of A, B, C, D and E waves expressed by the second derivative. QT interval of each beat was recorded by electrocardiogram, and was calculated automatically via Lab chart Pro version 7.2 without averaging. Data was spread out on Microsoft Office Excel 2013 and analysed using SPSS version 26. Among the 70 mothers, aged between 18 to 44 years, gestational diabetes was the commonest type 52(74.3%), and, among the 70 neonates, 52(74.3%) developed mild hypoglycaemia, 12(17.1%) hypocalcaemia, 26(37.1%) congenital heart disease, 50(71.4%) respiratory distress syndrome, 24(34.3%) hyperbilirubinaemia, 2(2.9%) congenital anomalies, 6(8.6%) prematurity, and 4(5.7%) developed birth asphyxia. Prematurity, female gender and low birthweight were significantly associated with hypoglycaemia (p<0.05). No significant differences were detected in terms of neonatal complications between pregestational and gestational diabetic mothers (p>0.05). Diabetic pregnancies were linked to a higher risk of neonatal complications.

Key Determinants of the Comprehensive Neonatal Emergency Obstetric Services Policy

Background: Effective implementation of comprehensive emergency obstetric and neonatal care programs is vital for improving maternal and neonatal health outcomes. Specific Background: At RSU Al-Islam H.M Mawardi, various factors—including communication, resources, disposition, and bureaucratic structure—affect program implementation. Knowledge Gap: Previous research has often neglected how these factors interact and their influence on healthcare policy implementation. Aims: This study evaluates the relationship between these factors and the implementation of the emergency obstetric and neonatal care program using a quantitative survey approach. Results: Analyzing data from 54 respondents revealed significant correlations between effective communication, resource allocation, and successful policy implementation (p &lt; 0.05), with the questionnaire demonstrating high reliability (Cronbach's Alpha = 0.969). Novelty: This research contributes empirical evidence on the specific elements influencing healthcare policy implementation locally. Implications: Strengthening communication and resource management is essential for enhancing policy implementation effectiveness, ultimately improving community health outcomes. Highlights : Factor Influence: Effective communication and resource allocation significantly impact program success. Research Contribution: The study provides empirical evidence on factors affecting healthcare policy implementation locally. Health Outcomes: Strengthening implementation strategies is crucial for improving maternal and neonatal health outcomes. Keywords: obstetric care, neonatal care, policy implementation, communication, healthcare resources

Efficacy of antimicrobial-impregnated catheters in preventing sepsis post epicutaneo-caval catheter (ECC) removal in neonates: A retrospective study.

Epicutaneo-caval catheters (ECC) are vital in neonatal intensive care units (NICU) in enabling prolonged venous access. Despite their benefits, central line-associated bloodstream infections (CLABSI) pose a potential risk. The ECC removal procedure may contribute to an increased risk of post removal sepsis through biofilm release. Antimicrobial-impregnated ECCs have been proposed as a potential solution to prevent this complication, but research on their effectiveness in neonates is limited. To compare post-ECC or neonatal peripherally inserted central catheter (n-PICCs) removal sepsis rates when using conventional or antimicrobial-impregnated catheters in neonates. A retrospective, single center cohort analysis using 2019 data from 421 neonates after successful ECC insertion at the Women's Wellness and Research Center, a large tertiary level NICU in Qatar. The study systematically collected data on demographics, insertion, and removal as well as microbiology, and infection data. Statistical analyses compared conventional and antimicrobial ECCs, with a focus on the incidence of sepsis within 72 hr post-removal. After excluding non-eligible, 349 cases were included in the analysis (138 conventional, 211 antimicrobial-impregnated). There were no significant demographic differences between the two groups. The CLABSI incidence was higher amongst the antimicrobial ECC group (4% vs 0.6%, p = 0.031). Among the included neonates, the confirmed post-removal sepsis incidence was 4.3% (6 cases) for the conventional and 10% (21 cases) for the antimicrobial ECC groups, which was not statistically significant (p = 0.055). The study noted a higher, but statistically insignificant, incidence of post removal sepsis when using antimicrobial-impregnated ECCs. This finding raises questions about the effectiveness of antimicrobial ECCs in preventing post-removal sepsis in this patient population. Further randomized trials are needed to assess the role of antimicrobial ECCs amongst neonates and to refine neonatal ECC care strategies.

Fathers’ Experiences Six Months After their Preterm Infant's Discharge from the NICU

ABSTRACT Although fathers experience emotional stress both during the care period and after discharge, there is limited research focusing exclusively on fathers’ experiences after their time in a neonatal intensive care unit. Their experiences are important for tailoring support to fathers based on their individual needs. This paper is part of a longitudinal study in which parents were followed by means of questionnaires and individual interviews during a two-year period after discharge from hospital-based neonatal home care. A qualitative content analysis with an inductive approach was used to elucidate the experiences of fathers six months after their preterm infant’s discharge. Twelve fathers participated in the study. The following categories emerged and constituted the result: “Vivid memories from the NICU,” “Struggling with new challenges in life” and “Transition to home still in their thoughts.” The approach and attitude of health-care professionals may contribute to fathers’ involvement during the care period, as fathers tend to set their own feelings aside.

Factors Associated with Newborn’s Survival: A Cross-Sectional Study at two Districts of Bihar

Family Participatory Care (FPC) is a relatively new concept adopted in SNCUs in India. Its effect on survival outcomes of sick newborns has not been studied much. As such newborn mortality studies are rare due to their large sample scale requirement. This is one of the few studies which have been conducted using primary data on this subject in India. In our study, we have found similar causes of death among newborns as published by renowned studies. Study findings highlighted that FPC may reduce newborn mortality by reducing the length of stay at the facility, newborn growth, and survival outcome of sick neonates, especially Kangaroo mother care and exclusive breastfeeding are key components of FPC, and help in reducing newborn deaths. Objectives: Family Participatory Care (FPC), a cost-effective innovation implemented in Special Newborn Care Units (SNCUs) where vulnerable newborns are treated, is a well-established concept akin to Family Centered Care (FCC) in developed nations. The study aims to assess the impact of FPC on the survival rates of sick neonates in SNCUs. The study explored the factors associated with the care of sick neonates after discharge from SNCU that adapted FPC and that did not adapt FPC. Methods: A multistage random sampling method was used to examine sick neonates and newborns discharged from Special Newborn Care Units (SNCUs) in selected districts of Bihar namely Nalanda SNCU with Family Participatory Care (FPC) and Vaishali SNCU without FPC. Findings: The study found a notable variance in the rate of newborn mortality between the district implementing Family Participatory Care and the district that did not implement FPC, with the former experiencing nearly double the rate of newborn deaths. 11 key factors (maternal, household, family support, newborn health-related) attributing towards newborn survival status were identified in this study. Novelty: Family Participatory Care (FPC) is a relatively new concept in India, and this is one of the few studies that have been conducted on this subject. Keywords: Neonatal death, Family Participatory Care, Newborn Survival, Newborn Care, Family participation in Newborn care

Are Turkish Midwifery Students Prepared for The Profession? Their Self-Confidence Levels and Associated Factors

Objective: To determine the self-confidence levels of midwifery students in line with the International Confederation of Midwives (ICM) competencies they are expected to possess before graduation and to explore effective factors. Materials and Methods: Descriptive and cross-sectional online survey design was used among quantitative research methods. The online survey link was spread through social media. In order to increase the response rate, the online survey links were posted every day. From March to June 2020, 763 midwifery students completed a survey on demographic characteristics and rated their confidence for essential midwifery skills listed by ICM. Results: Among the subscales, the highest average belonged to postpartum care (3.32 ± 0.66) and the lowest average to intrapartum care (2.94 ± 0.59). The students reported having less self-confidence in obstetrics emergencies, risky delivery, and neonatal care. The difference between descriptive characteristics and the ICM competencies subscales was found to be statistically significant (p