Neonatal Intensive Care Unit Group Research Articles

Alleviating Neonatal Intensive Care Unit Stress: A Chinese Medicine Approach in Neonatal Rats.

Premature infants are exposed to numerous stressors in neonatal intensive care unit (NICU) during a crucial period for brain development; this period exerts long-term influences on cognitive and behavioral development. To evaluate the effect of NICU-related stress on neonatal rat pups and explore the effect of Chinese medicine treatment (CMT). Sixty male rat pups were randomly assigned to three groups: the control group, the NICU group (NICU-related stress), and the CMT group (NICU-related stress plus CMT). All stressors and interventions were administered from 0 to 7 days after birth. Body weight, serum corticosterone levels, and behavior in the open field (OF) test, elevated plus maze (EPM) test, sucrose preference test, and Morris water maze (MWM) test were recorded, and blood samples were collected at five different time points (T0, T1, T2, T3, and T4). The body weights of rats in the CMT and control groups were heavier than those in the NICU group in both early life and adulthood (P < 0.05). Serum corticosterone levels significantly differed with time (except T0 vs. T1 and T3 vs. T4) but did not significantly differ among the three groups (F = 0.441, P = 0.894). Regardless of age, spatial memory and anxiety-like and depression-like behavior did not differ among the three groups. NICU-related stress exerted a long-term effect on rat growth and development but did not affect spatial memory, anxiety-like behavior, depression-like behavior, or serum corticosterone levels. CMT alleviated the impact of NICU-related stress on rats and promoted the growth and development of neonatal rats.

Comparative Study of PDA Ligation in the OR versus in the NICU: A 10-Year Retrospective Cohort Study

Objective: This study aimed to compare the outcomes of PDA (patent ductus arteriosus) ligation performed in NICU (neonatal intensive care unit) versus OR (operating room) and identify relevant influencing factors. Materials and Methods: In this retrospective review, spanning a decade (2012-2021) of NICU patients at Siriraj Hospital who underwent PDA ligation, patients were categorized into two groups: OR and NICU. Baseline clinical characteristics, operative details, and postoperative results (including hospital mortality, cause of death, and complications) were collected and analyzed. Results: A total of 118 patients were included, with 52 patients in the OR group and 66 patients in the NICU group. There were no statistically significant differences in postoperative outcomes between the two groups. The hospital mortality rates were 1.9% (1/52) and 10.6% (7/66), respectively (p = 0.08). Post hoc multivariable binary logistic regression analysis further confirmed that the location of PDA ligation was not associated with hospital mortality. However, higher oxygen requirements and lower postmenstrual age (PMA) were found to be independently associated with hospital mortality (OR 1.10, p =0.02 and OR 0.82, p&lt;0.01 respectively). Hypothermia, defined as a body temperature less than 36C, was more prevalent in the OR group (30.8% vs 16.7%, p=0.07). Other postoperative complications were not statistically different between the two groups. Lastly, no case of surgical site infection was observed in the NICU group. Conclusion: PDA ligation can be safely and effectively performed in the NICU with comparable hospital mortality, potentially offering better temperature control, and without an increased risk of complications, including surgical site infection.

Neonatal hearing screening in Soba University Hospital, Khartoum, Sudan: a cross-sectional study

BackgroundHearing loss in children constitutes a serious obstacle to their optimal development; early detection of hearing disability is vital to improve the outcome of management; currently, in Sudan, there is no national neonatal hearing screening program. The aim of this study is to discuss the results of neonatal hearing screening among newborns admitted to neonatal intensive care unit (NICU) and well-baby nursery, at Soba University Hospital, Khartoum (Sudan), and to reflect the magnitude of risk factors for hearing impairment present in these two different groups of newborns.MethodsIn this hospital-based cross-sectional study, newborns who were admitted to the NICU or being observed in the well-baby nursery in the period from February 2014 to February 2019 were screened for hearing loss using automated otoacoustic emission (OAE) device after recording the risk factors for hearing loss according to the Joint Committee on Infant Hearing (JCIH) year 2007 position statement and after conducting a detailed ear and general physical examination. Newborns who failed this screening test were rescreened using the same device after 48 h, and if they failed again, they underwent confirmatory auditory brainstem response test when they are 6 months old.ResultsOne thousand one hundred twenty newborns were tested; 736 were NICU and 384 were well-baby nursery newborns. The prevalence of hearing impairment after confirmatory test was found to be 10.8 per 1000 in the NICU group and 5.2 per 1000 in the well-baby nursery group considering that the drop rate for the confirmatory test was 50% and 66% respectively which is very high and reflect the poor compliance to the program. The risk factors for hearing loss were more encountered in the NICU group compared to well-baby nursery group. Unmonitored ototoxic drug use was found to be very prevalent and need urgent reconsideration.ConclusionIn this study, the estimated prevalence of neonatal hearing impairment is alarming; risk factors are very evident especially in the NICU group; this reflect the urgent need for establishing an efficient national program for neonatal hearing screening and working to eliminate the preventable risk factors for neonatal hearing impairment in this developing country.

Optimal timing for inguinal hernia repair in premature infants: surgical issues for inguinal hernia in premature infants.

We analyzed the timing of inguinal hernia repair in premature infants in the neonatal intensive care unit (NICU) considering recurrence, incarceration, and other complications. In this multicenter retrospective review, premature infants (<37 weeks) in the NICU diagnosed with inguinal hernia between 2017 and 2021 were segregated into 2 groups based on the timing of inguinal hernia repair. Of 149 patients, 109 (73.2%) underwent inguinal hernia repair in the NICU and 40 (26.8%) after discharge. Preoperative incarceration did not differ, but complications with recurrence and postoperative respiratory insufficiency were higher in the NICU group (11.0% vs. 0%, P = 0.029; 22.0% vs. 5.0%, P = 0.01). Multivariate analysis showed that the significant factors affecting recurrence were preoperative ventilator dependence and body weight of <3,000 g at the time of surgery (odds ratio [OR], 16.89; 95% confidence interval [CI], 3.45-82.69; P < 0.01 and OR, 9.97; 95% CI, 1.03-95.92; P = 0.04). Our results suggest that when premature infants are diagnosed with inguinal hernia in the NICU, inguinal hernia repair after discharge may decrease the odds of recurrence and postoperative respiratory insufficiency. In patients who have difficulty delaying surgery, it is thought that surgery should be performed carefully in a ventilator preoperatively or weighed <3,000 g at the time of surgery.

Sağlam Çocuk Polikliniğinde ve Yenidoğan Yoğun Bakım Ünitesinde Farmakolojik Olmayan Ağrı Giderme Yöntemlerinden Emzik Verme ve Anne Kucağının Yenidoğan Ağrısı Üzerine Etkisinin İncelenmesi

Introduction: The most important purpose in neonatal pain management is to minimize the pain felt by newborns and to help the newborn cope with pain. This study planned to examine the effects of two non-pharmacological methods, using pacifiers or maternal holding, on neonates’ pain admitted to the outpatient clinic (OC) and hospitalized in the Neonatal Intensive Care Unit (NICU). Material and Methods: Ninety newborns (30 used pacifiers, 30 maternal holding,30 control) who applied to the OC and 60 newborns (30 used pacifiers, 30 control) admitted to the NICU were prospectively included in this study. The Neonatal Infant Pain Scale (NIPS) was used to evaluate behavioral responses to pain perception. Physiological parameters of newborns and their durations of crying were also evaluated. Results: When the NIPS scores were analyzed in OC group during and after the procedure, the lowest score was found in the group using pacifiers (p&amp;lt;0.001). As for the NICU patients, both during and after the procedure, NIPS scores were found to be significantly lower in the pacifier users (p&amp;lt;0.001). It was observed that giving pacifiers and mathernal holding had positive effects on physiological parameters and duration of crying in OC patients (p&amp;lt;0.05). No significant difference in the NIPS score was found between OC and NICU group. Conclusion: This study showed that giving pacifiers and maternal holding during the procedure of blood sampling decreased the NIPS score, restored the changes in physiological parameters and decreased the duration of crying.

Risk factors for postpartum depression in mothers of newborns admitted to neonatal intensive care unit

ABSTRACT Background There is a lack of information on how maternal stress coping styles during admission of the newborn to the neonatal intensive care unit (NICU) influences the onset of the postpartum depression (PPD). We examined potential risk factors for the emergence of the PPD in mothers whose infants were admitted to the NICU. Methods A cross-sectional study was conducted on 401 mothers, 125 were mothers whose infants were admitted to the NICU and 276 mothers without NICU care. Newborn illness severity information score was taken throughout NICU admission via the Clinical Risk Index for Babies (CRIB). Six weeks after giving birth, participants from both groups individually completed the Edinburg Postnatal Depression Scale (EPDS), the Postpartum Bonding Questionnaire (PBQ) and the Coping Strategies Inventory (CSI) using an online platform. Results No differences were found regarding PPD and bonding in either groups. Multivariate analysis provided a final model in which cognitive restructuring, problem avoidance, severity of neonatal health problems during the first 12 hours of life, and problem solving were the best predictors of postpartum depression explaining, 43.7% of the variance in the NICU group. Conclusion It is necessary to obtain early detailed information on coping styles in the NICU environment to prevent the possible onset of PPD.

Neonatal bowel resections occurring in the NICU are associated with lower survival rates compared to the OR

Background and Hypothesis: Neonatal surgical procedures frequently occur at bedside in the neonatal intensive care unit (NICU) rather than in the operating room (OR). The goal of this study was to isolate risk factors for neonatal bowel resections occurring in the NICU, compare outcomes of bowel resections occurring both in the NICU and OR, and evaluate modifiable factors in both locations. &#x0D; Experimental Design or Project Methods: We reviewed 139 neonatal (&lt;30 days old) patients at Riley Hospital for Children who underwent bowel resection in either the NICU or the OR from 2014-2018. Statistical analysis included bivariate, multivariable, and propensity score matching analyses. &#x0D; Results: When compared to neonates who had bowel resection in the OR, the NICU group had lower mean gestational age (EGA) at birth (26 vs 34 weeks, p=&lt;0.0001), lower weight at surgery (72.7% NICU patients &lt;1000 grams vs 7.6% OR patients, p=&lt;0.0001), and had the operative diagnosis of spontaneous intestinal perforation (48.8%) or NEC (42.9%) compared to OR patients (18.7%) for both diagnoses (p=&lt;0.0001, p=0.0003). Bivariate analysis revealed that EGA at birth (OR 0.668, p=&lt;0.0001), APGAR 1 minute (OR 0.776, p=0.001), and pre-op respiratory FiO2 percentage (OR 2.514, p=&lt;0.0001) were significant predictors of operation location. Propensity score matching (15 matched pairs) showed survival rates were lower in the NICU group (p=0.0156). Modifiable risk factors, such as the usage of a heating device during surgery (p=&lt;0.0001) and temperature monitoring during surgery (p=&lt;0.0001) were positively correlated with survival, while blood administration in the first 24 hours post-surgery (p=0.001) was correlated with worse survival.&#x0D; Conclusions: There are definable characteristics of neonates who have bowel resections in the OR vs NICU, but the primary outcome difference between these groups is survival. We also identified modifiable factors that can be studied to further improve survival of patients with operations in both settings.&#x0D;  

Prenatal predictors of neonatal intensive care unit admission due to respiratory distress.

Admission to the neonatal intensive care unit (NICU) due to respiratory distress is determined according to subjective clinician judgement. We investigated prenatal factors predictive of NICU admission in neonates with respiratory distress. This case-control study was conducted at Nara Prefecture General Medical Center, Nara, Japan, from February 2013 to April 2017 and included neonates with birthweight ≥2,000g, ≥36weeks of gestational age, who required oxygen due to respiratory distress at birth. The cases consisted of neonates admitted to the NICU, and the control group consisted of neonates who did not require NICU admission. Perinatal factors between the groups were compared, and multivariate logistic regression analysis carried out to evaluate predictive factors. The NICU group consisted of 94 neonates, and the control group, 417 neonates during the period reviewed. On multivariate analysis, maternal anemia (OR, 2.97; 95%CI: 1.42-6.21), infertility treatment (OR, 2.79; 95%CI: 1.36-5.71), threatened preterm labor (OR, 2.16; 95%CI: 1.10-4.23), premature rupture of membranes (OR, 5.30, 95%CI: 2.52-11.17), fibroids (OR, 6.06; 95%CI: 1.57-23.41), history of uterine surgery (OR, 3.53, 95%CI: 1.13-11.06), abruptio placentae (OR, 10.21; 95%CI: 1.83-57.17), intrauterine growth restriction (OR, 6.69; 95%CI: 1.96-22.85), and having twins (OR, 0.23; 95%CI: 0.09-0.58) were significant prenatal predictors of NICU admission. Factors that potentially predict NICU admission were identified. Clinicians may wish to consider these factors when treating neonates with respiratory distress.

Changes in Neonatal Microbiota Distribution Influenced by the Environment of the Neonatal Intensive Care Unit in the First Month of Life

Commensal bacterial colonization is crucial for human health, and the early neonatal period is important for the establishment of microbial populations. However, studies on the developmental patterns of microbiota in early life, particularly in those exposed to the environment of the neonatal intensive care unit (NICU), are limited. Using a 16S ribosomal RNA polymerase chain reaction assay, this study aimed to evaluate the changes in the levels of representative microbiota in healthy term infants and infants who were admitted to the NICU during the first month of life. Compared with term infants, the NICU group showed lower levels of Bifidobacterium in the early days after birth but achieved the same levels as those of term infants after day 30 of probiotics use. In addition, we found that the presence of Staphylococcus aureus, including methicillin-resistant S. aureus, from fecal samples was not associated with disturbances in Bifidobacterium during the neonatal period. Clinical factors such as the mode of delivery, antibiotic therapy, and intubation for mechanical ventilation could change the neonatal distribution of microbiota, but the most important factor was insufficient enteral nutrition. This group, which had experienced poor general conditions and/or underwent surgery early in the neonatal period, showed are markable decrease in Bifidobacterium level at day 30. In conclusion, infants in the NICU developed similar microbiota composition as in the healthy term infants group in 1 month afterbirth; however, insufficient enteral nutrition could lead to disintegration of the microbiota distribution.

Attachment disorganization among children in Neonatal Intensive Care Unit: Preliminary results

BackgroundPreterm children have been reported to be at higher risk to develop attachment insecurity. AimsThe present study aimed to investigate potential differences in attachment security between newborns who were sent to Neonatal Intensive Care Unit (NICU) and those who were not, in a population of full-term children. Study designParticipants (162 mother–child dyads) were part of a longitudinal study (MAVAN). Twenty-three of these children received special care at birth (NICU group). Attachment security was assessed at 36months with the Strange Situation Procedure. Socio-economic status (SES), birth weight, maternal mood, maternal sensitivity, mental/psychomotor developmental indexes, Apgar scores, presence of complications during delivery and infant general health were assessed. ResultsIn the No-NICU group, 55.4% of children were securely attached, 24.5% were insecure and 20.1% were disorganized. However, in the NICU group, 43.5% of children were securely attached, 8.7% were insecure and 47.8% were disorganized (χ2=9.0; p=.01). The only differences between the 2 groups were a lower Apgar, more respiratory infections and more visits to walk-in clinic/hospital (p's<.05) and a trend for lower SES and more ear infections in the NICU group. Logistic regressions revealed an odds ratio of 6.1 (p=.003) of developing a disorganized attachment after a stay in NICU, when controlling for these confounding variables. ConclusionNewborns who were admitted to NICU have an odds ratio of about 6 to develop a disorganized attachment at 36months. These preliminary results support the importance of supportive parental proximity and contact with the infant in the NICU and possible after-care.

Comparative Study of Hearing Impairment among Healthy and Intensive Care unit Neonates in Mashhad, North East Iran.

According to World Health Organization (WHO) 2001 statistics, hearing disorders are the most common congenital disease, and the incidence rate among high-risk newborns is as much as ten times as high as that in healthy neonates. However, 78% of screening test failures are well-baby nursery babies. The Joint Committee on Infants' Hearing (JCIH) has emphasized the importance of early diagnosis and treatment in neonates with hearing impairments in order to preserve their maximum linguistic skills. The aim of our study was to compare the prevalence of hearing loss among babies in the neonatal intensive care unit (NICU) and the rooming-in unit (RIU). Neonates born in three hospitals in Mashhad between 2008 to 2010 were studied prospectively and screened for auditory disorders using the oto acoustic emission (OAE) test at the time of discharge and 3 weeks later. To confirm hearing loss, the auditory steady state response (ASSR) test was used among those participants who failed both OAE tests. Two-thousand and sixty-three neonates from the NICU were screened and compared with a control group consisting of 8,724 neonates from the RIU or the well-baby nursery. At the end of the study, hearing impairment as confirmed by failure in the ASSR test was diagnosed in 31 neonates (26 in the control group [0.30%] and five in the NICU group [1.94%]). In our study, the prevalence of hearing disorders among NICU neonates was 6.5-times greater than that among babies from the RIU or well-baby unit. This observation demonstrates the importance of universal screening programs particularly for high-risk population neonates.

Factors Influencing on Perinatal Outcomes of Asian Marriage Immigrant Women: Ten-year Experience in a Single Center

Purpose : We aimed to analyze the maternal and perinatal factors associated with perinatal outcomes by exa­ mining families comprised of Korean fathers, Asian immigrant mothers, and their newborns. Method : Medical records of newborn infants admitted to Jeonju Jesus Hospital nursery or ne­onatal intensive care unit (NICU) from January 2004 to June 2013 and their Asian immigrant mothers were reviewed retro­ spec tively. The newborns were divided into two groups depending on whether they were admitted NICU or not, and factors influencing on perinatal outcomes were compared between the two groups. The newborn were divided into the two groups, including those who did not receive inpatient care and those treated in the NICU. The differences between the two groups were analyzed. Results : The study included 180 newborns and 172 mothers, and 94 (52.3%) and 86 (47.7%) newborns were classified as the nursery group and the NICU group, respectively. There were no statistically significant diffe­ rences between the two groups in terms of the mothers’ nationality, maternal age, maternal education level, maternal occupation, residential area, maternal height and weight, maternal weight gain during pregnancy, maternal hepatitis B antigen positivity, maternal parity, paternal age, and age gap between spouses. However, underweight maternal prepregnancy body mass index (BMI) and hemoglobin level over 11.0 g/dL were signi­ ficantly more frequent in the NICU group in the comparative analysis. The NICU group showed significantly more frequent no iron supplements during pregnancy (OR=4.06) and gestational disease (OR=3.81). Conclusion : In cases where married immigrant mothers had underweight prepregnancy BMI, gestational dis­ ease, or no iron supplements during pregnancy, their newborns were more likely to have NICU care. Therefore, married immigrant women should have appropriate perinatal care including education about a balanced diet to maintain an appropriate body weight with ensuring an adequate iron supplements intake.

The Road to Redemption

The Road to Redemption Anonymous Two I “am Dr X.* and I am a trained and board certified neonatologist with some years of experience in a high volume NICU with complex pathologies. I have been dismissed from the care of your baby by the fetal surgeon who is not trained in what he’s attempting to do,” that was how I felt when I left the operating room (OR), after performing initial resuscitation on a newborn with congenital diaphragmatic hernia (CDH) with very poor prenatal prognostic indices. CDH is a diaphragm abnormality that allows abdominal organs to move into the chest and restrict lung development. The better part of me knew not to make such a statement and chose not to do so, as this was about the family and a very sick baby, not the professional wrangling of two medical teams or the expression of frustration by a neonatologist who was morally conflicted. I work in a level four Neonatal Intensive Care Unit (NICU) and a very large one by any standard. Staff turnover had been an almost nonexistent issue in previous years because of the very conducive work environment of the NICU. Every team member (physician, nurse, respiratory therapist, pharmacist, etc.) felt like a stakeholder in providing optimal outcomes for the vulnerable neonates in the NICU. As change is the only constant thing in life, the hospital management decided to explore new frontiers and open a center for fetal medicine, with the hope of being a referral center in the region. They brought in a surgeon who came highly recommended for clinical acumen, but not for interpersonal relationship skills (unbeknownst to me). This surgeon, Dr Y., was hired to oversee the fetal center and build it into a center of excellence. Since this had to be a collaborative effort, other specialties (and subspecialties) had to be involved to make this a success. A representative from each of these specialties, including bioethics, was assigned to the fetal center team. The first inkling of a major problem occurred with the very first patient. The team met for the weekly meeting, reviewed the patient’s history and made a tentative plan, which included multidisciplinary counseling. This would require either a joint meeting with the patient or individual consults with the patient at her convenience. The following week at the weekly meeting, Dr Y. informed the group that he had met with the patient and counseled her and she had agreed to an extraordinary procedure for an oral lesion. In my opinion (and that of others), this lesion was not obstructive and could be immediately dealt with at delivery by an Otolaryngologist (ENT) surgeon, without putting the mother at risk for complications arising from the procedure being offered. There was a long discussion about why this was inappropriate [End Page E1] and why further imaging, discussion between the subspecialties and counseling should have been done prior to making this delivery plan. All felt this delivery plan could be remedied prior to delivery. However the surgeon had made plans with the obstetric team (who were at his mercy for financial/ political reasons) to continue with this plan. On the day of delivery, the NICU resuscitation team was called to another operating room instead of the labor and delivery room. I was even more appalled when I realized that the oral lesion was the size of a peanut! I felt like I failed in my obligation of veracity by avoiding the mother’s questions regarding the necessity of the procedure. Every member of my team felt the same and on several occasions I had to reassure concerned nurses that this was an aberrant occurrence that would not repeat itself . . . so I thought. I informed my departmental chairperson, Dr Z., who had a conversation with the fetal surgeon, Dr. Y., to inform him of my concerns and the effect of Dr. Y.’s actions on my group (physician, nurse practitioner, nurses). This led to being labeled unsupportive of Dr Y.’s goals and caused a less than cordial relationship towards me and the entire NICU group. The next week a picture of Dr Y. and the parents with the baby was on the front page...

Maternal psychological problems associated with neonatal intensive care admission.

Background. Mothers of infants admitted to a neonatal intensive care unit (NICU) are believed to have heightened distress. The purpose of this paper was to determine depression and anxiety symptoms and attachment style in NICU mothers. Methods. The NICU group consisted of mothers whose infants were admitted to the NICU and the control group consisted of mothers of healthy term infants. The psychosocial assessments were done at the first month. Results. The mean Edinburgh Postpartum Depression (EPDS) score of NICU mothers was significantly higher than that of the control group mothers (9.6 ± 5.6 versus 7.3 ± 4.9, P = .005). NICU mothers who had high EPDS (≥13) scores had significantly higher anxiety scores and insecure attachment style in comparison to the subgroup of NICU mothers who had low EPDS scores. Conclusion. Mothers of NICU babies had higher EPDS scores. Mothers who had higher EPDS scores had higher anxiety scores as well. These NICU mothers should receive appropriate counseling during the hospitalization of their babies.

Perinatal characteristics and parents' perspective of health status of NICU graduates born at term

Long-term outcomes of preterm infants have been extensively studied, but few studies have examined long-term outcomes of term infants who require neonatal intensive care unit (NICU). Our objectives were to assess perinatal characteristics and health status of preschool age term babies using data from a population-based study of NICU graduates. Retrospective cross-sectional survey. All babies were born in 1996 to 1997 in BC (Canada). The Health Status Classification System Preschool (HSCS-PS) questionnaire was completed by parents at 42 months of age. HSCS-PS was grouped in four categories (neurosensory, learning, motor and quality of life). Logistic regression was used to identify perinatal risk factors associated with moderate/severe problems at 42 months of age. Completed surveys were received for 261 term NICU survivors and 393 control children. Term infants represent 32% of all NICU admissions. Mean birth weight of NICU graduates was 3458 g (s.d.=600 g). Median length-of-stay in NICU was 5 days. At 42 months, the NICU group had significantly more problems on the HSCS-PS as compared to the full-term healthy infants in neurosensory, motor and learning/remembering. Moderate/severe health status problems were associated with congenital anomalies (odds ratio (OR), 3.2; confidence interval (CI): 1.3 to 7.8); smoking status (OR, 2.7, CI: 1.1 to 6.6) and SNAP score (OR, 1.04; CI: 1.0 to 1.1). Term babies admitted to NICUs may have significant health issues in childhood. Greater attention needs to be paid to long-term outcomes of term NICU graduates. Further study is warranted to address which NICU term survivors warrant secondary and/or tertiary-level neurodevelopmental follow-up.

β‐lactam antibiotic resistance in aerobic commensal fecal flora of newborns

The purpose of the present paper was to prospectively determine the rate of beta-lactam antibiotic resistance in commensal fecal flora of newborns and the risk factors leading to this colonization. One hundred and eighteen newborns in the neonatal intensive care unit (NICU) group (n = 38), the neonatal ward group (n = 36), and the control group (n = 44) were enrolled. Three or four stool samples were obtained from each infant, 15 days apart. Bacterial growth in Eozin Methylene Blue (EMB) agar + 10 microg ampicillin/mL was considered to be ampicillin-resistant bacteria, and antibiotic susceptibility and extended spectrum beta-lactamases (ESBL) production was investigated in those bacteria. Colonization with ampicillin-resistant commensal fecal flora microorganisms was determined in 75.2% of 367 stool samples. Klebsiella spp. and Escherichia coli were identified in 59% and 41% of the samples, respectively. The lowest rate of ampicillin-resistant bacterial colonization was determined in the NICU group. Microorganisms producing ESBL were identified in 33.7% of 367 stool samples. Fifty-one and 73 of ampicillin-resistant E. coli and Klebsiella spp. isolates were determined to produce ESBL, respectively. There was no difference with respect to colonization with ESBL-producing microorganisms between the three groups. When risk factors related to colonization with ESBL-producing microorganisms in stool samples were evaluated through the whole study period, very low birthweight, vaginal delivery, infant antibiotic usage, maternal antibiotic usage, male sex and premature rupture of membranes were determined as risk factors, while feeding with nasogastric tube was identified as a protective factor. When the risk factors related to colonization with ESBL-producing bacteria in stool samples after discharge from the hospital were evaluated, failure to feed breast milk was determined as the only risk factor. To decrease mortality and morbidity due to infection caused by resistant microorganisms colonized in the intestine flora of the infant, protection of normal non-pathogenic bacterial colonization is important. This can be provided by feeding neonates with breast milk, application of infection control measures efficiently, and limitation of antibiotic usage only to strict clinical indications.

Congenital Diaphragmatic Hernia: Intensive Care Unit or Operating Room?

Despite improvements in prenatal diagnosis and neonatal intensive care, the Congenital Diaphragmatic Hernia (CDH) Registry still records a 64% survival rate. Many reports demonstrate, however, that approximately 80% of CDH patients with no other malformations may survive if managed with permissive hypercapnia, gentle ventilation, high-frequency oscillatory ventilation (HFOV), surfactant, inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO), and delayed surgical repair. We wished to define the evolving outcome of CDH newborns using a protocol approach to management, which includes surgery in the neonatal intensive care unit (NICU) or operating room (OR). From January 1996, data were collected prospectively on 42 consecutive live-born infants with CDH. Newborns symptomatic at birth were sedated and paralyzed in the delivery room, and treated with elective HFOV, iNO, surfactant, and ECMO as necessary, delaying surgical repair until their clinical conditions were stable. Once the CDH newborn was stabilized, a trial on conventional ventilation was started at least 24 hours before surgery; however, if the patient was unstable, therapy was switched back to HFOV and surgery was performed in the NICU. Demographic and clinical parameters were compared between CDH newborns who underwent surgery in the NICU and in the OR. The two groups were comparable in terms of clinical characteristics and baseline ventilatory and blood gas values. Mean age at surgery was 3 +/- 2 days. After surgery, the NICU group had more infectious complications. However, the survival rate of uncomplicated CDH was 78% and a low rate of chronic lung disease was reported. A prolonged phase of presurgery stabilization is proposed and strict control of infection is recommended for the CDH newborns who might benefit from an exclusive HFOV and NICU surgery.

Psychological health of family caregivers of children admitted at birth to a NICU and healthy children: a population-based cross-sectional survey

BackgroundThere is little information in the research literature on how parents of children who spend time in a neonatal intensive care unit (NICU) adapt psychologically to the demands of caregiving beyond the initial hospitalization period. Our aim was to compare parents of NICU children with parents of healthy full-term children, looking specifically at the relationship between parental psychosocial health and child characteristics, as well as the relationship between important predictor variables and psychosocial health.MethodsA cross-sectional survey was sent to parents as their child turned 3 1/2 years of age. The setting was the province of British Columbia, Canada. The sample included all babies admitted to tertiary level neonatal intensive care units (NICU) at birth over a 16-month period, and a consecutive sample of healthy babies. The main outcome was the SF-36 mental component summary (MCS) score. Predictor variables included caregiver gender; caregiver age; marital status; parental education; annual household income; child health status; child behavior; birth-related risk factors; caregiver strain; and family function.ResultsPsychosocial health of NICU parents did not differ from parents of healthy children. Child health status and behavior for NICU and healthy children were strongly related to MCS score in bivariate analysis. In the pooled multivariate model, parental age, low family function, high caregiver strain, and child's internalizing and externalizing behavioral symptoms were independently associated with lower psychosocial health. In addition, female gender was associated with lower psychosocial health in the NICU group, whereas lower education and child's problem with quality of life indicated lower psychosocial health in the healthy baby group.ConclusionsOverall, parental gender, family functioning and caregiver strain played influential roles in parental psychosocial health.

Factor V Leiden Mutation Enhances Thrombin Formation in Healthy Newborn Infants.

Background: At birth, the coagulation system is activated resulting in thrombin formation in the newborn. In sick newborns, the coagulopathy may lead to bleeding or thrombotic complications. Known genetic prothrombotic defects are risk factors for thrombosis in adults but their potential influence on perinatal coagulopathy remains unknown. Accordingly, we prospectively studied the influence of genetic thrombophilia on thrombin formation during the first two weeks of life.Methods: Newborns from 22 pregnant women with thrombophilia (Factor V Leiden (FVL), n=16; anticardiolipin antibodies, n= 3; lupus anticoagulant, n=1; protein C deficiency, n=1; prothrombin G20210A mutation, n=1) were enrolled into the study. All women were treated with low-molecular-weight heparin during pregnancy and all the infants were born at term. Blood samples were collected from the umbilical cord, and on postnatal days 1 and 14. Newborns were screened for FVL and prothrombin G20210A mutation. Eight FVL heterozygotes were found. No infant tested positive for anticardiolipin antibodies or lupus anticoagulant. Thrombin formation was assessed by measuring prothrombin fragment F1+2. For samples on day 1, a previous cohort of 32 newborns (mean gestational age 33.6 weeks, unknown FVL status) treated in our neonatal intensive care unit (NICU) was used as an additional control.Results: Relative to known normal range in adults, enhanced thrombin formation (F1+2>1.1 nM) was detected in cord blood and on day 1 in all newborns followed by near normalization on day 14. The median level of F1+2 from umbilical cord sample to day 1, and to day 14 in FVL negative newborns was 2.4 nM (n=13) − 2.0 nM (n=10) − 2.0 nM (n=12), and in FVL heterozygotes 4.8 nM (n=7) − 5.8 nM (n=5) − 1.7 nM (n=8). In FVL heterozygotes but not in FVL negative newborns the F1+2 decrease from umbilical cord sample to day 14 was significant (Wilcoxon p=0.02). On day 1, the FVL heterozygotes showed elevated F1+2 levels when compared with a cohort of 32 newborns in NICU (median F1+2 2.3 nM in NICU group vs 5.8 nM in FVL heterozygotes; p=0.06).Conclusions: Factor V heterozygosity was associated with transiently enhanced thrombin formation in healthy newborns during the first days of life.

Visual event-related brain potentials in 4-month-old infants at risk for neurodevelopmental impairments.

The recording of event-related potentials (ERPs) is an electrophysiologic technique that has been used to evaluate the functional maturation of neural pathways responsible for recognition memory systems in infants and children. The purpose of this study was to evaluate ERP correlates of visual recognition memory in 4-month-old infants at risk for later cognitive impairments. We compared ERPs using a test of shape recognition at 4 months of age (adjusted for prematurity) in 16 high-risk, neonatal intensive care unit (NICU) survivors and 16 healthy full-term infants. ERPs were recorded while infants were familiarized with one stimulus (a red cross, 15 trials), then tested with 60 trials of this familiar stimulus and a novel stimulus (a red corkscrew). Both the NICU and control groups' ERPs demonstrated evidence of differential processing of the two stimuli, but the NICU groups' ERP patterns were distinctly different from those of the control group. In the NICU group, the novel stimulus elicited parietal positivity at 1000-1700 ms poststimulus, whereas in the control group the novel stimulus elicited occipital and frontal negativity at 500-1700 ms poststimulus. The ERP pattern demonstrated by the NICU group was atypical as it has not been previously described in healthy infants. The results of the study indicate that the ERP technique can be used to demonstrate altered patterns of neural activity during tasks of visual recognition memory in high-risk infants. We speculate that the atypical ERP patterns described in this study may indicate that patterns of synaptic organization were altered by neonatal events.