Neonatal Intensive Care Unit Graduates Research Articles

Trends and challenges in United States neonatal intensive care units follow-up clinics

A mandate exists that all level III neonatal intensive care units (NICUs) provide a means to assess and follow their high-risk neonates after discharge. However, no standardized guidelines exist for the follow-up services provided. To determine trends of structure and care provided in NICU follow-up clinics in both the academic and private clinical setting. We sent an Internet survey to NICU follow-up clinic directors at both academically affiliated and private centers. This study received institutional review board exemption. We received 89 surveys from academic institutions and 94 from private level III follow-up programs. These responses represent 55% of academic programs and 40% of private programs in the United States. Similar to academic institutions, 18% of private NICU follow-up clinics provide primary care services to patients. In both settings, the hospital supports 60% of the funding required for clinic activities. Forty-five percent of NICU graduates seen in both private and academic follow-up clinics have public aid as their primary insurance. Eighty-five percent of NICUs in both settings have guidelines outlining requirements for referrals to the follow-up clinic. Academic programs find feeding difficulties the most difficult, whereas private programs find bronchopulmonary dysplasia and feeding difficulties equally as difficult. The care and struggles of NICU follow-up clinics are similar in both the academic affiliated and private settings. Similar referrals, clinical evaluation and medical care occur with varying struggles.

Neonatal Intensive-Care Unit Graduates Show Persistent Difficulties in an Intradimensional Shift Card Sort

Neonatal intensive-care unit (NICU) graduates, a group at risk for attention problems and attention-deficit hyperactivity disorder, performed an intradimensional shift card sort at 34, 42, 51, and 60 months to assess executive function and to examine effects of individual risk factors. In the “silly” game, children sorted cards (airplanes and dogs) so they were not the same as targets. In the “same” game, they did the opposite. Performance on the “silly” game was poor, especially when it was presented first. Success in following “silly” game rules improved with age and was significantly linked to maternal education and birth weight for gestational age, a measure of intrauterine stress. Degree of central nervous system injury differentiated children who completed the task from children who did not, and it also affected the need to repeat instructions in the “same” game. These results confirm an increased likelihood of impairments in executive function during preschool years in NICU graduates.

Differences in DPOAE and AABR in Noise‐Exposed Infants in the Neonatal Intensive Care Unit

Objectives: 1) Describe the differences in distortion product otoacoustic emissions (DPOAE) and automated auditory brainstem response (AABR) results in premature infants in the neonatal intensive care unit (NICU) with noise exposure. 2) Discuss optimal newborn hearing screen protocols for capturing at-risk NICU graduates. Methods: Prospective observational outcomes study from August to the present. Subjects: Admissions to the NICU, <37 weeks gestational age. Setting: NICU. Outcome Measurements: DPOAE, AABR, and follow-up audiometry collected by the Oregon Early Hearing Detection and Intervention (EHDI) program. Independent variables: Sound pressure levels and cumulative sound dosage. Preliminary analyses: This dataset represents preliminary data from an ongoing study with a target enrollment of 150 over 12 months. Results: The average sound pressure level per individual admission ranged from 57.4 to 67.8 dBA. DPOAE demonstrated a greater rate of abnormalities in the high frequency range of 4000-10000 Hz (40-45%) compared to lower frequencies (10-15%). AABR generated only a 5% rate of referrals; however, 50% of DPOAEs obtained showed abnormal results in at least 2/3 of the high frequencies tested. Conclusions: All infants received sound exposures that substantially exceeded AAP guidelines. More abnormalities were found on DPOAE than AABR, with a significantly higher rate in the high frequencies compared to lower frequencies, consistent with possible noise-induced cochlear dysfunction. Neonatal intensive care units should consider adding DPOAE to their hearing screen protocols so that infants at risk for noise-induced hearing loss are not missed.

Special care needs and risk for child maltreatment reports among babies that graduated from the Neonatal Intensive Care

Newborns discharged from intensive care are at elevated risk for child welfare reports, especially for child neglect. This study investigates the role of caregiving burden as a risk predictor among the NICU graduate population. Discharge data were captured for 2,463 infants graduating from a Neonatal Intensive Care Unit (NICU) during 2005–2008, then linked to child welfare reports at a median 3.2 year follow-up. Survival analyses were used to examine child welfare report outcomes conditional on caregiving burden and its moderating relationships with other family risk factors. Caregiving burden was associated primarily with an increased risk of child welfare reporting during the first few months to first year of life, after which risk was similar to NICU graduates without caregiving burden. Caregiving burden effects were potentiated by having three or more siblings in the family. A history of prior child welfare reports predicted very high risk, regardless of caregiving burden. Young maternal age increased risk. The findings suggest that the immediate months after NICU discharge may be an important window of child neglect prevention opportunity among newborns with special caregiving needs. This may be a key time to provide caregiver support and monitoring, particularly when caregivers have multiple children.

Brief parenting intervention for parents of NICU graduates: a randomized, clinical trial of Primary Care Triple P

BackgroundPreterm-born or asphyxiated term-born children who received neonatal intensive care show more emotional and behavioral problems than term-born children without a medical condition. It is uncertain whether regular parenting intervention programs to which the parents of these children are usually referred, are effective in reducing child problem behavior in this specific population. Our objective was to investigate whether a regular, brief parenting intervention, Primary Care Triple P, is effective in decreasing emotional and behavioral problems in preterm-born or asphyxiated term-born preschoolers.MethodsFor this pragmatic, open randomized clinical trial, participants were recruited from a cohort of infants admitted to the neonatal intensive care units (NICU) of two Dutch hospitals. Children born with a gestational age <32 weeks or birth weight <1500 g and children born at a gestational age 37–42 weeks with perinatal asphyxia were included. After screening for a t-score ≥60 on the Child Behavior Checklist (CBCL), children were randomly assigned to Primary Care Triple P (n = 34) or a wait-list control group (n = 33). The primary outcome was child emotional and behavioral problems reported by parents on the CBCL, 6 months after the start of the trial.ResultsThere was no effect of the intervention on the CBCL at the trial endpoint (t64 = 0.54, P = .30). On secondary measurements of child problem behavior, parenting style, parenting stress, and parent perceived child vulnerability, groups either did not differ significantly or the intervention group showed more problems. In both the intervention and control group there was a significant decrease in emotional and behavioral problems during the trial.ConclusionsPrimary Care Triple P, a brief parenting intervention, is not effective in reducing child emotional and behavioral problems in preterm-born children or term-born children with perinatal asphyxia.Trial registrationNetherlands National Trial Register (NTR): NTR2179

Application of multi-channel hybrid active noise control systems for infant incubators

High noise in infant incubators results in numerous adverse health effects which have lifelong consequences for neonatal intensive care unit (NICU) graduates. This paper presents multi-channel hybrid active noise control (ANC) systems for infant incubators. A hybrid ANC algorithm is an integration of a feedforward algorithm (to cancel noise generated from sources outside the incubator) and a feedback algorithm (to reduce the predictable noise inside the incubator). Computer simulation and real-time experiment results show that the proposed hybrid algorithms are effective in cancelling both outside and inside noises of infant incubators in real NICU environment.

Neonatal brainstem function and 4-month arousal-modulated attention are jointly associated with autism.

The authors evaluated the contribution of initially abnormal neonatal auditory brainstem responses (ABRs) and 4-month arousal-modulated attention visual preference to later autism spectrum disorder (ASD) behaviors in neonatal intensive care unit (NICU) graduates. A longitudinal study design was used to compare NICU graduates with normal ABRs (n = 28) to those with initially abnormal ABRs (n = 46) that later resolved. At 4 months postterm age, visual preference (measured after feeding) for a random check pattern flashing at 1, 3, or 8 Hz and gestational age (GA) served as additional predictors. Outcome measures were PDD Behavior Inventory (PDDBI) scores at 3.4 years (standard deviation = 1.2), and developmental quotients (DQ) obtained around the same age with the Griffiths Mental Development Scales (GMDS). Preferences for higher rates of stimulation at 4 months were highly correlated with PDDBI scores (all P-values < 0.01) and the GMDS Hearing and Speech DQ, but only in those with initially abnormal ABRs. Effects were strongest for a PDDBI social competence measure most associated with a diagnosis of autism. For those with abnormal ABRs, increases in preference for higher rates of stimulation as infants were linked to nonlinear increases in severity of ASD at 3 years and to an ASD diagnosis. Abnormal ABRs were associated with later reports of repetitive and ritualistic behaviors irrespective of 4-month preference for stimulation. The joint occurrence of initially abnormal neonatal ABRs and preference for more stimulation at 4 months, both indices of early brainstem dysfunction, may be a marker for the development of autism in this cohort.

Feeding Problems of Neonatal Intensive Care Unit and Pediatric Intensive Care Unit Graduates: Perceptions of Parents and Providers

There is little known about family experiences with pediatric feeding problems after neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) discharge. The study purposes were to better understand the family experiences with and consequences of feeding problems among NICU and PICU graduates after they transitioned home. Using a qualitative, descriptive design, 15 parents and 10 health professionals completed in-depth interviews. Data were analyzed using qualitative content analysis. Analysis revealed that feeding problems greatly impacted families. Education and resources were considered important but generally insufficient. Although some parent-provider partnerships were strong, many others were not, and at times, partnerships were fraught with conflict, communication problems, and lack of collaboration. System barriers and financial concerns escalated parents' distress, affecting their emotional responses. Parents' perceptions of discrepancies between their family situation and those of “normal” families violated their expectations. Understanding the perspectives of parents and providers regarding feeding problems common among NICU and PICU graduates is essential to developing effective interventions.

Follow-up Care For the Neonatal Intensive Care Unit Graduate

The birth of a preterm infant can be devastating for both mother and family. The dreams associated with the perfect pregnancy and birth have been shattered. Simultaneously as mothers are working to recover, they are tasked with learning their way around a neonatal intensive care unit (NICU) where their infants will be cared for by someone other than themselves. NICU hospitalizations can last for several weeks to several months depending on the medical diagnoses, and even following discharge, NICU graduates have higher-than-normal hospital readmission rates (10–35%), especially during the first few months. 1,2 There are few studies in current literature that provide a clear view of the period immediately following NICU discharge, and those that do, do not provide an in-depth look at the emotional or cognitive needs of infants and their families. 3 The purpose of this discussion is to highlight the need for continued medical and developmental follow-up care for NICU graduates, and to explore ways to increase parents' participation in these visits.

The Development of Selective Attention and Inhibition in NICU Graduates During the Preschool Years

Neonatal intensive care unit (NICU) graduates have a higher incidence of attention problems including attention deficit hyperactivity disorder (ADHD). Thus, we examined the effect of risk factors (birth weight (BW), central nervous system (CNS) injury, gender, maternal education) on attention/inhibition during reaction time, continuous performance and Go/No-Go tasks at 42, 51, and 60 months (n = 271). Very low BW NICU graduates (<1,500 g) performed worse than typical BW ones (>2,500 g), displaying poorer target/non-target discrimination. Males responded faster than females, but made more false alarms and random responses. Despite short duration tasks, attention waned. Performance improved with age, but even at 60 months children had difficulty inhibiting random responding.

Progress on vitamin A for newborn respiratory distress

Chronic lung disease (CLD) of prematurity is the major cause of long-term disability of extremely low birth weight ( ELBW ) premature infants, and it is the most cost consumptive disease in neonatal intensive care unit graduates. Vitamin A plays an important role in the development of premature lung. Nevertheless, premature infants are prone to vitamin A deficiency. Oral supplementation of vitamin A does not alter the incidence of CLD in ELBW infants. Intramuscular administration of vitamin A reduced the incidence of CLD. The treatment is considered painful and this way is not routinely practiced. Vitamin A is systemically bioavailable after intratracheal administration with surfactant in an animal model of newborn respiratory distress. Key words: Newborn ; Chronic lung disease; Vitamin A; lntratracheal administration

Separation anxiety disorder increases among neonatal intensive care unit graduates

Aim: To evaluate whether separation anxiety disorder (SAD) develops in the later life of the infants, who were separated from their mothers in relation to being in neonatal intensive care unit (NICU). Methods: A group of 57 children, ages over 6 years old who were cared in NICU has been evaluated retrospectively by using the SAD diagnostic scale which is adapted according to DSM-IV. Another age and sex matched 50 children who admitted to the outpatient unit were selected as control group. Results: We found that the scores and incidence of SAD were increased among children who were cared in the NICU and both were correlated with the duration of stay in the NICU. Conclusion: The NICU should be arranged to support the development of the baby. Families should be informed about the necessity of sustaining an early mother-infant interaction. By supporting mother-infant interaction, it will be provided that the baby will establish a more secure relation with his/her mother, develop more healthy and have less behavior problems in the future life.

The prevalence of mitochondrial mutations associated with aminoglycoside‐induced sensorineural hearing loss in an NICU population

Several mitochondrial DNA variants increase risk for developing sensorineural hearing loss following exposure to aminoglycoside antibiotics, a particular concern in the premature infant population, as many of these babies spend time in neonatal intensive care units and are treated with aminoglycosides. To determine the relative prevalence of five mitochondrial DNA variants in the 12S rRNA gene, MT-RNR1, we genotyped 703 neonatal intensive care unit patients and 1473 individuals from the general Iowa population. We found that the aggregate frequency of these variants (∼1.8%) was comparable between populations. Although no hearing loss was detected by newborn hearing screens in the at-risk patients, these neonatal intensive care unit graduates have an increased life-time risk for developing aminoglycoside-induced deafness.

Ten‐year quality assurance of the nationwide hearing screening programme in Dutch neonatal intensive care units

To evaluate 10-year quality assurance of newborn hearing screening (NHS) in Dutch neonatal intensive care units (NICU). Results of the two-stage automated auditory brainstem response (AABR) screening and diagnostic examination in NICU graduates were centrally registered between October 1998 and December 2008. This registration facilitates screening, tracking and follow-up after abnormal screening results. Outcome measures are referral rates, prevalence rate of hearing loss and (trends of) coverage rates and timeliness of follow-up. Thirty-two thousand one hundred and two infants have been screened. Referral rates were 9.2% at the first and 26.3% at the second stage. Hearing loss was diagnosed in 728 infants (2.2%). Coverage rates were 98.7% at the first, 92.1% at the second stage, 92.3% for the diagnostic examination and 97.9% for the complete programme. After correction for gestational age, 95.8% of the infants had their first AABR<1 month, 81.8% of the referred infants had their second AABR<6 weeks and 67.1% were diagnosed<3 months. There was a positive trend in referred infants that had their second AABR<6 weeks (p=0.004) as well as in infants diagnosed<3 months (p<0.001). The NHS in Dutch NICUs is effective. Timely identification of hearing loss is improving over time.

Neonatal Cochlear Function: Measurement after Exposure to Acoustic Noise during in Utero MR Imaging

To establish whether fetal exposure to the operating noise of 1.5-T magnetic resonance (MR) imaging is associated with cochlear injury and subsequent hearing loss in neonates. The study was performed with local research ethics committee approval and written informed parental consent. Neonatal hearing test results, including otoacoustic emission (OAE) data, were sought for all neonates delivered in Sheffield who had previously undergone in utero MR imaging between August 1999 and September 2007. The prevalence of hearing impairment in these neonates was determined, with corresponding 95% confidence intervals calculated by using the binomial exact method, and mean OAE measurements were compared with anonymized local audiometric reference data by using the t test. One hundred three neonates who had undergone in utero MR imaging were identified; 96 of them had completed hearing screening assessment. Thirty-four of these babies were admitted to the neonatal intensive care unit (NICU), and one of them had bilateral hearing impairment. The prevalence of hearing impairment was 1% (one of 96; 95% confidence interval: 0.03%, 5.67%), which is in accordance with the prevalence expected, given the high proportion of babies in this study who had been in the NICU (ie, NICU graduates). In addition, for the well babies, there was no significant difference in mean OAE cochlear response compared with that for a reference data set of more than 16,000 OAE results. When NICU graduates were included in the comparison, a significant difference (P = .002) was found in one of four frequency bands used to analyze the cochlear response; however, this difference was small compared with the normal variation in OAE measurements. The findings in this study provide some evidence that exposure of the fetus to 1.5-T MR imaging during the second and third trimesters of pregnancy is not associated with an increased risk of substantial neonatal hearing impairment.

Developmental neurotoxicity of sedatives and anesthetics: A concern for neonatal and pediatric critical care medicine?*

To evaluate the currently available evidence for the deleterious effects of sedatives and anesthetics on developing brain structure and neurocognitive function. A computerized, bibliographic search of the literature regarding neurodegenerative effects of sedatives and anesthetics in the developing brain. A growing number of animal studies demonstrate widespread structural damage of the developing brain and long-lasting neurocognitive abnormalities after exposure to sedatives commonly used in neonatal and pediatric critical care medicine. These studies reveal a dose and exposure time dependence of neuronal cell death, characterize its molecular pathways, and suggest a potential early window of susceptibility in humans. Several clinical studies document neurologic abnormalities in neonatal intensive care unit graduates, usually attributed to comorbidities. Emerging human epidemiologic data, however, do not exclude prolonged or repetitive exposure to sedatives and anesthetics in early childhood as contributing factors to some of these abnormalities. Neuronal cell death after neonatal exposure to sedatives and anesthetics has been clearly demonstrated in developing animal models. Although the relevance for human medicine remains speculative, the phenomenon's serious implications for public health necessitate further preclinical and clinical studies. Intensivists using sedatives and anesthetics in neonates and infants need to stay informed about this rapidly emerging field of research.

A Pediatrician's Guide to Postdischarge Nutrition in NICU Graduates

OPEN ACCESSDecember 30, 2009A Pediatrician's Guide to Postdischarge Nutrition in NICU Graduates Kimberly Ernst, MD, FAAP Kimberly Ernst, MD, FAAP University of Oklahoma College of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.7820 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: Postdischarge nutrition is important for both growth and development, yet neonatal intensive care unit (NICU) graduates are often quickly taken off their special postdischarge formulas or human milk fortification. This resource was developed to stress the importance of the role of the follow-up physician in ensuring these infants continue to receive their special diets for the appropriate time frame postdischarge. Methods: This resource contains a case-based PowerPoint lecture approximately 40 minutes long, followed by a 10-minute Q&A session. All participants receive a handout at the beginning of the lecture for reference. The handout does not include the entire presentation, instead highlighting important points that the audience should take home. Successful implementation is encouraged through an interactive session with the participants using the case-based method of teaching. Results: This resource was presented at the University of Oklahoma Department of Pediatrics Annual CME Conference in 2009. Conference participants felt the materials were interesting and helped them understand the importance of their role in encouraging appropriate nutrition postdischarge. Regarding the different scenarios physicians face when working with families of neonatal infants, one pediatrician said afterwards, “You nailed not just one, but every issue on the head.” Discussion: This resource could be used along with an audience response system or with another case presentation in which the infant receives human milk fortified with additional calories, vitamins, and minerals in order to solidify participants' understanding of postdischarge nutrition for those infants receiving human milk, the preferred food for all infants. Educational Objectives By the end of this session, learners will be able to: Identify the risk factors for nutritional deficiencies in neonatal intensive care unit (NICU) graduates.Develop strategies to assess for clinical signs and symptoms of nutritional deficiencies in NICU graduates.Assess normal and abnormal growth patterns in NICU graduates.Formulate strategies to enable optimal growth and development in NICU graduates. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx Handout.pdf Post Discharge Nutrition.pptx Post Discharge Nutrition Coversheet.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2009 Ernst. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsNICUPremature BirthNutritionDevelopmentPrematurityNeonatalGrowth Disclosures None to report. Funding/Support None to report. Prior Presentations University of Oklahoma Department of Pediatrics Annual CME Conference; May 2009; Oklahoma City, OK. Loading ...

Admissions of all gestations to a regional neonatal unit versus controls: 2‐year outcome

To assess neurodevelopmental outcome at 2 years for neonatal intensive care unit (NICU) admissions compared with controls, and to trial a parent-reporting scheme. All infants admitted to the NICU at Christchurch Women's Hospital over a 12-month period and whose parents were domiciled in a defined geographical region were eligible for study, together with every eighth term infant not admitted (to a total of 300). Parents completed a two-page questionnaire on their child's 2nd birthday. All infants <28 weeks gestation and a random 300 NICU admissions and 108 controls underwent a paediatric examination and Bayley II assessment at 2 years of age. A total of 387 NICU infants (86% eligible) and 306 controls were enrolled. At 2 years of age, 276 NICU infants (89% survivors) and 94 controls (87%) had some follow up. For infants of <33 weeks, 33-36 weeks, > or =37 weeks gestation and controls, the percentage >1 SD below the mean on the Bayley Mental Development Index scales were 33.3, 36.5, 44.6 and 24.1, respectively (P= 0.03); on the Psychomotor Developmental Index scales were 30.0, 29.1, 41.1 and 19.5 (P= 0.02) and the percentage with any cerebral palsy were 11.1, 2.8, 5.2 and 1.2. At 2 years of age, NICU graduates have more developmental problems than controls across a range of measures. In many cases, term NICU graduates have the least favourable outcome. There was only moderate agreement between parents' reporting of moderate or severe developmental disability by means of a questionnaire, compared with professionals (kappa statistic 0.38), with parents tending to underestimate problems.

Parenting Preemies

Research supports the importance of family-centered care in the neonatal intensive care unit (NICU). The significance of continuity in family-centered care beyond the NICU has recently gained attention. Parenting Preemies is a unique and easily replicated postdischarge program designed to ease the transition from hospital to home for NICU graduates and their families. The comprehensive program provides an effective means to demonstrate ongoing, family-centered, and cost-effective outreach after discharge. The specific target population includes premature, low birth-weight, and special needs infants, and their parents. A multidisciplinary team utilizes evidenced-based principles to facilitate an education and support group, in conjunction with home visits, as the foundation for promotion of optimal outcomes for preemies and their parents. Participant satisfaction is consistently positive.

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.