Infants In Neonatal Intensive Care Unit Research Articles

Depression in the early postpartum period and attachment to children—in mothers of NICU infants

AbstractDepression in early puerperium was evaluated in terms of maternal attachment in mothers of children admitted to the neonatal intensive care unit (NICU) in comparison to a control group of mothers of full‐term infants.A survey including Zung's self‐rating depression scale (ZSDS), a postpartum maternal attachment scale and items addressing the mother's feelings and peripheral conditions was conducted on mothers of children admitted to the NICU.Among the 153 mothers who gave valid responses, positive ZSDS scores of over 40 were seen in 61.8%. In terms of the children's disorder, strong depressive tendency was noted among mothers of low birth weight infants. Significant correlation was noted between the ZSDS and the ‘core maternal attachment’ (negative correlation) and ‘anxiety regarding children’ (positive correlation) subscales of postpartum maternal attachment. Path analysis revealed the father's positive reaction in learning of the pregnancy resulted in elevation of the ‘core maternal attachment’ score, in contrast to the control group mothers. Copyright © 2003 John Wiley & Sons, Ltd.

Sensors in neonatal monitoring

Monitoring the status of preterm infants in the Neonatal Intensive Care Unit (NICU) provides a unique and challenging environment for the design, function and use of sensor-based monitoring equipme...

Changing Prevalence of Prenatal Substance Abuse in Utah

In Brief OBJECTIVE To estimate the current prevalence of prenatal exposure to methamphetamines and other drugs of abuse among infants born in Utah and compare the results with those of a maternal substance abuse prevalence study performed in 1991 in the same geographic area. METHODS Thirteen well baby nurseries in calendar year 2000 and six neonatal intensive care units (NICUs) in 2001–2002 collected anonymous meconium samples and associated, but nonidentifiable, demographic data on consecutively born infants. Samples were screened by enzyme immunoassay and confirmed by gas chromotography/mass spectroscopy for methamphetamines, cannabinoids, and benzoylecognine. RESULTS Meconium samples were collected from 1202 well baby nursery infants and 317 NICU infants. There were no significant differences in the rates of positivity for methamphetamines (0.6% versus 0.4%) or marijuana (2.9% versus 1.8%) between the 1991 and 2000/2001 studies. Cocaine prevalence declined from 1.1% in 1991 to 0.3% in 2000/2001 (P = .04). The prevalence of positivity for any of these three drugs declined over the 10-year period from 4.4% to 2.4% (P = .02). The prevalence for positivity for any of these three drugs was higher in the NICUs (4.7%) than in the well baby nurseries (1.9%, P = .008). CONCLUSION The rate of drug-positive infants declined during the decade of the 1990s in a geographic area that is experiencing a sharp rise in the use of methamphetamine among women of childbearing age. Further studies that focus on women of childbearing age who use methamphetamine may help determine factors that impact their drug use during pregnancy and after the infant is born. Despite increasing use of methamphetamine among women of childbearing age in Utah, a decrease in prevalence of drug-exposed newborns was found over a 10-year period.

Changing prevalence of prenatal substance abuse in Utah.

To estimate the current prevalence of prenatal exposure to methamphetamines and other drugs of abuse among infants born in Utah and compare the results with those of a maternal substance abuse prevalence study performed in 1991 in the same geographic area. Thirteen well baby nurseries in calendar year 2000 and six neonatal intensive care units (NICUs) in 2001-2002 collected anonymous meconium samples and associated, but nonidentifiable, demographic data on consecutively born infants. Samples were screened by enzyme immunoassay and confirmed by gas chromotography/mass spectroscopy for methamphetamines, cannabinoids, and benzoylecognine. Meconium samples were collected from 1202 well baby nursery infants and 317 NICU infants. There were no significant differences in the rates of positivity for methamphetamines (0.6% versus 0.4%) or marijuana (2.9% versus 1.8%) between the 1991 and 2000/2001 studies. Cocaine prevalence declined from 1.1% in 1991 to 0.3% in 2000/2001 (P =.04). The prevalence of positivity for any of these three drugs declined over the 10-year period from 4.4% to 2.4% (P =.02). The prevalence for positivity for any of these three drugs was higher in the NICUs (4.7%) than in the well baby nurseries (1.9%, P =.008). The rate of drug-positive infants declined during the decade of the 1990s in a geographic area that is experiencing a sharp rise in the use of methamphetamine among women of childbearing age. Further studies that focus on women of childbearing age who use methamphetamine may help determine factors that impact their drug use during pregnancy and after the infant is born.

Ethics at the Limit of Viability: A Premie’s Progress

After completing this article, readers should be able to: 1. List the five epidemiologic truths that underlie ethical decision-making in the neonatal intensive care unit. 2. Describe how recent developments have altered some, but not all, of these epidemiologic observations. Progress in neonatology is generally portrayed as inexorable—doing better and better with smaller and smaller. For approximately the first 30 years of the specialty, this was true. A succession of manuscripts published between 1960 and 1990 bore witness to the success, with titles such as “1,500 g: How Small is Too Small?” that subsequently were followed by: 1,000 g:?, 800 g:?, and 500 g:?. By 1990, virtually all neonatal intensive care units (NICUs) had survival rates of 90% or greater for infants whose birthweights (BWs) were greater than 1,000 g. Consequently, for individual infants whose BWs were greater than 1 kg, parental refusal of intervention was precluded in the absence of other, nonBW-related circumstances. At the other end of a relatively narrow BW spectrum (approximately <450 g), survival was dismal. At a minimum, parental requests for nonresuscitation of infants who weighed less than this limit seemed supportable, under the broad rubric of futility. Thus, the ethical debate surrounding NICU care was played out along a birthweight dimension of roughly 1 lb. These epidemiologic truths were recognized by the early 1990s. However, much has changed in NICU care in the past decade. Exogenous surfactants are administered uniformly for respiratory distress. High-frequency oscillation and inhaled nitric oxide are widely available. Antenatal corticosteroids have become standard therapy for women in whom preterm delivery is threatened. In this brief article, we consider how these medical advances affected both the epidemiology and ethics of life and death for extremely low-birthweight (ELBW) infants in the NICU during the past 10 years. In parallel with Newton’s three laws for …

Implementation of a nation‐wide automated auditory brainstem response hearing screening programme in neonatal intensive care units

Aim: As part of a future national neonatal hearing screening programme in the Netherlands, automated auditory brainstem response (AABR) hearing screening was implemented in seven neonatal intensive care units (NICUs). The objective was to evaluate key outcomes of this programme: participation rate, first stage success rate, pass/referral rates, rescreening compliance, diagnostic referral rates, age of first diagnostic evaluation and prevalence of congenital hearing loss (CHL). Methods: This prospective cohort study collected data on 2513 survivors. NICU graduates with one or more risk factors according to the Joint Committee on Infant Hearing were included in a two‐stage AABR hearing screening programme. Conventional ABR was used to establish a diagnosis of CHL. Results: A total of 2513 newborns enrolled in the programme with a median gestational age of 31.6 (range 24–43) wk and a median birthweight of 1450 (range 510–4820) g. In 25 (1%) cases parents refused screening. Four out of 2513 newborns were initially lost; 2484 newborns have been tested initially. A final 98% participation rate (2465/2513) was obtained for the whole programme. After a median postmenstrual age at the first test of 33.7 (range 27–54) wk, a pass rate of 2284/2484 (92%) resulted at the first stage. The rescreening compliance after the first test was 92% (184/200). A referral rate for diagnostic ABR of 3.1% (77/2484) resulted. Of the 77 referrals 14 (18.2%) had normal screening thresholds, 15 (19.5%) had unilateral CHL and 48 (62.3%) had bilateral CHL. The prevalence of unilateral CHL was 0.6% (15/2484) and of bilateral CHL 1.9% (48/2484). Conclusion: A financially supported two‐stage AABR hearing screening programme can be successfully incorporated in NICU centres and detects a high prevalence of CHL in NICU graduates. Neonatal hearing screening should be part of standard clinical practice in all NICU infants.

Implementation of a nation-wide automated auditory brainstem response hearing screening programme in neonatal intensive care units

As part of a future national neonatal hearing screening programme in The Netherlands, automated auditory brainstem response (AABR) hearing screening was implemented in seven neonatal intensive care units (NICUs). The objective was to evaluate key outcomes of this programme: participation rate, first stage success rate, pass/referral rates, rescreening compliance, diagnostic referral rates, age of first diagnostic evaluation and prevalence of congenital hearing loss (CHL). This prospective cohort study collected data on 2513 survivors. NICU graduates with one or more risk factors according to the Joint Committee on Infant Hearing were included in a two-stage AABR hearing screening programme. Conventional ABR was used to establish a diagnosis of CHL. A total of 2513 newborns enrolled in the programme with a median gestational age of 31.6 (range 24-43) wk and a median birthweight of 1450 (range 510-4820) g. In 25 (1%) cases parents refused screening. Four out of 2513 newborns were initially lost; 2484 newborns have been tested initially. A final 98% participation rate (2465/2513) was obtained for the whole programme. After a median postmenstrual age at the first test of 33.7 (range 27-54) wk, a pass rate of 2284/2484 (92%) resulted at the first stage. The rescreening compliance after the first test was 92% (184/200). A referral rate for diagnostic ABR of 3.1% (77/2484) resulted. Of the 77 referrals 14 (18.2%) had normal screening thresholds, 15 (19.5%) had unilateral CHL and 48 (62.3%) had bilateral CHL. The prevalence of unilateral CHL was 0.6% (15/2484) and of bilateral CHL 1.9% (48/2484). A financially supported two-stage AABR hearing screening programme can be successfully incorporated in NICU centres and detects a high prevalence of CHL in NICU graduates. Neonatal hearing screening should be part of standard clinical practice in all NICU infants.

Is the BPD epidemic diminishing?

In a previous study of very low birth weight neonates, < or = 1500 g, admitted to the Vanderbilt University Neonatal Intensive Care Unit (NICU) from 1976-1990, improvements in survival were accompanied by a corresponding increase in the incidence of bronchopulmonary dysplasia (BPD). Since then, certain neonatal and perinatal interventions have been introduced and may influence neonatal outcomes. In this study, we have continued the analysis of the incidence of 3 outcomes: 1) Neonatal death (NEOD), 2) BPD, and 3) NEOD or BPD (NEOD/BPD) for an additional 7 years, 1991-1997. A retrospective study was performed of 3,837 patients with birth weight < or = 1500 g and admitted to the Vanderbilt NICU within 24 hours of birth from 1976 through 1997. The outcomes NEOD, BPD, or NEOD/BPD were modeled by using multiple logistic regression with the following risk factors included as covariates: birth weight, gestational age, Apgar scores at 1 and 5 minutes, gender, race, birth location, diagnosis of hyaline membrane disease, maternal age, maternal diabetes, delivery method, multiple births, duration of ruptured membranes, and biologically relevant interactions among these covariates. To assess time trends in the risk factors and outcomes, patients were divided into time periods (1 = 1976-80, 2 = 1981-85, 3 = 1986-90, 4 = 1991-95, and 5 = 1996-97). For each outcome, only covariates or interactions among covariates found to be significant were retained in the final model. Adjusted odds ratios and 95% confidence intervals were calculated to measure the risk associated with a given time period in comparison to the preceding period. There was a progressive decline in NEOD across all time periods. The previously described increase in BPD from period 1 through period 3 is followed by a decrease in periods 4 and 5. The risk of NEOD/BPD remained fairly constant from period 1 to period 3, but then showed a significant decrease over the two most recent periods. Prior to 1991, the cost of improved survival among very low birth weight infants in this large NICU was an increased incidence of BPD. Since 1991, the risk of BPD has been decreasing even though survival continues to improve. If these findings are also representative of other NICUs, they signify an important reduction in the impact of BPD as one of the costly sequelae of prematurity.

A new transcutaneous bilirubinometer, BiliCheck, used in the neonatal intensive care unit and the maternity ward

Transcutaneous bilirubin (TcB) was measured with a new bilirubinometer, BiliCheck, in 261 jaundiced infants in the neonatal intensive care unit (NICU) [gestational age (GA) 25–43 wk] (group 1) and in 227 healthy jaundiced term and near‐term infants (GA 35–43 wk) (group 2). Imprecision of a single determination of TcB measured on the forehead [TcB(h)], expressed as 1 standard deviation, was 15–18 μmol l−1. No statistically significant difference between intraoperator and interoperator imprecision was found. There was a good correlation between TcB(h) and total serum bilirubin (TSB) in both groups of infants, although TcB(h) was on average lower than TSB. In the NICU infants, TcB(h), other things being equal, was lower in males than in females, and decreased with increasing postnatal age, for the same TSB level. In the infants in both groups who had a GA ≥35 wk, sick infants had a higher TcB(h) than healthy infants for the same TSB level. The differences were statistically significant, but small and of minor clinical significance. Blood haemoglobin concentration, GA and ethnic origin were not found to influence TcB(h), i.e. BiliCheck corrects sufficiently for these factors. In all 488 infants, TcB was measured at four different body sites. Measurements on the forehead and sternum [TcB(s)] correlated well with TSB, while measurements on the knee and foot correlated less well. In the NICU infants TcB(h) predicted TSB statistically significantly better than TcB(s), while in the healthy term and near‐term infants TcB(h) and TcB(s) predicted TSB equally well. Therefore, the preferable body site for measurement of TcB under routine conditions is the forehead. By retrospective analysis of the data, a screening model is presented whereby TcB(h) can be used to screen infants who require phototherapy. We found that using screening limits for TcB(h), which are 70% of the currently used phototherapy limits for TSB, 80% of blood samples in healthy term and near‐term infants, and 42% of NICU infants with GA ≥32 wk, could be avoided. Conclusion: BiliCheck is suitable for screening both NICU and healthy newborn infants with jaundice, with regard to the need for phototherapy. The authors recommend using a TcB(h) limit which is 70% of the currently recommended TSB limits for phototherapy, to decide whether TSB needs to be measured.

A quantitative use of the NIDCAP tool. The effect of gender and race on very preterm neonates' behavior.

The purpose of this study was to demonstrate how the check sheet of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) can be quantified and used in research. Using the quantified NIDCAP measures, the hypothesis that Caucasian male infants are less behaviorally competent while in a neonatal intensive care unit (NICU) was explored. Participants included 42 very preterm NICU infants. Eighty-five NIDCAP behaviors were quantified into scores ranging from 0 to 1, indicating the percentage of time each behavior was observed. Multivariate analyses were used in grouping the 85 NIDCAP behaviors into three subsystems of functioning. The hypothesis that Caucasian male infants were less competent was not supported; neither were gender differences found. Contrary to this hypothesis, African American infants were identified as more vulnerable on several behaviors. NIDCAP assessments were easily quantified. Once the entire NIDCAP exam has been quantified, practice applications may involve automated development of individualized care plans.

Outcome of neonatal screening for hearing loss in neonatal intensive care unit and well-born nursery infants

A newborn hearing screening was conducted on 319 neonatal intensive care unit (NICU) and 1200 well-born nursery (WBN) infants. Mean NICU birth weight was 1997 g and mean gestational age 34 weeks. Auditory brainstem response was studied in screening in NICU infants. Otoacoustic emission (OAE) or automated auditory brainstem response (AABR) was used in primary WBN screening. All infants not bilaterally passing hearing screening before discharge were recalled for outpatient retesting. If the outcome was still failure, ABR screening was conducted. The prevalence of infants diagnosed with hearing loss was 1.1% (16 of 1519). Of these 16, 75% were from the NICU and 75% were at risk for hearing loss. Mean age at hearing loss identification was 12.9 weeks in the WBN and mean age at hearing aid fitting was 16.1 weeks. Mean age at hearing aid fitting was lower for WBN than for NICU infants. Hearing loss identification and hearing aid fitting are thus feasible in NICU and WBN infants in universal newborn hearing screening.

Molecular epidemiology of antibiotic-resistant gram-negative bacilli in a neonatal intensive care unit during a nonoutbreak period.

Gram-negative organisms that are resistant to parenteral antibiotics are a growing threat to hospitalized patients. This study was conducted to define the epidemiologic characteristics of these organisms during a nonoutbreak period in a neonatal intensive care unit (NICU). Nasopharyngeal and rectal swab specimens were obtained 3 times a week from every infant in a tertiary care NICU during a 12-month period. Specimens were processed to identify aerobic Gram-negative species resistant to gentamicin, piperacillin-tazobactam, or ceftazidime. Selected clinical parameters were tested for their association with colonization with a resistant organism. Restriction endonuclease digests of genomic DNA were derived from isolates of the most frequently occurring species. The fragments were analyzed by pulsed-field gel electrophoresis (PFGE) to determine the genetic relatedness of the various isolates and thereby determine the length of colonization, the frequency of horizontal transmission, and the size and duration of clusters. A total of 101 infants (8.6%) of 1180 admissions were colonized with at least 1 antibiotic-resistant bacillus before NICU discharge. Multiple parameters indicating a prolonged, complicated NICU course were associated with resistant colonization, including gestational age, length of stay, and exposure to several classes of antibiotics. Colonization with resistant bacilli occurred as early as the first NICU day, but acquisition continued throughout the infants' stay. A total of 436 isolates were analyzed by PFGE. On the basis of this molecular analysis, it was determined that duration of colonization was usually very short; the median for all species tested was <1 week. In addition, cross-colonization occurred in only 12% of all PFGE-analyzed isolates. Most clusters of cross-colonized infants were small, with the majority involving only 2 patients. During endemic periods, acquisition of antibiotic-resistant Gram-negative bacilli in the NICU may occur very soon after admission, but colonization continues over many weeks of NICU stay. The duration of colonization with resistant bacilli is short, and horizontal transmission is unusual. These characteristics suggest a gradual but temporary incorporation of these organisms from the NICU environment into the nascent newborn microflora over time with little cross-colonization. These observations may aid the rational development of infection-control strategies to contain the reservoir of resistant Gram-negative organisms in the NICU.antibiotic resistance, Gram-negative bacilli, neonatal intensive care, antibiotic utilization, colonization, pulsed-field gel electrophoresis.

Selective inner hair cell loss in premature infants and cochlea pathological patterns from neonatal intensive care unit autopsies.

Deafness and handicapping sensorineural hearing impairment occur frequently in neonatal intensive care unit survivors for unknown reasons. Hearing was tested early and repeatedly in neonatal intensive care unit patients with an auditory brainstem response (ABR) screener. The temporal bones of 15 nonsurvivors (30 ears) were fixed promptly (average, 5 hours) after death for histological evaluation. Among these patients, 12 failed the ABR screen bilaterally, 1 passed unilaterally, and 2 passed bilaterally. Cochlear histopathologic conditions that could contribute to hearing loss included bilateral selective outer hair cell loss in 2 patients, bilateral selective inner hair cell loss in 3 (all premature), and a combination of both outer and inner hair cell loss in 2. Other hair cell abnormalities were noted; the 2 infants who had passed the ABR screen demonstrated normal histological features. Neuronal counts were normal. Auditory brainstem response failure among these neonatal intensive care unit infants who died was extremely common in part owing to an unexpected histological alteration, selective inner hair cell loss among premature newborns, that should be detectable uniquely by the ABR testing method. Additional histological patterns suggest more than one cause for neonatal intensive care unit hearing loss. Hair cell loss patterns seem frequently compatible with in utero damage.

Why are NICU infants at risk for chronic otitis media with effusion?

Newborns in a Neonatal Intensive Care Unit (NICU) and even later have a high incidence of otitis media with effusion (OME). It is unclear which aspects play a role in the incidence of chronic OME during infancy. In order to investigate the effect of nasally-placed tubes, cranial growth, immune system, and neuromotor function on the occurrence of chronic OME, 83 NICU patients were observed prospectively for middle ear status. Duration and type of treatment with nasal tubes were obtained from the NICU notes. At the NICU, and 1 and 2 years of age the cranial circumference and neuromotor function were assessed. As a proxy for disturbed local immune system parental reports of snoring, mouth breathing and common cold were used. Multivariate analysis revealed that infants treated with nasotracheal and nasopharyngeal tubes showed a marginally significant increased risk for chronic OME (OR=3.2 [95% CI 0.5–21.2]). Treatment with nasogastric tubes appeared to have a lower risk for chronic OME (OR=1.5 [95% CI 0.1–25.1]). No significant effect was found for cranial circumference. Signs of disturbed local immunity during the first 6 months of life (OR=1.4 [95% CI 0.4–4.7]), as well as impaired neuromotor function (OR=1.9 [95% CI 0.5–6.8]), showed also a marginally significant increased risk for chronic OME. The cohort of NICU patients might be relatively too small in order to find significant effects. Although the results of this study should be interpreted cautiously, it is suggested that nasally-placed tubes for ventilatory assistance, disturbed local immunity and impaired neuromotor function are associated with chronic OME.

Identification of neonatal hearing impairment: hearing status at 8 to 12 months corrected age using a visual reinforcement audiometry protocol.

1) To describe the hearing status of the at-risk infants in the National Institutes of Health-Identification of Neonatal Hearing Impairment study sample at 8 to 12 mo corrected age (chronologic age adjusted for prematurity). 2) To describe the visual reinforcement audiometry (VRA) protocol that was used to obtain monaural behavioral data for the sample. All neonatal intensive care unit infants and well babies with risk factors (including well babies who failed neonatal tests) were targeted for follow-up behavioral evaluation once they had reached 8 mo corrected age. Three thousand one hundred and thirty-four (64.4%) of the 4868 surviving infants returned for at least one behavioral hearing evaluation, which employed a well-defined VRA protocol. VRA thresholds or minimum response levels (MRLs) were determined for speech and pure tones of 1.0, 2.0, and 4.0 kHz for each ear using insert earphones. More than 95% of the infants were reliably tested with the VRA protocol; 90% provided complete tests (four MRLs for both ears). Ninety-four percent of the at-risk infants were found to have normal hearing sensitivity (MRLs of 20 dB HL) at 1.0, 2.0, and 4.0 kHz in both ears. Of the infants, 2.2% had bilateral hearing impairment, and 3.4% had impairment in one ear only. More than 80% of the impaired ears had losses of mild-to-moderate degree. This may be the largest study to attempt to follow all at-risk infants with behavioral audiometric testing, regardless of screening outcome, in an effort to validate the results of auditory brain stem response, distortion product otoacoustic emission, and transient evoked otoacoustic emission testing in the newborn period. It is one of only a few studies to report hearing status of infants at 1 yr of age, using VRA on a clinical population. Successful testing of more than 95% of the infants who returned for the VRA follow-up documents the feasibility of obtaining monaural behavioral data in this population.

Exposure to Phthalate Esters

Exposure to Phthalate Esters

Identification of neonatal hearing impairment: auditory brain stem responses in the perinatal period.

1) To describe the auditory brain stem response (ABR) measurement system and optimized methods used for study of newborn hearing screening. 2) To determine how recording and infant factors related to the screening, using well-defined, specific ABR outcome measures. Seven thousand one hundred seventy-nine infants, 4478 from the neonatal intensive care unit (NICU) and the remaining from the well-baby nursery, were evaluated with an automated ABR protocol in each ear. Two channel recordings were obtained (vertex to mastoid or channel A and vertex to nape of neck or channel B) in response to click stimuli of 30 and 69 dB nHL in all infants as well as 50 dB nHL in infants who did not meet criteria for response at 30 dB. Criteria for response included F(SP) > or =3.1 and a tester-judgment of response. Criteria could be met in the first or repeat test with a maximum of 6144 accepted sweeps per test. More than 99% of infants could complete the ABR protocol. More than 90% of NICU and well-baby nursery infants "passed" given the strict criteria for response, whereas 86% of those with high risk factors met criterion for ABR response detection. The number of infants who did not meet ABR response criteria in one or both ears was systematically related to stimulus level with the largest group not meeting criteria at 30 dB followed by 50 and 69 dB nHL. Meeting criteria on the ABR was positively correlated with the amplitude of wave V, with low noise and low electrode impedance. Factors that predicted how many sweeps would be needed to reach criterion F(SP) included noise level of the test site, state of the baby (for example, quiet sleep versus crying), recording noise, electrode impedance and response latency. Channel A (vertex to mastoid) reached criterion more often than channel B (vertex to nape of neck) due to higher noise in channel B. Average total test time for 30 dB nHL screening in both ears was under 8 minutes. Well babies with risk factors took slightly longer to evaluate than other groups with this automated ABR procedure and have higher noise levels. ABR implemented with an automated detection algorithm using a 30 dB nHL click stimulus is reliable technique for rapid assessment of auditory status in newborns. Factors other than hearing loss that influenced the test result include infant state, electrode location and impedance, testing site, and infant risk status. Even so, ABRs were reliably recorded in the vast majority of babies under circumstances in which most babies are found in the perinatal period.

The New York State Universal Newborn Hearing Screening Demonstration Project: Ages of Hearing Loss Identification, Hearing Aid Fitting, and Enrollment in Early Intervention

To determine the ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention through a multi-center, state-wide universal newborn hearing screening project. Universal newborn hearing screening was conducted at eight hospitals across New York State. All infants who did not bilaterally pass hearing screening before discharge were recalled for outpatient retesting. Inpatient screening and outpatient rescreening were done with transient evoked otoacoustic emissions and/or auditory brain stem response testing. Diagnostic testing was performed with age appropriate tests, auditory brain stem response and/or visual reinforcement audiometry. Infants diagnosed with permanent hearing loss were considered for hearing aids and early intervention. Ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention were investigated regarding nursery type, risk status, unilateral versus bilateral hearing loss, loss type, loss severity, and state regions. The prevalence of infants diagnosed with permanent hearing loss was 2.0/1000 (85 of 43,311). Of the 85 infants with hearing loss, 61% were from neonatal intensive care units (NICUs) and 67% were at risk for hearing loss. Of the 36 infants fitted with hearing aids, 58% were from NICUs and 78% were at risk for hearing loss. The median age at identification and enrollment in early intervention was 3 mo. Median age at hearing aid fitting was 7.5 mo. Median ages at identification were less for infants from the well-baby nurseries (WBNs) than for the NICU infants and for infants with severe/profound than for infants with mild/moderate hearing loss, but were similar for not-at-risk and at-risk infants. Median ages at hearing aid fitting were less for well babies than for NICU infants, for not-at-risk infants than for at-risk infants, and for infants with severe/ profound hearing loss than for infants with mild/ moderate hearing loss. However, median ages at early intervention enrollment were similar for nursery types, risk status, and severity of hearing loss. Early ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention can be achieved for infants from NICUs and WBNs and for infants at risk and not at risk for hearing loss in a large multi-center universal newborn hearing screening program.

The New York State universal newborn hearing screening demonstration project: outpatient outcome measures.

To investigate outpatient outcome measures of a multi-center, state-wide, universal newborn hearing screening project. Eight hospitals participated in a 3-yr, funded project. Each hospital designed its own protocol using common criteria for judging whether an infant passed a hearing screening. Infants were tested in the hospital, and those either failing the in-hospital screening or who were not tested in the hospital (missed) were asked to return 4 to 6 wk after hospital discharge for outpatient rescreening. Those infants failing the outpatient rescreening were referred for diagnostic auditory brain stem response testing. Each hospital used its own audiological equipment and criteria to determine whether a particular infant had a hearing loss. All data were collected and analyzed for individual hospitals, as well as totaled across all hospitals. Data were analyzed in terms of year of program operation, nursery type, and geographic region. Seventy-two percent of infants who failed the in-hospital screening returned for outpatient testing. The percentage of in-hospital fails returning for retesting was significantly higher than the percentage of in-hospital misses returning for retesting. The percentage of infants returning for retesting increased with successive years of program operation. Some differences were noted in the percentage of infants returning for retesting among hospitals and geographic regions of the state. Some differences in outpatient outcome measures also were noted between infants originally born into the neonatal intensive care unit (NICU) and the well-baby nursery (WBN). The percentage of infants from the NICU who returned for retesting was slightly higher than that for infants from the WBN. The percentage of infants from the WBN passing the outpatient rescreening was higher than that for the NICU infants. The overall prevalence of hearing loss was 1.96/1000, with that in the NICU being 8/1000 and that in the WBN being 0.9/1000. Positive predictive value for permanent hearing loss based on inpatient screening was approximately 4% and based on outpatient rescreening was approximately 22%. Several outpatient outcome measures changed with successive years of program operation, suggesting that programs improve over time. Also, some outpatient outcome measures differ between NICU and WBN populations. The differences noted across regions of the state in the percentage of infants returning for outpatient retesting require further research to determine whether differences are due to demographic and/or procedural differences.

Cup feeding: an alternative to bottle feeding in a neonatal intensive care unit.

Cup feeding has been suggested as an alternative to bottle feeding to help promote breastfeeding by avoiding nipple confusion. To demonstrate the possibility and utility of cup feeding, records of 59 preterm and low birthweight babies (born before 37 weeks' gestation) admitted to a neonatal intensive care unit (NICU) from May 1995 to April 1996 were analyzed. Feeding was initiated on cup if swallowing was present and cup feeding was possible as early as 29 weeks' gestational age with a birthweight of 900 g. In the case of five infants (38 per cent) in the gestational age group 28-30 weeks, 19 infants (52 per cent) in the 31-34 weeks' gestation group, and six (56 per cent) in the 35-37 weeks' gestation group, feeding could be commenced directly with a cup. Out of 59 infants, 33 infants (56 per cent) could be discharged on exclusive breastfeeding. It was concluded that cup feeding is a useful alternative to bottle feeding and an effective method of feeding preterm and small infants in NICU. Cup feeding allows successful breastfeeding without causing 'nipple confusion'.