Neonatal Intensive Unit Research Articles

Follow-up observation of catch-up growth of preterm infants after discharge and risk factors for extrauterine growth retardation

To investigate the catch-up growth of preterm infants within a corrected age of 6 months and the risk factors for extrauterine growth retardation (EUGR). A total of 321 preterm infants who were discharged after treatment in the neonatal intensive care unit and had regular follow-up documents with complete follow-up records were enrolled. According to the Prenatal Health Care Norms in 2015, these infants were divided into low-risk group with 69 infants and high-risk group with 252 infants. The Z-score method was used to evaluate body weight, body length, and head circumference, and the catch-up growth of the preterm infants within a corrected age of 6 months was analyzed. A multivariate logistic regression analysis was performed to identify the risk factors for EUGR at the corrected age of 6 months. The percentage of preterm infants with Z scores of body weight, body length, and head circumference of < -2 (not reach the standard for catch-up growth) in both groups decreased gradually with increasing corrected age. At the corrected age of 6 months, the percentages of preterm infants whose body weight, body length, and head circumference did not reach the standard for catch-up growth in the low-risk group were reduced to 1.4% (1/69), 2.9% (2/69), and 1.4% (1/69) respectively, while in the high-risk group, these percentages were reduced to 1.2% (3/252), 1.6% (4/252), and 3.6% (9/252) respectively. The high-risk group had a significantly higher incidence rate of EUGR at the corrected age of 6 months than the low-risk group (28.2% vs 15.9%, P=0.039). The multivariate logistic regression analysis showed that multiple birth (OR=2.68, P=0.010), low birth weight (<1 000 g: OR=14.84, P<0.001; 1 000-1 499 g: OR=2.85, P=0.005), and intrauterine growth retardation (IUGR) (OR=11.41, P<0.001) were risk factors for EUGR at the corrected age of 6 months, while nutritional enhancement after birth (OR=0.25, P<0.001) reduced the risk of EUGR. Most preterm infants can achieve catch-up growth at the corrected age of 6 months. High-risk preterm infants have a high incidence rate of EUGR at the corrected age of 6 months. Multiple birth, low birth weight, and IUGR are risk factors for EUGR, while rational nutritional enhancement after birth can reduce the incidence rate of EUGR in preterm infants.

The clinical value for plasma heparin-binding protein in the early diagnosis of the neonatal sepsis

Objective To investigate the clinical value of plasmatic heparin-binding protein in early diagnosis and severity gradation of neonatal sepsis. Methods Thirty-nine patients with general sepsis, 37 patients with severe sepsis and 16 patients with septic shock were recruited as corresponding study groups respectively, who all had been admitted to the Neonatal Intensive Care Units(NICU) of Hunan Children′s Hospital from December 2016 to August 2017, meanwhile, 34 patients with local infection and 35 patients with non infection were enrolled as relevant control group respectively who all had been admitted to each neonatal ward in the retrospective study. The level of the heparin-binding protein(HBP), procalcitonin(PCT) and high sensitive C-reactive protein(hs-CRP) of all patients were detected respectively at the beginning of hospitalization. The difference of each group was compared by use of nonparametric statistics and the efficacy of every index on diagnosis of infection and sepsis was assessed with the receiver operating characteristic curve(ROC). Results The level of HBP in sepsis group, severe sepsis group and septic shock group HBP(H=91.764, P 0.05]. The area under the curve(AUC)of HBP in diagnosis of neonatal sepsis and infection are 0.885 and 0.904 respectively, more higher than PCT and hs-CRP; With the cut off value of 19.8 ng/ml, the sensitivity and specificity of HBP on diagnosis of infection are 85.7% and 82.9% respectively; the sensitivity and specificity 80.4% and 88.4% for neonatal sepsis with the cut-off value of 28.0 ng/ml respectively. Conclusion HBP probably has the better clinical value than PCT and hs-CRP in the early diagnosis and severity gradation of neonatal sepsis.(Chin J Lab Med, 2018, 41: 356-360) Key words: Neonatal sepsis; Blood proteins; Carrier proteins; Antimicrobial cationic peptides; Early diagnosis

Placentophagy among women planning community births in the United States: Frequency, rationale, and associated neonatal outcomes.

Limited systematic research on maternal placentophagy is available to maternity care providers whose clients/patients may be considering this increasingly popular practice. Our purpose was to characterize the practice of placentophagy and its attendant neonatal outcomes among a large sample of women in the United States. We used a medical records-based data set (n=23242) containing pregnancy, birth, and postpartum information for women who planned community births. We used logistic regression to determine demographic and clinical predictors of placentophagy. Finally, we compared neonatal outcomes (hospitalization, neonatal intensive unit admission, or neonatal death in the first 6weeks) between placenta consumers and nonconsumers, and participants who consumed placenta raw vs cooked. Nearly one-third (30.8%) of women consumed their placenta. Consumers were more likely to have reported pregravid anxiety or depression compared with nonconsumers. Most (85.3%) placentophagic mothers consumed their placentas in encapsulated form, and nearly half (48.4%) consumed capsules containing dehydrated, uncooked placenta. Placentophagy was not associated with any adverse neonatal outcomes. Women with home births were more likely to engage in placentophagy than women with birth center births. The most common reason given (73.1%) for engaging in placentophagy was to prevent postpartum depression. [Corrections added on 16 May 2018, after first online publication: The percentage values in the Results sections were updated.] CONCLUSIONS: The majority of women consumed their placentas in uncooked/encapsulated form and hoping to avoid postpartum depression, although no evidence currently exists to support this strategy. Preparation technique (cooked vs uncooked) did not influence adverse neonatal outcomes. Maternity care providers should discuss the range of options available to prevent/treat postpartum depression, in addition to current evidence with respect to the safety of placentophagy.

Reducing Unintended Extubation Rates in the Children’s National Neonatal Intensive Care Unit (NICU): A Quality Improvement Project

Background: Unintended Extubations (UE) are the 4th most common adverse event in the Neonatal Intensive Care Unit (NICU). They are associated with hypoxia, hypercarbia, airway trauma, subglottic stenosis, intraventricular hemorrhage, and code events. Most notably patients experiencing UEs have almost double the length of stay compared to those who do not. The cost of care increases by $36,000 per patient per admission with each UE. As a quality index for the US News and World Report (USWNR), NICUs strive to keep the UE median rate below the threshold (< 1 events/100 …

Initiation and Compliance with a Chest X-Ray (CXR) Reduction Protocol in the Children's National Medical Center Neonatal Intensive Care Unit (NICU)

Background: Daily chest X-rays (CXR)s for the sole purpose of verifying the position of the endotracheal tube (ETT) have been deemed by the American Academy of Pediatrics to be one of the top 5 unnecessary tests that increase cost and utilize resources but do not increase efficacy nor safety. Restricting the frequency of CXRs is not associated with an increase in hospital mortality, increased length of stay, nor an increase in duration of mechanical ventilation. Objective: To evaluate the effectiveness of a restrictive CXR protocol in the Neonatal Intensive Care Unit (NICU) by assessing …

Eastern Ghana’s first neonatal intensive care unit: achievements and lessons learned at 6 months

Introduction: Ghana’s Volta Region is home to 10% of the country’s births and has high neonatal mortality rates, yet historically has had no specialized neonatal services. At Volta Regional Hospital (VRH), sick newborns were previously cared for alongside other infants in a general babies ward. Recently, a new neonatal intensive care unit (NICU) was established as a major component of an ongoing quality improvement effort to improve paediatric outcomes at VRH. Here, we describe progress, achievements, and lessons learned in the NICU’s initial 6 months of operation. Methods: Volta Regional Hospital, commissioned …

Impact of Mother’s Own Milk on the Move (MOMM) Program on Breast Milk Feeding Rates at Discharge in a Freestanding Neonatal Intensive Care Unit

Background: Initiation of breastfeeding after delivery has been shown to increase long term breastfeeding rates. However, infant transport to a neonatal intensive care unit (NICU) away from the birthing center separates mother and baby. Obstacles such as decreased skin to skin contact, maternal stress related to transport of her baby to another hospital and inconsistent breastfeeding education and support impact a mother’s ability to provide breast milk. We developed Mother’s Own Milk on the Move (MOMM) program in 2014 to mobilize lactation support to mothers of infants transported to our NICU to improve …

Medically Complex Infants Benefit from Post-Discharge Telemedicine Visits

Background: The transition from the neonatal intensive care unit (NICU) to home is a challenging time for caregivers of medically complex infants. Discharging patients in a safe and efficient manner can also present many challenges for health care providers. Telemedicine can improve the complex infant’s transition to home for caregivers and health care providers alike. Objectives: 1) To identify issues encountered by caregivers’ post discharge. 2) To evaluate the efficacy of video communication during …

Patient Admission and Mortality Trends in the Neonatal Intensive Care Unit at University Teach Hospital Kigali, Rwanda

This is a retrospective chart review of total number of admissions, deaths and discharges at the neonatal intensive care nursery (NICU) at University Teaching Hospital Kigali (CHUK), Rwanda, from 2010-2015. This study establishes baseline admissions trends at the largest public NICU in Rwanda and the effect of gestational age and birth weight on mortality. Methods: Chart reviews were conducted using paper records located in …

A State Level Analysis of Factors Impacting Very Preterm Births at Non-Level III Hospitals

Background: The national Collaborative Improvement and Innovation Network to Reduce Infant Mortality set a national goal that 90% of very preterm (VPT, < 32 weeks gestation) infants be delivered at a hospital with a level III neonatal intensive care unit (NICU). Illinois has employed perinatal regionalization since the 1970s but still has not met the national goal for risk-appropriate care. This study aimed to identify factors associated with birth of VPT babies at inappropriate levels of care. Methods: Each Illinois non-Level III perinatal hospital was asked to complete review forms for VPT live births occurring at their facility during …

Implementation of I-PASS in the Neonatal Intensive Care Unit (NICU): Improving the Handoff Process

Handoffs are a critical aspect of medical provider transition during shift changes. Neonates admitted to the NICU are a high risk and vulnerable population. While I-PASS has been shown to improve the handoff process without extending handoff duration in the general pediatric inpatient setting, the I-PASS handoff tool has not previously been adapted or studied in the NICU setting. Our primary aim was to decrease the number of avoidable interruptions by 50% by August 2016. Our balancing measure was not to lengthen …

Impact of Neonatal Hypoglycemia Screening in the Well Baby Nursery and Trends in Neonatal Intensive Care Unit Admissions

Background: Blood glucose (BG) measurements are commonly used to screen for neonatal hypoglycemia (NH) among infants admitted to Well Baby Nurseries (WBN). The impact of hypoglycemia screening on WBN care has not been well characterized. Objective: To determine the proportion of initially well-appearing newborns screened for hypoglycemia and describe the indications and outcome of screening over 2.5 years at a single center. Methods: Retrospective cohort study of infants born from 1/1/2013-7/31/2015 at a large maternity center. Study focused on infants who otherwise would receive routine care: birth at ≥36 weeks gestational age (GA); birth weight (BW) ≥2 kg; admitted from delivery …

Associations in Electronic Data Warehouse Elements of Neonatal Hypoxic-ischemic Encephalopathy and Length of Stay

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is often accompanied by physiologic derangements and organ dysfunction; however, the natural history of these perturbations and their relationship with length of stay (LOS) remains uncertain. Objective: To describe daily markers of physiologic and organ dysfunction in infants with HIE and test their association with LOS in the neonatal intensive care unit. Methods: Eligible subjects were infants with HIE born ≥36 weeks' gestation from 2010-16 and received therapeutic hypothermia. Those with major congenital anomalies were excluded. From our institution’s electronic data warehouse (EDW), we …

Use of Paralytics for Nonemergent Neonatal Intubation in Very Low Birth Weight Infants

Background: Tracheal intubation (TI) is a commonly performed, high risk procedure within the neonatal intensive care unit (NICU). Use of sedation for the procedure has been associated with increased patient safety, but the use of paralytics remains controversial, especially for very low birth weight (VLBW) infants. Purpose: To examine the association between paralytic medication use during neonatal TI, TI success, the occurrence of TI adverse events (TIAEs), and other physiologic factors related to neonatal TI in VLBW infants who were less than 1500g at the time of intubation. Methods: A …

Goslings: An Early Language & Literacy Program for Families with Infants in the Neonatal Intensive Care Unit

Purpose: Research suggests that premature infants cared for in private NICU rooms show lower language scores at two years than premature infants cared for in multi-bed rooms (Pineda et al., 2014). With this in mind, Goslings was developed to teach families how to best engage medically fragile infants in the NICU using developmentally appropriate early language and literacy activities. Methods: A 60-minute program provided families with information regarding the importance of stimulating their infants’ language development through talking, reading, singing songs and reciting nursery rhymes. The concept of a traffic …

Can Placental Venous Blood be a Reliable Source for Initial Laboratory Studies for Patients Admitted to Neonatal Intensive Care Unit (NICU)

Background: Many ill newborns are admitted to NICU and undergo laboratory evaluations. Minimizing blood draws from neonates & the suffering associated with the process is important. The placenta has ample fetal blood that is otherwise discarded; obtaining admission laboratory studies from the PVB may provide a suitable alternative. Objective: We hypothesized that obtaining a complete blood count with manual differential (CBC/diff), C- reactive protein (CRP) and bacterial blood culture …

Discharge Readiness among Limited English Proficient (LEP) parents in the NICU

Purpose: Neonatal Intensive Care Unit (NICU) discharge preparation is a crucial step to ensure families’ competence in caring for their infants at home. Communication challenges between staff and families with Limited English Proficient (LEP) have been associated with less than optimal health care outcomes. We assessed if LEP families were less likely to be prepared …

Maternal Body Mass Index and Risk of Intraventricular Hemorrhage in Preterm Neonates

PURPOSE To evaluate the association between body mass index (BMI) and the development of intraventricular hemorrhage (IVH) in preterm infants. METHODS This is a retrospective cohort study of a population-based cohort of infants who were born between 22 and 32 weeks gestation from 2007 to 2011. Maternal and infant data were extracted from the California Office of Statewide Health Planning and Development (OSHPD) and the California Perinatal Quality Care Collaborative (CPQCC) datasets, from 136 neonatal intensive care units. Infants with major congenital anomalies, and those without neuroimaging performed were excluded. …

Salivary C-Reactive Protein as Non-Invasive Marker in Diagnosis of Neonatal Sepsis

Salivary C-Reactive Protein as Non-Invasive Marker in Diagnosis of Neonatal Sepsis Background: Neonatal sepsis is a major cause of morbidity and mortality in neonatal intensive care units. Neonatal saliva overcomes many of the hurdles associated with neonatal research and offers the investigator a new and exciting non-invasive sample source for exploring neonatal biology. Till now salivary …

Utilization of Kaizen Methodology to Promote Safe Care Paradigms in Neonatal ICUs

Keywords: Kaizen, Staffing Models, Care Paradigms Institutions: 1. Huntsville Hospital, Huntsville, AL, United States 2. Joe DiMaggio Children’s Hospital, Hollywood, FL, United States 3. Banner Thunderbird Medical Center, Phoenix, AZ, United States 4. Baptist South Medical Center, Montgomery, AL, United States Background: Allied Health Personnel are being utilized to enhance the care teams in Neonatal Intensive Care Units. Staffing models for Neonatologist and Allied Health Care Providers varies depending on the type, size, location, and acuity of the NICU. State …