Neonatal Intermediate Care Unit Research Articles

Colonization Screening Targeting Multidrug-Resistant Gram-Negative Pathogens Does Not Increase the Use of Carbapenems in Very Low Birth Weight Infants.

Since 2012, a colonization screening (CoS) for multidrug-resistant Gram-negative bacteria (MRGN) in very low birth weight infants (VLWBI) was implemented in order to provide a basis for an effective empiric therapy of subsequent nosocomial infections (NI). According to antibiotic stewardship, carbapenems should be reserved for NI caused by MRGN or severe NI. We examined whether the CoS increased the first-line use of carbapenems. In this retrospective cohort analysis, we enrolled all VLBWI before (2009–2011) and after (2012–2014) the introduction of CoS (2012) at a tertiary university neonatal intensive care and neonatal intermediate care unit (NIMC) in Germany. Rectal swabs were used to detect MRGN colonization (on admission and weekly until discharge from the NIMC). The use of carbapenems was measured by days of therapy (DoT). To exclude the replacement of carbapenems by other antibiotics, antibiotic therapy for late-onset sepsis (LOS) was assessed by DoT and length of therapy (LoT). In 55/201 (27.4%) VLBWI, CoS detected MRGN colonization. Compared to the cohort prior to the introduction of CoS (n = 191), a significant decrease in LoT (p < 0.001) and total DoT (p < 0.001) was seen (n = 201). This was due to a significant decrease in LoT (p < 0.001) and total DoT (p < 0.001) in the birth weight category of 1,000–1,499 g. In these infants, DoT for carbapenems (p = 0.009) was significantly lower, possibly caused by a significant decline of LOS (25 episodes vs. 39 episodes, p = 0.025). Conversely, no significant differences in LoT and total DoT were seen in infants with a birth weight <500 g (p = 1.000; p = 0.758) and in infants weighing 500–999 g (p = 0.754; p = 0.794). DoT for carbapenems was not significantly different in the total cohort after the introduction of CoS (p = 0.341). Prolonged exposure to carbapenems (in terms of DoT) significantly postponed the first detection of MRGN colonization (p = 0.023). The introduction of CoS did not result in an increased use of carbapenems. Concomitant carbapenem treatment may reduce the sensitivity of CoS relying on rectal swabs.

Factors associated with hospitalization and neonatal mortality in a cohort of newborns from the Unified Health System in São Paulo.

Newborn care is an important factor associated with hospitalization and neonatal mortality. To analyze factors associated with hospitalization and neonatal mortality of newborns (NBs) admitted to the Unified Health System (SUS), São Paulo, 2012. A cohort of NBs from the SUS was obtained by linking data: SUS Hospital Information System, Live Birth Information System, Mortality Information System and National Health Facility Registry. Poisson and Cox regression were performed. 16.5% (9,127) of the NBs were hospitalized, 4.7% (2,613) were admitted to a Neonatal Intensive Care Unit (NICU) and 11.8% (6,514) to a Neonatal Intermediate Care Unit (NIMCU). Maternal age ≥ 35 years (RR = 1.1, IC95% 1.1 - 1.2), inadequate prenatal care (RR = 1.2, IC95% 1.1 - 1.3), hospitalization for obstetric complications (RR = 1.1, IC95% 1.1 - 1.2), prematurity (≤ 32 weeks: RR = 1.6, IC95% 1.5 - 1.8; 32 to 36 weeks: RR = 1.7, IC95% 1.6 - 1,7), low weight (< 1,500 g: RR = 2.4, IC95% 2.1 - 2.6; 1,500 to 2,499 g: RR = 2.6, IC95% 2.5 - 2.7), APGAR 5º < 7 (RR = 1.9, IC95% 1.7 - 2.0), Cesarean section (RR = 1.1, IC95% 1.1 - 1.2) and Congenital Malformation (RR = 1.4, IC95% 1.3 - 1,5) were associated with the hospitalization of newborns. Neonatal mortality was associated with infants under 1,500 g (RR = 9.1, IC95% 6.3 - 13.1), very premature (RR = 2.6, IC95% 1.9 - 3.5), low APGAR (RR = 5.5, IC95% 4.6 - 6.7). Inadequate prenatal care, prematurity and low weight were risk factors for hospitalization and neonatal mortality.

Role of Lumbar Puncture in Late Onset Neonatal Sepsis

Introduction: Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. It is responsible for about 30-50% of the total neonatal deaths in developing countries. Neonatal sepsis can be divided into two sub-types depending upon whether the onset of symptoms within the first 72 hours of life (Early Onset Neonatal Sepsis) or after 72 hours of life (Late Onset Neonatal Sepsis ). Meningitis is an important complication of late onset neonatal sepsis.&#x0D; Method: This was hospital based prospective observational study conducted among the neonates admitted with diagnosis of late onset neonatal sepsis in Neonatal Intermediate Care Unit (NIMCU) and Neonatal Intensive Care Unit (NICU) of Kanti Children’s Hospital from July 2016 to June 2017. The objective of this study was to evaluate the importance of performing LP in neonates with LONS.&#x0D; Results: 16.8% neonates with late onset neonatal sepsis were found to have meningitis. Among the neonates with meningitis CRP was positive 57.2% and negative in 42.8 %. Among the cases with abnormal CSF findings, blood culture was sterile in 85% cases and organism was isolated 15% cases. In 88.8% cases with positive blood culture, no meningitis was detected. Lumbar puncture was traumatic in 1 neonate (0.8%) in first attempt. Apart from this no other complication of performing lumbar puncture was noted.&#x0D; Conclusion: Lumbar puncture and CSF examination is mandatory in all cases with late-onset sepsis.

Effect of Staff Development Program on Nurses' Performance Regarding Quality Standards of Neonatal Care

Background: The quality standards of neonatal care provide a basis for what is expected and required, support the monitoring and measurement of performance against measures of best practice in order to identify priorities for improvement and provide information on how best practice can be used to support high quality neonatal care. The aim of this study was to assess the effect of staff development program on nurses' performance regarding quality standards of neonatal care. Design: A quasi-experimental design was used in carrying out the study. Setting: The study was conducted at the Neonatal Care Units at Mansoura University Children's Hospital, Mansoura General Hospital and Mansoura Hospital for Health Insurance. Subjects: A convenient sample of 103 nurses working in neonatal intermediate care units in the previously mentioned study settings. Tools: Data were collected using the following tools; self- administered questionnaire sheet to assess nurses' knowledge about neonatal care standards and standardized practical observational checklist to assess the nurses' application of neonatal care standards in the intermediate care units (Level II). Results: The study results revealed that there was statistical significant difference in relation to nurses' knowledge and practices regarding standards of neonatal care in the intermediate care units pre, immediate post and at follow up of staff development program implementation. It was found that more than four fifth of nurses had poor knowledge before program implementation, while, immediately after the program and at follow up, 98% and 94.2% of them had good knowledge respectively. All of nurses achieved incompetent practice before the program implementation, while 36% and 16.5% of them achieved competent practice immediate post program and at follow up respectively. Conclusion: There was a significant positive effect of staff development program on nurses’ knowledge, while, there was a limited positive effect on their practices and on the achievement of quality standards of neonatal care. Recommendations: Emphasize on the importance of conducting periodical continuing staff development programs for neonatal nurses to improve their performance, and to achieve the quality standards of neonatal care.

Risk factors associated with prolonged neonatal intensive care unit stay after threatened late preterm birth

Objective To identify risk factors associated with neonatal intermediate or intensive care unit (NICU) stay ≥3 days among women with threatened late preterm birth (PTB). Study design Secondary analysis of women with nonanomalous, singleton gestations enrolled in multicenter trial of betamethasone versus placebo for late PTB. Maternal and obstetric characteristics at time of presentation with threatened PTB were compared between those with and without NICU stay ≥3 days. Multivariable logistic regression identified risk factors for NICU stay ≥3 days. Result Of 2795 eligible mother-neonate dyads, 962 (34%) had NICU stay ≥3 days. Gestational age and fetal growth restriction as the reason for threatened PTB had the strongest association with NICU stay ≥3 days in the final model (AUC 0.76). Conclusion Maternal and obstetric characteristics at the time of admission for threatened late PTB should be considered when counseling patients about the probability of NICU stay ≥3 days.

Overcrowding in a neonatal intermediate care unit: impact on the incidence of multidrug-resistant gram-negative organisms

BackgroundOvercrowding, reduced nurse to patient ratio, limited distance between incubators and absence of microbiological surveillance have been shown to promote spread of multidrug-resistant gram-negative organisms (MDRGN) in patients with birthweight < 1500 g. Patients > 1500 g treated on an intermediate care unit are unrepresented in recent literature. We therefore intended to present data obtained from a short-term overcrowded neonatal intermediate care unit (NIMCU) at a level III (international categorization) perinatal center at University Hospital Frankfurt, Germany.MethodsDuring a 25 day overcrowding (OV) and 28 day post-overcrowding period (POST-OV) on NIMCU, epidemiological data obtained from continuously hold microbiological surveillance were investigated and compared to the last 12 months of ward-regular bed occupancy preceding OV (PRAE-OV).ResultsDuring OV, the number of patients simultaneously treated at the NIMCU increased from 18 to 22, resulting in a reduced bed-to-bed space. Nurse: patient ratio was 4:22 during OV compared to 3:18 during PRAE-OV. Cumulative incidence of MDRGN was 4.7% in OV and 2.4% POST-OV compared to 4.8% to PRAE-OV, respectively, without any significant variations. During OV and POST-OV, septic episodes due to MDRGN were not observed. In one case, potential nosocomial transmission of Enterobacter cloacae resistant to Piperacillin and 3rd/4th generation cephalosporins was observed.ConclusionsPrevention of nosocomial spread of MDRGN in an overcrowded NIMCU is based on staff’s diligent training and adequate staffing. Concise microbiological surveillance should be guaranteed to escort through overcrowding periods. In our setting, impact of bed-to-bed distance on MDRGN transmission seemed to be less strong.

Bacteriological Profile and Antibiotic Sensitivity Pattern of Neonatal Sepsis in Central Paediatric Referral Hospital in Nepal

&#x0D; Introduction: Neonatal sepsis is the most common cause of neonatal morbidity and mortality. The causative organisms of neonatal sepsis are changing and so do their antibiotic sensitivity pattern. So it is important to regularly monitor the change in bacteriological profile and their antimicrobial sensitivity pattern to help update the treatment guidelines of neonates. This study aimed to study the microbiological patterns of neonatal sepsis and their antibiotic susceptibility pattern in a tertiary care centre in Kathmandu.&#x0D; Methods: A prospective study was carried out among cases of neonatal sepsis admitted in Neonatal Intermediate Care Unit (NIMCU) of a tertiary care referral hospital from August 2015 to August 2016. Prospective data were collected with pretested and standardised proforma and analysed using SPSS version 20. &#x0D; Results: Out of 311 neonates admitted over a period of one year with diagnosis of neonatal sepsis, male:female ratio was 2.1:1. Among them 234 (75.2%) cases were of LONS and 77 (24.8%) were of EONS. Blood culture was positive in 47 neonates (15.1%). The organisms isolated included staphylococcus aureus (34.0%), klebsiella (32%), CONS (24%), escherechia coli (6%) and enterobacter (4%). In LOS, gram positive organisms staphylococcus and CONS were the commonest ones (61.4%). In EOS, gram negative organism klebsiella (65%) was more common. Most of staph aureus were susceptible to penicillins, amikacin and cefotaxime. Klebsiella was found to be resistant to penicillins, amikacin and cefotaxime.&#x0D; Conclusion: There is possible increasing incidence of gram positive septicemia in LONS and increasing emergence of resistance of kleibsella to the common antibiotics ampicillin, amikacin and cefotaxime.&#x0D;

Factors Influencing the Success of Peripheral Venous Access in Neonates

PurposeIn neonatal units, the use of peripheral venous catheters is a commonly used technique involving risks and local complications. Catheter duration and viability is limited and may involve multiple insertion attempts. Catheterization was considered successful when there were no local complications and the catheter was removed owing to completion of treatment. The aim of the study was to determine the optimal location and instruments to reduce the number of catheter insertion attempts and to increase time without complications. Design and methodsA cross-sectional descriptive study was undertaken to analyze all the catheters inserted in the neonatal intermediate care unit of Vinalopó University Hospital (Elche, Spain). Between 2013 and 2017 the following variables were collected: sex, age, gestational age, and venipuncture site, as well as catheter type, number of insertion attempts, duration and complications. ResultsA total of 929 catheters were analyzed with a mean duration of 46.5 ± 33.9 h, and were removed upon completion of treatment (success 38.3%). The preferred site was the dorsal hand (48.2%) followed by the cubital fossa (20.1%). In both sites the success of the catheter and its duration was higher than the mean (42.4%; 43.9% and 49.4 ± 35.7; 50.3 ± 33.4 h respectively). The most frequent complications were extravasation (47.0%) and phlebitis (5.9%). Just one attempt was needed for 63.8% of cannulations of the dorsal hand, followed by 38.9% in the forearm. No significant differences were found in fixation type, sex, weight, gestational age or infusion type (continuous/intermittent). ConclusionsThe success of the technique is low. The preferred insertion sites with fewer complications, longer duration and fewer attempts were the dorsal hand and cubital fossa. With fewer attempts required for cannulation, better results were achieved on the dorsal hand.

Prospective surveillance of bacterial colonization and primary sepsis: findings of a tertiary neonatal intensive and intermediate care unit

Preterm infants and critically ill neonates are predisposed to nosocomial infections as sepsis. Moreover, these infants acquire commensal bacteria, which might become potentially harmful. On-ward transmission of these bacteria can cause outbreaks. To report the findings of a prospective surveillance of bacterial colonization and primary sepsis in preterm infants and neonates. The results of the surveillance of bacterial colonization of the gut and the respiratory tract, targeting meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and Gram-negative bacteria from November 2016 to March 2018 were analysed. Bacterial colonization was compared to surveillance of sepsis. Six-hundred and seventy-one patients were admitted and 87.0 % (N=584) of the patients were screened; 48.3% (N=282) of the patients screened were colonized with at least one of the bacteria included in the screening; 26.2% of them (N=74) had multi-drug-resistant strains. A total of 534 bacterial isolates were found. The most frequently found species were Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca and Klebsiella pneumoniae. Three MRSA but no VRE were detected. The surveillance detected a K.pneumoniae cluster involving nine patients. There were 23 blood-culture-confirmed sepsis episodes; 60.9% (N=14) were caused by staphylococci. Gram-negative bacteria (one Klebsiella aerogenes and two E.cloacae) caused three sepsis episodes which were preceded by colonization with the respective isolates. Surveillance of colonization provided a comprehensive overview of species and antibiotic resistance patterns. It allowed early detection of a colonization cluster. Knowledge of colonization and surveillance of sepsis is useful for guiding infection control measures and antibiotic treatment.

Knowledge of the nursing team about the newborn’s pain

ABSTRACT BACKGROUND AND OBJECTIVES: To describe the knowledge of the nursing team about the evaluation and treatment of pain in newborns hospitalized at the Neonatal Intermediate Care Unit of a university hospital in the state of Minas Gerais, due to the relevance of the issue regarding the quality of the neonatal care. METHODS: A descriptive and exploratory qualitative research with 13 professionals from a Neonatal Intermediate Care Unit. The data were collected through a semi-structured interview, and the data analysis was guided by the Content Thematic Analysis from January to June 2018. RESULTS: Four categories were elaborated: pain identification; methods for assessing pain; interventions of the nursing team to relieve pain, and nursing learnings in pain management. CONCLUSION: The knowledge of this team is based on the individual experience, showing the need for changes in the educational structures to reach better results and nursing practices based on scientific methods for quality assistance.

Continuous positive pressure on aircraft in neonates: care provided by the nursing team

ABSTRACT Objective: to describe the nursing care of the neonate in continuous positive airway pressure (CPAP) with prong analyzing them in the light of the systematization of nursing care / process. Method: Descriptive research, qualitative approach. We interviewed 30 nursing professionals from the neonatal intensive and intermediate care units of a school hospital in Maceió / Alagoas, from August / 2016 to January / 2017, through a semi-structured interview, in the light of Bardin's content analysis. Results: Although unit nurses are aware of the use of CPAP and the care associated with this therapy, mid-level professionals still find it difficult to systematize systematized knowledge about the system. The tripod's correlation between CPAP, the formation of nasal lesions and the assistance provided was highlighted. Conclusion: It is necessary to carry out training, such as raising the awareness of professionals about the importance of keeping records up to date and applying protocols.

Perception of mothers when visiting their child in the neonatal unit for the first time

Abstract Objective: to identify feelings, experiences and expectations of the mothers during the first visit to the child hospitalized in a Neonatal Intermediate Care Unit of a teaching hospital in the interior of the state of Minas Gerais. Method: qualitative research conducted between November 2016 and April 2017, with 24 mothers during a first visit to their children in the intermediate care unit. Data were collected through semi-structured interviews, transcribed and submitted to Content Analysis. Results: from the analysis emerged three thematic categories: feelings that precede the first visit, the experience of the first visit, feelings experienced during the first visit. Conclusion and implications for practice: the participants demonstrated that the first visit to their children can bring positive feelings and negative experiences. Strategies to minimize fears and clarify doubts favor the realization of motherhood.

Correlation of Premature Infant Sleep/Wakefulness and Noise Levels in the Presence or Absence of "Quiet Time".

Peak sound levels during sleep can compromise the development of hospitalized infants. Quiet time is a strategy implemented in neonatal units to promote the sleeping of neonates by reducing noise levels, luminosity, and handling during particular periods of the day. To determine the impact of quiet time on reducing sound levels and increasing total sleep time. This longitudinal study was conducted at a neonatal intermediate care unit with a convenience sample of 12 premature infants. Four times per day, 60-minute quiet times were provided in the neonatal unit. Sleep-awake states and sound levels were evaluated during quiet times as well as 60 minutes before and afterward. Polysomnography was used for sleep-awake state assessment, and a noise dosimeter was used to check sound levels every 24 hours. The preterm infants had a corrected gestational age of 35.0 ± 1.5 weeks and weighed 1606.0 ± 317.8 g. Total sleep time was highest during quiet time (P = .005). Premature infants remained awake for longer following quiet times (P = .005). There was also a reduction in sound level during quiet times compared with the other time frames (P = .006). No statistically significant relationship was found between total sleep time and sound levels more than 24 hours. Quiet time is a nursing intervention that should be implemented in all neonatal units. Future research should use a greater sample size and other factors that influence sleep should be further investigated.

Pressure ulcers' incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units.

Epidemiological studies on pressure ulcers (PUs) in hospitalised infants are scarce. Spain lacks comprehensive research studies providing data on the prevalence or incidence in this population. This work was developed to determine the incidence of PUs in hospitalised infants admitted to intensive and intermediate care units, along with relevant risk factors and preventive measures. A prospective study appraising the incidence of PUs in infants was performed. The risk factors and preventive measures were evaluated using a multivariate logistic regression model. A sample of 268 infants was included. The cumulative incidence of PUs was 12.70% (95% confidence interval, CI95% = [8.95%-17.28%]). The cumulative incidence in the intermediate care units was 1.90% (CI95% = [0.39%-5.45%]), while it was 28.18% (CI95% = [20.02%-37.56%]) in the intensive care units. The PUs were categorised as stage I, 57.10%; stage II, 31.70%; and stage III, 11.10%. The multivariate analysis found the following to be risk factors: low scores in the Spanish version of the Neonatal Skin Risk Assessment Scale (e-NSRAS) (Relative Risk (RR) 0.80; CI95% = [0.66-0.97]), the use of non-invasive mechanical ventilation (RR 12.24; CI95% = [4.02-37.32]), and the length of stay (RR 1.08; CI95% = [1.02-1.15]), suggesting a direct impact of these factors on PU development in infants. Kangaroo care influenced the prevention of PUs (RR 0.26; CI95% = [0.09-0.71]). The infants admitted in intermediate care units suffered PUs. In the case of intensive care units, the incidence is even higher. The risk increases with the length of stay, while the presence of medical devices, particularly non-invasive mechanical ventilation, is the main causal relationship. Kangaroo care has been shown to be an important preventive measure.

Delivery of the second twin: influence of presentation on neonatal outcome, a case controlled study

BackgroundSpontaneous vaginal twin delivery after 32nd week of gestation is safe when first twin presenting cephalic. Aim of this study is to identify obstetric factors influencing the condition of second twin and to verify whether non-cephalic presentation and vaginal breech delivery of the second twin is safe.MethodsThis is a retrospective case controlled cohort study of 717 uncomplicated twin deliveries ≥32 + 0 weeks of gestation from 2005 to 2014 in two tertiary perinatal centers. Obstetric parameters were evaluated in three groups with descriptive, univariate logistic regression analysis for perinatal outcome of second twins.ResultsThe three groups included twins delivered by elective cesarean section ECS (n = 277, 38.6%), by unplanned cesarean section UPC (n = 233, 32.5%) and vaginally (n = 207, 28.9%). Serious adverse fetal outcome is rare and we found no differences between the groups. Second twins after ECS had significant better umbilical artery UA pH (p < 0.001) and better Apgar compared to UPC (p = 0.002). Variables for a fetal population “at risk” for adverse neonatal outcome after vaginal delivery (UA pH < 7.20, Apgar 5´ < 9) were associated with higher gestational age (p = 0.001), longer twin-twin interval (p = 0.05) and vacuum extraction of twin A (p = 0.04). Non-cephalic presentation of second twins was not associated (UA pH < 7.20 OR 1.97, CI 95% 0.93–4.22, p = 0.07, Apgar 5´ < 9 OR 1.63, CI 95% 0.70–3.77, p = 0.25, Transfer to neonatal intermediate care unit p = 0.48). Twenty-one second twins (2,9%) were delivered by cesarean section following vaginal delivery of the first twin. Even though non-cephalic presentation was overrepresented in this subgroup, outcome variables were not significantly different compared to cephalic presentation.ConclusionsEven though elective cesarean means reduced stress for second twins this seems not to be clinically relevant. Non-cephalic presentation of the second twin does not significantly influence the perinatal outcome of the second twin but might be a risk factor for vaginal-cesarean birth.

Spectrum of Congenital Heart Disease in Neonates Admitted in an Intermediate Care Unit of a Tertiary Level Hospital

Introduction: Congenital Heart Disease is the most common cause of major congenital anomalies accounting 28.0%, representing a major global health problem. Prevalence of Congenital Heart Disease is 1.3 per 1000 in school children of Nepal.Material and Methods: A cross sectional prospective study was carried out in the neonatal intermediate care unit of Kanti Children’s Hospital, Nepal from Jan 2016 until Dec 2016 to see the spectrum of CHD.Results: Out of admitted 831 neonates, 85 were found to have CHD with prevalence of 102.28 per 1000 admitted neonate. Respiratory distress was the commonest symptom (51.8%) followed by cyanosis (11.8%) and reluctant to feed (10.6%) at presentation. ASD was the commonest (87.1%) cases followed by PFO 23.5%, PDA 21.2%, Complex congenital heart disease 11.8% and TOF 1.2%. Cleft lip and Cleft Palate was found in 5.9%, Down’s syndrome 3.5% of cases, polydactyly and syndactyly was detected in 2.4% newborn with CHD. The mode of delivery was spontaneous in 71.8% followed by Elective LSCS were 14.1% and Emergency LSCS were 9.4%.Conclusions: Prevalence of CHD was the 102.28 per 1000 neonates admitted in NIMCU. Atrial Septal Defect was the commonest congenital heart diseases. Cleft lip and Down’s syndrome were the most extra cardiac anomaly associated with CHD. Respiratory distress was the commonest presentation of CHD for hospital admission.

The impact of the Kangaroo Neonatal Intermediate Care Unit (UCINCa) on exclusive breastfeeding at the Odete Valadares Maternity (state reference of the Kangaroo methodology)

The impact of the Kangaroo Neonatal Intermediate Care Unit (UCINCa) on exclusive breastfeeding at the Odete Valadares Maternity (state reference of the Kangaroo methodology)

Sleep and salivary cortisol in preterm neonates: a clinical, randomized, controlled, crossover study.

Analyze the influence of ear protectors on the baseline levels of salivary cortisol and response and total sleep time of preterm neonates during two periods of environmental management of a neonatal intermediate care unit. A clinical, randomized, controlled and crossover study conducted with 12 preterm neonates. The use of ear protectors was randomized in two periods. Sleep evaluation was performed using one Alice 5 Polysomnography System and unstructured observation. No significant difference was observed between the baseline levels of salivary cortisol and response in preterm neonates from the control and experimental groups, and no statistical significance was observed between the total sleep time of both groups. No relationship was observed between the baseline levels of cortisol and response and total sleep time. Ear protectors in preterm neonates did not influence the salivary cortisol level and total sleep time in the studied periods.

Effects of Handling and Environment on Preterm Newborns Sleeping in Incubators

ObjectiveTo describe the total sleep time, stages of sleep, and wakefulness of preterm newborns and correlate them to levels of sound pressure, light, temperature, relative air humidity, and handling inside incubators. DesignObservational, correlational study. SettingA neonatal intermediate care unit. ParticipantsTwelve preterm newborns, who were 32.2 ± 4.2 weeks gestational age and weighed 1,606 ± 317 g. MethodsSleep records were assessed by polysomnograph. Environmental variables were measured with a noise dosimeter, light meter, and thermohygrometer. To record time and frequency of handling, a video camera was used. All recordings were made for an uninterrupted 24-hour period. ResultsMean total sleep time in 24 hours was 899 ± 71.8 minutes (daytime = 446 ± 45.3 and nighttime = 448 ± 60.2). Mean wakefulness was 552 ± 94.0 minutes. The predominant stage was quiet sleep. A significant correlation was identified only between the levels of light and wakefulness (r = 0.65 and p = .041). ConclusionThe environmental conditions and care provided to hospitalized preterm newborns did not influence sleep except for high light levels, which increased wakefulness. Nurses in clinical practice should implement strategies to promote and protect sleep by decreasing newborns' exposure to excessive light.

Effects of vibration techniques and expiratory flow acceleration on pain parameters in premature infants with pneumonia

Purpose: to evaluate the effects of vibration techniques and expiratory flow acceleration on pain parameters in preterm infants diagnosed with pneumonia hospitalized in the Neonatal Intensive Care Unit and Neonatal Intermediate Care Unit of the Santa Casa de Misericórdia Foundation of Pará, Brazil. Method: Randomized clinical trial, in which 28 preterm newborns were randomly divided into two groups: Group 1 - submitted to vibration technique and Group 2 - to expiratory flow acceleration. Both techniques were applied in a range of up to ten minutes, for three consecutive days. Pain indicators were assessed according to the Premature Infant Pain Profile (PIPP) at three times. For statistical analysis, the Friedman tests and Analysis of Variance were applied, the level of significance adopted was 5% (p &lt;0.05). Results: Among the preterm infants in Group 1, 64.29% were male, with a mean gestational age of 33.50 ± 2.65 weeks; in Group 2, 57.14% were male, with mean gestational age 33.07 ± 2.84 weeks. Significant changes were observed in the heart rate index, between days, in Group 1 (p &lt;0.05), and in facial mimetic aspects, between times (p &lt;0.05) in both groups. Conclusion: The two techniques used did not cause changes that characterized the presence of pain in the newborns studied. However, it is suggested that new research is carried out in order to further elucidate the subject.