Neonatal Nursery Research Articles

Cochrane review: Chest physiotherapy for reducing respiratory morbidity in infants requiring ventilatory support

AbstractBackgroundChest physiotherapy (CPT) has been used in many neonatal nurseries around the world to improve airway clearance and treat lung collapse; however, the evidence to support its use has been conflicting. Despite the large number of studies there is very little evidence of sufficiently good quality on which to base current practice.ObjectivesTo assess the effects of active CPT techniques, such as percussion and vibration followed by suction compared with suction alone, on the respiratory system in infants receiving mechanical ventilation. Additionally, differences between types of active CPT techniques were assessed.Search strategyOur search included The Cochrane Library (Issue 2, 2007), MEDLINE (1966 to 2007), EMBASE (1988 to 2007), CINAHL, Science Citation Index, previous reviews including cross‐references, abstracts, conference proceedings and grey literature.Selection criteriaTrials in which ventilated newborn infants up to four weeks of age were randomly or quasi‐randomly assigned to receive active CPT or suction alone. Infants receiving CPT for the extubation period were excluded.Data collection and analysisTwo review authors independently conducted quality assessments and data extraction for included trials. We analysed data for individual trial results using relative risk (RR) and mean difference (MD). Results are presented with 95% confidence intervals (CI). Due to insufficient data, we could not undertake meta‐analysis.Main resultsThree trials involving 106 infants were included in this review. In one trial (n = 20) CPT was no better than standard care in clearing secretions. No increase in the risk of intraventricular haemorrhage was noted. Two trials compared different types of active CPT. One trial (n = 56) showed that non‐resolved atelectasis was reduced in more neonates receiving the lung squeezing technique (LST) when compared to postural drainage, percussion and vibration (PDPV) (RR 0.25; 95% CI 0.11 to 0.57). No difference in secretion clearance or in the rate of intraventricular haemorrhage or periventricular leucomalacia was demonstrated. The other trial (n = 30) showed that the use of percussion or 'cupping' resulted in an increased incidence of hypoxaemia (RR 0.53; 95% CI 0.28 to 0.99) and increased oxygen requirements (MD ‐9.68; 95% CI ‐14.16 to ‐5.20) when compared with contact heel percussion. There was insufficient information to adequately assess important short and longer‐term outcomes, including adverse effects.Authors' conclusionsThe results of this review do not provide sufficient evidence on which to base clinical practice. There is a need for larger randomised controlled trials to address these issues.Plain Language SummaryChest physiotherapy for reducing respiratory morbidity in infants requiring ventilatory supportThere is not enough evidence to determine whether active chest physiotherapy is of benefit to neonates on mechanical ventilation. Babies who require mechanical ventilation are at risk of lung collapse from increased secretions. Chest physiotherapy (patting or vibrating the chest) is used to improve clearance of secretions from the airway to try to prevent lung collapse. This review found no clear overall benefit or harm from chest physiotherapy. Some individual chest physiotherapy techniques were more beneficial than others in resolving atelectasis and maintaining oxygenation. These results do not support one technique over another. Due to the limited number, poor quality and age of trials in this review, there is not enough evidence to determine whether or not chest physiotherapy is beneficial or harmful in the treatment of infants being ventilated in today's intensive care units. Further good quality trials are needed to address this issue.

Perinatal Outcomes of Women Intending to Give Birth in Birth Centers in Australia

A recent Australian study showed perinatal mortality was lower among women who gave birth in a birth center than in a comparable low-risk group of women who gave birth in a hospital. The current study used the same large population database to investigate whether perinatal outcomes were improved for women intending to give birth in a birth center at the onset of labor, regardless of the actual place of birth. Data were obtained from the National Perinatal Data Collection (NPDC) in Australia. The study included 822,955 mothers who gave birth during the 5-year period, 2001 to 2005, and their 836,919 babies. Of these, 22,222 women (2.7%) intended to give birth in a birth center at the onset of labor. Maternal and perinatal factors and outcomes were compared according to the intended place of birth. Data were not available on congenital anomalies, or cause, or timing of death. Women intending to give birth in a birth center at the onset of labor had lower rates of intervention and of adverse perinatal outcomes compared with women intending to give birth in a hospital, including less preterm birth and low birthweight. No statistically significant difference was found in perinatal mortality for term babies of mothers intending to give birth in a birth center compared with term babies of low-risk women intending to give birth in a hospital (1.3 per 1,000 births [99% CI = 0.66, 1.95] vs 1.7 per 1,000 births [99% CI = 1.50, 1.80], respectively). Term babies of women who intended to give birth in a birth center were less likely to be admitted to a neonatal intensive care unit or special care nursery, and no significant difference was found in other perinatal outcomes compared with term babies of low-risk women who intended to give birth in a hospital labor ward. Birth center care remains a viable option for eligible women giving birth at term.

P01-259 - Supporting the neonatal intensive care parent - research into parental supports and perceptions of the intensive care experience in Australia

ObjectiveIn 2008 a new support group based on psycho-educational principles, attachment theory and neurodevelopmental practice, began at the Womens and Childrens Hospital (WCH) in South Australia. This group caters for parents, grandparents and other carers, who have children in neonatal intensive care and special care nurseries.2 years of research have been done to evalaute the parent experience of neonatal intensive care and the support networks available for parents.MethodQualitative interviews have been performed with parents who have attended the group. The 1st set taken when their babies were in the nursery and then 5 months post discharge. Interviews with nursing staff who work within the nursery were also completed in 2009. A survey study using the PSS-NICU is underway at present and will conclude in late 2010.ResultsThe parent interviews were reviewed with framework analysisand indicated a number of themes. The main theme was the loss of control of the parental relationship and the distress at sharing their child with nursing staff. Nursing staff interviews were analysed with framework analysis and the main theme was of chronic parental distress and difficulties managing the parental grief.ConclusionsThese results indicate that psychological support should be focussed on 1. the attachment relationship in trauma and 2.dealing with grief at deviating from the normal parenting experience. These results were used to provide modifications to our parent group and to structure education and support for nursing staff in the intensive care unit.

Getting evidence into obstetric practice: appropriate timing of elective caesarean section

There is considerable variation in the timing of elective pre-labour caesarean section at term where there is no immediate threat to the life of the mother or baby. Given the outcomes, elective or pre-labour caesarean section ought not be offered or performed before 39 completed weeks' gestation. Primary data sources indicated that the rate of term elective caesarean sections with no medical indication undertaken before 39 weeks' gestation at our institution was ~30% in 2005 and 2006. A project was undertaken during the 6-month period from March 2007 to August 2007 with the aim of reducing this rate to 10%. Over the 6-month period, the rate of elective caesarean section with no medical indication done before 39 weeks' gestation in the target group fell to 10%. Over the same timeframe the number of admissions to the neonatal nursery of term babies born by caesarean section at less than 39 weeks fell to zero. Although the numbers are small and not statistically significant, this work suggests implementation across larger jurisdictions or states could result in significant improvements in clinical outcomes.

Involvement of parents in critical incidents in a neonatal–paediatric intensive care unit

Background:With more liberal visiting hours in paediatric intensive care practice, parents’ presence at the bedside has increased. Parents may thus become involved in critical incidents as contributors or detectors of...

Practice variation in the transfer of premature infants from incubators to open cots in Australian and New Zealand neonatal nurseries: Results of an electronic survey

The incubator environment is essential for optimal physiological functioning and development of the premature infant but the infant is ultimately required to make a successful transfer from incubator to open cot in order to be discharged from hospital. Criteria for transfer lack a systematic approach because no clear, specific guideline predominates in clinical practice. Practice variation exists between continents, regions and nurseries in the same countries, but there is no recent review of current practices utilised for transferring premature infants from incubators to open cots. To document current practice for transferring premature infants to open cots in neonatal nurseries. A descriptive, cross-sectional survey. Twenty-two neonatal intensive care units and fifty-six high dependency special care baby units located in public hospitals in Australia and New Zealand. A sample of 78 key clinical nursing leaders (nurse unit managers, clinical nurse consultants or clinical nurse specialists) within neonatal nurseries identified through email or telephone contact. Data were collected using a web-based survey on practice, decision-making and strategies utilised for transferring premature infants from incubators to open cots. Descriptive statistics (frequencies and crosstabs) were used to analyse data. Comparisons between groups were tested for statistical significance using Chi-squared or Fisher's exact test. Significant practice variation between countries was found for only one variable, nursing infants clothed (p=0.011). Processes and practices undertaken similarly in both countries include use of incubator air control mode, current weight criterion, thermal challenging, single-walled incubators and heated mattress systems. Practice variation was significant between neonatal intensive care units and special care baby units for weight range (p=0.005), evidence-based practice (p=0.004), historical nursery practice (p=0.029) and incubator air control mode (p=0.001). Differences in these variables were also found between nurseries in metropolitan and rural locations. Practice variation exists however; many practices are uniformly performed throughout neonatal nurseries in Australian and New Zealand. Commonality was seen between countries and in nurseries with a neonatal intensive care unit. Variation was significant between neonatal intensive care units and special care baby units and nurseries in metropolitan and rural locations.

The experiences of mothers in breastfeeding their very low birth weight infants

This paper is a report of a study of the breastfeeding experience of mothers of very low birth weight babies. Very low birth weight babies, being born preterm, are at risk for feeding difficulties. Medical complications may prolong their hospital stays and further delay their progression towards oral feeding. Many studies have focused on the benefits of breastfeeding to very low birth weight babies, but very few have explored the breastfeeding experiences of their mothers. Data were collected between 2005 and 2007. In-depth interviews were conducted during home visits with 31 mothers who breastfed their very low birth weight babies. Following her baby's discharge from hospital, each mother was interviewed twice about her breastfeeding experience. The data were analysed using qualitative content analysis. Five themes were identified from the mothers' reports: wanting to compensate, maintaining motivation and connectedness, needing 'extra helping hands', controlling emotions and matching baby's individual pace. Mothers' self-blaming provoked them to breastfeed their very low birth weight babies to compensate babies for the harm caused by them. These mothers learned how to express breast milk and this served as an important vehicle that gradually connected them to their babies. Breastfeeding a very low birth weight baby is a challenging and exhausting experience for the mother. A better teaching protocol for breastfeeding and an improved breastfeeding ethos need to be implemented in the neonatal intensive care unit and special care nursery to support families of very low birth weight infants.

FACTORES SOCIODEMOGRÁFICOS MATERNOS QUE PREDISPONEN A LA PRESENCIA DE SÍFILIS CONGÉNITA EN EL NEONATO

Este artículo presenta los principales resultados de uno de los objetivos específicos de la investigación denominada “Reconstrucción de la Atención de Enfermería al neonato con prueba sanguínea VDRL positiva y diagnóstico presuntivo de sífilis congénita que incluya a los progenitores, en el Servicio de Neonatología del Hospital de las Mujeres Dr. Adolfo Carit Eva”. Surgió la inquietud investigativa por la observación en la práctica clínica cotidiana, en donde se aprecia un aumento en el número de casos de neonatos atendidos e ingresados con el diagnóstico de “sífilis congénita” en las salas de neonatología; por lo cual deben permanecer por largos periodos de tiempo –de 15 días a un mes- recibiendo tratamiento. Además, por el cambio en el perfil epidemiológico que presenta actualmente Costa Rica, con respecto al aumento en los índices de enfermedades de transmisión sexual, según lo señala Alburg (2008).Se utilizó un diseño cuantitativo, de tipo descriptivo y transversal. La población estuvo conformada por 2346 mujeres atendidas por parto de las cuales se seleccionó una muestra de 69 mujeres estudiadas por sífilis, así como una muestra de 61 neonatos tamizados por sífilis congénita.El resultado relevante en este estudio radicó en el desconocimiento por parte de las mujeres gestantes sobre la sexualidad, el bajo nivel educativo y baja autoestima, así como otros factores de índole cultural, social y personal que las hace más vulnerables ante esta problemática de salud pública.

Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design

To compare perceived workplace quality in an open-bay neonatal intensive care unit (NICU) and a single-family room (SFR) NICU. Prospective non-randomized, non-controlled cohort study. Staff workplace quality perceptions assessed included the following: the quality of being a Sanford Health System employee (NS-not significant), the quality of the NICU physical work environment, the quality of NICU patient care, the job quality in the NICU, the quality of health and safety in the NICU (NS), the quality of safety and security in the NICU, the quality of interaction with other members of the NICU health-care team (NS; in subanalysis nurse scores significantly declined), the quality of interaction with NICU technology and the off-job quality of life (NS). Scores for each category and the total scores were statistically greater in the SFR, except as noted (NS). Staff perceptions of workplace quality were significantly greater in the SFR than the open-bay NICU.

Obstetric outcome in women with hepatitis C virus infection and thyroid dysfunction

OBJECTIVES. To determine the incidence of thyroid abnormality in pregnant women with hepatitis C virus (HCV) infection and evaluate pregnancy outcomes with respect to thyroid function status. DESIGN. Prospective cohort study. SETTING. Tertiary care hospital. POPULATION. Pregnant women with HCV infection. METHODS. Seventy-eight HCV positive women had radioimmunoassay thyroid function tests. All were followed until delivery. Pregnancy outcomes were compared in women with and without subclinical hypothyroidism. MAIN OUTCOME MEASURES. Maternal and perinatal outcomes. RESULTS. Of 78 anti-HCV antibody positive pregnant women, 13 (16.7%) had abnormal thyroid-stimulating hormone (TSH) (>5 mIU/L; hypothyroid group) and the remaining 65 (83.3%) had normal TSH values (euthyroid group). None had abnormal free T4 levels. None showed evidence of fetal distress in labor or fetal asphyxia. In the hypothyroid group, 23% compared to 6.2% in euthyroid group underwent cesarean section (p=0.07). The incidence of preterm delivery (7.7% vs. 24.6%; p=0.28), mean gestation at delivery (38.2+/-1.8 vs. 37.5+/-1.8 weeks, p=0.19), and birthweight (2,687+/-430 g vs. 2,846+/-379 g, p=0.18) was comparable. Neonatal nursery admissions were comparable. CONCLUSION. The presence of subclinical hypothyroidism in pregnant women with HCV infection does not adversely affect short-term pregnancy outcomes.

Birth after caesarean section: changes over a nine-year period in one Australian state

Objectives to describe the outcomes related to birth after a caesarean section (CS) in one Australian state, New South Wales (NSW), over a nine-year period. The objectives were to determine whether changes had occurred in the rates of attempted and successful vaginal birth after caesarean section (VBAC), induction of labour, place of birth, admission to special care or neonatal intensive care nursery and perinatal mortality. Design and setting cross-sectional analytic study of hospital births in New South Wales using population-based data from 1998–2006. Participants women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria. Measurements data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400 g birth weight in the state. Findings over the nine-year period, the rate of vaginal birth after caesarean section declined significantly (31–19%). The proportion of women who ‘attempted a vaginal birth’ also declined (49–35%). Of those women who laboured, the vaginal birth rate declined from 64% to 53%. Babies whose mothers ‘attempted’ a VBAC were significantly less likely to require admission to a special care nursery (SCN) or neonatal intensive care (NICU). The perinatal mortality rate in babies whose mothers ‘attempted’ a VBAC was higher than those babies born after an elective caesarean section although the absolute numbers are very small. Key conclusions rates of VBAC have declined over this nine-year period. Rates of neonatal mortality and proxy measures of morbidity (admission to a nursery) are generally in the low range for similar settings. Implications for practice decisions around the next birth after CS are complex. Efforts to keep the first birth normal and support women who have had a CS to have a normal birth need to be made. More research to predict which women are likely to achieve a successful VBAC and the most effective ways to facilitate a VBAC is essential. Midwives have a critical role to play in these endeavours.

Financial costs for parents with a baby in a neonatal nursery

To determine the additional financial cost to families of babies admitted to the nurseries of The Royal Women's Hospital, Melbourne, Australia. Prospective case series of consecutive babies admitted to the Special and Intensive Care Nurseries at The Royal Women's Hospital, Melbourne, Australia. Data were collected from diaries completed by parents who recorded expenses related to having their baby in hospital. Fifty nine families of babies born <34 weeks' gestation who were hospitalised for at least 2 weeks. The median expenditure per family per week was Australian (A) $243 and the median length of stay in the nurseries was 7 weeks. The major costs were related to food and transport. Expenses related to the expression/storage of breast milk and accommodation were also considerable consuming 11% and 14%, respectively of the weekly amount spent. Of the 23 families who reported lost or reduced income, the median amount lost per week per family was A$324. The financial burden on families with babies admitted to a tertiary neonatal unit is substantial. The median cost per week was approximately one quarter of the average gross weekly income and included lost income as well as additional expenses. It is important that institutions and health-care systems recognise the magnitude of this additional burden on vulnerable families.

Delayed Recognition of Profound Hearing Loss in a 7-Year-Old Girl With a Neurological Condition

Kelly is a 7-year-old girl with a complex medical history including asthma, mild spastic diplegia, and seizure disorder that is controlled with carbamazepine. She had a significant receptive and expressive language impairment and milder delays in gross and fine motor skills. Kelly is currently repeating first grade in a self-contained classroom; she receives speech, occupational, and physical therapy. At the 7-year-old well child visit, her mother is worried about Kelly's poor progress in school, and she expresses concern about her daughter's hearing. Her pediatrician observes that Kelly is withdrawn, uses minimal language, and is fearful of the examination.Kelly was born full-term by Cesarean section because of placental abruption. She was in the neonatal intensive care nursery for 2 weeks with metabolic acidosis because of acute tubular necrosis. One day after arriving home, she had a cardiopulmonary arrest followed by emergency open-heart surgery for critical pulmonary hypertension. Her postoperative course was significant for renal failure, extracorporal membrane oxygenation, ventilator dependency, tracheostomy, and gastrostomy. By 3 years of age her medical condition stabilized, and the tracheostomy and gastrostomy tubes were removed.A review of Kelly's previous audiological tests revealed a failed otoacoustic emission test at 5 months. An auditory brain stem response test at 8 months recorded normal hearing in the right ear. At 4 years, behavioral audiometry was attempted but not completed because Kelly cried throughout the session. At 5 years, testing with ear inserts showed normal hearing bilaterally.Because of the concerns raised by Kelly's mother at the pediatric visit, she was referred to audiology for a reevaluation. Testing at this time revealed moderate to profound sensorineural hearing loss in both the ears, which was confirmed on subsequent examinations. Kelly was promptly fitted for hearing aids. Her individual education plan was changed to reflect the diagnosis of hearing impairment, and hearing services were implemented in the classroom. On a recent follow-up visit, Kelly was talkative, engaging, and cheerful.

Measuring preterm cumulative stressors within the NICU: The neonatal infant stressor scale

Background Stress experiences, while pervasive, are less likely than painful experiences to be managed in still-hospitalised preterm infants. Aim We aimed to quantify the severity of common stressors for preterm infants with a view to providing a tool to manage presumed accumulated infant stress. Methods and subjects Seventeen doctors and 130 nurses who work in Neonatal Intensive and Special Care Nurseries rated the perceived stress severity of 44 acute events and 24 chronic living conditions for preterm infants at three ages (< 28 weeks, 28–32 weeks, > 32 weeks post-conceptional age) and for themselves. Acute items (such as heel lance) were organised into nursing, peripheral venous access, peripheral arterial access, central vascular access, ventilation, nutrition, medical procedures, surgery, radiology and miscellaneous categories. Chronic living conditions included items such as receiving intranasal oxygen and having a systemic infection. Results Doctors and nurses perceived nearly all items to be stressful to infants to some degree and to be equally stressful across ages. The degree of stress experienced by clinicians themselves was generally low and moderately correlated with presumed infant stress for the same items. Presumed infant stress was inversely related to clinician age. Conclusion Based on these results we developed the Neonatal Infant Stressor Scale to help track, measure and manage presumed accumulated stress in preterm neonates.

Adverse outcomes of labour in public and private hospitals in Australia: a population‐based descriptive study

Almost all women in Australia have free access to public hospitals, where intrapar- tum care is usually provided by a mixture of midwives, junior medical officers, specialty trainees, and specialist obstetricians. In con- trast, women choosing to deliver in private hospitals have their care directly managed by specialist obstetricians. Compared with public hospitals, birth in Australian private hospitals is characterised by a higher rate of obstetric interventions such as induction of labour, episiotomy, instrumental delivery, ABSTRACT Objective: To compare the rate of serious adverse perinatal outcomes of term labour between private and public maternity hospitals in Australia. Design, setting and participants: A population-based study of 789 240 term singleton births in public and private hospitals in 2001-2004, using data from the National Perinatal Data Collection. Main outcome measures: Third- and fourth-degree perineal injury, requirement for high level of neonatal resuscitation, Apgar score < 7 at 5 minutes, admission to neonatal intensive care unit or special care nursery, and perinatal death. Results: 31.4% of the term singleton births occurred in private hospitals. After adjusting for maternal age, Indigenous status, parity, smoking status, diabetes, hypertension, remoteness of usual residence, and method of birth, the rates of all adverse outcomes studied were higher for public hospital births. For women, the adjusted odds ratio (AOR) for third- or fourth-degree perineal injury was 2.28 (95% CI, 2.16-2.40). For babies, the odds of a high level of resuscitation (AOR, 2.37; 95% CI, 2.17-2.59), low Apgar score (AOR, 1.75; 95% CI, 1.65-1.84), intensive care requirement (AOR, 1.48; 95% CI, 1.45-1.51) and perinatal death (AOR, 2.02; 95% CI, 1.78-2.29) were all higher in public hospitals. Conclusion: For women delivering a single baby at term in Australia, the prevalence of

Two nosocomial norovirus outbreaks in the neonatal intensive and intermediate care unit

Norovirus is one of the major causes of non-bacterialacute gastroenteritis worldwide. Diagnostic methods in-clude electron microscopy, enzyme-linked immunosorbentassay (ELISA) and reverse-transcription polymerase chainreaction (RT-PCR) [1]. Electron microscopy has previous-ly been regarded as the gold standard for the diagnosis ofnorovirus, but RT-PCR appears to be a more sensitiveassay (36 to 58% versus 94 to 98%), with similarspecificity(96to98%and92to100%)[2, 3]. Studieson the sensitivity and specificity of the RIDASCREENenzyme immunoassay reported a broad range of 36 to 59%and73to100%,respectively[4, 5] (CDC, Atlanta, GA,USA). However, data for preterm and term born babies israre. Recent studies of norovirus in very young infantshave presumed many false-positive results and havequestioned the high specificity of enzyme immunoassay[2, 6]. The aim of this report is to characterise twooutbreaks of norovirus in neonatal nurseries by raisingquestions about the performance of diagnostic assays fornorovirus and the clinical presentation of norovirusinfectioninveryyounginfants.Faecal specimens of all tested persons were sent to theInstitute of Hygiene, Microbiology and EnvironmentalMedicine of the Medical University of Graz immediatelyafter collection or on the following day. Analysis wasdone for norovirus, adenovirus and rotavirus using anenzyme immunoassay (RIDASCREEN Norovirus ELISAkit, 3rd Generation) and/or real-time PCR (ANDIATECNorovirus real-time PCR kit, Bioproducts Company,designed to detect norovirus genotypes I and II). There-fore, stool cultures on bacteria and parasites were alsodone. To assess the clinical severity of disease, a 14-pointscoring system by Colomba et al. [7] was used. Duringboth outbreaks, the clinical records of all patients werecarefully documented and strict hygienic measures, in-cluding the cohorting of patients, mandatory use of glovesand gowns, and hand washing with disinfecting agents(Skinman® Soft N, Ecolab, Vienna, Austria), wereimplemented at the particular unit. Approval by theEthical Review Board was not necessary since the studywas performed by means of prospective surveillanceinvolving both outbreaks.First outbreak: January to March 2007In January 2007, a neonatologist on duty developedsymptoms of gastroenteritis, including fever, vomiting anddiarrhoea. The day after, the index patient (see Table 1),hospitalized at the Neonatal Intensive Care Unit (NICU) ofthe Pediatric Department of the Medical University Hospi-tal of Graz, Austria, recalled symptoms of bloody tingedstools for one day (14-point severity score: 6). Faecalspecimens of this infant and of the staff member were testedon virus, bacteria and parasites, and turned out to bepositive for norovirus tested by ELISA. Subsequently,faecal specimens of all neonates admitted to and treated atthe NICU were routinely tested three times a week byELISA and, due to repeatedly positive results, some of thespecimens were additionally tested by RT-PCR.

Comparison of clinical outcome after treatment of hip arthritis caused by MRSA with that caused by non-MRSA in infants

We compared the results of four patients treated for septic arthritis of the hip caused by methicillin-resistant Staphylococcus aureus (MRSA) with those of five non-MRSA cases. All four patients with MRSA were neonates when infection occurred, and all four had preceding sepsis and marked swelling of the thigh. The mean duration of follow-up was 5.6 years. At the time of most recent follow-up, all four exhibited severe discrepancy in leg length, and their femoral heads exhibited high-grade deformation according to the Choi classification. In contrast, in the non-MRSA cases, the mean age at infection was 2.2 years and the mean duration of follow-up was 2.9 years. At the most recent follow-up, they exhibited no remarkable discrepancy in leg length and only low-grade deformation of the femoral head. In this study, patients with MRSA showed more marked deformity of the hip and discrepancy of leg length because of lower age and to the presence of organisms resistant to antibiotics. Possible strategies for early diagnosis to prevent poor results after MRSA-induced hip arthritis include the following: (i) ensuring that pediatricians are familiar with the early signs of infection of the hip joint, (ii) aggressive puncture and drainage of pus from the affected joint, and (iii) initial use of antibiotics effective in treating MRSA, especially for patients suspected to have MRSA in the neonatal nursery.

Implementation and Evaluation of an Individualized Developmental Care Program in a Neonatal Intensive Care Unit

This study aims to detect differences in outcomes for very preterm infants after the introduction of developmental care in a neonatal nursery, and to evaluate the effect of developmental care on parental well-being. Prospective before and after cohort study of very preterm babies, with education for all staff between cohorts. No significant differences were found between cohorts for short-term outcomes for babies or parental anxiety levels or depression. All infants scored within normal temperament ranges at 4 months. Developmental care is a safe practice model. The interdisciplinary study facilitated professional development and increased the knowledge of nurses.

Individualized Developmental Care in the Neonatal Intensive Care Nursery

AbstractAdvances in medical care have improved the success of medical interventions in treating high-risk and premature infants, but long-term developmental outcomes are less positive. The neonatal intensive care unit (NICU) setting influences infant brain development and organization, as well as the parent-infant relationship. One advanced-practice role for a speech-language pathologist (SLP) is that of a newborn developmental specialist (NDS). The NDS working in the NICU understands the influence of medical, environmental, and caregiving interactions on the neurologic and neurobehavioral organization of the infant. The NICU setting advanced practice skills are grounded in an individualized, developmentally supportive care model, such as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Neurodevelopmental assessment focuses on the competence of the infant. The developmental assessment and intervention strategies are individualized to support the infant's own goal strivings. In this framework, interactions with infants become modified to increase competence and organization. The SLP working in the NICU is in a unique position to facilitate communication between the infant and the parent, as well as between the infant and professional caregivers. The SLP can help the parent interpret and respond appropriately to the infant's communication by focusing on non-verbal stress and stability cues, and by planning all interactions with a goal of co-regulation. Interactions with infants and families in this Model in the NICU have beneficial lifelong implications.

Rotavirus Infection in the Neonatal Nurseries of a Tertiary Care Hospital in India

The majority of neonatal rotavirus infections are believed to be asymptomatic, and protection from subsequent infection and disease has been reported in neonatally infected children. In this study, we present the results of a 4-year prospective surveillance in the neonatal nurseries of a tertiary care hospital in south India. Stool samples from neonates admitted for >48 hours either with gastrointestinal (GI) symptoms or with nonenteric pathology were screened for rotavirus. Careful assessment of clinical data was carried out. G- and P-typing for all symptomatic rotavirus positive cases and equal number of asymptomatic controls from the same month was determined by reverse transcription polymerase chain reaction. Rotavirus was detected in 43.9% of 1411 neonates, including those with and without gastrointestinal disease. Rotavirus detection was significantly higher among neonates with GI disease (55.5%) than asymptomatic neonates (44.4%) (P < 0.001). Rotavirus was seen in association with diarrhea, vomiting, feed intolerance, necrotizing enterocolitis, hematochezia, gastroesophageal reflux, and abdominal distension. Diarrhea was significantly more frequent in neonates with rotavirus infection (P < 0.001) whereas uninfected neonates developed significantly more feeding intolerance (P < 0.001). Significantly greater proportion of term neonates with GI disease were positive for rotavirus than preterm neonates (P < 0.001). G10P[11] was the most common genotype associated with both symptomatic and asymptomatic infections. This study documents the high rates of rotavirus infection in the neonatal nurseries and the continuing detection of the G10P[11] strain associated with GI disease in Vellore.