Neonates In Neonatal Intensive Care Unit Research Articles

Congenital Heart Disease in a Tertiary Care NICU; Pattern, Risk Factors and Outcome

Background: Identification of congenital heart disease (CHD) is increasing, may be due to advancement of diagnostic technology and availability of trained man power. Several studies have been conducted in Bangladesh to identify the prevalence and pattern of CHD but paucity of data regarding etiology and outcome. Objective: The aim of this study is to identify the frequency and risk factors of so that preventive measures can be taken. Methods: This retrospective case control study was conducted in the neonatal intensive care unit (NICU), BSMMU, Dhaka from January 2021 to June 2022. All admitted neonates in NICU with the diagnosis of CHD were considered as cases. Twice number of newborn having gestational age and birth weight matched neonates diagnosed other than CHD in NICU were considered as control. Data were extracted from the Medical records of patient files and computer electronic data records of “Newborn Birth Defect (NBBD) surveillance in Bangladesh.” The level of significance was set at 5% (P <0.05). Result: Total 914 patient were admitted during the study period among them 119 patient were CHD (frequency rate 13%). Mean birth weight and gestational age of CHD group were 2376±783.85g & 35.80±3.26 weeks respectively. About 85.7% had acyanotic CHD, among them most prevalent were atrial septal defect (42%) then patent ductus arteriosus (11.8%). Cyanotic CHD were 17 (14.3%). Maternal DM significantly increase the risk of developing CHD, Odd’s ratio 1.971 (CI: 1.182 - 3.285). Death were more in CHD group (34.5%) than control group (20.4%), p values = 0.005. Conclusion: Frequency (13%) of congenital heart disease was high. Maternal diabetes mellitus increases the risk of developing CHD of their baby. Death were more among babies with CHD. BANGLADESH J CHILD HEALTH 2022; VOL 46 (3) : 122-129

Study of usefulness of budesonide nebulization in oxygen dependent preterm newborns in NICU

Background: Increased duration of neonatal intensive care unit (NICU) stay of preterm neonates have becoming an emotional and financial burden to parents leading to very high chances of parents discontinuing the treatment and thus increased morbidity and mortality of neonates. Oxygen dependency is the major cause of the prolonged NICU stay for the neonates having respiratory illness like respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), and pneumonia. Inhaled budesonide being a safe immunosuppressor has shown the promising result in the treatment of these immune system activated respiratory disorders of neonate and thus reduction of oxygen dependency and later reducing the hospital stay duration. The intent of this study is to evaluate the usefulness of inhaled budesonide in such respiratory disorders of neonate. Methods: A randomized controlled trial involving 60 oxygen dependent neonates in NICU was conducted from July 2021 to March 2023. Results: Budesonide nebulization decreased the duration of oxygen dependency of neonates and thus reduced NICU stay. Conclusions: Budesonide nebulization is associated with improvements in respiratory parameters in neonates with RDS, MAS, Pneumonia leading to early oxygen weaning and early discharge.

Effects of white noise on preterm infants in the neonatal intensive care unit: A meta-analysis of randomised controlled trials.

To critically assess the effects of white noise on the pain level, weight gain and vital signs (heart rate, respiratory rate and oxygen saturation) of preterm infants in neonatal intensive care units (NICUs). A systematic review and meta-analysis of randomised controlled trials (RCTs). Ten databases (PubMed, Cochrane Library, Embase, Web of Science, CINAHL, PsycINFO, SinoMed, China National Knowledge Infrastructure, VIP and Wanfang Data) were systematically reviewed from inception to July 2022. Two reviewers evaluated the risk of bias separately using the Cochrane Collaboration criteria and extracted data using a predesigned information form. The meta-analysis included eight eligible RCTs. According to statistical analysis, white noise significantly affected the pain level, weight gain, heart rate, respiratory rate and oxygen saturation in preterm infants. Regardless of the outcome measurement timing, gestational age and birth weight of preterm infants, subgroup analysis demonstrated that white noise reduced the pain level, heart rate and respiratory rate and promoted weight gain in preterm infants in NICUs. White noise is a practical and potentially useful therapy for premature neonates in NICUs. No Patient or Public Contribution.

The practices of intravenous sodium bicarbonate therapy in neonatal intensive care units: A multi-country survey.

A common occurrence in the neonatal intensive care unit (NICU) is metabolic acidosis. Sodium bicarbonate (SB) has been widely used, but there is insufficient evidence on how SB affects neonates in NICUs with metabolic acidosis. The worsening of intracellular acidosis, the impairment of myocardial function, fluctuations in cerebral blood flow, and intracranial hemorrhage are some of the unfavorable effects of SB treatment in neonates that have been documented in the literature. This study aimed to explore neonatologists' practices for using intravenous SB (ISB) in NICUs. A multi-country survey was carried out in 2022 using an online questionnaire sent to neonatologists in various countries in order to gather information about the use of ISB in NICUs. A previously validated questionnaire was adapted and used in this study. The response rate was 67%. The findings show that 91.2% of neonatologists were using SB to correct metabolic acidosis in the NICU; 71.4% did not have written guidelines for using sodium bicarbonate. The majority of them (78.9%) reported that dosage is included in their guidelines for the use of ISB. The findings of this study emphasize the critical importance of providing guidelines in using ISB for managing metabolic acidosis in NICU to standardize procedures and reduce the use of potentially unsuitable and unsafe treatments, as it has been shown that 71.4% of neonatologists worldwide use sodium bicarbonate without guidelines.

Determinants of morbidity and mortality related to health care-associated primary bloodstream infections in neonatal intensive care units: a prospective cohort study from the SEPREVEN trial.

Health care-associated primary bloodstream infections (BSIs), defined as not secondary to an infection at another body site, including central line-associated BSI, are a leading cause of morbidity and mortality in patients in neonatal intensive care units (NICUs). Our objective was to identify factors associated with severe morbidity and mortality after these infections in neonates in NICUs. This ancillary study of the SEPREVEN trial included neonates hospitalized ≥2 days in one of 12 French NICUs and with ≥ 1 BSI during the 20-month study period. BSIs (all primary and health care-associated) were diagnosed in infants with symptoms suggestive of infection and classified prospectively as possible (one coagulase-negative staphylococci (CoNS)-growing blood culture) or proven (two same CoNS, or ≥1 recognized pathogen-growing blood culture). BSI consequences were collected prospectively as moderate morbidity (antibiotic treatment alone) or severe morbidity/mortality (life-saving procedure, permanent damage, prolonged hospitalization, and/or death). Of 557 BSIs identified in 494 patients, CoNS accounted for 378/557 (67.8%) and recognized bacterial or fungal pathogens for 179/557 (32.1%). Severe morbidity/mortality was reported in 148/557 (26.6%) BSIs. Independent factors associated with severe morbidity/mortality were corrected gestational age <28 weeks (CGA) at infection (P < .01), fetal growth restriction (FGR) (P = .04), and proven pathogen-related BSI vs. CoNS-related BSI (P < .01). There were no differences in severe morbidity and mortality between proven and possible CoNS BSIs. In possible BSI, S. epidermidis was associated with a lower risk of severe morbidity than other CoNS (P < .01), notably S. capitis and S. haemolyticus. In BSIs in the NICU, severe morbidity/mortality was associated with low CGA at infection, FGR, and proven pathogen-related BSIs. When only one blood culture was positive, severe morbidity/mortality were less frequent if it grew with S. epidermidis compared to other CoNS. Further studies to help distinguish real CoNS BSIs from contaminations are needed. ClinicalTrials.gov (NCT02598609).

A Comprehensive Echocardiographic Assessment of Neonatal Right Ventricular Function in Neonatal Intensive Care Unit Babies.

Background The right ventricle (RV) in the fetus is the predominant chamber, accounting for about 60% of the total cardiac output. The majority of the RV outflow volume is diverted from the pulmonary artery via the ductus arteriosus to the descending aorta. After birth, the RV undergoes extensive structural and functional modifications. The RV undergoes an improper transition from fetal to neonatal circulation in sick neonatal intensive care unit (NICU) babies. Functional echocardiography is now commonly being used in most NICUs as it is a noninvasive and bedside investigation that gives an immediate evaluation of hemodynamics and can be taken into consideration as an extension of clinical assessment to study a critically unwell neonate. Therefore, a study of RV functions in NICU neonates will help in better understanding the neonatal cardiopulmonary response to different diseases. Thus, this study aimed to assess RV functions in neonates getting admitted to the NICU of a tertiary care institute. Methodology This observational, cross-sectional study was approved by the Research & Recognition Committee of Dr. D. Y. Patil Vidyapeeth, Pune. In total, 35 cases of term neonates admitted to the NICU at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune who fulfilled the inclusion criteria were enrolled in this study after obtaining consent from their parents. Two-dimensional echocardiography was performed by a trained pediatric cardiologist, and the findings were substantiated by a neonatologist trained in echocardiography. Results Our study found a strong associationbetween tricuspid inflow velocity and neonates with sepsis. Similarly, a significant association was observed betweenabnormal tricuspid Inflow velocity (E/A and E/E')andneonates requiring inotropic support. Conclusions Data on the normal values of different echocardiographic parameters of the systolic and diastolic function of the RV during the neonatal phase of life are currently limited. Our data offer preliminary insights into this topic. Early echocardiography and intervention are advisable, especially in neonates with sepsis and requiring inotropic support.

Stress, postpartum depression, and anxiety in mothers of neonates admitted in the NICU: A cross-sectional hospital-based study.

Mothers of neonates admitted to a neonatal intensive care unit (NICU) experience heightened distress, anxiety, depression, and trauma symptoms. Despite their prevalence, these conditions are generally neither recognized nor treated due to the constraints of time and concerns about the social acceptability of screening. To study stress, postpartum depression, and anxiety in mothers of neonates admitted to the NICU. One hundred forty consecutive mothers having preterm and low birth weight neonates in the NICU were taken for the study as cases and an equal number of mothers of full-term neonates matched for age and socioeconomic status (SES), were recruited as controls with their informed consent. Subjects were assessed with the Acute Stress Disorder Scale (ASDS), Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), and Perinatal Anxiety Screening Scale (PASS). Mothers of preterm neonates in NICU had significantly higher scores on the ASDS, PSS, EPDS, and PASS compared to controls. There was a significant association of ASDS and PSS scores with younger age, higher education, middle SES, joint family, urban residence, unplanned pregnancy, and male child. There was a significant association of the EPDS scores with lower SES, low education, unemployment, and male child. There was a significant association of the PASS scores with younger age, lower SES, and cesarean section. Mothers of preterm neonates admitted to the NICU compared to controls have significantly higher levels of stress, anxiety, and depression.

Infants Born to Mothers Who Were SARS-CoV-2 Positive during Pregnancy and Admitted to Neonatal Intensive Care Unit

Introduction: Our objective was to compare neonatal outcomes and resource use of neonates born to mothers with SARS-CoV-2 positivity during pregnancy with neonates born to mothers without SARS-CoV-2 positivity. Methods: We conducted a two-country cohort study of neonates admitted between January 1, 2020, and September 15, 2021, to tertiary neonatal intensive care unit (NICU) in Canada and Sweden. Neonates from mothers who were SARS-CoV-2 positive during pregnancy were compared with three randomly selected NICU neonates of mothers who were not test-positive, matched on gestational age, sex, and birth weight (±0.25 SD). Subgroup analyses were conducted for neonates born <33 weeks’ gestation and mothers who were SARS-CoV-2 positive ≤10 days prior to birth. Primary outcome was duration of respiratory support. Secondary outcomes were in-hospital mortality, neonatal morbidity, late-onset sepsis, receipt of breast milk at discharge, and length of stay. Results: There were 163 exposed and 468 matched neonates in Canada, and 303 exposed and 903 matched neonates in Sweden. There was no statistically significant difference in invasive or noninvasive respiratory support durations, mortality, respiratory and other neonatal morbidities, or resource utilizations between two groups in both countries in entire cohort and in subgroup analyses. Receipt of breast milk at discharge was lower in the Canadian neonates of mothers who were SARS-CoV-2 positive ≤10 days before birth (risk ratio 0.68, 95% CI: 0.57–0.82). Conclusion: Maternal SARS-CoV-2 positivity was not associated with increased durations of respiratory support, morbidities, mortality, or length of hospital stay in Canada and Sweden among neonates admitted to tertiary NICU.

Clinical characteristics of 14 cases of neonatal tracheotomy in neonatal intensive care unit

Objective: To analyze the clinical characteristics of neonatal tracheotomy in neonatal intensive care unit (NICU). Methods: This single-center retrospective study included 14 neonates admitted to NICU of Beijing Children's Hospital, Capital Medical University from January 2016 to August 2021, and were<28 days of age on admission, who met the criteria of tracheotomy and finally completed the procedure. The clinical characteristics including age, weight, duration of ventilation, etiology of tracheotomy, length of hospital stay and prognosis were summarized and analyzed. Wilcoxon signed-rank test was used to compare the weight gain velocity and the duration of ventilation before and after tracheotomy. Paired t-test was used to compare the hospitalization length before and after tracheotomy. Spearman correlation was used to analyze the correlation between the clinical characteristics and outcomes. Results: For the 14 neonates, the gestational age was (38±4) weeks and birth weight was (2 824±949) g. Nine of them were male. The age on transportation was 16 (6, 25) d. A total of 10 neonates were on invasive ventilation on admission, the other 4 were on nasal continuous positive airway pressure support. Bilateral vocal cord paralysis (7 cases) was the commonest cause of tracheotomy. The age on operation was 33 (22, 44) d. There were statistically significant differences in duration of ventilation and weight gain velocity before and after operation (19.00 (10.50, 34.00) vs. 0.86 (0.06, 3.25) d, 1.66 (-0.16, 5.54) vs. 4.69 (2.30, 9.32) g/(kg·d), Z=3.01 and -1.98, both P<0.05). The total hospital stay in NICU was (37±12) d. One neonate died during hospitalization. The existence of pneumonia on admission was positively correlated to NICU stay length (r=0.57, P=0.027), the pre-operational weight gain velocity was negatively correlated to the post-operational NICU stay length (r=-0.73, P=0.020). There were 4 neonates de-cannulated during 7-38 months after the tracheotomy, and 5 neonates still wearing the tracheal cannulation during 15-66 months after the tracheotomy. Two neonates died and 2 neonates lost follow-up after discharge. All neonates could not vocalize normally before de-cannulation, and the language development obviously lagged behind the normal age group after de-cannulation. Conclusions: Bilateral vocal cord paralysis is the commonest cause of neonatal tracheotomy. The benefit of tracheotomy for NICU neonates with surgical indications is obvious, especially in facilitating extubation and improving weight gain.

Value of red cell distribution width-to-platelet ratio as a predictor for morbidity and mortality in neonatal intensive care unit.

Scoring neonatal acute physiology is significant for improving the survival rate of neonates in neonatal intensive care units (NICU). Red blood cell distribution width to platelet ratio (RPR) has been used to evaluate physiology of multiple diseases. However, the value of RPR as a predictor for morbidity and mortality in NICU remains unclear. The score for neonatal acute physiology and perinatal extension II (SNAPE-II) was used to evaluate the physiology and separate neonates into Mild (n = 45), Moderate (n = 45) and Severe (n = 45) groups. White blood cell count (WBC), procalcitonin (PCT) and C-reactive protein (CRP) in cord blood were examine. Spearman's correlation and receiver operating characteristic analysis were performed to demonstrated the correlations of these indicators. There was a positive correlation between the SNAPE-II scores and RPR in neonates in NICU. The WBC, PCT and CRP levels increased with the upregulation of SNAPE-II scores in neonates in NICU and there were positive correlations between RPR and WBC, PCT and CRP, respectively. RPR could be used as a supplementary predictor for the evaluation of neonatal morbidity and mortality in NICU beside SNAPE-II.

Role of Neurosonography in Critically Ill Neonates in NICU

Background Neurosonography has been commonly used for screening in neonatal intensive care unit (NICU), for early detection of defects in the central nervous system (CNS) which include findings like intracranial hemorrhage, hydrocephalus, cerebral edema, and other structural abnormalities. Aim To detect the CNS abnormality in critically ill neonates by neurosonography. Materials and Methods This was a cross-sectional study done in the NICU of AVBR Hospital, Sawangi Meghe, Wardha. Neonates were defined as “critically ill” after taking their detailed history and performing a complete physical examination. Following this, the newborns who fulfilled the studies’ inclusion criteria were subjected to neurosonogram. The following factors were considered: gestational age, clinical examination, investigations, neurosonography findings, and outcomes. Results A total of 150 critically ill newborns were subjected to neurosonography, 24 of them had abnormal findings. There was a significant correlation of gestational weeks, mode of delivery, and diagnosis of critically ill neonates with abnormal neurosonography ( P = .000, P = .000, and P = .000). Prematurity was the most common diagnosis followed by meningitis. A total of 16% of the newborns had abnormal results in neurosonography. About 6.67% of these had hydrocephalus, 5.34% had an intraventricular hemorrhage (IVH), 1.34% had periventricular echogenicity, 0.66% had cerebral edema, 0.67% had germinal matrix hemorrhage, and 0.66% had brain abscess. A total of 109 (72.67%) participants in the study had a positive outcome at the time of discharge from NICU; whereas, 27 (18%) unfortunately did not survive. Conclusion Neurosonography is thus a valuable, safe, and effective diagnostic tool used for screening critically ill neonates for abnormalities of the brain.

Comparison of the Effect of Nesting and Swaddling on Sleep Duration and Arousal Frequency among Preterm Neonates: A Randomized Clinical Trial.

Introduction: Sleep contributes a pivotal part in neurological improvement of new borns. New-borns admitted to neonatal intensive care unit (NICU) perceive many sounds of monitors and this disturb their rest period. To enhance the sleep duration of neonates many non-pharmacological methods are available like placing newborn in a nest made with rolled cotton bed sheet and wrapping the baby with white cotton cloth. In this research effect of these two positions were assessed. Methods: A randomized clinical trial was carried out on 76 preterm neonates in NICU of a tertiary care center. Neonates were included in the study by random method. Sleep duration and frequency of arousal was assessed through direct observation. Physiological parameters were assessed by using cardiac monitor. The information collected were analyzed using SPSS version 21. Results: Sleep duration of nesting group showed significantly higher than swaddling group, which mean (SD) was 206.4 (28), 183.1 (34.78) minutes, respectively. Additionally, waking up was observed less frequency in the nesting group.Conclusion: Nesting enhances the duration of sleep among preterm neonates and hence this can be given priority in NICU.

Non-contact automatic vital signs monitoring of neonates in NICU using video camera imaging

ABSTRACT Non-contact vital signs monitoring is desirable in both clinical and non-clinical sectors. However, there are limited camera-based studies to monitor the vital signs of neonatal infants in a clinical setting. In this study, a digital camera was used to remotely monitor the heart rate (HR) and respiratory rate (RR) of seven infants at Flinders Medical Centre Neonatal Intensive Care Unit (NICU). The region-of-interest (ROI) was automatically selected based on a skin detection method using skin hue. The experimental results have been validated with the reference data obtained from an ECG monitor, and they showed a strong correlation using the Pearson correlation coefficient, (PCC) .9836 and .9426 for HR and RR, respectively, and a lower error rate with RMSE 2.66 beats/min and 2.93 breaths/min between measured data and reference data. A Bland Altman analysis of the data also presented a close correlation between measured data and reference data for both HR and RR with a mean bias .69 beats/min and .28 breaths/min, and the lower and upper limit of agreement −4.4 to +5.8 beats/min and −5.5 to +6.1 breaths/min, respectively. Therefore, video camera imaging may replace conventional monitoring in NICU and has potential applications in other contexts such as home health monitoring.

Use of Meropenem and Other Antimicrobial Lock Therapy in the Treatment of Catheter-Related Blood Stream Infections in Neonates: A Retrospective Study

(1) Background: Newborns admitted to Neonatal Intensive Care Units (NICUs) often require the placement of central vascular catheters (CVC), which are a major risk factor for hospital infection. Numerous strategies exist to prevent central line-associated blood stream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs), with only a few offering options to save the catheter when it is impossible to replace. CRBSIs continue to be a major problem for neonates in NICUs. Most CRBSIs are resistant to systemic antibiotics due to the presence of intraluminal bacterial biofilm. Therefore, catheter removal is frequently necessary when a CRBSI occurs. The so-called Antibiotic Lock Therapy (ALT) is an antimicrobial therapeutic strategy which seems to be promising in neonates when catheter removal is difficult due to critical conditions. To date, evidence about the use of ALT in the neonatal period is still fragmentary, since only poor and heterogeneous data exist. (2) Methods: We report our successful experience with ALT in seriously ill neonates with CRBSI for whom the replacement of the catheter could have been life threatening. (3) Results: ALT repetitively performed for at least 12 h was effective in 11 out of 13 infants (84.6%). It was not effective in two infants in whom ALT was performed for only 6 h. Moreover, we present new data about the stability testing of meropenem for its use during ALT in neonates. (4) Conclusions: When CRBSI occurs—bearing in mind that the optimal management is catheter removal if antibiotic therapy is not effective within 48 h—ALT seems to be a valid alternative therapy when removal is impractical due to critical conditions.

Evaluation of influencing factors on the radiation dose of hospitalized neonates: Maturity status and type of disease

Context: Premature neonates have multiple medical and surgical problems; therefore, hospitalization and imaging are required. Recently there has been too much concern about the long-term effects of radiation in neonates. In this survey, we assessed the frequency of imaging and radiation dose in neonates hospitalized in neonatal intensive care unit (NICU) in our University-affiliated hospital. Materials and methods: This was a retrospective cross-sectional study conducted during a year (2019–2020) on 291 neonates. The information has been gathered from Health Information System and picture archiving and communication system, and analyzed with SPSS version 22. Results: 291 neonates were included in the study, from which 175 (60%) neonates were preterm and 116 (40%) neonates were term neonates. The mean gestational age (GA) was 35.5 weeks and the mean hospital admission duration was 15.8 days. The mean number of portable and non-portable imaging procedures was 5.13 and 0.62 for preterm and term neonates, respectively. There is a statistically significant relationship between gastrointestinal disease and the number of abdominal X-rays. There is also a statistically significant relationship between acute respiratory distress syndrome (ARDS) and chest X-rays; there is no statistically significant relationship between pneumonia and the number of chest X-rays in the hospital course. The mean accumulation effective doses in preterm and term neonates in-hospital course were 0.549 and 0.498 mSv, respectively. Discussion: The neonates in NICU are more susceptible to radiation hazards due to numerous imaging than other neonates. Portable imaging is eight times more dosing than non-portable imaging, so due to the scattered radiation from portable devices, the actual radiation dose may be higher than what we estimated. No brain CT scan was done for the neonates with convulsion because of using safer and more valuable modalities; so we could recommend radiologists and pediatrics to use substitute modalities like sonography and MRI instead of CT scan and X-rays.

Targeted newborn hearing screening in the neonatal intensive care unit of Assiut University Hospital

BackgroundEarly detection of congenital hearing loss (HL) and appropriate intervention is essential to minimize its dramatic impact. Target-based newborn hearing screening (TNHS) was initially targeted high-risk register (HRR) newborn. The advance techniques in neonatology in neonatal intensive care unit (NICU) lead to decrease mortality among low birth weight and preterm infants, but significant morbidities including hearing loss persist. In this study, we aimed to assess the prevalence of hearing loss and the percentage of different risk factors among the HRR neonates admitted to NICU at Assiut University Hospital.ResultsThe prevalence of hearing loss among the study group is 1%. The most common risk factor present between the study group was prematurity associated with the low birth weight (57%). The combination of preterm and low birth weight has statistically significant effect on hearing loss (p < 0.006). There was statistically significant difference in the pass rate of the transient evoked otoacoustic emission (TEOAE) frequencies included in the screening program. The highest pass rate 91% and 85% was at 4 KH and 3 KH, respectively, while the least pass rate was at 1 KH (11.5%).ConclusionTEOAE screener is safe, noninvasive, and doesn’t require sedation and cost-effective method in the newborn hearing screening at NICU. For HRR, it is better to do screening before hospital discharge so allowing enough time for comorbidities of the neonate to improve. Neonatal hearing screening in high-risk neonates in NICU allows early identification of children with hearing loss with early intervention.

Analysis of first-time hearing screening tests among singlets and twin neonates in neonatal intensive care unit

Objective:To investigate the failure in the hearing screening test among twin neonates in neonatal intensive care unit （NICU） and to further clarify the etiology of neonatal hearing impairment, thus to provide insights into prevention and early intervention. Methods:Automated auditory brainstem response（AABR）, distortion product otoacoustic emission（DPOAE） and acoustic immittance were performed on 1452 neonates（including 130 twins） admitted in NICU from January 2015 to June 2018 and the risk factors including premature birth, hyperbilirubinemia, neonatal respiratory distress syndrome, etc. were analyzed retrospectively by univariate chi-square test and multivariate logistic regression analysis. Results:The incidence of C-section, premature birth, hyperbilirubinemia, low birth weight, very low birth weight, in-vitro fertilization, pregnancy-induced hypertension syndrome and formula or mixed feeding among twin neonates were significantly higher than those of singleton neonates （P<0.05）. The pass rates of the first-time AABR, DPOAE and acoustic immittance were significantly lower than singleton neonates. The proportion of twin neonates who failed the initial screening but recovered in the following test was as high as 72.86%. AABR pass rate was correlated with congenital heart disease, neonatal respiratory distress syndrome, C-section and （very） low birth weight. The pass rate of DPOAE was correlated with low birth weight and C-section. The pass rate of acoustic immittance was correlated with preterm birth, C-section, low birth weight, gestational diabetes and gestational hypertension. The pass rate of diagnostic ABR was associated with gestational diabetes. And the pass rate of diagnostic DPOAE was associated with maternal age ≥40 years old. Conclusion:The first-time hearing screening pass rate of twin neonates in NICU is lower than that of neonatal singleton. Most twin neonates who fail in the first screening test will recover. Preterm birth, neonatal respiratory distress syndrome, （very） low birth weight, congenital heart disease, gestational diabetes, pregnancy-induced hypertension syndrome, maternal age ≥ 40 years old and C-section are associated with the first-time failure in hearing screening tests among twin neonates, thus entailing close follow-up.

Profile of Nosocomial Sepsis in a Neonatal Intensive Care Unit of Tertiary Care Hospital in Eastern Part of Nepal

Introduction: Nosocomial sepsis constitutes a global health problem. They lead to significant morbidity and mortality in both developed and resource-limited countries. The objective of the study was to describe the profile of nosocomial sepsis in neonatal intensive care unit (NICU). Methods: This was a prospective descriptive study conducted in a teaching and referral NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. Profile of nosocomial infection was analyzed with descriptive statistics. P value of &lt; 0.05 was considered significant wherever applicable. Results: The incidence rate and density of nosocomial sepsis were 47.3% and 39.3 infections per 1000 patient-days respectively. Blood stream infection was the commonest nosocomial infection. Pseudomonas aeruginosa was the most commonly isolated agent in blood cultures of patients with nosocomial sepsis. Conclusions: This study revealed a high incidence of nosocomial sepsis. Hence, there is urgent need to adopt policies to prevent these infections.

English

BACKGROUND Proper hand hygiene is the single most important, simplest, and least expensive means of reducing the prevalence of health care association infection (HAIs) and nosocomial infection. Several studies have demonstrated that hand washing virtually eradicates the carriage of infections in intensive care units (ICUs). For more than 150 years, hand hygiene has been researched in the hospital environment as a way of preventing transmission of bacteria, infection and death. The purpose of this study was to import the significance of the hand hygiene and to improve the skills in performing hand hygiene among mothers of neonates admitted in neonatal intensive care unit (NICU) at tertiary care hospital. METHODS A self structured knowledge questionnaire (KQ), practice questionnaire (PQ) and practice checklist (PC) was administered. The one to one method video on hand hygiene was played by using a laptop for about 15 minutes as an intervention with demonstration done by investigator and return demonstration was done by mothers, post test was conducted on 3rd day and 5th day followed by the intervention. RESULTS The mean scores of knowledge showed improvement in post test than the pre test in both the groups, but there was an increase in practice mean score between the groups which showed an improvement in the study group, it was higher than the control group which was statistically significant at P &lt; 0.001. Overall, there were minimal positive correlations between the level of knowledge and practice for the study group in post-test and post-test II. Minimum positive correlation was evident but there was no significance. CONCLUSIONS This study concludes that it enhanced the knowledge on hand hygiene among mothers of neonates and it helped mothers to understand the importance of hand hygiene, when to do, how to do, why to do. Thus, it expected directly or indirectly to reduce the infection rate among neonates admitted in NICU. Further, the nurses have a great responsibility in ensuring parents adherence to hand hygiene. KEY WORDS Mothers of Neonate in NICU, Hand Hygiene, Video cum Demonstration, Mothers KPC.

The Spectrum of Hemolytic Disease of the Newborn: Evaluating the Etiology of Unconjugated Hyperbilirubinemia Among Neonates Pertinent to Immunohematological Workup.

Background and objectiveThe exact burden of hemolytic disease of the newborn (HDN) attributed to neonatal unconjugated hyperbilirubinemia (NUH) in developing nations is still unclear. Still, anti-D is reported to be the most common cause of HDN in India. ABO incompatibility has emerged as a leading cause of exchange transfusion (ET) in many countries. But many centers in our country rely on direct antiglobulin test (DAT) as a screening tool to evaluate immunological causes, whereas advanced immunohematological workup like antibody screening, identification, and elution tests are also required. Early identification of implicated antibodies resulting in HDN can aid in the proper selection of blood units when ET is indicated, and hence also in managing the subsequent pregnancy. This study focused on determining the causes of neonatal hyperbilirubinemia (NH), especially with respect to immunohematological evaluation. This cross-sectional study was conducted on 240 neonates requiring neonatal intensive care unit (NICU) support for NUH at a tertiary care hospital.Materials and methodsDemographic data, along with detailed history pertaining to the cause of hyperbilirubinemia, was collected. Clinical and laboratory evaluation and complete immunohematological work including DAT, heat elution, antibody screening, antibody identification, and Rh Kell phenotyping were performed from neonate blood samples. Data were analyzed using SPSS Statistics version 19 (IBM Corp., Armonk, NY).ResultsPathological jaundice was more common (62.1%) than physiological jaundice (37.9%). The various pathological causes identified were HDN (42.6%), sepsis (12%), cephalohematoma (5.4%), and idiopathic (1.7%). Among HDN cases, ABO incompatibility (39.2%) was the most prevalent cause, followed by Rh HDN and G6PD deficiency (1.7% each). DAT was positive in only 14 cases out of 94 ABO-incompatible cases. Elution revealed antibodies in four DAT-negative neonates with ABO incompatibility and more specificity to the OA setting. DAT was positive with 100% sensitivity in Rh HDN cases (n=4). Elution demonstrated the presence of anti-D (n=2), anti-D + anti-C (n=1) and anti-E (n=1), confirming Rh HDN. DAT strength was found to be significantly associated with hemoglobin (Hb) level (p=0.048). The majority of cases were treated with phototherapy only (94.1%), and 10 cases received both ET and phototherapy. Four neonates' condition improved without any intervention.ConclusionThis study highlighted the shift in the trend from Rh HDN to ABO incompatibility as the cause of hemolytic jaundice in NICU neonates. Elution tests can aid in the diagnosis of DAT-negative ABO-incompatible hemolytic anemia. Early diagnosis, along with timely intervention and appropriate measures, can prevent neonatal morbidity and mortality. Negative DAT does not rule out HDN. Sensitive techniques like elution must be used in the presence of clinical suspicion.