Newborn Nursery Research Articles

Sensitivity of Dried Blood Spot Testing for Detection of Congenital Cytomegalovirus Infection

The sensitivity of dried blood spots (DBS) to identify newborns with congenital cytomegalovirus (cCMV) infection has not been evaluated in screening studies using the current, higher-sensitivity methods for DBS processing. To assess the sensitivity of DBS polymerase chain reaction (PCR) for newborn screening for cCMV infection using saliva as the reference standard for screening, followed by collection of a urine sample for confirmation of congenital infection. This population-based cohort study took place at 5 newborn nurseries and 3 neonatal intensive care units in the Minneapolis/Saint Paul area in Minnesota from April 2016 to June 2019. Newborns enrolled with parental consent were screened for cCMV using DBS obtained for routine newborn screening and saliva collected 1 to 2 days after birth. Dried blood spots were tested for CMV DNA by PCR at both the University of Minnesota (UMN) and the US Centers for Disease Control and Prevention (CDC). Saliva swabs were tested by CMV DNA PCR at the UMN laboratory only. Newborns who screened positive by saliva or DBS had a diagnostic urine sample obtained by primary care professionals, tested by PCR within 3 weeks of birth. Analysis began July 2019. Detection of CMV from a saliva swab using a PCR assay. Number of children with urine-confirmed cCMV and the proportion of them who were CMV positive through DBS screening. Of 12 554 individuals enrolled through June 2019 (of 25 000 projected enrollment), 56 newborns were confirmed to have cCMV (4.5 per 1000 [95% CI, 3.3-5.7]). Combined DBS results from either UMN or CDC had a sensitivity of 85.7% (48 of 56; 95% CI, 74.3%-92.6%), specificity of 100.0% (95% CI, 100.0%-100.0%), positive predictive value (PPV) of 98.0% (95% CI, 89.3%-99.6%), and negative predictive value (NPV) of 99.9% (95% CI, 99.9%-100.0%). Dried blood spot results from UMN had a sensitivity of 73.2% (95% CI, 60.4%-83.0%), specificity of 100.0% (100.0%-100.0%), PPV of 100.0% (95% CI, 91.4%-100.0%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Dried blood spot results from CDC had a sensitivity of 76.8% (95% CI, 64.2%-85.9%), specificity of 100.0% (95% CI, 100.0%-100.0%), PPV of 97.7% (95% CI, 88.2%-99.6%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Saliva swab results had a sensitivity of 92.9% (52 of 56; 95% CI, 83.0%-97.2%), specificity of 99.9% (95% CI, 99.9%-100.0%), PPV of 86.7% (95% CI, 75.8%-93.1%), and NPV of 100.0% (95% CI, 99.9%-100.0%). This study demonstrates relatively high analytical sensitivity for DBS compared with previous studies that performed population-based screening. As more sensitive DNA extraction and PCR methods continue to emerge, DBS-based testing should remain under investigation as a potential low-cost, high-throughput option for cCMV screening.

Noteworthy Professional News.

Noteworthy Professional News.

Is being small for gestational age at birth a predictive risk factor for retinopathy of prematurity? A study in Central Maharashtra, India

Background: Retinopathy of prematurity (ROP) is a leading cause of avoidable blindness in preterm infants. Born preterm with small gestation age (SGA) may be an additional risk factor for developing ROP. The study was conducted to evaluate the incidence, risk factors, and severity of ROP in SGA newborns admitted to the newborn nursery. Materials and methods: 91 preterm infants were screened for ROP in a prospective observational study conducted in a teaching hospital in central Maharashtra, India using the National Neonatology Forum of India criteria (NNF, 2010). Systemic risk factors and ocular findings were documented. The incidence, risk factors, and severity of ROP were compared between the SGA and appropriate for gestational age (AGA) newborns. Results: The incidence of ROP was 36.26% (total), 39.62% (SGA), and 31.57% (AGA) amongst screened infants. ROP was more common in babies with higher gestational age (35.4 weeks; p = 0.064) in the SGA group, and it was more in babies with lesser gestational age (32.2 weeks; p = 0.033) in the AGA group. There was no difference in the risk factors between the two groups on univariate and multivariate analysis. Conclusions: The incidence of ROP was higher in SGA infants than AGA infants in the present study. However, there was no difference in the risk factors and severity of ROP between the two groups.

South Korean nursing students' experiences of clinical practice in the newborn nursery and neonatal intensive care unit: A phenomenological study.

PurposeWhile clinical practice is crucial for nursing students to acquire the skills needed to provide professional, high-quality nursing care, further studies on improving undergraduate nursing programs are needed to provide a supportive clinical learning environment for student nurses. This study aimed to understand nursing students' clinical experiences in newborn nurseries and neonatal intensive care units and to provide basic data for the establishment of strategies to promote effective clinical education.MethodsInterviews were held with 15 nursing students at J University who had clinical practice experience in the newborn nursery and neonatal intensive care unit. The collected data were analyzed using the phenomenological analysis method developed by Colaizzi (1978).ResultsThe nursing students' experiences were grouped into four categories: expectations for and anxiety about clinical practice, acquisition of a wide range of knowledge regarding neonatal nursing, challenges faced in clinical practice, and experiencing interpersonal changes.ConclusionThe current neonatal practice nursing education system provides students with positive learning experiences. However, the lack of practice opportunities, insufficient instruction, and the theory-practice gap were identified as major issues hindering students' learning needs. These study results are expected to provide basic data for curriculum development to improve undergraduate nursing education.

What is a Pediatric Hospitalist?

Patient Education| 2021 What is a Pediatric Hospitalist? Connected Content Translation: ¿Qué es un pediatra hospitalario?: (What is a Pediatric Hospitalist?) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation What is a Pediatric Hospitalist?. Pediatric Patient Education 2021; 10.1542/peo_document158 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Topics: hospitalists If your child has an illness or injury requiring hospitalization, he or she may be cared for by a Pediatric Hospitalist. Pediatric hospitalists are pediatricians who work primarily in hospitals. They care for children in many hospital areas, including the pediatric ward, labor and delivery, the newborn nursery, the emergency department, the neonatal intensive care unit, and the pediatric intensive care unit. Pediatric hospitalists work with your regular pediatrician and other physicians and providers involved in your child's care. If there is a significant change in your child's condition, a pediatric hospitalist will update your pediatrician. When your child leaves the hospital, a pediatric hospitalist will give your pediatrician an overview of your child's hospital stay and detailed instructions for any necessary further care. Pediatric hospitalists are medical doctors who have had at least Four years of medical schoolThree years of... Copyright © 20042004American Academy of Pediatrics You do not currently have access to this content.

Tachypnea and Epistaxis in a Full-term Infant.

1. Daniela Titchiner, MD* 2. Priya Dukes, MD* 3. Rebecca Speier, MD* 4. Sharla Rent, MD* 1. *Duke University Hospital, Durham, NC 1. Address correspondence to Daniela Titchiner, MD, Department of Neonatology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27710. E-mail: daniela.titchiner{at}duke.edu A 3.8-kg male infant is born at 40 weeks’ gestation to a 30-year-old primigravida woman via normal spontaneous vaginal delivery. The pregnancy is uncomplicated, with appropriate prenatal care. Delivery is uneventful; the patient receives routine delivery care with Apgar scores of 7 at 1 minute and 9 at 5 minutes. The infant is transferred to newborn nursery with no complications. At 19 postnatal hours, he develops persistent tachypnea and stertor. The patient’s nares are suctioned bilaterally, followed by frank epistaxis and 2 episodes of bloody emesis. As a result, he is admitted to the NICU due to concern for respiratory distress and evaluation of bloody emesis. Initial examination in the NICU reveals an appropriate for gestational age term infant with mild tachypnea with RR 80, no increased work of breathing, saturating > 97% on room air. Chest radiograph demonstrates no abnormalities. The results of a complete blood cell count and coagulation studies are within normal limits. The examining NICU physician notes a soft-tissue mass in the left nasal meatus, without facial asymmetry or visible oropharynx abnormality noted. Pediatric otolaryngology (ENT) department is consulted and via flexible fiberoptic laryngoscopy visualizes a “soft, pink, mass in the …

Frequency of hypocalcemia in jaundiced term neonates under phototherapy.

Background: Jaundice is most frequent situations requiring medical attention in neonate (involvev 60% full-term infants and 80% preterm infants in the 1st week after birth). Neonatal jaundice is the most frequent cause for hospital admission in the first 2 weeks of life. Light therapy is one of ordinary approach to treat hyperbilirubinemi. Phototherapy plays a signifying part in treatment and prevention of hyperbilirubinemia. However, this treatment form may lead to development of some complications such as induction of hypocalcemia. Objective: The goal of research is to estimate the outcome of light therapy on serum calcium in neoborne with hyperbilirubinemia who undergo phtotherapy and to find the relation between effect of phototherapy on serum calcium and gender, mode of delivery and type of feeding. Methods: Across sectional study was conducted at neonatal care unit at AlZahraa teaching hospital from January 2017 to December 2017. This study was conducted on 62 neonates (37 male and 25 female) with neonatal hyperbilirubinemia admmited in newborn nursery of either gender managed by phototherapy entered in this study, calcium level evaluated before and 48 hours after light therapy for all neonate under phototherapy and the tow values were compared. Results: There was statistically important decline of serum calcium and bilirubin after phototherapy as compared with serum calcium and bilirubin levels before phototherapy in this study (P<0.001). Four neonates evolved hypocalcemia (sr.Ca<8 mg/dl) no one had symptoms. There was no expressive corporation between decline serum calcium level and gender, mode of delivery and type of feeding. Conclusion: There is significant decrease in serum calcium after light therapy but risk of hypocalcemia is low in healthy babies. No expressive corporation founds between decline in serum calcium and gender, mode of delivery and type of feeding.

1140. Awareness of Cytomegalovirus (CMV) Among Postpartum Mothers: Education Needed!

BackgroundCongenital cytomegalovirus (cCMV) infection is the leading cause of non-genetic sensorineural hearing loss and affects approximately 0.5%-1% of all live births in the United States. Despite its substantial burden, maternal awareness of congenital CMV disease is limited. In addition, there is no information on CMV awareness among postpartum women who ultimately would consent for CMV newborn screening. Thus our objective of this study was to determine the proportion and characteristics of postpartum women who had knowledge of CMV in an academic medical center in Columbus, OH.MethodsFrom May - December 2019, 276 postpartum women who delivered a newborn at the Ohio State University Wexner Medical Center, Columbus, OH were asked if they had prior knowledge of CMV. Eligible mothers had delivered an infant who was admitted to the Newborn Nursery, were ≥ 35 weeks’ gestational age, and had no signs of congenital CMV infection. These mothers had consented for enrollment of their newborn into the University of Alabama’s Collaborative Antiviral Study Group multicenter study on CMV screening (saliva) of asymptomatic infants. Pertinent demographic and clinical data were collected and subsequently managed using REDCap electronic data capture tools hosted at Nationwide Children’s Hospital, Columbus, OH. Statistical analyses were performed using GraphPad Prism.Results505 eligible infants were born during the study period and 276 (55%) of the mothers were asked about their awareness of CMV infection. Of the 276 mothers (62%, white; 24%, Black; 3%, Asian; 0.4%, Native Hawaiian or Pacific Islander; 3%, biracial; 8%, not known), 30 (10%) had prior knowledge of CMV. Mothers who were aware of CMV did not differ from mothers who did not know about CMV in primigravida status (12/30 [40%] vs. 84/246 [34%], P=.55) or age (median, IQR; 33 years [29-35] vs. 31 years [26-34], P=.11). All infants had a normal physical examination, and none had congenital CMV infection.ConclusionAmong postpartum mothers who consented to saliva screening of their newborns for congenital CMV infection, only 10% were previously aware of CMV. Such a knowledge gap should be addressed to better inform both universal and targeted newborn CMV screening among postpartum mothers.Disclosures All Authors: No reported disclosures

Non-COVID co-morbidity: potential indirect consequences of the SARS-CoV-2 pandemic in a neonatal intensive care unit

Non-COVID co-morbidity: potential indirect consequences of the SARS-CoV-2 pandemic in a neonatal intensive care unit

Where Will You Deliver this Fetus with an Abnormal Echocardiogram?

You are a neonatologist in a small rural hospital with a newborn nursery and no pediatric cardiology services. The nearest hospital with a NICU and pediatric cardiology services is 50 miles away. The closest tertiary care hospital, with all pediatric surgeries and subspecialties, is 100 miles away. An obstetrician wants your advice about the delivery plan for a pregnant woman with the fetal echocardiogram shown (Video). The family is currently planning on a home delivery. You counsel the family about the next steps for delivery. What is the best advice to give this family? 1. Deliver at home as planned because the infant is at low risk for initial medical needs 2. Deliver in the local hospital, transition with the mother in the nursery, and obtain an electrocardiogram before discharge 3. Deliver in the nearest hospital with a NICU and pediatric cardiology services, monitor oxygen saturations, and obtain an echocardiogram before discharge 4. Deliver in the nearest tertiary center, admit to the NICU, place umbilical lines, and start prostaglandin infusion 5. Deliver in the nearest tertiary center and plan for emergency cardiac surgery after birth Video. Click here to view the video. Fetal echocardiogram of a fetuswith tetralogy of Fallot. This video demonstrates a large ventricular septal defect, an overriding aorta, and mild obstruction of the right ventricular outflow tract. The 4th component of “tetralogy” is right ventricular hypertrophy, which is not well demonstrated in this clip. Which laboratory test, if performed, is most likely to have an abnormal …

Does gowning by attendants and visitors in newborn nurseries help prevent neonatal morbidity and mortality?

Does gowning by attendants and visitors in newborn nurseries help prevent neonatal morbidity and mortality?

Substance use during pregnancy: impact on Colorado community hospital

BackgroundNeonatal Abstinence Syndrome (NAS) leads to increased length of stay (LOS), which leads to increased healthcare costs, and can cause financial burdens for hospitals. The purpose of the study was to determine the impact of substance use by pregnant women on a Colorado (CO) community hospital after state legalization of recreational cannabis.MethodsData were gathered retrospectively through the electronic health record at an inpatient facility and described 607 mothers and 419 newborns (total N = 1026) who tested positive for drugs (urinalysis or blood for mother and urine, meconium, or cord blood for newborns). Screening for drugs was at discretion of healthcare provider if mother reported use or newborn showed symptoms of NAS. The patients who were not screened or tested negative were excluded from consideration. Newborns exposed to cannabis were compared to those exposed to other drugs (opioids, methadone, cocaine, barbiturates, benzodiazepines, amphetamines) on costs of newborn hospitalization, based on type of newborn bed and length of stay (LOS). Group comparisons were done using Cochran-Armitage chi-square tests and two-sample t-tests.ResultsThe proportion of screened patients testing positive for illicit and prescribed substances increased significantly from 2013 (33.4%) to 2017 (50.2%) (p < 0.001). The LOS of drug-exposed newborns increased significantly over the years (p < 0.0001). Newborns testing positive for cannabis were more likely to remain in a normal newborn nursery (NSY) bed (69.8%) than those testing positive for other drugs (27.7%), with an average hospital LOS (4.6 days) significantly shorter (p < 0.001) than that of other-drug exposed newborns (14.2 days). Combined healthcare costs for other-drug exposed newborns ($23,495,221) were significantly higher (p < 0.001) than for cannabis-exposed newborns ($2,885,139); both groups had significantly higher costs (p < 0.001) than normal healthy newborns ($2,166,649).ConclusionDrug-exposed newborns have a significant financial impact on hospital healthcare costs, largely due to more expensive bed placement and longer LOS.

Factors related to passing the safety fast test among neonates with hypoglycaemia in the neonatal intensive care unit.

To investigate the success rates and predictors of safety fast test among neonates admitted to the neonatal intensive care unit for hypoglycaemia. A retrospective review of neonates transferred from the newborn nursery unit to the neonatal intensive care unit for intravenous dextrose therapy for hypoglycaemia from January 2016 to June 2019. Neonatal clinical and demographic variables were abstracted from the medical records. A successful safety fast test was defined by blood glucose >60 mg/dL (3.3 mmol/L) at 3, 4, 5 and 6 h after a feed. Of the 76 neonates who had a safety fast test, 80% passed on their first attempt. Neonates who passed the safety fast test were less likely to be premature/small for gestational age (54.1% vs. 92.9%, P = 0.03), required less maximum glucose infusion rate (median 6 vs. 7 mg/kg/min; P = 0.04), and were younger at fasting challenge (median 5 vs. 9 days; P = 0.02), required lower overall intravenous glucose load (median 12 vs. 24 g/kg; P = 0.006). Safety fast test may be a useful tool evaluating discharge readiness of neonates with persistent hypoglycaemia.

Intra-amniotic Infection

Intra-amniotic Infection

Improving Evaluation and Treatment of Hyperbilirubinemia in Late Preterm Infants.

Late preterm (LPT) infants are at an increased risk for hyperbilirubinemia. Accurate identification and early treatment are needed for optimal health outcomes. In a newborn nursery at an academic medical center, bilirubin levels were drawn at 24 hours of life, per protocol. These infants were rarely treated at this time. Rather, predischarge bilirubin levels (at about 48 hours of life) would indicate treatment, often leading to increased length of hospital stay. The practice change evaluation was conducted using retrospective medical record review. Practice change to test serum bilirubin levels at 36 hours of life rather than 24 hours of life. Compliance with the practice change was achieved (P < .05). More LPT infants were identified and treated for hyperbilirubinemia without an increase in length of stay. Readmissions for hyperbilirubinemia and blood draw rates also declined. Although more LPT infants were identified and treated for hyperbilirubinemia, there is room for improvement, and increased adherence to the policy might yield an even greater impact on quality and safety of care surrounding bilirubin management.

Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico.

To determine the false-positive rate of pulse oximetry screening at moderate altitude, presumed to be elevated compared with sea level values and assess change in false-positive rate with time. We retrospectively analysed 3548 infants in the newborn nursery in Albuquerque, New Mexico, (elevation 5400 ft) from July 2012 to October 2013. Universal pulse oximetry screening guidelines were employed after 24 hours of life but before discharge. Newborn babies between 36 and 36 6/7 weeks of gestation, weighing >2 kg and babies >37 weeks weighing >1.7 kg were included in the study. Log-binomial regression was used to assess change in the probability of false positives over time. Of the 3548 patients analysed, there was one true positive with a posteriorly-malaligned ventricular septal defect and an interrupted aortic arch. Of the 93 false positives, the mean pre- and post-ductal saturations were lower, 92 and 90%, respectively. The false-positive rate before April 2013 was 3.5% and after April 2013, decreased to 1.5%. There was a significant decrease in false-positive rate (p = 0.003, slope coefficient = -0.082, standard error of coefficient = 0.023) with the relative risk of a false positive decreasing at 0.92 (95% CI 0.88-0.97) per month. This is the first study in Albuquerque, New Mexico, reporting a high false-positive rate of 1.5% at moderate altitude at the end of the study in comparison to the false-positive rate of 0.035% at sea level. Implementation of the nationally recommended universal pulse oximetry screening was associated with a high false-positive rate in the initial period, thought to be from the combination of both learning curve and altitude. After the initial decline, it remained steadily elevated above sea level, indicating the dominant effect of moderate altitude.

Reliability of routine anthropometric measurements to estimate body composition in term infants

Birth weight percentiles provide limited information on qualitative infant growth. Body composition provides estimates of fat mass, fat-free mass, and body fat percentage (adiposity). We sought to implement assessment of body composition at birth into clinical practice using a validated anthropometric equation and to evaluate measurement reliability. Body composition was incorporated into newborn nursery admission procedure. Body fat percentage derived from skinfold measurements performed by clinical nurses were compared to a historical database of similar measurements performed on newborns by experienced research staff. Body Mass Index (BMI) and Ponderal Index (PI) were used as surrogates for adiposity. Comparison of correlations between groups assessed measurement reliability. P < 0.05 was considered significant. Nine hundred and ninety-one infants had body composition evaluated. Correlations were similar between BMI and %BF for measurements performed by research and clinical nurses (r2 = 0.82 versus r2 = 0.80; P = 0.142 for the difference between correlation coefficients) demonstrating good reliability. Similar results were found using PI (r2 = 0.58 versus r2 0.53; P = 0.105). Body composition can be assessed at birth using a validated anthropometric equation. Measurements performed by clinical RNs were found to be reliable, allowing for a qualitative measure of growth beyond birth weight. Assessment of neonatal body composition at birth can be implemented into routine clinical practice using an anthropometric equation to estimate fat free-mass, fat mass, and percentage body fat. It provides a detailed, reproducible protocol to incorporate into routine practice. Assessment of fat mass, fat-free mass, and adiposity at birth allows for a qualitative measure of intrauterine growth beyond birth weight. Routine assessment of body composition provides a foundation for longitudinal follow-up of metabolic health in infancy and childhood.

Fetal Echocardiography in a Pregnancy with Planned Home Birth.

You are a neonatologist in a small rural hospital with a newborn nursery. The nearest hospital with a NICU is 50 miles away. The nearest tertiary care hospital, with all pediatric surgeries and subspecialties is 100 miles away. An obstetrician wants your advice about the delivery plan for a patient whose fetal echocardiogram is shown in the Video. The family is planning a home birth and would like “everything to be done” for their baby. What is the best advice to give this family? Video. Click here to view the video. The video clip shows a four-chamber view of a fetal heart illustrating a severely underdeveloped left ventricle, which is most consistent with hypoplastic left heart syndrome (HLHS). The patient goes into labor and delivers the infant at your hospital. Immediately after delivery, the neonate is given …

Michigan State University College of Human Medicine.

Michigan State University College of Human Medicine.

Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries.

Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation. We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS. Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation <90%, bradycardia <80 beats per minute, and apnea >20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and >34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS, >93% of NBNs retested in a car seat at a future time point, whereas only ∼1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%). There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.