NICU Graduates Research Articles

Follow-up of the preterm NICU graduates

Follow-up of the preterm NICU graduates

ASSESSMENT OF RISK FACTORS AND FOLLOW-UP OUTCOMES FOR HEARING LOSS IN HIGH-RISK NEONATES

Objective: Hearing loss in neonates, particularly those in high-risk categories such as NICU graduates, can significantly impede speech, cognitive, and psychosocial development. Early detection and management are pivotal to mitigating these risks. Methods: A prospective observational study was conducted on 425 neonates at SDM Medical College and Hospital, utilizing Otoacoustic Emissions (OAE) for initial auditory screening. This study assessed the incidence of hearing loss in relation to neonatal risk factors, including birth weight, ABO incompatibility, and maternal health conditions. Results: A majority of the neonates (58.82%) were screened within 3-7 d post-birth. Notable risk factors impacting hearing outcomes included low birth weight, with 11.53% of neonates weighing between 1.0 and 1.50 kg. The initial failure rates in OAE screenings were low, with 2.59% failing in the right ear, 1.18% in the left, and 0.94% in both ears. Conclusion: The study underscores the efficacy of early hearing screenings in identifying potential hearing loss in neonates, especially those exposed to multiple risk factors. Continuous and comprehensive monitoring is crucial for these high-risk groups to facilitate timely and effective interventions.

Muscle growth and motor development in NICU graduates and infants at high-risk of adverse neurological outcome over the first year

Muscle growth and motor development in NICU graduates and infants at high-risk of adverse neurological outcome over the first year

The financial burden experienced by families during NICU hospitalization and after discharge: A single center, survey-based study

To investigate a broad array of costs and perceived financial burden (FB) faced by families of NICU graduates both during hospitalization and after discharge. Cross-sectional survey-based study design. A survey measuring socio-demographics, direct non-medical costs, indirect costs, social support and perceived FB was developed. One-hundred-twenty-two pairs of parents of NICU graduates participated in the study. Most of the families (87.7%) experienced FB due to NICU hospitalization. The median cost of visiting infant during NICU admission was 615 euros (range: 42,7320). FB correlated with cost for drugs (ρ = .271, p < .05, 95%CI:[.020, .490]), dietary supplement (ρ = .385, p < .05, CI:[.010, .665]), behavioral disorders (ρ = −.186, p < .05, 95%CI:[−.356, −.003]), language delay (ρ = .243, p < .01, CI:[−.408, −.063]) and comorbidities (ρ = −.206, p < .05, 95% CI:[−.374, −.024]). Transportation costs due to medical visits (ρ = .415, p < .01, 95% CI:[.239, .564]) and therapy sessions (ρ = .517, p < .05, CI:[.121, .771]) correlated with higher FB. Grandparents of the infant were the most frequent source of help (86.1%). Families having infants with adverse outcome experienced more hospitalizations after NICU discharge (p < .05) and higher FB (p < .01) than families with typically developing infant. Lack of government financial help was associated with higher perceived FB (CI:[1.117,29.127], p < .05). Conclusions: Our findings demonstrated that parents of NICU graduates experience high rates of FB, highlighting their sources (e.g., grandparents support) and difficulties (e.g., private therapy costs) through the lens of patient perspective. Our study promotes reflection on policies which should be adopted from the European health services that are similar to the Italian one to support NICU graduate families and reduce inequalities.What is Known:• Families of NICU graduates face several kinds of costs during hospitalization and after discharge.What is New:• NICU hospitalization is a multifaceted event that impact financial burden experienced by families.• NICU graduate families whose infant had adverse outcome and felt lack of financial help from local policy makers experience higher rates of financial burden.

Telemedicine Improves Rate of Successful First Visit to NICU Follow-up Clinic.

NICU graduates require ongoing surveillance in follow-up clinics because of the risk of lower cognitive, motor, and academic performance. We hypothesized that multiple programmatic changes, including availability of telemedicine consultation before hospital discharge, would improve NICU follow-up clinic attendance rates. In this retrospective study, we included infants who survived and were premature (≤29 6/7 weeks/<1500 g) or had brain injury (grade III/IV intraventricular hemorrhage, stroke or seizure, hypoxic ischemic encephalopathy). We compared rates of follow-up for the early cohort (January 2018-June 2019; no telemedicine) with the late cohort (May 2020-May 2021; telemedicine available); and performed a mediation analysis to assess other programmatic changes for the late cohort including improved documentation to parents and primary care provider regarding NICU follow-up. The rate of successful 12-month follow-up improved from 26% (early cohort) to 61% (late cohort) (P < .001). After controlling for maternal insurance, the odds of attending a 12-month follow-up visit were 3.7 times higher for infants in the late cohort, for whom telemedicine was available (confidence interval, 1.8-7.9). Approximately 37% of this effect was mediated by including information for NICU follow-up in the discharge documentation for parents (P < .001). Telemedicine consultation before NICU discharge, in addition to improving communication regarding the timing and importance of NICU follow-up, was effective at improving the rate of attendance to NICU follow-up clinics.

From "A family of NICU graduates" to "A family of four".

From "A family of NICU graduates" to "A family of four".

Follow-up for a Preterm Infant with Beckwith-Wiedemann Syndrome.

Follow-up for a Preterm Infant with Beckwith-Wiedemann Syndrome.

Developmental Prognosis of NICU graduates

Developmental Prognosis of NICU graduates

Improving the Life Chances of NICU Graduates.

* Abbreviations: FBBH — : Following Baby Back Home RCT — : randomized clinical trial Although the rates of mortality among extremely preterm and/or low birth weight newborns have been declining for decades, addressing the ongoing health and developmental needs of NICU graduates continues to be of considerable importance, given their increased susceptibility to neurodevelopmental impairments, other health problems, and mortality over the life course.1 In the current issue of Pediatrics , McKelvey et al2 report on a propensity-matched study of a home-visiting program designed to support parents in addressing their infants’ needs after NICU discharge. The program, known as Following Baby Back Home (FBBH), is delivered by nurse–social-worker teams who focus on helping parents meet their children’s medical and developmental needs, including supporting adherence to medical appointments, linking families with other health and human services, and promoting infants’ growth and development. The program continues through child age 3. Using a carefully crafted propensity-matched design, the authors found that compared with those in the control group ( n = 485), infants enrolled in FBBH ( n = 485) had higher rates of health … Address correspondence to David Olds, PhD, Prevention Research Center for Family and Child Health, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13121 E 17th Ave, Room 5317, Aurora, CO 80045. E-mail: david.olds{at}cuanschutz.edu

Home Visiting for NICU Graduates: Impacts of Following Baby Back Home.

The Following Baby Back Home (FBBH) home visiting program supports families of high-risk low birth weight preterm infants after discharge from a hospital NICU. This study compares the health care use, immunization, and infant mortality rate of low birth weight preterm infants enrolled in FBBH with similar infants not in the program. From January 2013 to December 2017, 498 children enrolled in FBBH were identified in Arkansas vital statistics records and the Arkansas All-Payer Claims Database. Infants in FBBH were matched with children in a control group on the basis of demographics and medical conditions of the infant. Generalized linear mixed models with double propensity-score adjustment were used to estimate program effects. In the first year after discharge and compared with a propensity-score matched cohort of control infants, those enrolled in FBBH were significantly more likely to have higher numbers of medical appointments and more compliant immunization history. The odds of dying in the first year of life for control infants was 4.4 times (95% confidence interval: 1.2-20.7) higher than those managed in the program. A goal of the FBBH home visiting program is to work with parents to educate and support them as they care for their medically fragile infants. We conclude that education and support was instrumental in the infant health care use and outcome differences we observed during the first year of life.

596 Sleep Outcomes and Sleep-Related Behaviors in NICU Graduates

Abstract Introduction Previous studies of sleep patterns and problems in preterm infants and toddlers have yielded inconsistent results, with some studies noting differences on salient sleep parameters and others indicating similarities. Furthermore, little is known about any differences about sleep-related behaviors. Thus, the current aims of this study were to assess sleep patterns, problems, and sleep-related behaviors in young children born prematurely who were NICU graduates. Methods Caregivers of 262 children (53.4% boys; 35.9% Black, 40.5% White, 23.6% Other) being followed in a neonatal follow-up clinic at their corrected age one-year (10–16 months) or two-year (22–28 month) visit completed the Brief Infant Sleep Questionnaire-Revised SF (BISQ-R SF). Results At approximately one year of age, infants were going to bed at 8:36, taking 33 minutes to fall asleep, and waking .63 times per night for 19 minutes, for a total nighttime sleep duration of 8’01”. Similarly, at approximately two years of age, infants were going to bed at 8:16, taking 26.7 minutes to fall asleep, and waking .94 times per night for 16.3 minutes, for a total nighttime sleep duration of 8’26”. Sleep problems were reported by 18.1% and 19.6% of caregivers, respectively, with the majority indicating that their child slept well (78.5% and 76.5%) and minimal bedtime difficulties (13.6% and 14.6%). The majority of infants slept in their own crib (81%), with infants more likely to room share at 1-year compared to 2-year (49% vs 35%), and almost half falling asleep independently (43% and 46%). Conclusion Overall, sleep patterns and parent-perceived sleep problems (18–20%) in these NICU graduates were better than expected, and similar to normative data of similar age children (Sadeh et al., 2008). However, these infants/toddlers obtained less nighttime (8–8.5 hrs vs 10 hrs). Sleep education of parents of NICU graduates should not only focus on sleep behaviors, but also on ensuring sufficient sleep. Support (if any):

How Nurses on an Obstetric Unit Improved Maternal Outcomes in Indiana

Pregnant women are getting sicker as they wait longer to have children. In addition, “NICU graduates” are having their own children. Globally, the opioid epidemic is negatively affecting maternal health. Infant and maternal mortality rates are high in Indiana. We recognized an opportunity to better prepare the labor and delivery staff for the increasingly common cases of maternal cardiac arrest and cardiac-related codes. Historically, childbirth is a happy moment between a woman, her baby, and her family. Nurses now are challenged to acquire new crucial skills to handle the onslaught of medically unstable patients. We trained labor and delivery nurses in Advanced Cardiac Life Support With an Obstetric Focus ( ACLS OB), which focuses on the major differences and adaptations needed for pregnant patients. In the past, labor and delivery nurses either did not take ACLS or attended the housewide course that used minimal simulation and older, male patient examples. By making the course applicable to obstetric patients, our nurses were engaged in the learning. We ran multiple simulations in the simulation laboratory to improve performance and confidence. We led in situ simulations on the labor and delivery units, including physicians. We extended the training to the community to include paramedics and firefighters to improve our first responders’ knowledge. We are now creating an OB Code Team to increase our response times if pregnant patients code or suffer a cardiac event outside the labor and delivery unit. Nurses had an increase in confidence, per our evaluations. Obstetric physicians were candid that they did not feel comfortable leading codes, so they relied on the labor and delivery nurses to run the code until the code team arrived. This further increased nurse confidence and important dialog between physicians and nurses regarding best care. Obstetric nurses can learn ACLS and the pregnancy modifications to increase their competence and confidence in caring for pregnant patients.

CLINICAL AND BACTERIOLOGICAL PROFILE IN NEONATAL SEPTICEMIA AND ANTIBIOTIC SUSCEPTIBILITY PATTERN IN A RURAL TERTIARY CARE HOSPITAL

Background: Neonatal sepsis is an important cause of morbidity &amp; mortality among NICU graduates. The etiology of neonatal septicemia has variations depending upon various customs and practices in the perinatal and neonatal period and geographical area. Therefore, knowledge of microbial profile and antimicrobial susceptibility is very important for management of neonatal sepsis. The aim of our study is to determine the bacteriological profile of neonatal septicemia and the antimicrobial sensitivity pattern.&#x0D; Methods: This prospective study was conducted in the NICU of Department of Pediatrics, KD Medical College, Hospital and Research Centre Mathura (U.P.) among 100 neonates from july 2019 to December 2019. Two ml of venous blood was taken from each neonate &amp; cultured by automated BacT/Alert &amp; VITEK2 method for rapid isolation &amp; sensitivity test. A structured proforma was used to gather information for baseline features like age, gender, birth weight, gestational age, mode of delivery of the neonate and age of onset of illness.&#x0D; Result: In the present study, both Gram-negative &amp; Gram-positive organisms are responsible for neonatal sepsis. Klebsiella pneumoniae was found to be the predominant pathogen followed by Staphylococcus aureus. Most organisms are multi-drug resistant.&#x0D; Conclusion: Cefotaxim, amikacin, meropenam and vancomycin were found useful in treating neonatal septicemia and hence incorporated in our institutional antibiotic policy for use in NICU. Authors recommend an effective infection-control programme, regular antibiotic sensitivity surveillance, encouragement of rational antibiotic use. It will reduce nosocomial infections and development of bacterial resistance.&#x0D; Keywords: Neonatal sepsis, antimicrobial susceptibility, Klebsiella, antibiotic susceptibility surveillance.

Effects of motion and audio-visual redundancy on upright and inverted face and feature preferences in 4-13-month old pre- and full-term NICU graduates

NICU infants are reported to have diminished social orientation and increased risk of socio-communicative disorders. In this eye tracking study, we used a preference for upright compared to inverted faces as a gauge of social interest in high medical risk full- and pre-term NICU infants. We examined the effects of facial motion and audio-visual redundancy on face and eye/mouth preferences across the first year. Upright and inverted baby faces were simultaneously presented in a paired-preference paradigm with motion and synchronized vocalization varied. NICU risk factors including birth weight, sex, and degree of CNS injury were examined. Overall, infants preferred the more socially salient upright faces, making this the first report, to our knowledge, of an upright compared to inverted face preference among high medical risk NICU infants. Infants with abnormalities on cranial ultrasound displayed lower social interest, i.e. less of a preferential interest in upright faces, when viewing static faces. However, motion selectively increased their upright face looking time to a level equal that of infants in other CNS injury groups. We also observed an age-related sex effect suggesting higher risk in NICU males. Females increased their attention to the mouth in upright faces across the first year, especially between 7–10 months, but males did not. Although vocalization increased diffuse attention toward the screen, contrary to our predictions, there was no evidence that the audio-visual redundancy embodied in a vocalizing face focused additional attention on upright faces or mouths. This unexpected result may suggest a vulnerability in response to talking faces among NICU infants that could potentially affect later verbal and socio-communicative development.

What Is the Experience of Babywearing a NICU Graduate?

ObjectiveTo understand the experiences of caregivers using baby carriers to hold their infant after discharge from the NICU. DesignThe qualitative research design was transcendental phenomenology. Setting/Local ProblemCaregiving of NICU graduates is associated with greater incidence of depression, anxiety, and posttraumatic stress disorder, which can impair caregivers’ abilities to form secure attachments with their infants. In addition, lack of paid parental leave, especially among those of low socioeconomic status, can result in prolonged separations between infants and caregivers in the NICU, producing toxic stressors. ParticipantsEight caregivers ages 21 to 41 years whose infants were discharged from the NICU of a regional referral academic medical center in Oklahoma City, Oklahoma. Homogenous convenience sampling was used by posting recruitment flyers in common areas of the NICU frequented by family members. Intervention/MeasurementsParticipants were educated before discharge on using baby carriers that held their infants in kangaroo position. They were asked to carry their infant in the carrier for 3 hours a day for the 2-month study period. ResultsSix total themes were identified; four were previously identified in kangaroo care and skin-to-skin care research: Decreased Stress and Anxiety, Calmness and Sleep, Attachment, and Parental Empowerment; two were independent to this study: Ease of Work and Self-Care. ConclusionThe themes identified indicate that babywearing has the potential to address harms—such as stress, fear, depression, anxiety, and posttraumatic stress disorder—that may be experienced by caregivers of infants discharged from the NICU. Babywearing can be used as an intervention to support caregivers and promote positive health outcomes after a NICU discharge.

Follow up of growth, development and clinical outcome in neonates discharged from the NICU of tertiary care hospital in central India

Background: To assess the growth and neurodevelopmental outcome of all newborn discharged from the NICU of Netaji Subhash Chandra Bose Medical College, Jabalpur on follow up for 6 months.Methods: Prospective observational cohort study of 200 high risk newborn discharged from NICU. Babies were called for follow up at 1 month, 2 months, 4 month and 6 months of corrected age and detailed information was taken regarding NICU stay and morbidity with the help of data available from discharge card. Anthropometric parameters like weight, length, and head circumference were noted. Suitable screening tests like denver’s developmental screening test for Indian infants (DDSTII) for NDD (neurodevelopmental delay) and Amiel Tison scoring for tone assessment was done.Results: Among the 200 NICU graduates chosen, 40 lost during follow up. The neurodevelopmental delay in this study was 31.3%. Authors also analysed NDD according to gestational age wise groups. NDD in pre-terms was 39.6%. The developmental delay was more in babies with neonatal sepsis, perinatal asphyxia, prematurity, RDS, NEC etc.Conclusions: The morbidities like severe perinatal asphyxia, hypoglycaemia, seizures, shock, hypoxia, hypothermia, low gestational age have direct association with NDD.

Neurodevelopmental outcome of At Risk Newborns at 18 month of Age (Using CDC-KIMS Model)

Objectives: Present study was done with following objectives: Follow up of At risk NICU graduates for Growth and Neurodevelopmental outcome at 12 to 18 months of age using CDC-KIMS model, to study the risk stratification profile of these graduates and its impact on Neurodevelopmental impairment and to develop risk score from the risk stratification profile.Material and Methods: This is a prospective observational cohort study in neonates with risk factor for developing Neurodevelopmental impairment were followed up for a period of one and a half year to observe their neurodevelopmental outcome. The study was conducted at the High Risk Newborn follow up Clinic of the Department of Pediatrics, SSG hospital, Vadodara. Ninety patients completed 12 to 18 months follow up, who were analyzed in the final results. High Risk grading and stratification was done according to the CDC-KIMS model. All the perinatal details and their course in the NICU were noted in the predesigned Proforma.Results: The Male: Female ration observed in the total hospital admissions during our period of study was 1.3:1. There was a significant difference seen when the different risk groups were compared for their stay in NICU and total hospital stay. The mean length values did not show any significant difference (P > 0.05) between the risk groups at birth and on follow up at 3, 6, 9 and 12 months with 95% confidence limit. There is a significant chance (P< 0.05) of abnormal DASII and mild delay in the group having complex course / hypoxia, apnea, hypotension.Conclusion: CDC-KIMS model for neuron developmental follow up is user friendly. At the time of discharge At risk new born should stratified into mild, moderate and high risk group should have detailed initial assessment.

A study of incidence of hearing impairment in NICU graduates in tertiary care institute

A study of incidence of hearing impairment in NICU graduates in tertiary care institute

A family of NICU graduates!

A family of NICU graduates!

Acute Kidney Injury in the Preterm Neonate

Preterm neonates are at increased risk for developing acute kidney injury (AKI). This review describes recent studies evaluating the pathophysiology, diagnosis, prevention, treatment, and outcomes of AKI in neonates born preterm. Use of the modified neonatal diagnostic criteria from the Kidney Disease: Improving Global Outcomes consortium has helped standardize AKI detection. Novel methods to diagnose AKI, like continuous near infrared spectroscopy, are under investigation. AKI prevention is paramount, and early studies show caffeine results in reduced rates of AKI in preterm neonates. Renal replacement therapy is technically difficult in this population, although newer dialysis equipment created specifically for small neonates are currently being used. Treatment options remain limited with minimal new therapies developed over the past 5 years. Outcome studies of 2–5-year-old NICU graduates have shown that premature neonates with AKI have decreased renal function. The increased morbidity and mortality associated with preterm AKI demands continued research into early detection, prevention, and treatment strategies.