Normal Newborn Nursery Research Articles

Infant delivery and maternal stress during the COVID-19 pandemic: a comparison of the well-baby versus neonatal intensive care environments.

ObjectiveTo describe impact of COVID-19 pandemic on stress and mood of new mothers, in particular in neonatal intensive care unit (NICU); a secondary objective was to assess whether customary social gender distancing practiced by ultra-religious Jews and Muslims offers built-in anti-stress protection.MethodsCross-sectional, observational survey of mothers of 52 normal newborn nursery (NNB) and 52 NICU infants. In all, 86 filled all the 6 questionnaires (Demographics, COVID-19 virus experience, Mental Health Inventory, Neonatal Satisfaction Survey, Parental Stressor Scale, and Questionnaire of Coping Strategies).ResultsMost mothers stated that COVID-19 pandemic had hurt social and family relationships, maternal role, and expressed stress and loneliness. Mothers of NICU infants had higher degree of helplessness. Religious social distancing was not protective. Background tendency to coping poorly with stress and depression most highly predicted stress.ConclusionCOVID-19 pandemic harms psychosocial well-being of most mothers. Detection of high-risk individuals is necessary to provide appropriate support.

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.

Heart murmurs and echocardiography findings in the normal newborn nursery.

To determine the clinical findings and management implications of echocardiograms performed on infants with murmurs in the nursery. Retrospective cohort study conducted from January 2008 through December 2015. Patients in the study were followed by chart review for up to 5years. In addition, a survey of nursery providers was conducted in February 2016. A single community hospital associated with a university. All 26 573 infants who received care in the normal newborn nursery were eligible for inclusion in the study. Infants with echocardiograms were analyzed. The survey was sent by e-mail to all 135 physicians who work in the nursery. The primary outcomes include the specific findings on echocardiogram and whether the findings required an acute change in management, outpatient follow up, or were incidental findings. The primary survey question was how physicians would manage an otherwise asymptomatic newborn with a heart murmur. Four hundred ninety-nine infants had echocardiograms, and over the study period the utilization of echocardiography increased from 1.02% to 2.56% (P<.001) of all infants. Three hundred fifty-four babies had echocardiography performed because of a heart murmur. One hundred sixty-three (46.0%) of these echocardiograms were normal and 160 (45.2%) had findings that did not require additional care. Twenty-three neonates (6.5%) had echocardiographic findings that necessitated outpatient follow-up and 8 neonates (2.3%) required neonatal intensive care due to the findings on their echocardiogram. In total, 14 infants (4%) would go on to require heart surgery or interventional cardiac catheterization. 63/135 (47%) physicians completed the survey, with wide variations in the management of newborns with heart murmurs. The use of echocardiography in the normal newborn nursery has increased with time despite improved prenatal detection of heart disease and the use of pulse oximetry screening, and identifies significant heart disease in a small but important number of infants.

Newborn Care Curriculum: The Late Preterm Infant in the Level II Neonatal Intensive Care Unit.

Late preterm births represent the largest category of preterm deliveries. Although these infants are frequently managed in normal newborn nurseries, they have an increased risk of readmissions and mortality. Thus, we designed this PowerPoint-based learning module to provide learners with a computer-based educational resource on late preterm infants in the level II neonatal intensive care unit. This module can be completed using the included pretest and posttest to assess for change in knowledge. The module should take approximately 20 to 30 minutes to complete. Between May and June of 2016, members of the pediatric hospitalist division at Children's National Health System in Washington, DC participated in a study of the module as a self-directed learning tool and completed the pretest, posttest, and postmodule evaluation forms. There was an overall increase in knowledge, with an increase in posttest score from 64% to 94%. Furthermore, this module was well-received by learners, as 55% of learners agreed or strongly agreed that the material presented in the module would change their clinical practice, and 100% agreed or strongly agreed that the module increased their comfort with teaching on this topic. Initial implementation of the module indicates it could be a valuable tool to address a perceived educational need in the area of late preterm infant care in the level II neonatal intensive care unit.

Circumcision bleeding complications: neonatal intensive care infants compared to those in the normal newborn nursery

Purpose: To determine if a significant difference exists in the bleeding complications following circumcision in neonates admitted to neonatal intensive care unit (NICU) versus the normal newborn nursery (NNN).Materials and methods: Observational cohort study of 260 infants undergoing circumcision with Gomco clamp. Vitamin K was given to neonates at delivery. Demographic data, procedural characteristics, bleeding complications, and interventions were recorded. The bleeding rates of the two groups were compared using chi square.Results: NICU neonates experienced increased bleeding complications versus NNN neonates (22% vs. 9.6%, p = .029). No differences were found regarding gestational age at delivery, age at circumcision, and birth weight. Neonates with circumcision performed at ≥5 days of life experienced increased rates of bleeding complications versus those performed at ≤4 days (28% vs. 10.3%, p = .023). All neonates with circumcision performed ≥5 days of life were initially admitted to the NICU.Conclusion: NICU neonates had increased rate of bleeding complications following circumcision when compared to the NNN neonates. There was an increased rate of bleeding complications in neonates who undergo circumcision at ≥5 days of life. Further research may help to determine if redosing of vitamin K or variations in the circumcision procedure are necessary for circumcision at >4 days of life.

Legal Briefs: In Utero Cerebral Hemorrhage and Alloimmune Thrombocytopenia: Was It Preventable?

A 3,425-g, 39-week-gestation male infant was born to a 24-year-old gravida 1 para 0 woman via cesarean section because of a nonreassuring fetal heart rate tracing. Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. He was admitted to the normal newborn nursery, where the nurse noted that he had generalized petechiae. The complete blood cell count was normal, except for a platelet count of 7 × 103/μL (7 × 109/L). He was admitted to the NICU at 27 hours of age for evaluation and care. He was alert and active, with normal blood pressure and vital signs. The neonatologist ruled out autoimmune thromobocytopenia after determining that the mother's platelet count was normal. He asked the obstetrician to order an antiplatelet antibody test on the mother to determine if alloimmune thrombocytopenia was the diagnosis. Intravenous immunoglobulin (IVIG) was given, as well as 2 random donor platelet transfusions, which moderately elevated the platelet count. Because a heart murmur was noted, cardiac ultrasonography was performed, which showed the infant to have a hypoplastic right ventricle, tricuspid atresia, a ventricular septal defect, and a patent foramen ovale. Prostaglandins were started and the infant was sent to a referral center, where a balloon septostomy was performed. The neonatologist at the referral hospital requested a hematology consultation and ordered a platelet antibody test; however, because it was the weekend, the test was deferred until the following Monday. By Monday, the platelet count was normal, and the hematologist wrote a note that alloimmune thrombocytopenia was probably not the cause and the test was never performed. The parents were told that the low platelet count was idiopathic, and because it resolved, nothing further needed to be done. The complex cardiac defect was subsequently repaired, with excellent results. The mother shared …

Detection of critical congenital heart defects: Review of contributions from prenatal and newborn screening

In 2011, statewide newborn screening programs for critical congenital heart defects began in the United States, and subsequently screening has been implemented widely. In this review, we focus on data reports and collection efforts related to both prenatal diagnosis and newborn screening. Defect-specific, maternal, and geographic factors are associated with variations in prenatal detection, so newborn screening provides a population-wide safety net for early diagnosis. A new web-based repository is collecting information on newborn screening program policies, quality indicators related to screening programs, and specific case-level data on infants with these defects. Birth defects surveillance programs also collect data about critical congenital heart defects, particularly related to diagnostic timing, mortality, and services. Individuals from state programs, federal agencies, and national organizations will be interested in these data to further refine algorithms for screening in normal newborn nurseries, neonatal intensive care settings, and other special populations; and ultimately to evaluate the impact of screening on outcomes.

Newborn Car Bed Testing in a Community Hospital: Implementing the American Academy of Pediatrics Recommendations

This study was designed to describe our experience in implementing the American Academy of Pediatrics (AAP) recommendation to test infants in a car bed if they fail a car seat challenge test. Car seat challenge testing was performed for 90 minutes or the anticipated duration of the trip home, whichever was longer. Based on the pulse oximetry saturation values (90-92% or < 90%) two categories of test failure were used. Infants who failed in the car seat were tested in the car bed. Testing took place in both the normal newborn nursery (NBN) and special care nursery (SCN). NBN babies who failed in the car bed were transferred to our SCN for additional assessment and management. A total of 197 infants were tested in car seats out of which 177 (89.8%) passed the test. Of the 20 infants who failed, 16 passed the car bed challenge test on the first attempt and were discharged in those devices. All infants who failed the car bed challenge were NBN patients. Using 93% as the acceptable lower limit of oxygenation we successfully implemented the AAP recommendations for car bed challenge testing in our nursery.

Implementation of Critical Congenital Heart Disease Screening in Minnesota

To assess the level of preparedness and resources needed in Minnesota for the implementation of newborn screening for critical congenital heart diseases (CCHDs). A cross sectional survey of all birth centers in Minnesota was performed to assess the capacity to deliver care essential for the CCHD screening program. Compliance with the screening algorithm, nursing workload, and cost were assessed by using a pilot program implemented in 6 normal newborn nurseries. Ninety-one of 99 eligible centers participated in the survey and 90 reported the ability to screen newborns in accordance with recommendations. Only 22 centers, with 63% of births, had access to echocardiography and routinely stocked prostaglandins for neonatal use. Our pilot study screened 7549 newborns with 6 failed screens and 1 CCHD diagnosis. Two of the failed screens were due to misinterpretation of the algorithm, 1 failed screen was not reported, and 4 failed screens were not recognized. Repeated screens were required for 115 newborns, with 29% of retesting due to misinterpretation of the algorithm. The mean nursing time required was 5.5 minutes, and the cost was $5.10 per screen. In Minnesota, two-thirds of newborns are born in centers with resources for initial diagnosis and management of CCHD. Implementation of a pilot screening program demonstrated minimal increase in nursing workload, but identified problems with interpretation of the algorithm and data reporting. This pilot project suggests the need for simplification of the algorithm, additional training of health care providers, and development of a centralized reporting mechanism.

Clinician Adherence to Guideline for Phototherapy Use in Newborns

The objectives of this study were (1) to determine clinician adherence to the 2004 American Academy of Pediatrics guideline for phototherapy use in newborns; (2) to compare adherence to the guideline in 2 different hospitals; and (3) to determine whether adherence to the guideline improved after the phototherapy nomogram was available in newborn charts. This study was a retrospective review of medical records of 1160 newborns receiving care at the normal newborn nurseries at 2 Twin City, MN, hospitals. Four hundred thirty-six infants received phototherapy. When phototherapy was administered, it was indicated in 37% of cases and not indicated in 8%. In 56% of cases it was considered subthreshold. When phototherapy was not administered, it was appropriate in 99% of cases but was inappropriate or missed in 1% of cases. There was a significant difference in clinician adherence to the phototherapy guidelines between the hospitals. The addition of the phototherapy nomogram to the newborn charts did not change adherence to the guideline. Clinicians infrequently missed providing phototherapy when it was indicated. Most infants received phototherapy when their bilirubin level was in the "optional" range. The interhospital variability of guideline adherence confirms results found in other studies. Because the addition of the phototherapy nomogram alone did not improve adherence to the guideline, alternative interventions targeted at nurseries should be considered.

Normal Newborn Nursery – Neonatal Intensive Care Unit: What's in Between?

Newborn Care Poster Presentation Purpose for the Program A trend of term newborns requiring transfer from the newborn nursery to the neonatal intensive care unit (NICU) was identified in a Level III NICU at a Magnet hospital. This offering will detail the pragmatic strategies utilized to decrease NICU admissions of high-risk transition newborns and present specific obstetric-related diagnoses.

Central corneal thickness in full-term Saudi newborns

To establish a standard of normal central corneal thickness (CCT) in normal full-term Saudi newborn. These values could be used as a reference in the early diagnosis and control of the fairly common primary congenital glaucoma in Saudi newborns. The CCT was measured in 100 normal full-term Saudi newborns (200 eyes) during the first 6 days of the postnatal period. All measurements were carried out by one investigator using ultrasonic pachymeter DGH-1000. The mean CCT of 200 eyes (right and left) was 616 ± 61 μm. The mean CCT of the right and left eyes was similar (CCTRE was 617 ± 62 μm, and mean CCTLE was 616 ± 60 μm), with no statistically significant difference (p = 0.417). The mean CCT for males was 631 ± 66 μm and for females 600 ± 50 μm. This difference was statistically significant (p = 0.01). The mean CCT decreases significantly by age [day-1: 626 ± 65 μm, day-2: 601 ± 48 μm and day-3: 574 ± 45 μm (p = 0.049)]. No correlations were found between CCT and gestational age, birth weight, birth length and head circumference. The average CCT in full-term Saudi newborns was found to be 616 ± 61 μm. The mean CCT in males was significantly higher than in females. There was no correlation between CCT and gestational age, birth weight, birth length and head circumference. There were borderline significant differences between CCT in 1-day-, 2-day-, and 3-day-old babies.

Outcome and cost analysis of implementing selective Coombs testing in the newborn nursery

(1) To determine whether infants born to O+ mothers who had selective cord-blood testing would have higher rates of clinically significant hyperbilirubinemia compared with those newborns who had routine cord-blood testing. (2) To determine the amount of cost savings by implementing a policy of selective cord-blood testing in newborns born to O+ mothers. We conducted a retrospective pre/post intervention chart review on all infants in the normal newborn nursery at Loyola, born to blood type O+ women between 1 April 2008 and 1 April 2009. The pre-intervention group (routine testing) included infants born within 6 months before implementation of a new policy. The post-intervention group (selective testing) included infants born within 6 months following the implementation of a new policy. Data were collected for each of these groups regarding clinically significant hyperbilirubinemia. All 250 of the infants in the routine testing group had a cord-blood type and Coombs done, whereas 42 of 164 (25%) infants in the selective group had testing done. By the end of the 6 months following the policy change, only 8% of infants were undergoing cord testing. When comparing routine vs selective testing, there was no statistically significant difference in the 24-h serum bilirubin, rate of phototherapy during the birth hospitalization, rate of readmission for hyperbilirubinemia or peak serum bilirubin level at readmission. The 92% reduction of cord-blood typing and Coombs testing would lead to a cost saving of $4100 per year to our hospital and $18 900 per year to our patients, and 95 h per year of technician time to perform these tests. When extrapolated to Illinois births in 2008, this would lead to an annual cost saving of almost $800 000 to Illinois hospitals and about $3.6 million to patients. Selective newborn cord testing of infants born to O+ mothers can decrease the use of resources and costs without increasing the risk of clinically significant hyperbilirubinemia.

Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues

Guidelines for prevention of group B streptococcal (GBS) infection have successfully reduced early onset (EO) GBS disease. Study results suggest that Escherichia coli is an important EO pathogen. To determine EO infection rates, pathogens, morbidity, and mortality in a national network of neonatal centers. Infants with EO infection were identified by prospective surveillance at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network centers. Infection was defined by positive culture results for blood and cerebrospinal fluid obtained from infants aged ≤72 hours plus treatment with antibiotic therapy for ≥5 days. Mother and infant characteristics, treatments, and outcomes were studied. Numbers of cases and total live births (LBs) were used to calculate incidence. Among 396 586 LBs (2006-2009), 389 infants developed EO infection (0.98 cases per 1000 LBs). Infection rates increased with decreasing birth weight. GBS (43%, 0.41 per 1000 LBs) and E coli (29%, 0.28 per 1000 LBs) were most frequently isolated. Most infants with GBS were term (73%); 81% with E coli were preterm. Mothers of 67% of infected term and 58% of infected preterm infants were screened for GBS, and results were positive for 25% of those mothers. Only 76% of mothers with GBS colonization received intrapartum chemoprophylaxis. Although 77% of infected infants required intensive care, 20% of term infants were treated in the normal newborn nursery. Sixteen percent of infected infants died, most commonly with E coli infection (33%). In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge.

966 Hyperbilirubinemia in a Cohort of Infants in a Normal Newborn Nursery (NNN)

Background and aims: Jaundice is one of the most frequent indications for diagnostic and therapeutic intervention in otherwise normal newborns. The aim of the study was to analyse the frequency, severity and treatment of hyperbilirubinemia in relation to national guidelines in infants cared for in NNN. Methods: All infants cared for in NNN in 2008 with a measurement of serum bilirubin were included in the study. Patient data was gathered retrospectively from patient records. Results: Bilirubin was measured in 593 jaundiced infants (16.3 % of cohort) with an average of 4,9 analyses/infant (median 4, range 1 - 25). Maximum bilirubin (TsB) was increased in moderately premature infants compared to term and postterm infants. TsB ≥ 300 µmol/L and ≥ 350 µmol/L was seen in 35.2 and 14.5 % of jaundiced infants, respectively. Six infants were diagnosed with TsB ≥ 400 µmol/L, only one had blood group immunization (AB0). TsB was significantly related to older mothers and higher parity and in infants with greater weight loss. Infants born after c-section had significantly lower TsB, and no effect of gender, Apgar score, or season was found. Phototherapy (PT) was given to 50.3 % of jaundiced infants, i.e. 7.3 % of NNN cohort. 109 infants (20.3 % of jaundiced infants) were readmitted for PT, 75 of these had been discharged with increasing TsB. Conclusions: Hyperbilirubinemia is a major problem in NNN. Early discharge and significant weight loss is a risk factor for severe hyperbilirubinemia, as well as being discharged with increasing jaundice.

Identifying Later-Onset Hypoglycemia in Sga Infants Admitted to the Normal Newborn Nursery

Identifying Later-Onset Hypoglycemia in Sga Infants Admitted to the Normal Newborn Nursery

Pediatric hospitalists: Training, current practice, and career goals

To determine the range and frequency of experiences, clinical and nonclinical roles, training, work expectations, and career plans of practicing pediatric hospitalists. Mail survey study of a national sample of 530 pediatric hospitalists of whom 67% (N = 338) were from teaching hospitals, 71% (N = 374) were from children's hospitals, 43% (N = 230) were from freestanding children's hospitals, and 69% (N = 354) were from hospitals with >or=250 beds. The response rate was 84%. The majority (54%; N = 211) had been practicing as hospitalists for at least 3 years. Most reported that the pediatric inpatient unit (94%) and inpatient consultation service (51%) were a part of their regular clinical assignment. Most did not provide service in the normal newborn nursery (58%), subspecialty inpatient service (52%), transports (85%), outpatient clinics (66%), or as part of an emergency response team (53%). Many participated in quality improvement (QI) initiatives (84%) and practice guideline development (81%). This study provides the most comprehensive information available regarding the clinical and nonclinical roles, training, work expectations, and career plans of pediatric hospitalists. However, the field is currently a moving target; there is significant flux in the hospitalist workforce and variation in the roles of these professionals in their clinical and nonclinical work environment.

Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual frenulum function

Objective the Assessment Tool for Lingual Frenulum Function (ATLFF) is the only available tool designed to assess newborn babies for the severity of tongue-tie. The aim of this study was to describe the ATLFF scores obtained on a series of 148 tongue-tied newborn babies. Design prospective case series. Setting a 420-bed community hospital in St. Paul, Minnesota, USA. Participants newborn babies admitted to the normal newborn nursery from October 1, 2000 to May 1 2002. Measurements and findings all babies in the nursery were examined for tongue-tie. One-hundred and forty-eight tongue-tied babies were examined using the ATLFF by at least one of three examiners. The ATLFF could not be completed on five babies. Of the remaining babies, 40 (28%) received ‘perfect’ scores, five (3.5%) received ‘acceptable’ scores, and 19 (13.3%) received ‘function impaired’ scores. The remaining 79 (55.2%) babies received scores that did not fall into any of the three categories of scores. The inter-rater agreement on whether or not the baby had a score of ‘function impaired’ on the ATLFF was moderate (kappa=0.44). Key conclusions and implications for practice few tongue-tied babies had a score of ‘function impaired’ on the ATLFF. It is a major limitation of the ATLFF that it does not classify most babies. The development and testing of a useful tool to determine which tongue-tied babies will have difficulty with breast feeding remains a research priority.

CPT Code Changes for 2007

<i>CPT</i> Code Changes for 2007

Factors which contribute to time of first stool and first urine passage in Newborns

Purpose:To evaluate the factors which contribute to the time of the first stool and the first urine passage. Methods:We retrospectively reviewed a chart of 1,221 infants ≥34 weeks of gestational age admitted to the normal newborn nursery of Il Sin Christian Hospital, Busan, from November 2004 to April 2005. We compared the time to first stool and urine according to maternal factors(maternal age, parity, mode of delivery, meconium-stained amniotic fluid, and maternal diabetes) and infant factors (gender, Apgar score, gestational age, type of feeding during first 24 hours, age at the first feeding, number of feeds during the first 12 hours and age at discharge). Results:In total, 95.3 percent of our infants had passed their first stool by 24 hours and 99.8 percent of them had a stool by 36 hours. A total of 95.8 percent of our infants had passed urine by 24 hours of age and 98.3 percent of them by 36 hours. Comparing preterm and term infants, the time to first urine is 6.5±5.8 hours and 12.1±6.6 hours, respectively(P=0.000). The time to first stool is 20.7±13.5 hours and 10.0±6.3 hours, respectively(P=0.000) Early-fed infants were significantly earlier in time to first urine(P=0.023) and first stool(P=0.012). There was no statistically significant relationship between the number of feeds in 0-12 hours, mode of delivery, Apgar score, parity, gender, type of feeding, maternal diabetes and the time of the first urine and first stool. Conclusion:Gestational age, birth weight and age at first feeding were significantly related to the time of the first urine and first stool passage. When there is delayed passage of the first urine and first stool, we should consider close observation of other associated symptoms and other factors previously mentioned, to avoid extensive evaluation and intervention.