Normal Newborn Nursery Research Articles

A STATEWIDE SYSTEM FOR PERINATAL INFORMATION

A Statewide Perinatal Information System (SPINS) was developed in 1980, through the cooperation of South Carolina's twelve neonatologists and a grant from the State Department of Health and Enviromental Control. Using a Prime 550 computer and PSTAT, Inc. software package, SPINS collects 75 maternal and 222 neonatal items of information on all mother-infant pairs admitted to the five Level III Centers. The system collects information on infants admitted to normal newborn, intermediate and intensive care nurseries (ICN) of these five referral centers. In addition to vital statistics, areas covered are maternal history, labor, delivery and neonatal diagnoses, procedures, outcome. The number of infants entered into the system in 1982 was 14,417 of which 1749 were ICN admissions. SPINS has generated data for 1-Education: monthly ob-ped conference for perinatal outcome, 2-Quality Control: statistics of outcome by birth weight, length of hospital stay and average daily weight gain, 3-Health Costs: increased State Medicaid coverage of high risk neonates based on average length of hospital stay, 4-Research: changing bed requirements for care of very low birth weight infants. The personnel required statewide are five data collectors working 3/4 time, one full-time data entry clerk, and one full-time data analyst. The total yearly cost is approximately $100,000; $87,000 for salaries and $13,000 for computer time.

SUBEPENDYMAL GERMINAL MATRIX HEMORRHAGE (SEH) IN TERM NEONATES

Cerebral ultrasonography was done within 72 hours of birth on 505 newborns of ≥ 37 weeks gestation admitted during an 8 week period to the normal newborn nursery. Abnormalities were detected in 23 babies (4.6%). Bilateral SEH occurred in 14 (2.8%) and unilateral SEH in 6 (1.2%). Agenesis of the corpus callosum was detected in 2 (0.4%) and mild ventricular dilatation in 1 (0.2%). None of the 20 babies with SEH had intraventricular hemorrhage. When compared to babies with no SEH, those with SEH were of significantly lower gestational age and birth weight. The difference in weight was attributable to lower birth weights in females with SEH compared to females without SEH. Significantly more babies with SEH were small for gestational age, were delivered vaginally, and were black. No differences existed between babies with and without SEH in regard to gender, obstetrical presentation, use of forceps, birth trauma, Apgar scores, asphyxia, maternal age and parity, and clinical problems. Although SEH is primarily a problem of the premature baby, this study indicates that SEH is relatively common (4.0%) in the term newborn and may be clinically silent. In this study babies at greatest risk for SEH were black, small for gestational age, and vaginally delivered.

Bilirubin 20 mg/dL = Vigintiphobia

VIGINTIPHOBIA: A ONE-ACT PLAY Cast: A third-year pediatric resident A 40-year-old neonatologist A 50-year-old practicing pediatrician Scene: The hallway outside of the normal newborn nursery at almost any hospital Time: Any time in 1983 Resident:—(addressing the neonatologist) We just admitted an apparently healthy 4-day-old term infant for evaluation and treatment of jaundice. The baby was the product of a normal pregnancy and delivery and weighed 3,200 g when born at this hospital. The baby went home at 48 hours of age and was being fed a commercial formula. The infant now weighs 3,250 g. Physical examination is entirely normal and the baby is vigorous.

Automated neonatal hearing test in a community hospital.

A program to screen the hearing of newborn infants in a community hospital was instituted over a two-year period to determine if an automated program could function compatibly with a normal newborn nursery routine and still yield data as accurate as those reported in large-scale investigations done in academic medical centers with staffs operating under research grants. We describe the establishment and institution of the program, with particular attention to the administrative steps involved. Results of the study over a ten-month period revealed three confirmed hearing losses among 151 infants tested, a 2% incidence rate. The false-positive rate was 8% and the false-negative rate less than 1%. We conclude that an automated hearing screening program can be successfully instituted in a community hospital and that expected results compare favorably with those obtained in larger institutions.

Infections acquired by young infants.

Infections occurring among hospitalized young infants were surveyed for 24 months. Almost 10% of the 7,339 infants received antimicrobial therapy for five or more days for suspected community-acquired infections. Infants admitted directly to the normal-newborn nursery acquired infections at a rate of 0.6 per 100, whereas infants admitted to intensive care nurseries acquired infections at a rate of 16.9 per 100 infants. Bacteremia in association with nosocomial infection occurred frequently. The pathogens associated with community-acquired and nosocomial infections are different. Species of streptococci and relatively antibiotic-susceptible Enterobacteriaceae predominate as pathogens associated with infections in previously nonhospitalized infants. Organisms acquired in the hospital tend to be more antibiotic resistant.

Behavioral dimensions and cry sounds of infants of differential fetal growth

This report describes behavioral dimensions and spectrographic cry features of underweight-, average weight- and overweight-for-length newborn infants. Analyzed for this study were the four a priori dimensions of the Neonatal Behavioral Assessment Scale (NBAS), a dimension of the mean modal scores of the orientation items from the NBAS, and the highest dominant frequency of the cries occurring during the administration of the NBAS. Results indicate that both underweight-for-length and overweight-for-length infants showed less optimal performances on all dimensions of the NBAS than average weight-for-length infants, and also showed a high-pitched cry sound which has been used to indicate an impaired functioning of the central nervous system. No differences were found on any of these measures between the underweight- and overweight-for-length infants. These results suggest that, at a group level of analysis, a deviation from average fetal growth in either direction on the distribution of neonatal anthropometry is associated with similar changes in the behavioral functioning of infants in the normal newborn nursery. This differential behavioral functioning may be manifested in the daily activity of the infants and may alter the functional relationship between the infant and environment.

A written and audiovisual educational program for students assigned to the normal newborn nursery.

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A neonatal intensive care unit: a four-year summary.

This report summarizes the first four years' experience of a regional neonatal intensive care unit. The facility, located in a community hospital, includes a normal newborn nursery, an observation unit, and an intensive care unit. Seventeen percent of the births enter the observation unit, and 5% are admitted to the intensive care unit. A smaller percent of regional births (1.3%), totaling 604, were transferred to the intensive care unit in the four-year period. Respiratory distress was the reason for admission in about 45% of intensive care patients. Hyperbilirubinemia occured in 21%, and surgery was performed on 10%. A total of 25% of all patients admitted to the intensive care unit died. The survival rate increased with birth weight (20% to 30%

The effect of hexachlorophene on staphylococcal colonization rates in the newborn infant: A controlled study using a single-bath method

Three hundred and thirty-two infants admitted to the normal newborn nursery at Harbor General Hospital during January and February, 1972, were divided into two groups. Half received a single bath with 3 per cent hexachlorophene at 2 to 4 hours of age followed by thorough rinsing with water. The other half was bathed with water only. Cohort system and careful hand-washing technique with hexachlorophene were observed during the study period. Cultures of the anterior nares and cord were taken on the third day of life prior to discharge from the hospital. Twenty-one (12.6 per cent) of those bathed with water and nine (5.4 per cent) of those bathed with hexachlorophene were colonized with Staphylococcus aureus on discharge. Follow-up cultures 2 to 4 weeks after discharge showed that 6 of the 9 hexachlorophene-bathed infants and 14 of the 21 water bathed infants were still positive. An acceptably low staphylococcal carrier rate (9 per cent) was found in the infants discharged from the nursey during this study. It appears that a single bath with 3 per cent hexachlorophene in the early hours of life followed by thorough rinsing can be expected to effect an additional, significant reduction in the rate of staphylococcal colonization.

Approach to the Medical Care of the Sick Newborn

As the title indicates, this book emphasizes an approach to the care of the newborn infant. In certain ways the approach is unconventional, in that the presentation does not focus solely on the intensive care of the critically ill newborn infant. Since the most hazardous time in any infant's life is the newborn period, the term high-risk really applies to all neonates. This point of view results in a shift in emphasis away from the currently popular intensive-care nursery to the so-called normal newborn nursery. The shift is away from a definition of success based on mortality and a redefinition based on morbidity and the total functioning of survivors. Anticipatory observation is encouraged. Practical guidelines for the daily needs of newborn infants from delivery to the period beyond discharge from the nursery are defined. The quality of total newborn care can be no better than the level of expertise

Bullous impetigo due to group II Staphylococcus aureus. An epidemic in a normal newborn nursery.

Thirty-four cases of bullous impetigo caused by group II Staphylococcus (phage type 3B/71) arose in a normal newborn nursery. The disease followed an increased colonization rate which coincided with a change in infant bathing technique.