Practice In Neonatal Intensive Care Units Research Articles

Close Collaboration with Parents Affects the Length of Stay and Growth in Preterm Infants: A Register-Based Study in Finland

Introduction: This study aimed to evaluate how Close Collaboration with Parents (CC), a neonatal intensive care unit (NICU)-wide educational model for healthcare staff to improve their family-centred care practices, affects the length of stay (LOS), growth, and later hospital visits and rehospitalizations of preterm infants. Methods: This register-based study included all preterm infants born below 35 weeks of gestation in Finland from 2006 to 2020. Eligible infants were classified into the Full Close Collaboration (Full-CC) group (n = 2,104) if the NICUs of both the delivery and discharge hospitals had implemented the intervention; into the Partial-CC group (n = 515) if only one of the NICUs had implemented the intervention; and into the control group (n = 11,621) if neither had implemented the intervention. Results: The adjusted LOS, the primary outcome, was 1.8 days or 6% shorter in the Full-CC group than in the control group (geometric mean ratio 0.94, 95% confidence interval [95% CI] 0.89–1.00). Growth was better in the Full-CC group compared to the control group: adjusted group difference 11.7 g/week (95% CI, 1.4–22.0) for weight, 1.3 mm/week (95% CI, 0.6–2.0) for length. The Full-CC group infants had lower odds of having any unscheduled outpatient visits compared to the control group (adjusted odds ratio 0.81; 95% CI, 0.67–0.98). No significant differences were found in any other comparisons. Discussion/Conclusion: The unit-wide intervention improving family-centred care practices in NICUs may lead to more efficient use of hospital resources by shortening the LOS, improving growth, and decreasing hospital visits of preterm infants.

Fresh Parent's Own Milk for Preterm Infants: Barriers and Future Opportunities.

While direct at-the-breast feeding is biologically optimal, Neonatal Intensive Care Unit (NICU) admission due to infant immaturity or illness often necessitates the expression and storage of parent's milk. The provision of freshly expressed (never stored) parent's own milk to preterm infants is not widely prioritized, and this article provides an exploration of NICU practices and their implications for feeding premature or ill infants with parent's own milk. In this article, we discuss the potential biological benefits of fresh parent's own milk, highlighting its dynamic components and the changes incurred during storage. Research suggests that fresh milk may offer health advantages over stored milk. The authors advocate for further research, emphasizing the need for standardized definitions. Research is needed on the biological impact of fresh milk, both short- and long-term, as well as defining and understanding healthcare economics when using fresh milk.

Father Groups in the Neonatal Intensive Care Unit: A Supportive Intervention.

Parents' participation in the neonatal intensive care unit (NICU) reduces length of stay and positively affects infants' psychological, cognitive, and behavioural outcomes. Healthcare professionals in the NICU focus on both parents, but tend to have the main focus on the mother and the infant. Therefore, fathers may experience a lack of support and feel that they are being disregarded in the NICU. To study fathers' experiences with father groups during NICU admission with their preterm infant. The father group is a 90-minute intervention based on dialogue between fathers and a male healthcare professional. A qualitative content analysis was conducted using 10 online semistructured interviews with fathers participating in a father group. The study was reported according to the Standards for Reporting Qualitative Research. The overall theme emerging from our analysis was "Emotional support, encouragement, and an enhanced capacity to deal with the situation and with life in the NICU." This theme emerged from the categories "Meeting with peers and sharing reflections" and "Fathers' territory" based on 5 subcategories. Participation in father groups gives fathers recognition for being important as parents in the NICU, improves fathers' mental well-being, and enhances their coping capacity. Father groups support fathers in the NICU and can be integrated into NICU practices and policies to enhance a family-centered approach. This study revealed a need for further research to determine whether participation in a father group has a measurable effect on clinical outcomes.

Safety and feasibility of platelet transfusion through long catheters in the neonatal intensive care unit: an in vitro study

ObjectiveTo assess the safety and feasibility of platelet transfusion through small-bore long lines used in the neonatal intensive care unit (NICU), including double-lumen umbilical venous catheters (UVCs) and 24 G...

The Attitudes and Practices Among Neonatal Nurses Regarding Breastfeeding Support in The Neonatal Intensive Care Unit During Covid-19

Objective: Neonatal nurses have a main role which include promote and facilitate breastfeeding in in the Neonatal Intensive Care Unit (NICU). This study was conducted to determine the practices and attitudes of nurses towards breastfeeding support, which has critical importance in breastfeeding for newborns hospitalized in NICU during the Covid-19 pandemics. Material and method: The study was a cross-sectional descriptive survey design conducted with 252 nurses who were members of the Neonatology Nurses Society. The Data Collection Form, Survey Questionnaire, and the Iowa Infant Feeding Attitude Scale (IIFAS) were used for data collection. Results: The IIFAS median score of the participants was 70.0 (IQR=9.0). Statistically differences in the IIFAS scores were found according to age (χ2=11.703, p=0.008), education status in nursing (χ2=9.257; p=0.01), and status of attending to international scientific meetings (Z=-2.360; p=0.018). Participants who were age between 26-30 years (n=76, 30.2%), had post-education degree in nursing (n=32, 12.7%), and attended to international scientific meetings (n=47, 18.6) had higher positive attitudes of breastfeeding. The nurses (n=126, 50%) stated that it was difficult to reach mothers in terms of breastfeeding for newborns, and 61.8% of them (n=156) stated that they had difficulty initiating the mother-baby attachment process in the NICU. Conclusions: Although the attitudes of NICU nurses towards breast milk and breastfeeding were at a moderate level in our study, they struggled to support and maintain the lactation and they implemented to a number of supportive feeding practice in NICUs.

Blood culture collection practices in NICU; A national survey.

Sepsis is the leading cause of mortality and morbidity in neonates. Blood cultures are the gold standard in diagnosing neonatal sepsis; however, there are currently no consensus guidelines for blood culture collection in neonates and significant practice variation exists in Neonatal Intensive Care Units (NICUs) globally. To examine current practices in obtaining blood cultures in the evaluation of neonatal sepsis in NICUs across Canada. A nine-item electronic survey was sent to each of the 29 level-3 NICUs in Canada, which are equipped to provide highly specialized care for newborns. Responses were received from 90% (26/29) of sites. Sixty-five percent (17/26) of sites have blood culture collection guidelines for the investigation of neonatal sepsis. Forty-eight percent (12/25) of sites routinely target 1.0 mL per culture bottle. In late-onset sepsis (LOS), 58% (15/26) of sites process one aerobic culture bottle, whereas four sites routinely add anaerobic culture bottles. In early-onset sepsis (EOS) in very low birth weight infants (BW <1.5 kg), 73% (19/26) of sites use umbilical cord blood, and 72% (18/25) use peripheral venipuncture. Two sites routinely collect cord blood for culture in EOS. Only one site applies the concept of differential time-to-positivity to diagnose central-line-associated bloodstream infection. There is significant practice variation in methods used to obtain blood cultures in level-3 NICUs across Canada. Standardization of blood culture collection practices can provide reliable estimates of the true incidence of neonatal sepsis and help to develop appropriate antimicrobial stewardship strategies.

Parents' Experience in an Italian NICU Implementing NIDCAP-Based Care: A Qualitative Study.

Background: The birth of a preterm infant and his/her immediate admittance to the Neonatal Intensive Care Unit (NICU) are sudden, unexpected, stressful and painful events for parents. In the last decade, in response to the increased awareness of the stressful experiences of parents, much attention has been paid to Family-Centered Care (FCC) and the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). According to the NIDCAP model, the infant-parents' dyad is the core of the care provided by the NICU professionals to reduce the stress experienced by parents. So far, the literature does not show a clear correlation between parental experiences and the NICU practices according NIDCAP principles. Aims: To explore how parents of preterm infants experienced the NIDCAP-based care from admission to discharge, in particular, their relationships with NICU professionals and with other parents, and the organization of the couple's daily activities during this process. Design: Qualitative exploratory study. Methods: Twelve parents of preterm infants born between January 2018 and December 2020 at the NICU of Modena, with a gestational age at birth of less than 30 weeks and/or a birth weight of less than 1250 g, were recruited. Three couples had twins, and the total number of infants was 15. All infants were followed for up to 24 months post-term age (PTA) for neurological outcomes. Each couple was given a semi-structured online interview about their experience during their infant's hospitalization in the NICU up to discharge. The interview was developed around three time points: birth, hospitalization and discharge. The data analysis was conducted according to the template analysis method. Results: The admission to the NICU was unexpected and extraordinary, and its impact was contained by the skilled staff who were capable of welcoming the parents and making them feel they were involved and active collaborators in the care of their infant. The emotional experience was compared to being in a blender; they were overwhelmed by changing emotions, ranging from terrible fear to extreme joy. The couple's activities of daily life were reorganized after the infant's birth and admission to the NICU. Fathers felt unbalanced and alone in taking care of their partners and their children. Conclusions: This is the first study in Italy to explore parental experience in an NICU implementing NIDCAP-based care. The NIDCAP approach in the NICU of Modena helps parents to be involved early, to develop parental skills, and to be prepared for the transition home; and it also facilitates and enhances the relationship between parents and NICU staff.

Nursing students experiences in neonatal care: A qualitative study

Clinical practice is a moment of stress for nursing students with impact in academic outcomes. Neonatal Intensive Care Units (NICU) are a specific and multifaceted context that offer complex experiences to nursing students. A descriptive, cross-sectional, and observational study, with a qualitative approach was outlined that aimed to describe and categorize the experiences of nursing students in NICU. Semi structured interviews were used for data collection and content analysis for data analysis. Among eligible students (those that had performed clinical practice in NICU and agreed to participate) a purposive sample of 6 students was selected. Data analysis allowed the identification of five categories: clinical practice evolution, expectations about clinical practice, challenges faced in clinical practice, feelings for the babies and their parents, and comparing with the adult nursing clinical practice. The findings of this study indicate that nursing students experienced a wide range of feelings and experiences.

Recognizing Our Biases, Understanding the Evidence, and Responding Equitably: Application of the Socioecological Model to Reduce Racial Disparities in the NICU.

Implicit bias permeates beliefs and actions both personally and professionally and results in negative health outcomes for people of color-even in the neonatal intensive care unit (NICU). NICU clinicians may naïvely and incorrectly assume that NICU families receive unbiased care. Existing evidence establishing associations between sex, race, and neonatal outcomes may perpetuate the tendency to deny racial bias in NICU practice. Using the socioecological model as a framework, this article outlines evidence for racial health disparities in the NICU on multiple levels-societal, community, institutional, interpersonal, and individual. Using current evidence and recommendations from the National Association of Neonatal Nurses Position Statement on "Racial Bias in the NICU," appropriate interventions and equitable responses of the NICU clinician are explored. Based on current evidence, clinicians should reject the notion that the social construct of race is the root cause for certain neonatal morbidities. Instead, clinicians should focus on the confluence of medical and social factors contributing to each individual infant's progress. This critical distinction is not only important for clinicians employing life-saving interventions, but also for those who provide routine care, developmental care, and family education-as these biases can and do shape clinical interactions. Healthcare practitioners have an ethical and moral responsibility to maintain up-to-date knowledge of new evidence that impacts our clinical practice. The evidence demonstrates the importance of recognizing the enduring role of racism in the health and well-being of people of color and the need to adjust care accordingly.

Associated factors to breast feeding practice in neonatal intensive care unit

Abstract Background Improving breast milk feeding (BF) can avoid globally per year 800000 deaths in children under 5 years old. In Morocco the breast milk feeding rate decreased from 51% to 27,8% between 1992 and 2011, the breast feeding rate in neonatal intensive care unit (NICU) is lower (12,4%). The objective of this study is to determine the associated factors of BF practice in NICU. Methods A cross-sectional study was conducted between 04 January and 20 April 2021 in NICU ward of teaching hospital Ibn Roch of Casablanca (Morocco). We included Moroccan couples mother/newborn who can practice the BF presents during the study period. We used face to face interview using questionnaire. Student, Mann-Whitney-Wilcoxon and Khi2 tests were used to test association between BMF and potential associated factors. The potential associated factors with p ≤ 0.05 were considered as associated factors of BF practice. Data were analyzed using R 3.6.3. Results We included 107 couple mother/newborn. Around 77% of mothers practice BF. The mother factors associated with BF practice were: residence (30.5% rural; 69.5% urban; p = 0.007); marital status (2.4% single; 0% divorced; 97.6% married; p = 0.02); getting prior information about BF (6.2% no; 93.8%yes; p = 0.02), mother knowledge score about BF (median score yes = 10, no = 9;p= 0.03). The newborn associated factors were: hospitalization reasons (50.7% respiratory distress; 17.3% infections; 13.3% jaundice; 18.7% others; p = 0.03) and the gender (58.2% male; 41.8% female; p = 0,02) Conclusions The practice rate is lower for rural single mother who don't get any prior information about BF (lower knowledge). These mothers must get more attention from the healthcare staffs and training programs to improve the breast feeding in NICU. Key messages We can do better about the management of newborn hospitalized in NICU with actions like BF practice (promotion of breastfeeding). The benefits of breast feeding practice are significantly greater than his risks about the management of newborn hopitalized in NICU.

Assessment of Neonatal Intensive Care Unit Practices, Morbidity, and Mortality Among Very Preterm Infants in China

The Chinese Neonatal Network was established in 2018 and maintains a standardized national clinical database of very preterm or very low-birth-weight infants in tertiary neonatal intensive care units (NICUs) throughout China. National-level data on outcomes and care practices of very preterm infants (VPIs) in China are lacking. To assess the care practices in NICUs and outcomes among VPIs in China. A cohort study was conducted comprising 57 tertiary hospitals from 25 provinces throughout China. All infants with gestational age (GA) less than 32 weeks who were admitted to the 57 NICUs between January 1 and December 31, 2019, were included. Care practices, morbidities, and survival were the primary outcomes of the study. Major morbidities included bronchopulmonary dysplasia, severe intraventricular hemorrhage (grade ≥3) and/or periventricular leukomalacia, necrotizing enterocolitis (stage ≥2), sepsis, and severe retinopathy of prematurity (stage ≥3). A total of 9552 VPIs were included, with mean (SD) GA of 29.5 (1.7) weeks and mean (SD) birth weight of 1321 (321) g; 5404 infants (56.6%) were male. Antenatal corticosteroids were used in 75.6% (6505 of 8601) of VPIs, and 54.8% (5211 of 9503)were born through cesarean delivery. In the delivery room, 12.1% of VPIs received continuous positive airway pressure and 26.7% (2378 or 8923) were intubated. Surfactant was prescribed for 52.7% of the infants, and postnatal dexamethasone was prescribed to 9.5% (636 of 6675) of the infants. A total of 85.5% (8171) of the infants received complete care, and 14.5% (1381) were discharged against medical advice. The incidences of the major morbidities were bronchopulmonary dysplasia, 29.2% (2379 of 8148); severe intraventricular hemorrhage and/or periventricular leukomalacia, 10.4% (745 of 7189); necrotizing enterocolitis, 4.9% (403 of 8171 ); sepsis, 9.4% (764 of 8171); and severe retinopathy of prematurity, 4.3% (296 of 6851) among infants who received complete care. Among VPIs with complete care, 95.4% (7792 of 8171) survived: 65.6% (155 of 236) at 25 weeks' or less GA, 89.0% (880 of 988) at 26 to 27 weeks' GA, 94.9% (2635 of 2755)at 28 to 29 weeks' GA, and 98.3% (4122 of 4192) at 30 to 31 weeks' GA. Only 57.2% (4677 of 8171) of infants survived without major morbidity: 10.5% (25 of 236) at 25 weeks' or less GA, 26.8% (48 of 179) at 26 to 27 weeks' GA, 51.1% (1409 of 2755) at 28 to 29 weeks' GA, and 69.3% (2904 of 4192) at 30 to 31 weeks' GA. Among all infants admitted, the survival rate was 87.6% (8370 of 9552)and survival without major morbidities was 51.8% (4947 of 9552). The findings of this study suggest that survival and survival without major morbidity of VPIs in Chinese NICUs have improved but remain lower than in high-income countries. Comprehensive and targeted quality improvement efforts are needed to provide complete care for all VPIs, optimize obstetrical and neonatal care practices, and improve outcomes.

Potentially harmful excipients in neonatal medications: a multicenter nationwide observational study in Japan

BackgroundA multicenter investigation of neonate exposure to potentially harmful excipients (PHEs) in neonatal intensive care units (NICUs) in Japan has not been conducted.MethodsA multicenter nationwide observational study was conducted. Neonate patient demographic data and information on all medicines prescribed and administered during hospitalization on 1 day between November 2019 and March 2021 were extracted from the medical records. Nine PHEs, paraben, polysorbate 80, propylene glycol, benzoates, saccharin sodium, sorbitol, ethanol, benzalkonium chloride, and aspartame, were selected. PHEs were identified from the package insert and the Interview Form. The quantitative daily exposure was calculated if quantitative data were available for each product containing the PHE.ResultsPrescription data was collected from 22 NICUs in Japan. In total, 343 neonates received 2360 prescriptions for 426 products containing 228 active pharmaceutical ingredients. PHEs were found in 52 (12.2%) products in 646 (27.4%) prescriptions for 282 (82.2%) neonates. Benzyl alcohol, sodium benzoates, and parabens were the most common PHEs in parenteral, enteral, and topical formulations, respectively. Quantitative analysis showed that 10 (10%), 38 (42.2%), 37 (94.9%), and 9 (39.1%) neonates received doses exceeding the acceptable daily intake of benzyl alcohol, polysorbate 80, propylene glycol, and sorbitol, respectively. However, due to the lack of quantitative information for all enteral and topical products, accurate daily PHE exposure could not be quantified.ConclusionsNeonates admitted to NICUs in Japan were exposed to PHEs, and several of the most commonly prescribed medicines in daily clinical practice in NICUs contained PHEs. Neonate PHE exposure could be reduced by replacing these medicines with available PHE-free alternatives.

Effects of Virtual Reality Simulation Program Regarding High-risk Neonatal Infection Control on Nursing Students

PurposeVirtual reality simulation can give nursing students a safe clinical experience involving high-risk infants where access to neonatal intensive care units is limited. This study aimed to examine the effects of a virtual reality simulation program on Korean nursing students’ knowledge, performance self-efficacy and learner satisfaction. MethodsA nonequivalent control group design was applied. Senior nursing students were divided into an experimental group (n = 25) experiencing virtual reality simulation and routine neonatal intensive care unit practice and a control group (n = 25) having routine neonatal intensive care unit practice. The program consisted of three scenarios: basic care, feeding management and skin care and environmental management for prevention of neonatal infection. The total execution time for the three scenarios was 40 minutes. The simulation created immersive virtual reality experiences using a head-mounted display with hand-tracking technology. Data were collected from December 9, 2019, to January 17, 2020, and were analyzed using descriptive statistics and the t-test, paired t-tests, Mann-Whitney test and Wilcoxon signed-ranks test. ResultsCompared to the control group, the experimental group showed significantly greater improvements in high-risk neonatal infection control performance self-efficacy (t = −2.16, p = .018) and learner satisfaction (t = −5.59, p < .001). ConclusionThe virtual reality simulation program can expand the nursing students’ practice experience in safe virtual spaces and enhance their performance self-efficacy and learning satisfaction.

Brain growth in extremely preterm infants before and after implementing NAVA ventilation.

During neurally adjusted ventilatory assist (NAVA) both the timing and degree of ventilatory assist are controlled by the patient's respiratory center (1) resulting in improved synchrony and lower peak inspiratory pressures and lower oxygen requirements compared with conventional ventilation in low birth weight infants (2,3). However, there are no randomized controlled trials yet available evaluating the effects of NAVA ventilation on the neurodevelopmental outcomes, nor are there studies reporting the use of NAVA ventilation as a standard neonatal intensive care unit practice in extremely preterm infants.

Cost-effectiveness of Oral Versus Intravenous Ibuprofen Therapy in Preterm Infants With Patent Ductus Arteriosus in the Neonatal Intensive Care Setting: A Cohort-based Study

PurposeUse of ibuprofen for the patent ductus arteriosus (PDA) has become increasingly common. This study aimed to evaluate the clinical and economic impact of oral ibuprofen versus intravenous ibuprofen for PDA among preterm infants. MethodsThis retrospective, cohort-based pilot study examined the clinical and economic associations of oral versus intravenous ibuprofen for PDA. A decision-analytic model was constructed, from the hospital perspective, to follow the oral versus intravenous administrations of ibuprofen for PDA and their clinical and economic consequences. The course regimen of either formulation was an initial 10 mg/kg followed by 5 mg/kg at 24- and 48-h intervals. Clinical and resource utilization data were extracted from Cerner medical database, from 2014 through 2018, at the tertiary neonatal intensive care unit setting in Qatar. The primary outcome measures were the rate of successful closure based on the ductal diameter measure after the first course of treatment and the overall direct medical cost of PDA management. A population of 118 neonates was required for results with 80% power and 0.05 significance. Sensitivity analyses involving unit costs and a subgroup analysis based on gestational age and birth weight, added to a second-order probabilistic analysis of all model inputs, were performed. FindingsForty infants were available for inclusion in the oral ibuprofen study group, not achieving the desired sample size, with successful PDA closure reported in 64% of cases compared with a reduced success of 36% with intravenous ibuprofen (n = 59) (risk ratio = 0.56; 95% CI, 0.32–0.97; P = 0.04), which was associated with economic advantage to oral ibuprofen. The probabilistic analysis illustrated that oral ibuprofen costs less than intravenous ibuprofen in 72% of patient cases, with QAR 48,751 (US $13,356) (95% CI, QAR 47,500–50,000, US $13,014–$13,699) in mean savings. Sensitivity analyses confirmed the robustness of study conclusions and found that the rate of closure success versus failure was the most influential on results, followed by the occurrence of adverse drug events with both intravenous and oral ibuprofen. Although both ibuprofen formulations had similar safety profiles (P = 0.16), the intravenous formulation was associated with a larger number of adverse drug effects. ImplicationsThis is the first cost-effectiveness evaluation of oral versus intravenous formulations of ibuprofen among infants with PDA. The oral ibuprofen might be associated with an enhanced ductal closure at a considerably lower cost. The study results support recent trends in neonatal intensive care unit practices in favor of the oral administration of ibuprofen.

A Multisite Survey of NICU Healthcare Professionals' Perceptions About Family-Centered Care.

Family-centered care contributes to improved outcomes for preterm and ill infants. Little is known about the perceptions of neonatal intensive care unit (NICU) healthcare professionals regarding the degree to which their NICU practices or values family-centered care. The aims of this study were to describe attitudes and beliefs of NICU healthcare professionals about family-centered care and to explore professional characteristics that might influence those views. Data were derived from the baseline phase of a multicenter quasi-experimental study comparing usual family-centered NICU care with mobile-enhanced family-integrated care. Neonatal intensive care unit healthcare professionals completed the Family-Centered Care Questionnaire-Revised (FCCQ-R), a 45-item measure of 9 core dimensions of Current Practice and Necessary Practice for family-centered care. A total of 382 (43%) NICU healthcare professionals from 6 NICUs completed 1 or more of the FCCQ-R subscales, 83% were registered nurses. Total and subscale scores on the Necessary Practice scale were consistently higher than those on the Current Practice scale for all dimensions of family-centered care (mean: 4.40 [0.46] vs 3.61 [0.53], P < .001). Only years of hospital experience and NICU site were significantly associated with Current Practice and Necessary Practice total scores. Ongoing assessment of the perceptions of NICU healthcare professionals regarding their current practice and beliefs about what is necessary for the delivery of high-quality family-centered care can inform NICU education, quality improvement, and maintenance of family-centered care during the COVID-19 pandemic. Further research is needed to identify additional factors that predict family-centered care perceptions and behaviors.

Novice Occupational Therapist's Experience of Working in Neonatal Intensive Care Units in KwaZulu-Natal

Introduction: The neonatal intensive care unit, a specifically designed environment to meet the needs of severely ill neonates, is an area where occupational therapists have several roles to play. However, there is limited literature available around the training and practice of South African therapists in these units. Method: The study followed a qualitative, explorative design with homogenous purposeful sampling. Twelve occupational therapists with less than four years post-community service experience were recruited and underwent in-depth interviewing regarding their experiences in neonatal intensive care units in the public health sector. Thematic analysis, with deductive reasoning, was used. Results: The community service occupational therapists initially lacked the knowledge and skills for neonatal intensive care unit work. Knowledgeable supervisors and supportive multidisciplinary teams assisted their clinical practice; whereas a lack of resources, cultural barriers and poor orientation hindered practice. The community service occupational therapists went through a process of adaptation, gaining increased confidence and self-identity throughout their exposure, utilising many coping mechanisms. Conclusions: The training of occupational therapists for neonatal intensive care unit practice urgently requires more attention within the South African context. Recommendations include curriculum review, inclusion of practical exposure, providing additional post-graduate courses and ensuring appropriate community service occupational therapist supervision.

Assessment of Neonatal Intensive Care Unit Practices and Preterm Newborn Gut Microbiota and 2-Year Neurodevelopmental Outcomes

In very preterm newborns, gut microbiota is highly variable with major dysbiosis. Its association with short-term health is widely studied, but the association with long-term outcomes remains unknown. To investigate in preterm newborns the associations among practice strategies in neonatal intensive care units (NICUs), gut microbiota, and outcomes at 2 years. EPIFLORE is a prospective observational cohort study that includes a stool sample collection during the fourth week after birth. Preterm newborns of less than 32 weeks of gestational age (GA) born in 2011 were included from 24 NICUs as part of the French nationwide population-based cohort, EPIPAGE 2. Data were collected from May 2011 to December 2011 and analyzed from September 2016 to December 2018. Eight NICU strategies concerning sedation, ventilation, skin-to-skin practice, antibiotherapy, ductus arteriosus, and breastfeeding were assessed. A NICU was considered favorable to a practice if the percentage of that practice in the NICU was more than the expected percentage. Gut microbiota was analyzed by 16S ribosomal RNA gene sequencing and characterized by a clustering-based method. The 2-year outcome was defined by death or neurodevelopmental delay using a Global Ages and Stages questionnaire score. Of 577 newborns included in the study, the mean (SD) GA was 28.3 (2.0) weeks, and 303 (52.5%) were male. Collected gut microbiota was grouped into 5 discrete clusters. A sixth cluster included nonamplifiable samples owing to low bacterial load. Cluster 4 (driven by Enterococcus [n = 63]), cluster 5 (driven by Staphylococcus [n = 52]), and cluster 6 (n = 93) were significantly associated with lower mean (SD) GA (26.7 [1.8] weeks and 26.8 [1.9] weeks, respectively) and cluster 3 (driven by Escherichia/Shigella [n = 61]) with higher mean (SD) GA (29.4 [1.6] weeks; P = .001). Cluster 3 was considered the reference. After adjustment for confounders, no assisted ventilation at day 1 was associated with a decreased risk of belonging to cluster 5 or cluster 6 (adjusted odds ratio [AOR], 0.21 [95% CI, 0.06-0.78] and 0.19 [95% CI, 0.06-0.62], respectively) when sedation (AOR, 10.55 [95% CI, 2.28-48.87] and 4.62 [1.32-16.18], respectively) and low volume of enteral nutrition (AOR, 10.48 [95% CI, 2.48-44.29] and 7.28 [95% CI, 2.03-26.18], respectively) was associated with an increased risk. Skin-to-skin practice was associated with a decreased risk of being in cluster 5 (AOR, 0.14 [95% CI, 0.04-0.48]). Moreover, clusters 4, 5, 6 were significantly associated with 2-year nonoptimal outcome (AOR, 6.17 [95% CI, 1.46-26.0]; AOR, 4.53 [95% CI, 1.02-20.1]; and AOR, 5.42 [95% CI, 1.36-21.6], respectively). Gut microbiota of very preterm newborns at week 4 is associated with NICU practices and 2-year outcomes. Microbiota could be a noninvasive biomarker of immaturity.

Chlorhexidine Gluconate Utilization for Infection Prevention in the NICU: A Survey of Current Practice.

Central-line-associated bloodstream infection (CLABSI) contributes to significant morbidity and mortality in the neonatal intensive care unit (NICU). Disinfection of skin is part of bundled cares aimed at prevention of CLABSI. While considered an essential component of insertion and maintenance bundles, the optimal solution to disinfect neonatal skin remains controversial. The purpose of this project was to survey neonatal nurse practitioners and nursing leaders across NICUs regarding the current use of chlorhexidine gluconate (CHG) in term and preterm infants. This descriptive study involved the collection of survey data to determine NICU practices related to the use of CHG in their infant population. The sample was composed of nursing directors of NICUs and neonatal nurse practitioners who completed an electronic survey via a provided link. Chlorhexidine was reported to be used in 53 (82.81%) of the NICUs and was the primary agent used to prepare the skin for central vascular catheter insertion (53.23%) followed by povidone-iodine (45.16%), and 70% isopropyl alcohol (1.61%). Gestational age or birth weight restrictions for CHG use were reported in 43 (82.69%) NICUs. Trends in the data demonstrated nursing's role in using CHG in the NICU. Adverse events reported from CHG included burns, redness, dermatitis, and other irritations. Concerns included risk of absorption, burns, skin irritation, lack of evidence, and overall safety. Systematic monitoring by nurse leaders is needed to identify evidence related to skin disinfection and CHG in neonates. Targeted education for nursing staff related to directed to developmental maturation of the skin, safe use of CHG, review of best evidence, rationale for usage of CHG, and potential iatrogenic effects is recommended. Research is needed to evaluate the impact of educational offerings and surveillance for adverse events on CLABSI rates.

Facebook and WhatsApp in Identifying Current Practices of Neurological Physiotherapy Intervention in Neonatal Intensive Care Units: In Indian Scenario.

ABSTRACTBackground:Neonatal intensive care unit (NICU) is care of less gestational age babies, prenatal neurological insult such as asphyxia, and congenital abnormalities such as congenital heart disease (CHD). There is a few evidence about neurological interventions in NICUs.Aims and Objectives:To explore the current physiotherapy neurological practices in NICU by the cross-sectional online survey.Materials and Methods:150 physiotherapy students from different physiotherapy colleges, who were posted in NICU during their clinical posting as a part of curriculum in the age group between 18 and 25 years were enrolled in the study. The study was carried out by sending the link to the students through social networking sites such as Facebook and WhatsApp. The survey was administrated using the online survey portal, SurveyMonkey (online survey services). The questionnaire was filled by physiotherapy students. Validated questionnaire approved by student project committee comprising 10 questions were included in the survey.Results:Out of 150 physiotherapy students, only 107 were responded back. No incomplete questionnaire was received from survey. We obtained 31%––always; 23%––usually; 24%––sometimes; 6%––seldom; and 16%––never performed neurological physiotherapy intervention in NICU.Conclusion:Less than 50% physiotherapy students performed neurological physiotherapy intervention in NICU. Therefore, more awareness needs to be created regarding neurological physiotherapy intervention performed in NICU.