Care Of Preterm Infants Research Articles

Dose-related cardiac outcomes in response to postnatal dexamethasone treatment in premature lambs.

Postnatal corticosteroids are used in the critical care of preterm infants for the prevention and treatment of bronchopulmonary dysplasia. We aimed to investigate the effects of early postnatal dexamethasone therapy and dose on cardiac maturation and morphology in preterm lambs. Lambs were delivered prematurely at ~128 days of gestational age and managed postnatally according to best clinical practice. Preterm lambs were administered dexamethasone daily at either a low-dose (n=9) or a high-dose (n=7), or were naïve to steroid treatment and administered saline (n=9), over a 7-day time-course. Hearts were studied at postnatal Day 7 for gene expression and assessment of myocardial structure. High-dose dexamethasone treatment in the early postnatal period led to marked differences in cardiac gene expression, altered cardiomyocyte maturation and reduced cardiomyocyte endowment in the right ventricle, as well as increased inflammatory infiltrates into the left ventricle. Low-dose exposure had minimal effects on the preterm heart. Neonatal dexamethasone treatment led to adverse effects in the preterm heart in a dose-dependent manner within the first week of life. The observed cardiac changes associated with high-dose postnatal dexamethasone treatment may influence postnatal growth and remodeling of the preterm heart and subsequent long-term cardiac function.

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess: A Case Report.

Methicillin-susceptible Staphylococcus aureus (MSSA) occurs more frequently in the neonatal intensive care unit (NICU) than methicillin-resistant S. aureus (MRSA) and can result in comparable morbidity and mortality in the neonatal population. MSSA infection may present as pustulosis or cellulitis and evolve into bacteremia, pneumonia, endocarditis, brain abscesses, and osteomyelitis. There is a paucity of literature regarding the treatment and long-term outcomes in the premature infant. A 32-week twin developed MSSA sepsis with presentation of pain, decreased movement of upper extremities, and global hypotonia. Blood cultures remained positive despite antibiotic coverage. The infant was admitted to the level IV NICU with the diagnosis of MSSA bacteremia, with concern for dissemination and osteomyelitis. Diagnostic studies included laboratory testing for sepsis evaluation, radiologic studies to evaluate for dissemination, immunologic testing to rule out complement deficiency, and hematology testing to rule out hypercoagulable conditions. Diagnostic testing showed extensive cellulitis, osteomyelitis, multiple liver abscesses, and epidural abscesses suggestive of spinal epidural abscess (SEA). Abscess debridement and irrigation on the left distal femur, left elbow, and right tibia were performed. The infant completed 8 weeks of IV antibiotic therapy. Immunologic and hematology testing was within normal limits. Prompt recognition and follow-up for clinical signs of sepsis are vital when caring for premature infants. Inclusion of pediatric subspecialist recommendations to assure all diagnostic studies and treatments are completed can significantly impact the patient's outcome. Long-term follow-up is needed for premature infants with the diagnosis of SEA.

Morbidity and Mortality Trends in Preterm Infants of

Owing to advances in critical care treatment, the overall survival rate of preterm infants born at a gestational age (GA) <32 weeks has consistently improved. However, the incidence of severe intraventricular hemorrhage (IVH) has persisted, and there are few reports on in-hospital morbidity and mortality. Therefore, the aim of the present study was to investigate trends surrounding in-hospital morbidity and mortality of preterm infants with severe IVH over a 14-year period. This single-center retrospective study included 620 infants born at a GA <32 weeks, admitted between January 2007 and December 2020. After applying exclusion criteria, 596 patients were included in this study. Infants were grouped based on the most severe IVH grade documented on brain ultrasonography during their admission, with grades 3 and 4 defined as severe. We compared in-hospital mortality and clinical outcomes of preterm infants with severe IVH for two time periods : 2007-2013 (phase I) and 2014-2020 (phase II). Baseline characteristics of infants who died and survived during hospitalization were analyzed. A total of 54 infants (9.0%) were diagnosed with severe IVH over a 14-year period; overall in-hospital mortality rate was 29.6%. Late in-hospital mortality rate (>7 days after birth) for infants with severe IVH significantly improved over time, decreasing from 39.1% in phase I to 14.3% in phase II (p=0.043). A history of hypotension treated with vasoactive medication within 1 week after birth (adjusted odds ratio, 7.39; p=0.025) was found to be an independent risk factor for mortality. When comparing major morbidities of surviving infants, those in phase II were significantly more likely to have undergone surgery for necrotizing enterocolitis (NEC) (29.2% vs. 0.0%; p=0.027). Additionally, rates of late-onset sepsis (45.8% vs. 14.3%; p=0.049) and central nervous system infection (25.0% vs. 0.0%; p=0.049) were significantly higher in phase II survivors than in phase I survivors. In-hospital mortality in preterm infants with severe IVH decreased over the last decade, whereas major neonatal morbidities increased, particularly surgical NEC and sepsis. This study suggests the importance of multidisciplinary specialized medical and surgical neonatal intensive care in preterm infants with severe IVH.

The Relationship Between Enteral and Parenteral Nutrition on Body Weight, Incidence of NEC, Sepsis and Length of Care for Preterm Infant in Dr. Soetomo General Hospital Surabaya

The incidence of preterm birth in Indonesia still accounts for the highest mortality rate. Failure to provide adequate nutrition will have an impact on growth failure, risk of infection and longer duration of care for preterm infant. This study aims to analyzing the relationship between enteral and parenteral nutrition on body weight, the incidence of NEC, the incidence of sepsis and the length of care at Dr. Soetomo Hospital Surabaya. A total 106 subjects were enrolled, 78 infants were LBW, 19 infants were VLBW. Gestational age between 32-<37 weeks as many as 96 subjects. 68 infants were female. A total of 49 patients (46.2%) received parenteral nutrition. There is a relationship between enteral nutrition and the incidence of sepsis (p= 0.03), parenteral nutrition and body weight (p= 0.005), parenteral nutrition and the incidence of sepsis (p= 0.001), and parenteral nutrition and the length of care for preterm infants (p= 0.001). There is a relationship between enteral nutrition with the incidence of sepsis and parenteral nutrition with body weight, incidence of sepsis and length of care in preterm infants.

On the 10th Anniversary of the Korean Neonatal Network

The Korean Neonatal Network (KNN), which is celebrating its 10th anniversary, currently has more than 100 staff and researchers from &gt;70 neonatal intensive care units nationwide in Korea. More than 85% to 90% of the population of very low birth weight infants in Korea are registered yearly, and more than half are followed up for up to 3 years at the KNN. A total of &gt;19,000 cases have been accumulated through a strict data quality management process of the KNN. Based on this, &gt;100 research projects have been proposed, &gt;70 peer-reviewed papers have been published in leading international journals, and the cornerstone of the quality improvement project has been launched. In addition, we recently expanded the number of subjects for registration to very premature infants &lt;32 weeks of age and continue to provide essential evidence data for establishing national health policies, such as linking with government policy projects of the Ministry of Health and Welfare for preterm infants. In such manner, the KNN is confident to be successfully and actively moving toward reaching the ultimate goal of standardizing neonatal intensive care and management of preterm infants in Korea by providing essential data for national health policy establishment along with quality improvement through evidence-based interactive data.

A pressing need for research to reduce nutritional uncertainties in preterm infant care: Findings from a European roundtable discussion with parent representatives

IntroductionOther than for agreement that own mother's milk is the optimum feed, nutritional practice for very preterm babies varies widely. As part of the development of a randomised controlled trial to address preterm nutrition uncertainties, and with the help of the European Foundation for the Care of Newborn Infants (EFCNI), we sought the views of parents across Europe. MethodsWe held two roundtable discussions about the proposed trial, inviting the participation of parents and preterm adults through EFCNI. We sought their views and prior knowledge of preterm nutrition uncertainties, treatment comparisons and opinions on specific aspects of design such as cluster versus individual randomisation. We used thematic Framework Analysis to explore the data. ResultsThere were 11 participants (two men and nine women) from six European countries. Nine were parents and two were preterm adults. Participants strongly supported the need for research to improve care. However, we found little knowledge of methods to resolve uncertainties in care, and wide variation in information provided to parents during their baby's neonatal unit stay. No parent recalled a member of the clinical staff having told them about nutrition uncertainties. ConclusionsPresent-day best practice is to involve parents, patients, and the public in all stages of clinical research from design to dissemination and implementation. To strengthen involvement and participation we suggest there is need to improve knowledge of research methods. Clinicians may find it helpful to receive training on how to explain clinical uncertainties, and methods to resolve these.

Prevention of Admission Hypothermia in Low-Birth- Weight Infants Through PDSA Cycle of Quality Improvement Initiative

Background: Admission hypothermia (AH) is one of the key indicators in quality care of preterm infants. Unfortunately, AH rate in the authors’ institution was rather high. Therefore, the authors had set up quality improvement initiatives to improve rate of AH in the authors’ institution. The present study aimed to assess the effectiveness of the authors’ quality improvement initiatives (QI) to reduce admission hypothermia (AH) in infants less than 2,000 g. Materials and Methods: The present study was a retrospective evaluation of the authors’ QI program. The enrolled infants were inborn with birthweight less than 2,000 g, admitted in the NICU directly after birth. The QI consisted of increasing resuscitation area temperature (RT), use of heat protective measures, and transported with prewarmed transport incubator. To assess effectiveness, rate of admission hypothermia and admission temperature (AT) were selected as QI outcomes. The outcomes were compared between pre-QI period and post-QI period. Results: There were 117 and 133 infants in pre-QI and post-QI period, respectively. RT were 24.7±1.48℃ and 24.8±1.04℃,AT increased from 36.4±0.85℃ to 36.7±0.60℃ and incidence of hypothermia were decreased from 50.4% to 30.8%, in pre and post QI period (p-value&lt;0.05). Conclusion: The authors’ QI effectively reduced AH in infants under 2,000 g. Keywords: Preterm; Hypothermia; Quality improvement

The Triple Aim Quality Improvement Gold Standard Illustrated as Extremely Premature Infant Care.

The Triple Aim is widely regarded as the quality improvement gold standard that enhances population health, lowers costs, and betters individual care. There have been no large-scale, sustained demonstrations of such improvement in healthcare. Illustrating the Triple Aim using relevant extremely premature infant outcomes might highlight interwoven proficiency and efficiency complexities that impede sustained value progress. Ten long-term collaborating neonatal intensive care units (NICU) in the Vermont Oxford Network calculated the Triple Aim in 230/7 to 276/7-week infants using three surrogate measures: (1) population health/x-axis-eight major morbidity rates as a composite, risk-adjusted metric; (2) cost/y-axis-total hospital length of stay; and (3) individual care/z-axis-mortality, then illustrated this relationship as a sphere within a three-dimensional cube. Three thousand seven hundred six infants born between January 1, 2014 and December 31, 2019, with mean (standard deviation) gestational age of 25.7 (1.4) weeks and birth weight of 803 (208) grams were analyzed. Triple Aim three-axis cube positions varied inconsistently comparing NICUs. Each NICUs' sphere illustrated mixed x- and z-axis movement (clinical proficiency), and y-axis movement (cost efficiency). No NICU demonstrated the theoretically ideal Triple Aim improvement in all three axes. Backward movement in at least one axis occurred in eight NICUs. The whole-group Triple Aim sphere moved forward along the x-axis (better morbidities metric), but moved backward in the y-axis length of stay and z-axis mortality measurements. Illustrating the Triple Aim gold standard as extreme prematurity outcomes reveals complexities inherent to simultaneous attempts at improving interwoven quality and cost outcomes. Lack of progress using relevant Triple Aim parameters from our well-established collaboration highlights the difficulties prioritizing competing outcomes, variable potentially-better-practice applications amongst NICUs, unmeasured biologic interactions, and obscured cultural-environmental contexts that all likely affect care. Triple Aim excellence, if even remotely possible, will necessitate scalable, evidence-based methodologies, pragmatism regarding inevitable trade-offs, and wise constrained-resource decisions. · The Triple Aim gold standard is elusive. There is no demonstration of sustained, large-scale success in healthcare and our quality improvement network has previously published benchmark extreme prematuritymorbidity improvements.. · Extreme prematurity outcomes illustrated as the Triple Aim show uneven results in relevant surrogate parameters and Triple Aim achievement, if even possible, will necessitate evidence-based methodologies that are scalable.. · Pragmatism, inevitable trade-offs, and wise constrained-resource decisions are required for Triple Aim success..

Oropharyngeal application of colostrum or mother's own milk in preterm infants: a systematic review and meta-analysis.

Many preterm neonates often cannot be fed enterally and hence do not receive the benefits of colostrum. Oropharyngeal application of colostrum is a novel way of harnessing the immunological benefits of colostrum. Randomized controlled trials (RCTs) investigating the efficacy of this approach have shown variable results. The aim of this systematic review was to synthesize available data on the effect of oropharyngeal application of colostrum or mother's own milk (CMOM) in preterm infants. Six electronic databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Cochrane Library) were searched until January 13, 2022. Only RCTs comparing oral application of CMOM with placebo/routine care in preterm infants were eligible. Studies enrolling term neonates or administering enteral feeds were excluded. Two investigators independently extracted data using a structured proforma. The Cochrane Risk of Bias 2 tool was used to assess bias. Random-effects meta-analysis was undertaken using RevMan 5.4 software. From 2787 records identified, 17 RCTs enrolling 4106 preterm infants were included. There was no significant difference between groups in incidence of necrotizing enterocolitis (NEC) stage 2 or higher (RR = 0.65; 95%CI, 0.36-1.20; 1089 participants in 12 trials). Application of CMOM significantly reduced the incidence of sepsis (RR = 0.72; 95%CI, 0.56-0.92; 1511 participants in 15 studies) and any stage of NEC (RR = 0.58; 95%CI, 0.37-0.92; 1616 participants in 16 trials). The CMOM group achieved full enteral feeds 1.75 days sooner (95%CI, 0.3-3.2 days; 1580 participants in 14 studies) and had higher weight at discharge (MD = 43.9 g; 95%CI, 3-85 g; 569 participants in 3 studies). There were no statistically significant differences in other outcomes. Evidence with low to very low certainty suggests CMOM has a beneficial effect on NEC (any stage), sepsis, and time to full enteral feeds. Given its low cost and minimal risk of harm, routine CMOM use may be considered in preterm neonates. CRD42021262763.

168 - Assessing barriers to kangaroo care in premature infants admitted to the neonatal intensive care unit

168 - Assessing barriers to kangaroo care in premature infants admitted to the neonatal intensive care unit

Early prediction of bronchopulmonary dysplasia: can noninvasive monitoring methods be essential?

Despite remarkable breakthroughs in diagnosis and treatment, the prevalence of bronchopulmonary dysplasia (BPD) in preterm infants and the consequent mortality have remained high over the last half-century. The pathophysiology of BPD is complicated, with several causes. In addition, infants with severe BPD are predisposed to a variety of complications that need multidisciplinary collaboration during hospitalisation and post-discharge home treatment. Consequently, early prediction, precise prevention and individualised management have become the cornerstones of therapeutic care of preterm infants with BPD, thereby improving patient survival and prognosis. BPD has an operational clinical description; however, it has various clinical phenotypes and endotypes, making accurate prediction challenging. Currently, most approaches for predicting BPD in preterm infants include invasive collection of biofluids, which is inappropriate in fragile neonates. Consequently, researchers and clinicians are becoming more interested in noninvasive monitoring for BPD prediction. Comprehensive assessments of pertinent research, however, remain scarce. In this review, we compared many noninvasive monitoring techniques that contribute to early prediction of BPD development in premature infants.

Automated oxygen control for very preterm infants and neurodevelopmental outcome at 2 years−a retrospective cohort study

Faster resolution of hypoxaemic or hyperoxaemic events in preterm infants may reduce long-term neurodevelopmental impairment. Automatic titration of inspiratory oxygen increases time within the oxygen saturation target range and may provide a more prompt response to hypoxic and hyperoxic events. We assessed routinely performed follow-up at 2 years of age after the implementation of automated oxygen control (AOC) as standard care and compared this with a historical cohort. Neurodevelopmental outcomes at 2 years of age were compared for infants born at 24–29 weeks gestational age before (2012–2015) and after (2015–2018) the implementation of AOC as standard of care. The primary outcome was a composite outcome of either mortality or severe neurodevelopmental impairment (NDI), and other outcomes assessed were mild-moderate NDI, Bayley-III composite scores, cerebral palsy GMFCS, and CBCL problem behaviour scores. A total of 289 infants were included in the pre-AOC epoch and 292 in the post-AOC epoch. Baseline characteristics were not significantly different. Fifty-one infants were lost to follow-up (pre-AOC 6.9% (20/289), post-implementation 10.6% (31/292). The composite outcome of mortality or severe NDI was observed in 17.9% pre-AOC (41/229) vs. 24.0% (47/196) post-AOC (p = 0.12). No significant differences were found for the secondary outcomes such as mild-moderate NDI, Bayley-III composite scores, cerebral palsy GMFCS, and problem behaviour scores, with the exception of parent-reported readmissions until the moment of follow-up which was less frequent post-AOC than pre-AOC.Conclusion: In this cohort study, the implementation of automated oxygen control in our NICU as standard of care for preterm infants led to no statistically significant difference in neurodevelopmental outcome at 2 years of age. What is Known:• Neurodevelopmental outcome is linked to hypoxemia, hyperoxaemia and choice of SpO2 target range.• Automated titration of inspired oxygen may provide a faster resolution of hypoxaemic and hyperoxaemic events.What is New: • This cohort study did not find a significant difference in neurodevelopmental outcome at two years of age after implementing automated oxygen control as standard of care.

Risk factors for mortality of preterm infants in the neonatal medicine department of the ‘Mère-Enfant’ University Hospital Centre of Libreville

Background: Reducing neonatal mortality of preterm infants is a public health priority in developing countries. The objective of this study was to study the risk factors for mortality of preterm infants in the neonatology department of UHCME-JEF. Methods: A retrospective, analytical study was done over 36 months (January 2019-December 2021) in the neonatology department of UHCME-JEF. Maternal and newborn parameters were studied. All hospitalized preterm newborns were included. Results: The prevalence of prematurity was 44.6%. The mortality rate was 18.7%. The mean age of mothers was 28.05±6.5 years. They were unemployed (69.4%) and single (73.6%). The three main causes of death were sepsis (41.7%), respiratory failure (26.0%), and anoxic-ischemic encephalopathy (15.3%). The risk factors associated with death were multiparity [p=0.001, OR=2.0, IC 95% (1.32-3.00)], pre-existing maternal diabetes [p=0.007, OR=2.4, IC 95% (1.31-4.52)], prenatal check-up not done [p=0, 024, OR=1.5 IC 95% (1.04-2.05)], GA&lt;28SA [p&lt;0.001, OR=1.8 IC 95% (1.24 -2.71)], Apgar &lt;3 at the first [p=0.036, OR=1.8, IC 95% (1.21-2.76)] and fifth minute [p=0.010, OR=3.2, IC 95% (1.35-7.74)] resuscitation at birth [p=0.017, OR=1.5, IC 95% (1.04-2.05)], birth weight &lt;1000 g (p=0.001, OR=2.8, IC 95% (1.92-4.23)], hypotonia [p=0.001, OR=1.6, IC 95% (1.23-2.32)], asphyxia [p=0.020, OR=1.7 CI 95% (1.09-2.55)], hypothermia [p&lt;0.001, OR=2.1, CI 95% (1.56-2.86)], the presence of thrombocytopenia [p=0.001, OR=1.9, CI 95% (1.62-2.93)] and glycemic dysregulation [p=0.001, OR=2.8, CI 95% (2.09-3.73)]. Conclusions: The mortality of preterm newborns remains a major problem in our department. It is necessary to promote good surveillance of pregnancy, and correct care of premature infants in the delivery room and hospitalization.

Living with a birthmark: Phenomenology of prematurity for mothers in Turkey

BackgroundMothers of premature infants are in the risk group for having psychological symptoms and attachment-interaction difficulties. Preventing these maternal risks is essential for providing optimal care and health opportunities for infants, consequently improving developmental outcomes. MethodsIn this study, we aimed to understand how mothers experienced prematurity within four processes retrospectively: (a) the mother's hospitalization after birth, (b) the infant's hospitalization in the Neonatal Intensive Care Unit (NICU), (c) after discharge, and (d) in early childhood. We adopted Max van Manen's phenomenology of practice and interviewed nine mothers whose children were born premature and reached early childhood. FindingsThe themes were as follows: (a) incomplete mother; (b) facing prematurity, uncertainty, natural touch barrier, facing reductive social response, and NICU friendship; (c) being on the alert, a period of complete closure, and fighting with the reductive social response; (d) association to prematurity and (cannot) overcome the difficulties. We expressed the mothers' overall experiences through the metaphor “living with a birthmark.” This metaphor represents the longitudinal effects of prematurity. As much as it is apparent and painful at first, it fades over time, and the pain lessens, but the effects of the birthmark remain in early childhood. The birthmark becomes a part of the mother-baby relationship. Conclusions and practice implicationsOur study contributes to premature infant care and health literature by highlighting the longitudinal experiences of mothers on prematurity.

Association Between Neonatal Intensive Care Unit Type and Quality of Care in Moderate and Late Preterm Infants

A higher level of care improves outcomes in extremely and very preterm infants, yet the impact of neonatal intensive care unit (NICU) level on moderate and late preterm (MLP) care quality is unknown. To examine the association between NICU type and care quality in MLP (30-36 weeks' gestation) and extremely and very preterm (25-29 weeks' gestation) infants. This cohort study was a prospective analysis of 433 814 premature infants born in 465 US hospitals between January 1, 2016, and December 31, 2020, without anomalies and who survived more than 12 hours and were transferred no more than once. Data were from the Vermont Oxford Network all NICU admissions database. NICU types were defined as units with ventilation restrictions without surgery (type A with restrictions, similar to American Academy of Pediatrics [AAP] level 2 NICUs), without surgery (type A) and with surgery not requiring cardiac bypass (type B, similar to AAP level 3 NICUs), and with all surgery (type C, similar to AAP level 4 NICUs). The primary outcome was gestational age (GA)-specific composite quality measures using Baby-Measure of Neonatal Intensive Care Outcomes Research (Baby-MONITOR) for extremely and very preterm infants and an adapted MLP quality measure for MLP infants. Secondary outcomes were individual component measures of each scale. Composite scores were standardized observed minus expected scores, adjusted for patient characteristics, averaged, and expressed with a mean of 0 and SD of 1. Between May 2021 and October 2022, Kruskal-Wallis tests were used to compare scores by NICU type. Among the 376 219 MLP (204 181 [54.3%] male, 172 038 [45.7%] female; mean [SD] GA, 34.2 [1.7] weeks) and 57 595 extremely and very preterm (30 173 [52.4%] male, 27 422 [47.6%] female; mean [SD] GA, 27.7 [1.4] weeks) infants included, 6.6% received care in type A NICUs with restrictions, 29.3% in type A NICUs without restrictions, 39.7% in type B NICUs, and 24.4% in type C NICUs. The MLP infants had lower MLP-QM scores in type C NICUs (median [IQR]: type A with restrictions, 0.4 [-0.1 to 0.8]; type A, 0.4 [-0.4 to 0.9]; type B, 0.1 [-0.7 to 0.7]; type C, -0.7 [-1.6 to 0.4]; P < .001). No significant differences were found in extremely and very preterm Baby-MONITOR scores by NICU type. In type C NICUs, MLP infants had lower scores in no extreme length of stay and change-in-weight z score. In this cohort study, composite quality scores were lower for MLP infants in type C NICUs, whereas extremely and very preterm composite quality scores were similar across NICU types. Policies facilitating care for MLP infants at NICUs with less complex subspecialty services may improve care quality delivered to this prevalent, at-risk population.

The Effect of a Virtual Educational and Supportive Intervention on the Mothers’ Resilience with Preterm Infants: A Quasi-experimental Study

Background: Infants’ admission to neonatal intensive care units (NICUs) leads to the psychological vulnerability of their mothers. Providing education and implementing supportive interventions can improve the quality of parental care of premature infants and empower parents. The presence and participation of parents in the care of preterm infants may improve parents’ resilience. Objectives: This study aimed to examine the effect of a virtual educational and supportive intervention on the mothers’ resilience with preterm infants admitted to NICUs in 2020. Methods: This quasi-experimental study was conducted on 100 mothers with preterm infants admitted to Afzalipour Hospital in Kerman in 2020. The participants were selected by purposive and convenience sampling and were divided into intervention and control groups using a random number table. The educational and supportive training intervention program was implemented for 2 weeks in the intervention group. However, the control group only received routine care. The data were collected using a demographic information questionnaire and the Connor-Davidson Resilience Scale (CD-RISC). The collected data were analyzed using SPSS version 22 at a significance level of 0.05. Results: Resilience and all its dimensions showed significant improvements in the intervention group compared to their resilience before the intervention. The mean resilience scores in the intervention group were 57.62 ± 13.95 and 76.96 ± 08.07 before and after the intervention (P &lt; 0.05). The mean resilience scores in the control group were 60.40 ± 14.41 and 62.70 ± 11.09 before and after the intervention (P &gt; 0.05). Overall, the mean scores of resilience and its dimensions increased significantly in the intervention group than in the control group (P &lt; 0.05). Conclusions: Implementing a virtual educational and supportive intervention improved the resilience of mothers with preterm infants. Overall, this program can be used by nursing managers and nurses to provide supportive care for parents of premature infants to improve the quality of care in these wards. Further research can be done to examine the attitudes and experiences of health care workers in this field.

Exploring cultural determinants to be integrated into preterm infant care in the neonatal intensive care unit: an integrative literature review

BackgroundCultural practices are an integral part of childrearing and remain a significant aspect for healthcare professionals to ensure culturally sensitive care, particularly in the neonatal intensive care unit.ObjectiveTo synthesise literature on the cultural determinants that can be integrated into care of preterm infants admitted into the neonatal intensive care unit.MethodsThe current review followed the integrative literature review steps proposed by Lubbe and colleagues. The registration of the review protocol was in PROSPERO. There was a literature search conducted in the EBSCOhost, PubMed, ScienceDirect and Scopus databases using the search string developed in collaboration with the librarian. Three reviewers employed a three-step screening strategy to screen the articles published in English between 2011 and 2021 that focused on culturally sensitive care. The Johns Hopkins Nursing Evidence-Based Practice Evidence critical appraisal toolkit assessed the methodological quality of the articles included at the full-text screening level.ResultsThere were 141 articles retrieved, and 20 included on the full-text screening level; the exclusion of one article was due to a low critical appraisal grade. Four topical themes emerged from 19 articles: spiritual care practices, intragenerational infant-rearing practices, infant physical care practices, and combining treatment practices.ConclusionOverall, the findings indicated that parental cultural beliefs and practices mostly influenced infant-rearing practices, emphasising the significance of integrating cultural practices when rendering healthcare services. The recommendation is that healthcare professionals understand various cultural determinants, mainly those specific to the community they serve, to provide culturally sensitive care.

РАЗРАБОТКА РЕКОМЕНДАЦИЙ ПО ФОРМИРОВАНИЮ ТАРИФА ОМС ДЛЯ УХОДА ЗА НЕДОНОШЕННЫМИ ДЕТЬМИ

Premature babies require special care and medical care, the cost of which is often quite high. In Russia, medical care for premature infants is provided in the system of compulsory medical insurance (CHI). However, the current tariffs do not correspond to the real situation. As a result, there is a shortage of funding for medical organizations, which directly affects the quality of services provided. The article is devoted to the analysis of recommendations on the formation of the compulsory medical insurance tariff for children born prematurely. The domestic and foreign experience is being investigated. An estimate of the costs of care, nursing and rehabilitation of premature infants is given. An important aspect in the development of recommendations for the formation of the CHI tariff is the participation of experts in the field of healthcare, including pediatricians, neonatologists, obstetricians and gynecologists and other specialists familiar with the problems of caring for premature babies. They can provide valuable information about the required level of medical care, possible complications and required resources. Based on the analysis of the costs of caring for premature babies in Russia, recommendations are formulated for the formation of compulsory health insurance tariffs: the inclusion in the tariff of the cost of all necessary procedures and medical services related to the care of premature babies; the determination of the tariff depending on the age and body weight of the child at birth, the presence of complications, the length of hospital stay, the level of medical services and qualifications of medical personnel; regular updating of tariffs taking into account changes in the cost of medical services and procedures; ensuring the availability of high-quality medical care for premature babies, despite their social status. In addition, the main factors affecting the cost of caring for premature babies have been identified. The developed recommendations can help improve the quality of medical care for premature babies and reduce the socio-economic burden on their parents.

A modern approach to developing care for a premature baby

Around the world every year, about 15 million children are born prematurely. On average, 1 in 10 babies are born prematurely. In Russia, more than 110,000 children are born prematurely every year, which is about 5.7 % of all newborns per year [1]. The most important role in nursing, treatment and provision of high-tech medical care, solving moral and ethical problems is assigned to the neonatologist and nurses at all stages of nursing premature babies. The neonatology service currently uses developmental care for premature babies

Analysis of Fractional Cerebral Oxygen Extraction in Preterm Infants during the Kangaroo Care

Introduction: We aimed to investigate the cerebral fractional tissue oxygen extraction (FtOE) during kangaroo care (KC) in premature infants and compare cardiorespiratory stability and hypoxic or bradycardic events between KC and incubator care. Methods: A single-center prospective observational study was carried out at the NICU of a level 3 perinatal center. Preterm infants <32 weeks gestational age were subjected to KC. Patients were subjected to continuous monitoring of regional cerebral oxygen saturation (rScO₂), peripheral oxygen saturation (SpO₂), and heart rate (HR) during KC, before KC (pre-KC), and after KC (post-KC). The monitoring data were stored and exported to MATLAB for synchronization and signal analysis including the calculation of the FtOE and events analysis (i.e., desaturations and bradycardias counts and anormal values). Furthermore, the event counts and the mean SpO₂, HR, rScO₂, and FtOE were compared between studied periods employing the Wilcoxon rank-sum test and the Friedman test, respectively. Results: A total of forty-three KC sessions with their corresponding pre-KC and post-KC segments were analyzed. The distributions of the SpO₂, HR, rScO₂, and FtOE showed different patterns according to the respiratory support, but not differences between the studied periods were detected. Accordingly, no significant differences in monitoring events were evidenced. However, cerebral metabolic demand (FtOE) was significantly lower during KC compared with post-KC (p = 0.019). Conclusion: Premature infants remain clinically stable during KC. Moreover, cerebral oxygenation is significantly higher and cerebral tissular oxygen extraction is significantly lower during KC compared with incubator care in post-KC. No differences in HR and SpO₂ were shown. This novel data analysis methodology could be expanded to other clinical situations.