Low Birth Weight Preterm Infants Research Articles

Impact of Kangaroo mother care plus massage therapy on growth of preterm low birth weight infants at discharge

Background: To assess the impact of kangaroo mother care plus massage therapy on growth of preterm low birth weight infants at discharge. Methods: This randomized controlled trial was conducted in Department of Neonatology in Bangabandhu Sheikh Mujib Medical University over a period of 15 months from March 2022 to June 2023. Total 122 newborns were admitted in neonatal intensive care unit (NICU) of BSMMU during the study period with birth weight 800g to <2000g and gestational age 28 weeks to <34 weeks were enrolled in the study after getting informed written consent from parents or caregiver. Infants with major congenital anomalies were excluded from this study. All data were analyzed by statistical package for social sciences (SPSS) version 25 (IBM, USA). Results: Total 122 newborns were admitted in neonatal intensive care unit (NICU) of BSMMU during the study period with birth weight 800g to <2000 g. Among them, 80 infants fulfilled inclusion criteria. Growth was significantly better in KMC plus massage therapy group. Mean weight gain per kg per day in KMC plus massage therapy group was 13.34±10.20 g and it was nearly half in KMC group 6.18±11.84 g only (p-value-0.01). Increase in length was 0.95±0.62 cm in KMC plus massage therapy group vs KMC group 0.66±0.49 cm (p-value-0.04). Increase in OFC was 0.59±0.29 cm in KMC plus massage therapy group vs KMC group 0.42±0.33 cm at discharge (p-value-0.03). Hospital stay in KMC group was 6.36±3.52 days, alternatively it was more 8.33±2.39 days in KMC plus massage therapy group. The dissimilarity was statistically significant (p-value-0.01) Study implication: Massage therapy potentiates benefits of kangaroo mother care in respect to better growth, so massage can be added along with KMC for better outcome. Conclusions: Massage therapy added to KMC is more effective than KMC alone in improving growth, although it did not affect the hospital stay.

3D scanner measuring preterm infants’ head circumference and cranial volume: validation in a simulated care setting

IntroductionWeekly head circumference (HC) measurements using a measuring tape is the current standard for longitudinal brain growth monitoring of preterm infants. The MONITOR3D (M3D) 3D scanner has been developed to measure both HC and cranial volume (CrV) of preterm infants within incubators. The M3D’s usability, accuracy and precision were validated in a simulated setting in a neonatal intensive care unit (NICU).Materials and methodsDuring a simulated routine care moment, NICU nurses conducted M3D scans of a preterm doll simulating an extreme low birthweight preterm (ELBW; BW < 1,000 g) infant, followed by manual HC measurements using a measuring tape. Usability was quantified by percentage of successful HC and CrV measurements from scans. HC and CrV were calculated by marking anatomical landmarks on the 3D image. Measurements were compared to the real, ground truth (GT) values of the doll’s head, defined by an accurate medical scanner. Measurement accuracy was assessed using mean or median absolute measurement error (ME), and precision by the spread of ME, represented by the 95% interval of the ME range. ME intervals were compared with preterm weekly growth increases to assess clinical usability.ResultsRegarding usability, 56 M3D scan sessions resulted in 25 successful (44.6%) HC and CrV measurements, with incomplete 3D data being the primary cause of unsuccessful scans. Accuracy of the measuring tape for HC was 0.2 cm (proportional 0.9% of GT), and precision was 1.6 cm (6.3%). M3D’s accuracy of HC was 0.4 cm (1.5%), and precision was 0.7 cm (2.9%). For CrV, M3D’s accuracy was 8.0 mL (3.8%) and precision 22.6 mL (10.8%).ConclusionThe M3D scanner is suitable for measuring HC and CrV in ELBW infants. However, current scan success rate is too low for practical usability. The M3D’s accuracy and precision are clinically sufficient, while the precision of the current measuring tape method is inadequate for preterm infants. This makes the M3D a promising alternative for HC, offering less disturbance to the infant. In the future, the M3D technique could facilitate the creation of CrV growth reference charts for ELBW infants, enhancing the accuracy of clinical growth monitoring for preterm infants.

Effects of rapid enteral feed advancement with early human milk fortification in very low birth weight preterm infants > 30 weeks gestation in a resource limited setting- a randomized controlled trial.

To study the effects of rapid enteral feed advancement with early feed fortification in stable very low birth weight (VLBW) infants >30 weeks gestation. Preterm infants (N = 92) were randomized to a) rapid feed advancement-early fortification - REF group (enteral feed advanced at 25-30 ml/kg/day, fortification at 50 ml/kg/day) or b) slow feed advancement-late fortification-SLF group (feed advanced at 15-20 ml/kg/day, fortification at 100 ml/kg/day). The primary outcome-time to regain birth weight was significantly lower in REF group (9 days vs 13 days, P = 0.02). REF group reached full enteral feeds earlier (6 days vs 9 days, P = 0.001), had lower rates of sepsis (13% vs 38%, P = 0.007) and shorter hospital stay (10 days vs 15 days, P = 0.01). At one year, the median Z-scores for weight [-1.5 vs -2.2, P < 0.001] and head circumference [1.1 vs 0, P < 0.001) were significantly higher in the REF group. In VLBW preterm infants >30 weeks, rapid feed advancement with early fortification resulted in early postnatal regain of birth weight with positive effects on growth at one year.

Effect of hospital nutrition program on growth of very low birth weight preterm babies.

Objective: To determine the effect of hospital nutrition program on growth of very low birth weight (VLBW) and extremely low birth weight (ELBW) babies. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of Recep Tayyep Erdogan Hospital, Muzaffargarh, Pakistan. Period: February 2024 to July 2024. Methods: Inclusion criteria were preterm newborns weighing below 1500 grams, admitted in NICU and who received total parenteral nutrition (TPN). VLBW was labeled as birth weight between 1000-1499 grams, while ELBW as birth weight &lt;1000 grams. Hospital nutrition program included TPN plus orogastric feed or nasogastric feeding plus micronutrients. Effect of hospital nutrition program was described as effective if the baby at the time of discharge added 17-20 g/kg/day according to ESPHGAN recommendation. Results: In a total of 131 newborns, 69 (52.7%) were boys. The mean gestational age, and birth weight were 29.68±1.87 weeks, and 1024.50±144.23 grams, respectively. The mean net daily weight gain at the time of discharge was 12.77±3.63 grams. The effective hospital nutrition program was noted in 23 (17.6%) babies. Effectiveness of hospital nutrition program was significantly associated with higher birth weight (1094.78±114.41 vs. 1009.54±145.93 grams, p=0.010), very low birth weight versus extremely low birth weight (87.0% vs. 13.0%, p&lt;0.001), head circumference ≥30 cm (87.0% vs. 53.7%, p=0.003), and gestational age &gt; 28 weeks (87.0% vs. 57.4%, p=0.008). Conclusion: The hospital nutrition program had limited effectiveness, with only 17.6% of VLBW and ELBW infants achieving the recommended weight gain by discharge.

Association between maternal smoking and duration of breastfeeding in very low birth weight preterm infants after discharge from a Neonatal Intensive Care Unit

Association between maternal smoking and duration of breastfeeding in very low birth weight preterm infants after discharge from a Neonatal Intensive Care Unit

Cardiogenic Necrotizing Enterocolitis in Infants with Congenital Heart Disease: A Systematic Review and Meta-analysis.

Necrotizing enterocolitis (NEC) is a known cause of morbidity and mortality in infants with congenital heart disease (CHD), but reports about the burden of cardiogenic NEC frequently conflict. To synthesize the extant literature on the incidence, risk factors, and prognosis of NEC in patients with CHD. Medline, Cochrane, and EMBASE were searched from 1946 through 2023 for studies of NEC in infants 0-12months of age with CHD. Risk of bias was assessed with validated tools for incidence and risk factors. Pooled estimates were meta-analyzed by risk of bias or synthesized without meta-analysis. Eighty-six studies with a total of 67,924 participants were included. The incidence of cardiogenic NEC was 7.1% (95% CI 4.7-10.5%) in term infants and 13.0% (10.2-16.5%) in low birthweight preterm infants. NEC required surgery in 0.8% (0.5-1.1%) of term and 2.7% (2.0-3.7%) of premature infants, respectively. Only gestational age and birth weight were consistently associated with risk of NEC. Restricting pooled estimates to studies of moderate or low risk of bias significantly reduced the number of studies included. Necrotizing enterocolitis is a common cause of morbidity in infants with CHD, but additional research is needed to determine which infants are at highest risk of developing NEC and would benefit most from a change in management. This systematic review and meta-analysis was conducted according to a prespecified protocol registered at the Prospective Register of Systematic Reviews (CRD42021282114).

A Moving Target: Studying the Effect of Continuous Transcutaneous CO2 Monitoring in ELBW Infants During an Equipoise Shift.

Objectives: To assess whether continuous non-invasive pCO2 monitoring by transcutaneous pCO2 monitor (TCpCO2) among extremely low birth weight (ELBW) premature infants, during the first week of life, will decrease the rate of high-grade intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) or the combined outcome of IVH/PVL and death. Methods: This was a prospective, observational, multicenter study. Due to ethical constraints, allocation was based on TCpCO2 monitor availability. ELBW infants were either monitored by TCpCO2 monitor (Sentec, Therwil, Switzerland) (study group), or recruited to the control group if a TCpCO2 monitor was not available. Results: A total of 132 ELBW infants participated in the study. The size of the study group (106 infants) and the control group (26 infants) differed because monitor availability increased during the study period reflecting change in standard of care. The groups had comparable gestational age and baseline characteristics. No difference was found in the rate of IVH/PVL in the study vs. control groups (10% vs. 4%; p = 0.7, respectively), or in the combined outcome of PVL/IVH and death (16% vs. 15%; p = 1.0, respectively). Conclusions: This study demonstrates the challenges in conducting a prospective controlled trial in a rapidly evolving medical field. While the study began with a clear equipoise, this balance shifted as the care team gained more experience with TCpCO2 monitoring among the study population, despite the absence of new clinical evidence to justify such a shift. Consequently, the small control group limited our ability to draw definitive conclusions regarding the study's objective. However, our findings may increase awareness of continuous non-invasive pCO2 monitoring in extremely premature infants.

Oral Gastrografin: A Safe Alternative in Meconium Obstruction of Prematurity

Meconium obstruction of prematurity is primarily seen among very low birthweight or extremely low birthweight premature babies, causing low intestinal obstruction. It may delay the establishment of early full enteral feeding and compromise nutrition or cause obstruction requiring surgery or intestinal perforation. Currently, the management is mainly based on expert opinion and low-quality evidence. Conventional hyperosmolar contrast enema and gastrografin enema may not reach the site of obstruction because of the proximal nature of the meconium obstruction. Oral gastrografin is an effective and safe alternative for relieving meconium obstruction in a 28-week preterm baby. This avoids the need for surgery. This article highlights the use of oral route of gastrografin as a good nonsurgical alternative in extreme preterm babies in resource-limited circumstances.

Analysis of zinc and copper levels in very low birth weight infants using human milk additives: phase 1 trial findings

ObjectiveThe aim of this study was to assess whether the micronutrients zinc and copper, provided by human milk additives, are sufficient for very low birth weight preterm infants. MethodA phase 1 randomized double-blind controlled trial was conducted with very low birth weight preterm infants. This is a secondary analysis of copper and zinc. Sixty-six newborns were part of the initial sample, with forty participating and reaching the final stage of the study. Inclusion criteria were: gestational age less than 37 weeks, birth weight greater than or equal to 750 g and less than or equal to 1500 g, small or appropriate for gestational age, exclusively receiving human milk at a volume greater than or equal to 100 mL per kilogram per day, and hemodynamically stable. Participants were randomly assigned to two groups: intervention, Lioneo (received human milk with additive based on lyophilized human milk), n = 20, and control, HMCA (received human milk with commercial additive based on cow's milk protein), n = 20, and their serum levels of zinc and copper were measured on the first and twenty-first days. ResultsThere was a reduction in intragroup zinc serum levels from the first to the twenty-first day of the study (p < 0.01). There was no intergroup difference. No difference was found in serum copper levels. ConclusionHuman milk additives were not sufficient to maintain adequate zinc serum levels in very low birth weight newborns. It was not possible to affirm whether human milk additives were sufficient to maintain adequate serum copper levels in the studied sample. UTN: U1111–1220–0550.

Analysis of nutritional support status and related factors in low birth weight premature infants

Analysis of nutritional support status and related factors in low birth weight premature infants

Effect of Interpregnancy Interval on Pregnancy Outcome in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Interpregnancy interval has a major impact on the maternal and fetal health worldwide. Women with short interpregnancy interval show higher rates of low birth weight and preterm babies. So this study aimed to study the effect of interpregnancy interval on pregnancy outcomes.Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care center after taking ethical approval from Institutional Review Committee (Reference number:229/080/081(6-11)E2). Data from September 1st, 2023 to January 30th, 2024 was collected. All multigravida women with singleton pregnancy after 28 weeks of gestation who delivered in our hospital with previous birth were enrolled in the study. Convenience sampling method was done. Point estimate and 95% Confidence Interval were calculated. The data was entered and analyzed using IBM SPSS Statistics version 26.0Results: Among the women , 31 (3.57%) women had short interpregnancy interval ≤18 months whereas 836 (96.43%) had interpregnancy interval of &gt;18 months. The mean age of the women was 28 years. Previous cesarean section was common indication of cesarean section 27 (87.09%) among women with short interpregnancy interval. These women had higher rates of preterm and low birth weight babies 11(35.58%) &amp; 15(48.38%).Conclusions: Women with short interpregnancy interval ≤18 months had higher preterm births and low birth weight babies. Pregnancy induced hypertension, hypothyroidism and gestational diabetes were increased in women with interpregnancy interval of &gt;18 months.

Adjusted versus Targeted Fortification in Extremely Low Birth Weight Preterm Infants: Fortin Study-A Randomized Clinical Trial.

Fortified human milk is the first choice for preterm infants. Although individualized fortification is recommended, the optimal method for this population remains uncertain. We conducted a comparative study assessing the growth effects of adjusted (AF) and targeted fortification (TF) in extremely low birth weight (ELBW) infants. This single-center, randomized, controlled clinical trial was conducted at a tertiary neonatal unit in Spain. Eligible participants were premature infants with a birthweight of <1000 g exclusively fed with human milk. A total of 38 patients were enrolled, 15 of them randomized to AF group and 23 to TF group. AF was based on blood urea nitrogen (BUN) concentration and TF on human milk analysis. The primary outcome was weight gain velocity (g/kg/day). No significant differences were found in weight gain velocity at 28 days, at 36 weeks of postmenstrual age, at discharge, nor during the intervention. Protein intake was significantly higher in the AF group (5.02 g/kg/day vs. 4.48 g/kg/day, p = 0.001). No differences were found in the lipid, carbohydrate, and energy intake; in the weight z score change between the different time points; nor in the length and head circumference growth. Both AF and TF are comparable methods of fortification and provide the appropriate growth rate in ELBW infants.

The effect of kangaroo mother care on weight gain pattern in low birth weight premature babies at a tertiary care hospital

Abstract Background: Premature infants are at high risk of death. They need specialized incubatory care which is very costly and requires skilled workforce and specialized equipment. Kangaroo mother care (KMC) does the same job with no cost and does not require set-up as for incubatory care. It can prevent mortality and morbidity and also promotes bonding between mother and child. Objective: The objective of the study was to study the effect of KMC on weight gain pattern in low birth weight premature babies compared to incubatory care. Materials and Methods: A nonrandomized experimental study was carried out among 200 premature infants. They were divided into two groups of 100 each. Randomization was not done. One group was given KMC. The second group was given incubatory care. The weight of babies in both groups was measured with a digital weighing machine. Both groups were followed till the 9th day with a follow-up frequency of days – 1, 3, 5, 7, and 9. On each follow-up day, weight was recorded. Results: Both groups were comparable for gender, birth weight, and gestational age. In the KMC group, there was significant weight gain on day 2 compared to day 1 and on day 7 compared to day 6. But weight gain on day 3 compared to day 2 and on day 9 compared to day 8 was not significant. In the non-KMC group, there was significant weight gain on day 3 compared to day 2 and on day 9 compared to day 8. From 2nd day to 9th day, each day weight gain in the KMC group was higher compared to the non-KMC group. Conclusion: We conclude that the KMC significantly improved weight gain on a daily basis. The KMC also improved the weight gain compared to that of the non-KMC group. Hence, we recommend to create awareness among the community at all health-care levels and among health-care professionals on the benefits of KMC/the importance of KMC.

Weaning off heated humidified high flow nasal cannula successfully in a 24-week extreme low birth weight infant in South-South Nigeria: a case report

The use of heated humidified high flow nasal cannula (HHHFNC) has become increasingly popular for providing noninvasive respiratory support for neonates with respiratory distress syndrome (RDS). However, there are several challenges to its use as primary respiratory support in extreme low birth weight (ELBW) preterm infants delivered before 28 weeks gestational age (GA), these include: lack of established guideline; and conflicting reports from studies on the risk of respiratory failure (apnea), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and death. In Nigeria, HHHFNC is not widely known nor used in most neonatal care facilities, including level III Neonatal care facilities. Despite adequate literature search, there is little or no known report or guideline for the successful use of and weaning from HHHFNC in ELBW neonates, delivered before 28 weeks GA in the Country. We present the successful weaning from HHHFNC as primary respiratory support at 30 weeks post conception age (PCA) in an ELBW preterm infant (weighing 700 gm) with severe RDS, delivered at 24 weeks GA in a neonatal care facility in Nigeria. HHHFNC was commenced at 6l/min following surfactant administration and successfully weaned off at 2l/min at 30 weeks PCA, with no incidence of apnea, BPD, NEC, air leaks, nasal septum damage and death. HHHFNC used as noninvasive primary respiratory support for ELBW preterm neonates with severe RDS delivered before 28 weeks GA is effective and safe; in addition, weaning off HHHFNC in this group of infants at 30 weeks PCA should be explored and recommended as a guideline in Nigeria and globally.

Healthcare workers attitude regarding kangaroo mother care in Nyeri county referral hospital, Kenya.

Background: Kangaroo Mother Care (KMC) is a system used for the care of preterm babies and low birth weight babies. The World Health Organization (WHO) recommends the use of KMC to help achieve Sustainable Development Goal (SDG) 3.2, with an aim of reducing neonatal mortality to 12 per 1,000 live births per country. Healthcare workers play a significant role in initiating, supporting and sustaining the practice of KMC. This study assessed the healthcare workers attitude regarding KMC in Nyeri county referral hospital, Kenya. Methods: This was a cross sectional descriptive survey study. Census sampling method was used to recruit 28 respondents. A researcher administered questionnaires were used to collect data. Analysis was done using SPSS software Version 26. Descriptive statistics and chi-square tests were used for analysis. Results: The study found that 89% (n=25) of the respondents had a positive attitude about KMC practice. Half of all the healthcare workers 50% (n= 14) had received training on KMC. Majority of the healthcare workers 71% (n=25) preferred incubators over KMC. However there was no significant relationship between (X2 = 0.700, df = 1, p = 0.403) training of healthcare worker and KMC adoption. Conclusion: The study concluded that the healthcare workers had a positive attitude towards KMC. Half of them had received training on KMC however, majority preferred incubators over KMC. The study recommends KMC sensitization seminars and continuous training of healthcare workers on KMC. Establishment of excellent centers as a way of motivating them is also recommended.

Particulars of breastfeeding age in preterm child (case report)

Background. General physicians often encounter preterm infants and adverse sequelae of prematurity-related morbidities. Interruption of intrauterine development leads to considerable deficits in the internal organs structure and function. It can lead to endothelial dysfunction, hypertension, proteinuria and metabolic abnormalities that persist throughout life. Children born early or low birth weight (LBW) infants also have relatively increased risk for the deve­lopment of kidney injury later in life. Often these infants have history of treatment at the intensive care unit due to hypoxic damage or inflammatory response that also affects kidneys necessitating the use of nephrotoxic medications. The treatment and diagnosis outcomes were applied to make a conclusion about clinical features of the preterm 7-month-old girl. The data were analyzed using PubMed/MEDLINE and Google Scholar databases. The aim is to summarize particulars of breastfeeding period in a LBW baby, providing a physician with practical information regar­ding organization of a follow-up. Material and methods. The baby was moderately preterm (32–33 weeks of gestation) with LBW (2100 g). Her mother was consulted regarding hypertension and threat of miscarriage during pregnancy. The child had renal borderline states in the newborn period. Apgar score was low, neonatal resuscitation and respiratory support by the continuous positive airway pressure were used. The newborn had poor regulation of body temperature, depended on environmental factors and prone to rapid heat loss, so she was nursed in incubator. A feeding tube was used despite poor sucking at the first days after delivery and breastfeeding was continued as soon as possible. Eventually, formula feeding was started. Results. Fever, vomiting, dehydration, loss of body weight and oliguria appeared in the 7-month-old baby after the upper respiratory tract infection. Examination showed the stigmas, neurodevelopmental delay, physical growth gap. Blood tests revealed anemia of the first stage and a rapid increase in the level of white blood cells with a left shift and electrolyte imbalance. The laboratory tests of primary and secondary hemostasis were normal. Physical, chemical and microscopic urine properties were changed according to results of urine test. The sonography revealed changes in renal tissue and thymic hyperplasia. The child was diagnosed with acute pyelonephritis and treated. Conclusions. Physicians should focus attention on the stigmas, neurodevelopmental delay, physical growth gap, life history, clinical signs and results of examination to make timely conclusion about child’s general state. Kidney injury could be diagnosed in preterm LBW infants.

Neurodevelopmental Outcomes of Very Low Birth Weight Preterm Infants in the Regional Pediatric Clinic

Aim: To examine the incidence and etiology of neurodevelopmental outcomes in very low birth weight preterm infants, maternal and perinatal risk factors, comorbidities, and clinical presentation and compare with newborns of the same gestational age who did not develop a neurodevelopmental disorder.Methods: The research was conducted at the Pediatric Clinic in KBC (Clinical Hospital Center) Osijek. All newborns born from 1 January 2018 to 31 December 2019 with birth weight &amp;lt; 1,500 g and gestational age &amp;lt; 37 weeks are included in the research. The data were collected by reviewing medical records and the hospital’s IT system.Results: In the observed period, 120 children with birth weight &amp;lt; 1,500 g and gestational age &amp;lt; 37 weeks were born. Maternal and perinatal risk factors for premature birth include autoimmune diseases of the mother, infections during pregnancy and birth complications. Early complications that accompany the selected group are RDS, ROP, NEC, IVH, sepsis, congenital heart defects and glucose metabolism disorder. Slowed motor, cognitive and speech development are mostly influenced by low body weight, higher degree of IVH, lower AS in the first minute and the presence of NEC. Significant risk factors for death are gestational age &amp;lt; 25 weeks, body weight &amp;lt; 800 g, infections in pregnancy and autoimmune diseases of the mother.Conclusion: The neurodevelopmental outcome of very low birth weight preterm infants depends on a combination of comorbidities, as well as maternal, perinatal and neonatal risk factors.

Antibiotics and beyond: Unraveling the dynamics of bronchopulmonary dysplasia in very preterm infants.

Bronchopulmonary dysplasia (BPD) remains a significant challenge in neonatal care. Prenatal inflammation and neonatal sepsis contribute to the multifactorial nature of BPD. A potential association between empirical antibiotic therapy and BPD risk has been proposed due to microbiota dysbiosis in very low birth weight premature infants. A single centered retrospective cohort study of preterm infants (24-32 weeks gestation) from 2014 to 2021. The study compared groups that received empirical antibiotics in the first days of life and those that did not receive any antibiotic in the first days of life. The primary outcomes studied were BPD, death, and the combined outcome of BPD/death. Statistical analysis employed t-tests, Mann-Whitney U, Chi-square, and logistic regression. Of 454 preterm infants, 61.5% received antibiotics. This group had lower gestational age, birth weight, and Apgar scores. Antibiotic use was associated with higher incidence of BPD (35.5% vs. 10.3%), death (21.5% vs. 8.6%), and combined outcomes (54.5% vs. 18.3%). In multivariate analysis, antibiotic use independently associated with BPD (OR 2.58, p < 0.001) and combined outcome BPD/death (OR 2.06, p < 0.02). Antenatal corticosteroids provided protection against BPD, but not mortality. This study suggests an association between early empirical antibiotic use and BPD in preterm infants, emphasizing the need for judicious antibiotic practices in neonatal care.

A quality improvement project on reducing antibiotic use duration in very low birth weight preterm infants in the neonatal intensive care unit

To develop effective measures to reduce antibiotic use duration in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit through quality improvement methods. The study population consisted of hospitalized VLBW preterm infants, with the percentage of hospitalization time during which antibiotics were used from November 2020 to June 2021 serving as the baseline. The specific quality improvement goal was to reduce the duration of antibiotic use. Factors affecting antibiotic use duration in preterm infants were analyzed using Pareto charts. Key drivers were identified, and specific interventions were formulated based on the stages of antibiotic use. Changes in the percentage of antibiotic use duration were monitored with run charts until the quality improvement target was achieved. From November 2020 to June 2021, the baseline antibiotic use duration percentage was 49%, with a quality improvement target to reduce this by 10% within 12 months. The Pareto analysis indicated that major factors influencing antibiotic duration included non-standard antibiotic use; delayed cessation of antibiotics when no infection evidence was present; prolonged central venous catheter placement; insufficient application of kangaroo care; and delayed progress in enteral nutrition. The interventions implemented included: (1) establishing sepsis evaluation and management standards; (2) educating medical staff on the rational use of antibiotics for preterm infants; (3) supervising the enforcement of antibiotic use standards during ward rounds; (4) for those without clear signs of infection and with negative blood cultures, discontinued the use of antibiotics 36 hours after initiation; (5) reducing the duration of central venous catheterization and parenteral nutrition to lower the risk of infection in preterm infants. The control chart showed that with continuous implementation of interventions, the percentage of antibiotic use duration was reduced from 49% to 32%, a statistically significant decrease. The application of quality improvement tools based on statistical principles and process control may significantly reduce the antibiotic use duration in VLBW preterm infants. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(7): 736-742.

Lobar Emphysema Successfully Operated in an Extreme Premature Neonate

Background: Lobar emphysema in a newborn may be due to a rare congenital developmental anomaly of the lung, termed congenital lobar emphysema (CLE) or may develop secondary to lung damage, especially with positive airway pressures in premature newborns, known as acquired lobar emphysema (LE). They may have overlapping clinical and radiological features. However, surgical lobectomy is required whenever there is significant respiratory compromise. Reports of surgery in LE in extreme preterms are sparse. Clinical Description: A female newborn with gestational age of 28 weeks, weight of 1.180 kg, presented with respiratory distress after birth, initially treated as hyaline membrane disease. With worsening respiratory distress on positive airway pressures, repeat chest X-ray and computed tomography (CT) chest on day 15 of life, suggested possible LE on the left side with the tracheo-mediastinal shift to the right. Management and Outcome: Left thoracotomy and left upper lobectomy was done, following which, there was rapid improvement in respiratory distress, the newborn being extubated after 6 hours, and weaned off oxygen over the next 3 days. The baby was discharged after 8 weeks and at the last follow-up of 3 years of age, the child was growing well with no complications. Conclusion: Preterm neonates with initial radiological features of hyaline membrane disease, requiring prolonged respiratory support, may be harboring other underlying lung anomalies, which are identified by CT chest. Lobar emphysema with tracheo-mediastinal shift warrants prompt surgery, which is feasible and successful, even in a low birth-weight premature infant.