Skin-to-skin Research Articles

Effect of kangaroo mother care and white noise on physiological-stress parameters in heel lancing: randomized controlled study

BackgroundNewborns are exposed to varying degrees of stressful interventions due to procedures such as heel lancing used in routine metabolic screenings. It is an examination of the effects of white noise and kangaroo care on some physiological parameters and stress markers (cortisol and glucose-regulated protein 78-GRP78) in heel lancing in newborns.MethodsRandomized controlled study was conducted at a gynecology service of a hospital between January and September 2023. 90 babies were divided into three groups: 30 babies in the Kangaroo Care Group (KCG), 30 babies in the White Music Group (WMG), and 30 babies in the Control Group (CG). All babies were randomly divided into groups. Stress parameters were measured by saliva collection method and physiological parameters by saturation device.ResultsA statistically significant difference was determined between the total crying time, pulse and saturation values ​​according to the groups (p < 0.001; p = 0.001). A statistically significant difference was determined between the mean values ​​of cortisol and GRP78 measurements according to group and time interaction (p < 0.001). KCG was more effective in reducing total crying time and stabilizing pulse, saturation, salivary cortisol, GRP-78 values compared to WNG and CG.ConclusionIt was concluded that white noise and kangaroo care help reduce newborns’ stress in the case of heel lancing.Practical implicationsThe practice of kangaroo care and the use of white noise methods may assist healthcare professionals as supportive methods in stress management during invasive procedures.Trial RegistrationNCT06278441, registered on 19/02/2024.

Impact of Kangaroo Mother Care on Severely Acute Malnourished Infants- A Comparative Hospital-Based Study

Impact of Kangaroo Mother Care on Severely Acute Malnourished Infants- A Comparative Hospital-Based Study

Longer skin-to-skin contact after birth enhances breastfeeding quality and duration: A cohort study.

Skin-to-skin contact (SSC) immediately after birth may improve breastfeeding outcomes. This study explored the effect of the duration of SSC in the delivery room on breastfeeding quality and duration. In this prospective observational cohort study, mother-infant pairs practising SSC were categorised into two groups based on SSC duration (≤45 or >45 min). Outcomes included breastfeeding quality in the delivery room and at 24 h of age assessed by the Infant-Breastfeeding Assessment Tool (IBFAT) score, and long-term breastfeeding duration up to 6 months while accounting for potential confounding variables. The study included 72 mother-infant pairs. SSC for more than 45 min was significantly correlated with longer immediate breastfeeding (65 vs. 19 min, p < 0.001) and higher breastfeeding quality scores immediately after birth (IBFAT score of 10 vs. 7, p < 0.001). Regarding the long-term effect, infants in the extended SSC group were breastfed longer (5.2 vs. 3.7 months, p = 0.005) and had exclusive breastfeeding (4.7 vs. 2.7 months, p > 0.001). No significant confounding variables were identified. Extended SSC (>45 min) correlated with prolonged, higher-quality breastfeeding after birth and longer successful breastfeeding.

Theophylline impact on weaning in oxygen-dependent infants followed in an outpatient Kangaroo Program.

Theophylline was an orally administered xanthine used for treatment of apnea of prematurity and Bronchopulmonary Dysplasia in ambulatory follow-up of Low-Birth-Weight infants (LBWI) with oxygen-dependency in the outpatient Kangaroo Mother Care Program (KMCP). Theophylline's main metabolic product is caffeine; therefore, it was an alternative due to the frequent lack of ambulatory oral caffeine in low and middle-income countries. To assess the effectiveness of oral theophylline in decreasing days with oxygen and to describe frequency of adverse related events. Quasi-experiment before and after withdrawal of theophylline given systematically to LBWI with ambulatory oxygen in two KMCPs. 729 patients were recruited; period 1: 319 infants when theophylline was given routinely and period 2: 410 infants when theophylline was no longer used. The theophylline cohort had less gestational age, less weight at birth, more days in Neonatal Intensive Care Unit, more days of oxygen-dependency at KMCP admission, and more frequencies of Intrauterine Growth Restriction and apneas. After adjusting with propensity score matching, multiple linear regression showed that nutrition was associated with days of oxygen-dependency, but theophylline treatment not. No differences were found in frequencies of readmissions up to 40 weeks, intraventricular hemorrhage or neurodevelopmental problems. Participants in period 2 had more tachycardia episodes. We did not find association between oral theophylline treatment and the reduction of days with ambulatory oxygen. For the current management of oxygen-dependency in LBW infants, the importance of nutrition based on exclusive breast feeding whenever possible, is the challenge.

Effect of post-discharge online kangaroo care training on breastfeeding self-efficacy in mothers with preterm infants: A randomised controlled study.

Preterm newborns face many health problems due to their incomplete intrauterine development and the immaturity of their systems. One of these problems concerns nutrition. This study aimed to determine the effect of online kangaroo care (KC) training provided post-discharge on breastfeeding self-efficacy in mothers with preterm infants. This research was conducted as an experimental study with a randomised control group. Two groups were formed: kangaroo care and control. The sample of the study consisted of 68 mothers of preterm infants. The mothers in the KC group were given online KC training after discharge from the hospital. The mothers were asked to perform KC regularly, at least once a day, for 20 min, 7 days a week. The Breastfeeding Self-Efficacy Scale was administered to the mothers before and after training. The results of the study revealed that the difference between the pre-test and post-test breastfeeding self-efficacy scores was statistically significantly higher among the mothers who received online KC training compared with the controls (p < 0.001). According to the results of our research carried out in this context, the mothers who received online KC training had increased breastfeeding self-efficacy compared to those in the control group.

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.

Parents' and healthcare providers' perceptions, experiences, knowledge of, and attitudes toward kangaroo care of preterm babies in hospital settings: Mixed-methods systematic review.

Kangaroo care is an effective intervention to increase survival and improve the health and development of preterm infants. Despite this, implementation of kangaroo care globally remains low. The objectives of this review were to: (a) synthesize evidence on parents' and healthcare practitioners' perceptions, experiences, knowledge of, and attitudes toward kangaroo care of preterm babies in hospital settings; and (b) establish parents' satisfaction with kangaroo care. Studies of any design were included if they focused on parents' or healthcare practitioners' perceptions, experiences, knowledge of, and attitudes to kangaroo care of preterm babies, or reported parents' satisfaction, and were conducted in hospital settings. The search of seven electronic databases, African Journals Online, World Health Organization regional databases, and a gray literature search was conducted in April/May 2020, and updated in January 2024. Study selection was undertaken by two independent reviewers. Quality assessment using the Mixed Method Appraisal Tool and data extraction were completed by one reviewer with a 10% check by a second reviewer. Data were synthesized narratively using a parallel results convergent integrated design. Thirty-seven studies, 19 quantitative, 16 qualitative, and 2 mixed methods, were included. The findings suggested that while healthcare practitioners generally demonstrated knowledge about kangaroo care, there was a notable minority with insufficient understanding among those who received training. Parents' knowledge, particularly among fathers, was limited. Both healthcare practitioners and parents appeared to have positive attitudes to kangaroo care. Little is known about parental satisfaction with kangaroo care. Most healthcare practitioners were knowledgeable about kangaroo care, but parents had limited knowledge. This review findings suggest a need to enhance parental knowledge of kangaroo care before neonatal unit admission, and training is needed for HCPs to implement kangaroo care consistently.

Monitoring lung and cerebral oxygenation using near-infrared spectroscopy in preterm infants during kangaroo mother care

Lung function has never been assessed during kangaroo mother care (KMC) in preterm infants. We measured lung (rSO2L) and cerebral (rSO2C) oxygenation by near-infrared spectroscopy (NIRS) in infants born at less than 32 weeks of gestation or weighing ≤ 1500 g during KMC. rSO2L, rSO2C, and pulmonary (FOEL) and cerebral (FOEC) tissue oxygen extraction fraction were measured in 20 preterm infants before, during, and after a 2-h period of KMC at a mean postnatal age of 36 ± 21 days of life. We found that rSO2L, rSO2C, FOEL, and FOEC did not change in our patients. After 120 min of KMC, rSO2L was lower (71.3 ± 1.4 vs. 76.7 ± 4.6%; P = 0.012) in infants with BPD (n = 6; 30%) than in infants without BPD (n = 14 = 60%), while FOEL was higher (0.26 ± 0.02 vs. 0.20 ± 0.05; P = 0.012).Conclusion: Cerebral and lung oxygenation did not change in preterm infants during KMC. A transient decrease in lung oxygenation was offset by the increase in oxygen extraction, but these changes were clinically insignificant. These results confirm the safety of KMC in preterm infants who are in stable clinical conditions.What is Known• Kangaroo mother care (KMC) is widely used to improve the care of preterm newborns since it improves their outcome.• KMC is safe as patients’ vital parameters, are not negatively affected, but lung function has never been directly assessed.What is New• Cerebral and lung oxygenation measured by near-infrared spectroscopy did not change during KMC.• A transient decrease in lung oxygenation compensated for by the increase in oxygen extraction occurred only in infants with BPD, but these changes were clinically insignificant.

A swallowing and breastfeeding intervention programme for small and sick neonates embedded in kangaroo mother care.

Available evidence of oral sensorimotor interventions for small neonates is not strong. Evidence of interventions for sick term neonates is largely lacking. Studies are limited by risk of bias and inconsistency. Evidence of interventions relying on a single stimulation technique only appears to be low to very low. Ongoing research is required.Contribution:We describe a five-component neonatal swallowing and breastfeeding intervention programme embedded in the practice of kangaroo mother care (KMC). Drawing on oropharyngeal physiology, neonatology, neurodevelopmental care, breastfeeding- and KMC science, the programme is the product of collaboration between a speech-language therapist and a medical doctor, and their team. Its implementation is dependent on coaching mothers and the neonatal care team. Researchers are invited to determine outcomes of the programme.

SAFETY OF SKIN-TO-SKIN CONTACT WITH UMBILICAL VENOUS CATHETER IN PRETERM INFANTS: A PROSPECTIVE STUDY.

Objective For many healthcare providers, an umbilical venous catheter (UVC) may be a contraindication for skin-to-skin contact (SSC). Our aim was to assess the safety of the procedure. Study Design Prospective observational study in newborns less than 35 weeks' gestation. UVC-related adverse events were compared between neonates who performed SSC and those who didn't. The incidence of catheter-related displacement, leak, loss, hemorrhage, malfunction and bloodstream infection (CRBSI) was studied. Results From 226 patients, 171 performed SSC with UVC. Their first contact was earlier than in those who remained in incubator (SSC-UVC 29 hours (IQR 21-53); vs No SSC-UVC 132 hours (IQR 96-188); p<0.001). Both groups were similar in gestational age (p = 0.331) and birth weight (p = 0.2). Studied complications were not more frequent in patients who performed SSC. In fact, although it was not statistically significant, a lower overall incidence of adverse events (SSC-UVC 13.5% vs No SSC-UVC 20%; p=0.237) and catheter-related bloodstream infection (SSC-UVC 4.7% vs No SSC-UVC 10.9%; p=0.111) was observed in this group. Conclusion SSC with an UVC is a safe procedure and there are no more complications in newborns who perform SSC compared to those who remain in the incubator. Due to its demonstrated benefits, SSC should be promoted in the premature newborn regardless of the type of catheter.

Comparison of Thermal Stability Between Immersion Bath and Sponge Bath Followed by Kangaroo Mother Care in Stable Preterm in Postnatal Ward.

Preterm neonates are at high risk of hypothermia, which can lead to adverse health outcomes. This study aimed to compare the effects of immersion bath followed by Kangaroo Mother Care (KMC) versus sponge bath followed by KMC on the thermal stability of preterm neonates. A prospective interventional study was conducted on 76 preterm neonates, with 38 neonates in each group (immersion bath and sponge bath). Axillary temperature was measured before the bath and at various time intervals after the bath (immediately, 15, 30, 45, and 60 minutes). The mean axillary temperature was significantly higher in the immersion bath group compared to the sponge bath group immediately after the bath (97.6°F vs. 96.3°F, p<0.001), at 15 minutes (97.6°F vs. 96.8°F, p<0.001), 30 minutes (97.9°F vs. 97.3°F, p=0.001), and 45 minutes (98.1°F vs. 97.7°F, p=0.002) post-bath. However, the difference was not statistically significant at 60 minutes post-bath (98.2°F vs. 98.0°F, p=0.091). Immersion bathing followed by KMC is more effective than sponge bathing followed by KMC in maintaining thermal stability in preterm neonates. Healthcare providers should consider adopting this approach as the preferred bathing method for preterm neonates to promote better health outcomes.

BARRIERS AND ENABLERS OF KANGAROO MOTHER CARE IN SOUTH WOLLO PUBLIC HOSPITALS, NORTHEAST ETHIOPIA

BARRIERS AND ENABLERS OF KANGAROO MOTHER CARE IN SOUTH WOLLO PUBLIC HOSPITALS, NORTHEAST ETHIOPIA

Kangaroo mother care prior to clinical stabilisation: Implementation barriers and facilitators reported by caregivers and healthcare providers in Uganda.

Kangaroo mother care (KMC) is an evidence-based method to improve newborn survival. However, scale-up even for stable newborns has been slow, with reported barriers to implementation. We examined facilitators and barriers to initiating KMC before stabilisation amongst neonates recruited to the OMWaNA study in Uganda. The OMWaNA study was a randomised controlled trial that examined the mortality effect of KMC prior to stabilisation amongst newborns weighing ≤2000 grams. At the four trial hospitals, we conducted focus group discussions (FGD) separately with caregivers and healthcare providers, in-depth interviews (IDI) with caregivers and key informant interviews (KII) with hospital administrators and healthcare providers. The World Health Organisation (WHO) Health Systems Building Blocks were used to guide thematic analysis. Eight FGDs (4 caregivers, 4 healthcare providers), 41 caregiver IDIs (26 mothers, 8 grandmothers, 7 fathers), and 23 KIIs were conducted. Key themes based on the building blocks were; family and community support/ involvement, health workforce, medical supplies and commodities, infrastructure and design, financing, and health facility leadership. We found that the presence of a family member in the hospital, adequate provision of healthcare workers knowledgeable in supporting KMC prior to stability, and adequate space for KMC beds where neonatal care is being delivered, can enable implementation of KMC before stability. Implementation barriers included fear of inadvertently causing harm to the newborn, inadequate space to practice KMC in the neonatal unit, and a limited number of trained healthcare workers coupled with insufficient medical supplies.

Kangaroo mother care enhances exclusive breastmilk feeding and shortens time to achieve full enteral feeding in extremely preterm infants requiring non-invasive assisted ventilation

BackgroundExtremely preterm infants (EPIs) frequently encounter challenges in feeding due to their underdeveloped digestive systems. Attaining full enteral feeding at the earliest possible stage can facilitate the removal of vascular catheters and decrease catheter-related complications.MethodsWe performed a retrospective cohort study comprising 145 extremely preterm infants with a gestational age < 28 weeks who underwent non-invasive mechanical ventilation at Shenzhen Maternity & Child Healthcare Hospital between January 2019 and June 2020. The KMC group received standard nursing care along with KMC, while the control group received standard nursing care without KMC. KMC initiation took place three weeks after admission and continued for a period of two weeks or more while maintaining stable vital signs. We evaluated the rate of exclusive breastmilk feeding within 24 h prior to discharge and the time to full enteral feeding throughout hospitalization. Additionally, we conducted a multiple linear regression analysis to identify the independent factors associated with exclusive breastmilk feeding rates and the time to full enteral feeding.ResultsThe KMC group exhibited a significantly higher rate of exclusive breastmilk feeding in the 24 h before discharge in comparison to the Non-KMC group (52.8% vs. 31.5%, OR 2.43; 95% CI 1.24, 4.78). Moreover, the KMC group achieved full enteral feeding in a shorter duration than the Non-KMC group (43.1 ± 9.6 days vs. 48.7 ± 6.9 days, p < 0.001). Multiple linear regression analysis revealed that KMC was an independent protective factor associated with improved exclusive breastmilk feeding rates (OR 2.43; 95% CI 1.24, 4.78) and a reduction in the time to full enteral feeding (β -5.35, p < 0.001) in extremely preterm infants.ConclusionKangaroo Mother Care (KMC) can expedite the achievement of full enteral feeding and enhance exclusive breastmilk feeding rates in extremely preterm infants receiving non-invasive assisted ventilation. These findings highlight the beneficial effects of KMC on the feeding outcomes of this vulnerable population, underscoring the importance of implementing KMC as a part of comprehensive care for extremely preterm infants.

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.

Investigating the Start time and duration of skin-to-skin contact in the delivery or operating room in the hospitals of Khorasan Razavi Province, Iran

Background. Skin-to-skin contact (SSC) plays a significant role in the initiation and continuation of breastfeeding and maintaining and improving the health of infants. The goal of this research was to study the start time and duration of SSC in the labor rooms or operating rooms of the hospitals in Khorasan Razavi province. Methods. This descriptive study has been done on 714 newborn babies in labor rooms and ORs of governmental hospitals in Khorasan Razavi province from 1399 to 1401 through convenience sampling method. A midwife who did not have any role in the delivery process kept a record of the time of the SSC and its duration after the delivery. In the next stage, probable reasons for not having SSC, the connection of the start time of SSC and its duration with the start time and duration of breastfeeding were studied. Results. Based on the results of the study, 65% of the cases had SSC after the delivery in labor rooms under study . The mean start time of the SSC was 5.06±12.30 minutes, and the mean duration of the SSC after the birth was 9.28±13.66 minutes. Non-cooperation of the mother (61.38%), the fear of non-sterile environment (8.62%) and hastening the delivery process by the professionals involved (3.79%) were the most common reasons for not having SSC. Conclusion. In 35% of cases, there was no SSC after birth. Starting the contact early after birth can increase the success rate of breastfeeding. Practical Implications. According to the results of our study, skin-to-skin contact in our maternity hospitals is not done in one-third of the cases, which is necessary after the birth of babies. Babies who received skin-to-skin contact started breastfeeding earlier and held the breast longer, indicating that skin-to-skin contact facilitates the initiation of breastfeeding and increases its duration. The non-cooperation of the mother is the most common reason for not having skin-to-skin contact. Therefore, providing the necessary information and training to mothers about the importance of skin-to-skin contact in maintaining the health of babies, facilitating the initiation of breastfeeding, and changing the attitudes and behaviors of mothers seems necessary.

Parental perceptions and experiences of kangaroo care for preterm infants in neonatal intensive care units in China: a qualitative study

Backgroundkangaroo care (KC), endorsed by the World Health Organization, is an evidence-based intervention that plays a pivotal role in mitigating preterm infant mortality and morbidity. However, this intervention has not been fully integrated into healthcare systems in China. This study aimed to gain insight into parents’ perceptions and experiences of KC for preterm infants to contribute to the KC implementation on a larger scale.MethodsThis study employed a descriptive qualitative design, using face-to-face, semi-structured, in-depth interviews. Fifteen parents participating in KC for preterm infants in the neonatal intensive care units (NICUs) were purposively sampled from four hospitals across four cities in Zhejiang Province, China. Thematic analysis was employed to analyze the data.ResultsFour themes and twelve subthemes regarding the parents’ perceptions and experiences about KC were identified. The four themes included: (1) Low motivation upon initial engagement with KC, (2) Dynamic fluctuations of emotional states during KC, (3) Unexpected gains, and (4) Barriers to participation.ConclusionsParents’ perceptions and experiences of KC was a staged process, with parents exhibiting distinct cognitive patterns and unique experiences at each stage. Overall, as KC progresses, parents’ experiences tended to become increasingly positive, despite potential obstacles encountered along the way. To enhance the implementation of KC, healthcare providers could utilize prenatal and postnatal education programs. These programs aim to enhance the understanding of KC among parents of preterm infants, fostering sustained engagement in KC practices.

Parent-Guided Developmental Intervention for Infants With Very Low Birth Weight

Early interventions improve neurodevelopmental outcomes after preterm birth, but few studies of early intervention have focused on preterm infants whose families reside in low- or middle-income countries (LMICs). To evaluate whether parent-guided early intervention improves the neurodevelopmental outcomes of preterm infants in an LMIC. This randomized clinical trial was performed at a high-risk obstetric referral hospital in Brazil, with outcome evaluations by examiners masked to randomization group. Eligibility criteria were (1) birth at the study hospital, (2) residence within 40 km of the birth hospital, and (3) gestational age of less than 32 weeks or birth weight of less than 1500 g. Of 138 enrolled infants, 19 died after randomization and 19 withdrew from the study; all other enrollees (50 per randomization group) were evaluated for the primary outcome. Data were collected from January 1, 2016, to May 31, 2022, and analyzed from June 10 to July 31, 2022. On postnatal day 7, infants were randomized to usual care, consisting of support for lactation, kangaroo care, and routine developmental therapies, or to a parent-guided enhanced developmental intervention, consisting of usual care plus infant massage and enhanced visual stimulation, auditory stimulation, social interactions, and support for motor development, instructed by developmental therapists. The primary outcome was the Bayley Scales of Infant and Toddler Development-Third Edition score at 18 months of age adjusted for prematurity. Among the 100 infants included in the analysis, mean (SD) gestational age was 28.4 (2.2) weeks, and 57 (57%) were male. The mean (SD) gestational age for the intervention group was 28.3 (2.3) weeks; for the usual care group, 28.5 (2.2) weeks. Female infants accounted for 21 infants (42%) of the intervention group and 22 (44%) of the usual care group; male infants, 29 (58%) and 28 (56%), respectively. The enhanced developmental intervention group had higher cognitive scores at 18 months of corrected age (mean [SD], 101.8 [11.9] vs 97.3 [13.5]; mean difference, 4.5 [95% CI, 0.1-8.9]). In this randomized clinical trial of a parent-guided developmental intervention for early cognitive function of very preterm or very low birth weight infants implemented in an LMIC, the intervention improved very preterm infants' neurodevelopmental outcomes at 18 months of adjusted age. Parent-guided early intervention can improve neurodevelopmental outcome of very preterm infants born in LMICs. ClinicalTrials.gov Identifier: NCT02835612.

A Hybrid Form of Telemedicine and Quality Improvement: A Unique Way to Extend Intensive Care Services to Neonates.

To evaluate the impact of hybrid support (tele-mentoring and conventional support) on adverse outcome among neonates admitted to 10 special newborn care units (SNCUs) in Chhattisgarh. This before-and-after study was conducted at 10 SNCUs in Chhattisgarh in 2022. Conventional support was given earlier and later, that was supplemented with tele-rounds which were carried out using Skype technology. The principal investigator (PI) visited each unit for one day per month to kickstart quality improvement (QI) projects and provide guidance. Patient outcome data were collected on clinical sepsis proportion, IV fluid usage, antibiotic usage, length of stay, referral and mortality. A total of 2807 babies across 10 units were assessed. This was retrospectively correlated with 5169 babies in these units in the year before the intervention was started. The percentage of clinical neonatal sepsis cases decreased from 53.4% to 29.4% (P < 0.05). IV fluid usage dropped from 40% to 22.2% (P < 0.05). The initiation and continuation of kangaroo mother care (KMC) increased from 55.5% to 93.8% (P < 0.05). The average length of stay decreased from 5.5 ± 0.97 d to 4 ± 0.2 d (P < 0.05). Oxygen utilization decreased from 39.3% to 33.6% (P < 0.05). The proportion of antibiotic usage decreased from 50.2% to 39.7% (P < 0.05). The mortality rate decreased from 8.18% to 6.99% (P < 0.05). Referral rate decreased from 13.12% to 11.93% (P < 0.05). The implementation of a QI package through hybrid support, which includes tele-mentoring, supportive supervision visits, and local QI project advocacy, proves to be an effective approach in enhancing newborn intensive 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.