Neonatal Intensive Care Research Articles

Monte Carlo Simülasyonu ile Yenidoğan Transportunda Fizyolojik Stabilite Risk Skor Değişiminin Tahminlemesi

Yenidoğan yoğun bakım hastalarının transportu yüksek risk ve mortaliteye sahiptir. Bu nedenle transport süreci dikkatle ele alınmalı ve değerlendirilmelidir. Bu sürecin performansının değerlendirildiği transport skorlama sistemleri bulunmaktadır. Bunlardan hastanın fizyolojik stabilite risk skoru değişimini ölçen Transport Risk Index of Physiologic Stability (TRIPS) skorlaması yaygın olarak kullanılmaktadır. TRIPS skor değeri transportun ilk 15 dakika ve sonunda olmak üzere en az iki defa ölçülür. Bu çalışmada 2011-2022 yılları arasında 1117 sayıda hastanın teslim alındığında ilk TRIPS skoru ve teslim edilmeden hemen önce ölçülen TRIPS skor değerleri ile bebeklerin kayıtlı ağırlık parametre değeri alınmıştır. Retrospektif olarak yapılan bu çalışmada hastanın ağırlığına bağlı olarak ölçülen iki TRIPS skor değeri arasındaki fark, Monte Carlo simülasyon modeli ile tahminlenmiştir. Her hasta ağırlık grubu için ayrı ayrı ortalama TRIPS skor farkı taminlenerek, farklı hasta gruplarının transport süreci birbirleri ile kıyaslanarak gruplar arası farklar tespit edilmiş ve süreç analiz edilmiştir. Bu analiz sürecin iyileştirilmesi, planlanması ve kararların alınmasına katkı sağlayacaktır.

The Effects of a Three-Stair Positioning Pillow Used for Preterm Infants on Physiologic Parameters and Sleep-Wakefulness Status: Randomized Controlled Trial.

It is important to provide the necessary sleep for the growth of preterm infants in the neonatal intensive care unit. The purpose of this study was to determine the effect of 3-stair positioning pillows (TSPPs) developed for preterm infants with postnatal age 28 to 35weeks on physiologic parameters and sleep-wakefulness status. This research was conducted as a randomized controlled experimental study. The CONSORT flowchart was used in the implementation of the randomized controlled trial. The preterm infants in the experimental group were placed in the prone position with TSPPs, whereas the preterm infants in the control group were followed in the routine prone position given in the neonatal intensive care unit. Preterm infants were followed for a total of 3hours. The sample of the study consisted of 60 preterm infants (experiment group=30; control group=30) who were hospitalized in the neonatal intensive care unit and met the selection criteria. Compared with the infants in the control group, the preterm infants in the experimental group were determined to have significantly lower heart rates, higher oxygen saturations, lower respiratory rates, longer sleep durations, and shorter wakefulness times (P <.001). It was found that positioning preterm infants using TSPP had positive effects on physiological parameters (heart rate, oxygen saturation, and respiratory rate) and sleep-wakefulness status in favor of the experimental group. It is recommended to use a TSPP that supports the prone position to improve the physiologic parameters and sleep-wakefulness status of preterm infants in the neonatal intensive care unit. Larger studies need to be conducted utilizing longer follow-up protocols. Examining the effectiveness of TSPPs with different positioning materials in preterm infants is needed.

Vasopressin induced hyponatremia in infants

Vasopressin is used for shock and acute pulmonary hypertension in the neonatal intensive care unit (NICU) and is associated with hyponatremia. The purpose of this study was to determine the incidence, severity, contributing risk factors associated with vasopressin-induced hyponatremia in neonates and infants <3 months of age in the NICU. The primary objective was to determine the incidence of hyponatremia (<130 mEq/L) and severe hyponatremia (<125 mEq/L). The secondary objectives were to compare clinical characteristics and the vasopressin regimen between those with and without hyponatremia. This retrospective cohort study included neonates and infants <3 months from 1/1/2017-12/31/2022 receiving vasopressin for >6 h. Analyses were performed using SAS v9.4, with a priori less than 0.05. A multiple variable logistic regression was employed to assess odds of hyponatremia. Of the 105 patients included, 57 (54.3%) developed hyponatremia, and 17 (29.8%) were classified as severe hyponatremia. Overall, the median (interquartile range, IQR) gestational and postnatal age at vasopressin initiation were 35.4 (27-38.7) weeks and 2 (1-12) days. There was no difference in vasopressin dose, but duration of treatment was longer in those with hyponatremia. Higher baseline serum sodium was associated with decreased odds of hyponatremia [adjusted odds ratio (OR): 0.90 (95% CI: 0.83-0.99), p = 0.03], and increased vasopressin duration was associated with increased odds of hyponatremia [aOR: 1.02 (95% CI: 1.01-1.03), p < 0.001]. Hyponatremia occurred in half of patients included. The pre-vasopressin sodium value and the vasopressin duration were independently associated with hyponatremia.

Epidemiological Determinants and Risk Factors Contributing to the Rise in Neonatal Morbidity and Mortality in Liberia: A Quantitative Analysis

Background: Neonatal mortality has remained a significant public health challenge in Liberia, necessitating a thorough understanding of factors contributing to adverse neonatal outcomes. This study aimed to investigate demographic and clinical factors associated with neonatal mortality among infants admitted to the Neonatal Intensive Care Unit (NICU) in Liberia.  Objectives: The primary objective was to identify demographic and clinical factors associated with neonatal mortality in NICU admissions. Secondary objectives include assessing the impact of antenatal care and the follow-up, mode of delivery, gestational age at birth, and multiple births on neonatal mortality rates.  Methods: A retrospective analysis was conducted using data from NICU admissions in Liberia. Demographic and clinical variables, including sex of neonate, ANC follow-up, mode of delivery, multiple births, and gestational age at birth, were analyzed for their association with neonatal mortality using logistic regression models.  Keyresults: The study included various neonatal admissions to the NICU. While male neonates constituted a slight majority of admissions, gender did not significantly influence neonatal mortality rates. Lack of ANC follow-up emerged as a significant risk factor for mortality, with neonates whose mothers did not receive ANC showing a substantially higher risk. C-Section delivery was correlated with a significantly increased risk of neonatal mortality compared to spontaneous vaginal delivery. Preterm birth was also identified as a significant risk factor for mortality, highlighting the vulnerability of preterm neonates. Multiple births presented unique challenges but did not significantly impact mortality rates after adjustment.  Conclusion: This study underscored the critical importance of ANC follow-up, appropriate delivery practices, and specialized care for preterm neonates in reducing neonatal mortality rates in Liberia. Findings provided informed valuable insights for policymakers and healthcare practitioners to develop targeted interventions aimed at improving neonatal health outcomes and reducing mortality rates in the country.

Comparison of the Effect of Oral Dydrogesterone with Oral Nifedipine on the Treatment of Threatened Preterm Labor: A Randomized Controlled Trial

Background: Determining the most effective treatment for women at risk of preterm labor is crucial in reducing potential complications and neonatal mortality. This study aimed to compare the effects of two oral medications, Dydrogesterone and nifedipine, on managing preterm labor in pregnant women admitted with threatened preterm labor. Objectives: The trial aimed to compare the efficacy of Dydrogesterone versus nifedipine in preventing preterm labor. Methods: In this randomized controlled clinical trial, 54 pregnant women aged 18 to 45 years, with a gestational age of 26 to 34 weeks and at risk of preterm labor, were randomly assigned to receive either 40 mg oral Dydrogesterone or a standard dose of nifedipine (10 mg for the first dose) as a tocolytic. Key maternal and neonatal outcomes, including the interval between intervention and delivery, delivery type, neonatal intensive care unit (NICU) admission, NICU stay duration, and Bishop scores, were evaluated and compared between the two study groups. Results: The mean age of participants was 27.78 ± 2.53 years in the nifedipine group and 27.67 ± 2.53 years in the Dydrogesterone group. There were no significant differences (P &gt; 0.05) between the two groups in baseline characteristics. The mean NICU stay in the Dydrogesterone group (2.3 ± 0.5 days) was significantly shorter than in the nifedipine group (4.6 ± 0.5 days) (P = 0.001). Although the frequency of gestational age at delivery, NICU admission, the interval between intervention and delivery, and repeated preterm labor were lower in the Dydrogesterone group, the differences between the groups were not statistically significant (P &gt; 0.05). Conclusions: The findings suggest that Dydrogesterone is effective in treating preterm labor. Both drugs prevented preterm labor; however, nifedipine, despite being a standard treatment, has potential side effects and may not be suitable for all patients. These results indicate that Dydrogesterone, with fewer side effects, could be an alternative for patients who cannot use nifedipine. Further studies with larger sample sizes are needed to confirm or refute this finding.

Delivery room resuscitation and short-term outcomes in very preterm infants: a multicenter cross-sectional study in China.

To explore the risk factors of delivery room (DR) resuscitation and assess the association of DR resuscitation with neonatal outcomes in very preterm infants (VPIs). A multicenter retrospective cross-sectional study included VPIs with gestational age (GA) <32 weeks born between January, 2022 and June, 2023 and admitted to neonatal intensive care units of six tertiary hospitals in Shenzhen within 24 h after birth. They were divided into routine care group, positive-pressure ventilation (PPV) group, and endotracheal intubation (ETT) group based on the highest intensity of resuscitation received at birth. The association of antepartum and intrapartum risk factors and short-term outcomes with the intensity of DR resuscitation was evaluated. Of 683 infants included in this study, 170 (24.9%) received routine care, 260 (38.1%) received bag and mask ventilation or T-piece ventilation and 253 (37%) received ETT. Among the antepartum and intrapartum factors, exposure to antenatal steroids (ANS) decreased the likelihood of ETT. Increasing GA decreased the likelihood of receiving a higher level of DR resuscitation. Among the neonatal outcomes, increasing intensity of DR resuscitation was associated with a raise in the risk of Bronchopulmonary dysplasia. Higher levels of DR resuscitation were associated with the risk of early-onset sepsis. ETT was significantly associated with an increased risk of death. Among VPIs, low GA and no ANS use increased the risk of high-intensity DR resuscitation interventions; and those who receiving ETT were associated with an increased risk of adverse clinical outcomes.

Effects of kangaroo mother care combined with nurse-assisted mindfulness training for reducing stress among mothers of preterm infants hospitalized in the NICU: a randomized controlled trial

BackgroundKangaroo mother care (KMC) can have a positive effect on the mental well-being of a mother. However, there are specific challenges associated with the process that may contribute to increased anxiety for the mother. By integrating nurse-assisted mindfulness training alongside KMC guidance, nurses may effectively alleviate maternal stress to a greater extent.MethodsA single-centre randomized controlled trial was conducted to investigate the effects of KMC combined with nurse-assisted mindfulness training. The study included preterm infants with a gestational age of less than 32 weeks or a birth weight of less than 1500 g and their mothers, who were randomly divided into two groups. The intervention group consisted of mothers who received KMC combined with nurse-assisted mindfulness training for 14 days. The control group comprised mothers who received only KMC for 14 days. Data from both groups were collected and compared for analysis.ResultsForty-seven infants and their mothers were included in the intervention group, whereas 44 pairs were included in the control group. After the intervention, the parental stressor scale scores for the neonatal intensive care unit (PSS: NICU) (3), PSS: NICU (4), and Hospital Anxiety and Depression Scale (HADS) scores for the intervention group were lower than those for the control group, whereas the Five Facet Mindfulness Questionnaire (FFMQ) (1), FFMQ (4), and FFMQ (5) scores for the intervention group were higher. The degree of change in the PSS: NICU and HADS scores was inversely correlated with the degree of change in the FFMQ score. The breast milk feed rate and weight gain rate were greater in the intervention group than in the control group. No adverse reactions were observed in either group.ConclusionsKangaroo mother care combined with nurse-assisted mindfulness training is an acceptable, feasible, and effective procedure for reducing anxiety in mothers of preterm infants in the NICU, with potential benefits for the short-term prognosis of these infants.Trial registrationChinese Clinical Trial Registry, ChiCTR1900023697, registered on June 8, 2019, retrospectively registered.

Resuscitation education for NICU providers: Current practice and recommendations for NRP and PALS in the NICU

The Neonatal Resuscitation Program (NRP) is the most used resuscitation algorithm for infants requiring resuscitation in the neonatal intensive care unit (NICU). The population of infants cared for in the NICU is varied and complex with resuscitation needs that may extend beyond the NRP algorithm. To provide resuscitation care that addresses these needs, institutions may choose to incorporate algorithms from the Pediatric Advanced Life Support or a “hybrid” approach that includes NRP. Limited evidence exists to support one algorithm or approach over another. In this article, we identify potential gaps in the application of using NRP or PALS in the NICU population, present select patient decompensations and discuss the resuscitation management approach using the NRP or PALS algorithms. Challenges associated with NICU resuscitation education will be explored as well as approaches to overcome some of the identified resuscitation education obstacles.

An Examination of the Benefits of Lactation Consultant Services in NICUs for Mothers and Their Newborn: A Systematic Review.

Background: It is well accepted that lactation consultant (LC) services can enhance the breastfeeding success in mother-infant dyads. However, despite such advantages, not all neonatal intensive care units (NICUs) offer LC services. The objective of this systematic review was to assess the available evidence on the effect of LC service on breastfeeding outcomes for mothers whose infants are in the NICU. Methods: The PRISMA Extension for Systematic Reviews were used to conduct this systematic review. The following databases: Embase, Medline, CINAHL, and Cochrane library were searched. An initial 464 studies were obtained. Duplicates and studies that did not fit the inclusion criteria were removed, leaving 30 full-text articles to review. Nineteen were further excluded after full-text review. A total of 11 studies were included. Due to the heterogeneity of the included studies, a meta-analysis could not be performed, instead a qualitative numerical summary was conducted. Results: Overall, 10/11 (90%) of studies observed a 6-31% increase in the number of infants who received mother's own milk, and 11-27% in the number of infants who received direct breastfeeds associated with the implementation of LC services in the NICU. The two most common types of LC services studied included: i) multidisciplinary lactation support-described as a team-based approach that includes at least one LC and ii) designation of LC formal role in the NICU. Conclusions: This review highlights that having LC services in the NICU is vital for meeting the unique needs and enhancing breastfeeding outcomes for mothers whose infants are in the NICU.

A Scoping Review of Multimodal, Dyadic Early Relational Health Interventions in NICUs in the United States.

Early relational health (ERH) interventions can buffer toxic stress and improve the developmental trajectories of neonatal intensive care unit (NICU) infants. The purpose was to examine the current state of the science related to multimodal, dyadic ERH interventions implemented in the NICU setting in the United States and identify gaps in the current literature. PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo were searched in November 2022 and November 2023 for original studies and conference proceedings from 1970 to present in the English language. Gray literature searches were performed in February 2023 and December 2023. English language, original research, with a focus on multimodal, dyadic ERH interventions that took place primarily in a NICU in the United States were included. Outcome measures could be related to implementation, relational health, or physical and/or mental health outcomes of parent and/or infant. Eighteen of 2021 reviewed articles met the inclusion criteria. Data were extracted for author, year, intervention, purpose, methods, sample, paternal inclusion, dyadic components, non-dyadic components, and major outcomes/results and distilled for study characteristics, multimodal, dyadic intervention characteristics, and outcome measures. Several multimodal dyadic interventions exist to aid ERH in the NICU, providing evidence of improved outcomes for infants and families. More research is required using higher sample sizes and replication studies. ERH interventions show promise in improving neurodevelopmental, behavioral, and maternal mental health outcomes and should be considered for implementation into NICU services.

Assessment of the clinical and laboratory risk factors for thrombosis in neonates admitted to neonatal intensive care unit (two Egyptian tertiary centers experience).

In neonates admitted to the neonatal intensive care unit (NICU), arterial and venous thromboembolism is a major cause of morbidity and death which could be attributed to multiple risk factors exposure. This study aimed to evaluate the clinical characteristics, laboratory and radiological assessments, predisposing risk factors, and outcomes of thrombosis in neonates admitted to NICU. This prospective cohort study was conducted at NICU, Minia, and Alexandria University Children's Hospital. Screening of 886 patients admitted to NICU over one year with different clinical presentations, patients were classified into the thrombotic and non-thrombotic groups based on the presence or absence of thrombosis. Thrombosis was diagnosed based on clinical, laboratory and different radiologic assessments. Genetic testing for factor V Leiden mutations G1691A, prothrombin mutation G20210A, protein C, protein S, and antithrombin III gene mutations were performed for patients with a family history of thrombosis. Out of a total of 886 neonatal admissions, 36 patients were diagnosed with evident thrombosis (40 per 1000 NICU admissions). The sites of venous thrombosis detection were Portal vein thrombosis in 11 patients (30.6%), superior vena cava thrombosis in 7 patients (19.4%), deep venous thrombosis in 5 patients (13.9%), central venous thrombosis in 5 patients (13.9%), intra-cardiac thrombosis in 3 patients (8.3%) and necrotic skin patches in one patient (2.8%). Only 69% of enrolled thrombosis patients showed genetic mutations the most common of which was factor V Leiden mutation (52.3%). Sepsis, central venous line (CVL) insertion, C reactive protein (CRP), and duration of NICU admission were significantly more common in the thrombotic group (p < 0.001) and were associated with a higher risk of thrombosis (ORs: 1.02, 7.7, and 1.11, respectively) (p < 0.001). Higher mortality occurred in thrombosis neonates compared with a non-thrombotic group (52.8% versus 17.4%) (p < 0.001). NICU-admitted neonates are exposed to multiple overlapped risk factors, the detection of which is important for preventing potential thrombosis and improving the patient's outcomes. The complexity of sepsis pathogenesis and management could potentiate multiple acquired risk factors. inherited thrombophilia detection is required for prevention of further morbidities.

Variation in NICU utilization: a narrative review and path forward.

Utilization of the Neonatal Intensive Care Unit (NICU) varies widely in the United States. Over recent decades, there has been a growth in NICUs, that varies by region, and has not been correlated to changes in demand or illness severity. Unnecessary NICU admissions are costly, stressful to families, may increase the risk of hospital acquired morbidities, and decrease breast feeding. Most of the variation in NICU utilization is based on the care of late preterm, early term, and term babies and is related to hospital level factors, including financial incentives, driving utilization. Improvement strategies to reduce variation include regionalization of care, certificate of need legislation, improving discharge processes, and caring for babies with some conditions such as Neonatal Opioid Withdrawal Syndrome or those with risk factors for sepsis outside of the NICU.

Predictors of Direct Breastfeeding in Preterm Infants.

Objective: Rates of mother's own milk (MOM) provision in the neonatal intensive care unit (NICU) vary widely, despite acceptance as the gold standard for nutrition in preterm infants. Direct breastfeeding (DBF) supports long-term provision of MOM, but factors that support DBF in preterm infants are unknown. The purpose of this study was to identify factors that predict DBF at oral feeding initiation and at NICU discharge. Methods: This was a retrospective cohort study of preterm infants born at ≤ 32 weeks who were receiving MOM at 32 weeks corrected gestational age (cohort 1) and at discharge to home (cohort 2). The primary outcomes were rates of DBF at oral feeding initiation (cohort 1) and at hospital discharge (cohort 2). We examined bivariate associations between infant characteristics, maternal sociodemographic factors, and hospital practices (e.g., lactation visit timing and frequency) with DBF outcomes and then built logistic regression models to determine the adjusted odds ratio and 95% confidence interval ([adjusted odds ratio [aOR] [95%CI]) for independent predictors of the DBF outcomes. Results: Sixty-four percent of eligible infants initiated DBF, and 51% were DBF at discharge. Sociodemographic, NICU, and lactation support factors were associated with both outcomes. Post hoc analysis showed that similar factors also influenced lactation support provision. Conclusions: Lactation support, NICU and sociodemographic variables influence DBF initiation and DBF at discharge. Interventions that optimize efficient use of available lactation support, address bias, and provide ample opportunity for DBF practice could improve rates.

Embedding the ‘CoolCuddle’ intervention for infants undergoing therapeutic hypothermia for hypoxic-ischaemic encephalopathy in NICU: an evaluation using normalisation process theory

ObjectivesNewborn infants exposed to lack of oxygen and blood flow to the brain around birth may develop brain dysfunction (hypoxic-ischaemic encephalopathy—HIE). These infants undergo 72 hours of cooling therapy and...

Acute respiratory compromise in the NICU

Acute respiratory compromise (ARC) is a significant and frequent emergency in the Neonatal Intensive Care Unit (NICU), characterized by absent, agonal, or inadequate respiration that necessitates an immediate response. The primary etiologies of ARC in neonates can be categorized into upper and lower airway issues, disordered control of breathing, and lung tissue disease. ARC events are particularly dangerous as they compromise oxygen delivery and carbon dioxide removal, potentially leading to cardiopulmonary arrest. Approximately 1 % of NICU admissions experience cardiopulmonary arrest, and ARC is the primary cause of most events. This article provides a comprehensive review of the etiologies of ARC, including anatomical abnormalities, syndromic disorders, airway obstruction, and pulmonary diseases such as bronchopulmonary dysplasia and pneumonia. Management strategies include the use of continuous positive airway pressure, positive pressure ventilation, and advanced interventions like extracorporeal membrane oxygenation (ECMO) in cases of severe respiratory distress. Additionally, quality improvement initiatives aimed at reducing incidents such as unplanned extubations (UE) are discussed, along with emergency responses to ARC, which often require multidisciplinary collaboration and advanced airway management. The article emphasizes the importance of preparedness, training, and structured emergency protocols to ARC in the NICU to optimize patient care.

Barriers to Effective Infection Prevention in the Neonatal Intensive Care Unit: A Qualitative Study.

Infection prevention (IP) behaviors such as hand hygiene (HH) and mobile device disinfection are important to reduce the risk of infection transmission from both family members and hospital staff to critically ill neonates. To inform the design of educational interventions to improve both patient family and staff IP behaviors, we engaged separate groups of nurses and family members to understand perceptions about the spread of infection and barriers to implementing effective IP strategies. This was a qualitative study using focus groups to gather data from neonatal nurses and patient family members. Data were triangulated with hospital-wide survey data and analyzed using inductive content analysis. Twelve nurses and 4 patient family members participated. Themes related to communication about IP between staff and family members emerged: stakeholders expressed discomfort with the timing and nature of just-in-time HH education. These communication challenges contributed to stress levels within the neonatal intensive care unit. This finding was reflected in the hospital-wide survey. Steps should be taken to improve communication about IP behaviors between patient family members and frontline staff. Reducing nurse burden of providing just-in-time HH reminders to patient family members through increased IP education may decrease stress and facilitate IP behaviors. This has the potential to decrease infection spread and improve patient outcomes. The development of interventions targeting stakeholder communication is therefore warranted, but additional research is needed to understand the timing and process for delivery of the educational material.

Clinical Factors Related to Abnormal General Movements Trajectories: Development of a Multicriteria Index.

To create a multicriteria index with clinical factors associated with abnormal general movements (GMs) trajectories during a stay in the neonatal intensive care unit. A longitudinal study assessed abnormal GMs trajectories in preterm infants in the neonatal intensive care unit. The multicriteria index included clinical factors such as intraventricular hemorrhage, respiratory support, gestational age, patent ductus arteriosus, and infection based on multi-attribute utility theory. A total of 52 preterm newborns, 57.7% male, were evaluated. The multicriteria index correlated with abnormal GMs trajectories and explained 26.5% of the variance in these trajectories. The developed multicriteria index, with the inclusion of combined clinical factors, allowed the identification of part of the abnormal trajectories of GMs in preterm infants. The multicriteria analysis can help clinicians to identify infants who have a greater chance of poor developmental trajectories before hospital discharge.

Gabapentin for Delirium in Infants in the Neonatal Intensive Care Unit

OBJECTIVE A protocol was developed for neonatal intensive care unit (NICU) delirium: Step 1, gabapentin for pain or melatonin for sleep; Step 2, add on other Step 1 agent; Step 3, antipsychotics. The purpose of this study was to describe the utility and dosing of gabapentin for NICU delirium. METHODS Retrospective evaluation of NICU patients from January 1, 2021–December 31, 2022 who received &amp;gt;1 dose of gabapentin based on the delirium protocol. Data collection included demographics, gabapentin regimen, and concomitant sedatives and analgesics. The primary objective was to identify the number of patients receiving gabapentin for Step 1 or Step 2. Secondary objectives included identifying the number of patients requiring antipsychotics (Step 3), the gabapentin regimen, comparison of Échelle de Douleur et d'Inconfort du Nouveau-né (EDIN), Cornell Assessment of Pediatric Delirium (CAPD), and Withdrawal Assessment Tool-1 (WAT-1) scores 72 hours pre- and post-gabapentin initiation, and comparison of opioids, clonidine, and melatonin 24 hours pre- and 72 hours post-gabapentin initiation. Wilcoxon signed rank tests were employed with significance defined at p &amp;lt; 0.05. RESULTS Twenty-nine patients were studied. The majority (n = 22; 75.9%) received gabapentin for Step 1; no patients required Step 3. The median initial dose was 14.4 mg/kg/day divided every 8 hours. Twelve (41.4%) required increase to a median of 16.9 mg/kg/day. A significant decrease in EDIN and WAT-1 scores was noted, but there was no change in CAPD scores or opioid, clonidine, or melatonin doses pre- versus post-gabapentin. CONCLUSION The majority received gabapentin at a median dose of 14 mg/kg/day as Step 1 for delirium. Gabapentin was associated with a significant decrease in pain and withdrawal scores.

Serratia marcescens outbreak at a neonatal intensive care unit in an acute care tertiary hospital in Singapore

To report the epidemiological, diagnostic, and genetic investigation of an outbreak of neonatal patients infected or colonized with Serratia marcescens (S. marcescens) including the infection control interventions. Outbreak investigation report. 28-bedded neonatal unit in an acute care tertiary hospital in Singapore divided into three areas: two negative-pressure airborne infection isolation rooms with a shared anteroom, 10 neonatal intensive care unit (NICU) beds, and 16 high dependency beds. A total of five neonates were involved in this outbreak. Screening of in-flight patients and their immediate environment for S. marcescens to determine probable environmental sources, whole genome sequencing (WGS) analysis of resulting isolates to determine clone-relatedness and possible transmission patterns. Implementation of infection control interventions included prompt isolation of cases, enhanced equipment and environmental disinfection, use of alcohol-based hand rub as the preferred hand hygiene mode, enhanced infection prevention orientation for parents, review of practices, audits, and immediate feedback on non-compliance. Five neonates infected or colonized with S. marcescens were involved in this outbreak. Four were infection cases whilst one identified through contact tracing. Three NICU sinks and the milk preparation room sink were tested positive for S. marcescens. WGS confirmed clonality of strains from two NICU sinks, and milk preparation room sink with that of the five neonates. Multiprong strategy was required to contain this outbreak. WGS analysis showed association of biofilms in sinks with the outbreak.

Early parental vocal contact in neonatal units: rationale and clinical guidelines for implementation.

This paper aims to present clear and evidence-based proposals for the integration of Early Parental Vocal Contact into the clinical practices of neonatal units. In the first part, we present a comprehensive rationale exploring the ontogenesis of voice perception in both term and preterm newborns that establishes a foundational understanding. This knowledge serves as a crucial starting point for developing evidence-based auditory and multisensory interventions aimed at fostering the developmental trajectory of preterm infants. Drawing insights from neuroscience and brain development, our proposals underscore the significance of tailoring auditory environments within neonatal settings. Special attention is given to the unique needs of preterm infants, factoring in their gestational age and maturation levels. In the second part clinical guidelines for implementation are provided and healthcare professionals are supported to assist parents in modulating their vocal interactions, aligning them with the infant's responses. Furthermore, we provide practical suggestions for engaging in discussions with parents about the content, duration, and frequency of vocal interventions. Finally, we delve into the potential roles of caregivers, parents, and health professionals within this enriched parental vocal interactional environment. Our perspective is firmly grounded in an infant and family-centered developmental care philosophy, aiming to enhance the overall well-being and the neurodevelopment of preterm infants in neonatal units.