Stable Preterm Infants Research Articles

Improving survival of infants with low birthweight cared for outside hospitals

In 1978, Edgar Rey was the director of a large and overcrowded neonatal unit in Bogota, Colombia. Shortage of incubators and prolonged hospital stay were harming and resulting in the deaths of already stable premature infants. To overcome those circumstances, Rey started an early discharge programme in which infants were placed in skin-to-skin contact on top of their mothers' chests to ensure thermal stability (kangaroo position), and if the babies tolerated the position well and regulated their temperature, the mother and baby were sent home in the kangaroo position while receiving breastmilk-based nutrition and close ambulatory follow-up—ie, after discharge from hospital, kangaroo mother care was provided in specifically designated ambulatory outpatient clinics, where the family came for follow-up visits from discharge until up to 1 year after birth.

Factors affecting cerebrovascular reactivity to CO2 in premature infants.

Background Hypercarbia increases cerebral blood flow secondary to cerebral vasodilatation, while hypocarbia can lead to vasoconstriction with a subsequent decrease in cerebral blood flow. The aim of this study was to examine CO2 cerebral vasoreactivity in a cohort of premature infants and to identify factors which influence this reactivity. Methods We prospectively studied a cohort of hemodynamically stable premature infants [birth weight (BW) <1500 g and gestational age (GA) ≤34 weeks]. Subjects underwent two studies, one in the first 72 h and the second after 1 week of life. Infants were continuously monitored via a physiology station that included transcutaneous CO2 (tcPCO2) monitor, near-infrared spectroscopy (NIRS), arterial pulse oximetry and heart rate. The total hemoglobin (Hb-T) signal of NIRS was used as an indicator of cerebral blood volume (CBV). Correlation between tcPCO2 and Hb-T was performed in each 1-h period using Pearson's correlation. Factors affecting the CO2 cerebrovascular reactivity were examined using bivariate and linear regression analyses. Results A total of 3847 1-h epochs were obtained from 140 studies of 72 premature infants. tcPCO2 correlated positively with Hb-T in 42% of epochs. In regression analysis, factors associated with increased percentage of positive correlation epochs were male sex and younger postmenstrual age (PMA; β = 0.176, 0.169 and P-value = 0.036, 0.047 respectively). Factors associated with increased strength of positive correlation were mechanical ventilation and increased average tcPCO2 (β = 0.198, 0.220 and P-value = 0.024, 0.011 respectively). Conclusion Increased prematurity, male sex, mechanical ventilation and hypercarbia are associated with stronger PCO2 cerebrovascular reactivity in premature infants. This association may explain their role in the pathogenesis of brain injury.

Behavioural Language of Preterm Infants: Cardiorespirography and Video Recording of Motor Behaviour as an Integration of the Newborn Indiviualized Developmental Care and Assessment Program (NIDCAP) Observation

Understanding early preterm infants’ strengths, vulnerabilities, thresholds to stress and disorganization, and behavioural state regulation is of great importance in view of the daily care in the NICU and stabilization of preterm infants. Preterm infants display observable behaviours along three main systems: the autonomic, the motor and the state systems. These behaviours according to the NIDCAP method are coded and recorded on a score sheet based on naturalistic observation, performed with unaided eyes.

The Effect of Extended Continuous Positive Airway Pressure on Changes in Lung Volumes in Stable Premature Infants: A Randomized Controlled Trial

To compare changes in lung volumes, as measured by functional residual capacity (FRC), through to discharge in stable infants randomized to 2weeks of extended continuous positive airway pressure CPAP (eCPAP) vs CPAP discontinuation (dCPAP). Infants born at ≤32weeks of gestation requiring ≥24hours of CPAP were randomized to 2weeks of eCPAP vs dCPAP when meeting CPAP stability criteria. FRC was measured with the nitrogen washout technique. Infants were stratified by gestational age (<28 and≥28weeks) and twin gestation. A linear mixed-effects model was used to evaluate the change in FRC between the 2 groups. Data were analyzed blinded to treatment group allocation. Fifty infants were randomized with 6 excluded, for a total of 44 infants. Baseline characteristics were similar in the 2 groups. The infants randomized to eCPAP vs dCPAP had a greater increase in FRC from randomization through 2weeks (12.6mL vs 6.4mL; adjusted 95% CI, 0.78-13.47; P=.03) and from randomization through discharge (27.2mL vs 17.1mL; adjusted 95% CI, 2.61-17.59; P=.01). Premature infants randomized to eCPAP had a significantly greater increase in FRC through discharge compared with those randomized to dCPAP. An increased change in FRC may lead to improved respiratory health. ClinicalTrials.gov: NCT02249143.

Contemporary Challenges and Developments: Antenatal Corticosteroid Therapy

The purpose of this review is to (i) provide an update to the current challenges surrounding the use of antenatal corticosteroids (ACS) and (ii) to provide a brief synthesis of recent findings relating to work to optimize the efficacy and safety and of ACS therapy to better understand its short- and long-term impacts on the developing foetus. There are numerous human and experimental animal studies describing the impact of ACS exposure on foetal growth and programming, in particular, changes to the cardiovascular, endocrine and central nervous systems. Moreover, recent studies have reported adverse impacts on brain development and potential risk of neurological disorders in term-born infants unnecessarily exposed to a single course of ACS. Of particular interest are recent studies describing the potential for transgenerational transmission of ACS-induced effects. When administered to the right women at the right time, ACS are an effective therapy to mature lung function and circulatory stability in preterm infants. Their judicious use reduces neonatal mortality and morbidity. However, much remains to be understood with regard to the optimal use of ACS. Current challenges in the field relate to the limited durability of lung maturation following ACS treatment, the difficulty in predicting preterm delivery and thus the optimal timing of ACS administration. Furthermore, despite some 50 years of clinical use, there has been little in the way of optimization of ACS therapy with respect to the dose and route of drug administration. The use of ACS in late preterm infants requires further cautious consideration due to the modest benefits relative to potential risks that include hypoglycaemia and developmental programming in foetus. Given the variable efficacy of ACS therapy, further work is needed to fully realize the therapeutic potential of this important treatment.

Transferring preterm infants into an open cot using a heated mattress at ≤ 1400 g.

The objective of this study is to evaluate the corrected age and weight that infants were transferred into an open cot using a heated mattress, in overall and within the subgroups of early (weight ≤ 1400 g) and standard transfer (weight > 1400 g). Retrospective cohort study in a tertiary neonatal unit RESULTS: One hundred and thirty-five preterm infants were analysed. The mean weight of moving into an open cot was 1370 ± 167 g at a corrected age 33 ± 1.8 weeks. Eighty-three infants (61%) were transferred early at a mean weight 1276 ± 98 g compared with 52 infants of standard transfer with a mean weight 1522 ± 141 g. Infants of the early group had higher weight gain, were discharged earlier and had shorter length of stay. Stable preterm infants can be safely moved to an open cot at < 33 weeks and weight ≤ 1400 g.

Protein hydrolysate versus standard formula for preterm infants.

When human milk is not available for feeding preterm infants, protein hydrolysate, rather than standard cow's milk formulas (with intact proteins), is often used because it is perceived as being tolerated better and less likely to lead to complications. However, protein hydrolysate formulas are more expensive than standard formulas, and concern exists that their use in practice is not supported by high-quality evidence. To assess the effects of feeding preterm infants hydrolysed formula (vs standard cow's milk formula) on risk of feed intolerance, necrotising enterocolitis, and other morbidity and mortality. We used the standard Cochrane Neonatal search strategy including electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1), in the Cochrane Library; Ovid MEDLINE (1966 to 28 January 2019); Ovid Embase (1980 to 28 January 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (28 January 2019), as well as conference proceedings and previous reviews. Randomised and quasi-randomised controlled trials that compared feeding preterm infants protein hydrolysate versus standard (non-hydrolysed) cow's milk formula. Two review authors assessed trial eligibility and risk of bias and extracted data independently. We analysed treatment effects as described in the individual trials and reported risk ratios and risk differences for dichotomous data, and mean differences for continuous data, with respective 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses and explored potential causes of heterogeneity in sensitivity analyses. We assessed quality of evidence at the outcome level using the GRADE approach. We identified 11 trials for inclusion in the review. All trials were small (total participants 665) and had various methodological limitations including uncertainty about methods to ensure allocation concealment and blinding. Most participants were clinically stable preterm infants of less than about 34 weeks' gestational age or with birth weight less than about 1750 g. Fewer participants were extremely preterm, extremely low birth weight, or growth restricted. Most trials found no effects on feed intolerance, assessed variously as mean pre-feed gastric residual volume, incidence of abdominal distension or other gastrointestinal signs of concern, or time taken to achieve full enteral feeds (meta-analysis was limited because studies used different measures). Meta-analysis showed no effect on the risk of necrotising enterocolitis (typical risk ratio 1.10, 95% CI 0.36 to 3.34; risk difference 0.00, 95% CI -0.03 to 0.04; 5 trials, 385 infants) (low-certainty evidence; downgraded for imprecision and design weaknesses). The identified trials provide only low-certainty evidence about the effects of feeding preterm infants protein hydrolysate versus standard formula. Existing data do not support conclusions that feeding protein hydrolysate affects the risk of feed intolerance or necrotising enterocolitis. Additional large, pragmatic trials are needed to provide more reliable and precise estimates of effectiveness and cost-effectiveness.

Sustained efficacy of kangaroo care for repeated painful procedures over neonatal intensive care unit hospitalization: a single-blind randomized controlled trial.

Preterm neonates hospitalized in the neonatal intensive care unit undergo frequent painful procedures daily, often without pain treatment, with associated long-term adverse effects. Maternal-infant skin-to-skin contact, or kangaroo care (KC), and sweet-tasting solutions such as sucrose are effective strategies to reduce pain during a single procedure; however, evidence of sustained efficacy over repeated procedures is limited. We aimed to determine the relative sustained efficacy of maternal KC, administered alone or in combination with 24% sucrose, to reduce behavioral pain intensity associated with routine neonatal procedures, compared with 24% sucrose alone. Stable preterm infants (n = 242) were randomized to receive KC and water, KC and 24% sucrose, or 24% sucrose before all routine painful procedures throughout their neonatal intensive care unit stay. Pain intensity, determined using the Premature Infant Pain Profile, was measured during 3 medically indicated heel lances distributed across hospitalization. Maternal and neonatal baseline characteristics, Premature Infant Pain Profile scores at 30, 60, or 90 seconds after heel lance, the distribution of infants with pain scores suggesting mild, moderate, or severe pain, Neurobehavioral Assessment of the Preterm Infant scores, and incidence of adverse outcomes were not statistically significantly different between groups. Maternal KC, as a pain-relieving intervention, remained efficacious over time and repeated painful procedures without evidence of any harm or neurological impact. It seemed to be equally effective as 24% oral sucrose, and the combination of maternal KC and sucrose did not seem to provide additional benefit, challenging the existing recommendation of using sucrose as the primary standard of care.

Physiological effects of high-flow nasal cannula therapy in preterm infants

ObjectiveHigh-flow nasal cannula (HFNC) therapy is increasingly used in preterm infants despite a paucity of physiological studies. We aimed to investigate the effects of HFNC on respiratory physiology.Study designA prospective...

Heart rate fluctuation after birth predicts subsequent cardiorespiratory stability in preterm infants.

Cardiorespiratory stability of preterm infants is a prerequisite for discharge from the neonatal intensive care unit (NICU) but very difficult to predict. We aimed to assess whether characterizing heart rate fluctuation (HRF) within the first days of life has prognostic utility. We conducted a prospective cohort study in 90 preterm infants using a previously validated surface diaphragmatic electromyography (sEMG) method to derive interbeat intervals. We characterized HRF by time series parameters including sample entropy (SampEn) and scaling exponent alpha (ScalExp) obtained from daily 3-h measurements. Data were analyzed by multivariable, multilevel linear regression. We obtained acceptable raw data from 309/330 sEMG measurements in 76/90 infants born at a mean (range) of 30.2 (24.7-34.0) weeks gestation. We found a significant negative association of SampEn with duration of respiratory support (R2 = 0.53, p < 0.001) and corrected age at discontinuation of caffeine therapy (R2 = 0.35, p < 0.001) after adjusting for sex, gestational age, birth weight z-score, and sepsis. Baseline SampEn calculated over the first 5 days of life carries prognostic utility for an estimation of subsequent respiratory support and pre-discharge cardiorespiratory stability in preterm infants, both important for planning of treatment and utilization of health care resources.

Massage intervention for preterm infants by their mothers: A randomized controlled trial.

Studies of the impact of infant massage intervention on the growth of preterm infants have been conducted in neonatal intensive care units (NICUs) and have demonstrated positive effects; however, few data exist regarding the effects of massage interventions by mothers on the growth of infants in the NICU. The purpose of this randomized controlled trial was to examine the effects of a 2-week massage intervention conducted by mothers on their preterm infants. Of 112 stable preterm infants born at a gestational age(GA) between 32 and 34 weeks and enrolled from an affiliated hospital, 54 were randomly allocated to an intervention group, and 58 were allocated to a control group. Mothers were trained to conduct a massage intervention in the intervention group, while the control group received standard care. For the infants in both groups, height (Ht), weight (Wt), and head circumference (HC) were measured at the onset of massage intervention, after one week, and after two weeks. Fifteen mothers were interviewed about their preparation for and completion of the massage intervention. Repeated-measures analysis of variance showed that weight, height and head circumference significantly increased in the intervention group. Preterm infants who underwent the two-week massage intervention had higher mean weight, height, and head circumference (F = 41.151, 6.621, 24.158, respectively; p < .001). This study developed modified massage intervention guidance to provide recommendations for optimal massage intervention by mothers in the NICU: (a) Adapt to the NICU atmosphere; (b) control the mother's strength; (c) slowly perform each period of the massage, that is (i) place in a prone position (5 + 5 min); (ii) place in supine position (5 min); (d) stay relaxed and watch the preterm infant's response. Trained mothers conducted massage interventions, which can improve the growth of preterm infants. We developed massage intervention guidance to provide recommendations for optimal massage intervention by mothers in the NICU. We recommend that mothers apply massage intervention for preterm infants in the NICU.

The Effect of Short Duration Skin to Skin Contact on Premature Infants' Physiological and Behavioral Outcomes: A Quasi-Experimental Study

PurposeThis study aimed at assessing the effect of short duration Skin to skin contact (SSC) (5 days) on premature infants' short-term physiological and behavioral outcomes. Design and methodsA quasi-experimental control group design was utilized. 89 stable premature infants were allocated to either an interventional or control group. ResultsResults showed that in comparison to the control group, newborns in the SSC group demonstrated higher weight gain (g/day) from day 3–5 of practicing SSC (53.7 g Vs. 32.6 g; P < .05), experienced significantly fewer numbers of apneas (48% Vs. 33.3%; P = .001), and were less likely to use formula feeding (60% Vs. 90%) and more likely to use mixed feeding (formula and breastfeeding) at discharge (33.3% Vs. 10%). Significant differences were also found in the crying, and sleeping patterns of the infants; infants of mothers who practiced SSC were less likely to cry in a continuous pattern and more likely to experience good sleep than infants in the control group. ConclusionsThe study highlights the importance of the early and short duration of SSC for premature infants. Practice implicationsThe initiation of SSC in the first few days of life may have a significant influence on the newborn's short-term outcomes.

Parent Engagement Correlates With Parent and Preterm Infant Oxytocin Release During Skin-to-Skin Contact.

Preterm infants remain increasingly neurodevelopmentally disadvantaged. Parental touch, especially during skin-to-skin contact (SSC), has potential to reduce adverse consequences. To examine relationships between parental engagement and salivary oxytocin and cortisol levels for parents participating in SSC intervention. A randomized crossover design study was conducted in a neonatal intensive care unit; 28 stable preterm infants, mothers, and fathers participated. Parental engagement was measured using the Parental Risk Evaluation Engagement Model Instrument (PREEMI) prior to hospital discharge. Saliva samples for oxytocin and cortisol levels were collected 15-minute pre-SSC, 60-minute during-SSC, and 45-minute post-SSC. Data were analyzed using Pearson's correlation to measure relationships between parental engagement composite scores and salivary oxytocin and cortisol levels. A significant negative correlation between paternal engagement and paternal oxytocin levels (r = -0.43; P = .03) and a significant negative correlation between infant oxytocin levels and maternal engagement (r = -0.54; P = .004) were present. Adjusted linear regression models demonstrated that as infant oxytocin levels increased during SSC, maternal engagement scores significantly decreased at discharge (β = -.04; P = .01). Linear regression, adjusting for infant oxytocin and cortisol levels, showed that as paternal oxytocin levels increased, there was a significant decrease in paternal engagement (β = -.16; P = .03) and as paternal cortisol levels increased, there was a significant decrease in paternal engagement (β = -68.97; P =.05). Significant relationships exist between parental engagement and salivary oxytocin and cortisol levels. Defining parent engagement facilitates identification of parent risks and needs for intervention to optimize preterm outcomes. The PREEMI can serve as a standardized instrument to examine parent engagement.

Early discharge of premature infants < 37weeks gestational age with nasogastric tube feeding: the new standard of care?

Most premature infants are hospitalised until they no longer need monitoring of vital parameters and are independent of nasogastric tube feeding (NTF). Hospital admission time easily reaches a length of multiple months in extremely preterm infants, but also in late preterms, in whom drinking may be the only problem, hospital admission time can reach weeks. This is a very stressful time for both parents and child. Parents in the Albert Schweitzer Hospital (ASH) are taught to give their child NTF. When monitoring is no longer necessary, the child can be discharged with NTF, with home care by paediatric nurses. In this study duration of NTF at home, safety of the procedure and parental satisfaction with NTF at home were evaluated. Duration of NTF at home was compared to admission time from cessation of monitoring till discharge independent of NTF in infants born in two comparable hospitals where discharge with NTF is not standard care. Median duration of NTF at home in the ASH infants was 9days. In the control group, median admission time after cessation of monitoring was 9days. No complications related to NTF at home were noted. Ninety-six percent of parents regarded NTF at home as safe and would repeat it in the future.Conclusion: NTF at home in premature infants shortens hospital admission time, is safe and results in high parental satisfaction rates. What is Known: • Premature infants are most often hospitalised until they are no longer dependent on NTF. Hospital admission time therefore easily reaches a length of multiple months for the extremely preterm infant. This can be a very stressful time for both parents and child. What is New • Making discharge with NTF in otherwise stable premature infants possible, by teaching parents the procedure and by providing home care by paediatric nurses. • NTF at home in premature infants is safe, limits hospital admission time and has high parental satisfaction rates.

Stable Preterm infants can have better Neurobehavioral state after 5 days of AVTK (Audio, Visual, Tactile, Kinesthetic) Stimulation

The immature brain, lungs, gastrointestinal tract and skin of preterm infants are particularly susceptible to injury and abnormal development and function, often leading to long-term neurological and health problems. The present study was aimed to evaluate the effectiveness of AVTK (Audio, Visual, Tactile and Kinesthetic) stimulation on neurobehavioral state among preterm. Quasi experimental-one group pre and posttest with control group design was used in this study. Purposive sampling technique was used for selecting 30 samples. The tools used for the study were demographic, clinical variables and modified Morgan's Neonatal Neurobehavioral Examination Tool. The intervention was given for the duration of 30 minutes, twice a day for 5 days. Results showed that there were significant differences between control and experimental group. The unpaired t’ test value showed statistical significance (t= 3.76). In relation to the demographic variable there were no significant association with post test scores in control and experimental group. AVTK was quiet significantly effective in enhancing the neurobehavioral state among preterm.

Oral feeding readiness and premature infant outcomes

BackgroundPreterm infants develop a coordinated suck and swallow depending upon their postmenstrual age and neurological status. However, criteria to determine when to best initiate oral feeding are unclear. Yet, infant readiness for oral feeding is essential for successful transition from enteral tube to oral feeding. AimThis study aimed to (a) identify infant characteristics associated with feeding readiness assessed with the Neonatal Oral Motor Assessment Scale (NOMAS)1 and (b) examine the relationship between readiness and preterm infants’ time to reach full oral feeding and length of hospital stay. Study designThis is a secondary descriptive analysis from a randomized controlled study to determine the effect of a premature infant oral motor intervention on feeding progression and length of hospital stay. Seventy-five stable premature infants were recruited from five neonatal intensive care units in Assiut city, Assiut governorate, Egypt. Eligible infants’ gestational age ranged from 30 to 32 weeks gestational age (GA). Readiness was assessed individually for each infant during non/nutritive sucking using NOMAS. ResultPreterm infants who demonstrated greater oral feeding readiness achieved full oral feeding sooner (P < 0.0001) and were discharged earlier from the hospital (P < 0.0001) than those with less readiness. Gender, gestational age at birth, birth weight, number of intervention days were not related to infant oral feeding readiness. ConclusionReadiness for oral feeding in premature infants is related to earlier feeding progression and shorter hospital stays.

Supine vs. Prone Position With Turn of the Head Does Not Affect Cerebral Perfusion and Oxygenation in Stable Preterm Infants ≤32 Weeks Gestational Age.

Intraventricular hemorrhage (IVH) is a frequent major damage to the brain of premature babies ≤32 weeks gestational age, and its incidence (20–25%) has not significantly changed lately. Because of the intrinsic fragility of germinal matrix blood vessels, IVH occurs following disruption of subependymal mono-layer arteries and is generally attributed to ischemia-reperfusion alterations or venous congestion, which may be caused by turn of the head. Therefore, supine position with the head in a midline position is considered a standard position for preterm infants during their first days of life. We asked whether a change in body position (supine vs. prone) linked with a turn of the head by 90° in the prone position would change blood flow velocities and resistance indices in major cerebral arteries and veins of stable premature babies at two different time points (t0, day of life 2, vs. t1, day 9). Moreover, we assessed cerebral tissue oxygenation (cStO2) by near-infrared spectroscopy and determined correlations for changes in velocities and oxygenation. Twenty one premature infants [gestational age 30 (26–32) weeks] with sufficiently stable gas exchange and circulation were screened by ultrasonography and near-infrared spectroscopy. Peak systolic and end-diastolic blood flow velocities in the anterior cerebral arteries (29 ± 6 m/s vs. 28 ± 7 peak flow at t0, 36 ± 8 vs. 35 ± 7 at t1), the basilar artery, the right and the left internal carotid artery, and the great cerebral vein Galen (4.0 ± 0.8 m/s vs. 4.1 ± 1.0 maximum flow at t0, 4.4 ± 0.8 vs. 4.4 ± 1.0 at t1) did not show significant differences following change of body and head position. Also, there were no differences in cStO2 (83 ± 7% vs. 84 ± 7 at t0, 76 ± 10 vs. 77 ± 11 at t1) and in vital signs such as heart rate and blood pressure. We conclude that change in body position with turn of the head in the prone position does not elicit significant alterations in cerebral blood flow velocities or in oxygenation of cerebral tissues. Maturational changes in arterial flow velocities and cStO2 are not correlated. For this subgroup of premature infants at low risk of IVH our data do not support the concept of exclusive preterm infant care in supine position.

Does kangaroo mother care improve preterm infant's temperature?

Abstract: Kangaroo mother care is a method of care of preterm infants (before 37 completed weeks of gestation). The method involves infants being carried, usually by the mother, with skin-to-skin contact. This improves stability of preterm infant temperature. The aim of the study: To investigate the effect of kangaroo mother care on preterm infant’s temperature in a neonatal intensive care unit at the Khartoum teaching hospital - Sudan. Methodology: The study design was Nonequivalent Groups Design (a pretest-posttest randomized experiment), 120 mother-preterm infant pairs were selected through purposive sampling. Subjects: The target population for this study were all medically stable preterm infants who were admitted to the neonatal intensive care unit at the time of the study. Preterm infants of gestational age 30–36 weeks (n=120), 60 intervention groups received KMC and another 60 were control group received conventional care. The researcher was available five days per week, five hours per day from 9 am to 2pm. The average number of cases that was taken per week ranged from8 to 10 premature infants and their mothers. Setting: This study was conducted in neonatal intensive care unit (NICU) in Khartoum teaching hospital. Tools: The tools of study divided into two tools; Tool I: Questionnaire was used to collect the demographic data related to preterm infants and their mothers in the intervention and control group, and auxiliary temperature before and after kangaroo mother care for intervention group and also done for control group in conventional care. Tool II: Mercury thermometer. The results: Independent–sample t test was calculated and showed that there is a significant difference regarding the mother's age, and preterm infant weight (P-value = .06 & . 00) Respectively. And there is no significant difference regarding preterm infants gestational age, and preterm infants age since birth (P-value = .82 & . 50) respectively. Mothers' educational level the majority were secondary school, (40.83%), and the lowest were intermediate school (11.67%). The majority of preterm gender were male (60%), and the other was female (40%). Regarding preterm infant's temperature, independent–sample t test showed that there is no significant difference between intervention and control group before KMC (P-value = .86). And there is a significant difference between intervention and control group after KMC (P-value = .01). Paired sample test investigate that, there is a significant difference regarding the level of temperature for intervention group before and after KMC (P-value:. 000). Conclusion: KMC was effective and positively promoted premature infant's temperature than those cared by the conventional care. Recommendation: Educational training program for all neonatal nurses in skills necessary to implement the KMC and further studies should be conducted to assess the neonatal nurses' knowledge, attitudes and practices regarding KMC. Abbreviations: Skin to Skin Contact (SSC), World Health Organization (WHO), Kangaroo Care (KC), Neonatal Intensive Care Unit (NICU), Kangaroo Mother Care (KMC), Gestational Age (GA). Keywords: kangaroo mother care, preterm infants, temperature.

Effects of Prone Sleeping on Cerebral Oxygenation in Preterm Infants

To determine the effect of prone sleeping on cerebral oxygenation in preterm infants in the neonatal intensive care unit. Preterm infants, divided into extremely preterm (gestational age 24-28 weeks; n = 23) and very preterm (gestational age 29-34 weeks; n = 33) groups, were studied weekly until discharge in prone and supine positions during active and quiet sleep. Cerebral tissue oxygenation index (TOI) and arterial oxygen saturation (SaO2) were recorded. Cerebral fractional tissue extraction (CFOE) was calculated as CFOE = (SaO2 - TOI)/SaO2. In extremely preterm infants, CFOE increased modestly in the prone position in both sleep states at age 1 week, in no change in TOI despite higher SaO2. In contrast, the very preterm infants did not have position-related differences in CFOE until the fifth week of life. In the very preterm infants, TOI decreased and CFOE increased with active sleep compared with quiet sleep and with increasing postnatal age. At 1 week of age, prone sleeping increased CFOE in extremely preterm infants, suggesting reduced cerebral blood flow. Our findings reveal important physiological insights in clinically stable preterm infants. Further studies are needed to verify our findings in unstable preterm infants regarding the potential risk of cerebral injury in the prone sleeping position in early postnatal life.

Effect of reading to preterm infants on measures of cardiorespiratory stability in the neonatal intensive care unit.

To evaluate the impact of parental bedside reading (PR) on cardio-respiratory (CR) stability of preterm infants. Prospective examination of the impact of PR on CR stability in preterm NICU infants. CR data from 3 time points: pre-reading (3 and 1 h before reading), during PR, and post-reading (1 h after reading) were compared. Eighteen infants born at 23-31wks gestation, and 8 to 56 days old, were enrolled. Episodes of oxygen desaturation to <85% were fewer during PR as compared to the pre-reading periods and were fewer with live and maternal PR. Preterm infants showed fewer desaturation events less than 85% during PR than prior to reading exposure. This effect persisted up to 1 h after reading exposure. Desaturation events were fewer with live and maternal PR. Voice exposure can be an important way for parents to participate in the care of their preterm infants.