Survival Rate Of Infants Research Articles

Infants with Atypical Presentations of Alveolar Capillary Dysplasia with Misalignment of the Pulmonary Veins Who Underwent Bilateral Lung Transplantation

ObjectiveTo describe disease course, histopathology, and outcomes for infants with atypical presentations of alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV) who underwent bilateral lung transplantation.Study designWe reviewed clinical history, diagnostic studies, explant histology, genetic sequence results, and post-transplant course for 6 infants with atypical ACDMPV who underwent bilateral lung transplantation at St. Louis Children's Hospital. We compared their histology with infants with classic ACDMPV and compared their outcomes with infants transplanted for other indications.ResultsIn contrast with neonates with classic ACDPMV who present with severe hypoxemia and refractory pulmonary hypertension within hours of birth, none of the infants with atypical ACDMPV presented with progressive neonatal respiratory failure. Three infants had mild neonatal respiratory distress and received nasal cannula oxygen. Three other infants had no respiratory symptoms at birth and presented with hypoxemia and pulmonary hypertension at 2-3 months of age. Bilateral lung transplantation was performed at 4-20 months of age. Unlike in classic ACDMPV, histopathologic findings were not distributed uniformly and were not diffuse. Three subjects had apparent nonmosaic genetic defects involving FOXF1. Two infants had extrapulmonary anomalies (posterior urethral valves, inguinal hernia). Three transplanted children are alive at 5-16 years of age, similar to outcomes for infants transplanted for other indications. Lung explants from infants with atypical ACDMPV demonstrated diagnostic but nonuniform histopathologic findings.ConclusionsThe 1- and 5-year survival rates for infants with atypical ACDMPV are similar to infants transplanted for other indications. Given the clinical and histopathologic spectra, ACDMPV should be considered in infants with hypoxemia and pulmonary hypertension, even beyond the newborn period.

Survival and morbidities in very low birth weight (VLBW) infants in a tertiary care teaching hospital

Background: Very low birth weight (VLBW) infants often need institutional advanced neonatal care. There is paucity of literature about the survival and morbidities of this very vulnerable group of preterm very low birth weight infants in tertiary care teaching hospitals. The aim of the study was to measure the outcome of VLBW infants in terms of survival and various short-term morbidities in a tertiary care teaching hospital.Methods: This was a retrospective data analysis of all VLBW infants born in a tertiary care teaching hospital of eastern India, between 01 July 2014 and 31 December 2016. 35 VLBW infants were studied for the outcomes in terms of survival and morbidities like respiratory distress, apnoea of prematurity, intra ventricular haemorrhage, necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity and broncho pulmonary dysplasia.Results: The overall survival rate of VLBW infants weighing >750 g (n=30) was 96.6% and <750 gm (n=5), was 40%. The commonest complications were respiratory distress (65.7%), neonatal hyperbilirubinemia (74.3%) and suspect early onset sepsis (51.4%) based on maternal risk factors.Conclusions: The majority of VLBW infants above 750 g at birth or ≥ 26 weeks POG, survived in a tertiary care teaching hospital.

Flexible Laryngoscopy in Management of Congenital Stridor.

The incidence of congenital stridor is on rise due to improved neonate and infant survival rate. The gold standard investigation for evaluation of stridor is rigid laryngotracheobronchoscopy, but this is invasive andrequires general anesthesia. Flexible fibreoptic laryngoscopy, a relatively simpleand less invasive procedure can be done under topical anaesthesiafor evaluation of stridor. In this study, we havepresented our experience of flexible laryngoscopy in children with congenital stridor, their results and management. Laryngomalacia was the commonest cause of stridor accounting for 80% of cases. 15% (6) patients required tracheostomy for relieving airway obstruction and 22.5% (9) patients required a definitive surgical procedure for correcting the cause. Flexible laryngoscopy is safe and gives a comprehensive analysis of airway including its dynamic functions. We also recommend flexible laryngoscopy as a frontline investigation for evaluation of stridor.

Surgical Interventions in Infants Born Preterm with Congenital Heart Defects: An Analysis of the Kids' Inpatient Database

To evaluate short-term outcomes in infants born preterm with congenital heart defects (CHDs) and the factors associated with surgery, survival, and length of hospitalization in this population. We analyzed data from infants born preterm (gestational age <37 weeks) enrolled in the multicenter Kids' Inpatient Database of the Healthcare Cost and Utilization Project who were admitted to the hospital within 30 days after birth. Infants with atrial septal defects were excluded. Of 1 429 762 enrolled infants born preterm, 27 434 (2.0%) with CHDs were included. Overall survival to discharge was 90.5%; 74.0% among infants with critical CHDs and 45.7% among infants with hypoplastic left heart syndrome. Cardiac surgeries were performed in 12.2% of all infants born preterm. Rates of surgical intervention for infants with critical CHDs were lower for very low birth weight (≤1.5 kg) vs larger infants >1.5 kg (27% vs 44%), and only 6.3% of infants born with very low birth weight underwent surgeries in Risk-adjustment for Congenital Heart Surgery categories 4 or greater. Greater birth weight, left-sided lesions, care at children's hospitals, and absence of trisomies were associated with a greater likelihood of surgery. Birth weight <2 kg, nonwhite race, trisomy syndromes, prematurity-related morbidities, and Risk-adjustment for Congenital Heart Surgery category 4 or greater were independent predictors of mortality. Birth weight <2 kg, Risk-adjustment for Congenital Heart Surgery category, morbidities, and sidedness of lesion predicted length of stay. The high survival rates of infants born preterm with CHDs suggests that a cautiously optimistic approach to surgery may be warranted in all but the most immature infants with the greatest-risk conditions.

Fathering style influences health outcome in common marmoset (Callithrix jacchus) offspring.

In the cooperative breeding common marmoset monkey, Callithrix jacchus, fathers share the care responsibility and energetic load with their mate from the time their infants are born. However, not all fathers show the same level of participation in direct infant care. Here we present the first results demonstrating that fathering style can improve both survival and growth trajectory of a male’s offspring during the first 30 weeks of life and that these infant outcomes are consistent within a father throughout successive births. Twenty-four marmoset fathers were tested for their responsiveness to an infant distress call when their infants were approximately two weeks old. These fathers were categorized as either responsive (RS) or nonresponsive (NRS) based on their response to the calls. Survival past 1 month was then determined and bi-monthly weights of current infants through 30 weeks of age were taken. Infant survival to the first month was significantly higher with RS fathers than with NRS fathers during this critical time period. Infants from RS fathers also had a higher growth trajectory with significant differences in body weight in the 28th and 30th week after birth. Only the RS fathers showed a significant increase in serum testosterone in response to infant cries suggesting a physiological role of testosterone in the motivation to search for the infant. Furthermore, all offspring born to RS fathers from subsequent births also showed a significantly higher survival rate and higher growth trajectory than for offspring of NRS fathers. These results suggest that fathering style is a consistent trait and responsive fathers improve infant survival rate and growth during the first 30 weeks. Such fathering style traits may be passed on to the male offspring due to environmental or genetic factors.

Chondroitin sulfate proteoglycans inhibit the migration and differentiation of oligodendrocyte precursor cells and its counteractive interaction with laminin.

Cerebral white matter injury (WMI) is a recognized problem in premature infants, particularly in those with very low birth weights. Although the survival rate of premature infants has notably increased due to the advancement of modern medical treatments, their likelihood of developmental disability is higher than infants with an average birth weight. It has been previously reported that oligodendrocyte precursor cells (OPCs) are selectively vulnerable to WMI in premature infants. Following brain injury, glial scars may develop within the white matter. Their main constituent is chondroitin sulphate proteoglycans (CSPGs), revealing a potential association between CSPGs and OPCs. In the present study rat OPCs were cultured in vitro, and the effect of CSPGs on the proliferation, migration and differentiation of OPCs was determined. It was revealed that CSPGs did not affect proliferation, but they did inhibit the migration and differentiation of OPCs. It was also identified that the inhibitory effect of CSPGs was counteracted by laminin. Factor analysis revealed that CSPGs and laminin served interactive roles in OPC differentiation. The effect of CSPGs on OPCs was associated with the downregulation of β1-integrin, indicating that CSPGs potentially competitively inhibit the β1-integrin signaling pathway. Collectively, these results suggest that CSPGs serve a role as inhibitors of OPC differentiation and migration, as well as indicating an interaction between CSPGs and laminin. The present study has revealed a potential novel therapeutic target for WMI in premature infants, and identified β1-integrin signaling as a pathological mechanism for dysfunctional myelination in white matter.

Creating an Inclusive Culture for the Next Generation of Nurses

Health care needs of the US population are changing, and the US population is aging in tandem. Technological and medical advances are improving the survival rate of infants, children, and adults. As a result, there are increased numbers of children and older adults with complex medical needs secondary to chronic conditions such as diabetes, asthma, and chronic obstructive lung disease. Dementia among the adult population is also on the rise. Never have the demographics of the US population been more diverse. African Americans, Hispanic Americans, and Native Americans now comprise nearly 40% of the US population. 1 United States Census Bureau American Fact Finder. https://www.census.gov/quickfacts/fact/table/US/PST045216Date: April 21, 2016 Google Scholar It is projected that by 2020, more than half of the nation's children will be part of a minority race or ethnic group and that by 2060 the minority population is expected to rise to over 56% of the nation's total population. 1 United States Census Bureau American Fact Finder. https://www.census.gov/quickfacts/fact/table/US/PST045216Date: April 21, 2016 Google Scholar Significant health disparities exist among ethnic and racial minorities. 2 Martin JA Hamilton BE Sutton PD et al. Births: final data for 2007. Natl Vital Stat Rep. 2010; 58: 1-8 PubMed Google Scholar The US Department of Health and Human Services’ Healthy People 2020 goal is to achieve health equity, eliminate disparities, and improve the health of all groups. Nurses from ethnic and racial minority groups have lived experiences and also have an understanding of the experiences of others with their like backgrounds. These lived experiences positions them to provide care that meets these health disparities in a deeper and more meaningful way. 3 Ayoola A Why Diversity in the Nursing Workforce Matters. Culture of Health blog. Robert Wood Johnson Foundation, May 7, 2013http://www.rwjf.org/en/culture-of-health/2013/05/why_diversity_inthe.html Google Scholar A diverse nursing workforce is essential to meeting the health care needs of the nation and in reducing health disparities that exist among minority populations. Health care needs of the US population are changing, and the US population is aging in tandem. Technological and medical advances are improving the survival rate of infants, children, and adults. As a result, there are increased numbers of children and older adults with complex medical needs secondary to chronic conditions such as diabetes, asthma, and chronic obstructive lung disease. Dementia among the adult population is also on the rise. Never have the demographics of the US population been more diverse. African Americans, Hispanic Americans, and Native Americans now comprise nearly 40% of the US population. 1 United States Census Bureau American Fact Finder. https://www.census.gov/quickfacts/fact/table/US/PST045216Date: April 21, 2016 Google Scholar It is projected that by 2020, more than half of the nation's children will be part of a minority race or ethnic group and that by 2060 the minority population is expected to rise to over 56% of the nation's total population. 1 United States Census Bureau American Fact Finder. https://www.census.gov/quickfacts/fact/table/US/PST045216Date: April 21, 2016 Google Scholar Significant health disparities exist among ethnic and racial minorities. 2 Martin JA Hamilton BE Sutton PD et al. Births: final data for 2007. Natl Vital Stat Rep. 2010; 58: 1-8 PubMed Google Scholar The US Department of Health and Human Services’ Healthy People 2020 goal is to achieve health equity, eliminate disparities, and improve the health of all groups. Nurses from ethnic and racial minority groups have lived experiences and also have an understanding of the experiences of others with their like backgrounds. These lived experiences positions them to provide care that meets these health disparities in a deeper and more meaningful way. 3 Ayoola A Why Diversity in the Nursing Workforce Matters. Culture of Health blog. Robert Wood Johnson Foundation, May 7, 2013http://www.rwjf.org/en/culture-of-health/2013/05/why_diversity_inthe.html Google Scholar A diverse nursing workforce is essential to meeting the health care needs of the nation and in reducing health disparities that exist among minority populations.

Treatment outcomes and associated factors among extremely preterm infants in a major children hospital in Guangxi, China

In developing countries, infant survival rate and long-term outcomes of extremely preterm infants(EPIs) have significantly improved due to advances in perinatal care. The striking gap in the treatment outcome of EPIs between China and the other developed countries was a major concern. To assess treatment outcomes and associated factors among EPIs in Nanning, China. This was a perspective study consisting of eligible cases with gestational age between 22 and 28 weeks and infants were followed to 18-24 months of age. Data including clinical characteristics, perinatal factors and after-birth conditions were collected from the neonatal intensive care unit (NICU) in a major women's and children's health hospital in Guangxi Province from January 1st 2010 to February 1st 2015. During that period 79 EPIs were born in the hospital. Twenty-eight infants died in hospital after their parents decided to withdraw clinical treatment. Of the 51 surviving infants, 5 infants were lost to follow-up. Eleven of the 46 infants were evaluated at 18-24 months of age and were diagnosed with neurodevelopmental disability and 35 infants showed normal motor language development. The incidence of intrauterine infection and intraventricular hemorrhage (IVH) grade III were both higher in the group of infants who were diagnosed neurodevelopmental disability than in the group of infants with normal motor language development (p<0.05). Logistic regression analysis showed that intrauterine infection (OR=33.290, 95%CI=2.180-508.351) and IVH grade III (OR=26.814, 95%CI=3.631-197.989) were the major risk factors for neurodevelopmental disability in EPIs. Intrauterine infection and IVH grade III were associated with the neurodevelopmental disability in EPIs.

The Role of Maternal HIV Envelope-Specific Antibodies and Mother-to-Child Transmission Risk.

Despite the wide availability of antiretroviral therapy (ART) prophylaxis during pregnancy, >150,000 infants become infected through mother-to-child transmission (MTCT) of HIV worldwide. It is likely that additional intervention strategies, such as a maternal HIV vaccine, will be required to eliminate pediatric HIV infections. A deeper understanding of the fine specificity and function of maternal HIV envelope (Env)-specific responses that provide partial protection against MTCT will be critical to inform the design of immunologic strategies to curb the pediatric HIV epidemic. Recent studies have underlined a role of maternal HIV Env-specific neutralizing and non-neutralizing responses in reducing risk of MTCT of HIV and in prolonging survival rates in HIV-infected infants. However, critical gaps in our knowledge include (A) the specific role of maternal autologous-virus IgG-neutralizing responses in driving the selection of infant transmitted founder (T/F) viruses and (B) Env mechanisms of escape from maternal autologous virus-neutralizing antibodies (NAbs). A more refined understanding of the fine specificities of maternal autologous virus NAbs and ways that maternal circulating viruses escape from these antibodies will be crucial to inform maternal vaccination strategies that can block MTCT to help achieve an HIV-free generation.

The Effects of Developmental Care on Short-Term Outcomes of Preterm Infants: A Quasi-Experimental Study

Background: Technological advances in neonatal care have increased the survival rate of preterm infants, but they have not been able to reduce the risk of the multiple complications developing in them. Objectives: To determine the short-term effects of developmental care on preterm infants. Methods: The present quasi-experimental study was conducted on 105 preterm infants (three groups of 35) born in Al-Zahra hospital of Tabriz, Iran, from September 2013 to November 2015. The sampling method was convenience, based on study’s eligibility criteria. The control group received no developmental care. Intervention group 1 received developmental care at the neonatal intensive care unit and the neonatal ward, and intervention group 2 received developmental care from birth in the delivery and operating rooms and continued to receive it at the NICU and the neonatal ward. Short-term neonatal outcomes were analyzed with descriptive and inferential statistics. Results: The overall duration of hospital stay was significantly shorter in intervention group 2 compared to the control group (mean difference: - 13.6; confidence interval: -24.8 to -2.4; P = 0.013) and intervention group 1 (-12.5; -23.7 to-1.3; P = 0.024), and the duration of NICU stay was also shorter in intervention group 2 compared to the control group (-12.4; -22.2 to -2.5; P = 0.009). The incidence of sepsis was significantly lower in intervention groups 1 and 2 compared to the control group, and the incidence of prematurity anemia and the need for blood transfusion were also significantly lower in intervention group 2 compared to intervention group 1 and the control group (P < 0.05). No significant differences were observed between the groups in terms of neonatal growth parameters at full term corrected age. Conclusions: The results obtained showed that developmental care for preterm infants, especially when initiated as early as in the delivery and operating room, can improve certain short-term neonatal outcomes.

LungMAP: The Molecular Atlas of Lung Development Program.

The National Heart, Lung, and Blood Institute is funding an effort to create a molecular atlas of the developing lung (LungMAP) to serve as a research resource and public education tool. The lung is a complex organ with lengthy development time driven by interactive gene networks and dynamic cross talk among multiple cell types to control and coordinate lineage specification, cell proliferation, differentiation, migration, morphogenesis, and injury repair. A better understanding of the processes that regulate lung development, particularly alveologenesis, will have a significant impact on survival rates for premature infants born with incomplete lung development and will facilitate lung injury repair and regeneration in adults. A consortium of four research centers, a data coordinating center, and a human tissue repository provides high-quality molecular data of developing human and mouse lungs. LungMAP includes mouse and human data for cross correlation of developmental processes across species. LungMAP is generating foundational data and analysis, creating a web portal for presentation of results and public sharing of data sets, establishing a repository of young human lung tissues obtained through organ donor organizations, and developing a comprehensive lung ontology that incorporates the latest findings of the consortium. The LungMAP website (www.lungmap.net) currently contains more than 6,000 high-resolution lung images and transcriptomic, proteomic, and lipidomic human and mouse data and provides scientific information to stimulate interest in research careers for young audiences. This paper presents a brief description of research conducted by the consortium, database, and portal development and upcoming features that will enhance the LungMAP experience for a community of users.

Professional Nurses' Perceptions of Skills Required for Performing Preterm Infants' Follow-up Assessments

Improved perinatal and neonatal care enhances preterm infant survival rates, but the adverse outcomes remain high. Nurses play vitally important roles regarding the follow-up assessments, treatment, and care of preterm infants. This explorative, descriptive study aimed to describe nurses' perceptions of skills required to perform effective preterm infant assessments. Thirteen semistructured interviews were conducted. Identified themes included the role of the professional nurse, the importance of preterm infant assessments, lack of skills and knowledge to conduct quality assessments, formal and continuous development training needs, the absence of assessment tools and physical resources to perform standardized assessments of preterm infants, and the required support and referral systems.

Providing active antenatal care depends on the place of birth for extremely preterm births: the EPIPAGE 2 cohort study

Survival rates of infants born before 25 weeks of gestation are low in France and have not improved over the past decade. Active perinatal care increases these infants’ likelihood of...

Reducing Viability Bias in Analysis of Gut Microbiota in Preterm Infants at Risk of NEC and Sepsis.

Necrotising enterocolitis (NEC) and sepsis are serious diseases of preterm infants that can result in feeding intolerance, the need for bowel resection, impaired physiological and neurological development, and high mortality rates. Neonatal healthcare improvements have allowed greater survival rates in preterm infants leading to increased numbers at risk of developing NEC and sepsis. Gut bacteria play a role in protection from or propensity to these conditions and have therefore, been studied extensively using targeted 16S rRNA gene sequencing methods. However, exact epidemiology of these conditions remain unknown and the role of the gut microbiota in NEC remains enigmatic. Many studies have confounding variables such as differing clinical intervention strategies or major methodological issues such as the inability of 16S rRNA gene sequencing methods to determine viable from non-viable taxa. Identification of viable community members is important to identify links between the microbiota and disease in the highly unstable preterm infant gut. This is especially important as remnant DNA is robust and persists in the sampling environment following cell death. Chelation of such DNA prevents downstream amplification and inclusion in microbiota characterisation. This study validates use of propidium monoazide (PMA), a DNA chelating agent that is excluded by an undamaged bacterial membrane, to reduce bias associated with 16S rRNA gene analysis of clinical stool samples. We aim to improve identification of the viable microbiota in order to increase the accuracy of clinical inferences made regarding the impact of the preterm gut microbiota on health and disease. Gut microbiota analysis was completed on stools from matched twins (n = 16) that received probiotics. Samples were treated with PMA, prior to bacterial DNA extraction. Meta-analysis highlighted a significant reduction in bacterial diversity in 68.8% of PMA treated samples as well as significantly reduced overall rare taxa abundance. Importantly, overall abundances of genera associated with protection from and propensity to NEC and sepsis such as: Bifidobacterium; Clostridium, and Staphylococcus sp. were significantly different following PMA-treatment. These results suggest non-viable cell exclusion by PMA-treatment reduces bias in gut microbiota analysis from which clinical inferences regarding patient susceptibility to NEC and sepsis are made.

Risk factors for the development of post-traumatic stress disorder and coping strategies in mothers and fathers following infant hospitalisation in the neonatal intensive care unit.

The aim of this study was to identify the potential risk factors for the development of post-traumatic stress disorder in mothers and fathers following infant hospitalisation in the neonatal intensive care unit. The development of neonatal intensive care units has increased the survival rate of infants. However, one of the major parental problems is post-traumatic stress disorder. An observational study covered 125 parents (72 mothers and 53 fathers) of infants aged 3-12months who were hospitalised in the neonatal intensive care unit during the neonatal period. Third-referral neonatal intensive care unit. Several standardised and self-reported research tools were used to estimate the level of post-traumatic stress symptoms (Impact Event Scale-Revised), perceived stress (Perceived Stress Scale) and coping strategies (COPE Inventory). The respondents also completed a Parent and Infant Characteristic Questionnaire. The mothers and fathers did not differ in their parental and infant characteristics. Post-traumatic stress disorder was present in 60% of the mothers and 47% of the fathers. Compared to the fathers, the mothers felt greater stress (p=.020) and presented a higher severity of post-traumatic stress disorder (p<.001). Previous miscarriages (p=.023) and the presence of chronic diseases (p=.032) were risk factors for post-traumatic stress disorder in the mothers. In the fathers, an Apgar test at 1min after birth (p=.030) and a partner's post-traumatic stress disorder (p=.038) were related to post-traumatic stress disorder. The mothers compared to the fathers were more likely to use strategies such as: positive reinterpretation and growth, focusing on and venting of emotions, instrumental social support, religious coping and acceptance. In the fathers, the predictors included an Apgar score at 1min after birth, a lack of congenital anomalies in the child and mental disengagement. Risk factors for post-traumatic stress disorder, as well as coping strategies, differ in women compare to men. Knowledge of risk factors for post-traumatic stress disorder, specific to men and women, may help identify the parents in whom probability of the occurrence of this disorder is increased.

Perspectives and attitudes of pediatricians concerning post-discharge care practice of premature infants

Survival rates of premature infants are at a historical high and increasingly more pediatricians are caring for former premature infants. The goal of this study was to describe the perspectives and attitudes of pediatricians, as well as, the challenges of rendering post-neonatal intensive care unit (NICU) discharge care for premature infants. An anonymous 22-question web-based survey was emailed to pediatricians who are current members of the American Academy of Pediatrics (AAP) and practicing in Kings County, New York. There were 148 completed surveys with 79% being general pediatricians. Of all respondents, 63% believed that premature infants should have a neonatal high risk follow-up visit within days after discharge and 64% were satisfied with the NICU discharge summary acquisition. While 74% of pediatricians felt comfortable following up with former extremely premature infants, 65% referred to specialists, most often to child development, neurology, and physical and/or occupational therapy. The majority (85%) were more likely to refer premature infants to early intervention. Participating pediatricians varied in their knowledge of immunization and breastfeeding guidelines. Finally, 88% of respondents acknowledged that caregivers of premature infants experience increased stress, with 53% stating that the stress should be addressed. Understanding the perceptions and challenges of pediatricians who care for premature infants may help improve post NICU quality of care. Transition to the outpatient setting is a crucial step in the management of premature infants and a focus on improved hand-off procedures between hospital and physicians may prove beneficial. Also, pediatricians must stay abreast of current recommendations for breastfeeding and vaccinations. Furthermore, emphasis should be given to stress reduction and management for caregivers of former premature infants.

Exploring NICU Nurses' Affective Responses to End-of-Life Care.

The survival rate for infants born with life-threatening problems has improved greatly over the last few decades. Nevertheless, infants still die in neonatal intensive care units (NICUs) every day. Despite existing standards of care, some aspects of end-of-life care (EOLC) are still not delivered consistently. Little is known about how NICU nurses' individual experiences affect EOLC. The purpose of this study was to explore, through lived and told stories, the affective, interactional, and meaning-related responses that NICU nurses have while caring for dying infants and their families. Coping strategies and changes in practice were also explored. Thirty-six members of the National Association of Neonatal Nurses submitted written narratives about an EOLC experience during which the nurse experienced strong emotions. Narrative analysis revealed many affective responses, but 3 were the most frequent: responsibility, moral distress, and identification. Coping methods included healthy and less healthy strategies, such as colleague support, informal and formal debriefing, practicing intentional gratefulness, avoidance, and compartmentalization. Changes in practice identified were universally described as professional growth through the use of reflective practice. Educators should discuss the range of emotions experienced by caregivers related to EOLC and healthy coping strategies and encourage the use of reflective practice as a facilitator of professional growth. Nurse leaders should promote supportive environments in NICUs and ensure debriefing opportunities for nurses who have recently cared for a dying infant. Future research should focus on formulating interventions to utilize debriefing with NICU nurses and perhaps the development of EOLC mentors.

Neurobiological Consequences of Early Painful Experience: Basic Science Findings and Implications for Evidence-Based Practice.

As healthcare teams have worked to improve infant survival rates, the management of painful events experienced by these hospitalized neonates has increased and yet pain management remains highly variable between healthcare institutions. At the same time, emerging evidence suggests that these early painful experiences may alter the trajectory of development for pain-processing pathways both peripherally and centrally. This concise review highlights findings from both the basic and clinical science literature supporting the hypothesis that early painful experiences can have long-lasting negative effects on biological, psychological, and socioemotional functions. Implications for pain management in neonates and considerations for evidence-based practice change are discussed.

Survival of Premature and Low Birth Weight Infants: A Multicenter, Prospective, Cohort Study in Iran

ABSTRACTBackground: The survival rate of preterm and low-birth-weight (LBW) infants depends on various factors such as birth weight, gestational age, and quality of care. The present study aimed at evaluating the survival rate of preterm and LBW infants, predictive factors, and the risk of mortality in three training hospitals of Mashhad and Tabriz cities.Methods: This prospective, cohort study was conducted during six months from 2013 to 2014. Infants with birth weight ≤1500 g or gestational age ≤32 weeks were enrolled. Their information was gathered by using data collection forms and clinical risk index for infants (CRIB II) was calculated for each participant. Infants were followed up until discharge from the hospital and their outcomes were determined. Kaplan-Meier and Log rock tests were used for survival analysis. Cox regression was also applied in order to find out the factors associated with infants’ survival.Results: Among the 338 followed up infants, 97 (28.7%) died and 241 (71.3%) remained alive. The median of preterm and LBW infants’ overall survival rate was 76 days (CI: 60.4-91.5). Multivariate Cox regression analysis indicated that three factors of birth weight, base excess, and fifth minute Apgar score had a significant relationship with the survival rate of infants (P<0.05).Conclusion: The survival rate of preterm and low-weight infants was acceptable in this study (71%). Birth weight, fifth minute Apgar score, and base excess were important items that affected infants’ survival and could be considered in predicting it in neonatal intensive care units.

Effect of Early Physical Activity Programs on Motor Performance and Neuromuscular Development in Infants Born Preterm: A Randomized Clinical Trial.

Introduction: Although the survival rate of infants born preterm has increased, the prevalence of developmental problems and motor disorders among this population of infants remains the same. This study investigated the effect of physical activity programs in and out of water on motor performance and neuromuscular development of infants born preterm and had induced immobility by mechanical ventilation. Methods: This study was carried out in Al-Zahra hospital, Tabriz. 76 premature infants were randomly assigned into four groups. One group received daily passive range of motion to all extremities based on the Moyer-Mileur protocol. Hydrotherapy group received exercises for shoulders and pelvic area in water every other day. A combination group received physical activity programs in and out of water on alternating days. Infants in a containment group were held in a fetal position. Duration of study was two weeks ‘from 32 through 33 weeks post menstrual age (PMA). Motor outcomes were measured by the Test of Infant Motor Performance. Neuromuscular developmental was assessed by New Ballard scale and leg recoil and Ankle dorsiflexion items from Dubowitz scale. Data were analyzed using SPSS version 13. Results: TIMP and neuromuscular scores improved in all groups. Motor performance did not differ between groups at 34 weeks PMA. Postural tone of leg recoil was significantly higher in physical activity groups post intervention. Conclusion: Physical activities and containment didn’t have different effects on motor performance in infants born preterm. Leg recoil of neuromuscular development items was affected by physical activity programs.