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Background: Involving parents in decisions about the care of their infant is common practice in most neonatal intensive care units. However, involvement is less common in neonatal research and a gap appears to exist in understanding the process of patient and public involvement. The aim of this study was to explore parents and researchers' experiences of patient and public involvement in a neonatal research project. Methods: A qualitative design was employed, consisting of two focus group interviews, one dyadic interview, and four individual interviews with parents and researchers. The interviews followed a semi-structured guide specific to both parents and researchers. Data were analysed using content analysis as described by Graneheim and Lundman. Results: A total of nine parents and four researchers participated in the study. Seven themes were consolidated into three core concepts: Embracing the ethos and pathos of patient and public involvement, Finding the path to maximise meaningful involvement, and Becoming skilled in engaging patients and the public in research. The core concepts highlighted both similarities and differences, as well as challenges and facilitators, of the experiences of the patient and public involvement process. Conclusion: Patient and public involvement in research was a mutually beneficial process, facilitating learning and reflective opportunities for parents and researchers. However, there were challenges that emphasised the need for rapport building between parents and researchers, valuing everyone's unique perspective and expertise, with clear communication and well-defined roles and goals. These insights offer a contribution for future patient and public involvement in health research. Plain English summary: It is usual practice to involve parents in decisions about their babies care in neonatal intensive care units, but their involvement in research is less common. Although patient and public involvement in research is increasing, there is a lack of strategies to ensure meaningful involvement. This qualitative study used interviews, to explore how parents and researchers experienced patient and public involvement in a research project about couplet care in a neonatal intensive care unit. Nine parents and four researchers participated and the analysis revealed several themes that describes their experiences. These themes were consolidated into three main concepts: (1) Embracing the ethos and pathos of patient and public involvement, which focuses on the emotional and ethical aspects of involvement, (2) Finding the path to maximize meaningful involvement, which addresses the strategies and methods to ensure effective involvement, and (3) Becoming skilled in engaging patient and the public in research, which emphasizes the need for developing skills and knowledge for better involvement practices. These core concepts provide a comprehensive understanding of how to enhance involvement, not only in the neonatal setting, but research in general. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to prove the effectiveness of physiological flexion swaddling and oromotor interventions in terms of the duration needed to achieve the oral feeding ability of preterm infants in the NICU. Methods: A randomized clinical trial in five Neonatal intensive care units (NICU) was performed involving 70 preterm infants born at 28-34 weeks gestational age. Participants were allocated to 1) the experimental group (n = 39) received physiological flexion swaddling and oromotor interventions, and 2) the control group (n = 31) received conventional swaddling and oromotor interventions. Mann-Whitney U analysis was used to determine the effectiveness of each group according to the duration needed to achieve oral feeding ability, while Kaplan-Meier survival analysis was applied to compare the duration of both groups. Results: The experimental group had a significantly shorter duration in achieving oral feeding ability [4 (1-15) vs. 7 (2-22) days; p = 0.02]. The Kaplan-Meier survival curve analysis showed that infants in the experimental group achieved full oral feeding ability earlier than those in the control group (15 vs. 22 days). Conclusions: Physiological flexion swaddling and oromotor interventions have been proven to be effective in shortening the number of days needed to achieve the oral feeding ability of preterm infants in the NICU. [ABSTRACT FROM AUTHOR]

Aim: To systematically review the literature on noise exposure within the neonatal intensive care unit/special care nursery settings, specifically to describe: noise characteristics, sources of noise and ways of measuring noise. Methods: Systematic searches were conducted through databases Medline, Embase and PubMed. Studies were included if they met the inclusion criteria (1) reported noise characteristics; (2) reported noise exposure measurements; (3) in the neonatal intensive care unit/ special care nursery settings. Methods and key findings were extracted from included studies. Quality analysis was done using a modified version of the Newcastle‐Ottawa Scale. Results: We identified 1651 studies, screened 871, reviewed 112 and included 47. All reported NICU average equivalent sound levels were consistently louder than recommended guidelines (45 dB). The most consistent association with higher sound pressure levels were noise sources grouped under people congregation. Half of the studies did not use measuring devices adhering to international sound level meter (SLM) standards. Conclusion: All NICUs exceeded recommended accumulative sound levels. People were the most consistent source of noise. Sound pressure levels need to be consistently measured with devices adhering to international SLM standards in future studies. [ABSTRACT FROM AUTHOR]

Background: Retinopathy of prematurity (ROP) is a significant cause of preventable childhood blindness, particularly affecting premature infants in developing countries. With improved survival rates of preterm infants, understanding its risk factors and clinical profile is crucial for early detection and management. Objective: To investigate the incidence, risk factors, and staging of ROP in preterm babies admitted to the NICU at Karnataka Institute of Medical Sciences, Hubli. METHODS: A hospital-based observational study was conducted from December 2012-November 2013. Preterm infants =34 weeks gestational age and/or birth weight =2000 grams were screened for ROP. Detailed maternal and neonatal data were collected, and ROP screening was performed using indirect ophthalmoscopy. Statistical analysis included descriptive statistics, chi-square tests, and unpaired t test. Results: Of 176 screened preterm infants, 71 (40.3%) developed ROP. Stage II was predominant (73.2%) followed by Stage I (26.8%), with no advanced stages observed. Significant risk factors included lower gestational age (p=0.0002), birth weight <1500g (p=0.024), multiple gestation (p<0.001), oxygen therapy (p<0.001), sepsis (83.1% vs 17.1%, p<0.001), respiratory distress syndrome (50.7% vs 15.2%, p<0.001), and apnea (19.7% vs 4.8%, p=0.001). Laboratory parameters showed significantly higher infection markers in the ROP group, with increased CRP and blood culture positivity (p<0.001). Most cases (88.7%) showed spontaneous resolution, with only 5.6% requiring intervention. Conclusion: The study demonstrated a significant ROP incidence of 40.3%, with multiple risk factors identified. Strong associations were found between ROP development and lower gestational age, birth weight, multiple gestation, oxygen therapy, and neonatal complications, particularly sepsis. [ABSTRACT FROM AUTHOR]

Purpose of Review: Newborns and infants in the neonatal intensive care unit (NICU) may be at uniquely high risk of developing delirium. Because there is a dearth of NICU-focused literature, providers must rely on evidence derived from older children and infants in other care settings to guide management. The literature was rigorously reviewed to highlight evidence specific to newborns and infants and is summarized here. Recent Findings: Delirium likely occurs in newborns and infants at similar or higher rates than what is seen in other care settings. Recent literature calls particular attention to the lack of assessment tools validated in a NICU setting. Summary: Evidence for the evaluation and management of delirium in the NICU is lacking. More study specific to the NICU is needed to build consensus toward best practice. [ABSTRACT FROM AUTHOR]

Aim: This research was conducted to evaluate the effects of Reiki and facilitated tucking position on pain, stress and physiologic parameters in preterm infants during orogastric tube (OGT) insertion. Methods: The study used a single‐blind, parallel‐group randomised controlled experimental design. It was carried out in the neonatal intensive care unit of a hospital in Niğde/Turkey between February 2022 and January 2023. A total of 45 preterm infants, who met the study criteria and whose sample size was determined according to power analysis, were randomly divided into three groups. As an intervention, the facilitated tucking position was applied to the first group, and Reiki was applied to the second group during OGT insertion. Routine application continued in the control group. The Infant Introductory Information Form, Physiological Parameter Follow‐up Chart, Infant Stress Scale (ISS) and Premature Infant Pain Profile Scale‐Revised (PIPP‐R) were used for data collection. Significance was accepted as P < 0.05 in the statistical analysis. Results: It was determined that the infants were homogeneously distributed between the experimental and control groups (P > 0.05). Infants who received the facilitated tucking position and Reiki intervention had better physiological stability compared to the control group (P < 0.05). The group with the lowest average stress (1.53 ± 0.99) and pain scores (4.06 ± 1.22) during OGT insertion was the facilitated tucking group (P < 0.001). After the procedure, stress and pain scores in both the facilitated tucking group and the Reiki group were found to be significantly lower than those in the control group (P < 0.001). Conclusions: The results of the study showed that the facilitated tucking position during OGT insertion was especially effective in reducing the pain and stress of infants. Both the facilitated tucking position and Reiki were determined to be effective interventions in reducing the pain and stress of infants more quickly after the procedure. The results of study contribute to the recommendation that NICU nurses should include non‐pharmacological methods to decrease the pain of preterm infants during procedural pain. [ABSTRACT FROM AUTHOR]

Healthcare associated infections are the potential cause of morbidity and mortality amongst paediatric population. Widespread antimicrobial use amongst paediatric population leads to the antimicrobial resistance. Bloodstream infections amongst the paediatric population are the leading cause of death. The objective of the study was to determine the general trend of antimicrobial susceptibility pattern in the paediatric and neonatal age group in the ICU setting. Retrospective analysis was done of all the patients of paediatric and neonatal age group who were admitted in ICU including patients on ventilators, and whose blood samples were sent to the lab for culture and sensitivity testing. The sample profile from PICU and NICU shows the total numbers of 3056 samples (including blood, ET secretion, pus, urine, pleural fluid, etc.) were received in the laboratory from paediatric and Neonatal ICU during the study period. Total blood samples received from PICU and NICU were 1310 (sample size). Out of these, blood samples received from PICU were 618 (33.76%), of which 173 (28%) were positive, whereas, 692 (56.52%) blood samples were received from NICU, of which 242 (35%) were positive. The blood samples showed that in PICU, CONS (20.75%), and Staphylococcus aureus (16.98%) were found in maximum numbers. In NICU, Klebsiella pneumoniae were obtained in maximum numbers (30.77%), followed by Acinetobacter baumanii (21.98%). CONS (Methicillin resistant) were found 100% susceptible against Linezolid, followed by Vancomycin and Clindamycin (83% each). Staphylococcus aureus showed 100% sensitivity for Teicoplanin. Klebsiella pneumoniae, were found to be most susceptible to Tigecycline (74.07%) and Colistin (70.37%). Acinetobacter in blood of PICU patients showed high level of resistance with only 37.5% sensitivity for Colistin and Minocycline each, 12.5% sensitivity for Amikacin. To our conclusion, Linezolid was found to be the best Antimicrobial agent against MRCONS, whereas, Linezolid, Teicoplanin, Tetracyclines were found to have good efficacy against Staphylococcus aureus. The best antimicrobial agents against Klebsiella pneumoniae and E. coli were Colistin and Tigecycline. [ABSTRACT FROM AUTHOR]

A neonatal intensive care unit (NICU) provides an optimal environment for the care of preterm babies. Bedside nurses are fundamental to this care provided to preterm babies in the NICU. Modern NICUs are technology-intensive space, instrumented with several monitoring technologies to help the nurses track the babies in their care. These technologies help the nurses in a way that is essential for the successful operation of the NICU. To understand how these monitoring technologies function in the NICU from the viewpoint of the nurses, we conducted semi-structured interviews with seven nurses who work at a NICU in the US. We then performed a thematic analysis on the interviews and we found that, despite the utility of the monitoring technologies, they also pose several challenges to the nurses in performing their duties. More specifically, we discovered that: (1) all elements of the monitoring technologies posed a challenge in some way; (2) in a few specific situations, the nurses were able to make up for some of these challenges; and (3) the nurses suggested improvements to all elements of the monitoring technologies. Based on these findings, we describe six areas of future research that argue for the design of monitoring technologies as a way to empower nurses. These include: improved vital signs monitoring that facilitate kangaroo care, using voice to manage alarms, video feeds controlled by nurses in the patient rooms, giving more control over the alarm sounds to the nurses, having a common interface and leveraging augmented reality to help the nurses control the monitoring technologies. [ABSTRACT FROM AUTHOR]

Objective: To identify the causative bacteria responsible for early and late onset neonatal sepsis and to determine their antibiotic susceptibilities at Central Park Teaching Hospital. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of Central Park Teaching Hospital, Lahore. Study Period: Jan to June 2024. Methods: Neonates up to 28 days old with clinical features of sepsis were randomly sampled and included in the study. Key maternal and neonatal risk factors were evaluated. Blood cultures were analyzed to identify microbial isolates and assess resistance patterns. Demographic data, clinical features, and blood culture results were collected and analyzed using SPSS version 26.0. Results: Out of the cases studied, 55% were male. Early onset sepsis was slightly more prevalent at 51.5%. Significant maternal risk factors for early sepsis included maternal fever, offensive liquor, and prolonged second stage of labor. Blood cultures were positive in 18.8% of cases, with early onset sepsis accounting for 44.7% of positives and late onset sepsis for 55.3%. Gram-positive bacteria were more common in early sepsis (48.1%), with Acinetobacter baumannii and Candida blankii being notable isolates, while Gram-negative bacteria were more prevalent in late sepsis (63.6%), with Bacillus spp. and Burkholderia cenoc as key pathogens. Coagulase-negative Staphylococcus was the most frequently isolated pathogen in both early and late sepsis. Conclusion: The study underscores the importance of developing tailored antimicrobial strategies based on the timing of sepsis onset to improve neonatal outcomes. Significant differences in microbial distribution between early and late neonatal sepsis were observed (p < 0.001). [ABSTRACT FROM AUTHOR]

Background: The newborn period is the most vulnerable phase for a child's survival, with around half of all under-five deaths worldwide occurring during this time. Despite existing policies and measures, Ethiopia ranks among the top 10 African countries in terms of newborn mortality. In spite of many studies being carried out in the country, the incidence and predictors of neonatal mortality in the Pastoralist and agro-pastoralist parts of the country's southern still remain unidentified. Therefore, this study aimed to identify the predictors of neonatal mortality in selected public Hospitals in southern Ethiopia. Materials and methods: An institution-based retrospective cohort study was conducted among 568 neonates admitted to the neonatal intensive care unit at Bule Hora University teaching Hospital and Yabelo General Hospital, Southern Ethiopia from 1 January 2020–31 December 2021. A simple random sampling technique was used to select records of neonates. Data entry was performed using Epidata version 3.1 and the analysis was performed using STATA version 14.1 Kaplan Meir curve and Log-rank test were used to estimate the survival time and compare survival curves between variables. Hazard Ratios with 95% CI were computed and all the predictors associated with the outcome variable at p-value 0.05 in the multivariable cox proportional hazards analysis were declared as a significant predictor of neonatal death. Results: Out of 565 neonates enrolled, 54(9.56%) neonates died at the end of the follow-up period. The overall incidence rate of death was 17.29 (95% CI: 13.24, 22.57) per 1000 neonatal days with a restricted mean follow-up period of 20 days. Of all deaths, 64.15% of neonates died within the first week of life. In the multivariable cox-proportional hazard model, neonatal age < 7 days (AHR: 9.17, 95% CI: (4.17, 20.13), place of delivery (AHR: 2.48, 95% CI: (1.38, 4.47), Initiation of breastfeeding after 1 h of birth (AHR: 6.46, 95% CI: (2.24, 18.59), neonates' body temperature <36.5 °C (AHR: 2.14, 95% CI: (1.19, 3.83), and resuscitated neonates (AHR: 2.15, 95% CI: (1.20, 3.82) were independent predictors of neonatal death. Conclusion: In the research setting, the incidence of neonatal death was high, especially during the first week of life. The study found that neonatal age < 7 days, place of delivery, Initiation of breastfeeding after 1 h of birth, neonates' body temperature <36.5 °C, and resuscitated neonates were predictors of neonatal death. To improve newborn survival, significant neonatal problems, improved resuscitation, and other relevant factors should be addressed. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether pre- and postoperative follow-up based on lung ultrasound is associated with the respiratory and clinical evolution of patients undergoing cardiac surgery in the neonatal period. Methods: Prospective observational unicentric study from December 2020 to October 2023 in a neonatal intensive care unit, a referral center for congenital heart diseases (CHD). Neonates with CHD exposed to heart surgery or percutaneous catheterization in their first 28 days of life were included. LU follow-up was performed before surgery (LUSpre) and on days 1 (LUS_1), 3 (LUS_3), and 7 (LUS_7) afterwards by mean of a dedicated score (LUS) ranging from 0 to 3 points in 8 areas (total score 0–24). Results: Fifty-five neonates were included. Median gestational age was 39.1 weeks (37.8–40.1), birth weight 3088 g (IQR 2910–3400). Forty-nine received surgery and 6 only percutaneous catheterization. Median LUSpre score was associated with total respiratory support in the first 30 postoperative days (p = 0.034). Median postoperative LUS was significantly higher than LUSpre in the surgery cohort at all time points (p < 0.05). LUS_1 was associated with respiratory and several clinical outcomes: for each point increase in the ultrasound score, the days on invasive mechanical ventilation, the need for any respiratory support within the first 30 postoperative days, and the length of NICU stay increased significantly (p < 0.05). The presence of consolidations in any area in the postoperative lung ultrasounds was associated with worse respiratory outcomes: higher invasive mechanical ventilation duration (6.84 days), longer total respiratory support (6.07 days), and NICU admission (21.61 days). The presence of consolidations in LUS_7 was significantly associated with the occurrence of ipsilateral diaphragmatic paralysis (odds ratio of 10.25 (95% CI 2.05–51.26, p = 0.006). Conclusion: Performance of lung ultrasound follow-up in CHD in the NICU is feasible and predictive of the respiratory evolution of the patient. LUS_1 presented the highest predictive values. The presence of consolidations is associated with a worse respiratory evolution and if they persist for a week after the procedure, it may raise suspicion of ipsilateral diaphragmatic paralysis. What is known: • Lung ultrasound evaluates lung aeration and predicts respiratory outcomes in premature infants. What is new: • Follow-up based on lung ultrasound in congenital heart diseases postoperative period is associated with respiratory evolution and length of admission. [ABSTRACT FROM AUTHOR]

Although fathers experience emotional stress both during the care period and after discharge, there is limited research focusing exclusively on fathers' experiences after their time in a neonatal intensive care unit. Their experiences are important for tailoring support to fathers based on their individual needs. This paper is part of a longitudinal study in which parents were followed by means of questionnaires and individual interviews during a two-year period after discharge from hospital-based neonatal home care. A qualitative content analysis with an inductive approach was used to elucidate the experiences of fathers six months after their preterm infant's discharge. Twelve fathers participated in the study. The following categories emerged and constituted the result: "Vivid memories from the NICU," "Struggling with new challenges in life" and "Transition to home still in their thoughts." The approach and attitude of health-care professionals may contribute to fathers' involvement during the care period, as fathers tend to set their own feelings aside. [ABSTRACT FROM AUTHOR]

The Maryland's Premature Infant Developmental Enrichment (PRIDE) program is a unique collaborative endeavor between the University of Maryland School of Medicine and the Part C program for Baltimore City residents (Baltimore Infants and Toddlers Program; BITP). To evaluate the impact of PRIDE, the current study compared premature infants from low-income families who participated in BITP with (BWP) and without PRIDE (BWOP). A total of 956 premature infants (nBWP = 271; nBWOP = 685) were included in the study. Results showed that infants in BWP were referred at a younger age and stayed in BITP longer. A smaller percentage of parents in BWP withdrew from BITP and a larger percentage of BWP infants were eligible for special education preschool services under Part B of the Individuals with Disabilities Education Act (IDEA) at age 3. These findings provide support for the relative benefits of PRIDE to the traditional system of early intervention referral, evaluation, and service coordination. [ABSTRACT FROM AUTHOR]

Targeted neonatal echocardiography (TNE) is essential when approaching hemodynamic instability in neonates. Competency in this field requires standardized training, including robust hands-on experience. Proficiency in understanding the key elements of ultrasound knobology is indispensable for optimal acquisition of imaging. This is a narrative review summarizing the key elements of knobology in TNE. Literature review was mainly done through PubMed. There was no funding allocated for the production of this manuscript. Key Points Robust and structured training is essential Understanding knobology is required to achieve competency in TNE Optimizing knobology is critical for an accurate hemodynamic interpretation report [ABSTRACT FROM AUTHOR]

Depth cameras can provide an effective, noncontact, and privacy-preserving means to monitor patients in the Neonatal Intensive Care Unit (NICU). Clinical interventions and routine care events can disrupt video-based patient monitoring. Automatically detecting these periods can decrease the time required for hand-annotating recordings, which is needed for system development. Moreover, the automatic detection can be used in the future for real-time or retrospective intervention event classification. An intervention detection method based solely on depth data was developed using a vision transformer (ViT) model utilizing real-world data from patients in the NICU. Multiple design parameters were investigated, including encoding of depth data and perspective transform to account for nonoptimal camera placement. The best-performing model utilized ∼85 M trainable parameters, leveraged both perspective transform and HHA (Horizontal disparity, Height above ground, and Angle with gravity) encoding, and achieved a sensitivity of 85.6%, a precision of 89.8%, and an F1-Score of 87.6%. [ABSTRACT FROM AUTHOR]

Background: The World Health Organisation states that newborns should receive colostrum as soon as possible after birth. However, among newborns needing neonatal intensive care, initiation of lactation and access to colostrum might be delayed. At the centre of this study, a tertiary care hospital in Sweden (10,000 deliveries/year), few admitted infants received colostrum within the day of birth, warranting a quality improvement. In order to reduce the time from birth to first colostrum received by infants admitted to the Neonatal Intensive Care Unit (NICU), a new clinical routine including a colostrum-kit, was implemented as standard care in June 2018. The colostrum-kit contained information about hand expression of breastmilk as well as material for collecting, labelling and transporting the colostrum. The kit should be handed to all birthing parents with infants admitted to the NICU. Methods: Data on time in minutes from birth to first colostrum administered to the infant (oral mouth care, oral feeding or gavage feeding) was retrieved for all infants born between 1 September 2016 and 31 October 2023, admitted to the NICU within 1h from birth. Infants were divided into four time-cohorts, compared with nonparametric ANOVA. Results: The study included 3618 infants born at 22 + 0 – 43 + 0 weeks gestational age, of whom 2814 (78%) had available data on time to colostrum. Median (IQR) time in hours was 35 (20–36) pre-implementations, followed by 18 (7–38), 11 (4–26) and 8 (3–22) in the subsequent follow-up cohorts, p < 0.001. Subgroups of mode of delivery had median (IQR) pre-implementation of 30 (19–54) for vaginal and 47 (23–72) for caesarean section that reached 7 (2–18) and 9 (3–26) in the last follow-up. Subgroups of gestational age (< 28, 28–31, 32–36, > 36 weeks) had a pre-implementation time of 48 (26–80), 46 (23–73), 33 (20–60) and 32 (19–57), that in the last follow-up was reduced to 4 (2–20), 7 (2–29), 9 (2–33) and 9 (4–19). Conclusions: Implementing a colostrum-kit for infants admitted to the NICU significantly reduced the time to first colostrum administered to the infant in all gestational ages. The difference between subgroups of gestational age or mode of delivery was reduced. The effect persisted over time. [ABSTRACT FROM AUTHOR]

Background:Numerous negative outcomes are linked to the existence of patent ductus arteriosus (PDA) in neonates. There is a lack of information regarding the proper diagnosis and pathophysiologyin relation to long-term outcomes. We aimed to investigate the role of targeted neonatal echocardiography (TNE) in hemodynamically unstable neonates for diagnosis of neonatal PDA that may help in changing the management plan and improving the survival outcome. Methods: This cohort study was conducted at the Pediatric Neonatology and Cardiology Units at Pediatrics Department, Faculty of Medicine, Zagazig University on 85 neonates who were clinically suspected to have PDA. We performed TNE for all patients and cases with confirmed PDA were followed up every 3 days to assess changes in management plan till improvement or death. Results: Out of 85 cases examined, 43 were confirmed to have patent ductus arteriosus (PDA). Therapeutic interventions were provided, and Post treatment echo revealed that PDA was closed in 34.9% of patients, 25.6% still had PDA, and39.5% died. Comparing pre- to postechocardiographic analysis, there was statistically significant decrease in the mean of TR pressure gradient, pulmonary artery pressure, LT atrial/aortic ratio and LVESV also there was statistically significant decrease in LV output. Conclusions: We concluded that TNE can help in diagnosis of neonatal PDA. We recommend considering TNE as an early detector of PDA to achieve better outcomes. [ABSTRACT FROM AUTHOR]

Background: Mothers of high‐risk neonates experience tremendous stress during neonatal intensive care unit (NICU) admission. This stress has a negative impact on mothers' participation in neonatal care activities, psychological health and coping skills in the NICU. Objective: To determine the impact of interventional strategies to reduce maternal stress and enhance coping skills during neonatal admission to the NICU. Design: A scoping review was carried out following the methodological framework outlined by Arksey and O'Malley. Methods: This scoping review was conducted as per the Joanna Briggs Institute guidelines, including a quality appraisal checklist for randomised and nonrandomised controlled trials. Patterns, advances, gaps, evidence for practice and research recommendations from the review (PAGER framework) were used to report the results. The following international databases were used to search for primary articles: Medline via PubMed, EBSCOhost via CINAHL, Scopus, Web of Science and the ProQuest Medical Library. Original studies published in English between January 2011 and January 2023 from low‐ and middle‐income countries (LMICs) that assessed maternal stress and coping skills during neonatal NICU admission were included in the review. Results: The review included 15 articles from LMICs, of which 60% were from middle‐income, 25% were from lower‐middle‐income and 15% were from low‐income countries. Interventional strategies were described under five categories. Maternal stress decreased significantly across all three subscales of the PSPS: 'sight and sound', 'baby looks and behavior' and 'parental relationship with baby and role alteration' during neonatal NICU admission. Interventional strategies involving family‐centred care and emotional and psychological supportive care have been reported to have a consistently positive impact on alleviating maternal stress and enhancing coping skills in the NICU. Conclusion: Healthcare professionals, especially nurses, are pivotal in promptly recognising maternal stress and NICU stressors. The participation of mothers in neonatal care, such as through family‐centred care and emotional support interventions, significantly reduces maternal stress and enhances coping skills. [ABSTRACT FROM AUTHOR]

Background: Intrapartum hypoxia causes fetal suffocation, acidosis, newborn brain damage, long-term morbidity, and mortality.1 As a result, intrapartum fetal monitoring is performed to detect early indicators of fetal hypoxia and to take appropriate action as soon as possible to avoid fetal hypoxia complications. Objectives: 1. To study the correlation between fetal Doppler ultrasound and umbilical cord blood gas analysis in detecting fetal academia. 2. To identify the maternal and obstetric determinants associated with fetal acidemia. MATERIAL & METHODS: Study Design: Hospital-based prospective observational study. Study area: The study was conducted in the Department of Obstetrics and Gynaecology. Study Period: 1 year. Sample size: Using a sample size calculator, expecting a correlation coefficient of r=0.300, the required sample size was calculated to be 85. Study population: During the study period, a total of 92 pregnant women with abnormal fetal Doppler ultrasound findings, meeting the below-mentioned inclusion and exclusion criteria were eventually recruited into this study. Sampling Technique: Simple Random technique. Study tools and Data collection procedure: The institutional ethical committee clearance was obtained. The design and nature of the clinical study were explained to the patients and significant relatives of the patients. Informed consent was obtained from patients. The sociodemographic data was collected and recorded in the specially designed proforma. The socioeconomic class was assessed using the Socio-Economic Status Schedule. The obstetric history data was gathered and recorded in the proforma. All the patients in the sample group (n=92) were subjected to thorough clinical examination which included general physical, systemic examination and pelvic examination. Maternal blood samples for routine laboratory investigations (including tests for acidosis) were sent. Results: There was a significant correlation between gestational age and fetal acidemia (p value=0.0096). A gestational age of 41 weeks or more has a lesser incidence of fetal acidemia. Middle cerebral artery pulsatility index (MCAPI) was significantly associated with fetal academia (p-value of <0.0001). The umbilical artery pulsatility index (UAPI) had a highly significant correlation (p <0.0001) with the umbilical cord blood gas analysis. Conclusion: Based on the statistical analysis of the data, it is safe to assume that fetal Doppler ultrasound can predict the development of fetal acidemia. Two indicators, the Middle cerebral artery pulsatility index and the Umbilical artery pulsatility index, are strong predictors of fetal acidemia. Similarly, determinants like obstetric score, medical comorbidity, general physical examination and status of labour per vaginal examination were also not found to be significantly associated with fetal acidemia. [ABSTRACT FROM AUTHOR]

Background: Blood draws for laboratory investigations are essential for patient management in neonatal intensive care units (NICU). When blood samples clot before analysis, they are rejected, which delays treatment decisions and necessitates repeated sampling. Aim: To decrease the incidence of rejected blood samples taken for laboratory investigation as a result of clotted sample. Study Design: This retrospective observational study used routine data on blood draws from preterm infants collected between January 2017 and June 2019 in a 112‐cot NICU in Qatar. Quality improvement interventions to reduce the rate of clotted blood samples included: awareness raising and safe sampling workshops with NICU staff, involvement of the neonatal vascular access team, development of a complete blood count (CBC) sample collection pathway, review of sample collection equipment, introducing the Tenderfoot® heel lance, establishment of benchmarks and provision of dedicated blood extraction equipment. Results: First attempt blood draw occurred in 10 706 cases, representing a 96.2% success rate. In 427 (3.8%) cases, the samples were clotted requiring repeat collection. The overall rate of clotted specimens decreased from 4.8% in 2017 and 2018 to 2.4% in 2019, with odds ratios of 1.42 (95% confidence interval [CI] 1.13–1.78, p =.002), 1.46 (95% CI 1.17–1.81, p <.001) and 0.49 (95% CI 0.39–0.63, p <.001), respectively. The majority (87%–95%) of blood samples were by venepuncture using an intravenous (IV) catheter or the NeoSafe™ blood sampling device. Heel prick sampling was the second (2%–9%) most common method. Clotted samples were most frequently associated with needle use, 228 of 427 (53%), and IV cannula, 162 of 427 (38%), with odds ratios of 4.14 (95% CI 3.34–5.13, p <.001) and 3.11 (95% CI 2.51–3.86, p <.001), respectively. Conclusions: Our interventions over 3 years were associated with reduced rates of sample rejection due to clotting, and this led to improved patient experience through fewer repeated samplings. Relevance to Clinical Practice: The insights gained from this project can help to improve patient care. Interventions that reduce the rate of blood sample rejection by clinical laboratories can lead to economic savings, timelier diagnostic and treatment decisions, and contribute to an improved quality care experience for all critical care patients, irrespective of age, by reducing the need for repeated phlebotomy and the risk of related complications. [ABSTRACT FROM AUTHOR]

Background/Objectives: Kangaroo Care (KC) has been proven to enhance physiological stability, growth, and bonding in preterm, low-birthweight infants. Despite its benefits, KC is underutilized in Level IV Neonatal Intensive Care Units (NICUs) due to challenges in managing medical equipment. This study introduces the Kangarobe™, a novel garment designed to facilitate safe, comfortable, and efficient KC for medically fragile infants in high-acuity NICUs. Methods: From 2021 to 2023, a feasibility study was conducted involving 25 infant-parent dyads in a Level IV NICU. The Kangarobe™ was designed using human-centered design principles and tested on infants dependent on respiratory support. Surveys employing a 5-point Likert scale were administered to parents and nursing staff to assess safety, comfort, ease of use, and procedural access. Results: Survey results showed positive feedback from both parents and nursing staff, particularly in the areas of safety and comfort. For example, 72–80% of parents and nurses responded positively regarding ease and comfort. High level of agreement (76%) on the security of medical line management, with minimal negative feedback. In addition, parents using the Kangarobe™ held their infants for an average of 171 min per session, with a notable increase compared to the typical 75 min, indicating enhanced comfort and feasibility for extended KC sessions. The Kangarobe™ successfully enabled the secure management of medical lines and tubes, with the vertical access window improving procedural efficiency without interrupting KC. Conclusions: The Kangarobe™ demonstrates promise in addressing barriers to KC in high-acuity NICUs. By enhancing safety, comfort, and ease of use, it supports wider adoption of KC practices, potentially improving patient safety, staff efficiency, and family-centered care. [ABSTRACT FROM AUTHOR]

Background: The reported data on European universal neonatal hearing screening (UNHS) practices tend to be scarce, despite the fact that the European Union project, EUScreen, collected unofficial data from 38 collaborating European institutions. The objectives of this systematic review were as follows: (a) to identify the most recent (in a 20-year span) literature information about UNHS programs in Europe and (b) to provide data on the procedures used to assess the population, the intervention policies, and on the estimated prevalence of congenital hearing loss with emphasis on the bilateral hearing loss cases. Methods: Queries were conducted via the Pubmed, Scopus and Google Scholar databases for the time period of 2004–2024. The Mesh terms used were "OAE", "Universal Neonatal Hearing Screening", "congenital hearing loss" and "well babies". Only research articles and review papers of European origin were considered good candidates. The standard English language filter was not used, in order to identify information from non-English-speaking scientific communities and groups. Results: Very few data and reports were identified in the literature search. Eleven manuscripts were identified corresponding to eight UNHS programs. Except in Poland, most of the data refer to regional and not national programs. The screening coverage estimates of all programs exceed 90%; infants were mostly assessed by a three-stage protocol (TEOAE + TEOAE + AABR), followed by a clinical ABR test. The average prevalence (i.e., from well babies AND NICU infants) of bilateral hearing loss ranged from 0.5 to 20.94 per 1000 (Zurich sample). Infants presenting unilateral or bilateral hearing losses were first rehabilitated by hearing aids and consequently (>15 mo) by cochlear implants. Conclusions: Even though UNHS programs are well-established clinical practices in the European States, the amount of information in the literature about these programs is surprising low. The existing data in the timespan 2004–2024 corroborate the international UNHS data in terms of coverage and bilateral hearing loss prevalence, but there is a strong need to supplement the existing information with the latest developments, especially in the area of hearing loss rehabilitation. [ABSTRACT FROM AUTHOR]

Prematurity can disrupt the psychological transition to parenthood, with the unfamiliar environment of the Neonatal Intensive Care Unit (NICU) often exacerbating parental concerns about their baby's health and survival. This study explores factors influencing parental coping mechanisms during their NICU stay, focusing on gender differences and parental perceptions of staff support. Sixteen Italian parents of preterm infants (born before 37 weeks of gestation and hospitalized for at least 10 days) participated in remote narrative interviews. Thematic analysis revealed key differences in the emotional experiences and care participation between mothers and fathers, shaped by traditional Italian gender norms and further impacted by COVID-19 restrictions limiting fathers' access to the NICU. Additionally, parents who were more involved in their infant's recovery through interactions with doctors reported higher levels of personal well-being. These findings highlight the importance of fostering parent-staff communication and support, particularly during times of crisis, to promote positive outcomes in the parent-infant relationship and enhance parental well-being. Recommendations include tailored interventions to ensure mothers and fathers are actively engaged in their infant's care. [ABSTRACT FROM AUTHOR]

Introduction: Parents of preterm infants face a stressful life event which might have long term impact on the parent-child relation as well as on the infant's cognitive and socio-emotional development. Both music therapy (MT) and physical contact (PC) are stress-reducing interventions for parents and preterm infants on the neonatal intensive care unit (NICU). Meanwhile, especially close PC is considered as standard care (SC) in most NICUs. However, the effect of live performed MT with PC on parental perceived stress and cortisol levels has barely been investigated. We hypothesized that MT with PC leads to reduced stress levels and lower salivary cortisol concentrations compared to SC in parents of preterm infants during the first 4 weeks after birth. Methods: Randomized-controlled trial enrolling the parents of 99 preterm infants (MT n = 50, SC n = 49 infants). The infants received either MT with PC or SC only. Perceived stress was measured with the perceived stress questionnaire 20 (PSQ-20) after birth and 4 weeks later. Salivary cortisol levels were obtained and measured weekly after birth for 4 weeks. Results: Forty-two mothers and eight fathers of the intervention group (MT with PC) as well as n = 43 mothers and n = 6 fathers of the control group (SC) were enrolled. For the intervention group, salivary cortisol was reduced 4 weeks after birth [mothers 5.5 nmol/l (confidence interval (CI) 3.6-7.5); fathers 8.3 (CI 7.2-9.4)] compared to the control group [mothers 10.3 nmol/l (CI 5.4-15.3); fathers 14.8 (CI 8.9-20.7)]. Overall perceived stress scores decreased in the intervention group (mothers -17.6; fathers -12.6) and increased in the control group (mothers +6.1; fathers +21.4) over 4 weeks. Discussion: Live-performed MT with PC in preterm infants might be an effective, non-invasive intervention to reduce parental stress and cortisol levels. Future studies should investigate the long-term effects of this intervention on the parent-infant relation as well as on the infants' cognitive and socio-emotional development. [ABSTRACT FROM AUTHOR]

Objective Hypoglycemia, the most common metabolic derangement in the newborn period remains a contentious issue, not only due to various numerical definitions, but also due to limited therapeutical options which either lack evidence to support their efficacy or are increasingly recognized to lead to adverse reactions in this population. This study aimed to investigate neonatologists' current attitudes in diagnosing and managing transient and persistent hypoglycemia in newborns admitted to the Neonatal Intensive Care Unit (NICU). Methods A web-based electronic survey which included 34 questions and a clinical vignette was sent to U.S. neonatologists. Results There were 246 survey responses with most respondents using local protocols to manage this condition. The median glucose value used as the numerical definition of hypoglycemia in first 48 hours of life (HOL) for symptomatic and asymptomatic term infants and preterm infants was 45 mg/dL (2.5 mmol/L; 25–60 mg/dL; 1.4–3.3 mmol/L), while after 48 HOL the median value was 50 mg/dL (2.8 mmol/L; 30–70 mg/dL; 1.7–3.9 mmol/L). There were various approaches used to manage transient and persistent hypoglycemia that included dextrose gel, increasing caloric content of the feeds using milk fortifiers, using continuous feedings, formula or complex carbohydrates, and use of various medications such as diazoxide, glucocorticoids, and glucagon. Conclusion There is still large variability in current practices related to hypoglycemia. Further research is needed not only to provide evidence to support the values used as a numerical definition for hypoglycemia, but also on the efficacy of current strategies used to manage this condition. Key Points Numerical definition of glucose remains variable. Strategies managing transient and persistent hypoglycemia are diverse. There is a need for further research to investigate efficacy of various treatment options. [ABSTRACT FROM AUTHOR]

Background: The neonatal outcomes across different percentiles of birth weight for gestational age are still unclear. Methods: This retrospective cohort study was conducted within 57 tertiary hospitals participating in the Chinese Neonatal Network (CHNN) from 25 provinces throughout China. Infants with gestational age (GA) 24+0-31+6 weeks who were admitted within 7 days after birth were included. The composite outcome was defined as mortality or any one of neonatal major morbidities, including necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH), cystic periventricular leukomalacia (cPVL), severe retinopathy of prematurity (ROP), and sepsis. Multivariable logistic regressions using generalized estimating equation approach were conducted. Results: A total of 8380 infants were included with a mean GA of 30 (28–31) weeks. Of these, 1373 (16.5%) were born at less than 28 weeks, while 6997 (83.5%) had a GA between 28 and 32 weeks. Our analysis indicated that the risk of composite outcomes was negatively associated with birth weight for gestational age, and compared to the reference group, the multiple-adjusted ORs (95%CI) of composite outcomes were 4.89 (3.51–6.81) and 2.16 (1.77–2.63) for infants with birth weight for gestational less than 10th percentile and 10th -30th percentile, respectively. The ORs (95%CI) of mortality, NEC, BPD, severe ROP, and sepsis in infants with birth weight for gestational age at 10th-30th percentile were 1.94 (1.56–2.41), 1.08 (0.79–1.47), 2.48 (2.03–3.04), 2.35 (1.63–3.39), and 1.39 (1.10–1.77), respectively. Conclusion: Our study suggested that the risk of adverse neonatal outcomes increased significantly when the birth weight for gestational age was below the 30th percentile. Regular monitoring and early intervention are crucial for these high-risk infants. [ABSTRACT FROM AUTHOR]

Purpose and background: Parental peer support is part of the Family Integrated Care model in NICUs. However, little attention has been devoted to the specific content and organization of parental peer support programs. This scoping review aimed to identify (1) the preferred content of a parental peer support intervention, (2) the organizational processes, and (3) the suggested educational curriculum for peer support providers within existing programs in neonatal care. Discussion: Parental peer support programs have the goal to provide emotional support, information and assistance, and are to empower parents in the NICU. To achieve these goals, veteran parents receive training in communication skills, roles and boundaries, mental health, (non)medical aspects in the NICU and post-discharge preparation. Data on the organizational components remain limited. Hence, the question remains how the organization of a parental peer support program, and the training and supervision of veteran parents should be managed. Implications for research and practice: This scoping review provides a variety of aspects that should be considered when developing and implementing a parental peer support program in the NICU. Program development preferably involves NICU staff at an early stage. Future research should focus on the support of diverse populations in terms of culture, social economic status and gender, and on the effects of parental peer support on parent and infant. [ABSTRACT FROM AUTHOR]

Background: Uterine fibroids or leiomyomas are benign smooth muscle tumours of the uterus, found in approximately 20-50% of women of reproductive age and many are asymptomatic. The main objectives of this study were to assess the obstetric outcome in pregnancy with fibroid, its complications and management. Materials and Methods: This was a prospective observational study following confirmed diagnosis of uterine fibroids from ultrasonography with continuing pregnancy. The study conducted over two years pried from January 2022 to December 2023. All demographic information, baseline characteristics, Obstetric outcome-mode of delivery, complications and management and the foetal outcome-abortions, low birth weight, term or preterm, and associated complications and Neonatal intensive care (NICU)admissions. were noted. Results: Out of 6142 antenatal visits, 54 cases were identified with uterine fibroids during pregnancy, incidence being 0.8%. Majority belonged to age group between 25-30 years were about 31 (57%), 32 (59.2%) were primigravida, 18 (33.3%) had BMI more than 25 kg/m2, 8 (14.81%) had spontaneous miscarriages, 46 cases (85%) continued pregnancy, among them 28 (51.8%) underwent Lower segment caesarean section (LSCS), 18(33.27%) vaginal deliveries. 15 (32.6%) had pain abdomen, low birth weight (LBW) seen in 16 (34%) of deliveries. Conclusion: Pregnancy with uterine fibroids associated with various untoward obstetric outcomes. Pre-conceptional counselling, frequent antenatal visits and multidisciplinary team approach for planning delivery in tertiary care centres is essential for safe maternal and foetal outcome. [ABSTRACT FROM AUTHOR]

Background: Preterm infants are at risk of complications due to their prematurity and Retinopathy of Prematurity (ROP) is one of them. To discover and treat ROP the preterm infants regularly undergo eye examinations. Nurses are responsible for the infants' care during this painful and stressful procedure. Aim: The aim of this study was to explore nurses' perceptions of preterm infants' eye examinations. Methods: Data were collected through semi-structured interviews with 10 nurses experienced in participating in preterm infants' eye examinations. Data were analysed using a phenomenographic approach. Results: The results showed several perceptions of the eye examinations, and the analysis resulted in four descriptive categories: Infants are affected by the eye examination; Nurses have comprehensive overall responsibility for the infants; Parents are important to their infants, but they need support to fulfil their parental role, and Collaboration is important for the examination's favourable outcome. The category Nurses have comprehensive overall responsibility for the infants was regarded as the most comprehensive, covering all the other categories. Conclusions: Nurses felt a great responsibility during a painful and stressful procedure for preterm infants. Infants' well-being could be better protected by interprofessional collaboration, improved nursing care and involved parents. [ABSTRACT FROM AUTHOR]

Introduction: To determine if anti-Xa testing is associated with improved outcomes for patients <19-years-old on ECMO. Methods: We evaluated the clinical benefit of anti-Xa heparin monitoring utilizing the Bleeding and Thrombosis during ECMO (BATE) database of 514 patients <19-years-old. The BATE database includes incidences of bleeding, thrombosis, and mortality. The database also describes anti-coagulation test utilization. We grouped and analyzed patients based on ECMO indication (cardiac, respiratory, or extracorporeal cardiopulmonary resuscitation [E-CPR]) and age (neonatal vs pediatric). We constructed multivariable logistic regression models to analyze the impact of anti-Xa testing on mortality, bleeding, and thrombosis in each group. Results: Across the entire population, anti-Xa testing did not have a significant effect on the incidence of mortality (43% with anti-Xa testing vs 49% without), bleeding (68% vs 74%), or thrombosis (37% vs 39%). However, among cardiac indicated patients on ECMO (n = 207), anti-Xa testing was significantly associated with reduced odds ratio (OR) of mortality (adjusted OR 0.527, p =.040) and bleeding (adjusted OR 0.369, p =.021). In addition, among neonatal patients on ECMO (n = 264), anti-Xa testing was associated with a significant reduction in the odds ratio of bleeding (adjusted OR 0.534, p =.046). Conclusion: Anti-Xa testing is associated with improved outcomes among cardiac indicated and neonatal patients on ECMO. Additional research to find the optimal heparin monitoring regimen is needed to better support these critically ill patients. In the interim, we recommend clinicians consider utilizing anti-Xa assays as part of their heparin monitoring plan for neonatal and cardiac indicated patients on ECMO. [ABSTRACT FROM AUTHOR]

This study was taken up to determine the prevalence of potential pathogens in most touched fomites in Neonatal Intensive Care Units (NICUs) and to determine their antibiogram. Fifty swabs each were collected from fomites from In-born (for babies born in our center) and out-born (for babies born elsewhere, brought to our center) NICUs, before and after cleaning. Samples were processed using standard Microbiological techniques. Antibiogram was determined by Kirby-Bauer disc diffusion method. From In-born NICU, before cleaning, 42 (84%) samples yielded growth with 48 bacterial isolates of which 31 (64.6%) were pathogens and after cleaning, 40 (80%) samples yielded growth with 41 bacterial isolates, of which 30 (73.1%) were pathogens. Most frequent isolates were non-fermenting gram-negative bacilli (NFGNB) and Klebsiella pneumoniae before and after cleaning, respectively. Prevalence of bacteria from In-born NICU before and after the cleaning was statistically significant (p = 0.025). From Out-born NICU, before cleaning, 42 (84%) samples yielded growth with 45 bacterial isolates, of which 25 (55.55%) were pathogens. Samples collected after cleaning; 42 (84%) samples yielded growth with 43 bacterial isolates of which 19 (44.18%) were pathogens. Most frequent isolates were NFGNB and Klebsiella pneumoniae from In-born NICU and K. pneumoniae and Escherichia coli from Out-born NICU before and after cleaning, respectively. Overall prevalence of pathogens was significant (p = 0.007). Staphylococcal isolates were resistant to Methicillin. NFGNB exhibited highest resistance (55.9%) towards Gentamicin. Significant decrease in the frequency of pathogens after cleaning indicates stringent practice of sterilization protocol would be essential in hospital environment. [ABSTRACT FROM AUTHOR]

Although newborn intensive care (NICU) research highlights the mental health and support needs of parents, a majority of the research and interventions focus on the needs of the mother. Engaging and partnering with male caregivers (like female caregivers) in the care of their NICU infants yields positive health outcomes for the infant and better mental health outcomes for the father. Yet there are few articles about male NICU caregiving experiences, and scant articles exploring the mental health and support needs of Black NICU fathers. Utilizing two case studies of Black fathers, this paper will identify their mental health needs. This article will outline and integrate the Recommendation for Psychosocial Support of NICU Families and existing literature to these case studies. Based on their unique needs, NICU providers must do more to engage Black fathers and explore alternative models of care that are culturally aware for psychosocial support. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate and compare the noise levels in current incubator models and a prototype designed to improve acoustic comfort in neonatal incubators. Methods: Tests were carried out on three different models of incubators and a prototype called Neonatal Incubator Acoustic Comfort Class (NICA). The tests measured both internal and external sound pressure levels under laboratory conditions. The noise index has been taken as the A-weighted equivalent continuous sound pressure level (LAeq,T) for a time interval of 1 min. Results: The results obtained show variations between the different models of incubators, although, overall, they are high values (around 56/60 dBA). The results prove that premature newborns under normal conditions of using these incubators are exposed to noise levels above international recommendations. The new incubator design minimizes noise generation and generates noise levels lower than international recommendations. Conclusions: The results obtained from the prototype (NICA+) show the effectiveness of the proposed design in improving acoustic comfort in neonatal incubators. The data show that the noise levels generated by the prototype under normal operating conditions are significantly lower than international recommendations. [ABSTRACT FROM AUTHOR]

The developing brain, particularly in premature infants, is highly susceptible to environmental and pharmacological influences. Premature neonates often require prolonged stays in the NICU, where midazolam (MDZ), a benzodiazepine, is commonly used as a sedative, despite concerns raised by the FDA in 2016 regarding its potential neurological complications in infants. Understanding the long-term effects of MDZ on these vulnerable patients is hindered by ethical considerations and limited research. This review emphasizes the vulnerability of premature infants to sedation and anesthesia and outlines how early exposure to MDZ can impact brain development at both molecular and behavioral levels, drawing from clinical and preclinical data. Additionally, we highlighted existing knowledge gaps and suggested avenues for further research to better comprehend the enduring consequences of MDZ exposure on neurodevelopment in this population. [ABSTRACT FROM AUTHOR]

Purpose: Determine physiological and behavioral stress in preterm infants during bodysuit application in the Neonatal Intensive Care Unit (NICU). Design: Randomized crossover design using two clothing interventions: 1) hospital blanket swaddling and 2) a short-sleeve bodysuit. Sample: Preterm infants (N = 8) at 320 /7 to 346 /7 weeks postmenstrual age (PMA) at testing. Main Outcome Variables: Heart rate (HR), oxygen saturation (O2 ), and Neonatal Pain, Agitation, and Sedation Scale (N-PASS) measured in three phases: baseline before a diaper change, intervention after the diaper change, and recovery. Results: An increase in HR above normal limits and a clinically significant increase in N-PASS scores were observed when the infants were dressed in a bodysuit compared to swaddled only. Donning a bodysuit did not affect O2 levels. Dressing a preterm infant in a bodysuit while in the NICU added temporary but consistent stress and should be avoided. [ABSTRACT FROM AUTHOR]

Few studies have investigated parent's experiences with racism in the neonatal intensive care unit (NICU). Our objective was to explore how parents perceive their interactions with NICU staff and if/how racism in the NICU was experienced. Parents of infants receiving care in an urban NICU completed fixed choice surveys regarding their experiences and demographics, with 6 open-ended questions to elaborate on their fixed-choice responses. Using a constant comparative method informed by Constructivist Grounded Theory, we identified 3 main themes from the comments provided by 97 respondents: Care and harm coexisting, racism often manifesting as neglectful care, and the power differential is most impactful during times of parent advocacy. Parents spoke positively regarding their experiences and also reported disparate treatment attributed to their racial/ethnic identity. Racism was experienced by inappropriate comments and apathy toward parent requests, occurring during intimate interactions between staff and parents. Descriptions of parental advocacy efforts highlighted the lack of power they held in relation to the NICU staff. We recommend strengthening the focus on equity and mitigating power imbalances in the NICU. [ABSTRACT FROM AUTHOR]

Over the past decades, music therapy in the neonatal intensive care unit (NICU) has been proven effective in physiological and psychological outcomes, including sucking, behaviour, stress reduction, neurodevelopment and promoting emotional bonding. However, not every NICU administers music therapy in their ward. Research on music therapy for neonates and their caregivers has lately accumulated, increasing the evidence of health benefits on brain development and across a variety of NICU‐related pathologies, including neurological, cardiological, pulmonary and gastrointestinal problems. Conclusively, we will present the studied methods of music therapy for clinical benefits in neonatal intensive care. [ABSTRACT FROM AUTHOR]

Despite the growing body of literature supporting the use of point-of-care lung ultrasound (POC-LU) in neonates, its adoption in Canadian neonatal intensive care units (NICUs) remains limited. This study aimed to identify healthcare providers' perceptions and barriers to implementing POC-LU in Canadian NICUs. We conducted an electronic survey targeting neonatologists, neonatal fellows, neonatal nurse practitioners, and registered respiratory therapists in 20 Canadian NICUs. The survey comprised a 28-item questionnaire divided into four sections: (1) participants' demographics and availability of POC-LU equipment, (2) experience and interest in POC-LU learning, (3) perception of POC-LU as a diagnostic tool, and (4) barriers to POC-LU implementation in NICUs. A total of 194 participants completed the survey, with neonatologists comprising the majority (45%). Nearly half of the participants (48%) reported prior experience with POC-LU. The most prevalent indications for POC-LU use were diagnosis of pleural effusion (90%), pneumothorax (87%), and respiratory distress syndrome (76%). Participants identified the primary barrier to POC-LU adoption as the lack of trained providers available for both training and clinical integration. Notably, most respondents (87%) expressed keen interest in learning neonatal POC-LU. A subgroup analysis based on the responses collected from NICU-directors of 12 institutions yielded results consistent with those of the overall participant pool. Conclusion: This survey underscores the perceived importance of POC-LU among NICU healthcare providers. A Canadian consensus is required to facilitate the development of widespread training programs as well as standardized clinical practice guideline for its implementation. What is Known: • In recent years, point-of-care lung ultrasound (POC-LU) has emerged as an important tool in neonatology, revolutionizing the assessment and management of critically ill infants. However, its adoption in Canadian Neonatal Intensive Care Units remains limited. What is New: • Most Canadian healthcare providers showed high level of interest in learning POC-LU techniques. Additionally, POC-LU was perceived as a useful tool for diagnosis and guiding intervention in various neonatal respiratory diseases. Nonetheless, the lack of expertise emerged as the primary barrier to its adoption and practice across different groups of participants regardless of their clinical experience level. [ABSTRACT FROM AUTHOR]

Background: Mothers and fathers may experience negative emotions as a result of an unusual early delivery and giving birth to high-risk newborns who require hospitalization in the neonatal intensive care unit (NICU) adds layers of stress on them. Hence, a variety of psychological and emotional services are required. Aim: The aim of this study was to identify common stressors in both parents of preterm children in the NICU and determine the effect of psychological intervention in the form of acceptance and commitment therapy (ACT) on stress in both parents. Materials and Methodology: A total of 60 parents of preterm children were randomly assigned to Intervention Group A and Control Group B. Group A received five sessions of ACT and routine counseling, while Group B received only routine nursing staff counseling. The Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU) was used for pre- and postassessments to measure the parents' stress levels on the 1st and 5th days, respectively. Results: Mothers' stress levels in the NICU are significantly higher when they have a higher socioeconomic status, a higher education level, and a length of stay of more than 6 days, but significant stress is not found in fathers. ACT, when used along with routine counseling, is effective in reducing stress in both parents. Conclusion: ACT can be combined with routine counseling to help parents cope with depression, anxiety, and stress associated with preterm birth in the NICUs. [ABSTRACT FROM AUTHOR]

Background: Bacterial infections are the leading cause of death in newborns. The growing resistance of bacteria to antibiotics is a major concern. In this study, we identified isolates from blood cultures in the neonatal intensive care unit (NICU) of a major referral hospital in Shiraz in southwest Iran and determined antibiotic resistance patterns. Methods: All newborns admitted to the NICU were evaluated in a four-year study. The blood samples were cultured using a BACTEC system. From May 2015 to March 2020, 5937 blood culture samples were analyzed. The antibacterial sensitivity test was conducted using the disk diffusion method, following the guidelines of Clinical & Laboratory Standards Institute (CLSI) 2018. Results: In this study, 507 isolates were obtained from 5937 specimens. The most commonly isolated gram-negative bacteria were Acinetobacter (8.7%), Escherichia coli (5.7%), Klebsiella (1.6%), Enterobacter (1.4%), and Pseudomonas (0.9%). Among the gram-positive bacteria, coagulase-positive staphylococci (51.1%), coagulase-negative staphylococci (15.4%), Staphylococcus epidermidis (10.2%), non-hemolytic streptococci (2.4%), alpha-hemolytic streptococci (1.4%), and Streptococcus pneumonia (1.3%) were the most frequently isolated bacteria. Of the 318 Staphylococcus aureus isolates, 88.5% were resistant to methicillin. Conclusion: Staphylococcus, with a high frequency in the NICU, can be an alarm for medical centers. Also, in dead infants, the most observed bacterial infection was Acinetobacter infection, which requires the serious attention of the hospital infection control unit. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study to determine the prevalence of mother postpartum depression and to examine the association between infant characteristics and postpartum depression in the neonatal intensive care unit. Methods: A quantitative cross-sectional survey design was conducted in three government teaching hospitals in Jordan. A convenience sample of 188 mothers with hospitalized 188 infants in NICU was recruited. Questionnaires were used to collect the quantitative data, which include Infant Demographic Data Questionnaire, Mother Demographic Data Questionnaire and Edinburgh Postnatal Depression Scale (EPDS). The study revealed that infant characteristics such as gestational age, medical condition classification, and birth weight are found to be significant factors that influence depression among mothers. Results: The results showed that mothers with infants admitted to NICU experience postpartum depression with a mean of 3.82 and median of 4.04. There were significant differences based on gestational age, birth weight, and classification of medical condition and mothers' postpartum depression. Conclusion: Knowing the relationship of certain infant's characteristics and postpartum depression can help to focus on relevant infant characteristics so that timely interventions to improve mothers' well-being can be developed. [ABSTRACT FROM AUTHOR]

Central nervous system infections are among the most severe infectious conditions in the neonatal period and are still burdened by significant mortality, especially in preterm infants and those with a low birth weight or other comorbidities. In this study, we examined the role of fosfomycin-containing antibiotic regimens in neonates with central nervous system infections. We included six neonates over a period of five years: four with meningitis and two with cerebral abscesses. All patients underwent fosfomycin therapy after failing first-line antibiotic regimens. Of the six neonates, two died; two developed neurological and psychomotor deficits and two recovered uneventfully. None of the neonates experienced adverse reactions to fosfomycin, confirming the safety of the molecule in this population. In conclusion, the deep penetration in the central nervous system, the unique mechanism of action, the synergy with other antibiotic therapies, and the excellent safety profile all make fosfomycin an attractive drug for the treatment of neonatal central nervous system infections. [ABSTRACT FROM AUTHOR]

This research explores parents' experiences in the NICU to inform design and implementation of processes that motivate and direct parent participation in healthcare processes for their children. Qualitative methods were employed combining elements of grounded theory and phenomenology. Findings reveal that despite known benefits, parent participation does not always occur in NICUs due to difficulties NICUs face while balancing technologically complex care that increases survival rates with parent-participation models that provides holistic wellbeing. Self-determination theory provides a work design perspective that can guide design and implementation of parent participation, as partial employees, as a key component of NICU healthcare processes. [ABSTRACT FROM AUTHOR]

Background: Mothers and fathers may experience negative emotions as a result of an unusual early delivery and giving birth to high-risk newborns who require hospitalization in the neonatal intensive care unit (NICU) adds layers of stress on them. Hence, a variety of psychological and emotional services are required. Aim: The aim of this study was to identify common stressors in both parents of preterm children in the NICU and determine the effect of psychological intervention in the form of acceptance and commitment therapy (ACT) on stress in both parents. Materials and Methodology: A total of 60 parents of preterm children were randomly assigned to Intervention Group A and Control Group B. Group A received five sessions of ACT and routine counseling, while Group B received only routine nursing staff counseling. The Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU) was used for pre- and postassessments to measure the parents' stress levels on the 1st and 5th days, respectively. Results: Mothers' stress levels in the NICU are significantly higher when they have a higher socioeconomic status, a higher education level, and a length of stay of more than 6 days, but significant stress is not found in fathers. ACT, when used along with routine counseling, is effective in reducing stress in both parents. Conclusion: ACT can be combined with routine counseling to help parents cope with depression, anxiety, and stress associated with preterm birth in the NICUs. [ABSTRACT FROM AUTHOR]

Background: Pulse oximetry is widely used in the NICU and PICU to monitor oxygenation in newborns and children with respiratory distress. This study aimed to evaluate the relationship between arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation (SpO2) values in this patient population. Methods: A total of 50 newborns and children with respiratory distress admitted to the NICU and PICU were included in this observational study. PaO2 and SpO2 values were obtained simultaneously, and their relationship was analyzed using correlation, linear regression, and agreement analyses. Results: A strong positive correlation was found between PaO2 and SpO2 (r = 0.78, p < 0.001). The linear regression equation was PaO2 = 21.5 + 0.46 x SpO2 (R-squared = 0.61, adjusted R-squared = 0.60, p < 0.001). The mean difference between PaO2 and SpO2 was 2.8 (SD = 8.2), with 95% limits of agreement ranging from -13.3 to 18.9. The sensitivity and specificity of SpO2 for detecting hypoxemia (PaO2 < 60 mmHg) were 85.7% and 91.2%, respectively. Conclusions: SpO2 is a reliable tool for monitoring oxygenation in newborns and children with respiratory distress, showing a strong correlation with PaO2. However, its accuracy may be influenced by factors such as the FiO2 level and the severity of hypoxemia. Clinicians should use SpO2 in conjunction with other clinical parameters and diagnostic tools when assessing and managing this patient population. [ABSTRACT FROM AUTHOR]

Critically ill newborns admitted to Neonatal Intensive Care Unit often require a centrally inserted central catheters (CICCs) inserted by ultrasound-guided puncture of the internal jugular or brachio-cephalic vein. Achieving an appropriate level of sedation and analgesia is paramount for procedure success and patient safety, avoiding the potential risks associated with excessive deep sedation. The aim of this study is to evaluate the feasibility of a novel protocol of sedation. Data from 46 patients were prospectively collected. The feasibility was assessed throughout the monitoring of adverse events and the incidence of spontaneous movements. The procedure was completed in 100% of cases. There were no cases of escalation of the baseline ventilatory support despite the procedure and no case of hypotension, and all spontaneous movements were controlled with additional boluses when required. Conclusion: Our study represents the very first step towards the design of a validated protocol for analgosedation during ultrasound-guided CICC insertion in NICU. What is Known: • Critically ill newborns admitted to Neonatal Intensive Care Unit often require a centrally inserted central catheter. • Achieving an appropriate level of sedation and analgesia is paramount for procedure success and patient safety, avoiding the potential risks associated with excessive deep sedation. What is New: • The use of this new protocol for analgosedation is able to achieve a good level of sedation and pain control without significant adverse event. • Ultrasound-guided CICC insertion can be performed even in non-ventilated newborns. [ABSTRACT FROM AUTHOR]

Diagnosing and treating newborn seizures accurately and promptly is crucial for providing the best possible care for these patients. For the purpose of intelligently identifying newborn seizures, this work introduced a unique method that uses spectral and spatial graph neural networks (SSGNNs) optimized with the Aquila algorithm. Using electroencephalogram (EEG) recordings, the suggested methodology takes advantage of the complex spatial and spectral characteristics of infant brain activity. Spatial and spectral GNNs were used to extract significant spatiotemporal patterns suggestive of seizure episodes by organizing the brain activity data as a graph, with nodes representing various brain regions and edges signifying functional relationships. By combining spectral and spatial data, the depiction of newborn brain dynamics was improved and made it possible to distinguish between seizure and non-seizure phases with greater accuracy. Moreover, the introduction of the Aquila algorithm improved the GNNs’ performance in seizure identification tasks by streamlining the training process. A large dataset of EEG recordings from newborns with and without seizures was used to assess the effectiveness of the suggested method. Higher accuracy, sensitivity, and specificity in seizure detection were achieved in the experimental results, which showed greater performance when compared to conventional methods. This work offered an automated, data-driven method for identifying newborn seizures, which is a major development in the treatment of newborns. By combining spectral and spatial GNNs and optimizing the results using the Aquila method, it is possible to enhance seizure detection accuracy and potentially prevent neurological consequences in affected children by intervening early. This method has the potential to completely change the way neonatal care is provided by giving medical professionals a strong tool for accurate and prompt seizure monitoring in neonatal intensive care units (NICU). [ABSTRACT FROM AUTHOR]

Background: Preterm neonates are repeatedly exposed to many stressors in initial days of life such as environmental stressor (light and noise) and caregiver interventions (weighing, oral and tracheal suctioning, drawing blood samples, etc.). If preterm neonates' stress is not recognized and left untreated, there may be long-term effects. Objective: To assess the neonatal stress behavior among preterm neonates admitted in neonatal intensive care unit (NICU), Nehru Hospital, PGIMER, Chandigarh. Methodology: A descriptive study was conducted to assess neonatal stress behavior among preterm neonates admitted in NICU, Nehru Hospital, PGIMER, Chandigarh. Ethical clearance was taken from Institutional Ethics Committee of PGIMER, Chandigarh. Total 100 participants admitted in NICU during the period of July–December 2022 were enrolled for the study using consecutive sampling technique. Data was collected by interviewing mother using interview schedule. It comprised of sociodemographic cum clinical profile of the preterm neonate. Observation was made by using—(a) modified infant positioning assessment tool (IPAT), (b) neonatal stress scale, and (c) preterm neonate's behavior assessment scale. Results: The present study shows that 88% of the preterm neonates show moderate stress and 70% of preterm neonates exhibit suspected abnormal behavioral response in terms of autonomic visceral subsystems, while 54% of the preterm neonates show suspected abnormal behavioral response in terms of state regulation attention interaction subsystem. Conclusion: The present study concluded that moderate stress level and suspected abnormal behavioral response were found among hospitalized preterm neonates. [ABSTRACT FROM AUTHOR]

Objective This study aimed to characterize the spiritual beliefs, practices, and needs of parents of very preterm infants, those born <32 weeks of gestation, in a level-III NICU and to characterize parental perception of the spiritual support received in the neonatal intensive care unit (NICU). Study Design Within 14 days of their infants' birth, parents underwent a recorded semistructured interview. Responses were organized into unique themes using standard qualitative methods. Parents completed the Spiritual Involvement and Beliefs Scale (SIBS) and Spiritual Needs Inventory (SNI). Results Twenty-six parents from 17 families were interviewed and provided SIBS and SNI surveys. Interviews yielded seven major themes describing parents' spirituality and support. Most parents identified themselves as spiritual (n = 14) or sometimes spiritual (n = 2). A high SIBS score was associated with Christian religion (p = 0.007) and non-White race (p = 0.02). The SNI showed ≥80% of parents reported a "frequent" or "always" need for laughter, being with family, thinking happy thoughts, and talking about day-to-day things. The most commonly mentioned sources of spiritual support were parents' connection with a higher power through their faith (n = 12) or religious activities (n = 8). Many parents reported receiving sufficient spiritual support outside of the hospital during their unique experience in the NICU. Conclusion Parents of infants born <32 weeks of gestation in our NICU commonly self-identified themselves as spiritual. Many parents have similar spiritual needs which are often met by sources outside of the hospital. Key Points Parents of infants born <32 weeks of gestation in our NICU commonly self-identify as spiritual. Many parents of preterm infants describe their spirituality as a personal experience. Many parents of preterm infants have similar spiritual needs. Many parents of preterm infants have their spiritual needs met outside of the hospital. [ABSTRACT FROM AUTHOR]

Background: Patent ductus arteriosus is a common congenital heart defect among preterm neonates. Preterm newborns with prolonged ductal patency have been linked to considerable short- and long-term morbidities, as well as higher mortality; however, systematic treatment of everyone during the neonatal period has resulted in a detectable improvement in long-term results. COX inhibitors like Indomethacin and Ibuprofen are approved for PDA closure in preterm neonates. This study compares the efficacy and safety of IV Paracetamol and oral Ibuprofen in preterm and term neonates with HsPDA. Material and Methods: This is an open-label randomized study that was conducted on preterm and term neonates with HsPDA at the NICU of the Government Thoothukudi Medical College among 104 neonates. In total 104 neonates were examined, 52 of whom received 15mg/kg/q6hr of intravenous paracetamol for 3 days, and 52 neonates received 10mg/kg oral ibuprofen on the first day, 5 mg/kg for the next 2 days. The clinical and echocardiography findings were compared. Non-constricted neonates after the first course were subjected to the same drugs for the second course. The closure and constriction rates were studied using echocardiography. Results: Out of 52 neonates in both groups, 38 neonates(73.07%) had closure of PDA in the paracetamol group vs 42 neonates(80.7%) had closure of PDA in the ibuprofen group. There is no significant difference in closure rate between intravenous paracetamol vs oral ibuprofen after 2 courses of treatment. Conclusion: Intravenous paracetamol had a similar efficacy compared to oral ibuprofen for PDA closure in preterm and term neonates. Intravenous Paracetamol is a safe and effective alternative for PDA closure when compared with Ibuprofen. [ABSTRACT FROM AUTHOR]