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Background: Extracorporeal membrane oxygenation (ECMO) is the only treatment option that can stabilize patients with congenital diaphragmatic hernia (CDH) with severe pulmonary hypertension. This study assessed the effects of a multidisciplinary ECMO team approach (META) as part of a quality improvement initiative aimed at enhancing the survival rates of neonates with CDH., Methods: The medical records of infants with CDH treated at a tertiary center were retrospectively reviewed. Patients were categorized into two groups based on META implementation. The META group (P2) were given key interventions, including on-site ECMO management within the neonatal intensive care unit (NICU), use of venoarterial modality, ECMO indication as a priority even before the use of inhaled nitric oxide, and preplanned surgery following ECMO discontinuation. These approaches were compared with standard protocols in the pre-META group (P1) to assess their effects on clinical outcomes, particularly in-hospital mortality., Results: Over a 16-year period, 322 patients were included. P2 had a significantly higher incidence of non-isolated CDH and higher rate of cesarean section compared with P1. Moreover, P2 had delayed time to surgical repair (9.4 ± 8.0 days) compared with P1 (6.7 ± 7.3 days) ( P = 0.004). The overall survival rate at NICU discharge was 72.7%, with a significant improvement from P1 (66.3%, 132/199) to P2 (82.9%, 102/123) ( P = 0.001). Among the 68 patients who received ECMO, P2 had significantly lower baseline oxygenation index and serum lactate levels before ECMO cannulation than P1. The survival rate of patients who received ECMO also remarkably improved from P1 (21.1%, 8/38) to P2 (56.7%, 17/30). Subgroups who could be weaned from ECMO before 2 weeks after cannulation showed the best survival rate., Conclusion: META significantly improved the survival rate of newborn infants with CDH. Further interventions, including prenatal intervention and novel ECMO strategies, may help improve the clinical outcomes and quality of life., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

Background and Aim: Unplanned extubation (UE) is an adverse event that can occur for neonates that are intubated and mechanically ventilated. UE is recognised as an important quality measure in the neonatal intensive care unit (NICU) due to the negative impact these events may have on the neonate. We aimed to use quality improvement (QI) methodology to reduce the rate of UE to the global standard of <1/100 ventilation days., Methods: A 12-month retrospective audit on mechanically ventilated neonates in our NICU identified a mean UE rate of 1.78/100 ventilation days. A clinical guideline focusing on best practice was introduced with key interventions identified by a review of the literature as those which were thought to reduce UE rates. The key interventions in the clinical guideline were introduced sequentially. UE rates were analysed monthly using control charts and the reported cause of each UE event was analysed. Three 12-month periods were included: preintroduction of QI interventions (period 1), during introduction of QI interventions (period 2), and after introduction of QI interventions (period 3)., Results: The introduced interventions reduced the mean rate of UE from 1.78/100 ventilation days in period 1 to 0.8/100 ventilation days in period 3 of the QI project., Conclusions: The key interventions introduced in this QI project were successful in reducing rates of UE by 55%, allowing achievement of the global standard of <1/100 ventilation days., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Up to 30% of newborns with in-utero selective serotonin reuptake inhibitor (SSRI) exposure experience withdrawal symptoms. The impact of newborn feeding method on alleviating withdrawal has not been investigated. We examined the effect of newborn feeding method (breastfeeding versus formula) among a cohort of Neo nates W ith I n-utero S SRI E xposure (NeoWISE)., Methods: This population-based retrospective cohort study included newborns born in Ontario hospitals between April 1, 2012, and March 31, 2020 to Ontario Drug Benefit Program beneficiaries who filled at least one SSRI prenatal prescription. Linked administrative health and registry data were used. Method of newborn feeding was available from birth to hospital discharge. The primary outcome was newborn withdrawal. The secondary outcome was transfer to the Neonatal Intensive Care Unit (NICU). Adjusted risk ratios (adjRR) in breast- versus formula-fed newborns and our outcomes were estimated using generalized linear models. Propensity scores based on antepartum and intrapartum characteristics and inverse probability of treatment weighting were used to balance differences in maternal-newborn characteristics by treatment., Results: Overall, 5,079 newborns were included in the NeoWISE Cohort, with 3,321 (65.4%) exclusively breastfeeding from birth to hospital discharge. Among the breastfed newborns, 50 (1.5%) had neonatal withdrawal versus 41 (2.3%) in the formula-fed newborns. There was no difference in risk of withdrawal in breast versus formula-fed newborns (adjRR 0.86, 95% CI 0.56, 1.34). Breastfed newborns had a reduced risk of transfer to the NICU compared to formula-fed newborns (adjRR 0.80, 95% CI 0.66, 0.97); however, this finding did not persist in sensitivity analysis., Conclusion: The rate of newborn withdrawal was low in this cohort of SSRI-exposed neonates and was not associated with feeding method in the hospital. The results of this study inform shared decision-making around newborn feeding for perinatal women who take SSRI medications., Competing Interests: Statement on conflicts of interest: The authors reported no conflicts of interest.

Background: Thrombocytopenia might be the only clinical clue of diseases in neonates. Classification of thrombocytopenia according to severity, onset offset, nadir and duration might help in identification of the etiology., Aim: This study aims to estimate the prevalence and, identify the determinants and patterns of thrombocytopenia among neonates., Method: An observational retrospective cohort study was conducted and included records of neonates admitted to neonatal intensive care unit of Alexandria University Maternity Hospital. Data were collected using a checklist and analyzed by SPSS version 20.0. Chi square test and independent sample t- test were used to compare different variables between thrombocytopenic and non- thrombocytopenic patients. Logistic regression analysis was carried out in order to identify the independent contribution of various maternal and neonatal variables influencing thrombocytopenia and factors impacting mortality in thrombocytopenic patients., Results: Four-thousands five hundred neonates, were randomized to have sample of 1011 neonates to be included in the analysis. Patients were divided into thrombocytopenic group (n = 375) and thrombocytopenic group (n = 636). Gestational age and birthweight were significantly lower in thrombocytopenic group with p values < .001 and .03, respectively. Necrotizing enterocolitis, early onset sepsis and late onset sepsis were the main determinants of neonatal thrombocytopenia with OR (95% CL), 2.25 (1.25-3.98), 4.8 (3.249-7.19) and 6.567(4.083-10.562). severe intraventricular hemorrhage, pulmonary hemorrhage and cardiovascular instability were main predictors of death in thrombocytopenic patients with OR (95% CL), 4 (1.9-8.34), 20.9 (6.7 -64.9), and 5.76 (2.1-15.8), respectively., Conclusion: Identification of severity and patterns of thrombocytopenia can help the clinician to recognize the etiology and consequently optimize management of thrombocytopenic neonates., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol has been approved on 15th December 2022 by the Research Ethics Committee of Alexandria faculty of medicine. Approval no. is 0107515 in. IRB no. is 00012098 and FWA no. is 00018699. Written informed consents were waived as anonymous data were extracted from files and were stated unnecessary by Research Ethics Committee of Alexandria faculty of medicine (IRB). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Competing Interests: Competing interests: None declared.

Objective: Following very preterm birth, some children require ongoing intensive care after the neonatal period and transition directly from neonatal units (NNUs) to paediatric intensive care units (PICUs) around term-corrected age.We aimed to understand, at a national level, characteristics and outcomes of children born very preterm who transitioned directly from NNUs to PICUs., Design: Retrospective cohort study, using data linkage of National Neonatal Research Database, Paediatric Intensive Care Audit Network and Office for National Statistics datasets., Setting: All NNUs and PICUs in England and Wales., Patients: Children born <32 gestational weeks between 1 January 2013 and 31 December 2018, admitted to NNUs, and who transitioned directly to PICU without return to NNU at ≥36 weeks corrected gestation age were included., Main Outcome Measures: Mortality, length of PICU stay, invasive ventilation in PICU (including via tracheostomy), PICU readmission until 2 years of age., Results: Direct NNU-to-PICU transitions occurred in 276 babies during the study period. An increasing yearly trend was observed: 36 transitions of babies born in 2013, 65 in 2018.Of this cohort, 22% of children died before their second birthday, 59% of survivors had ≥1 PICU readmission, 33% of children had long stays in PICU (≥28 days) and 25% received tracheostomy ventilation., Conclusions: An increasing number of very preterm children require ongoing intensive care at the end of their neonatal stay, with high rates of mortality and morbidity. Multidisciplinary involvement and planning around the time of transition from NNU to PICU, informed by national guidance, may be beneficial., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background/Objectives: Adequate folate intake is required in preterm infants for rapid growth and development, but there is little evidence to back recommendations. We aimed to assess folate status in preterm infants at discharge and in early infancy, according to exposure to folate sources, particularly in those exclusively/predominantly breastfed. Methods: A prospective, multicenter, observational cohort study was conducted in the UK, involving 45 preterm infants <33 weeks' gestational age (GA) exclusively/predominantly fed human milk when approaching NICU (Neonatal Intensive Care Unit) discharge. Serum folate levels were measured near NICU discharge (T1) and at 2-3 months corrected age (T2). Folate status was categorized per WHO (World Health Organization) guidelines: deficiency (<6.8 nmol/L), possible deficiency (6.8-13.4 nmol/L), normal (13.5-45.3 nmol/L), and elevated (>45.3 nmol/L). Nutritional information on feed and supplements was collected from hospital notes and maternal interviews. Results: Thirty-two infants (71%) received parenteral nutrition. Twelve infants (32%) remained exclusively breastfed at T2. No infant from the whole cohort had a serum folate concentration <13.5 nmol/L at either time point. A proportion of infants had serum folate concentrations >45.3 nmol/L: 14/45 (31%) at T1, 19/37 (42%) at T2, and 7/37 (16%) at both time points. Elevated concentrations were seen particularly in infants who received folic acid supplements or nutrition containing folic acid, such as parenteral nutrition and breastmilk fortifiers. Conclusions: Folate deficiency was not observed in this cohort; folate concentrations were high and in line with those observed in healthy term infants. Further research is needed to assess the high folate concentrations in premature babies and whether they may have any adverse clinical impact.

Background: One of the important problems for mothers after the birth of a premature infant is a decrease in milk production. This study aimed to investigate the effect of foot reflexology on the volume and composition of breast milk in mothers of premature infants hospitalized in the neonatal intensive care unit., Methods: This randomized clinical trial was conducted on 76 primiparous mothers whose premature infants up to 34 weeks were hospitalized in the neonatal intensive care unit of Ayatollah Rouhani Hospital from February 2023 to November 2023. Mothers in the intervention group received foot reflexology for 20 min on both feet (ten minutes per foot) for seven consecutive days every morning. On the first and seventh days of the study, both groups were compared in terms of milk volume (ml), triglycerides, cholesterol, albumin, total protein, and calcium (mg/dl)., Results: The mean difference in breast milk characteristics before and after the intervention in the control and intervention groups were as follows: in terms of breast milk volume 12.43 and 23.51 ml, triglyceride 418.37 and 406.21, cholesterol 5.48 and 3.67, albumin 1.02 and 0.35, total protein 1.89 and 4.59, calcium was -3.54 and -1.83 mg/dL; the net difference in breast milk volume in the intervention group compared to the control group increased, which was not statistically significant but was significant in terms of value. No significant difference was observed in other components of breast milk., Conclusion: In this single-center study, foot reflexology massage showed a trend towards increasing the volume of breast milk, total protein and calcium, although it was not statistically significant. Therefore, it needs further investigation., Trial Registration: IRCT, IRCT20221220056872N1. Registered 22 January 2023- prospective registered, https://irct.behdasht.gov.ir/trial/67512 ., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.REC.1401.132). The trial was registered in IRCT (IRCT20221220056872N1). In the study samples, we did not have mothers of premature infants younger than 16 years old, therefore, informed written consent was not obtained from the parents or legal guardians of the mothers of premature infants. The age of mothers of premature infants participating in the study is from 16 to 46 years old, and informed written consent was obtained from all mothers of premature infants before participating in the study. This study followed the Clinical Trials Flowchart guidelines for reporting randomized controlled trials. Consent for publication: The article does not contain any individual’ details and consent for publication is not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: (1) To assess how main pulmonary artery peak Doppler velocity (MPAVpeak) correlates with right ventricular output (RVO) and superior vena cava flow (SVCf), (2) to assess the reproducibility of MPAVpeak and (3) to test the prognostic accuracy of MPAVpeak to predict high-grade intraventricular haemorrhage (IVH) or death at seventh day of life., Design: Prospective cohort study., Setting: Nine third-level neonatal units in Spain., Patients: Preterm infants <33 weeks of gestational age who had standardised measurements of MPAVpeak, RVO and SVCf at 6, 12 and 24 hours of life., Main Outcome Measures: High-grade IVH or death at seventh day of life., Results: One hundred and ninety preterm infants with a median (IQR) gestational age and birth weight of 29.7 weeks (27.1-31.8) and 1152 g (892-1491), respectively, were included. High-grade IVH or death at seventh day of life occurred in 24 (12.6%). MPAVpeak was strongly correlated with RVO (Spearman rho 0.826-0.843). MPAVpeak discriminated well for low RVO (<120 mL/kg/min) at 6 (AUROC, area under the receiver operating characteristic curve=0.90), 12 (AUROC 0.94) and 24 hours (AUROC 0.86). Observer reproducibility was better for MPAVpeak (inter-observer limits of agreement ±8.4%) compared with RVO (±18.8%) and SVCf (±32.2%). The prognostic accuracy of MPAVpeak to predict high-grade IVH or death was good (AUROC >0.75) and non-inferior to RVO and SVCf (DeLong's test p>0.05)., Conclusions: MPAVpeak is an adequate marker of systemic blood flow with high reproducibility and acceptable prognostic accuracy in preterm infants below 33 weeks of gestational age during the first day of life., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Large prospective clinical trials are underway or planned that examine the clinical utility and cost effectiveness of genome-based newborn screening (gNBS). One gNBS platform, BeginNGS, currently screens 53,575 variants for 412 severe childhood genetic diseases with 1,603 efficacious therapies. Retrospective evaluation of BeginNGS in 618,290 subjects suggests adequate sensitivity and positive predictive value (PPV) to proceed to prospective studies. To inform pivotal clinical trial design, we undertook a pilot clinical trial. We enrolled 120 infants in a regional neonatal intensive care unit (NICU) who were not under consideration for rapid diagnostic genome sequencing (RDGS). Each enrollee received BeginNGS and two index tests (California state NBS and RDGS). California NBS identified 4 of 4 true positive (TP) findings (TP rate 3.6%, sensitivity 100%) and 11 false positive (FP) findings (PPV 27%). RDGS identified 41 diagnostic findings in 36 neonates (diagnostic rate 30%). BeginNGS identified 5 of 6 on-target TP disorders (TP rate 4.2%, 95% confidence interval 1%-8%, sensitivity 83%) and no FPs (PPV 100%). Changes in management were anticipated following the return of 27 RDGS results in 25 enrollees (clinical utility [CU] 21%), 3 of 4 NBS TPs (CU 2.7%), and all BeginNGS TPs (CU 4.2%). The incidence of actionable genetic diseases in NICU infants not being considered for RDGS suggests (1) performance of RDGS in ∼20% of admissions misses many genetic diagnoses, (2) NICU enrollment in gNBS trials will greatly increase power to test endpoints, and (3) NICUs may be attractive for early implementation of consented BeginNGS screening., Competing Interests: Declaration of interests C.M.K. and S.S.M. are employees and shareholders of Illumina, Inc. W.R.M., Y.L., and T.D. are employees and shareholders of Alexion, AstraZeneca Rare Disease. J.L. is an employee and shareholder of TileDB, Inc., (Copyright © 2024 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.)

Background: Satisfaction reflects a consumer's judgment regarding the quality of care received. Satisfaction of parents with healthcare services can serve as a reliable indicator for evaluating the quality of care given to their newborns. The aim of this study is to determine the pooled prevalence of parental satisfaction with neonatal intensive care unit services and its associated factors in Ethiopia., Methods: International databases such as PubMed/Medline, African Journals Online, SCOPUS, Web of Science, and Google Scholar were used to identify relevant published articles. Risk of bias was assessed independently by two authors. Funnel plot and Egger regression test were also employed to assess publication bias. A significant p-value of 0.05 or less suggests the presence of publication bias. PROSPERO registration number is CRD42024570971., Results: The researchers initially identified a total of 1,264 articles through their search strategy from all databases. Finally, eleven studies met the inclusion criteria and were considered suitable for the final meta-analysis. The pooled prevalence of parental satisfaction with neonatal intensive care unit services in Ethiopia was 55% (95% CI: 49%-60%). There was neither publication bias nor small study impact among the included studies. Based on the subgroup analysis by region, the pooled prevalence in Oromia were slightly higher, 63% (95% CI: 57%-69%). Birth weight, length of hospital stays, place of residence, and availability of necessary information are factors identified as significant predictors for parental satisfaction with neonatal intensive care unit service., Conclusion: According to the study's findings, there is a lower pooled prevalence of parental satisfaction than in previous research that was published in some countries. By working to raise the satisfaction levels of parents in neonatal intensive care units, healthcare facilities can enhance the overall experience for both parents and infants, leading to improved outcomes and a more positive care environment., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Haile et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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%.

Objective: To investigate the demographic characteristics, maternal, and perinatal factors associated with the hospitalization of moderate to late preterm and term neonates within 72 h of birth in the Dedza and Mangochi districts of Malawi., Methods: This case-control study was conducted with one-to-one matching for age, location, and sex. Cases were sick neonates who were admitted in the Sick Intensive Neonatal Care Unit (SINCU) within 72 h of life, while controls were non-sick neonates delivered within two weeks of the birth dates of cases. Prenatal data were extracted from case files, while other maternal practices and demographic characteristics were obtained by interviewing primary care takers or legal guardians after obtaining consent. Descriptive analyses and logistic regression were used to identify factors associated with hospitalization of moderate to late preterm and term neonates within 72 h of birth., Results: Application of tetracycline eye ointment (AOR: 0.41, 95% CI: 0.20-0.82, p = 0.012) applying chlorhexidine to the umbilical cord stump (AOR: 0.30, 95% CI: 0.10-0.88, p = 0.027), and stimulation resuscitation (AOR: 0.20, 95% CI: 0.05-0.78, p = 0.020) were associated with a reduced odd of hospitalization. An increased odds of hospitalization was significantly associated with low birth weight (AOR: 10.48, 95% CI: 4.25-25.89, p = 0.001), Apgar score < 5 (AOR: 5.0, 95% CI: 2.14-11.63, p = 0.001), suctioning resuscitation (AOR: 2.82, 95% CI: 1.17-6.83, p = 0.021), and resuscitation using O 2 (AOR: 4.23, 95% CI: 1.32-13.56, p = 0.015). Maternal factors associated with reduced odds of hospitalization included the mother testing positive and successfully treated for syphilis antenatally (AOR: 0.06, 95% CI: 0.02-0.18, p = 0.001) and the mother being married (AOR: 0.39, 95% CI: 0.16-0.93, p = 0.34). Maternal factors associated with an increased odds of hospitalization include premature rupture of membranes (AOR: 2.49, 95% CI: 1.12-5.52, p = 0.025) and presence of meconium stain during delivery (AOR: 3.14, 95% CI: 1.63-6.06, p = 0.001)., Conclusion: The research findings indicate that several interventions significantly reduce infections in neonates within their initial 72 h of life. These include the application of ophthalmic ointment to all neonates, utilization of chlorhexidine on the umbilical cord stump, and provision of antenatal treatment for syphilis and HIV in infected mothers. Conversely, certain factors increase the likelihood of neonatal morbidity and potential hospitalization during this critical period. These risk factors include low birth weight, a low Apgar score, and conditions necessitating suctioning or oxygen resuscitation at birth. Furthermore, infants born to mothers who experienced premature rupture of membranes or meconium-stained amniotic fluid during parturition are more susceptible to infectious conditions, which may necessitate hospitalization within the first 72 h postpartum. We recommend that stimulation be used as the core procedure for resuscitation, whereas suctioning should be used with caution and only when it is essential. Infection prevention measures should always be adhered to during all procedures on neonates. We recommend intensifying HIV and syphilis testing and treating during the antenatal period to reduce neonatal infection., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by National Health Sciences Research Committee (NHSRC) under registration number #21/03/2659. Written informed consent was sought from the legal guardians before the neonate was enrolled. Competing interests: Upon reviewing the journal’s guidelines, it is noted that the following authors of this manuscript have disclosed competing interests: Jacqueline Rose. Chinkonde, Mesfin Senbete, Charles Nwosisi, Fatima Gohar and Tedbabe D. Hailegebriel are affiliated with UNICEF as employees. The remaining authors have stated that they have no conflicting interests to declare. Clinical trial number: not applicable., (© 2024. The Author(s).)

Objective: Hyperglycemia in preterm infants is usually treated with adjustment of glucose intake and, if persistent, with continuous insulin infusion. However, hypoglycemia is a well-known complication of intravenous (iv) insulin treatment. The aim of this study was to evaluate the feasibility of continuous subcutaneous insulin infusion (CSII) in extremely preterm infants., Methods: Clinical data from extremely premature infants (<28 weeks of gestation) undergoing CSII treatment for severe hyperglycemia in the neonatal intensive care unit were included. Blood glucose levels during CSII, as well as the nutritional intake and insulin intake were recorded. Data were analyzed and compared to a control group of very preterm infants receiving iv insulin therapy., Results: Normoglycemia rates were best in the iv insulin-cohort (n=22, 50.3%) compared to the CSII group (n=15, 15.6%). Hypoglycemia was very rare in both groups (0.4% vs. 0.0%). CSII therapy appears to require higher insulin doses compared to continuous iv therapy to achieve a similar effect. Subcutaneous Insulin therapy in extremely preterm infants is feasible, at least for prevention of hypoglycemia. However, dose control needs to be improved., Conclusion: The results justify further model validation and clinical trial research to explore a model-based protocol and the use of CSII in this population., Competing Interests: Conflict of interest: None declared., (©Copyright 2024 by Turkish Society for Pediatric Endocrinology and Diabetes / The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.)

Importance: Among preterm newborns undergoing resuscitation, delayed cord clamping for 60 seconds is associated with reduced mortality compared with early clamping. However, the effects of longer durations of cord clamping with respiratory support are unknown., Objective: To determine whether resuscitating preterm newborns while keeping the placental circulation intact and clamping the cord after a long delay would improve outcomes compared with umbilical cord milking., Design, Setting, and Participants: This randomized clinical trial (PCI Trial) was conducted at 8 Italian neonatal intensive care units from April 2016 through February 2023 and enrolled preterm newborns born between 23 weeks 0 days and 29 weeks 6 days of gestation from singleton pregnancies., Interventions: Enrolled newborns were randomly allocated to receive at-birth resuscitation with intact placental circulation for 180 seconds or umbilical cord milking followed by an early cord clamping (within 20 seconds of life)., Main Outcomes and Measures: The primary outcome was the composite end point of death, grade 3 to 4 intraventricular hemorrhage, and bronchopulmonary dysplasia at 36 weeks of postconception age. Prespecified secondary end points were the single components of the composite primary outcome. An intention-to-treat analysis was conducted., Results: Of 212 mother-newborn dyads who were randomized, 209 (median [IQR] gestational age, 27 [26-28] weeks; median [IQR] birth weight, 900 [700-1070] g) were enrolled in the intention-to-treat population; 105 were randomized to the placental circulation intact group, and 104 were randomized to the cord milking group. The composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 35 of 105 newborns (33%) in the placental circulation intact group vs 39 of 104 newborns (38%) in the cord milking group (odds ratio, 0.83; 95% CI, 0.47-1.47; P = .53)., Conclusions and Relevance: In a randomized clinical trial of preterm newborns at 23 to 29 weeks' gestational age, intact placental resuscitation for 3 minutes did not lower the composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia compared with umbilical cord milking., Trial Registration: Clinicaltrials.gov Identifier: NCT02671305.

Objective: To investigate the risk factors of initial non-invasive ventilation(NIV) failure and its association with adverse outcomes in very low birth weight infants (VLBWI). Methods: A retrospective cohort study was conducted, collecting clinical data of 2 102 VLBWI who received NIV within 30 minutes after birth, admitted to 18 NICU of Suxinyun Neonatal Perinatal Collaboration Network (SNPN) from January 1 st , 2019 to December 31 st , 2022. According to the outcome of NIV within the first 72 hours, the study cohort was divided into success group and failure group. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for NIV failure and its association with adverse outcome. Results: A total of 2 102 VLBWI were included, consisting of 1 078 males (51.3%). The gestational age was 29 (28, 31) weeks, and the birth weight was 1 250 (1 090, 1 380) g. The initial NIV failure rate was 15.3%(321/2 102). Multivariate Logistic regression analysis showed that smaller gestational age ( OR =0.67, 95% CI 0.61-0.74, P< 0.001), maternal hypertensive disorders during pregnancy ( OR =10.31, 95% CI 7.48-14.21, P <0.001), Apgar score at the first minute ≤7 ( OR =1.40, 95% CI 1.01-1.93, P= 0.042), grade 3-4 respiratory distress syndrome (RDS)( OR =2.85, 95% CI 1.69-4.81, P <0.001), ≥2 times pulmonary surfactant (PS) treatment ( OR =3.78, 95% CI 2.09-6.83, P <0.001), fraction of inspired oxygen (FiO 2 )>0.30 ( OR =2.21, 95% CI 1.64-2.98, P <0.001) were all independent risk factors for initial NIV failure. The failure group had higher risks of mortality ( OR =10.19, 95% CI 6.50-15.97, P< 0.001), pneumothorax ( OR= 4.33, 95% CI 1.59-11.79, P =0.004), neonatal pulmonary hemorrhage ( OR =8.48, 95% CI 4.08-17.64, P <0.001), moderate to severe bronchopulmonary dysplasia (BPD)( OR =1.75, 95% CI 1.19-2.56, P =0.004), and intraventricular hemorrhage (IVH) ≥grade Ⅲ ( OR= 2.18, 95% CI 1.27-3.73, P =0.004) compared to the success group. Conclusions: Small gestational age, maternal hyertensive disorders during pregnancy, Apgar score at the first minute ≤7, grade 3-4 RDS, PS treatment ≥2 times and FiO 2 >0.30 are risk factors for initial NIV failure in VLBWI. Initial NIV failure is associated with increased risk of mortality, pneumothorax, pulmonary hemorrhage, moderate to severe BPD, and IVH ≥grade Ⅲ.

Background: Preterm infants face challenges to feed orally, which may lead to failure to thrive. Oral feeding skill development requires intact neurobehaviors. Early life stress results in DNA methylation of NR3C1 and HSD11B2, which may disrupt neurobehaviors. Yet, the extent to which early life stress impairs oral feeding skill development and the biomechanism whereby this occurs remains unknown. Our team is conducting an NIH funded study (K23NR019847, 2022-2024) to address this knowledge gap., Purpose: To describe an ongoing study protocol to determine the extent to which early life stress, reflected by DNA methylation of NR3C1 and HSD11B2 promoter regions, compromises oral feeding skill development., Methods: This protocol employs a longitudinal prospective cohort study. Preterm infants born between 26 and 34 weeks gestational age have been enrolled. We evaluate early life stress, DNA methylation, cortisol reactivity, neurobehaviors, and oral feeding skill development during neonatal intensive care unit hospitalization and at 2-week post-discharge., Results: To date, we have enrolled 70 infants. We have completed the data collection. Currently, we are in the data analysis phase of the study, and expect to disseminate the findings in 2025., Implications for Practice and Research: The findings from this study will serve as a foundation for future clinical and scientific inquiries that support oral feeding and nutrition, reduce post-discharge feeding difficulties and lifelong risk of maladaptive feeding behaviors and poor health outcomes. Findings from this study will also provide further support for the implementation of interventions to minimize stress in the vulnerable preterm infant population., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Background: In 2020, the rate of newborns diagnosed with neonatal abstinence syndrome (NAS) in the United States was 6.3 for every 1000 newborn hospitalizations. Resources used to care for this population, particularly NICU beds, are being overwhelmed. In 2020, the state of Ohio saw a rate of 9.5 newborns with NAS for every 1000 newborn hospitalizations., Purpose: To determine if using the Eat, Sleep, Console (ESC) model of care to guide management of neonates with NAS instead of the Finnegan Scale would reduce the number of admissions of neonates diagnosed with NAS to the neonatal intensive care unit (NICU)., Methods: The PDSA (Plan, Do, Study, Act) method was used in the planning and implementation of this pilot quality improvement project. Education regarding the ESC model of care was provided to the Mother/Infant Unit (MIU), with ongoing education and resources provided and readily available on the unit., Results: Fifteen neonates were managed with ESC. Of the 5 who would have been admitted to the NICU for pharmacological treatment if Finnegan Scores were the determining factor for admission, 2 were discharged home from the MIU having been managed with ESC., Implications for Practice and Research: The use of the ESC model of care can be a useful tool in the management and assessment of neonates with NAS. Resource allocation for care of this population must be assessed to provide optimal non-pharmacological interventions., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Background: Treprostinil is a prostacyclin analogue that is frequently used in the pediatric and adult population to treat pulmonary hypertension; however, it is not often a drug of choice for patients in the neonatal intensive care unit (NICU)., Purpose: To evaluate the efficacy of treprostinil as a treatment for pulmonary hypertension of the neonate., Data Sources: Electronic databases such as PubMed, CINAHL, and Embase were used for this literature review. Twelve articles within the last 10 years (2014-2024) were included in this review., Study Selection: 136 articles were identified and primary research studies published in English and with patients younger than one year of age were included. Duplicates were removed and studies discussing genetics and congenital heart disease were excluded., Data Extraction: Abstracts were reviewed and articles referencing treprostinil use in the NICU were included for review. Independent extraction was completed by author., Results: Findings showed treprostinil to have a therapeutic benefit in infants with congenital diaphragmatic hernias and possibly with premature infants. Some adverse effects were noted, one of which included hypotension; however, management strategies exist to mitigate this effect., Implications for Practice and Research: Initiating treprostinil in the NICU may help decrease the severity of persistent pulmonary hypertension of the newborn (PPHN) which can help reduce neonatal morbidity and mortality. Future research is needed to determine the optimal timeframe to initiate treprostinil in the NICU; the duration of treatment; use in other conditions that can cause PPHN (i.e. meconium aspiration syndrome); and the other potential effects it may have for the preterm infant., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Background: The challenging transition to parenthood affects both mothers and fathers; yet, the strain intensifies with a premature birth in the neonatal intensive care unit (NICU), underscoring the importance of acknowledging and addressing potential differences in parental roles., Purpose: This paper aimed to investigate how parental role conflicts among mothers and fathers of preterm-born infants hospitalized in German NICUs manifest and investigated potential parental resources., Methods: Twenty-four participants, 17 mothers, and seven fathers of very low birth-weight infants were interviewed. A thematic content analysis was performed at a semantic level., Results: Fathers feel pressured to fulfill the role expectations, often leading to the suppression of paternal feelings and needs. For mothers, deviating from societal expectations regarding their expressive roles can be distressing, as they worry that such deviation might hinder their infants from having a successful start in life. Consulting with healthcare professionals shows to ease challenges for both parental roles., Implications for Practice and Research: Maternal and paternal challenges are often rooted in expectations placed on their societal roles. Highlighting these challenges can be essential for increasing awareness and effectively addressing them. Tailored nursing practices may have the potential to facilitate individuals' navigation of uncertainties and fulfillment of caregiving roles., Competing Interests: Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Objective: Neonates with medical problems need transfer from the place of birth to a neonatal (intensive care) unit after birth by a specialized neonatal transport team. Neonatal transport is accompanied by a high emotional burden for the families due to spatial separation, uncertainty and care for the neonate. This survey of parents' needs was a quality control project of the neonatal transport team of the University Children's Hospital Zurich, Switzerland. The aim was to identify areas for improvement of family-centred care and to derive concrete suggestions for adjustments in the transport process., Methods: This single-center prospective cross-sectional study included parents of neonates transported between January 2021 and February 2022. Based on a literature review, an anonymous questionnaire was developed (mini-Delphi method) and conducted using an online survey tool. The survey results were analyzed descriptively., Results: The response rate was 77% (168/217). The majority of parents agreed with the current procedures for neonatal transports and experienced the transport team as professional. There were no (emotional) support measures applied by the transport team which were not approved by the parents. Some parents suggested the following additions: the possibility of parental accompaniment during transport, contact by telephone on arrival at the destination hospital, and an improvement in the transmission of medical information, both prenatally and in the context of transport., Conclusion: There is potential for improvement in meeting parental needs during neonatal transport. Some parental suggestions can be implemented easily and cost-effectively. The importance of professional communication and situationally adapted information for parents was confirmed.

Background and Objectives: Many genetic conditions present in the NICU, where a diagnostic evaluation is pursued. However, understanding of the impact of a genetic diagnosis on clinical outcomes and health-related quality of life for these infants remains incomplete. We therefore evaluated parent-reported outcomes complemented by clinical outcomes measures over one year for a cohort of infants in the NICU undergoing genetic evaluation., Methods: Prospective cohort study evaluating outcomes after genetics consultation in a level IV NICU via parent report and electronic medical record review. Eligible infants were genetically undiagnosed at enrollment. Parent surveys were administered at baseline and 3, 6, and 12 months following enrollment and assessed genetic testing utility as well as parent-reported infant health-related quality of life using the Infant Toddler Quality of Life Questionnaire., Results: A total of 110 infant-parent pairs were enrolled. Infants had a median age at enrollment of 15 days (interquartile range 8-37.75). At baseline, 74% (81/110) of parents endorsed high importance of finding a genetic diagnosis, but perceived importance significantly decreased over time. Over the study period, 38 infants received a molecular diagnosis per parent report, although this was discordant with electronic medical record review. Identification of a diagnosis did not significantly impact health-related quality of life across most domains, which was lower overall than population norms., Conclusions: A genetic diagnosis is highly desired by parents in the NICU, though waning interest over time for undiagnosed families may reflect parental emotional adaptation and acceptance. Additional supports are needed to improve perceived quality of life., (Copyright © 2024 by the American Academy of Pediatrics.)

Neonatal intensive care unit resuscitative care continually evolves and increasingly relies on data. Data driven precision resuscitation care can be enabled by leveraging informatics tools and artificial intelligence. Despite technological advancements, these data are often underutilized due to suboptimal data capture, aggregation, and low adoption of artificial intelligence and analytic tools. This review describes the fundamentals and explores the evidence behind informatics and artificial intelligence tools supporting neonatal intensive care unit resuscitative care, training and education. Key findings include the need for effective interface design for accurate data capture followed by storage and translation to wisdom using analytics and artificial intelligence tools. This review addresses the issues of data privacy, bias, liability and ethical frameworks when adopting these tools. While these emerging technologies hold great promise to improve resuscitation, further study of these applications in neonatal population and awareness of informatics and artificial intelligence principles among clinicians is imperative., (Copyright © 2024. Published by Elsevier Inc.)

Effective resuscitation of neonates with congenital heart disease (CHD) depends on comprehensive planning, thorough understanding of physiology, vigilant monitoring, and interdisciplinary collaboration to achieve the best outcomes. Neonatal heart disease can affect cardiac structure, rhythm, or ventricular function, and may be either congenital or acquired. Critical congenital heart disease (CCHD) can result in inadequate pulmonary blood flow, impaired intracardiac mixing, airway obstruction, or insufficient cardiac output. Tailored resuscitation strategies are important as early as the delivery room, where some CHD lesions may cause immediate cardiovascular instability during the transition from fetal to postnatal circulation. Premature infants with CHD are at higher risk due to their small size and the complications associated with prematurity, affecting both CHD management and overall clinical stability. Addressing both cardiac and non-cardiac causes of decompensation requires a precise understanding of each patient's unique physiology and trajectory from delivery through postintervention intensive care., Competing Interests: Declaration of competing interest The authors have no special interests or conflict of interests to disclose., (Copyright © 2024. Published by Elsevier Inc.)

Resuscitation of an infant with surgical complications includes both perioperative and post-operative management. In most cases this requires a multidisciplinary approach to achieve the best outcomes. Challenges include immediate expert management at infant delivery with the use of protocolized care, available anesthesia expertise, close monitoring of electrolytes with prompt attention to fluid status, and meticulous pain management. In this review, we will address contemporary research and ongoing challenges associated with resuscitation. We will make recommendations for effective resuscitation of this vulnerable and unique population from premature infant to term infant with complex surgical needs., Competing Interests: Declaration of competing interest There is no conflict of interest, including relevant financial interests, activities, relationships and affiliations., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Donor human milk (DHM) can provide many benefits to neonates. This study examines access to DHM and how structural barriers may exacerbate inequities. Study Design: The median test and analysis of variance test were used to compare the distribution of maternal race/ethnicity and insurance status variables with DHM access for California neonatal intensive care units (NICUs) in 2021. Results: Across 124 NICUs, those serving a higher percentage of white families were more likely to have access to DHM ( p = 0.04). NICUs with a higher percentage of Hispanic families were less likely to have access to DHM ( p = 0.03). Hospitals that had higher proportions of uninsured patients were also less likely to have access to DHM ( p = 0.015). Conclusion: Inequities in DHM access and use among NICU infants begin at the structural level. Policies that reduce barriers to DHM access may reduce health inequities for Hispanic and uninsured families.

Cardiopulmonary resuscitation is a critical component of neonatal care. While the basic principles of resuscitation are consistent across different settings, the specific challenges and resources available in the delivery room and the Neonatal Intensive Care Unit (NICU) vary significantly. Understanding the differences between these settings is essential for optimizing resuscitation outcomes. This article explores four key areas of difference-environment and equipment, team composition and roles, care protocols and practices, and patient population and condition-and how they impact neonatal resuscitation efforts. By examining these differences, healthcare neonatal care teams can better prepare for the specific resuscitation needs in each setting, ultimately improving neonatal survival and long-term health outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Skin-to-skin care (SSC) is an evidence-based care method for preterm-born infants. Staff may hesitate to initiate early SSC, the first or second week of life, for the most extremely preterm infants; 1 reason could be nurses' attitudes., Purpose: The aim was to investigate the attitudes and experiences of neonatal nurses regarding early SSC for the most extremely preterm infants, born at gestational week (GW) 22-23, using an exploratory and descriptive approach., Methods: A web-based survey was sent to all nurses across the 6 Swedish units routinely caring for the most extremely preterm infants. Descriptive statistics and qualitative content analysis were used to analyze the data., Results: The response rate was 258 out of 547 (47%). This study reveals a spectrum of attitudes and experiences among nurses, ranging from viewing early SSC as an integral aspect of infant care to deeming it very challenging or simply not feasible. The outcomes are presented in 2 categories, describing both facilitators and challenges associated with early SSC. Noteworthy, facilitators include well-implemented guidelines that support early SSC. Conversely, challenges encompass knowledge gaps and the scarcity of scientific evidence demonstrating the safety of all SSC, including early, for the most extremely preterm infants., Implications for Practice and Research: This study underscores the importance of spreading knowledge, and has clinical adapted guidelines about the practical aspects of SSC for infants born at 22-23 GW. Future research is required to clarify safety aspects pertaining to SSC for the most extremely preterm infants., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the National Association of Neonatal Nurses.)

Background: Point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) is becoming increasingly utilized, with the focus of training aimed at physicians. However, the role of neonatal nurse practitioners (NNPs) in the development of POCUS programs is not well described., Purpose: To describe the NNP role in the implementation of a NICU POCUS program and exemplify the potential to expand the professional scope and educational advancement of NNPs., Methods: In 2018, a multidisciplinary team assembled to develop a POCUS program in the NICU at Lucile Packard Children's Hospital (LPCH). Three NNPs received formal POCUS training in order to provide onsite training, perform and supervise POCUS imaging, and participate in quality assurance sessions. NNPs also assisted with the development of a REDCap database and imaging protocols., Results: The LPCH POCUS NNP providers contributed to the advancement of the profession by practicing to the full scope of their role, providing leadership in program development, research, and education. Incorporating NNPs into the programmatic structure of a POCUS program can be a model for others. With advancing skill set, NNPs can be positioned to be national leaders and educators., Implications for Practice and Research: NICUs developing POCUS programs can benefit from the integration of NNPs to serve as consistent content experts to expand the number of trained providers while assuring the quality of image capture. POCUS is becoming increasingly essential to the care of newborns. NNPs can play a central role in performing POCUS, participating in quality improvement and research, and educating other NICU providers., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Acute respiratory compromise (ARC) is a significant and frequent emergency in the Neonatal Intensive Care Unit (NICU), characterized by absent, agonal, or inadequate respiration that necessitates an immediate response. The primary etiologies of ARC in neonates can be categorized into upper and lower airway issues, disordered control of breathing, and lung tissue disease. ARC events are particularly dangerous as they compromise oxygen delivery and carbon dioxide removal, potentially leading to cardiopulmonary arrest. Approximately 1 % of NICU admissions experience cardiopulmonary arrest, and ARC is the primary cause of most events. This article provides a comprehensive review of the etiologies of ARC, including anatomical abnormalities, syndromic disorders, airway obstruction, and pulmonary diseases such as bronchopulmonary dysplasia and pneumonia. Management strategies include the use of continuous positive airway pressure, positive pressure ventilation, and advanced interventions like extracorporeal membrane oxygenation (ECMO) in cases of severe respiratory distress. Additionally, quality improvement initiatives aimed at reducing incidents such as unplanned extubations (UE) are discussed, along with emergency responses to ARC, which often require multidisciplinary collaboration and advanced airway management. The article emphasizes the importance of preparedness, training, and structured emergency protocols to ARC in the NICU to optimize patient care., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Metabolic emergencies in neonates can present with nonspecific signs and symptoms. Sudden acute deterioration in a neonate should prompt consideration of metabolic disease. Common metabolic emergencies in the Neonatal Intensive Care Unit (NICU) include hypoglycemia, hyperammonemia, hyperbilirubinemia, metabolic acidosis, adrenal insufficiency, and electrolyte imbalances. These emergencies often require prompt recognition and intervention to prevent serious complications. Appropriate management depends on the diagnosis. However, initial resuscitation and stabilization can be started without a definitive diagnosis. Confirmatory testing and long-term management vary by condition and should be guided by symptoms and endocrinologist input., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Post-cardiac arrest syndrome is a unique pathophysiologic condition that is well-described in adult and pediatric populations. Early, goal-directed care after cardiac arrest can mitigate ongoing injury, improve clinical outcomes, and prevent re-arrest. There is a paucity of evidence about post-cardiac arrest care in the NICU, however, pediatric principles and guidelines can be applied in the NICU in the appropriate clinical context., (Copyright © 2024. Published by Elsevier Inc.)

Aim: Medical institutions restricted visitation to neonatal intensive care units (NICUs) during the coronavirus disease (COVID-19) pandemic. Therefore, this study aimed to investigate the impact of COVID-19 NICU visitor restrictions on parents., Methods: We conducted a questionnaire of 378 parents of infants who were hospitalised for more than 1 week at two NICUs in our area and discharged between 1 April 2020 and 31 March 2022. While the visiting rules for NICUs during this period varied depending on the phase of the COVID-19 epidemic, generally, only parents were allowed to visit the NICUs for a few hours daily., Results: A total of 157 parents (A University Hospital (AMUH), n = 79; AK General Hospital (AKGH), n = 78) responded to the survey (41.3% response rate), with 40% stating that their emotions towards their infants were affected by restrictions due to the COVID-19 pandemic. Parents' feelings towards their infants were influenced by mode of delivery, parity, duration of hospitalisation and opportunities to visit the NICU. More than 70% of respondents felt stressed due to COVID-19 restrictions, and anxiety and emotional stress related to visitor restrictions were significantly affected by the number and duration of visits and allowability of family member visits. Parents felt that the restrictions had a negative impact on breastfeeding, overall infant care and infant-family bonding., Conclusion: As parents felt an impact on the bond with their infant during visitation restrictions, it is essential for facilities to implement measures to protect infant-family bonding during potential future pandemics., (© 2024 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

The Neonatal Resuscitation Program (NRP) is the most used resuscitation algorithm for infants requiring resuscitation in the neonatal intensive care unit (NICU). The population of infants cared for in the NICU is varied and complex with resuscitation needs that may extend beyond the NRP algorithm. To provide resuscitation care that addresses these needs, institutions may choose to incorporate algorithms from the Pediatric Advanced Life Support or a "hybrid" approach that includes NRP. Limited evidence exists to support one algorithm or approach over another. In this article, we identify potential gaps in the application of using NRP or PALS in the NICU population, present select patient decompensations and discuss the resuscitation management approach using the NRP or PALS algorithms. Challenges associated with NICU resuscitation education will be explored as well as approaches to overcome some of the identified resuscitation education obstacles., (Copyright © 2024 Elsevier Inc. All rights reserved.)

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., (© 2024 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aim: The aim of this study was to compare patients referred to our retrieval service who were palliated before transfer, versus those transferred who were palliated within 7 days of birth., Methods: We conducted a retrospective chart review of infants referred to our neonatal retrieval service between 1 December 2015 and 31 March 2022 who died during retrieval or within 7 days of referral. Demographic and clinical data were collected from the service database and electronic medical records., Results: Data on 60 infants were analysed; 25 (42%) infants were not transported and were palliated at the referring hospital, 35 (58%) infants were transported and later palliated at the accepting hospital. The most common primary diagnoses were prematurity (42%) and hypoxemic ischemic encephalopathy (HIE) (42%). Infants palliated at the referring hospital were more likely than those transported and later palliated to require resuscitation including chest compressions (52% vs. 23%, P = 0.02), management for hypotension (72% vs. 20%, P < 0.001) and management for pneumothorax (28% vs. 0%, P = 0.001) and less likely to require management for seizures (8% vs. 43%, P = 0.003)., Conclusions: Palliation at the referring hospital should be considered as an option when escalating care is predicted to not affect outcome. In this cohort the infants least likely to be transported required significant management during stabilisation. Determining the infants for whom transport is non-beneficial remains difficult., (© 2024 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: More than 350,000 U.S. infants are admitted to the neonatal intensive care unit (NICU) annually and likely experience discomfort. Although nurse perceptions of infant symptoms, suffering, and quality of life (QOL) are valuable, the availability of standardized assessment tools to measure these concepts are limited., Purpose: To provide preliminary evidence of the internal structure, reliability, and validity of the Nurse Perception of Infant Condition (NPIC) scale., Methods: Infants were enrolled from a Level IV NICU in the U.S. Midwest. Nurses reported on their perceptions of the infant symptom experience and their expectations for infant survival. Weekly behavioral observations of infants were obtained before and after standard delivery of care to obtain a comfort score., Results: 237 nurses who cared for 73 infants completed 569 surveys over 28 months. All NPIC items were significantly correlated with each other ( P < .001). Factor analysis revealed strong evidence of a 2-factor structure (survival and suffering subscales). Both subscales demonstrated good to excellent internal consistency. Together the 2 factors explained 82% of the variability in the scale responses. Limited validity evidence was found., Implications for Practice and Research: Evidence was found to support the internal structure and reliability of the NPIC scale. However, further item development and refinement is needed to increase the utility NPIC scale in clinical and research settings. The development of improved assessments of the infant NICU experience is warranted. Nurse perceptions of infant suffering or poor QOL may have implications for their expectations for infant survival and possibly care delivery., (Copyright ©.)

Objectives: To evaluate blood culture sample volumes, identify factors linked to insufficient samples, and compare volumes among neonates treated for culture-negative-sepsis, sepsis-rule-outs, and bloodstream infections (BSI)., Methods: Observational cohort of blood cultures collected during NICU stay. Association of age, weight, gender, source, and collection time with lower-than-recommended volumes was determined by logistic regression. Blood culture inocula of patients with culture-negative-sepsis, sepsis rule-out, and BSI were compared using ANOVA., Results: 742 blood cultures were obtained from 292 neonates. Median inoculum was 1 mL (IQR:0.6-1.4), and 259 bottles (35%) had inocula <0.9 mL. Night shift sample collection was associated with lower-than-recommended volumes (p = 0.006). No difference in sample volumes was observed between culture-negative-sepsis, sepsis-rule-outs, and BSI (p = 0.5)., Conclusions: Median NICU blood culture volumes align with recommendations. Night shift collections correlate with lower volumes. Sample volumes don't differ in patients with culture-negative-sepsis, BSI, and sepsis-rule-out, and should not be a justification for longer duration of antibiotics., Competing Interests: Ethics approval and consent to participate: All methods were performed in accordance with the relevant guidelines and regulations. Approval was obtained from the Children’s National Institutional Review Board (Pro00011458). Informed consent was waived. Competing interests: Dr. Soghier is an editor for American Academy of Pediatric “Reference Range Values in Pediatric Care” and “Neonatal Simulation” textbooks. The remaining authors of this manuscript have no conflicts of interest to disclose., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background and Significance: In neonatal intensive care, the communication of difficult news can have lingering repercussions throughout the lives of those receiving such information. Uncertainty and stress associated with the COVID-19 pandemic may negatively influence this sensitive yet essential communication process., Purpose: To analyze the communication of difficult news during the COVID-19 pandemic from the perspective of parents of newborns admitted to a neonatal intensive care unit., Methods: A qualitative, descriptive research study was completed in a hospital in Brazil. Individual and semistructured interviews were conducted with 21 parents of newborns hospitalized in an intensive care unit and submitted to thematic analysis., Results: Three themes were built: "Tools and strategies to manage difficult news," "What makes difficult news hard to listen," and "The importance of being prepared to receive difficult news." When comparing these findings with prepandemic literature, the COVID-19 period changed communication dynamics, including coping tools and altered family dynamics. Additionally, assessing healthcare providers' positive and negative behaviors by parents could clarify essential skills to support the family's hospitalization process during a crisis., Implications for Practice and Research: Applying and investing in skills training such as spirituality assessment, providing clear and straightforward information, and empathy can reduce the impact of difficult news and, thus, requires both recognition and action from healthcare professionals. Knowing some of the effects COVID-19 had on the communication process for parents with critically ill infants, healthcare providers can better prepare themselves for communication in several scenarios and establish successful interactions., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Background: Due to the geographical distance, work obligations, and parenting responsibilities, it is often difficult for parents to visit the neonatal intensive care unit (NICU). Limited parent presence might also constrain updates about infant status thus increasing anxiety, which potentially leads to a stronger necessity for visitation., Purpose: Examine the evidence for use of electronic visit (eVisit) technology for parents of newborns in NICU, for example, do eVisits decrease anxiety and are there other factors that demonstrate effectiveness., Data Sources: Seven databases were used to search for evidence from 1 January 2000 to 13 November 2023., Study Selection: Studies were included with terms related to eHealth, NICU, infant, parent and 41 eligible studies were assessed., Data Extraction: Data were extracted by 2 reviewers with a systematic-staged review approach., Results: Eight studies with a total of 1450 cases were included. Results of meta-analysis showed that eVisit technology improved anxiety compared with conventional visitation (MD = - 5.04, 95% CI [-5.92, - 4.17], P < .01) and hospitalization satisfaction (RR = 1.09, 95% CI [1.05, 1.13], P < .01), but the effect was not significant with regard to reduction in infant length of stay (MD = - 1.07, 95% CI [-5.39, 3.25], P = .63)., Implications for Practice and Research: A large sample, high-quality, multi-centered randomized controlled study needs to be conducted to validate the effect of eVisit technology on the psychological state of parents, implications for nursing practice as well as potential newborn affects to improve future ease of use., Video Abstract: Available for more insights from the authors. This video shows the concept, current status, significance, and implications for practice and research of eVisit technology., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the National Association of Neonatal Nurses.)

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&#95;1), 3 (LUS&#95;3), and 7 (LUS&#95;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&#95;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&#95;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&#95;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., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Feeding skill acquisition is commonly a limiting factor determining when an infant born prematurely can be discharged., Purpose: This study aimed to determine if the addition of a novel feeding progression algorithm (combination of objective data from a suck measurement device and slow flow/low variability nipples) to current neonatal intensive care unit (NICU) standards could decrease feeding-related length of stay (primary outcome). We hypothesized that by timing the initiation of oral feedings to coincide with adequate sensory-motor skill development, feeding-related length of stay may be decreased., Methods: This was a prospective intervention study, with a historical control cohort, of infants born less than 30 weeks' gestational age without comorbidities affecting feeding skill acquisition at a Regional Level III-S NICU at a women and infant's hospital in Louisiana. A novel feeding progression algorithm utilized objective assessment of sucking to determine progression in nipple flow rates with slow flow/low variability nipples (flow rates from 0 to 9 mL/min) for infants receiving intervention (n = 18). Thirty-six controls who did not receive the feeding progression algorithm were identified via electronic medical record retrospective chart review., Results: Eighteen completed the study. Compared to the control group, infants receiving feeding interventions had delayed sequencing initiation, extended time between initially off positive pressure ventilation and initiation of sequencing, and decreased feeding-related length of stay, with similar total length of stay., Implications for Practice and Research: This study adds to existing research supporting the effectiveness of novel feeding progression algorithms and interventions to support the health and outcomes of infants born prematurely. Future research should focus on implementation studies for feeding progression algorithm integration into standard NICU care., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Purpose of Review: Critically ill children are at risk of neurologic dysfunction and acquiring primary and secondary brain injury. Close monitoring of cerebral function is crucial to prevent, detect, and treat these complications., Recent Findings: A variety of neuromonitoring modalities are currently used in pediatric and neonatal ICUs. These include noninvasive modalities, such as electroencephalography, transcranial Doppler, and near-infrared spectroscopy, as well as invasive methods including intracranial pressure monitoring, brain tissue oxygen measurement, and cerebral microdialysis. Each modality offers unique insights into neurologic function, cerebral circulation, or metabolism to support individualized neurologic care based on a patient's own physiology. Utilization of these modalities in ICUs results in reduced neurologic injury and mortality and improved neurodevelopmental outcomes., Summary: Monitoring of neurologic function can significantly improve care of critically ill children. Additional research is needed to establish normative values in pediatric patients and to standardize the use of these modalities., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Nosocomial infections pose a serious threat. In neonatal intensive care units (NICUs) especially, there are repeated outbreaks caused by micro-organisms without the sources or dynamics being conclusively determined., Aim: To use amorphous silica nanoparticles with encapsulated DNA (SPED) to simulate outbreak events and to visualize dissemination patterns in a NICU to gain a better understanding of these dynamics., Methods: Three types of SPED were strategically placed on the ward to mimic three different dissemination dynamics among real-life conditions and employee activities. SPED DNA, resistant to disinfectants, was sampled at 22 predefined points across the ward for four days and quantitative polymerase chain reaction analysis was conducted., Findings: Starting from staff areas, a rapid ward-wide SPED dissemination including numerous patient rooms was demonstrated. In contrast, a primary deployment in a patient room only led to the spread in the staff area, with no distribution in the patient area., Conclusion: This study pioneers SPED utilization in simulating outbreak dynamics. By unmasking staff areas as potential key trigger spots for ward-wide dissemination the revealed patterns could contribute to a more comprehensive view of outbreak events leading to rethinking of hygiene measures and training to reduce the rate of nosocomial infections in hospitals., Competing Interests: Conflict of interest statement None declared., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate the performance (i.e., agreement between set and measured parameters) and safety (adverse events, device malfunctions, and ventilator alarms) of the fabian HFOi neonatal ventilator in volume guaranteed (VG) mode during conventional ventilation. To analyze the impact of leakage around the endotracheal tube and the set maximum allowed inflating pressure (Pmax)., Design: Prospective multicenter observational study., Methods: Clinical and ventilator data were collected from 71 infants receiving VG ventilation for ≥12 h in four neonatal intensive care units (NICUs). Ventilator settings, parameters, and alarms were downloaded with 0.5 Hz sampling rate., Results: Data from 4,341 h of ventilation were analyzed. The median (interquartile range, IQR) of the absolute difference between the target and measured expired tidal volume was 0.76 (0.51-1.16) mL/kg. It was less when leak was <50% (median 0.36, IQR: 0.25-0.64 mL/kg, p < .001) and even less when the required peak inflating pressure (PIP) was also below Pmax (median: 0.09 mL/kg, IQR: 0.00-0.16 mL/kg, p < .001). On NICUs setting Pmax higher, tidal volume was maintained significantly closer to target. In 56 patients VG was continued until extubation. Two ventilator malfunctions were reported, none of them resulting in patient harm. "Tidal volume not reached" alarm occurred 32 times hourly, usually lasting for <10 s., Conclusion: The fabian HFOi ventilator maintains tidal volume close to its target, particularly when leak is <50% and when PIP is below Pmax. In most patients VG can be continued until extubation. Despite frequent ventilator alarms, ventilator malfunctions occur very rarely., (© 2024 Wiley Periodicals LLC.)

Background: Interpretation of coagulation testing in neonates currently relies on reference intervals (RIs) defined from older patient cohorts. Direct RI studies are difficult, but indirect estimation may allow us to infer normative neonatal distributions from routinely collected clinical data., Objective: Assess the utility of indirect reference interval methods in estimating coagulation reference intervals in critically ill neonates., Methods: We analyzed first-in-life coagulation testing results from all patients admitted to a level IV neonatal intensive care unit between January 1, 2018, and January 1, 2024. Results obtained after transfusion of any blood product were excluded. Indirect RIs were estimated across gestational age groups using refineR and compared with currently reported intervals for patients less than 1 year of age., Results: Prothrombin times (PTs) and international normalized ratios (INRs) were available for 1128 neonates, while activated partial thromboplastin times (APTTs) were available for 790 neonates. The indirect RI was 10 to 25 seconds in preterm, 10 to 22 seconds in term, and 10 to 24 seconds in all neonates for PT; 0.7 to 2.1 in preterm, 0.8 to 1.8 in term, and 0.8 to 1.9 in all neonates for INR; and 25 to 68 seconds in preterm, 25 to 58 seconds in term, and 25 to 62 seconds in all neonates for APTT. Compared with our current intervals, the indirect RIs would flag 58% fewer PT, 43% fewer INR, and 17% fewer APTT results as abnormal., Conclusion: Indirectly estimated RIs in neonates admitted to intensive care show substantial divergence from current, first-year-of-life RIs, leading to an abundance of abnormal flags. The associations between these flags and provider behavior, transfusion practice, or clinical outcomes are areas of future exploration., Competing Interests: Declaration of competing interests The authors have no competing interests to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)