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Aim: To assess the incidence and severity of nasal pressure injuries caused by nasal CPAP nasal masks and binasal prongs. Methods: Single NICU observational study among infants who required nCPAP, using the Nasal Injury Assessment Score Chart (NIASC). Results: In 90.7% (N = 118) skin injuries were observed. Eleven infants had no skin injury, 68 mild, 26 moderate and 13 severe. The severity of the injury was categorized into groups; group I (NIASC

Under a Creative Commons license: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Clinical practice is a moment of stress for nursing students with impact in academic outcomes. Neonatal Intensive Care Units (NICU) are a specific and multifaceted context that offer complex experiences to nursing students. A descriptive, cross-sectional, and observational study, with a qualitative approach was outlined that aimed to describe and categorize the experiences of nursing students in NICU. Semi structured interviews were used for data collection and content analysis for data analysis. Among eligible students (those that had performed clinical practice in NICU and agreed to participate) a purposive sample of 6 students was selected. Data analysis allowed the identification of five categories: clinical practice evolution, expectations about clinical practice, challenges faced in clinical practice, feelings for the babies and their parents, and comparing with the adult nursing clinical practice. The findings of this study indicate that nursing students experienced a wide range of feelings and experiences. info:eu-repo/semantics/acceptedVersion

Refereed/Peer-reviewed Lethal short-limb skeletal dysplasia Al-Gazali type (OMIM %601356), also called dysplastic cortical hyperostosis, Al-Gazali type, is an ultra-rare disorder previously reported in only three unrelated individuals. The genetic etiology for Al-Gazali skeletal dysplasia has up until now been unknown. Through international collaborative efforts involving seven clinical centers worldwide, a cohort of nine patients with clinical and radiographic features consistent with short-limb skeletal dysplasia Al-Gazali type was collected. The affected individuals presented with moderate intrauterine growth restriction, relative macrocephaly, hypertrichosis, large anterior fontanelle, short neck, short and stiff limbs with small hands and feet, severe brachydactyly, and generalized bone sclerosis with mild platyspondyly. Biallelic disease-causing variants in ADAMTSL2 were detected using massively parallel sequencing (MPS) and Sanger sequencing techniques. Six individuals were compound heterozygous and one individual was homozygous for pathogenic variants in ADAMTSL2. In one of the families, pathogenic variants were detected in parental samples only. Overall, this study sheds light on the genetic cause of Al-Gazali skeletal dysplasia and identifies it as a semi-lethal part of the spectrum of ADAMTSL2-related disorders. Furthermore, we highlight the importance of meticulous analysis of the pseudogene region of ADAMTSL2 where disease-causing variants might be located.

Cellulitis of neonates and infants younger than three months of age is rare and often atypical in presentation. Because of the potentially (and rapidly) lethal course of group B streptococcal sepsis, it is essential to avoid delay in diagnosis and treatment. We report the case of a neonate with group B streptococcal retroauricular cellulitis. Admitted for late bacterial neonatal infection with cutaneous location. The history of the disease dates back to one day before admission, with the appearance of a painful cervical swelling without other associated signs evolving in a context of fever of 39°. The clinical examination found a pink tonic reactive newborn in good hemodynamic and respiratory condition, febrile at 39.5°. With the presence of a painful and warm latero-cervical mass of hard consistency and the presence of associated bilateral latero-cervical adenopathies was noted. The oral cavity examination was unremarkable; Cellulitis in newborns and infants under 3 months of age is rare and has not been described in the literature except in a few clinical cases. In the case of any cellulitis of the face in a newborn or before the age of 3 months, late infection with group B streptococci (GBS) should be considered.

Rapid genomic sequencing (rGS) is being increasingly used in neonatal and paediatric intensive care units. While there is emerging evidence of clinical utility and cost-effectiveness, concerns have been raised regarding the impact of delivering genomic results in an acute care setting. To help investigate these concerns, we analysed survey data collected from caregivers whose children had received rGS through a national rapid genomic diagnosis program. The impact of rGS on families was assessed through the PedsQL2.0 Family Impact Module and the State-Trait Anxiety Inventory (STAI-6). Sixty-one parents/carers completed the survey during the study period (response rate 48%; 61/128). Mean parent and family functioning was reduced in this sample, reflecting the stressful conditions facing families with critically unwell children. We found caregivers whose children had received a diagnostic result through rGS reported a reduced family relationships score compared to caregivers of children who did not receive a diagnosis. These findings have implications for genetic counselling practice in this setting. ispartof: EUROPEAN JOURNAL OF HUMAN GENETICS vol:30 issue:9 pages:1036-1043 ispartof: location:England status: published

Place: France; This literature review focuses on the neonatal context. It provides an update of knowledge on the psychosocial consequences and communication needs expressed by parents. It highlights the obstacles to communication and proposes lines of thought for the development of new training systems to improve the communication practices of caregivers. OBJECTIVE: This review aims to assess and categorize the specific needs and expectations of families in terms of communication within the neonatal intensive care unit (NICU). METHODS: A bibliographic search was carried out on the Web of Sciences, PubMed and PsycArticles databases with the following keywords: "neonat* AND new* AND communication AND parent*". RESULTS: In total, 16 papers were selected showing that information and communication are particular needs for parents in NICUs. They are confronted with a stressful situation and have to deal with the fear and anticipation of the situation in a context of uncertainty. Parents are satisfied with the caregiver-parent relationship when the type of communication is adapted to the context and to their changing needs. Conversely, they feel excluded when they cannot be involved as they would like to be in the care or in the decision-making process. CONCLUSION: The development of new communication training methods and tools such as simulation would allow healthcare workers to acquire new communication skills focused on the needs of families.

The possibility to identify patients with spinal muscular atrophy through neonatal screenings has highlighted the need for clinical assessments that may systematically evaluate the possible presence of early neurological signs. The aim of this study was to use the Hammersmith Neonatal Neurological Examination (HNNE) and a module specifically designed for floppy infants to assess the possible variability of neurological findings in infants identified through neonatal screening. The infants included in this study were identified as part of a pilot study exploring neonatal screening in two Italian regions. A neurological examination was performed using the HNNE and an additional module developed for the assessment of floppy infants. Seventeen infants were identified through the screening. One patient had 1 SMN2 copy, 9 had 2 copies, 3 had 3, and 4 had more than 3 copies. Nine of the 17 infants (53%) had completely normal results on both scales, 3 had minimal signs, and the other 5 had more obvious clinical signs. The number of SMN2 copies was related to the presence of abnormal neurological signs (p = 0.036) but two SMN2 copies were associated with variable clinical signs as they were found in some infants with respectively normal examination or obvious severe early signs.Conclusions: Our results suggest that the combination of both scales increases the possibility to detect neonatal neurological signs and to define different early patterns of involvement also identifying paucisymptomatic patients. What is Known:• The use of new therapeutic options in presymptomatic SMA patients leads to a dramatic reduction of the onset and severity of the diesease.• The already existing tools commonly used in Type I SMA (HINE and CHOP-intend) may not be suitable to identify minor neurological signs in the neonatal period. What is New:• Combining the HNNE and the floppy infant module, we were able to identify early neurological signs in SMA infants identified through newborn screening and may help to predict the individual therapeutic outcome of these patients.• Iinfants with 2 SMN2 copies identified through the screening had a more variable neonatal examination compared to those with three or more copies, in agreement with similar findings in older infants.

ObjectiveIn response to the increasing focus on family-centred care, neonatal intensive care unit (NICU) environments have gradually shifted towards the single-room design. However, the assumed benefits of this emerging design remain a subject of debate. Our goal was to evaluate the impact of single-room versus open-bay care on the risk of neonatal morbidity and mortality in preterm neonates.DesignRetrospective cohort study.SettingLevel III NICU.PatientsNeonates born Main outcome measuresMortality and morbidities of a cohort of neonates admitted to a new, single-room unit (SRU) were compared with a historical cohort of neonates admitted to an open-bay unit (OBU). Group differences were evaluated and multivariable logistic regression analyses were performed.ResultsThree-hundred and fifty-six and 343 neonates were admitted to the SRU and OBU, respectively. No difference in neonatal morbidities and mortality were observed between cohorts (bronchopulmonary dysplasia: OR 1.08, 95% CI 0.73 to 1.58, p=0.44; retinopathy of the prematurity stage ≥2: OR 1.36, 95% CI 0.84 to 2.22, p=0.10; intraventricular haemorrhage: OR 0.89, 95% CI 0.59 to 1.34, p=0.86; mortality: OR 1.55, 95% CI 0.75 to 3.20, p=0.28). In adjusted regression models, single-room care was independently associated with a decreased risk of symptomatic patent ductus arteriosus (adjusted OR 0.54, 95% CI 0.31 to 0.95). No independent association between single-room care and any of the other investigated outcomes was observed.ConclusionsImplementation of single-rooms in our NICU did not lead to a significant reduction in neonatal morbidity and mortality outcomes.

Introduction There is growing evidence that parental participation in the care of small and sick newborns benefits both babies and parents. While studies have investigated the roles that mothers play in newborn units in high income contexts (HIC), there is little exploration of how contextual factors interplay to influence the ways in which mothers participate in the care of their small and sick newborn babies in very resource constrained settings such as those found in many countries in sub-Saharan Africa. Methods Ethnographic methods (observations, informal conversations and formal interviews) were used to collect data during 627 h of fieldwork between March 2017 and August 2018 in the neonatal units of one government and one faith-based hospital in Kenya. Data were analysed using a modified grounded theory approach. Results There were marked differences between the hospitals in the participation by mothers in the care of their sick newborn babies. The timing and types of caring task that the mothers undertook were shaped by the structural, economic and social context of the hospitals. In the resource constrained government funded hospital, the immediate informal and unplanned delegation of care to mothers was routine. In the faith-based hospital mothers were initially separated from their babies and introduced to bathing and diaper change tasks slowly under the close supervision of nurses. In both hospitals appropriate breast-feeding support was lacking, and the needs of the mothers were largely ignored. Conclusion In highly resource constrained hospitals with low nurse to baby ratios, mothers are required to provide primary and some specialised care to their sick newborns with little information or support on how undertake the necessary tasks. In better resourced hospital settings, most caring tasks are initially performed by nurses leaving mothers feeling powerless and worried about their capacity to care for their babies after discharge. Interventions need to focus on how to better equip hospitals and nurses to support mothers in caring for their sick newborns, promoting family centred care.

Background Family-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child’s bedside during hospital rounds is a promising solution. We aim to evaluate the impact of virtual family-centered hospital rounds in the neonatal intensive care unit on parental and neonatal outcomes. Methods This two-arm cluster randomized controlled trial will randomize families of hospitalized infants to have the option to use telehealth for virtual hospital rounds (intervention) or usual care (control). The intervention-arm families will also have the option to participate in hospital rounds in-person or to not participate in hospital rounds. All eligible infants who are admitted to this single-site neonatal intensive care unit during the study period will be included. Eligibility requires that there be an English-proficient adult parent or guardian. We will measure participant-level outcome data to test the impact on family-centered rounds attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Discussion The findings from this trial will increase our understanding about virtual family-centered hospital rounds in the neonatal intensive care unit. The mixed methods implementation evaluation will enhance our understanding about the contextual factors that influence the implementation and rigorous evaluation of our intervention. Trial registration ClinicalTrials.gov Identifier: NCT05762835. Status: Not yet recruiting. First posted: March 10, 2023; last update posted: March 10, 2023.

A ventilação de alta frequência (VAF) é uma estratégia de proteção pulmonar que pode ser utilizada desde pacientes neonatais a adultos com lesão pulmonar aguda. Embora a evidência estatística que apoia a VAF seja particularmente baixa, benefícios potenciais para sua aplicação em muitas manifestações clínicas ainda permanecem. Todos os pacientes com lesão pulmonar induzida por ventilação ou com risco de desenvolver lesões ou Síndrome do Desconforto Respiratório Agudo seriam candidatos adequados para a VAF, especialmente aqueles que falharam na ventilação mecânica convencional. Esta narrativa tem como objetivo fornecer uma revisão da VAF quanto às suas indicações, contra indicações, perigos, objetivos clínicos, mecanismos de ação e controles para otimização da ventilação e oxigenação na nossa população neonatal e pediátrica.

ObjectiveTo describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.DesignProspective observational study.SettingNeonatal intensive care unit (NICU).MethodsWe conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.ResultsA NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.ConclusionsIn comparison to fast outbreaks, outbreaks that are "slow and sustained" may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 200 million people worldwide and has likely exposed millions of neonates to SARS-CoV-2 in utero. A large body of literature has examined the possibility of vertical transmission from pregnant women infected with SARS-CoV-2 to their neonates. In this chapter, we review mechanisms of—and evidence for—vertical transmission of SARS-CoV-2, including transplacental, through other biospecimens and breastfeeding, and discuss neonatal outcomes following in utero exposure. Based on the available literature, we conclude vertical transmission of SARS-CoV-2 is rare, and exposed neonates generally show favorable health outcomes.

Background Next-generation sequencing (NGS) based population screening holds great promise for disease prevention and earlier diagnosis, but the costs associated with screening millions of humans remain prohibitive. New methods for population genetic testing that lower the costs of NGS without compromising diagnostic power are needed. Methods We developed double batched sequencing where DNA samples are batch-sequenced twice — directly pinpointing individuals with rare variants. We sequenced batches of at-birth blood spot DNA using a commercial 113-gene panel in an explorative (n = 100) and a validation (n = 100) cohort of children who went on to develop pediatric cancers. All results were benchmarked against individual whole genome sequencing data. Results We demonstrated fully replicable detection of cancer-causing germline variants, with positive and negative predictive values of 100% (95% CI, 0.91–1.00 and 95% CI, 0.98–1.00, respectively). Pathogenic and clinically actionable variants were detected in RB1, TP53, BRCA2, APC, and 19 other genes. Analyses of larger batches indicated that our approach is highly scalable, yielding more than 95% cost reduction or less than 3 cents per gene screened for rare disease-causing mutations. We also show that double batched sequencing could cost-effectively prevent childhood cancer deaths through broad genomic testing. Conclusions Our ultracheap genetic diagnostic method, which uses existing sequencing hardware and standard newborn blood spots, should readily open up opportunities for population-wide risk stratification using genetic screening across many fields of clinical genetics and genomics.

This scoping review will provide a clear definition of prolonged pain and contribute to the operationalization of the updated findings for the clinical practice in neonatal prolonged pain management. This protocol describes the methodology for a scoping review that aims to determine the scope, extent and nature of the available literature on prolonged pain in premature neonates hospitalized in the NICU. This scoping review will follow the PRISMA-ScR guidelines.

Neonatal drug information (DI) is essential for safe and effective pharmacotherapy in (pre)term neonates. Such information is usually absent from drug labels, making formularies a crucial part of the neonatal clinician's toolbox. Several formularies exist worldwide, but they have never been fully mapped or compared for content, structure and workflow. The objective of this review was to identify neonatal formularies, explore (dis)similarities, and raise awareness of their existence. Neonatal formularies were identified through self-acquaintance, experts and structured search. A questionnaire was sent to all identified formularies to provide details on formulary function. An original extraction tool was employed to collect DI from the formularies on the 10 most commonly used drugs in pre(term) neonates. Eight different neonatal formularies were identified worldwide (Europe, USA, Australia-New Zealand, Middle East). Six responded to the questionnaire and were compared for structure and content. Each formulary has its own workflow, monograph template and style, and update routine. Focus on certain aspects of DI also varies, as well as the type of initiative and funding. Clinicians should be aware of the various formularies available and their differences in characteristics and content to use them properly for the benefit of their patients. ispartof: Children (Basel) vol:10 issue:5 pages:848- ispartof: location:Switzerland status: Published online

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The aim of this review is to map the existing research about nurses' knowledge and practices on non-pharmacological pain management in neonatology.

Objective: This study aimed to investigate whether neonatal intensive care units (NICUs) in Brazilian hospitals use a protocol for weaning from noninvasive ventilation (NIV), how this ventilatory support is withdrawn, and whether there is consensus among the methods used by the institutions. Methods: A cross-sectional survey was conducted from December 2020 to February 2021, based on responses to an electronic questionnaire, filled out by physical therapists working in NICU in Brazilian hospitals about the routine of physical therapy and the use of NIV and its weaning. Results: A total of 93 answers to the electronic questionnaire met the study criteria: 52.7% were from public health institutions, with an average of 15 NICU beds (15.2±15.9), 85% of the physical therapists worked exclusively in the NICU, 34.4% of the NICU had 24-h physical therapy care, 66.7% of the units use the continuous positive airway pressure (CPAP) as ventilatory mode, and 72% the nasal prong as NIV interface; 90% of the NICU physical therapists answered that their NICU had no NIV weaning protocol, with various methods of weaning reported, the most cited being pressure weaning. Conclusions: Most Brazilian NICUs have no NIV weaning protocol. The most used method among institutions, with or without a protocol, is pressure weaning. Although most of the participating physical therapists work exclusively in NICU, many hospitals do not have the recommended workload, which can be one of the negative factors in the organization of protocols and in the progress of ventilatory weaning. RESUMO Objetivo Investigar se as unidades de terapia intensiva neonatal (UTIN) dos hospitais brasileiros utilizam protocolo para desmame de ventilação não invasiva (VNI), de que forma é realizada a retirada desse suporte ventilatório e se há consenso entre os métodos utilizados pelas instituições. Métodos Foi realizado um estudo de corte transversal de dezembro de 2020 a fevereiro de 2021, com base nas respostas a um questionário eletrônico, preenchidas por fisioterapeutas que trabalham em UTIN de hospitais brasileiros sobre a rotina da fisioterapia, o uso de VNI e seu desmame. Resultados Preencheram os critérios do estudo 93 respostas ao questionário eletrônico: 52,7% foram de instituições públicas de saúde, com média de 15 leitos de UTIN (15,2 ±15,9); 85% dos fisioterapeutas trabalhavam exclusivamente na UTIN, 34,4% das UTIN possuíam atendimento fisioterapêutico 24 horas por dia; 66,7% das unidades utilizam o Continuous Positive Airway Pressure (CPAP) como modo ventilatório e 72% a pronga nasal como interface de VNI; 90,3% dos fisioterapeutas responderam que suas UTIN não possuíam protocolo de desmame de VNI, com métodos de desmame relatados variados, sendo mais citado o desmame de pressão. Conclusões A maior parte das UTIN brasileiras não possui protocolo de desmame de VNI; o método mais utilizado entre as instituições que possuem ou não protocolo é o desmame de pressão. Apesar de a maioria dos voluntários trabalhar exclusivamente em UTIN, muitos hospitais não possuem a carga horária recomendada, o que pode ser um dos fatores negativos na organização dos protocolos e no andamento do desmame ventilatório.

The milk fat globule membrane (MFGM) appears to play an important role in infant neurocognitive development; however, its mechanism(s) of action remains unclear. This study aimed to investigate the role of a dietary MFGM supplement on the lipid profiles of different neonatal brain regions. Ten-day-old male piglets (4–5 kg) were fed unsupplemented infant formula (control, n = 7) or an infant formula supplemented with low (4%) or high (8%) levels of MFGM (n = 8 each) daily for 21 days. Piglets were then euthanized, and brain tissues were sectioned. Untargeted liquid chromatography-mass spectrometry lipidomics was performed on the cerebellum, hippocampus, prefrontal cortex, and the rest of the brain. The analyses identified 271 and 171 lipids using positive and negative ionization modes, respectively, spanning 16 different lipid classes. MFGM consumption did not significantly alter the lipidome in most brain regions, regardless of dose, compared to the control infant formula. However, 16 triacylglyceride species were increased in the hippocampus (t-test, p-value < 0.05) of the high-supplemented piglets. Most lipids (262 (96.7%) and 160 (93.6%), respectively) differed significantly between different brain regions (ANOVA, false discovery rate corrected p-value < 0.05) independent of diet. Thus, this study highlighted that dietary MFGM altered lipid abundance in the hippocampus and detected large differences in lipid profiles between neonatal piglet brain regions.

Objective: to produce and validate a booklet, based on Jean Watson’s Theory, on home care for premature newborns, based on caregivers’ experiences. Method: a methodological study, developed in the following stages: diagnosis of knowledge needs about home care; survey of scientific content; educational material production; and validity by judges/experts. Results: the literature review resulted in 19 articles. The main themes (breastfeeding, bath care, bond building, infection prevention and support network) were listed for producing the booklet “Booklet for Premature Newborns: Demystifying Home Care”. The booklet content and appearance received the overall Content Validity Index of 0.85, considered suitable within the scientific rigor of validity. Final considerations: the booklet produced and validated is an educational material whose main role is to provide knowledge and awaken caregivers’ autonomy in providing home care to newborns. RESUMEN Objetivo: producir y validar una cartilla, basada en la Teoría de Jean Watson, sobre el cuidado domiciliario del recién nacido prematuro, a partir de las experiencias de los cuidadores. Método: estudio metodológico, desarrollado en las siguientes etapas: diagnóstico de las necesidades de conocimiento sobre el cuidado domiciliario; encuesta de contenido científico; producción de material educativo; y validación por jueces/expertos. Resultados: la revisión de la literatura resultó en 19 artículos. Se enumeraron los temas principales (lactancia materna, cuidado del baño, creación de vínculos, prevención de infecciones y red de apoyo) para la producción del folleto “Cuaderno para Recién Nacidos Prematuros: Desmitificando el Cuidado Domiciliario”. El contenido y apariencia del cuadernillo recibió el Índice de Validez de Contenido Global de 0,85, considerado adecuado dentro del rigor científico de la validez. Consideraciones finales: la cartilla producida y validada es un material educativo que tiene como función principal proporcionar conocimientos y despertar la autonomía de los cuidadores en la atención domiciliaria al recién nacido. RESUMO Objetivo: produzir e validar cartilha, baseado na Teoria de Jean Watson, sobre os cuidados domiciliares ao recém-nascido prematuro, a partir de vivências de cuidadores. Método: estudo metodológico, desenvolvido nas etapas: diagnóstico das necessidades de conhecimento sobre os cuidados domiciliares; levantamento dos conteúdos científicos; produção de material educativo; e validação por juízas/experts. Resultados: a revisão da literatura resultou em 19 artigos. Elencaram-se os principais temas (amamentação, cuidados com o banho, construção de vínculo, prevenção de infecções e rede de apoio), para produção da cartilha intitulada “Cartilha de Cuidados com o Recém-Nascido Prematuro: Desmistificando o Cuidar no Domicílio”. O conteúdo e aparência da cartilha recebeu o Índice de Validade de Conteúdo Global de 0,85, considerado adequado dentro do rigor científico de validade. Considerações finais: a cartilha produzida e validada é um material educativo cujo papel principal é proporcionar conhecimento e despertar a autonomia dos cuidadores na prestação dos cuidados domiciliares ao recém-nascido.

We study the effect of hypothermia (HT) following hypoxic-ischaemic (HI) brain injury in postnatal day 7 (P7) rats. In 2015, new European Union animal transport regulations prompted a change in practice at the breeding facility, which henceforth crossfostered P3 litters to P8 older lactating dams prior to transportation. It is generally assumed that crossfostering does not significantly affect the experimental results. The aim of this study was to examine whether crossfostering affects our model consistency by modifying injury susceptibility and hypothermic neuroprotection. We analysed 219 pups from 11 experiments conducted between 2013 and 2015: 73 non-crossfostered and 146 crossfostered pups. At P7, all pups underwent unilateral common carotid artery ligation followed by 50 min of hypoxia (8% O2, 36°C). Immediately after this mild insult, the pups were randomized to post-insult normothermia or HT treatment. Pups were culled at P14. Injury was assessed by area loss of the ipsilateral hemisphere and histopathology scoring of the hippocampus, cortex, thalamus, and basal ganglia. Crossfostered pups had double the injury compared to non-crossfostered pups irrespective of the treatment group. Hypothermic neuroprotection was statistically significant, but with a smaller and less consistent effect in crossfostered pups (relative neuroprotection 16% vs. 31% in non-crossfostered). These results demonstrate hypothermic neuroprotection following a mild HI insult. A representative subset of 41 animals was also assessed for evidence of microglial reactivity; however, no detectable difference in microglial reactivity was observed between any of the groups. In conclusion, crossfostering alters outcomes in our established model through reduced insult tolerance and variable neuroprotection. Crossfostering as a common breeding practice is a largely unexplored variable in animal research that may result in invalid research conclusions if inadequately adjusted for by larger group sizes. As a result, crossfostering is likely to be inconsistent with the principles of replacement, reduction, and refinement.

Infants born in early term (37-38 weeks gestation) experience slower neurodevelopment than those born at full term (40-41 weeks gestation). While this could be due to higher perinatal morbidity, gestational age at birth may also have a direct effect on the brain. Here we characterise brain volume and white matter correlates of gestational age at birth in healthy term-born neonates and their relationship to later neurodevelopmental outcome using T2 and diffusion weighted MRI acquired in the neonatal period from a cohort (n = 454) of healthy babies born at term age (>37 weeks gestation) and scanned between 1 and 41 days after birth. Images were analysed using tensor-based morphometry and tract-based spatial statistics. Neurodevelopment was assessed at age 18 months using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Infants born earlier had higher relative ventricular volume and lower relative brain volume in the deep grey matter, cerebellum and brainstem. Earlier birth was also associated with lower fractional anisotropy, higher mean, axial, and radial diffusivity in major white matter tracts. Gestational age at birth was positively associated with all Bayley-III subscales at age 18 months. Regression models predicting outcome from gestational age at birth were significantly improved after adding neuroimaging features associated with gestational age at birth. This work adds to the body of evidence of the impact of early term birth and highlights the importance of considering the effect of gestational age at birth in future neuroimaging studies including term-born babies. ispartof: HUMAN BRAIN MAPPING vol:43 issue:5 pages:1577-1589 ispartof: location:United States status: published

O nascimento de um bebê é um momento feliz para os pais, porém quando necessita de cuidados diferenciados a motivação de alegria se transforma em preocupação. E se este recém-nascido possui alguma deformidade ou má formação e não existe possibilidade de cura, os profissionais que irão cuidar desta criança necessitam de muita sensibilidade ao tratar com os familiares, pois haverá muita aflição por parte dos pais neste ambiente de UTIN. Os cuidados paliativos são importantes para os RN por não conseguirem se expressar muitas vezes de uma forma clara e assim sempre haverá estresse por parte da equipe, já que existe sempre uma linha tênue entre o tratamento e a morte.

Resumen: La historia de los inicios en Chile de la implementación nacional de las unidades de cuidados intensivos neonatales, y por ende de los inicios de la neonatología moderna en Chile, es de visionarios motivados exclusivamente por el profundo deseo de mejorar la sobrevida y calidad de vida de pequeños que nacían, muy a su pesar, antes de tiempo. Es una historia que, como muchas otras del desarrollo de la medicina, vale la pena relatar no solo por los logros que alcanzó, sino que también por el proceso de gestación y desarrollo en sí. Recordaremos para ello primero la historia de los orígenes y desarrollo del cuidado de los recién nacidos en el mundo, su avance gradual en el siglo XIX y principios del siglo XX, su consolidación a partir de la década de los 60, y finalmente su impulso en Chile con especial mención de la gestación del programa nacional de cuidados intensivos de prematuros en la década de los 80. Summary: The story of the onset of nationwide implementation of neonatal intensive care units in Chile, and therefore the beginnings of modern neonatology in Chile, is a story of visionaries motivated exclusively by a deep desire to improve the survival rate and quality of life of the little ones who were born, much to their regret, before their time. It is a story that, like many others of advances in medicine, is worth telling not only for the achievements acomplished but also for the gestation and development process itself. We’ll begin this story by recalling the history of the origins and development of newborn care in the world, its gradual growth in the 19th and early 20th centuries, its consolidation from the 1960s onward and finally its development in Chile, with special focus on the gestation of the national program of intensive care for premature infants in the 1980s.

Background: Limited data exist regarding how medications for pediatric use can be developed to minimize medication errors. The integrase inhibitor raltegravir was developed for use in neonates (≥2 kg). Anticipating that neonatal administration would be performed primarily by mothers with varying degrees of health literacy, a health literate, patient-focused, iterative process was conducted to update/redesign the raltegravir granules for oral suspension pediatric kit and instructions for use (IFU) for neonatal use to be ready for regulatory submission. Methods: Prototypes of an updated/redesigned raltegravir IFU were systematically assessed through multi-stage, iterative testing and evaluation involving untrained lay individuals with varying levels of health literacy, healthcare professionals and health literacy experts. Results: This iterative process resulted in numerous refinements to the IFU and kit, including wording, layout, presentation, colored syringes and additional instructional steps. The revised raltegravir pediatric kit and IFU (to include neonatal dosing) were approved by the US Food and Drug Administration in 2017 and the European Union in 2018. No reported medication errors related to IFU utilization had been reported as of March 2021, reflecting >3 years of commercial use worldwide. Conclusions: This patient-focused process produced health literate instructions for preparing and administering an antiretroviral for neonatal use with complex dosing requirements. Testing demonstrated that lay users with a range of health literacy levels were able to accurately mix, measure and administer the product. This process demonstrates how a neonatal medication can be optimized for use through collaboration between the infectious disease expert community and a manufacturer.

Background To determine whether restricted diffusion of the callosal splenium is specific for seizure activity in neonates. Methods We performed a retrospective chart review of 123 neonates who had a diagnosis of hypoxic ischemic encephalopathy (HIE) who underwent therapeutic cooling and had magnetic resonance imaging (MRI) within the first 10 days of life. The regions examined for injury include the callosal splenium, cortex, deep gray matter, and subcortical white matter. Neurodevelopmental outcomes were secondarily assessed using the Bayley Scales of Infant Development at 12 to 18 months of age and > 18 months of age. APGAR scores and pH, two important markers of hypoxia/ischemia and encephalopathy, were also analyzed in relation to these outcomes. Results Approximately 41% of the neonates had at least one abnormal region on brain MRI, and 21% had abnormal signal in the splenium. Clinical and/or electrographic seizures were documented in 32%. Changes in the splenium had a sensitivity of 54%, specificity of 94%, and positive predictive value of 81% for seizure presence. The presence of seizures and splenium lesion was associated poor developmental outcomes at 12 to 18 months of age. APGAR scores at 10 minutes, but not lowest pH was associated with splenial changes. Conclusions Restricted diffusion of the callosal splenium is specific for recent seizures in neonates with HIE. Seizures and splenial lesion represent risk factors for poor neurodevelopmental outcomes. Child neurologists and neonatologists should consider splenial signal abnormality in their assessment of neonates at risk for seizures and counsel families about likely outcomes accordingly.

Background Family Integrated Care (FICare) benefits preterm infants compared with Family-Centered Care (FCC), but research is lacking in United States (US) Neonatal Intensive Care Units (NICUs). The outcomes for infants of implementing FICare in the US are unknown given differences in parental leave benefits and health care delivery between the US and other countries where FICare is used. We compared preterm weight and discharge outcomes between FCC and mobile-enhanced FICare (mFICare) in the US. Methods In this quasi-experimental study, we enrolled preterm infant (≤ 33 weeks)/parent dyads from 3 NICUs into sequential cohorts: FCC or mFICare. Our primary outcome was 21-day change in weight z-scores. Our secondary outcomes were nosocomial infection, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and human milk feeding (HMF) at discharge. We used intention-to-treat analyses to examine the effect of the FCC and mFICare models overall and per protocol analyses to examine the effects of the mFICare intervention components. Findings 253 infant/parent dyads participated (141 FCC; 112 mFICare). There were no parent-related adverse events in either group. In intention-to-treat analyses, we found no group differences in weight, ROP, BPD or HMF. The FCC cohort had 2.6-times (95% CI: 1.0, 6.7) higher odds of nosocomial infection than the mFICare cohort. In per-protocol analyses, we found that infants whose parents did not receive parent mentoring or participate in rounds lost more weight relative to age-based norms (group-difference=-0.128, CI: -0.227, -0.030; group-difference=-0.084, CI: -0.154, -0.015, respectively). Infants whose parents did not participate in rounds or group education had 2.9-times (CI: 1.0, 9.1) and 3.8-times (CI: 1.2, 14.3) higher odds of nosocomial infection, respectively. Conclusion We found indications that mFICare may have direct benefits on infant outcomes such as weight gain and nosocomial infection. Future studies using implementation science designs are needed to optimize intervention delivery and determine acute and long-term infant and family outcomes. Clinical Trial Registration NCT03418870 01/02/2018.

This study investigated the neonatal intensive care unit (NICU) clinical practicum status during the COVID-19 pandemic and the need for extended reality (XR)-based training for neonatal care. A structured questionnaire was distributed to 132 prelicensing nursing students. Data were analyzed using importance-performance analysis and Borich needs analysis. Students wanted to use XR to learn about treating high-risk preterm infants. COVID-19 limited clinical training in NICUs, and most students preferred training in XR programs to improve their nursing competency for neonates. There is a large demand for nursing skills concerning high-risk newborns and hands-off training.

To map strategies for the prevention of pressure injuries in neonates admitted to neonatal intensive care units.

IntroductionPreeclampsia, one of the leading causes of maternal and fetal morbidity and mortality, demands accurate predictive models for the lack of effective treatment. Predictive models based on machine learning algorithms demonstrate promising potential, while there is a controversial discussion about whether machine learning methods should be recommended preferably, compared to traditional statistical models.MethodsWe employed both logistic regression and six machine learning methods as binary predictive models for a dataset containing 733 women diagnosed with preeclampsia. Participants were grouped by four different pregnancy outcomes. After the imputation of missing values, statistical description and comparison were conducted preliminarily to explore the characteristics of documented 73 variables. Sequentially, correlation analysis and feature selection were performed as preprocessing steps to filter contributing variables for developing models. The models were evaluated by multiple criteria.ResultsWe first figured out that the influential variables screened by preprocessing steps did not overlap with those determined by statistical differences. Secondly, the most accurate imputation method is K-Nearest Neighbor, and the imputation process did not affect the performance of the developed models much. Finally, the performance of models was investigated. The random forest classifier, multi-layer perceptron, and support vector machine demonstrated better discriminative power for prediction evaluated by the area under the receiver operating characteristic curve, while the decision tree classifier, random forest, and logistic regression yielded better calibration ability verified, as by the calibration curve.ConclusionMachine learning algorithms can accomplish prediction modeling and demonstrate superior discrimination, while Logistic Regression can be calibrated well. Statistical analysis and machine learning are two scientific domains sharing similar themes. The predictive abilities of such developed models vary according to the characteristics of datasets, which still need larger sample sizes and more influential predictors to accumulate evidence.

Clostridium perfringens and Clostridioides difficile cause significant morbidity and mortality in foals. Antemortem diagnosis of C. perfringens infection has been complicated by a paucity of tests available for toxin detection. Fecal PCR panels have assays for a variety of C. perfringens toxin gene sequences as well as for several other foal gastrointestinal pathogens. We evaluated results of a comprehensive fecal diarrhea PCR panel in 28 foals that had been presented to a referral hospital because of diarrhea. Sixteen (57%) foals were positive for C. perfringens and/or C. difficile toxin gene sequences on fecal PCR, including 3 foals positive for NetF toxin. These foals were younger ( p = 0.0029) and had higher hematocrits ( p = 0.0087), hemoglobin ( p = 0.0067), and red blood cell concentrations ( p = 0.028) than foals with diarrhea that tested negative for clostridial toxins. The foals had lower total protein concentrations ( p = 0.045) and were more likely to have band neutrophils on a CBC ( p = 0.013; OR: 16.2). All 3 foals with NetF toxin gene sequences detected in feces survived to discharge, indicating that diarrhea caused by NetF toxigenic C. perfringens isolates is not uniformly fatal.

Fang Liu,1 Mingyu Shao,1 Feng Xu,2 Fang Rong3 1Department of Child Health Care, Zibo Central Hospital, Zibo, 255000, Shandong, People’s Republic of China; 2Department of Pediatrics, Zibo Central Hospital, Zibo, 255000, Shandong, People’s Republic of China; 3The Community Clinic of Overseas Chinese Town, Zibo Central Hospital, North Gate of Zhongrun Overseas Chinese Town, Zibo, 255000, Shandong, People’s Republic of ChinaCorrespondence: Fang RongThe Community Clinic of Overseas Chinese Town, Zibo Central Hospital, North Gate of Zhongrun Overseas Chinese Town, Zhangdian District, Zibo, 255000, Shandong, People’s Republic of ChinaTel +86-18678186178Email rongfang0817@163.comBackground: Autophagy is implicated in neonatal hypoxia-ischemia (HI) induced cognitive impairment. The nucleotide-oligomerizing domain-1 (NOD1), a protein involved in inflammatory responses, has been shown to activate autophagy to promote progression of other diseases. We aimed to investigate whether and how NOD1 is involved in HI-induced brain injury using an HI mouse model.Methods: We induced HI in neonatal mice and examined levels of NOD1 and genes associated with autophagy. We then inhibited NOD1 by intracerebroventricular injection of si-NOD1 following HI induction and tested the effects on autophagy, inflammatory responses and long-term behavioral outcomes through Morris water maze and open field tests.Results: We found that HI induction significantly elevated mRNA levels of NOD1 (3.54 folds change) and autophagy-related genes including Atg5 (3.89 folds change) and Beclin-1 (3.34 folds change). NOD1 inhibition following HI induction suppressed autophagy signaling as well as HI induced proinflammatory cytokine production. Importantly, NOD1 inhibition after HI improved long-term cognitive function, without impacting exploratory and locomotor activities.Conclusion: We show here that NOD1 is involved in the pathogenesis of HI-induced brain injury through modulation of autophagy-related proteins and inflammatory responses. Our findings suggest that NOD1 may be a potent target for developing therapeutic strategies for treating HI-induced brain injury.Keywords: neonatal, hypoxia-ischemia, cognitive impairment, NOD1, autophagy

ObjectiveTo evaluate trends in respiratory care practices and bronchopulmonary dysplasia (BPD) among very preterm infants born in Spain between 2010 and 2019.Study designThis was a retrospective cohort study of data obtained from a national population-based database (SEN1500 network). Changes in respiratory care and BPD-free survival of infants with gestational age (GA) of 230–316 weeks and ResultsA total of 17 952 infants were included. In the second period, infants were less frequently intubated in the delivery room and during neonatal intensive care unit stay. This corresponded with an increase in use of non-invasive ventilation techniques. There were no significant differences between the periods in BPD-free survival or survival without moderate-to-severe BPD. After adjusting for covariates, the RR for the change per year was significant for the following variables: never intubated (RR 1.03, 95% CI 1.02 to 1.04); intubation in the delivery room (RR 0.98, 95% CI 0.97 to 0.99); use of nasal intermittent positive pressure ventilation (RR 1.08, 95% CI 1.05 to 1.11); and BPD-free survival (only in the group with the lowest GA; RR 0.98, 95% CI 0.97 to 0.99).ConclusionOur findings reveal significant changes in respiratory care practices between 2009 and 2019. Despite an increase in use of non-invasive respiratory strategies, BPD-free survival did not improve and even worsened in the group with the lowest GA (230–256).

Introduction Gastroschisis is a congenital malformation characterized by intestinal herniation through an abdominal wall defect. Despite its unknown pathogenesis, known risk factors include maternal smoking, alcohol use, and young maternal age. Previous work has shown that gastroschisis is associated with placental delayed villous maturation, and the goal of this study was to assess for additional associated placental pathologies that may help clarify the pathogenesis of gastroschisis. Methods We conducted a retrospective slide review of 29 placentas of neonates with gastroschisis. Additionally, we reviewed pathology reports from one control group of 30 placentas with other congenital malformations. Gross and histological data were collected based on a standardized rubric. Results Gastroschisis was associated with increased placental fetal vascular malperfusion (FVM) in 62% of cases (versus 0% of controls, p Conclusion Our study demonstrates an association between gastroschisis and FVM. While FVM could be the consequence of vascular disruption due to the ventral location of gastroschisis, it could also reflect estrogen-induced thrombosis in early pregnancy. Further research is needed to separate these possibilities and determine the cause of the placental FVM observed in gastroschisis.

Introduction: Bartter’s syndrome comprises a heterogeneous group of inherited salt-losing tubulopathies. There are two forms of clinical presentation: classical and neonatal, the most severe type. Types I and II account for most of the neonatal cases. Types III and V are usually less severe. Characteristically Bartter’s syndrome type IV is a saltlosing nephropathy with mild to severe neonatal symptoms, with a specific feature - sensorineural deafness. Bartter’s syndrome type IV is the least common of all recessive types of the disease. Description: the first reported case of a Portuguese child with neurosensorial deafness, polyuria, polydipsia and failure to thrive, born prematurely due to severe polyhydramnios, with the G47R mutation in the BSND gene that causes Bartter’s syndrome type IV. Discussion: there are few published cases of BS type IV due to this mutation and those reported mostly have moderate clinical manifestations which begin later in life. The poor phenotype-genotype relationship combined with the rarity of this syndrome usually precludes an antenatal diagnosis. In the presence of a severe polyhydramnios case, with no fetal malformation detected, normal karyotype and after maternal disease exclusion, autosomal recessive diseases, including tubulopathies, should always be suspected.

Purpose: Video visits, or televisits, have become increasingly popular across various medical subspecialties. Within the University of California, Davis, Neonatal Intensive Care Unit, a video visitation program known as FamilyLink allows families to remotely view their babies when they are otherwise unable to visit. This study aimed to explore parents' perceived effects of video camera use as well as the relationship of video visit use with rates of breast milk feedings at hospital discharge. Materials and Methods: Families enrolled in this study completed a series of two identical surveys that gathered self-reported data on their experiences during their infant's hospitalization. Comparisons were made considering whether the FamilyLink program was utilized during the admission as well as changes in self-reported experiences over the time course of the hospital admission. The type of enteral feeding at discharge was recorded and reviewed for each baby. Results: Of 100 families enrolled in the study, 30 were found to have used FamilyLink to visit with their baby. The use of FamilyLink was associated with survey findings of sustained intention to breastfeed or provide breast milk to the baby, as well as increased perceived parental involvement in the baby's care. Improved rates of breast milk feedings at the time of discharge were also found among babies whose families conducted televisits using FamilyLink. Conclusions: Video viewing in the NICU has effected a positive impact on breast milk feedings and parents' feelings of involvement during the admission, with the potential to further improve on families' experiences with a hospitalized baby.

Aim To review the evidence on safety of maintaining family integrated care practices and the effects of restricting parental participation in neonatal care during the SARS‐CoV‐2 pandemic. Methods MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched from inception to the 14th of October 2020. Records were included if they reported scientific, empirical research (qualitative, quantitative or mixed methods) on the effects of restricting or promoting family integrated care practices for parents of hospitalised neonates during the SARS‐CoV‐2 pandemic. Two authors independently screened abstracts, appraised study quality and extracted study and outcome data. Results We retrieved 803 publications and assessed 75 full‐text articles. Seven studies were included, reporting data on 854 healthcare professionals, 442 parents, 364 neonates and 26 other family members, within 286 neonatal units globally. The pandemic response resulted in significant changes in neonatal unit policies and restricting parents' access and participation in neonatal care. Breastfeeding, parental bonding, participation in caregiving, parental mental health and staff stress were negatively impacted. Conclusion This review highlights that SARS‐CoV‐2 pandemic‐related hospital restrictions had adverse effects on care delivery and outcomes for neonates, families and staff. Recommendations for restoring essential family integrated care practices are discussed.

Resumen: Introducción: La piel es fundamental en la transición de la vida intrauterina a la extrauterina. El recién nacido presenta cambios fisiológicos, siendo frecuente observar hallazgos cutáneos benignos y transitorios que varían según las características maternas, neonatales y de la gestación. Objetivos: Estimar la frecuencia de distintos hallazgos dermatológicos en neonatos en las primeras 72 h de vida e identificar la existencia de diferencias de proporciones estadísticamente significativas con factores neonatales, maternos y de la gestación. Métodos: Se realizó un estudio descriptivo, observacional de corte transversal entre abril-julio 2015 y julio-noviembre de 2017 en la maternidad del Centro Hospitalario Pereira Rossell. Se incluyeron neonatos de hasta 72 h de vida, a los que se les practicó un examen dermatológico completo. Se presenta la proporción de cada uno de los hallazgos con el intervalo de confianza (IC) correspondiente. Se analiza la relación entre los hallazgos y determinados factores asociados. Resultados: Se incluyeron 2811 neonatos. El 100% presentó al menos un hallazgo a nivel de la piel. La mediana fue de 8 lesiones por paciente (rango intercuartílico: 6-9/mínimo-máximo: 1-16). De los 46 hallazgos explorados clínicamente se encontraron 42. Las lesiones benignas y transitorias correspondieron al 99,9%. Entre ellas se observó: lanugo 98% (IC: 97,7-98,7), descamación fisiológica 79,7% (IC: 78,2-81,1) e hiperplasia sebácea 73,3% (IC: 71,6-74,9). El lanugo (p = 0,001), la descamación fisiológica (p

Background and Aims: Inadequate nutrient provision causes neonatal growth failure and malnutrition. Therefore, this study aimed to 1) quantify infant growth velocity from birth to hospital discharge, 2) determine the incidence of neonatal malnutrition at the time of discharge from a government hospital newborn unit in Nakuru, Kenya. Methods: After ethical approval, data was collected for infants (n=104) hospitalized >14 days (June 2016 - December 2018) including: birth gestational age (GA), birth and discharge weight (grams, g) with z-scores (2013 Fenton Preterm or 2006 World Health Organization 0-2 Year growth chart), hospital length of stay (LOS) days. Growth during hospitalization was calculated in g/day [(discharge weight – birth weight)/LOS] and g/kilogram(kg)/day [1000xln(birth weight/discharge weight)/LOS). Malnutrition was diagnosed by birth to discharge weight z-score change (decline): mild = 0.8-1.2 standard deviations (SD), moderate = >1.2-2.0 SD, severe = >2.0 SD. P-value Results: 94/104 (90.4%) infants were preterm with median birth GA 32 weeks, weight 1500 g (z-score -0.33), LOS 21 days and discharge weight 1735 g (z-score -1.95). Median weight gain was 8.2 g/day or 5.2 g/kg/day with weight z-score change -1.34 SD. Linear regression predicted each hospital day decreased z-score by -0.031 (p 81.7% of infants met malnutrition criteria—27.1% mild, 49.4% moderate, 23.5% severe. Conclusions: Infants with LOS >14 days in a government hospital newborn unit in Nakuru, Kenya, experience growth rates below recommended velocities by the World Health Organization (23-34 grams/day from 0-4 months). Nutrition intervention is necessary to support appropriate growth.

Amac: Premature bebekler, cevresel stres faktorlerine karsi ozellikle yasamin ilk haftalarinda daha savunmasizdir. Bu sure zarfinda, ozellikle bebeklerin etrafinda kullanilan destekleyici konumlandirma, kendilerini uterus icinde oldugu gibi daha iyi hissetmelerini saglar. Bu calismanin amaci, yenidogan yogun bakim unitesinde destekleyici konumlandirmanin; premature bebeklerin kilo alimi, yasamsal belirtileri, beslenme intoleranslari, ventilasyon sureleri, hastanede kalis sureleri ve konfor olcegi puanlari uzerine etkisini degerlendirmektir. Gerec ve Yontemler: Calismaya rastgele olarak secilen, 25'i desteklenen grupta ve 25'i kontrol grubunda olmak uzere toplam 50 premature bebek dahil edildi. Desteklenen gruptaki bebekler pozisyon malzemesi olarak yumusak ortuler ve yastiklarla yuvalandi. Kontrol grubunda yuvalama ya da kundaklama yoktu. Bebeklerin demografik ozellikleri, konfor olcegi skorlari, kalp hizi, solunum hizi ve oksijen saturasyonu kaydedildi ve karsilastirildi. Bulgular: Desteklenen grup ve kontrol grubunun sirasiyla ortalama gestasyonel haftalari 32,9±2,5 (26-36) ve 32,7±2,8 (26-36) hafta (p=0,791), ortalama dogum agirliklari ise 1554±492 (680-2380) ve 1772±439 (590-2375) gramdi (p=0,105). Kilo alimi, ventilator gunleri ve hastanede kalis gunleri gruplar arasinda benzerdi, ancak ortalama oksijen saturasyonu ve derin sedasyon gosteren konfor olcegi skorlari desteklenen grupta gunluk bakim sonrasi daha yuksekti (sirasiyla; p=0,024, p

Giriş: Türkiye’deki yenidoğan hekimlerinin klinik ultrasonografi (US) kullanımı, görüş ve deneyimleri hakkında bilgi bulunmamaktadır. Çalışmamızın amacıülkemizdeki yenidoğan hekimlerinin klinik US kullanımı konusundaki, tutum, tercih, kullanım sıklığı ve bakış açılarının değerlendirilmesidir.Gereç ve Yöntem: Çalışma Türkiye’deki yenidoğan hekimlerinin anket yoluyla elektronik ortamda 01 Şubat-1 Mart 2020 tarihleri arasında katılımı ile gerçekleştirildi. Katılımcıların yaş, cinsiyet, görev yapılan sağlık kurumu, yenidoğan yoğun bakımdaki deneyim süresi ve akademik unvan bilgileri kaydedildi. Ankete katılan katılımcılara, klinikte US kullanıp kullanmadığı, kullanıyorsa hangi vücut bölgesi ve hangi girişim için kullandığı, bunun için eğitim alıp almadığı gibi sorular yöneltildi. Klinik US ile ilgili tutumları 5 noktalı Likert skalası ile değerlendirildi.Bulgular: Çalışmaya 120 yenidoğan hekimi katıldı. Katılımcıların yaş ortalaması 40,38±5,24 yıl olarak bulundu. Katılımcıların kliniklerinde %90 (n=108) oranındaUS cihazı bulunurken katılımcılar arasında US yapma sıklığı %69,1 (n=83) olarak tespit edildi. Klinikte US cihazı mevcudiyeti, kullanımı, klinik US eğitiminekatılım, pediatrik radyoloji rotasyonunun yenidoğan yandal eğitim programında yer alması, kranial US, abdominal US ve santral ven kateterizasyonu için USkullanımı konusunda akademik ünvana göre cevaplarda gruplar arası fark bulunmadı (p>0,05). Akciğer US kullanımı yandal araştırma görevlisi grubunda(%86,7) diğer akademik ünvanlara oranla anlamlı olarak daha yüksek oranda bulundu (p, Introduction: There is no information about the clinical ultrasonography (US)use, opinion and experiences in neonatal physicians in Turkey. The aim of ourstudy is to evaluate the attitudes, preferences, frequency of use and perspectives ofneonatal physicians in our country regarding clinical use of US.Materials and Methods: The study was conducted through a survey with theparticipation of neonatal physicians in Turkey with electronically between 1February to 1 March 2020. The information about participants’ age, gender,type of institution, experience period in neonatal intensive care and academictitle were recorded. The participants were asked questions such as whetherthey use US in the clinic, if they are using, which part of body and for which intervention, and whether they received training for this purpose. The attitudes about Clinical US were evaluated using a5-point Likert scale.Results: 120 neonatal physicians participated in the study. The average age of the participants was determined as 40.38 ± 5.24 years.While 90% (n=108) of the participants had US devices in their clinics, the use of frequency of US among the participants was foundas 69.1% (n=83). There was no difference between groups in the answers according to academic title about US device availabilityin the clinic, use of, participation in clinical US training, pediatric radiology rotation in the neonatal fellow education program,useof US for cranial US, abdominal US and central vein catheterization (p>0,05). Lung US use was found at a significantly higher ratein the neonatology fellows group (86.7%) compared to other academic titles (p

A fetal scalp electrode (FSE) is a frequently used investigation during labor. However, it is an invasive procedure which can lead to complications. Our patient developed a very large brain abscess after initial superficial infection of the skin site due to an FSE. The patient was admitted to the hospital after an asymmetric growth of the skull was noticed with no further signs of clinical illness. MRI showed a very large brain abscess which was aspirated and treated with antibiotics for 10 weeks. A 2-year follow-up showed only a slight developmental delay in gross motor skills. Only once before a similar case has been described at which the patient developed a brain abscess after superficial infection of the scalp following an FSE. In both cases, the brain abscess was noticed due to an asymmetric growth of the skull without any further signs of clinical illness. A brain abscess has a high mortality and morbidity rate, and early diagnosis is vital for the optimal outcome. We therefore recommend to organize an out-patient clinical follow-up for every infant with a superficial infection of the skin site after placement of an FSE.

A scoping review protocol to explore infection prevention and control measures and recommendations for preterm infants discharged into the community.

This scoping review protocol describes an investigation of severity scales used for neonatal skin injury; and with determination of, (i) characteristics of severity scales such as ordinal or categorical groupings will identified, and (ii) assessment of scale validation for population

Carotid artery (CA) dissection is a rare etiology of neonatal arterial ischemic stroke (NAIS).We describe one novel case and conduct a systematic literature review on NAIS attributed to CA dissection, to collect data on its clinical-radiological presentation, treatment, and outcome.Eight published cases of NAIS attributed to CA dissection were identified and analyzed with our case. All patients (nine of nine) were born at term, and eight of nine experienced instrumental/traumatic delivery or urgent Caesarean section. None had fetal problems during pregnancy or thrombophilia. Signs and symptoms at presentation (between days of life 0 and 6) included seizures (eight of nine), respiratory distress or irregular breathing (five of nine), hyporeactivity, decreased consciousness or irritability (four of nine), and focal neurological signs (two of nine). At magnetic resonance imaging (MRI), stroke was unilateral in seven of nine and extensive in five of nine. CA dissection was documented by neuroimaging or at postmortem studies (seven of nine), and hypothesized by the treating physicians based on delivery and neuroradiology characteristics (in the remaining two of nine). Antithrombotic treatment was used in two of nine. According to available follow-up, one of eight died at age seven days, seven of eight had neurological/epileptic sequelae, and CA recanalization occurred in three of four.NAIS attributed to CA dissection is rarely identified in the literature, often preceded by traumatic/instrumental delivery, presenting with seizures and systemic signs/symptoms, and often characterized by extensive MRI lesions and neurological sequelae. Definite evidence and recommendations on antithrombotic treatment are lacking.

Background/Significance: Thermal management is a cornerstone of care within the neonatal population. Technology has progressed from a relatively simple incubator to one that is fully automated and designed to keep a neonate warm while maintaining a neutral thermal environment. If used correctly and to their full capacity, these advanced incubators provide improved temperature regulation to support neonatal growth and reduce morbidities. Purpose: The purpose of this evidence-based practice initiative is to reduce variability and create standardization of the use of the servo control thermoregulation function for infants less than 32 weeks gestation. Methods: The Iowa Model-Revised (2017) was the framework for implementing this project. The National Association of Neonatal Nurses (NANN) guideline for thermoregulation in the NICU was utilized to educate NICU RN staff regarding thermoregulation and the use of the incubator servo control mode. Chart audits of infants meeting criteria for servo mode were conducted pre and post the education sessions (Time 1 and Time 2). Results: There was improved compliance with set temperature point from 53.3% to 86.6%. Alternative sites for probe placement were utilized by the staff to include the axilla. Documentation in the EHR improved with additional rationale added when appropriate, reflecting nurses understanding of the education provided and the incorporation of key points into their practice. Implications for Practice: Utilizing established practice guidelines can facilitate education and optimize nursing practice. Key Words: thermoregulation, neonatal, servocontrol, temperature control, preterm

ObjectiveLate preterm infants have an increased risk of morbidity relative to term infants. We sought to determine the rate, temporal trend, risk factors, and reasons for 30-day readmission.MethodsThis is a retrospective cohort study of infants born at 34 to 42 weeks' gestation in California between January 1, 2011, and December 31, 2017. Birth certificates maintained by California Vital Statistics were linked to discharge records maintained by the California Office of Statewide Health Planning and Development. Multivariable logistic regression was used to identify risk factors and derive a predictive model.ResultsLate preterm infants represented 4.3% (n = 122 014) of the study cohort (n = 2 824 963), of which 5.9% (n = 7243) were readmitted within 30 days. Compared to term infants, late preterm infants had greater odds of readmission (odds ratio [OR]: 2.34 [95% confidence interval (CI): 2.28-2.40]). The temporal trend indicated increases in all-cause and jaundice-specific readmission infants (P < .001). The common diagnoses at readmission were jaundice (58.9%), infections (10.8%), and respiratory complications (3.5%). In the adjusted model, factors that were associated with greater odds of readmission included assisted vaginal birth, maternal age ≥34 years, diabetes, chorioamnionitis, and primiparity. The model had predictive ability of 60% (c-statistic 0.603 [95% CI: 0.596-0.610]) in late preterm infants who had

Background Despite technological advances and specialist training of neonatal teams, perinatal deaths still occur. Such events are traumatic experiences for the parents and increase the risk of pathological grieving. Nursing is one of the main sources of support. However, the important work of nurses in these situations is made more difficult by the lack of recognized strategies that can be implemented to assist parents and family members in the bereavement process. Aim Identify nursing interventions to help parents of neonates admitted to neonatal intensive care units cope with perinatal loss. Methods A scoping review based on the methodological framework established by Arksey and O'Malley was used. A total of 327 relevant studies were identified through a bibliographic search in Pubmed, CINAHL Plus, APA PsycNET and Scopus between 2000 and 2019. The screening process included an initial analysis of the relevance of the abstract and, when required, an extensive review of the full paper. Results A total of 9 papers were finally selected which responded to the research question. All nine papers are from the USA and have different methodological characteristics. A number of effective interventions were identified, including legacy creation, support groups, family-centred accompaniment and follow-up, parental involvement in pre-mortem care, intergenerational bereavement programmes, and the use of technological and spiritual resources. Conclusion In general, the scant evidence that is available about nursing interventions around perinatal bereavement care underlines the requirement to thoroughly assess the effectiveness of those that have already been designed and implemented. Implications for nursing practice and policy This scoping review contributes to the potential implementation of effective interventions to deal with and help parents and family members cope with perinatal bereavement, with nursing staff as the main source of support and leading interventions which have family members in the care team. This review also makes a substantial contribution to the development of a practical and evidence-based clinical guide for nursing, with recommendations that can be adapted to effective quality care criteria. It is additionally intended to encourage visibility in health policies of care and attention to perinatal grief in neonatal intensive care units.

The skin is potentially an important vaccine delivery route facilitated by a high number of resident antigen presenting cells (APCs), which are known to be stimulated by different Toll-like receptor agonists (TLRa). In this study, neonatal and adult pigs were vaccinated in the skin using dissolving microneedle patches to investigate the immuno-stimulatory potential of different TLRa and possible age-dependent differences early after vaccination. These patches contained TLR1/2a (Pam3Cys), TLR7/8a (R848) or TLR9a (CpG ODN) combined with inactivated porcine reproductive and respiratory syndrome virus (PRRSV) or with an oil-in-water stable emulsion. Vaccinated skin and draining lymph nodes were analysed for immune response genes using microfluidic high-throughput qPCR to evaluate the early immune response and activation of APCs. Skin pathology and immunohistochemistry were used to evaluate the local immune responses and APCs in the vaccinated skin, respectively.In both neonatal and adult pigs, skin vaccination with TLR7/8a induced the most prominent early inflammatory and immune cell responses, particularly in the skin. Skin histopathology and immunohistochemistry of APCs showed comparable results for neonatal and adult pigs after vaccination with the different TLRa vaccines. However, in vaccinated neonatal pigs in the skin and draining lymph node more immune response related genes were upregulated compared to adult pigs. We showed that both neonatal and adult skin could be stimulated to develop an immune response, particularly after TLR7/8a vaccination, with age-dependent differences in regulation of immune genes. Therefore, age-dependent differences in local early immune responses should be considered when developing skin vaccines.