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Background: Supporting therapies that provide stress and pain control of preterm and term newborns infants contribute positively to the neuropsychomotor development. Non-pharmacological interventions that involve manual techniques are described, considering protocols that can be reproduced by physical therapists, with positive and negative outcomes reports. Data sources: Systematic review follows PRISMA 2020 statements guidelines. Primary and specific health sciences databases (Science Direct, Pubmed, Scielo, Embase and Scopus) were consulted between October 2021 and May 2022. Articles considered were clinical trials, randomized or not, that included descriptions of the type of intervention as non-pharmacological and that studied the following outcomes: "pain" and "stress". Results: Fifteen articles were selected for analysis, reaching a methodological quality of at least 3 on the Jadad Scale for the Quality of Researched Sources. The non-pharmacological therapies most applied in isolation were massage, swaddling or wrapping, gentle touch and kinesthetic stimulation, and the combined therapies were non-nutritive sucking and swaddling, oral sucrose and swaddling, sensory stimulation and familiar odors, and sensory saturation. The outcomes found were relaxation, pain, and stress reduction after the application of painful procedures. The behavioral changes included crying, grimacing, yawning, sneezing, jerky arm or leg movements, startles, and finger flaring. The vital signs included heart rate, blood oxygen saturation level, and pulse respiration. Conclusions: Combined techniques lead to better results in controlling neonatal pain when compared to isolated techniques. They can be applied both in preterm and term infants in a safe way and are reproducible in any health unit in a simple and economical way. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the prevalence of IVH and its associated risk factors in premature newborn admitted to NICU in Southwestern Iran.This cross-sectional study involved all premature newborn admitted to Namazee NICU, Southwestern Iran, during the year 2022. The diagnosis of IVH was confirmed using brain ultrasonography, following Papille’s criteria. Demographic data and potential risk factors were collected and analyzed for two groups: neonate diagnosed with IVH and those without the condition.Among the 275 preterm neonates studied (125 girls, 150 boys), the mean gestational age was 29.22 ± 1.44 weeks. The prevalence of IVH was found to be 20.4% within the first 7th day after birth. The recognized risk factors of IVH in our study were gestational age, pneumothorax, hypoxia, antenatal steroids, and transfusion of packed red blood cell. Duration of intubation and CPAP therapy were found to be other risk factors, too. The logistic regression model showed preterm newborns born between gestational age of 28+1 and 30+6 weeks had a twofold increased risk of developing IVH.The prevalence of IVH in NICU hospitalized newborns with a gestational age of ≤ 32 weeks was around 20%, which is consistent with other studies conducted in Iran. The findings emphasize the importance of enhanced antenatal care for early intervention for neonates born at early gestational age to reduce or prevent the risk of IVH.Methods and materials: The purpose of this study was to investigate the prevalence of IVH and its associated risk factors in premature newborn admitted to NICU in Southwestern Iran.This cross-sectional study involved all premature newborn admitted to Namazee NICU, Southwestern Iran, during the year 2022. The diagnosis of IVH was confirmed using brain ultrasonography, following Papille’s criteria. Demographic data and potential risk factors were collected and analyzed for two groups: neonate diagnosed with IVH and those without the condition.Among the 275 preterm neonates studied (125 girls, 150 boys), the mean gestational age was 29.22 ± 1.44 weeks. The prevalence of IVH was found to be 20.4% within the first 7th day after birth. The recognized risk factors of IVH in our study were gestational age, pneumothorax, hypoxia, antenatal steroids, and transfusion of packed red blood cell. Duration of intubation and CPAP therapy were found to be other risk factors, too. The logistic regression model showed preterm newborns born between gestational age of 28+1 and 30+6 weeks had a twofold increased risk of developing IVH.The prevalence of IVH in NICU hospitalized newborns with a gestational age of ≤ 32 weeks was around 20%, which is consistent with other studies conducted in Iran. The findings emphasize the importance of enhanced antenatal care for early intervention for neonates born at early gestational age to reduce or prevent the risk of IVH.Results: The purpose of this study was to investigate the prevalence of IVH and its associated risk factors in premature newborn admitted to NICU in Southwestern Iran.This cross-sectional study involved all premature newborn admitted to Namazee NICU, Southwestern Iran, during the year 2022. The diagnosis of IVH was confirmed using brain ultrasonography, following Papille’s criteria. Demographic data and potential risk factors were collected and analyzed for two groups: neonate diagnosed with IVH and those without the condition.Among the 275 preterm neonates studied (125 girls, 150 boys), the mean gestational age was 29.22 ± 1.44 weeks. The prevalence of IVH was found to be 20.4% within the first 7th day after birth. The recognized risk factors of IVH in our study were gestational age, pneumothorax, hypoxia, antenatal steroids, and transfusion of packed red blood cell. Duration of intubation and CPAP therapy were found to be other risk factors, too. The logistic regression model showed preterm newborns born between gestational age of 28+1 and 30+6 weeks had a twofold increased risk of developing IVH.The prevalence of IVH in NICU hospitalized newborns with a gestational age of ≤ 32 weeks was around 20%, which is consistent with other studies conducted in Iran. The findings emphasize the importance of enhanced antenatal care for early intervention for neonates born at early gestational age to reduce or prevent the risk of IVH.Conclusion: The purpose of this study was to investigate the prevalence of IVH and its associated risk factors in premature newborn admitted to NICU in Southwestern Iran.This cross-sectional study involved all premature newborn admitted to Namazee NICU, Southwestern Iran, during the year 2022. The diagnosis of IVH was confirmed using brain ultrasonography, following Papille’s criteria. Demographic data and potential risk factors were collected and analyzed for two groups: neonate diagnosed with IVH and those without the condition.Among the 275 preterm neonates studied (125 girls, 150 boys), the mean gestational age was 29.22 ± 1.44 weeks. The prevalence of IVH was found to be 20.4% within the first 7th day after birth. The recognized risk factors of IVH in our study were gestational age, pneumothorax, hypoxia, antenatal steroids, and transfusion of packed red blood cell. Duration of intubation and CPAP therapy were found to be other risk factors, too. The logistic regression model showed preterm newborns born between gestational age of 28+1 and 30+6 weeks had a twofold increased risk of developing IVH.The prevalence of IVH in NICU hospitalized newborns with a gestational age of ≤ 32 weeks was around 20%, which is consistent with other studies conducted in Iran. The findings emphasize the importance of enhanced antenatal care for early intervention for neonates born at early gestational age to reduce or prevent the risk of IVH. [ABSTRACT FROM AUTHOR]

Neonatal mortality is one of the important health indicators and mortality prediction is applied for auditing and benchmarking, comparing the outcomes in neonatal intensive care units (NICUs), controlling individual differences in populations in clinical trials and evaluating efficacy. In this research work, we aimed to establish and compare two models (neural network and logistic regression models) for prediction of mortality in premature neonates upon admission to the NICU. This modeling research was conducted based on the information of 1618 neonates for prediction of mortality risk until the 28th day of life. In total, 80% and 20% of the data were considered for training and testing of the designed models, respectively. Finally, we achieved to predict the probability of infant mortality based on the 5th minute after birth data. Modeling was performed with two methods; neural network [multi layer perceptron (MLP) with education of back-propagation (BP)] and logistic regression (binominal form in MATLAB R2016a). The results showed that the MLP (with 60 neurons in the hidden layer) had more acceptable indices compared to logistic regression. While both neural network and logistic regression were able to predict the neonatal mortality risk, the neural network is more effective than logistic regression model in performance comparison. [ABSTRACT FROM AUTHOR]

Purpose: Off-label (OL) use of drugs for hospitalized children is very common. OL use occurs especially in the youngest patients, neonates. This study focused on the OL use of antimicrobials in neonates. To our knowledge, only few studies have focused on the prevalence of OL use of antimicrobials in neonates. Methods: We investigated the OL use of antimicrobials in neonates in a tertiary children's hospital. First, we investigated what were the most consumed OL antimicrobials in defined daily doses according to hospital's registry data from neonatal intensive care unit (NICU) during 2009-2014. Second, we conducted a targeted retrospective study of premature neonates (400-2000 g) with blood culture-positive infections and receiving antimicrobial therapy between 2005 and 2014 ( N = 282). The data were obtained from the electronic patient records and from the hospital's electronic infection registry. Statistical analysis was conducted by using a univariate logistic regression model fitted for OL usage. Results: In NICU, 35% (7/20) of antimicrobials used were OL. Eighteen percent (51/282) of premature neonates with blood culture-positive infections received at least one antimicrobial OL. The most commonly used OL antimicrobials in neonates were meropenem 88% (45/51), rifampicin 18% (9/51), and ciprofloxacin 8% (4/51). The odds for OL use were significantly higher the smaller the neonate birth weight was. An increase in birth weight was found to statistically significantly decrease the probability of OL usage (odds ratio = 0.85 for 100 g increase in birth weight, p value <0.001). Conclusion: More studies in neonates on especially dosing and pharmacokinetics of antimicrobials are urgently needed. [ABSTRACT FROM AUTHOR]

Introduction: Reports describing methadone overdose in adult and pediatric patient populations are not uncommon. Reports in the preterm neonate patient population, however, are infrequent even though the utilization of methadone in that population continues to increase. Significant age-related pharmacokinetic differences complicate the management of methadone overdose in neonates, and literature involving methadone toxicokinetics and toxicodynamics in pediatric and neonate populations is largely limited. Case Report: The clinical course and pharmacologic data of a massive methadone overdose in a 20-day-old male neonate is described, and a contemporary review of developmental pharmacology is presented. Discussion: As clinicians continue to use methadone in neonates, they should be aware of the many significant peculiarities regarding its toxicology and pharmacology in that patient population. [ABSTRACT FROM AUTHOR]

Bronchoalveolar lavage fluid (BALF) is an important diagnostic source to investigate molecular changes occurring in lung disorders. The objective of this study was to assess and compare the peptidomic profiles of BALF from premature neonates with and without bronchopulmonary dysplasia (BPD). Samples were obtained on the 3rd day of life from 34 neonates with gestational age ≤32 weeks. Two pools of samples from patients with and without BPD were analyzed by high performance liquid chromatography. Several differentially expressed peptides were collected and sequenced. Moreover, samples from single donors were analyzed by liquid chromatography-electrospray ionization mass spectrometry to define the molecular mass values of various peptides and to quantify their expression. Levels of some matrix metalloproteinases and their tissue inhibitors were also determined in single samples. Neonates of the BPD group ( N = 16) showed significantly lower mean gestational age and birth weight with respect to the no-BPD group ( N = 18; P < 0.0001). Levels of six peptides were significantly higher in BPD patients ( P < 0.05). Two of them were identified as the albumin fragments 1–21 (2,428 Da) and 399–406 (956 Da). Levels of matrix metalloproteinase-3 (MMP-3) enzyme probably involved in albumin fragment generation were also significantly higher in the BPD group compared to the no-BPD group ( P < 0.05), whereas the levels of tissue inhibitor of metalloproteinases-1 were significantly lower ( P < 0.05). Levels of albumin fragments and MMP-3 showed a significant correlation ( P < 0.05). This study shows that proteomic techniques can be applied to investigate the involvement of proteolytic enzymes on the airways of mechanically ventilated premature infants. [ABSTRACT FROM AUTHOR]

Objective: Case report on the effect of inhaled prostacyclin in a preterm infant (28 weeks gestational age) with respiratory distress syndrome complicated by marked hypoxemia due to persistent pulmonary hypertension of the newborn. Treatment with surfactant, hyperventilation, and elevation of systemic blood pressure had failed to improve oxygenation.Measures: A solution containing 10 micrograms PGI2/ml was aerosolized by the SPAG-2 aerosol-generator and then introduced into the afferent loop of the ventilatory circuit.Results: Oxygenation improved dramatically and worsened when aerosolization was withdrawn. Intravenous prostacyclin had no additional effect on oxygenation. We observed no side effects on blood pressure and no bleeding complications. Inhalation was stopped after 40 hours and the baby was successfully weaned from the ventilator after 108 hours.Conclusion: Inhaled PGI2 had a beneficial effect on the oxygenation of a preterm neonate with persistent pulmonary hypertension of the newborn. [ABSTRACT FROM AUTHOR]

Catheter-related sepsis is commonly encountered in the neonatal intensive care unit. We retrospectively studied infants with vascular catheters at 2 NICUs. Data were obtained from the computerised admission records available at both the hospitals. Our aims were to describe the clinical and microbial profile of nosocomial sepsis in infants with vascular catheters [umbilical artery (UA), umbilical venous (UV), central venous Broviac (CV), percutaneously placed central venous (PC), peripheral artery (PA)], and to determine the association between catheter type, duration and sepsis in a subset of the population. Nosocomial sepsis (positive blood culture after the 3rd postnatal day) occurred in 217 of 2091 (10.4%) infants. Infected infants, in contrast to non-infected, had a significantly (P < 0.001) greater number of multiple catheters (2.3 vs 1.4) had lower birth weights (1.2 vs 2.1 kg), were younger (28 vs 33 weeks) and had lower 1 and 5 minute Apgar scores (4.3 and 6.7 vs 5.5 and 7.4). The most common organism was coagulase negative Staphylococcus. In a subset population as analyses revealed, longer duration of UA use was associated with higher infection rates [13.6% with UA use for > or = 8 days vs 1.3% for < or = 7 days (P < 0.0001)]. PC use had a lower rate of sepsis than CV use (5.1% vs 15.2%; P < 0.05). Use of intravascular catheters should be balanced between the need for vascular access and the risk of sepsis. [ABSTRACT FROM AUTHOR]

Unlabelled: Classically, systemic Candida infections in preterm neonates occur at a mean age of 1 month. Over an 18-month period in a Regional Neonatal Intensive Care Unit we encountered seven cases of severe Candida infection, all in babies below 26 weeks gestation and weighing less than 0.75 kg. The median age of onset was 7 days (range 0-17), with thrombocytopenia, coagulopathy, hypotension, oedema, and skin breakdown being prominent features.Conclusion: The thin cutaneous barrier may contribute to early onset of systemic Candida infection in preterm infants. The characteristic skin appearance may assist early diagnosis. [ABSTRACT FROM AUTHOR]