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Our previous studies revealed that milk proteases begin to hydrolyze proteins in the mammary gland and that proteolytic digestion continues within the infant stomach. No research has measured how the release of milk peptides differs between the gastric aspirates of term and premature infants. This study examined the presence of milk peptides in milk and gastric samples from term and preterm infants using an Orbitrap Fusion Lumos mass spectrometer. Samples were collected from nine preterm-delivering and four term-delivering mother-infant pairs. Our study reveals an increased count and ion abundance of peptides and decreased peptide length from mother's milk to the infant stomach, confirming that additional break-down of the milk proteins occurred in both preterm and term infants' stomachs. Protein digestion occurred at a higher level in the gastric contents of term infants than in gastric contents of preterm infants. An amino acid cleavage site-based enzyme analysis suggested that the observed higher proteolysis in the term infants was due to higher pepsin/cathepsin D activity in the stomach. Additionally, there was a higher quantity of antimicrobial peptides in term infant gastric contents than in those of preterm infants, which could indicate that preterm infants benefit less from bioactive peptides in the gut.

BackgroundIn extremely premature infants, postnatal growth restriction (PNGR) is common and increases the risk of developing bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). Mechanisms by which poor nutrition impacts lung development are unknown, but alterations in the gut microbiota appear to play a role. In a rodent model, PNGR plus hyperoxia causes BPD and PH and increases intestinal Enterobacteriaceae, Gram-negative organisms that stimulate Toll-like receptor 4 (TLR4). We hypothesized that intestinal dysbiosis activates intestinal TLR4 triggering systemic inflammation which impacts lung development.MethodsRat pups were assigned to litters of 17 (PNGR) or 10 (normal growth) at birth and exposed to room air or 75% oxygen for 14 days. Half of the pups were treated with the TLR4 inhibitor TAK-242 from birth or beginning at day 3. After 14 days, pulmonary arterial pressure was evaluated by echocardiography and hearts were examined for right ventricular hypertrophy (RVH). Lungs and serum samples were analyzed by western blotting and immunohistochemistry.ResultsPostnatal growth restriction + hyperoxia increased pulmonary arterial pressure and RVH with trends toward increased plasma IL1β and decreased IκBα, the inhibitor of NFκB, in lung tissue. Treatment with the TLR4 inhibitor attenuated PH and inflammation.ConclusionPostnatal growth restriction induces an increase in intestinal Enterobacteriaceae leading to PH. Activation of the TLR4 pathway is a promising mechanism by which intestinal dysbiosis impacts the developing lung.

Background: Magnesium sulfate (MgSO4) is a common substance administered to pregnant women with preeclampsia or eclampsia to prevent and treat seizures or gestational hypertension. This study aimed to evaluate whether administering maternal magnesium sulfate increased the risk of early-onset hyperkalemia in preterm infants. Methods: This single-center, propensity score-matched, case–control study examined preterm infants born within 24–36 weeks of gestation using electronic medical records between January 2015 and June 2019, in the Saitama City Hospital, Japan. We categorized infants according to their maternal MgSO4 administration status. After adjusting for perinatal information and maternal treatment, we compared the incidence of the variables, including neonatal hyperkalemia, within 24 h after birth between the matched cohorts. All infants in Model 1 were analyzed separately, while in Model 2 infants with birth weight of less than 1000 g were excluded. Results: We enrolled 421 infants (maternal MgSO4 group, 124; control group, 297). Ninety-five infants in Model 1 and 86 in Model 2 were matched in each group using propensity scores, respectively. In the matched cohorts of both models, infants in the maternal MgSO4 group had a higher hyperkalemia incidence than did those in the control group (42.1% vs. 7.4% in Model 1, 44.2% vs. 5.8% in Model 2, respectively; p

Care of extremely premature infants is in constant need for evaluation and progress. WINROP, a predictive model based on weight gain, has been developed to reduce the number of stressful examinations for retinopathy for prematurity. Validation studies of WINROP emphasize the difference of applicability in neonatal units of various practice. The aim of the study was to assess the standard of neonatal care by WINROP. Data on extremely premature infants were collected from medical records and entered in WINROP. High- and low-risk WINROP distribution and retinopathy of prematurity outcomes were analyzed. Fifty-four infants, gestational age ≤28 weeks, were included in the study after exclusion of weight related comorbidities. High risk was noted in 74% (n=40) of infants with 24% (n=13) developing retinopathy of prematurity requiring treatment. In low alarm group, there were 3 cases with severe disease. In conclusion, WINROP is not just a provider of predictive information on the severity of retinopathy of prematurity. High-risk alarm indicates the need of adjustment of nutritional strategies. Infants without pathological growth morbidities who develop severe retinopathy of prematurity in low-risk group point to other risk factors for retinopathy of prematurity to be evaluated and changed in future practice.

Background Congenital hypothyroidism (CH) is the leading cause of preventable physical and intellectual disabilities. This study aimed to assess the incidence and clinical characteristics of CH in newborns. Methods We retrospectively reviewed the medical records of all newborns delivered at the Pusan National University Hospital between January 2011 and March 2021. The incidence of CH was compared according to gestational age, birth weight, and small for gestational age (SGA). The patients aged ≥3 years who could not maintain normal thyroid function and required levothyroxine treatment were diagnosed with permanent CH. Logistic regression analysis was performed to compare CH risks. Results Of 3,722 newborns, 40 were diagnosed with CH (1.07%). Gestational age and birth weight were significantly associated with CH incidence. The odds ratios (ORs) of CH in infants delivered at 32–37, 28–31, and

This review article summarizes current data on malnutrition etiology and pathogenesis in infants. Topical requirements for revealing this condition, its diagnosis and severity assessment via centile metrics are presented. The characteristics of the most common clinical phenotypes of postnatal growth insufficiency in infants (premature infants with different degree of maturation, including patients with bronchopulmonary dysplasia) are described. Differential approaches for malnutrition nutritional correction in these children are presented. The final section of the article describes special nutritional needs for children with congenital heart defects in terms of hemodynamic disorders nature and severity. Modern nutritional strategies for preparation of these patients to surgery and for their postoperative period are presented. The use of high-calorie/high-protein product for malnutrition correction in the most vulnerable patients with described in this review phenotypes is worth noticing.

Abstract Background The gastrointestinal (GI) microbiota has been linked to health consequences throughout life, from early life illnesses (e.g. sepsis and necrotising enterocolitis) to lifelong chronic conditions such as obesity and inflammatory bowel disease. It has also been observed that events in early life can lead to shifts in the microbiota, with some of these changes having been documented to persist into adulthood. A particularly extreme example of a divergent early GI microbiota occurs in premature neonates, who display a very different GI community to term infants. Certain characteristic patterns have been associated with negative health outcomes during the neonatal period, and these patterns may prove to have continual damaging effects if not resolved. Results In this study we compared a set of premature infants with a paired set of term infants (n = 37 pairs) at 6 weeks of age and at 2 years of age. In the samples taken at 6 weeks of age we found microbial communities differing in both diversity and specific bacterial groups between the two infant cohorts. We identified clinical factors associated with over-abundance of potentially pathogenic organisms (e.g. Enterobacteriaceae) and reduced abundances of some beneficial organisms (e.g. Bifidobacterium). We contrasted these findings with samples taken at 2 years of age, which indicated that despite a very different initial gut microbiota, the two infant groups converged to a similar, more adult-like state. We identified clinical factors, including both prematurity and delivery method, which remain associated with components of the gut microbiota. Both clinical factors and microbial characteristics are compared to the occurrence of childhood wheeze and eczema, revealing associations between components of the GI microbiota and the development of these allergic conditions. Conclusions The faecal microbiota differs greatly between infants born at term and those born prematurely during early life, yet it converges over time. Despite this, early clinical factors remain significantly associated with the abundance of some bacterial groups at 2 years of age. Given the associations made between health conditions and the microbiota, factors that alter the makeup of the gut microbiota, and potentially its trajectory through life, could have important lifelong consequences.

Background & Aim: Mothers with premature babies are more likely to experience anxiety than mothers with full-term babies. The separation of the mother from the baby disrupts physical contact with the baby, which is the most important component affecting attachment. The aim of this study was to determine the effect of a group positive thinking program on anxiety and attachment in mothers with premature infants admitted to the neonatal intensive care unit. Methods & Materials: This study is a randomized clinical trial conducted in Kermanshah in 2020. A total of 72 mothers with premature infants admitted to the neonatal intensive care unit of Imam Reza and Mohammad Kermanshahi hospitals were randomly assigned into two groups of control and intervention. The Spielberger State Trait Anxiety Inventory and Postpartum Attachment Scale were used to collect the data. The collected data were analyzed using the SPSS software version 16 using statistical tests (ANOVA and Chi-Square). Results: There was no significant difference in the state anxiety levels before (p =0.791) and after the intervention (p =0.373) between the control and intervention groups. Likewise, no statistically significant difference was observed in the latent anxiety levels before (p =0.831) and after the intervention (p =0.093) between the two groups but comparing the amount of changes showed a significant difference (p =0.025). Regarding attachment, none of the attachment subscales had a statistically significant difference between the two groups before the intervention (p>0.05). After the intervention, a significant difference was observed in the scores of the subscales “lack of hostility" and "satisfaction with the interaction" (p

Resumen: Introducción: El monitor NIPE (Newborn Infant Parasympathetic Evaluation) es una herramienta rápida, continua y objetiva de evaluación del disconfort neonatal. Los objetivos fueron describir los cambios del NIPE tras una extracción sanguínea y los factores implicados en su variación. Material y métodos: Estudio observacional analítico con recogida de datos prospectiva. Se incluyeron los recién nacidos ingresados en cuidados intensivos entre junio y diciembre de 2021 a quienes se les realizó extracción sanguínea. Se recogieron variables demográficas, las relacionadas con la realización del procedimiento, la puntuación NIPE, la frecuencia cardiaca previa y en los minutos 1, 2, 3, 4, 5, 10 y 15 posteriores. Resultados: Se incluyeron 86 registros de 49 pacientes. Durante los primeros cuatro minutos tras el procedimiento hubo un descenso significativo en la puntuación NIPE, siendo el descenso máximo de un 22,8% respecto al valor basal, produciéndose el nadir a los 2,79 minutos. El mayor descenso del NIPE ocurrió en pacientes prematuros, varones, con menor Apgar a los cinco minutos, en procedimientos ya realizados previamente, tras cesárea y en horario matutino. No hubo diferencias con la realización en canguro. La correlación entre NIPE y frecuencia cardíaca fue débil. Conclusiones: Tras un procedimiento doloroso, como una extracción sanguínea, el monitor NIPE mostró un descenso significativo los primeros cuatro minutos, agudizándose el descenso con la prematuridad, la reiteración de procedimientos o el nacimiento tras cesárea. El monitor NIPE puede ayudar a identificar eficazmente a aquellos neonatos que sufren dolor agudo tras un procedimiento, complementándose con las escalas de valoración clínica. Abstract: Introduction: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. Material and methods: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15 min after the procedure. Results: The study included 86 records for 49 patients. In the first 4 min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79 min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. Conclusions: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4 min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales.

Abstract Background The purpose of this study was to investigate the effect of family integrated care (FICare) on the prognosis of children hospitalized with preterm infants. Methods Two hundred thirty preterm infants admitted to our hospital from January 2019 to April 2021 were enrolled in a prospective randomized study and divided into 115 cases in the intervention group and 115 cases in the control group according to the random number table method, and given the FICare and the conventional care, respectively. The duration of nasogastric tube retention, time to achieve total enteral nutrition, rate of weight gain, exclusive breastfeeding rate, length of hospital stay, growth and development, readmission rate, parental self-efficacy, family functioning and complications related to prematurity were compared between the two groups. Results Compared with the control group, the intervention group had shorter nasogastric tube retention time, shorter time to achieve total enteral nutrition, higher exclusive breastfeeding rate, shorter time of hospital stay and better growth rate. Before the intervention, there was no difference in parental self-efficacy and family functioning between the two groups; after the intervention, the intervention group had higher parental self-efficacy and higher ratings of family functioning, and the difference was statistically significant. Compared with the control group, the intervention group had a lower readmission rate and significantly lower incidence of infection and choking. Conclusion The FICare can shorten the time of nasogastric tube retention, shorten time to achieve total enteral nutrition and hospital stay, increase the rate of exclusive breastfeeding and the rate of weight gain, finally improve the prognosis of preterm infants and have a positive effect on parents.

Background: Intratracheal intubation is associated with many side effects. Different groups of drugs have been used to control these side effects, but there is still no consensus on the most suitable drugs. This study aimed to compare the effect and possible side effects of fentanyl, remifentanil, and atropine plus remifentanil on the vital signs of preterm infants in non-emergency intratracheal intubation. Methods: In this randomized clinical trial study, 75 neonates with a gestational age of 27 to 34 weeks who required temporary intubation were included in the study and divided into three groups by computer randomization. Then, the effects and possible side effects of remifentanil, fentanyl, and remifentanil with atropine on clinical parameters (blood pressure, heart rate, and arterial oxygen saturation) were investigated. Results: A total of 75 neonates with a mean gestational age of 30.4 weeks were studied. There was no significant difference between study groups in terms of changes in the systemic blood pressure and heart rate, but the mean oxygen saturation in all three groups was significantly different at different measurement times (P-value: 0.036). The group receiving remifentanil plus atropine reported minimal changes in oxygen saturation and their oxygen saturation was significantly higher than the other groups 30 min after extubation. Conclusion: The use of remifentanil with atropine in preterm infants is associated with lower changes in oxygen saturation and higher arterial oxygen saturation 30 min after extubation. The use of remifentanil or remifentanil with atropine or fentanyl has no significant effect on the blood pressure and heart rate of neonates in non-emergency intratracheal intubation.

Objective: Preterm infants are subjected to numerous painful procedures during their neonatal intensive care unit (NICU) hospitalization. Despite advancements in pain alleviation, nurses remain challenged to provide timely and effective pain management for preterm infants. Greater understanding of the lived experience of nurses caring for preterm infants in pain could provide novel insights to improve pain management for this vulnerable population. The aim of this meta-ethnography was to synthesize and interpret qualitative findings of nurses’ experiences of taking care of preterm infants in pain. Methods: An extensive literature search in PubMed, CINAHL, PsycINFO, Scopus, BIOSIS and ProQuest Dissertation and Theses Database was conducted, including studies within the past 10 years. Two nursing researchers conducted data extraction and analysis independently. Inclusion criteria were applied to search for qualitative studies of nurse participants who worked in the NICU taking care of preterm infants. Studies published in a language other than English, articles that did not include qualitative data and qualitative data that could not be extracted from the findings or did not discuss nurses’ experiences were excluded. Critical Appraisal Skills Programme was used for literature quality evaluation. Results: Eight studies remained after further screening according to inclusion and exclusion criteria. These eight studies were conducted from 2013 to 2018 and totally enrolled 205 nurses from Iran, Canada, the United States, Finland, Sweden, Switzerland, and Australia. Five themes emerged on the nurses’ perspectives of taking care of preterm infants in pain: 1) They sense the neonatal pain; 2) Adverse consequences of unrelieved pain; 3) Barriers of managing pain; 4) Concerns of available approaches for pain relief; 5) Failure to work with parents. Conclusions: This meta-ethnography identified nurses’ understanding of pain in preterm infants that can be assessed, and they acknowledged that unrelieved pain could cause developmental deficits in infants. The barriers are lack of training and support on pain assessment and intervention in preterm infants. Optimizing workload and environment, developing age-specified pain assessment and intervention, receiving emotional support and training, and building up a rapport with parents are urgent needs for nurses to provide better care to infants having pain.

Background: Preterm birth remains a significant burden to families, health systems and societies. The aim was to quantify the incremental prematurity-related public health expenditure in Hungary and to estimate the potential impact of a decrease in the prevalence of prematurity on the public payer's spending. Methods: Over a 6-year time horizon, public financing data of inpatient, outpatient and pharmaceutical care for children born at ≥ 25 weeks of gestation in 2009/2010 were retrieved from the Hungarian National Health Insurance Fund database. In descriptive analysis, the public payer's spending was given as cost/capita. The impact of a decrease in prematurity prevalence was specified as the total budget impact. An exchange rate of 294 Hungarian forint/Euro was applied. Results: A total of 93,124 children (including 8.6% who were premature babies) were included in the analysis. A strong negative relationship was shown between gestational age and per capita cost. The 6-year cost of care for the cohort born at 26 weeks of gestation (28,470 Euro per capita) was 24 times higher than that for the cohort born at 40 weeks. First-year inpatient spending accounted for the largest proportion of total health care spending across all gestational ages. All investigated prematurity complications (retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular cerebral bleeding and leukomalacia) resulted in additional significant incremental spending. If 70% of pregnancies ending with preterm birth could be prolonged by 1 week, the savings would be almost 7.0 million Euros in the first 6 years of life. Conclusion: This comprehensive analysis of prematurity-related health care spending confirmed that premature infants have much higher costs for care than those born at term in Hungary. These quantitative outcomes can provide essential inputs for the cost-effectiveness analysis of medical technologies and public health interventions that can decrease the prevalence of premature birth. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: To assess demographics and outcomes up to 3 years of age among children with cytomegalovirus (CMV) infection in California neonatal intensive care units (NICUs) during 2010–2021. Methods: The California Perinatal Quality Care Collaborative (CPQCC) collects data on all very low birth weight (VLBW, birth weight ≤ 1500 g) and acutely ill infants with birth weight > 1500 g across 92% of NICUs in California. VLBW infants and those with neurological conditions are referred to a statewide high‐risk infant follow‐up (HRIF) program. CMV infection was defined as a positive culture or PCR identified during the NICU hospitalization. Results: During 2010–2021, CMV reporting rates averaged 3.5/1000 VLBW infants (n = 205) and 1.1/1000 infants >1500 g (n = 128). Among all 333 infants with CMV, 314 (94%) were discharged home alive, 271 (86%) were referred for HRIF and 205 (65%) had ≥1 visit. Whereas infants born to mothers <20 years of age had highest CMV reporting rates and those born to Hispanic mothers comprised 49% of all infected infants, they had the highest loss of follow‐up. At the 12‐month visit (n = 152), 19 (13%) infants with CMV had bilateral blindness and 18 (12%) had hearing loss. At the 24‐month visit, 5 (5%) of 103 had severe cerebral palsy. Conclusions: Among infants admitted to the NICU, those with CMV diagnoses may over represent infants with more severe CMV disease and outcomes. The CPQCC and HRIF program findings may help inform implementation of surveillance for congenital CMV infection in other U.S. states and guide strategies to reduce disparities in access to services. [ABSTRACT FROM AUTHOR]

Congenital left atrial appendage ostial stenosis is a very rare congenital cardiac condition. We present the case of an extremely premature infant with congenital left atrial appendage ostial stenosis diagnosed by transthoracic echocardiographic imaging. [ABSTRACT FROM AUTHOR]

Physical activity (PA) participation is important for children born extremely preterm or extremely low birthweight as it provides opportunities to improve motor skills and cardiovascular fitness; however there is little evidence on interventions promoting PA participation for this group, particularly at preschool age. This study aims to explore the acceptability, a critical component of intervention feasibility, of a novel dance participation intervention. Semi-structured interviews explored the acceptability of Dance PREEMIE, a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age (trial registration ACTRN12619001266156), from the perspectives of dance teachers delivering the intervention (n = 6), and parents of participating children (n = 6). Data were analyzed using reflexive thematic analysis. Five themes were developed: 1) placing the child center-stage: a shared motivation to promote child wellbeing and development; 2) Dance PREEMIE as a catalyst for participation; 3) child development takes time, practice and exposure; 4) the value of being informed; and 5) dance teachers as architects of the learning environment. Dance PREEMIE was acceptable to both parents of participating children and dance teachers. Findings from this study may inform future interventions aiming to improve PA participation for children with motor impairment at preschool age. [ABSTRACT FROM AUTHOR]

Aim: Cytomegalovirus (CMV) is a virus that can cause congenital and postnatal infections. Postnatal CMV is mainly transmitted via breast milk and blood transfusions. Frozen–thawed breast milk is used to prevent postnatal CMV infection. A prospective cohort study was conducted to determine the infection rate, risk, and clinical findings of postnatal CMV infection. Methods: This prospective cohort study included infants born at 32 weeks or earlier than the gestational age (GA). Participants were prospectively screened for infection in the urine by performing urine CMV DNA tests twice, that is, once within the first 3 weeks of life and again after 35 weeks postmenstrual age (PMA). Postnatal CMV infection was defined as a case of CMV negative tests within 3 weeks of birth and CMV positive tests after 35 weeks PMA. CMV‐negative blood products were used for transfusions in all cases. Results: A total of 139 patients were subjected to two urine CMV DNA tests. The prevalence of postnatal CMV infection was 5.0%. One patient died of sepsis‐like syndrome. The risk factors of postnatal CMV infection were younger GA and older age of the mother. The characteristic clinical findings of postnatal CMV infection were pneumonia. Conclusions: Frozen–thawed breast milk feeding is not fully effective in preventing postnatal CMV infection. The prevention of postnatal CMV infection is important to further improve the survival rate of preterm infants. Development of guidelines on breast milk feeding for the prevention of postnatal CMV infection is necessary in Japan. [ABSTRACT FROM AUTHOR]

Aim: To explore mothers' experiences of the EArly Collaborative Intervention. Background: Preterm birth puts a considerable emotional and psychological burden on parents and families. Parents to moderate and late premature infants have shorter stays at the neonatal intensive care unit and have described a need for support. The EArly Collaborative Intervention was developed to support parents with preterm infants born between gestational Weeks 30 to 36. In this study, mothers' experiences of the new intervention were explored. Design: A qualitative design guided by a reflexive thematic analysis according to Braun and Clarke. Interviews were individually performed with 23 mothers experienced with the EArly Collaborative Intervention. Data were identified, analysed and reported using reflexive thematic analysis. The COREQ checklist was used preparing the manuscript. Results: Two main overarching themes were constructed. The first theme, 'mothers' feelings evoked from the EArly Collaborative Intervention' describes the emotions raised by the intervention and how the intervention affected their parental role. Their awareness of the preterm baby's behaviour increased, and the intervention helped the parents to communicate around their baby's needs. The second theme, 'based on the preterm baby's behavior', describes experiences of the provision and the learning process about their preterm baby's needs and communication. The intervention was experienced as helpful both immediately and for future interaction with the baby. Conclusions: Mothers found the intervention to be supportive and encouraging. They came to look upon their baby as an individual, and the new knowledge on how to care and interact with their baby affected both their own and their baby's well‐being. Furthermore, the intervention felt strengthening for their relationship with the other parent. Relevance to Clinical Practice: The EArly Collaborative Intervention can support parents' abilities as well as their relation to their baby and may thereby contribute to infant development, cognition and well‐being. [ABSTRACT FROM AUTHOR]

Aim: In Denmark, preterm infants are recommended to receive childhood vaccinations without correction for gestational age. This study aimed to describe the timeliness of the Danish Childhood Vaccination Program in preterm infants during the first 13 months of life and to evaluate possible determinants of delay. Methods: This retrospective cohort study included preterm infants admitted to a level III neonatal intensive care unit between October 2019 and October 2020. Clinical data were retrieved from medical records and the Danish Vaccination Register. Timely vaccination was defined corresponding to chronological age of 3‐, 5‐ and 12 months, within a time interval of 30 days before to 29 days after the expected date. Results: Analyses included 365 infants. Timely vaccination occurred in 91%, 83% and 67% of preterm infants for the first, second and third vaccination, respectively, and timeliness was highest if born before gestational age 28 weeks. Gestational age 28–31 + 6 weeks and delayed former vaccinations negatively influenced the timeliness of the following vaccinations. Conclusion: Most preterm infants received the first vaccination timely; however, timeliness decreased with each subsequent vaccination. Efforts to improve timeliness should focus on counselling healthcare personnel and parents to follow the recommendations for the first and the following vaccinations. [ABSTRACT FROM AUTHOR]

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Necrotizing enterocolitis (NEC) is the leading cause of death caused by gastrointestinal disease in preterm infants. Major risk factors include prematurity, formula feeding, and gut microbial colonization. Microbes have been linked to NEC, yet there is no evidence of causal species, and select probiotics have been shown to reduce NEC incidence in infants. In this study, we evaluated the effect of the probiotic Bifidobacterium longum subsp. infantis (BL. infantis), alone and in combination with a human milk oligosaccharide (HMO)—sialylactose (3′SL)—on the microbiome, and the incidence of NEC in preterm piglets fed an infant formula diet. We studied 50 preterm piglets randomized between 5 treatments: (1) Preterm infant formula, (2) Donor human milk (DHM), (3) Infant formula + 3′SL, (4) Infant formula + BL. infantis, and (5) Infant formula and BL. infantis + 3′SL. NEC incidence and severity were assessed through the evaluation of tissue from all the segments of the GI tract. The gut microbiota composition was assessed both daily and terminally through 16S and whole-genome sequencing (WGS) of rectal stool samples and intestinal contents. Dietary BL. infantis and 3′SL supplementation had no effect, yet DHM significantly reduced the incidence of NEC. The abundance of BL. infantis in the gut contents negatively correlated with disease severity. Clostridium sensu stricto 1 and Clostridium perfringens were significantly more abundant in NEC and positively correlated with disease severity. Our results suggest that pre- and probiotics are not sufficient for protection from NEC in an exclusively formula-based diet. The results highlight the differences in microbial species positively associated with both diet and NEC incidence. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of white noise therapy on growth development, neurobehavioral development and puncture pain in premature infants. Methods: 113 premature infants who were admitted to our hospital from March 2020 to February2022 were included. According to the two-color sphere method, premature infants were divided into control group (56 cases) and study group (57 cases). The control group received conventional therapy, and the study group received white noise therapy on the basis of the control group. Growth development, neurobehavioral development, minimum oxygen saturation, maximum heart rate and puncture pain score of preterm infants in the two groups were compared. Results: Compared with the control group, after intervention, the premature infants in the study group had larger body weight, head circumference and longer body length (P＜0.05). After intervention, the passive muscle tone, behavioral ability, active muscle tone, general response and primitive reflex of preterm infants in the study group were higher than those in the control group (P＜0.05). After intervention, the minimum blood oxygen saturation in the study group was higher than that in the control group, and the maximum heart rate was lower than that in the control group (P＜0.05). The puncture pain score in the study group was lower than that in the control group (P＜0.05). Conclusion: The application of white noise therapy in premature infants can promote their growth development, neurobehavioral development, and reduce puncture pain. [ABSTRACT FROM AUTHOR]

Objective: Owing to advances in critical care treatment, the overall survival rate of preterm infants born at a gestational age (GA) <32 weeks has consistently improved. However, the incidence of severe intraventricular hemorrhage (IVH) has persisted, and there are few reports on in-hospital morbidity and mortality. Therefore, the aim of the present study was to investigate trends surrounding in-hospital morbidity and mortality of preterm infants with severe IVH over a 14-year period. Methods: This single-center retrospective study included 620 infants born at a GA <32 weeks, admitted between January 2007 and December 2020. After applying exclusion criteria, 596 patients were included in this study. Infants were grouped based on the most severe IVH grade documented on brain ultrasonography during their admission, with grades 3 and 4 defined as severe. We compared in-hospital mortality and clinical outcomes of preterm infants with severe IVH for two time periods: 2007-2013 (phase I) and 2014-2020 (phase II). Baseline characteristics of infants who died and survived during hospitalization were analyzed. Results: A total of 54 infants (9.0%) were diagnosed with severe IVH over a 14-year period; overall in-hospital mortality rate was 29.6%. Late in-hospital mortality rate (>7 days after birth) for infants with severe IVH significantly improved over time, decreasing from 39.1% in phase I to 14.3% in phase II (p=0.043). A history of hypotension treated with vasoactive medication within 1 week after birth (adjusted odds ratio, 7.39; p=0.025) was found to be an independent risk factor for mortality. When comparing major morbidities of surviving infants, those in phase II were significantly more likely to have undergone surgery for necrotizing enterocolitis (NEC) (29.2% vs. 0.0%; p=0.027). Additionally, rates of late-onset sepsis (45.8% vs. 14.3%; p=0.049) and central nervous system infection (25.0% vs. 0.0%; p=0.049) were significantly higher in phase II survivors than in phase I survivors. Conclusion: In-hospital mortality in preterm infants with severe IVH decreased over the last decade, whereas major neonatal morbidities increased, particularly surgical NEC and sepsis. This study suggests the importance of multidisciplinary specialized medical and surgical neonatal intensive care in preterm infants with severe IVH. [ABSTRACT FROM AUTHOR]

Germinal matrix and intraventricular hemorrhage (GM-IVH) are the major causes of intracranial hemorrhage in premature infants. Cranial ultrasound (cUS) is the imaging modality of choice for diagnosing and classifying GM-IVH. Magnetic resonance imaging (MRI), usually performed at term-equivalent age, is more sensitive than cUS in identifying hemorrhage in the brain. Post-hemorrhagic ventricular dilatation is a significant complication of GM-IVH and correlates with adverse neurodevelopmental outcomes. In this review, we discuss the various imaging findings of GM-IVH in premature infants, focusing on the role of cUS and MRI. [ABSTRACT FROM AUTHOR]

Aim: This descriptive study was conducted to evaluate chronic pain in premature infants on invasive and noninvasive mechanical ventilation. Material and Methods: The sample of this study consisted of 110 premature infants with a gestational age of ≥25 weeks and ≤36 weeks in the Neonatal Intensive Care Unit. Data were collected between February 2018 and April 2019 with the Descriptive Information Form to determine the infants' characteristics and the Newborn Pain and Discomfort Scale (EDIN). The data were analyzed with tests suitable for normal distribution, and the significance level was accepted as p <.05. Results: It was determined that the average total pain score of premature infants from the EDIN scale was 5.43 ± 1.86, and 35.5% of them experienced pain (> 6 points). It was found that the chronic pain scores increased as the length of hospital stay and the duration of mechanical ventilation increased in premature infants who were applied mechanical ventilation (p <.05). It was determined that the average chronic pain score was higher in infants with a risk of impaired skin integrity (p <.01). Conclusions: It has been recommended to give importance to skin assessment of premature infants receiving mechanical ventilation, to perform routine pain assessment, and to take measures to reduce pain in infants whose duration of stay on mechanical ventilation exceeds five days. [ABSTRACT FROM AUTHOR]

Objective The study aimed to investigate the neonatal outcomes of infants born to mothers on hemodialysis. Study Design This retrospective, case-control, and observational study included 17 infants born to 16 mothers on dialysis in 2003 to 2016. We compared their clinical characteristics to those of 51 gestational age- and sex-matched control infants. Statistical comparisons were made between the two groups by using the Wilcoxon–Mann–Whitney test for continuous variables and the Chi-square test or Fisher's exact test for categorical variables. Results Of the 16 pregnancies of mothers on dialysis, 15 (94%) deliveries were premature (<37 weeks), and 16/17 (94%) infants survived to discharge. The incidences of neonatal complications, such as intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus, and periventricular leukomalacia, were not significantly different between the groups. However, 5/17 (29%) of the infants had congenital anomalies. Conclusion Although infants born to mothers on dialysis have a high risk of prematurity, they do not have any additional risk of neonatal complications, except for congenital anomalies. The potential risk of congenital anomalies should be investigated further. Key Points Preterm birth rate among mothers on hemodialysis was 94%. Complications in these infants were similar to controls. Twenty-nine percent of infants had congenital anomalies. [ABSTRACT FROM AUTHOR]

Aim: to describe the feeding and growth patterns of preterm-born children at preschool age, considering feeding problems based on behaviours and skills, diet quality and parental feeding practices. Methods: a cross-sectional study was performed on preterm children born in Asturias (Spain) in 2016 (n = 94). When preterm-born children reached 3-4 years of age their families were asked to complete the Behavioral Pediatrics Feeding Assessment Scale and a food frequency questionnaire to identify possible feeding problems and assess diet quality (KIDMED index), respectively. Self-reported anthropometric data were also collected to assess weight growth. Electronic health records were reviewed to gather gestational and neonatal clinical data. Results: feeding problems were found in 7.4% of children and 20.2% of parents. According to the KIDMED index, 25.5 % of children had a high-quality diet. Feeding problems were higher in children born before 32 weeks of gestation, and decreased in frequency as the gestational age increased (p = 0.030). No differences were found in parental feeding practices (p = 0.455) or diet quality according to gestational age (p = 0.399), but body weight at 3-4 years was lower in preterm-born children (p = 0.015). Conclusions: feeding patterns of preterm-born children were suitable at the age of 3-4 years, but diet quality was moderate to poor in the majority of children. Follow-up of very preterm children beyond 3-4 years of age becomes necessary as they displayed more feeding problems and lower body weight. [ABSTRACT FROM AUTHOR]

Copyright of Health Bulletin / Zdravstveni Glasnik is the property of Faculty of Health Studies, University of Mostar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Neonatal meningitis is one of the important causes of mortality and morbidity in newborns. In this study, it was aimed to examine the microbiological factors, biochemical and clinical characteristics of neonatal meningitis cases, to reveal the risk factors, and to investigate the effect on the morbidities associated with meningitis in the first year of life. Materials and Methods: The files of patients diagnosed with meningitis in the level 3 Neonatal Intensive Care Unit between January 2010 and December 2015 were retrospectively analyzed. Results: There were 118 patients diagnosed with meningitis. The median gestational age of the patients was 32 weeks (24-40 weeks), and the median birth weight was 1987 grams (690-5020 grams). Most of the meningitis patients (n=106, 90%) were with late sepsis. The diagnosis day of those with poor prognosis was found to be greater [9.7 (2-28) days to 15.5 (3-138) days, p=0.03]. Cerebrospinal fluid (CSF) leukocytes were significantly higher in term babies with abnormal cranial magnetic resonance imaging (MRI) findings (p=0.037) and loss in hearing tests (p=0.045). CSF sugar levels were significantly lower in preterm babies with neuromotor retardation (p=0.001), history of seizures (p=0.003), abnormal cranial MRI findings (p=0.008) and hearing loss (p=0.005). Conclusion: In the long term, a significant number of cases with neonatal meningitis have neuromotor retarda-tion and hearing problems. Factors that can be used as predictors for poor neurological development; late-onset day, increased CSF leukocyte in all babies, and decreased CSF sugar in preterm babies. [ABSTRACT FROM AUTHOR]

Summary: Premature infants often require prolonged hospitalisation in the neonatal intensive care unit (NICU) where they are exposed to adverse noise that may disrupt sleep and further compromise recovery and developmental outcomes. This single‐session trial assessed the effects of a novel circumaural hearing protection device (DREAMIES®; NEATCAP Medical LLC) on sleep in 10 premature infants (mean 34.1 weeks GA) in a Level III NICU. Using polysomnography (PSG), the infant's sleep was compared between three interfeed periods throughout which DREAMIES® was ON or OFF. Each infant received the same condition order, OFF1‐ON‐OFF2. The PSG 30 s epochs were scored by a rater masked to the condition as Quiet Sleep, Active Sleep, Indeterminate Sleep, and Wake. There was a 14.1% increase in sleep from OFF1 to ON (p = 0.05) and an 18.4% decrease in sleep from ON to OFF2 (p = 0.02); an analogous inverse effect was observed for wake (χ2 = 5.03, p = 0.08). There was a main effect of DREAMIES on active sleep (χ2 = 7.4, p = 0.025) due to more active sleep for ON1 (46%) compared with OFF2 (32%; p = 0.074). No significant effect was observed for quiet sleep or indeterminate sleep. On average, the sound level was 51 dBA (range 36–113 dBA) and did not differ significantly among the three periods. The strongest relationship between the minute‐by‐minute maximum sound level and movement actigraphy was observed for the OFF1 condition (ρ0.301, p < 0.001). These findings suggest that DREAMIES® may augment sleep in premature infants by reducing acute episodes of adverse noise in the NICU. [ABSTRACT FROM AUTHOR]

Background: The opportunity to establish a direct breastfeeding (DBF) relationship with a preterm infant, if desired by the mother or lactating parent, is a known driver of positive healthcare experiences. Preterm birth is an independent risk factor for early human milk (HM) cessation, and DBF at the first oral meal promotes continued DBF during hospitalization and HM duration beyond discharge. While the Spatz 10-step model for protecting and promoting HM and breastfeeding in vulnerable infants provides best practices, lack of standardized implementation results in missed opportunities to meet parents' DBF goals. Purpose: To standardize clinical practices to increase DBF at the first oral meal, total DBF meals during hospitalization, and use of test weighing to measure milk transfer for preterm infants. Methods: Quality improvement methods were used to develop and implement Encourage, Assess, Transition (EAT): a DBF protocol for infants less than 37 weeks gestation at birth, in a level II neonatal intensive care unit. Results: Thirty-eight (45%) infants from 27.7 to 36.7 weeks of gestation initiated the protocol. The proportion of infants' DBF at first oral meal increased from 22% to 54%; mean DBF meals during hospitalization increased from 13.3 to 20.3; and use of test weighing increased by 166%. Implications for Practice and Research: Standardizing DBF practices with the EAT protocol increased DBF during hospitalization—a known driver of patient experience—and HM duration beyond discharge, in hospitalized preterm infants. Researchers should validate the reported benefits of EAT (increased DBF during hospitalization, use of test weighing, and improved patient experience), methods to promote passive dissemination of evidence, and sustain change. https://journals.lww.com/advancesinneonatalcare/pages/video.aspx?v=61. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hypocalcemia is one of the most common neonatal disorders that has a good prognosis if treated promptly and diagnosed correctly. This study aimed to determine the prevalence of hypocalcemia and associated factors in premature infants in Jiroft, southeastern Iran. Materials and Methods: In this cross-sectional study, the cases of infants born in the spring and summer of 2019 in Imam Khomeini Hospital in Jiroft, southeastern Iran, were examined by the census method. The required information was extracted from the infants' files and entered into SPSS24 software for analysis. Results: Based on the results of the study, out of 78 hypocalcemic premature neonates admitted to Imam Khomeini Hospital, 42 (53.8%) were boys and 36 (46.2%) were girls. Thirty-six (46.2%) infants had a birth weight of between 1,500 and 2,000 g, and 42 (35.8%) infants were born between 35 and 37 weeks of age. Most preterm infants (60.3%) had a diabetic mother. Moreover, the number of female preterm hypocalcemic infants with a weight of 2,000 to 2,500 g was higher than their male counterparts. Conclusion: The results of this study indicated that prematurity, weight less than 2,000 g, and maternal diabetes were the factors affecting hypocalcemia in preterm infants that should be considered in public health programs. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería Neonatal is the property of Fundacion para la Salud Materno Infantil (FUNDASAMIN) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background and Aims Respiratory physical therapy is recommended to prevent complications of accumulated secretion in mechanical ventilated infants, but no consensus about the best technique is available. Aims To evaluate the effects of manual hyperinflation maneuver (MHM) and thoracoabdominal rebalancing method (TRM) in preterm newborns (PTNB) for bronchial hygiene. Methods Single‐blind randomized crossover trial with intention‐to‐treat analysis was carried out with 24 PTNB (

Abstract Objective: The objective of the study was to identify in the scientific papers the variables associated with parental stress of premature babies’ parents through the graph analytics technique. Methods: This is a Systematic Literature Review performed in the CINAHL, Cochrane Library, Medline, PsycInfo and Web of Science databases. Results: The search yielded 12 articles that were submitted to the data graph analytics technique for analysis and visualization through the NodeXL Program. Among the variables reviewed, the following stand out: parental psychological distress, risk factors, maternal characteristics, child characteristics, environmental characteristics, parent-infant relationship, and intervention. The main symptoms associated with parental stress were depression, anxiety and post-traumatic stress. Conclusion: The implementation of interventions aimed at the baby and the family’s well-being can minimize the conditions faced.

Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. Methods: 367 preterms born at p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). Conclusions: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

• Admitted newborns in neonatal intensive care unit had a high rate of initial colonization with gram-negative bacteria. • About 17% of colonizing gram-negative organisms were multi-drug resistant. • A high concordance was observed between early colonizing and early-onset bacterial infection. In this study, we aim to describe the patterns of early-life surface colonization with multi-drug resistant (MDR) organisms (MDROs) among newborns admitted to the neonatal intensive care unit (NICU). We conducted a retrospective descriptive study of infants with culture-positive external ear surface swabs performed immediately after admission to our NICU from January 1, 2017 – December 31, 2021. Clinical characteristics, culture and antibiotic susceptibility data were extracted from the department data collection and hospital electronic databases. A total of 314 infants were included - median 34 weeks gestation (interquartile range [IQR] 30, 38) and median birthweight 2147 g (IQR 1470, 2875). Of the 379 bacterial isolates obtained, 259 (68.3%) were gram-negative with Escherichia coli (149/379, 39.3%) and Klebsiella spp (57/379, 15.0%) the most common gram-negatives isolated. MDROs accounted for 17.4% (45/259) of gram-negative isolates. There was no methicillin-resistant Staphylococcus aureus (0/22 isolates) or vancomycin-resistant Enterococcus (0/68) detected among isolates tested. A total of 27 (8.6%) infants developed bacteremia, of which 21/27 (77.8%) had concordant bacteria isolated from surface cultures, with identical resistance patterns, and 4/21 (19.0%) isolates were MDROs. In our setting where gram-negative bacteria accounted for a high proportion of initial colonization, MDR gram-negatives accounted for up to 17% of colonizing gram-negative bacteria detected. [ABSTRACT FROM AUTHOR]

Objectives: Premature infants in the neonatal intensive care unit (NICU) are exposed to environmental risks that may cause developmental problems i. The present study aimed to investigate the predictive effect of individual and environmental factors on the motor performance of low birth weight preterm infants. Methods: This cross-sectional study was performed in the neonatal clinic of Shahid Akbarabadi Hospital in Tehran City, Iran. A group of 90 low birth weight infants were enrolled in the study by non-probabilistic method and according to the inclusion criteria. Test of infant motor performance (TIMP), sensory profile2 (infant section), affordance in the home environment for motor development (AHEMD), and a demographic questionnaire were used to evaluate motor performance, sensory status, home environment, and other factors (birth weight, corrected age, parent’s education, etc.), respectively. Results: TIMP elicited score was positively correlated with the infant’s age (r=0.390, P

Abstract Background Ethanol intoxications in newborns are generally due to false preparation of formula with alcoholics or alcohol consumption by the breastfeeding mothers. Rarely, intoxications occur in hospitalized newborns, e.g., from excessive use of alcoholic hand sanitizers. We herein report a strange case of acute ethanol intoxications in our NICU. Case presentation An extremely premature infant (23 0/7 weeks gestational age, birthweight 580 g) suffered from repeated life-threatening events with hemodynamic compromise, apnea, and lactic acidosis while being treated in our neonatal intensive care unit (NICU). Symptomatic treatment with intravenous fluids and, if necessary, intubation and catecholamine therapy led to recovery after several hours each time. The episodes eventually turned out to be severe ethanol intoxications brought about by breast milk contaminated with ethanol. The breast milk was supplied by the infant’s mother, who consumed non-trivial amounts of alcohol to build up her strength and make herself produce more milk, which was recommended to her by a family member. Additionally, she supplemented her own mother’s milk with cow’s milk because she was worried her baby was underserved with her milk. The mother admitted to this in intensive conversations with our team and a professional translator. Conclusions This unique case underlines how different cultural dynamics can attribute to life-threatening events in the care of premature infants. It is important for us to emphasize that intensive communication and building a confident relationship with the parents of patients is essential to the work on NICUs. Child safeguarding issues and possibilities of intoxications have to stay in mind even in a supposedly safe space like the NICU.

Background and Objectives: Hypocalcemia is one of the most common neonatal disorders that has a good prognosis if treated promptly and diagnosed correctly. This study aimed to determine the prevalence of hypocalcemia and associated factors in premature infants in Jiroft, southeastern Iran. Materials and Methods: In this cross-sectional study, the cases of infants born in the spring and summer of 2019 in Imam Khomeini Hospital in Jiroft, southeastern Iran, were examined by the census method. The required information was extracted from the infants' files and entered into SPSS24 software for analysis. Results: Based on the results of the study, out of 78 hypocalcemic premature neonates admitted to Imam Khomeini Hospital, 42 (53.8%) were boys and 36 (46.2%) were girls. Thirty-six (46.2%) infants had a birth weight of between 1,500 and 2,000 g, and 42 (35.8%) infants were born between 35 and 37 weeks of age. Most preterm infants (60.3%) had a diabetic mother. Moreover, the number of female preterm hypocalcemic infants with a weight of 2,000 to 2,500 g was higher than their male counterparts. Conclusion: The results of this study indicated that prematurity, weight less than 2,000 g, and maternal diabetes were the factors affecting hypocalcemia in preterm infants that should be considered in public health programs.

High-risk newborns are exposed to neonatal conditions such as prematurity, very low birth weight, and congenital malformations that can affect development and behavior. Coronavirus disease 2019 (COVID-19) restraint and control measures have been identified as important stressor events and cumulative risk factors for behavioral changes in these children. This study examined social isolation-related factors that contribute to internalizing and externalizing behavior problems in children already at risk for neurodevelopmental disorders. This cross-sectional, multicenter study included 113 children (18 months to 9 years) who were followed in reference services for neonatal follow-up in tertiary units of the public health system in the city of Rio de Janeiro, Brazil. Behavior was assessed using the child behavior checklist, and a structured questionnaire was used to assess sociodemographic aspects. In the bivariate analysis, prematurity was associated with externalizing problems and change in eating habits with internalizing problems. The logistic model indicated that both parents having completed high school and both sharing care of the child were protective factors for behavioral problems; however, reports of sleep problems and living with another child were risk factors. In conclusion, the study identified internalizing and externalizing behavior problems related to prematurity and aspects of family structure and routine in children at risk. The findings confirm the importance of family functioning for child health and family-centered interventions.

ObjectiveThis study aimed to analyze the correlation between PICC tip position and weight/length changes in preterm infants in different positions using ultrasonography.MethodsThe study is a prospective before and after self-control clinical trial. The study analyzed the distance between the PICC tip and the entrance of the heart under ultrasonography for premature infants who underwent PICC insertion. The infants were positioned and tracked weekly, and their weight and length were recorded. The Spearman rank correlation test was used to analyze the relationship between the displacement distance of the PICC tip under ultrasonography in different positions and weight/length changes.ResultsA total of 202 premature infants were included in the study, and 100% of them experienced changes in the PICC tip position. During the first week, 134 (66.33%) cases in a flexed position and 153 (75.74%) cases in a straight position showed displacement of the catheter toward the heart. The displacement distance of the tip during catheter retention was significantly correlated with weight change (rs = 0.681/0.661, P < 0.05) and length change (rs = 0.629/0.617, P < 0.05). In the third and fifth weeks, weight increased by 451 ± 178 and 750 (715–975) g, length increased by 1.50 (1.00–2.12) and 3.00 (2.00–3.70) cm, the catheter moved 1.27 ± 0.89 and 2.23 ± 0.95 cm, respectively, in a flexed position.ConclusionThe PICC tip position in preterm infants is influenced by weight and length changes. It is crucial to use ultrasonography to track and locate the catheter within the first week of placement and to increase the frequency of catheter localization starting from the third and fifth weeks. The flexed position is recommended during catheter localization.

BackgroundRegarding neonatal hypotension, there is no certainty as to whether inotrope properties are beneficial or whether they may be harmful. However, given that the antioxidant content of human milk plays a compensatory role in neonatal sepsis and that human milk feeding has direct effects in modulating the cardiovascular function of sick neonates, this research hypothesized that human milk feeds might predict lower requirements of vasopressors in the management of neonatal septic shock.MethodBetween January 2002 and December 2017, all late preterm and full-term infants attending a neonatal intensive care unit, with clinical and laboratory findings of bacterial or viral sepsis, were identified in a retrospective study. During their first month of life, data on feeding type and early clinical characteristics were collected. A multivariable logistic regression model was constructed to determine the impact of human milk on the use of vasoactive drugs in septic newborns.Results322 newborn infants were eligible to participate in this analysis. Exclusively formula-fed infants were more likely to be delivered via C-section, to have a lower birth weight and a lower 1-minute Apgar score than their counterparts. Human milk-fed newborns had 77% (adjusted OR = 0.231; 95% CI: 0.07–0.75) lower odds of receiving vasopressors than exclusively formula-fed newborns.ConclusionWe report that any human milk feeding is associated with a decrease in the need for vasoactive medications in sepsis-affected newborns. This observation encourages us to undertake further research to determine whether human milk feeds mitigate the use of vasopressors in neonates with sepsis.

Background: Treatment fidelity (TF) refers to methodological strategies used to monitor and enhance the reliability and validity of interventions. We evaluated TF in a pragmatic RCT of music therapy (MT) for premature infants and their parents. Methods: Two hundred thirteen families from seven neonatal intensive care units (NICUs) were randomized to receive standard care, or standard care plus MT during hospitalization, and/or during a 6-month period post-discharge. Eleven music therapists delivered the intervention. Audio and video recordings from sessions representing approximately 10% of each therapists' participants were evaluated by two external raters and the corresponding therapist using TF questionnaires designed for the study (treatment delivery (TD)). Parents evaluated their experience with MT at the 6-month assessment with a corresponding questionnaire (treatment receipt (TR)). All items as well as composite scores (mean scores across items) were Likert scales from 0 (completely disagree) to 6 (completely agree). A threshold for satisfactory TF scores (≥4) was used in the additional analysis of dichotomized items. Results: Internal consistency evaluated with Cronbach's alpha was good for all TF questionnaires (α ≥ 0.70), except the external rater NICU questionnaire where it was slightly lower (α 0.66). Interrater reliability measured by intraclass correlation coefficient (ICC) was moderate (NICU 0.43 (CI 0.27, 0.58), post-discharge 0.57 (CI 0.39, 0.73)). Gwet's AC for the dichotomized items varied between 0.32 (CI 0.10, 0.54) and 0.72 (CI 0.55, 0.89). Seventy-two NICU and 40 follow-up sessions with 39 participants were evaluated. Therapists' mean (SD) TD composite score was 4.88 (0.92) in the NICU phase and 4.95 (1.05) in the post-discharge phase. TR was evaluated by 138 parents. The mean (SD) score across intervention conditions was 5.66 (0.50). Conclusions: TF questionnaires developed to assess MT in neonatal care showed good internal consistency and moderate interrater reliability. TF scores indicated that therapists across countries successfully implemented MT in accordance with the protocol. The high treatment receipt scores indicate that parents received the intervention as intended. Future research in this area should aim to improve the interrater reliability of TF measures by additional training of raters and improved operational definitions of items. Trial registration: Longitudinal Study of music Therapy's Effectiveness for Premature infants and their caregivers – "LongSTEP". ClinicalTrials.gov Identifier: NCT03564184. Registered on June 20, 2018 [ABSTRACT FROM AUTHOR]

OBJECTIVE: To characterize clinical and epidemiological aspects of transfused neonates in Intensive and Special Care Units of a high-complexity Institution in Medellín, Colombia. MATERIALS AND METHODS: Retrospective descriptive study that included hospitalized neonates in intensive or special care units between 2017 and 2018 who received transfusions during their hospital stay. For data collection information from medical records was used. The data analysis was done in the SPSS software, average and standard deviation were calculated for quantitative variables, and for qualitative variables, proportions were estimated. This study had ethical approval. RESULTS: 175 patients were included, with an average gestational age at birth of 31 weeks and an average weight of 1610 grams. 52.9% of the population was female. The main diagnoses were prematurity 127 (72.6%), respiratory distress syndrome 93 (53.1%), sepsis 75 (42.8%), and unspecified anemia 53 (30.3%). 94.4% of the neonates were hospitalized in the intensive care unit, with a median hospital stay of 35 days. Discharge was the main outcome with 83.7%, followed by death with 11.6%. CONCLUSIONS: Red blood cell transfusion in the neonatal population was frequently used in those admitted to intensive and special care units, this intervention showed favorable results but the lack of data in the medical records as a retrospective study limits the establishment of further associations. [ABSTRACT FROM AUTHOR]

Background: Congenital hydrocephalus (CH) is a complicated syndrome that may be linked to a wide range of brain disabilities. It results from restricted cerebrospinal fluid flow either functionally or physically, causing advanced cerebral ventricular dilation and compression of brain tissue. The physical characteristics of CH are persistent open anterior fontanelle, dome shape head, and ventrolateral strabismus on both sides. There are also, headache, nausea, crossing normal centile lines, sunset eyes, distended scalp veins, delayed development, poor feeding, as well as Parinaud’s syndrome and possible abducent nerve palsy. CH is linked to variable risk factors including prematurity, congenital infections, maternal pathologies, medications, alcohol use, trauma and tumors. It may be related to other congenital abnormalities like spina bifida, aqueductal stenosis, ArnoldChiari and Dandy-Walker anomalies. This review summarizes CH as regards the pathophysiology, risk factors, genetics, clinical picture, and associated CNS defects, providing information that can help in prevention of some cases of CH. Conclusion: Protection of infants against CH could be achieved by avoiding risk factors, early diagnosis and proper management. [ABSTRACT FROM AUTHOR]

Magnesium sulfate (MgSO 4) is a common substance administered to pregnant women with preeclampsia or eclampsia to prevent and treat seizures or gestational hypertension. This study aimed to evaluate whether administering maternal magnesium sulfate increased the risk of early-onset hyperkalemia in preterm infants. This single-center, propensity score-matched, case–control study examined preterm infants born within 24–36 weeks of gestation using electronic medical records between January 2015 and June 2019, in the Saitama City Hospital, Japan. We categorized infants according to their maternal MgSO 4 administration status. After adjusting for perinatal information and maternal treatment, we compared the incidence of the variables, including neonatal hyperkalemia, within 24 h after birth between the matched cohorts. All infants in Model 1 were analyzed separately, while in Model 2 infants with birth weight of less than 1000 g were excluded. We enrolled 421 infants (maternal MgSO4 group, 124; control group, 297). Ninety-five infants in Model 1 and 86 in Model 2 were matched in each group using propensity scores, respectively. In the matched cohorts of both models, infants in the maternal MgSO 4 group had a higher hyperkalemia incidence than did those in the control group (42.1% vs. 7.4% in Model 1, 44.2% vs. 5.8% in Model 2, respectively; p < 0.0001). However, there was no relationship between the duration of intrauterine exposure to MgSO 4 and early-onset neonatal hyperkalemia incidence. Our study demonstrated that maternal MgSO 4 administration, even for a short period of time, may increase the risk of early-onset hyperkalemia in preterm infants. Accordingly, physicians should be cautious when administering serum potassium to infants born to mothers administered MgSO 4 , especially within 24 h after birth. [ABSTRACT FROM AUTHOR]