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Introduction: Introduction: the follow-up of small for gestational age (SGA) preterm infants is critical due to their differentiated postnatal growth pattern. Objective: to investigate the weight z-score behavior in SGA preterm infants during a four-week stay in a Neonatal Intensive Care Unit. Methods: a retrospective longitudinal study with data from nutritional anamneses of 190 preterm infants admitted to a Neonatal Intensive Care Unit between January/2017 and December/2019, classified according to nutritional status at birth as either SGA or appropriate for gestational age (AGA). Linear regression was used to verify association between weight z-score with gestational age, birth weight, initiation of enteral nutrition and relative amount of energy and protein administered. Results: SGA preterm infants accounted for 23 % of the study participants. In SGA, the difference in weight score was observed at week 1 when compared to admission (p < 0.05), while in AGA there was a difference sustained during the whole period (p < 0.05). In SGA, the linear regression analysis showed that the change in z-score was explained by time to start of enteral nutrition (p = 0.033), gestational age (p = 0.003) and birth weight (p = 0.001). In AGA the change was explained by gestational age (p = 0.000) and birth weight (p = 0.000). Conclusion: the weight z-score behavior in preterm infants was downward compared to admission, stable at the end of 4 weeks, and different according to nutritional status at birth. In the AGA group the decline in nutritional status was not recovered throughout hospitalization and in the SGA group the unfavorable nutritional status was maintained. [ABSTRACT FROM AUTHOR]

Examination for retinopathy of prematurity (ROP) is a very painful procedure. Therefore, pain management is essential given the possibility of sensory and behavioral problems in newborns, who are constantly exposed to painful stimuli. In this light, the use of nonpharmacological methods alone or in combination with pharmacological methods is recommended for pain control. This systematic review and meta-analysis was to evaluate the effects of nonpharmacological treatments on pain during ROP examination. Randomized controlled trials published in English between 2011 and 2021 and available in the electronic databases of Medline, Web of Science, Nursing & Allied Health, and PubMed were reviewed. The meta-analysis was performed using Review Manager 5.4. Six randomized controlled studies were included. Glucose (mean difference [MD]: −1.64, 95% confidence interval [CI]: −2.34 to 0.94, P <.0001) and sucrose (MD: −2.50, 95% CI: −3.20 to −1.79, P <.0001) solutions were effective in reducing pain. However, breast milk did not reduce the Premature Infant Pain Profile score (MD: −2.50, 95% CI: −6.10 to 1.10, P >.05). The application of sucrose and glucose solutions for pain management during ROP examination can be effective and safe. [ABSTRACT FROM AUTHOR]

Intraventricular hemorrhage (IVH) is a serious problem in preterm infants. Brazilian national data are unknown. To evaluate the incidence and temporal trend of IVH in very low birth weight (VLBW) preterm infants of 18 centers of the Brazilian Network on Neonatal Research. National prospective multicenter cohort study including inborn VLBW preterm infants aged 230/7- 336/7 weeks' gestation, admitted between 2013 and 2018. The center with the mean incidence rate was used as reference. We applied two adjustments models using perinatal variables, and perinatal + neonatal diseases. Of 6,420 infants, 1951/30.4% (range 27.1–33.8%) had IVH and the disease showed a significant trend towards an overall increase in incidence over time (p = 0.003), especially in three centers. Severe IVH (grade III or IV) occurred in 32.2% (range 29.2–34.5%) of those affected by IVH, with a stable incidence. After adjustments for perinatal variables, the differences persisted among centers: for global IVH, 7 centers had significantly lower rates (OR ranging from 0.31 to 0.62), and 2 presented rates higher than the reference center (OR ranging from 2.00 to 12.46) for severe HIV. Considering perinatal and neonatal variables, 6 centers had significantly lower rates (OR ranging from 0.36 to 0.60) for global IVH than the reference center and 3 had statistically higher rates (OR 1.72, 1.86 and 11.78) for severe forms. The incidence rate of IVH in this Brazilian cohort was high and it revealed an increasing trend towards over time. The severe IVH rate was also worrisome. • This study provided a multicenter evaluation of the trend of IVH rate in very low birth weight Brazilian preterm infant. • The incidence of global and severe IVH showed a broad variation among the centers, and there was an increasing trend in frequency. • The results may provide an instrument to be employed in quality improvement programs in Brazilian hospitals. [ABSTRACT FROM AUTHOR]

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Background: Retinopathy of Prematurity (ROP) is a pathologic condition in the retina characterized by abnormal vasoproliferation. We aim to investigate the correlation of different birth- and hospitalizationrelated factors in the progression of ROP. Methods: This historical cohort study performed in the ophthalmology center of Ayatollah Rouhani Hospital in Babol (Babol University of Medical Sciences, Babol, Iran), included 828 infants (gestational age <35 weeks and birth weight <2500 g). Also, data were collected from the history of hospitalized premature infants. Results: The lower gestational weight of infants has been observed in ROP infants (1418.05±547.09 g) compared to non-ROP infants (1917.31±486.01 g) (p<0.001). In addition, the average gestational age of ROP infants (30.28±2.34 weeks) was younger than non-ROP infants (33.26±1.00 weeks) (p=0.042). Increase in the duration of hospitalization increased 6% the chance of ROP in infants (OR=1.06; 95%CI: [1.05,1.08]) (p<0.001). Furthermore, increase in the count of blood replacement decreased 29% the chance of complete remission of ROP (OR=0.71; 95%CI: [0.51,0.95]) (p=0.029). The blood group does not have an impact on ROP development or remission. Conclusion: More birth weight of premature infants is associated with less chance of ROP incidence. Moreover, the lower gestational age is related to more chances of ROP. [ABSTRACT FROM AUTHOR]

Copyright of Výživa a Potraviny is the property of Spolecnost pro Vyzivu 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.)

Incubator care is essential for premature infants during early hospitalization. As the infants' conditions improve, incubator weaning becomes necessary. This retrospective study aimed to evaluate the effect of body weight gain and status of intake-calorie gain on the incubator weaning process for very low birth weight (VLBW) premature infants. The study included 127 VLBW premature neonates. We analyzed data on clinical characteristics potentially associated with the weaning period and the end-weaning body weight (EWBW), including body weight gain status, intake-calorie gain status, and disease conditions. The neonates were weaned from the incubators at a mean postmenstrual age (PMA) of 35.1 ± 1.3 weeks; postnatal days, 37.7 ± 18.2 days; and body weight, 1882.8 ± 157.1 g. The total weaning period was 3.5 ± 3.1 days. Regarding the weaning period, there was a strong positive relationship only in the end-weaning PMA and the daily body weight within 3 days before incubator weaning. Further, regarding the factors associated with EWBW, only the end-weaning PMA and necrotizing enterocolitis had a significant positive impact. Body weight gain and the status of intake-calorie gain showed no association with either the weaning period or the EWBW and, thus, were not related to the incubator weaning process. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: La retinopatía del prematuro (ROP) se caracteriza por el desarrollo vascular insuficiente en la retina que, en los casos severos precisa tratamiento precoz para evitar secuelas visuales. Es actualmente la segunda causa mundial de ceguera infantil prevenible. Pacientes y métodos: Estudio observacional, retrospectivo, de casos-controles sobre 233 recién nacidos prematuros explorados entre 1999-2019. Resultados: La ganancia de peso posnatal en las primeras 4 semanas, el peso al nacer, la edad gestacional, la ventilación mecánica, las transfusiones recibidas y la presencia de sepsis, ductus arteriovenoso persistente, enterocolitis necrosante, hemorragia intraventricular o leucomalacia periventricular, mostraron diferencias significativas entre el grupo de ROP no susceptible de tratamiento frente al grupo candidato a tratamiento. La ganancia ponderal media fue 12,75 ± 5,99 g/día en el grupo no susceptible de tratamiento y 9,50 ± 5,45 g/día en el susceptible de tratamiento. El riesgo de ROP candidata a tratamiento se redujo progresivamente con el aumento de ganancia ponderal. La reducción del riesgo fue de 2,76 - 8,35% en ganancias de 10 g/día, y alcanza el 7,17 - 12,76% en ganancias de 20 g/día. Conclusiones: El riesgo de presentar ROP severa candidata a tratamiento disminuye con el aumento de la ganancia de peso posnatal en las primeras 4 semanas. Esta relación se mantiene en ganancias de peso > 14 g/día. Sin embargo, se deben tener en cuenta la edad gestacional y peso al nacer del recién nacido, la duración de la ventilación mecánica y su comorbilidad para la evaluación global del riesgo de ROP que precisa tratamiento. Abstract: Introduction: Retinopathy of prematurity (ROP) is characterised by insufficient vascular development in the retina, and requires early treatment to avoid visual disability in severe cases. ROP is currently the second leading cause of preventable child blindness in the world. Patients and methods: This was an observational, retrospective, case-control study including 233 preterm infants examined between 1999 and 2019. Results: Postnatal weight gain in the first 4 weeks of life, birth weight, gestational age, mechanical ventilation, transfusion, presence of sepsis, persistence of arterial ductus, necrotising enterocolitis, intraventricular haemorrhage, or periventricular leukomalacia were found to be significantly different between the ROP groups requiring and not requiring treatment. The mean postnatal weight gain in the ROP group not requiring treatment was 12.75 ± 5.99 g/day, whereas it was 9.50 ± 5.45 g/day in the ROP group requiring treatment. The risk of developing ROP that required treatment decreased with an increase in weight gain. The risk reduction was 2.76 - 8.35% in preterm infants gaining 10 g/day, and 7.17 - 12.76% in infants gaining 20 g/day. Conclusions: The risk of developing ROP requiring treatment decreased with increasing weight gain in the first 4 weeks of life. This was applicable in infants with postnatal weight gain ≥ 14 g/day. However, gestational age, birth weight, time of mechanical ventilation, and comorbidity should be taken into account when evaluating the risk of ROP requiring treatment.

Abstract Background Necrotising enterocolitis (NEC) is a devastating bowel disease, primarily affecting premature infants, with a poorly understood aetiology. Prior studies have found associations in different cases with an overabundance of particular elements of the faecal microbiota (in particular Enterobacteriaceae or Clostridium perfringens), but there has been no explanation for the different results found in different cohorts. Immunological studies have indicated that stimulation of the TLR4 receptor is involved in development of NEC, with TLR4 signalling being antagonised by the activated TLR9 receptor. We speculated that differential stimulation of these two components of the signalling pathway by different microbiota might explain the dichotomous findings of microbiota-centered NEC studies. Here we used shotgun metagenomic sequencing and qPCR to characterise the faecal microbiota community of infants prior to NEC onset and in a set of matched controls. Bayesian regression was used to segregate cases from control samples using both microbial and clinical data. Results We found that the infants suffering from NEC fell into two groups based on their microbiota; one with low levels of CpG DNA in bacterial genomes and the other with high abundances of organisms expressing LPS. The identification of these characteristic communities was reproduced using an external metagenomic validation dataset. We propose that these two patterns represent the stimulation of a common pathway at extremes; the LPS-enriched microbiome suggesting overstimulation of TLR4, whilst a microbial community with low levels of CpG DNA suggests reduction of the counterbalance to TLR4 overstimulation. Conclusions The identified microbial community patterns support the concept of NEC resulting from TLR-mediated pathways. Identification of these signals suggests characteristics of the gastrointestinal microbial community to be avoided to prevent NEC. Potential pre- or pro-biotic treatments may be designed to optimise TLR signalling.

We present a case of a transient acquired zinc deficiency in a breast-fed, 4-month-old-male prematurely born infant, with acrodermatitis enteropathica-like symptoms such as crusted, eroded, erythemato-squamous eruption in periorificial and acral patterns. The laboratory investigations showed low zinc levels in the infant’s and the mother’s serum and in the mother’s milk; genetic analysis did not show any mutation in the SLC39A4 gene, involved in acrodermatitis enteropathica. Acquired zinc deficiency is often found in premature infants because of their increased requirement, the low serum and milk zinc levels in breastfeeding women being also an important risk factor, as in this case. A prompt zinc supplementation is essential for the good prognosis of the disease.

Objectives: To develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. Methods: Three examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31–45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers’ satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). Results: The scorers’ satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p

A continuous real-time video monitoring for preterm infants that suffer from fragile condition attracts increasing attention due to its significance in the early screening of diseases. Specially, the limb movement recognition of preterm infants in neonatal intensive care units (NICUs) plays an important role for assessing the health status of preterm infants. The main challenges of the preterm infant limb movement recognition are arisen from the irregular movement speed and the multi-limb classification. To address these issues, a novel convolution graph recognition network (CGRN) is proposed by integrating three-dimensional (3D) convolution neural networks (CNNs) with graph convolution networks (GCNs). Particularly, the spatial–temporal frequency characteristics of different channels in 3D CNN generally have poor adaptability to characterize fast limb movement. Thus, GCN is merged to enhance the channel connection and improve the capabilities of representation learning. The node filtering and topological connection are learned by GCN to establish dependencies among different channels. A fusion multi-label loss function consisting of the Binary Cross Entropy (BCE) and the Multi-label Soft-Margin (MSM) loss is further developed to train the proposed CGRN. Experiments on the preterm Infant Activity Dataset (IAD) are conducted to demonstrate the effectiveness of the proposed CGRN algorithm. The ablations studies indicate that the structure optimization process and the auxiliary performance of Laplace matrices are worked effectively, and the proposed CGRN obtains the average accuracy of 94.1%, the CF1 value of 88.4%, and the OF1 score of 91.7%. • A novel CGRN is developed for limb movement recognition of premature infants. • The CNN is used to reduce GCN's dependence on formatted data. • The Laplacian matrix is used to represent the relationship of feature channels. • Model fusion addresses CNN channel independence and GCN data restrictions. • Unlike the fully connected layer, the GCN layer uses Laplacian matrix weighting. [ABSTRACT FROM AUTHOR]

BackgroundWhile black mothers initiate human milk (HM) provision at lower rates than non-black mothers in the United States, some neonatal intensive care units (NICUs) report similar initiation rates regardless of race/ethnicity for mothers of very-low-birth-weight (VLBW) infants. However, racial disparity frequently becomes evident in the proportion of black infants who continue to receive HM feedings at NICU discharge. Since social factors have been associated with differences in HM provision for term infants, we sought to identify differences in social factors associated with HM feeding at discharge based on race/ethnicity.Materials and methodsA prospective cohort study of racially diverse mothers of VLBW infants measured social factors including maternal education, breastfeeding support, return to work/school, HM feeding goal, previous breastfeeding, or formula experience. Multivariate logistic regression modeling was applied to social factors to predict HM feeding at discharge. Additional regression models were created for racial/ethnic subgroups to identify differences.ResultsFor all 362 mothers, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and maternal goal near time of discharge of providing any HM negatively and positively predicted HM feeding at discharge, respectively. Perceived breastfeeding support from the infant's maternal grandmother negatively predicted HM feeding at discharge for black mothers.ConclusionsFuture interventions to increase duration of HM provision in VLBW infants should focus on the establishment and maintenance of maternal HM feeding goals. Further studies of the familial support system of black mothers are warranted to determine multigenerational impact and potential interventions.

OBJECTIVE: To determine the frequency of dermatological diagnoses in preterm newborns and the associated perinatal factors. METHODS: This is a cross-sectional analytical study with a convenience sample and prospective data collection, carried out between November 2017 and May 2018. Were examined 151 premature and late preterm neonates admitted to the neonatal intensive care unit in a hospital of tertiary care level. The studied population was evaluated to evidence, describe and photograph the dermatological diagnoses present up to 28 days of life. RESULTS: The frequency of dermatological diagnoses was 99.3%, being the most observed: lanugo in 128 newborns (84.7%), salmon spot in 115 (76.1%), sebaceous hyperplasia in 89 (58. 9%), physiological flaking in 74 (49%), mongolian stain in 54 (35.7%), Epsteins pearl in 43 (28.4%), traumatic skin lesions in 42 (27.8%), milia cyst in 40 (26.4%), jaundice in 36 (23.8%) and toxic erythema in 20 (13.2%). Participants with a higher gestational age had a higher frequency of salmon spot, toxic erythema, mongolian spot, sebaceous hyperplasia, milia cyst and Epsteins pearl. CONCLUSION: Dermatological diagnoses were frequent and those of older gestational age had a higher frequency of physiological changes and birthmarks. Traumatic skin lesions were among the 10 most frequently observed, reinforcing the need to implement protocols for neonatal skin care, with emphasis on premature infants.

ObjectiveWe developed a fiberoptic-assisted tracheoscopy (FAST) method to avoid direct laryngoscopy during surfactant replacement therapy and compared two training approaches on a very low birth weight (VLBW) infant simulator.DesignThis prospective randomized controlled study was conducted at the Department of Neonatology and Pediatric Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf, Germany.ParticipantsWe recruited physicians, trainees, students, and nurses without prior experience in endoscopic techniques.InterventionsParticipants were assigned randomly to a group that received instructions according to Peyton’s Four-Step Approach and a control group that received standard bedside teaching only.Main outcome measuresPrimary endpoints were the total and the component times required to place the bronchoscope and the method success.ResultsWe recruited 186 participants. Compared with the control group, the Peyton group had a lower mean (±standard deviation) FAST completion time (33.2 ± 27.5 s vs. 79.5 ± 47.9 s, p < 0.001; d = 1.12) and a higher FAST success rate (95% vs. 84%, p = 0.036, V = 0.18).ConclusionAfter standardized training, the vast majority of novices completed FAST successfully. Peyton’s four-step approach resulted in faster and more successful performance than standardized training.

Objective: Attachment is a socio-emotional relationship between the mother and infant that increases the probability of a preterm infant's survival. This study aimed to evaluate the effectiveness of Kangaroo Mother Care (KMC) on maternal attachments of mothers with premature infants. Study design: This quasi-experimental study was performed on 100 mothers of premature infants who were admitted to neonatal intensive care units. A questionnaire comprising demographic information and the Maternal Attachment Scale were used as data collection tools. All data analysis was performed using SPSS software version 25. Significant level is considered P

BackgroundHuman milk (HM) for premature infants is frequently Holder pasteurized (heated at 62.5 ± 0.5°C for 30 min) despite its detrimental effects on heat-sensitive milk components. This tolerated compromise ensures HM's microbial safety while less detrimental methods like short-time HM treatments (HTST) are still being evaluated. Dry-tempering devices (DT-HoP) were recently introduced in clinical practice due to hygienic concerns about water-based Holder pasteurizers (WB-HoP). Evidence on the impact of such dry-tempering devices on HM quality is lacking. The aim of this study was to compare protein retention rates after DT-HoP, WB-HoP and HTST.MethodsWe colorimetrically determined alkaline phosphatase activity (ALP), concentrations of secretory immunoglobulin A (sIgA), and lactoferrin (LF) before and after DT-HoP, WB-HoP and HTST.ResultsALP was below the detection limit after HoP, but retained 52.8 ± 13% activity after HTST (p < 0.01). Secretory IgA (WB-HoP = 73.2 ± 13.5% vs. DT-HoP = 57 ± 14%, p = 0.0018) and LF retention (WB-HoP=47 ± 40% vs. DT-HoP=25 ± 8%, p = 0.07) differed between the two HoP modes. Again, retention was better maintained after HTST compared to HoP (80.4 ± 23% sIgA and 70 ± 42% LF concentration, all p < 0.01).ConclusionDry-tempering milk lowers even further the quality of HM when performing HoP compared to water-bath pasteurization, while HTST warrants continued evaluation for clinical application.

Background Prematurity is a risk factor of neonatal sepsis and its associated morbidities and mortality. Most deaths in neonatal sepsis occur within the first seven days. Presepsin has been reported as one of the earliest biomarkers for predicting mortality. Objective To determine the association between presepsin levels and mortality risk, as well as the optimal presepsin cut-off point for predicting mortality, in premature infants with neonatal sepsis .Method This was an observational prospective cohort study on 62 preterm infants born at 28 to 1057 ng/mL was associated with increased mortality [RR 3.02; 95%CI 68.3 to 89.4; P

Abstract Objectives: to investigate the association between Vertically Transmitted Infections (VTI) and Extrauterine Growth Restriction (EUGR) among premature infants in Neonatal Intensive Care Units (NICU). Methods: part of a large non-concurrent cohort study with medical records analysis. We evaluated EUGR in premature infants at a gestational age at birth of > 32 weeks and

Understand how high-risk infants' development changes over time. Examine whether NICU Network Neurobehavioral Scale (NNNS) profiles are associated with decrements in developmental outcomes between ages 2 and 3 years in infants born very preterm. The Neonatal Outcomes for Very preterm Infants (NOVI) cohort is a multisite prospective study of 704 preterm infants born <30 weeks' gestation across nine university and VON affiliated NICUs. Data included infant neurobehavior measured by NNNS profiles at NICU discharge and the Bayley Scales of Infant and Toddler Development (BSID-III) at ages 2 and 3 years. Generalized estimating equations tested associations between NNNS profiles and BSID-III composite score changes between ages 2 and 3 years. The final study sample included 433 infants with mean gestational age of 27 weeks at birth. Infants with dysregulated NNNS profiles were more likely to have decreases in BSID-III Cognitive (OR = 2.66) and Language scores (OR = 2.53) from age 2 to 3 years compared to infants with more well-regulated neurobehavioral NNNS profiles. Further, infants with more well-regulated NNNS profiles were more likely to have increases in BSID-III Cognitive scores (OR = 2.03), rather than no change, compared to infants with dysregulated NNNS profiles. Prior to NICU discharge, NNNS neurobehavioral profiles identified infants at increased risk for developing later language and cognitive challenges. Findings suggests that neonatal neurobehavior provides a unique, clinically significant contribution to the evaluation of very preterm infants to inform treatment planning for the most vulnerable. • Very preterm infants (VPI) are at a heightened risk for poor developmental outcomes. • VPI with dysregulated neurobehavioral profiles at NICU discharge were at highest risk. • These infants were more likely to have decrements in cognitive and language scores from 2 to 3 years. • Neurobehavior profiles can prospectively identify VPI at highest risk for poor outcomes. [ABSTRACT FROM AUTHOR]

Exposure to repetitive pain during the neonatal period has been shown to have important short and long-term effects on the neurodevelopment of the premature neonate and can contribute to experienced prolonged pain. A uniform taxonomy of neonatal prolonged pain is still lacking to this day which contributes to suboptimal prolonged pain management in neonatal intensive care units. Accordingly, a scoping review exploring the state of knowledge about prolonged pain in preterm neonates hospitalised in the neonatal intensive care unit will contribute to the developing field of neonatal prolonged pain and provide recommendations for clinical prolonged pain management. To determine the scope, extent, and nature of the available literature on prolonged pain in premature neonates hospitalised in neonatal intensive care units. Scoping review. An electronic search was conducted from inception to November 2023 in the databases of CINAHL, PubMed, Medline, Web of Science, GeryLit.org and Grey Source Index. Included studies discussed concepts related to neonatal prolonged pain such as definitions of prolonged pain, indicators of prolonged pain, contexts that result in prolonged pain, prolonged pain evaluation tools, consequences of prolonged pain and interventions for prolonged pain management. Key concepts of neonatal prolonged pain were identified in the 86 included articles of this scoping review such as definitions (n = 26), indicators (n = 39), contexts (n = 49), scales (n = 56), consequences of prolonged pain (n = 30) and possible interventions for prolonged pain management (n = 22). Whilst a consensus on a definition has yet to be achieved, no proximate event was shown to cause prolonged pain and a time criterion was identified by authors as being relevant in defining prolonged pain. Interestingly, the context of hospitalisation was identified as being the most indicative of prolonged pain in premature neonates and should guide its evaluation and management, whilst only limited pain management interventions and consequences were discussed. The findings of this scoping review contribute to the foundation of growing knowledge in neonatal prolonged pain and shed light on the ambiguity that currently exists on this topic in the scientific literature. This review summarises knowledge of key concepts necessary for a better understanding of prolonged pain and stresses the importance of considering contexts of hospitalisation for prolonged pain evaluation and management in neonatal intensive care units, with the objective of improving developmental outcomes of premature neonates. A scoping review reveals that the contexts of prolonged pain in premature neonates hospitalised in the neonatal intensive care unit are essential in guiding its evaluation and management. [ABSTRACT FROM AUTHOR]

Background: Preterm infants have a low level of bone mineralization compared to those born at term, since 80% of calcium incorporation occurs at the end of pregnancy. The purpose of the present study was to investigate the effect of reflex locomotion therapy on bone modeling and growth in preterm infants and to compare its effect with those of other Physiotherapy modalities.Methods: A multicentre randomized controlled clinical trial was conducted (02/2016 - 07/2020). 106 preterm infants born at the Virgen de la Arrixaca University Clinical Hospital, the General University Hospital of Elche and the Torrecárdenas University Hospital of Almería, between 26 and 34 weeks with hemodynamic stability, complete enteral nutrition and without any metabolic, congenital, genetic, neurological or respiratory disorders were evaluated for inclusion. Infants were randomly assigned to three groups: one group received reflex locomotion therapy (EGrlt); another group received passive mobilizations with gentle joint compression (EGpmc); and the control group received massage (CG). All treatments were carried out in the neonatal units lasting one month. The main outcome measure was bone formation and resorption measured with bone biomarkers. A mixed ANOVA was used to compare the results of bone biomarkers, and anthropometric measurements.Results: Infants were randomized to EGrlt (n = 38), EGpmc (n = 32), and CG (n = 36). All groups were similar in terms of gender (p = 0.891 female 47.2%), gestational age (M = 30.753, SD = 1.878, p = 0.39) and birth weight (M = 1413.45, SD = 347.36, p = 0.157). At the end of the study, significant differences were found between the groups in their interaction in bone formation, measured with osteocalcin [F (2,35) = 4.92, p = 0.013, ηp2 = 0.043], in benefit of the EGrlt.Conclusions: Reflex locomotion therapy has been effective in improving bone formation, more so than other Physiotherapy modalities. Therefore, reflex locomotion therapy could be considered one of the most effective physiotherapeutic modalities for the prevention and treatment of osteopenia of prematurity.Trial Registrstion: Trial retrospectively registered at ClinicalTrials.gov. First posted on 22/04/2020.Registration Number: NCT04356807 . [ABSTRACT FROM AUTHOR]

• A preterm baby boy presenting with fetal hydrops and bilateral pleural effusions at birth. High output chylothorax bilaterally that persisted during hospitalization, requiring continuous fluid replacement. • Autopsy findings confirmed X-linked myotubular myopathy and primary pulmonary lymphangiectasia. We hypothesized a possible pathophysiological sequence to explain an association between two primary conditions. • This case highlights the importance of considering congenital myopathies as a possible differential diagnosis in fetal hydrops, particularly in cases deemed to be idiopathic. Chylothorax has been reported in rare cases of X-linked myotubular myopathy, but the pathophysiology of this association is not fully understood. We report a case of a neonate presenting prenatally with hydrops and chylothorax. The patient died at 17 days of life due to respiratory failure secondary to severe pulmonary hypertension. Comprehensive genetic testing identified a de novo hemizygous frameshift mutation in the MTM1 gene (c.142-143del, p.Glu48Serfs*12) with subsequent autopsy confirming the diagnosis of X-linked myotubular myopathy. Lung microscopy demonstrated primary pulmonary lymphangiectasia as the cause for the massive chylothorax. To the best of our knowledge, this is the first reported case of molecularly confirmed X-linked myotubular myopathy with pulmonary lymphangiectasia with prenatal findings of hydrops, chylothorax and postnatal severe pulmonary hypertension. [ABSTRACT FROM AUTHOR]

• A prior RCT of Family Nurture Intervention (FNI) improved outcomes of preterm infants and increased brain activity at term age. • This study replicated these findings at two NICUs providing strong support that FNI enhances brain activity of preterm infants. • A nurture-based intervention that fosters mother-infant emotional connection may have profound effects on early brain development. This trial (RCT-2) sought to replicate the EEG findings of a randomized controlled trial of Family Nurture Intervention in the NICU (FNI-NICU) (RCT-1) comparing infants receiving standard care (SC) with infants receiving SC plus FNI. RCT-2 (NCT02710474) was conducted at two NICUs. Subjects were randomly assigned to receive SC or FNI during their NICU stay. The primary outcome was EEG power in the frontal polar region at 39–41 weeks gestational age (GA). Sixty preterm infants (26–34 weeks GA; 33 SC, 27 FNI) were assessed. FNI-NICU consisted of repeated calming sessions (∼4 times/week) facilitated by Nurture Specialists during which mothers engaged in emotional expression during clothed or skin-to-skin holding, vocal soothing, and eye contact. EEGs were collected from 128 leads. EEG power was computed using Fast Fourier Transforms. RCT-2 replicated RCT-1 results; FNI-NICU led to significantly increased frontal polar power at frequencies > 12 Hz. Effects were spatially more widespread than in RCT-1, with substantial effect sizes (∼0.50) in frontal and parietal regions. RCT-2 results provide further evidence that FNI-NICU increases term age brain activity. FNI-NICU is designed to facilitate autonomic emotional connection and coregulation between mothers and infants in the NICU resulting in profound effects on early brain development. [ABSTRACT FROM AUTHOR]

Background: Premature neonates require assisted heating devices for thermoregulation in the neonatal intensive care unit (NICU). Traditional use of a cloth blanket and cloth towels during peripherally inserted central catheter (PICC) placement may hinder heat transfer from the assisted heating mechanisms, increasing the risk for neonatal hypothermia.Purpose: This quality improvement project's goal was to reduce the hypothermia rate in very low birth-weight (VLBW) neonates by replacing cloth blanket/towels with a plastic drape during PICC placement.Methods: The FOCUS-PDSA method was used to implement the intervention (plastic drape) over 3 months, during 58 PICC procedures in a level 3 NICU. A pre-/posttest design was used to evaluate the impact of the intervention on hypothermia rates compared with a baseline cloth group and a concurrent cloth cohort.Results: After the 3-month implementation period, the hypothermia rate for the intervention group was lower than that for the baseline cloth group (5.2% and 11.3%, respectively), but this difference was not statistically significant. Post-PICC hypothermia rates were significantly lower for the intervention group than for the concurrent cloth cohort (P = .004).Implications For Practice: Preliminary evidence demonstrated the plastic drape reduced the hypothermia rate in the NICU for VLBW neonates during PICC placement compared with cloth blanket/towels. A plastic drape shows promise in improving nursing practice by providing improved thermoregulation for premature neonates during PICC placement.Implications For Research: Further research is recommended to replicate findings with larger samples of PICC insertions, using a plastic drape in the operating room and other NICU procedures. [ABSTRACT FROM AUTHOR]

Background: Access to donor human milk (DHM) has primarily been based on the health and development outcomes of premature infants but there has been little examination of the broader impact of an infant receiving it upon parental mental health. Breastfeeding and mental health are closely tied with women who experience breastfeeding difficulties or are unable to meet their own breastfeeding goals often experiencing feelings of guilt, sadness and anger, alongside an increased risk of postnatal depression. The aim of the current study was to explore how experience of receiving DHM for their baby affected the wellbeing of parents.Methods: UK parents of infants aged 0 - 12 months who had received screened DHM from a milk bank (typically on the neonatal unit or in some cases in the community) completed an online questionnaire exploring their experiences. The questionnaire included Likert scale items examining perceived impact upon infant health, own wellbeing and family functioning alongside open-ended questions exploring perceptions of how receiving DHM affected wellbeing.Results: Almost all of the 107 participants (women = 102) agreed that receiving DHM had a positive impact upon infant health and development, their own mental and physical health, and their family's wellbeing. Parents felt relieved that their infant was receiving DHM for health reasons but also due to the experience of being listened to, supported and having their infant feeding decisions facilitated. Receiving DHM helped mothers to process some of their emotions at not being able to breastfeed, in part because knowing their baby was being fed gave them the space to focus on recovery and bonding with their baby. Some parents did experience challenges, feeling guilty at receiving DHM, insecure that another woman was able to feed their baby when they could not, or negative reactions from family. Although the impact of receiving DHM upon breastfeeding was not measured, some women who were working to build their own milk supply noted that it helped motivate them to continue.Conclusions: DHM may play an important role not only in protecting infant health and development but in supporting the mental health and wellbeing of mothers for whom their infant receiving human milk is important. [ABSTRACT FROM AUTHOR]

There is no current theory that explains the process of a fathers' bonding with their infants born prematurely. Through meta-synthesis of 19 qualitative studies, we developed a conceptual framework to illustrate how fathers perceive the relationship with their premature infant formed over the first 18 months of life. It details the contextual factors that contribute to that process. Findings reveal a complex process comprised of five stages, derived from five core themes and related subthemes. Fathers progress through five sequential stages to establish their role as fathers and form emotional connections with their child. Stages include: (a) feeling alien and lacking emotional connection to the infant, (b) caregiving engagement and claiming the role as a father, (c) claiming the infant as their own, (d) adjusting to having the infant home, and (5) normalizing family life. This conceptual framework can inform future research and clinical interventions designed to foster father−infant bonding. [ABSTRACT FROM AUTHOR]

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Neonatal respiratory distress syndrome (RDS) is a condition of pulmonary surfactant insufficiency in the premature newborn. As such, artificial pulmonary surfactant administration is a key treatment. Despite continued improvement in the clinical outcomes of RDS, there are currently no established bedside tools to monitor whether pulmonary surfactant is effectively instilled throughout the lungs. Electrical impedance tomography (EIT) is an emerging technique in which physiological functions are monitored on the basis of temporal changes in conductivity of different tissues in the body. In this preliminary study, we aimed to assess how EIT tidal volumes correlate with ventilator tidal volumes in an RDS animal model, namely untreated, surfactant-treated, and normal control rabbit pups. Tidal volumes were measured simultaneously on an EIT system and a mechanical ventilator and compared at different peak inspiratory pressures. The linear correlation between tidal volumes measured by EIT and by ventilator had an R 2 of 0.71, 0.76 and 0.86 in the untreated, surfactant-treated, and normal control groups, respectively. Bland–Altman analysis showed a good correlation between the measurements obtained with these two modalities. The intraclass correlation coefficients (ICC) between ventilator tidal volume and EIT tidal volume were 0.83, 0.87, and 0.93 (all p < 0.001) in the untreated, surfactant-treated, and normal control groups, respectively, indicating that the higher ICC value, the better inflated status of the lung. In conclusion, we demonstrated that EIT tidal volume correlated with ventilator tidal volume. ICC was higher in the surfactant treated group. [ABSTRACT FROM AUTHOR]

Objective To explore the characteristics of neurobehavioral development of premature infants of different gestational ages corrected within one year old under the outpatient follow-up mode, to provide a reference for standardizing the follow-up of premature infants. Methods The basic data of 219 premature infants who accordanced with the inclusive criteria and followed up in the hospital from January 2019 to December 2020 were collected, as well as the development quotient(DQ) of each functional area in the relevant corrected month age Gesell development scale were collected. They were divided into the observation group (122 cases) and the control group(97 cases) according to the follow-up situation. The observation group received regular follow-up visits to the department of rehabilitation at the age of every month after discharge, early intervention guidance was given after each follow-up, and Gesell development scale was evaluated at the corrected age of 3,6,9 and 12 months. The control group received irregular follow-up visits to the department of rehabilitation, during which the number of lost visits was more than six, but Gesell development scale was evaluated at the corrected age of 3,12 months. According to birth gestational age, they were divided into the 35-36+6weeks group, the 32-34+6 weeks group and the <32 weeks group. Results When the corrected age was 12 months, the DQ of the Gesell development scale in the observation group was higher than that in the control group, and the difference was statistically significant(P <0.05). In the observation group, the DQ of premature infants in the 35-36+6weeks group reached normal, while in the 32-34+6weeks group and the < 32 weeks group, the DQ of premature infants reached a critical state. Conclusion Under the regular outpatient follow-up mode, the neurobehavioral development of premature infants within one year old is better than [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factor (VEGF) and its receptors (VEGFRs) regulate both vasculogenesis, the development of blood vessels from precursor cells, and angiogenesis, the formation of blood vessels from preexisting vessels. In the fetal lung, high-affinity receptors for VEGF are expressed mainly in alveolar epithelial cells and myocytes, suggesting a paracrine role for VEGF in modulating activities in adjacent vascular endothelium. Previous studies have shown that vascular growth is impaired in bronchopulmonary dysplasia (BPD). The goal of this study was to examine tracheal (T-VEGF) and gastric (G-VEGF) levels in premature infants in the first and third day of life and examine if these levels were associated with the development of BPD. Tracheal aspirates from intubated infants and gastric samples from others were obtained on postnatal days 1 (D1) and 3 (D3) from 43 preterm infants (<2000 g birth weight, ≤34 wks gestation). VEGF was quantified by a VEGF Elisa Kit. Demographic, clinical, and pulmonary outcome data were collected including information on respiratory support (oxygenation index (OI) and ventilatory index (VI)) and on the development of BPD, determined at 36 weeks PMA using NICHD criteria. The mean birth weight was 1060 ± 379 g and gestational age 27.5 ± 2.8 wks. BPD was diagnosed in 26 infants who were less mature than the 17 controls without BPD. Day 1 and day 3T-VEGF concentrations did not correlate, but day 3 levels correlated with gestational age (r = 0.75, p <.05). BPD infants, characterized by longer ventilator, CPAP and oxygen days, had day 1T-VEGF levels similar to control infants (126.6 ± 194.7 vs. 149.7 ± 333.2 pg/ml) but day 3 levels were significantly lower (168.9 ± 218.8 vs. 1041.6 ± 676.7 pg/ml). Day 1G-VEGF levels reflected tracheal samples, trending lower in BPD infants. Mode of delivery, race, sex, antenatal steroid administration, chorioamnionitis, sepsis, or growth restriction did not impact VEGF levels. However, lower VEGF levels were associated with a lower VI and lower OI: Day 3 OI correlated with day 3T-VEGF (r = 0.72, p >.05), albeit not significantly. T-VEGF increased from day 1 to day 3 in controls and decreased in BPD infants. There was no relationship between oxygen, CPAP and ventilator days and day 1 or day 3T-VEGF levels. BPD may be associated with low-serum VEGF levels during the first week of life. This finding is likely related to decreased expression in the lungs of the less mature infants, who are at the highest risk for BPD. [ABSTRACT FROM AUTHOR]

Objectives: Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. Physiologically, the closure of the ductus arteriosus occurs within 48-72 hours after birth in healthy term neonates. This study aimed to compare oral paracetamol and oral ibuprofen in the closure of PDA in preterm neonates. Materials and Methods: This study is a single-blind randomized clinical trial. A total of 90 preterm neonates with a gestational age of less than 32 weeks were divided into two groups of oral ibuprofen and oral paracetamol. Oral ibuprofen was administered at a dose of 10 mg/kg on the first day and 5 mg/kg on the second and the third days. Oral paracetamol was administered at a dose of 10 mg/kg every 6 hours for 3 consecutive days. The primary outcome measure was the closure of the ductus arteriosus. The secondary outcome measure was the assessment of any type of complications following the administration of oral paracetamol. Results: The DA closure rate was 82.2% in the oral paracetamol group and it was 91.41% in the oral ibuprofen group P<0.65, (odds ratio [OR] = 2.22, 95% CI = 0.62-7.97). We did not see any unwanted complication during treatment with oral paracetamol. Conclusions: The present study showed that oral paracetamol is effective in the closure of PDA. On the other hand, it does not cause any unwanted side effects on the patient. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is little published data on how to prepare probiotic supplements for enteral delivery in the NICU. The objective of this study was to determine how a three-strain probiotic blend (Bb-02, TH-4® and BB-12®) would behave when mixed and held for 4 hours with saline water, sterile water, dextrose 5% in water (D5W), 24 kcal preterm formula, and human milk. METHODS: A packet of a three-strain probiotic supplement was mixed with 3 mL of saline water, sterile water, D5W, 24 kcal preterm formula, and human milk (tested at 3 mL and 2 mL). Samples were stored at room temperature for 60 minutes then refrigerated for 180 minutes. Probiotic survival, using quantitative enumeration, and pH were monitored over 4 hours. Samples were passed through a 5 French (Fr) feeding tube at the end of the study to evaluate viscosity. RESULTS: The largest variation in total cell count from 0-time was sterile water with a + 0.26 log(CFU)/mL change at 90 minutes and typical variation is considered±0.50 log units indicating no significant change between samples in 4 hours. Saline water had the lowest final pH at 4.88. All samples easily passed through a 5 Fr feeding tube. CONCLUSION: The study showed minimal change in cell counts across solutions for 4 hours of storage, indicating health care facilities may be able to prepare probiotic supplements with a variety of solutions in pharmacies or milk rooms. This allows greater flexibility for probiotic delivery to preterm infants. [ABSTRACT FROM AUTHOR]

Aim: Benefits of mothers' own milk (MOM) for premature and sick neonates are well documented. To increase access, many neonatal units have a lactation consultant (LC) on staff. This study aimed to assess the impact of a permanent LC on (i) maternal access to LC support; (ii) staff confidence in providing Breast Feeding (BF) education and (iii) provision of MOM. Methods: Study included a staff survey and chart audit. Questions provided feedback on access to lactation support and meeting maternal needs. Audit data included: gestational age, birthweight, intention to breastfeed, documentation of LC appointment, provision of MOM at 12 hours, days 3, 7, 28 and discharge. Student's t‐tests were used for numerical data and chi‐squared tests for categorical variables. Results: Ninety‐one staff surveys were returned, (pre 35/75 (47%), post 56/85 (66%) with staff reporting organising an LC appointment was significantly easier (P < 0.0001). Staff perceived maternal lactation needs and confidence to breastfeed post‐discharge had significantly improved post‐LC. The chart audit showed a significant increase in maternal access to LC appointments (15% vs. 80%; P < 0.01), breast pump education by day 3 (65% vs. 81%; P < 0.01), and an increase in MOM provision by 12 h (46% vs. 61%; P < 0.01) post‐LC but not at days 7, 28 or discharge. Conclusion: A dedicated LC increases staff and maternal access to lactation education and support, improving provision of early MOM. Further research is required to assess the effect of LCs in improving breastfeeding rates in neonatal units. [ABSTRACT FROM AUTHOR]

Background: Mother's own milk (MOM) is the gold standard of nutrition for premature infants. Yet, Hispanic and Black preterm infants are less likely than their White counterparts to receive MOM feedings. Evidence is lacking concerning potential modifiable factors and evidence-based strategies that predict provision of MOM among minority mothers of premature infants. Purpose: A review of the literature was conducted to answer the clinical question: "What evidence-based strategies encourage and improve mother's own milk expression in Black and Hispanic mothers of premature infants?" Methods/Search Strategy: Multiple databases including PubMed, Cochrane, and CINAHL were searched for articles published in the past 10 years (2010 through May 2020), reporting original research and available in English. Initial search yielded zero articles specifically addressing the impact of lactation interventions on MOM provision in minority mothers. Additional studies were included and reviewed if addressed breastfeeding facilitators and barriers (n = 3) and neonatal intensive care unit breastfeeding support practices (n = 7). Findings/Results: Current strategies used to encourage and improve MOM expression in minority mothers are based on or extrapolated from successful strategies developed and tested in predominantly White mothers. However, limited evidence suggests that variation in neonatal intensive care unit breastfeeding support practices may explain (in part) variation in disparities and supports further research in this area. Implications for Practice: Neonatal intensive care unit staff should consider implementing scaled up or bundled strategies showing promise in improving MOM milk expression among minorities while taking into consideration the cultural and racial norms influencing breastfeeding decisions and practice. Implications for Research: Experimental studies are needed to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers. [ABSTRACT FROM AUTHOR]

AIM: To observe the hyaloid artery remnants in the eyes of premature infants.METHODS: This retrospective study recruited premature infants who consecutively attended the Tongji Hospital for retinopathy of prematurity(ROP)screening from May 2018 to November 2018. The binocular indirect ophthalmoscope was used for examination.RESULTS: In total, 60 cases were pulled for data analysis. The cases were categorized as having the following condition: hyaloid artery remnants positive(49 cases)or hyaloid artery remnants negative(11 cases). It was showed that the remnants positive group had significant lower gestational age and birth weight than those of the negative group(P0.05). The hyaloid artery remnants completely regressed in all the follow-up cases. The range of disappearing time of hyaloid artery remnants was 37-44wk of corrected gestational age.CONCLUSION: The hyaloid artery remnants in preterm infants are most likely to be physiological residues. Younger or lower weight premature infants will have higher positive detection rates of hyaloid artery remnants. It seems like co-existence with ROP has no significant association with the detection of hyaloid artery remnants. When the corrected gestational age extends over 43wk, if the hyaloid artery remnants don't regress, there is a possibility of pathological changes, and appropriate interventions should be selected according to the severity of the lesions.

Abstract Background To study optic disc features of premature infants and compare to that of term infants to explore the pattern and features of newborn optic disc development and provide the basis for the diagnosis of newborn optic disc disease. Methods This was a prospective clinical research. Newborns underwent newborn fundus disease screening from January 1st, 2016 to October 31st, 2016 in the neonatal ward of Ruian City Maternal and Child Health Hospital were selected. RetCam 3 Version6.1.25.0 Wide-Field Digital Pediatric Retinal Imaging System developed by Clarity Medical Systems, Inc was adopted to conduct fundus examination on both eyes, 130 degree wide-angle lens was used to film the images centering optic disc. Results For both premature infants and full-term newborns, vertical diameter of the optic disc to lateral diameter of the optic disc ratio was > 1, and the shape of the optic disc was a vertical oval. The difference of each optic disc parameter between premature infants and full-term newborns was not statistically significant (P > 0.05). There’s a difference of constitution of sclerotic ring type on optic disc between premature infants and full-term newborns. Among which, the proportion of single ring type and double ring type in premature infants was higher than that in full-term newborns (P 0.05) between premature infants and full-term newborns. Conclusions We found that The proportion of mature types (single ring type and double ring type) in full-term newborns was higher than that in premature infants. While there’s no statistical difference of the proportion of mixed types between premature infants and full-term newborns. Double ring type was a normal stage of the development of optic disc.

Abstract Background The efficacy of continuous kangaroo mother care (C-KMC) in reducing neonatal mortality and morbidity among low birthweight and premature infants has been confirmed. Despite the recommendations of the World Health Organization, UNICEF, and the Ministry of Health of Iran to use C-KMC for eligible hospitalized neonates, this type of care is not performed due to implementation problems. This protocol aims to describe the design, implementation, and assessment of C-KMC in one tertiary hospital by means of participatory action research. Methods The objective of this study is to design and implement a C-KMC program for neonates that will be performed in two phases using a stages-of-change model. The first phase will be conducted in three consecutive activities of designing, implementing, and assessing the introduction of C-KMC. The second phase of the study has a before-and-after design to assess the effectiveness of C-KMC by comparing the length of preterm neonates’ stay in hospital and exclusive breastfeeding at discharge before and after implementing C-KMC. Discussion KMC is an important component of neonatal developmental care as part of family-centered care. Applying this type of care requires creating appropriate strategies, budget allocation, and clear and coordinated planning at different levels of the health system. The stages-of-change model is one of the appropriate approaches to the implementation of C-KMC.

Introduction. Premature infants undergo a lot of stressful procedures during care and treatment procedure, which may lead to weight changes. Multisensory stimulation is a broad classification of interventions designed to improve the developmental and physiological outcomes of preterm infants admitted to the neonatal intensive care unit (NICU). The aim of this study was to evaluate the effect of multisensory stimuli on weight gain in preterm infants admitted to the NICU. Materials and methods. This study was a two-group randomized controlled trial (multisensory stimulation and control group). Forty preterm infants admitted to the NICU who met the inclusion criteria were selected. The intervention method was a multisensory stimulation program including auditory stimulation, tactile stimulation, visual stimulation and vestibular stimulation, which were performed by the researcher for 12 min (each stimulation lasting for 3 min). The infant nutrition was monitored and recorded during the intervention and the infant’s weight was measured after changing diapers every morning for a 7 days. It was conducted in the two groups using a calibrated scale of confirmed validity and reliability. Data were analyzed using SPSS 20 software, paired t-test and independent t-test. Results. Based on the findings of the present study, an upturn was observed in weight gain of preterm infants as a result of multisensory intervention. This indicates that the intervention improves weight gain in premature infants. Conclusions. Since premature infants are usually hospitalized in the NICU for a long time due to their low weight and poor physical condition, they are mostly cared by nurses. Hence, considering its positive outcomes, besides specialized care, this effective and very low cost method could be used by nurses to promote weight gain and early discharge of preterm infants.

Introduction: Neonatal respiratory distress is a life-threatening lung disorder, so it is important to examine the effect of different intervention and care methods on respiratory distress in premature infants. The aim of this study was to determine the effect of foot reflex massage on the reduction of respiratory distress in premature infants in the intensive care unit. Methods: In this study, in 2018, 100 premature infants were randomly assigned to two intervention and control groups by clinical trial method. In the intervention group, reflexive foot massage was performed for three days and the control group received normal care. In both groups, a personal profile questionnaire and a respiratory distress index were completed before and after the intervention. Data analysis was performed using SPSS 16. Results: The results showed that in the intervention and control group, the difference between mean oxygen saturation (Spo2) and respiratory distress rate on the third day after the intervention was statistically significant and in infants who undergone interventional foot massage, the mean respiratory distress is lower than the control group and oxygen saturation is higher than the control group Conclusion: Reflective foot massage is effective on physiological responses and reducing respiratory distress in premature infants. It seems that this easy, cheap and efficient intervention program can be considered in the executive instructions of health care and nurses' intervention and its education to mothers can be included in the country's educational programs.

Abstract Background Nowadays, it is generally assumed that non-pharmacologic pain relief in preterm infants is an important measure to consider. Research findings suggest that familiar odors have soothing effects for neonates. The aim of this study was to compare the effect of maternal breast milk odor (MBMO) with that of another mother’s breast milk odor (BMO) on the behavioral responses to pain caused by hepatitis B (HB) vaccine injection in preterm infants. Methods This single-blind randomized clinical trial was performed over the period between February 2019 and March 2020 in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. Ninety preterm infants, who were supposed to receive their HB vaccine, were randomly assigned into three groups: MBMO (A), another mother’s BMO (B), and control with distilled water(C). Oxygen saturation (SaO2), blood pressure (BP) and heart rate (HR) were recorded for all participants through electronic monitoring. In addition, premature infant pain profiles (PIPP) were determined through video recording for all three groups during intervention. The chi-square, ANOVA and ANCOVA were used for analyzing the data, and P 0.05). After the intervention, however, the means for heart rate in groups A, B, and C were 146 ± 14.3, 153 ± 17.5 and 155 ± 17.7, respectively (P = 0.012). Moreover, the means for PIPP scores in groups A, B and C were 6.6 ± 1.3, 10 ± 2, and 11.4 ± 1.9, respectively (P 0.05). Conclusions The results indicate that stimulation with MBMO is effective in reducing pain in preterm infants; therefore, it can be postulated that this technique can be considered in less invasive procedures such as needling. Trial registration IRCT, IRCT20190220042771N1 . Registered 18 May 2019- Retrospectively registered,

Background: Premature birth is a crisis for mothers and affects resilience. Premature babies are atrisk for developmental disorders. The Kangaroo Mother Care (KMC) can reduce maternal stress andimprove the growth of the baby. This study aimed at assessing the effect of home visit based on thecontinued KMC on maternal resiliency and development of premature infant.Methods: This randomized controlled trial conducted on 50 pairs of mothers and premature babieswith gestational age of 26-32 weeks who were admitted to Neonatal Intensive Care Unit of Om-al-Banin Hospital, Mashhad, Iran in 2019. The KMC is practiced routinely for all eligible newborns in thishospital. The experimental group continued the KMC one month after discharge at home and receivedtwo home visits. Resiliency of the mothers was assessed in admission, discharge, and one monthafter discharge with the Connor and Davison questionnaire and the development of the newborns wasassessed in two months of adjusted age with Ages and Stages Questionnaire (ASQ). Data analysis wasperformed using SPSS software version 16 and t-test, Mann-Whitney, ANOVA, Friedman, Chi-square,Fishers exact. The significance level was set at p

Introduction: Skin interventions have been implemented to reduce neonatal mortality, demonstrating the skin’s role in neonatal innate immunity. We examined the impact of birthweight and environmental conditions on skin integrity in infants receiving oil massage in rural Nepal. Methods: In a community-based cluster randomized controlled trial, 991 premature and full-term infants were grouped by birthweight as: (1) 920–1,560 g, (2) 1,570–2,450 g, (3) 2,460–2,990 g, and (4) 3,000–4,050 g and by high or low heat index (HI). Skin integrity was measured as erythema, rash, dryness, pH, protein concentration, and transepidermal water loss (TEWL). Results: Skin pH was higher for the smallest (group 1) than the largest infants (group 4) and higher for group 2 than 3 and 4. Arm and leg rash differed for all 4 groups, with the least amount of rash for the smallest babies. Erythema was lower for group 1 than all others. The lower day 1 values for pH, TEWL and protein at high versus low HI remained lower over 28 days. The pH reduction was faster at high HI. Erythema (arm, leg) was more severe at high HI. Rash severity was greater at high HI for arms and legs every day. Conclusions: Birthweight influenced the skin response to oil massage. The smallest infants had the lowermost skin irritation, suggesting diminished ability to mount an inflammatory response. High HI may be protective for premature infants in low resource settings.

Purpose The symptoms and impairments caused by cerebral palsy usually require long-term treatment, resulting in a substantial burden on the family of affected children. This study explored the experiences of fathers with prematurely-born children with cerebral palsy, with a focus on how such experiences influenced their families. Methods A qualitative case study method was used. Nine subjects were recruited from April 2018 to June 2019 at one hospital, and each was interviewed three times by a neonatal nurse. Results Five core experiences of fathers were identified: regret for an insufficient initial response, confronting my child born as a premature baby, the position of being a dad who can't do anything, the process of treatment like a tunnel with no exit, and a father's getting meaning in life through children. These stories covered an individual's timeline and family interactions. Conclusion Our findings suggest that fathers of prematurely-born children tend to suppress their emotions; therefore, a novel intervention program to encourage fathers’ emotional expression and to support healthier interactions with their families is needed. Moreover, our findings could contribute basic information for the construction of a community-based support system to aid families, including prematurely-born children and other persons with impairments.

Objective: To verify the relationship between sleep characteristics and motor development in low-birth-weight preterm infants during infancy and preschool years. Method: Forty-one healthy preterm infants (

Neonatal respiratory distress syndrome (RDS) is a condition of pulmonary surfactant insufficiency in the premature newborn. As such, artificial pulmonary surfactant administration is a key treatment. Despite continued improvement in the clinical outcomes of RDS, there are currently no established bedside tools to monitor whether pulmonary surfactant is effectively instilled throughout the lungs. Electrical impedance tomography (EIT) is an emerging technique in which physiological functions are monitored on the basis of temporal changes in conductivity of different tissues in the body. In this preliminary study, we aimed to assess how EIT tidal volumes correlate with ventilator tidal volumes in an RDS animal model, namely untreated, surfactant-treated, and normal control rabbit pups. Tidal volumes were measured simultaneously on an EIT system and a mechanical ventilator and compared at different peak inspiratory pressures. The linear correlation between tidal volumes measured by EIT and by ventilator had an R2 of 0.71, 0.76 and 0.86 in the untreated, surfactant-treated, and normal control groups, respectively. Bland–Altman analysis showed a good correlation between the measurements obtained with these two modalities. The intraclass correlation coefficients (ICC) between ventilator tidal volume and EIT tidal volume were 0.83, 0.87, and 0.93 (all p < 0.001) in the untreated, surfactant-treated, and normal control groups, respectively, indicating that the higher ICC value, the better inflated status of the lung. In conclusion, we demonstrated that EIT tidal volume correlated with ventilator tidal volume. ICC was higher in the surfactant treated group.

ObjectivesThe objectives of the study were to determine the efficacy of flexible endoscopy (FE) to assess the approachable aeroesophageal tract (AET) and subsequent changes in clinical management in infants with severe bronchopulmonary dysplasia (sBPD).MethodsThis retrospective study investigated sBPD infants who received FE measurement from 2011 to 2020. FE was supported with non-invasive ventilation (FE-NIV) of pharyngeal oxygen with nose closure and abdominal compression without any mask or laryngeal mask airway. Data on AET lesions, changes in subsequent management, and FE therapeutic interventions were collected and analyzed.ResultsForty-two infants were enrolled in the study. Two thin scopes (1.8- and 2.6-mm outer diameter) were used. FE analysis revealed 129 AET lesions in 38 (90.5%) infants. Twenty-eight infants (66.7%) had more than one lesion. Thirty-five (83.3%) infants had 111 airway lesions where bronchial granulations (28, 25.2%), tracheomalacia (18, 16.2%), and bronchomalacia (15, 13.5%) were the main complications. Eighteen esophageal lesions were found in 15 (35.7%) infants. No significant FE-NIV complications were observed. The FE findings resulted in changes in management in all 38 infants. Thirty-six (85.7%) infants underwent altered respiratory care with pressure titrations (29, 45.3%), shortened suction depth (17, 26.6%), immediate extubation (8, 12.5%), changed insertion depth of endotracheal tube (7, 10.9%) and tracheostomy tube (3, 4.7%). Twenty-one (50%) infants had 50 pharmacotherapy changes, including added steroids, anti-reflux medicine, antibiotics, and stopped antibiotics. Eighteen (42.8%) infants received 37 therapeutic FE-NIV procedures, including 14 balloon dilatations, 13 laser-plasty, and 10 stent implantations. Seven (16.7%) infants underwent surgeries for four tracheostomies and three fundoplications.ConclusionFlexible endoscopy with this non-invasive ventilation could be a safe and valuable technique for direct and dynamic visual measurement of AET, which is essential for subsequent medical decision making and management in infants with sBPD.

Giant inguinal hernias are rare in children, and they represent a unique challenge for pediatric surgeons. The sparse literature includes variable definitions of the disease and different surgical techniques without significant difficulties with the decrease of abdominal domain. We present a prematurely born boy with a unilateral giant inguinal hernia which developed promptly after birth. This case highlights the multiple possible challenges related to giant inguinal hernias in children. We also discuss the possible treatment options and the advantages and disadvantages based on the current literature.