Search

Background: Scabies infections of the breast in lactating individuals are not well described, especially how maternal infection can impact human milk feeding of hospitalized infants in the intensive care setting. Methods: This case report presents a critically ill female infant with a complex surgical history whose mother had an active scabies infection around the breast postpartum and wished to provide expressed human milk. Results: In this case report, human milk was recommended despite maternal scabies infection. Conclusion: Given the limited information that is known about the risk of scabies transmission in human milk for critically ill infants, this case adds to the knowledge base and supports the call for further research.

Background: Involving parents in decisions about the care of their infant is common practice in most neonatal intensive care units. However, involvement is less common in neonatal research and a gap appears to exist in understanding the process of patient and public involvement. The aim of this study was to explore parents and researchers' experiences of patient and public involvement in a neonatal research project. Methods: A qualitative design was employed, consisting of two focus group interviews, one dyadic interview, and four individual interviews with parents and researchers. The interviews followed a semi-structured guide specific to both parents and researchers. Data were analysed using content analysis as described by Graneheim and Lundman. Results: A total of nine parents and four researchers participated in the study. Seven themes were consolidated into three core concepts: Embracing the ethos and pathos of patient and public involvement, Finding the path to maximise meaningful involvement, and Becoming skilled in engaging patients and the public in research. The core concepts highlighted both similarities and differences, as well as challenges and facilitators, of the experiences of the patient and public involvement process. Conclusion: Patient and public involvement in research was a mutually beneficial process, facilitating learning and reflective opportunities for parents and researchers. However, there were challenges that emphasised the need for rapport building between parents and researchers, valuing everyone's unique perspective and expertise, with clear communication and well-defined roles and goals. These insights offer a contribution for future patient and public involvement in health research. Plain English summary: It is usual practice to involve parents in decisions about their babies care in neonatal intensive care units, but their involvement in research is less common. Although patient and public involvement in research is increasing, there is a lack of strategies to ensure meaningful involvement. This qualitative study used interviews, to explore how parents and researchers experienced patient and public involvement in a research project about couplet care in a neonatal intensive care unit. Nine parents and four researchers participated and the analysis revealed several themes that describes their experiences. These themes were consolidated into three main concepts: (1) Embracing the ethos and pathos of patient and public involvement, which focuses on the emotional and ethical aspects of involvement, (2) Finding the path to maximize meaningful involvement, which addresses the strategies and methods to ensure effective involvement, and (3) Becoming skilled in engaging patient and the public in research, which emphasizes the need for developing skills and knowledge for better involvement practices. These core concepts provide a comprehensive understanding of how to enhance involvement, not only in the neonatal setting, but research in general. [ABSTRACT FROM AUTHOR]

Aim: To systematically review the literature on noise exposure within the neonatal intensive care unit/special care nursery settings, specifically to describe: noise characteristics, sources of noise and ways of measuring noise. Methods: Systematic searches were conducted through databases Medline, Embase and PubMed. Studies were included if they met the inclusion criteria (1) reported noise characteristics; (2) reported noise exposure measurements; (3) in the neonatal intensive care unit/ special care nursery settings. Methods and key findings were extracted from included studies. Quality analysis was done using a modified version of the Newcastle‐Ottawa Scale. Results: We identified 1651 studies, screened 871, reviewed 112 and included 47. All reported NICU average equivalent sound levels were consistently louder than recommended guidelines (45 dB). The most consistent association with higher sound pressure levels were noise sources grouped under people congregation. Half of the studies did not use measuring devices adhering to international sound level meter (SLM) standards. Conclusion: All NICUs exceeded recommended accumulative sound levels. People were the most consistent source of noise. Sound pressure levels need to be consistently measured with devices adhering to international SLM standards in future studies. [ABSTRACT FROM AUTHOR]

Background: Retinopathy of prematurity (ROP) is a significant cause of preventable childhood blindness, particularly affecting premature infants in developing countries. With improved survival rates of preterm infants, understanding its risk factors and clinical profile is crucial for early detection and management. Objective: To investigate the incidence, risk factors, and staging of ROP in preterm babies admitted to the NICU at Karnataka Institute of Medical Sciences, Hubli. METHODS: A hospital-based observational study was conducted from December 2012-November 2013. Preterm infants =34 weeks gestational age and/or birth weight =2000 grams were screened for ROP. Detailed maternal and neonatal data were collected, and ROP screening was performed using indirect ophthalmoscopy. Statistical analysis included descriptive statistics, chi-square tests, and unpaired t test. Results: Of 176 screened preterm infants, 71 (40.3%) developed ROP. Stage II was predominant (73.2%) followed by Stage I (26.8%), with no advanced stages observed. Significant risk factors included lower gestational age (p=0.0002), birth weight <1500g (p=0.024), multiple gestation (p<0.001), oxygen therapy (p<0.001), sepsis (83.1% vs 17.1%, p<0.001), respiratory distress syndrome (50.7% vs 15.2%, p<0.001), and apnea (19.7% vs 4.8%, p=0.001). Laboratory parameters showed significantly higher infection markers in the ROP group, with increased CRP and blood culture positivity (p<0.001). Most cases (88.7%) showed spontaneous resolution, with only 5.6% requiring intervention. Conclusion: The study demonstrated a significant ROP incidence of 40.3%, with multiple risk factors identified. Strong associations were found between ROP development and lower gestational age, birth weight, multiple gestation, oxygen therapy, and neonatal complications, particularly sepsis. [ABSTRACT FROM AUTHOR]

Depth cameras can provide an effective, noncontact, and privacy-preserving means to monitor patients in the Neonatal Intensive Care Unit (NICU). Clinical interventions and routine care events can disrupt video-based patient monitoring. Automatically detecting these periods can decrease the time required for hand-annotating recordings, which is needed for system development. Moreover, the automatic detection can be used in the future for real-time or retrospective intervention event classification. An intervention detection method based solely on depth data was developed using a vision transformer (ViT) model utilizing real-world data from patients in the NICU. Multiple design parameters were investigated, including encoding of depth data and perspective transform to account for nonoptimal camera placement. The best-performing model utilized ∼85 M trainable parameters, leveraged both perspective transform and HHA (Horizontal disparity, Height above ground, and Angle with gravity) encoding, and achieved a sensitivity of 85.6%, a precision of 89.8%, and an F1-Score of 87.6%. [ABSTRACT FROM AUTHOR]

Objective: To identify the causative bacteria responsible for early and late onset neonatal sepsis and to determine their antibiotic susceptibilities at Central Park Teaching Hospital. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of Central Park Teaching Hospital, Lahore. Study Period: Jan to June 2024. Methods: Neonates up to 28 days old with clinical features of sepsis were randomly sampled and included in the study. Key maternal and neonatal risk factors were evaluated. Blood cultures were analyzed to identify microbial isolates and assess resistance patterns. Demographic data, clinical features, and blood culture results were collected and analyzed using SPSS version 26.0. Results: Out of the cases studied, 55% were male. Early onset sepsis was slightly more prevalent at 51.5%. Significant maternal risk factors for early sepsis included maternal fever, offensive liquor, and prolonged second stage of labor. Blood cultures were positive in 18.8% of cases, with early onset sepsis accounting for 44.7% of positives and late onset sepsis for 55.3%. Gram-positive bacteria were more common in early sepsis (48.1%), with Acinetobacter baumannii and Candida blankii being notable isolates, while Gram-negative bacteria were more prevalent in late sepsis (63.6%), with Bacillus spp. and Burkholderia cenoc as key pathogens. Coagulase-negative Staphylococcus was the most frequently isolated pathogen in both early and late sepsis. Conclusion: The study underscores the importance of developing tailored antimicrobial strategies based on the timing of sepsis onset to improve neonatal outcomes. Significant differences in microbial distribution between early and late neonatal sepsis were observed (p < 0.001). [ABSTRACT FROM AUTHOR]

Healthcare associated infections are the potential cause of morbidity and mortality amongst paediatric population. Widespread antimicrobial use amongst paediatric population leads to the antimicrobial resistance. Bloodstream infections amongst the paediatric population are the leading cause of death. The objective of the study was to determine the general trend of antimicrobial susceptibility pattern in the paediatric and neonatal age group in the ICU setting. Retrospective analysis was done of all the patients of paediatric and neonatal age group who were admitted in ICU including patients on ventilators, and whose blood samples were sent to the lab for culture and sensitivity testing. The sample profile from PICU and NICU shows the total numbers of 3056 samples (including blood, ET secretion, pus, urine, pleural fluid, etc.) were received in the laboratory from paediatric and Neonatal ICU during the study period. Total blood samples received from PICU and NICU were 1310 (sample size). Out of these, blood samples received from PICU were 618 (33.76%), of which 173 (28%) were positive, whereas, 692 (56.52%) blood samples were received from NICU, of which 242 (35%) were positive. The blood samples showed that in PICU, CONS (20.75%), and Staphylococcus aureus (16.98%) were found in maximum numbers. In NICU, Klebsiella pneumoniae were obtained in maximum numbers (30.77%), followed by Acinetobacter baumanii (21.98%). CONS (Methicillin resistant) were found 100% susceptible against Linezolid, followed by Vancomycin and Clindamycin (83% each). Staphylococcus aureus showed 100% sensitivity for Teicoplanin. Klebsiella pneumoniae, were found to be most susceptible to Tigecycline (74.07%) and Colistin (70.37%). Acinetobacter in blood of PICU patients showed high level of resistance with only 37.5% sensitivity for Colistin and Minocycline each, 12.5% sensitivity for Amikacin. To our conclusion, Linezolid was found to be the best Antimicrobial agent against MRCONS, whereas, Linezolid, Teicoplanin, Tetracyclines were found to have good efficacy against Staphylococcus aureus. The best antimicrobial agents against Klebsiella pneumoniae and E. coli were Colistin and Tigecycline. [ABSTRACT FROM AUTHOR]

Although fathers experience emotional stress both during the care period and after discharge, there is limited research focusing exclusively on fathers' experiences after their time in a neonatal intensive care unit. Their experiences are important for tailoring support to fathers based on their individual needs. This paper is part of a longitudinal study in which parents were followed by means of questionnaires and individual interviews during a two-year period after discharge from hospital-based neonatal home care. A qualitative content analysis with an inductive approach was used to elucidate the experiences of fathers six months after their preterm infant's discharge. Twelve fathers participated in the study. The following categories emerged and constituted the result: "Vivid memories from the NICU," "Struggling with new challenges in life" and "Transition to home still in their thoughts." The approach and attitude of health-care professionals may contribute to fathers' involvement during the care period, as fathers tend to set their own feelings aside. [ABSTRACT FROM AUTHOR]

Aim: This research was conducted to evaluate the effects of Reiki and facilitated tucking position on pain, stress and physiologic parameters in preterm infants during orogastric tube (OGT) insertion. Methods: The study used a single‐blind, parallel‐group randomised controlled experimental design. It was carried out in the neonatal intensive care unit of a hospital in Niğde/Turkey between February 2022 and January 2023. A total of 45 preterm infants, who met the study criteria and whose sample size was determined according to power analysis, were randomly divided into three groups. As an intervention, the facilitated tucking position was applied to the first group, and Reiki was applied to the second group during OGT insertion. Routine application continued in the control group. The Infant Introductory Information Form, Physiological Parameter Follow‐up Chart, Infant Stress Scale (ISS) and Premature Infant Pain Profile Scale‐Revised (PIPP‐R) were used for data collection. Significance was accepted as P < 0.05 in the statistical analysis. Results: It was determined that the infants were homogeneously distributed between the experimental and control groups (P > 0.05). Infants who received the facilitated tucking position and Reiki intervention had better physiological stability compared to the control group (P < 0.05). The group with the lowest average stress (1.53 ± 0.99) and pain scores (4.06 ± 1.22) during OGT insertion was the facilitated tucking group (P < 0.001). After the procedure, stress and pain scores in both the facilitated tucking group and the Reiki group were found to be significantly lower than those in the control group (P < 0.001). Conclusions: The results of the study showed that the facilitated tucking position during OGT insertion was especially effective in reducing the pain and stress of infants. Both the facilitated tucking position and Reiki were determined to be effective interventions in reducing the pain and stress of infants more quickly after the procedure. The results of study contribute to the recommendation that NICU nurses should include non‐pharmacological methods to decrease the pain of preterm infants during procedural pain. [ABSTRACT FROM AUTHOR]

A neonatal intensive care unit (NICU) provides an optimal environment for the care of preterm babies. Bedside nurses are fundamental to this care provided to preterm babies in the NICU. Modern NICUs are technology-intensive space, instrumented with several monitoring technologies to help the nurses track the babies in their care. These technologies help the nurses in a way that is essential for the successful operation of the NICU. To understand how these monitoring technologies function in the NICU from the viewpoint of the nurses, we conducted semi-structured interviews with seven nurses who work at a NICU in the US. We then performed a thematic analysis on the interviews and we found that, despite the utility of the monitoring technologies, they also pose several challenges to the nurses in performing their duties. More specifically, we discovered that: (1) all elements of the monitoring technologies posed a challenge in some way; (2) in a few specific situations, the nurses were able to make up for some of these challenges; and (3) the nurses suggested improvements to all elements of the monitoring technologies. Based on these findings, we describe six areas of future research that argue for the design of monitoring technologies as a way to empower nurses. These include: improved vital signs monitoring that facilitate kangaroo care, using voice to manage alarms, video feeds controlled by nurses in the patient rooms, giving more control over the alarm sounds to the nurses, having a common interface and leveraging augmented reality to help the nurses control the monitoring technologies. [ABSTRACT FROM AUTHOR]

Background: The newborn period is the most vulnerable phase for a child's survival, with around half of all under-five deaths worldwide occurring during this time. Despite existing policies and measures, Ethiopia ranks among the top 10 African countries in terms of newborn mortality. In spite of many studies being carried out in the country, the incidence and predictors of neonatal mortality in the Pastoralist and agro-pastoralist parts of the country's southern still remain unidentified. Therefore, this study aimed to identify the predictors of neonatal mortality in selected public Hospitals in southern Ethiopia. Materials and methods: An institution-based retrospective cohort study was conducted among 568 neonates admitted to the neonatal intensive care unit at Bule Hora University teaching Hospital and Yabelo General Hospital, Southern Ethiopia from 1 January 2020–31 December 2021. A simple random sampling technique was used to select records of neonates. Data entry was performed using Epidata version 3.1 and the analysis was performed using STATA version 14.1 Kaplan Meir curve and Log-rank test were used to estimate the survival time and compare survival curves between variables. Hazard Ratios with 95% CI were computed and all the predictors associated with the outcome variable at p-value 0.05 in the multivariable cox proportional hazards analysis were declared as a significant predictor of neonatal death. Results: Out of 565 neonates enrolled, 54(9.56%) neonates died at the end of the follow-up period. The overall incidence rate of death was 17.29 (95% CI: 13.24, 22.57) per 1000 neonatal days with a restricted mean follow-up period of 20 days. Of all deaths, 64.15% of neonates died within the first week of life. In the multivariable cox-proportional hazard model, neonatal age < 7 days (AHR: 9.17, 95% CI: (4.17, 20.13), place of delivery (AHR: 2.48, 95% CI: (1.38, 4.47), Initiation of breastfeeding after 1 h of birth (AHR: 6.46, 95% CI: (2.24, 18.59), neonates' body temperature <36.5 °C (AHR: 2.14, 95% CI: (1.19, 3.83), and resuscitated neonates (AHR: 2.15, 95% CI: (1.20, 3.82) were independent predictors of neonatal death. Conclusion: In the research setting, the incidence of neonatal death was high, especially during the first week of life. The study found that neonatal age < 7 days, place of delivery, Initiation of breastfeeding after 1 h of birth, neonates' body temperature <36.5 °C, and resuscitated neonates were predictors of neonatal death. To improve newborn survival, significant neonatal problems, improved resuscitation, and other relevant factors should be addressed. [ABSTRACT FROM AUTHOR]

Neonatal seizures (NS) represent an important clinical manifestation among critically ill infants and are often the first sign of underlying brain injury. Early recognition and treatment are essential to reduce morbidity and mortality. The present study investigated the NS management and treatment approaches employed by level II/III neonatal intensive care units (NICUs) across the United States to identify areas of consensus and variability. Personnel associated with level II/III NICUs were directly surveyed with an electronic questionnaire. Access to neurology specialists, on-site electroencephalography (EEG) monitoring, and use of antiseizure medications was directly queried. A total of 51 NICUs participated in this survey. Twenty-five percent of the surveyed NICUs reported having an established clinical practice pathway available for treating NS. Twenty-four percent endorsed having written guidelines that provided a formal definition for the concept of "neonatal seizures." Although the majority of NICUs reported having phenobarbital available for rapid seizure management, most NICUs lacked access to additional antiseizure medications for treatment escalation. Twenty-four percent of the surveyed NICUs had no access to EEG monitoring available to them on-site. Daytime and overnight access to neurology consultants was limited and variable. Findings were consistent with a lack of equitable access for NS treatment. Areas of potential improvement include development and implementation of a protocol for rapidly treating NS that emphasizes enhanced access to EEG and rapid neurology consultation, acknowledging and improving upon resource limitations. These developments may eventually provide earlier detection, evaluation, and treatment of seizures in newborns, contributing to improved long-term outcomes. [ABSTRACT FROM AUTHOR]

The Maryland's Premature Infant Developmental Enrichment (PRIDE) program is a unique collaborative endeavor between the University of Maryland School of Medicine and the Part C program for Baltimore City residents (Baltimore Infants and Toddlers Program; BITP). To evaluate the impact of PRIDE, the current study compared premature infants from low-income families who participated in BITP with (BWP) and without PRIDE (BWOP). A total of 956 premature infants (nBWP = 271; nBWOP = 685) were included in the study. Results showed that infants in BWP were referred at a younger age and stayed in BITP longer. A smaller percentage of parents in BWP withdrew from BITP and a larger percentage of BWP infants were eligible for special education preschool services under Part B of the Individuals with Disabilities Education Act (IDEA) at age 3. These findings provide support for the relative benefits of PRIDE to the traditional system of early intervention referral, evaluation, and service coordination. [ABSTRACT FROM AUTHOR]

Targeted neonatal echocardiography (TNE) is essential when approaching hemodynamic instability in neonates. Competency in this field requires standardized training, including robust hands-on experience. Proficiency in understanding the key elements of ultrasound knobology is indispensable for optimal acquisition of imaging. This is a narrative review summarizing the key elements of knobology in TNE. Literature review was mainly done through PubMed. There was no funding allocated for the production of this manuscript. Key Points Robust and structured training is essential Understanding knobology is required to achieve competency in TNE Optimizing knobology is critical for an accurate hemodynamic interpretation report [ABSTRACT FROM AUTHOR]

Purpose: To determine whether pre- and postoperative follow-up based on lung ultrasound is associated with the respiratory and clinical evolution of patients undergoing cardiac surgery in the neonatal period. Methods: Prospective observational unicentric study from December 2020 to October 2023 in a neonatal intensive care unit, a referral center for congenital heart diseases (CHD). Neonates with CHD exposed to heart surgery or percutaneous catheterization in their first 28 days of life were included. LU follow-up was performed before surgery (LUSpre) and on days 1 (LUS_1), 3 (LUS_3), and 7 (LUS_7) afterwards by mean of a dedicated score (LUS) ranging from 0 to 3 points in 8 areas (total score 0–24). Results: Fifty-five neonates were included. Median gestational age was 39.1 weeks (37.8–40.1), birth weight 3088 g (IQR 2910–3400). Forty-nine received surgery and 6 only percutaneous catheterization. Median LUSpre score was associated with total respiratory support in the first 30 postoperative days (p = 0.034). Median postoperative LUS was significantly higher than LUSpre in the surgery cohort at all time points (p < 0.05). LUS_1 was associated with respiratory and several clinical outcomes: for each point increase in the ultrasound score, the days on invasive mechanical ventilation, the need for any respiratory support within the first 30 postoperative days, and the length of NICU stay increased significantly (p < 0.05). The presence of consolidations in any area in the postoperative lung ultrasounds was associated with worse respiratory outcomes: higher invasive mechanical ventilation duration (6.84 days), longer total respiratory support (6.07 days), and NICU admission (21.61 days). The presence of consolidations in LUS_7 was significantly associated with the occurrence of ipsilateral diaphragmatic paralysis (odds ratio of 10.25 (95% CI 2.05–51.26, p = 0.006). Conclusion: Performance of lung ultrasound follow-up in CHD in the NICU is feasible and predictive of the respiratory evolution of the patient. LUS_1 presented the highest predictive values. The presence of consolidations is associated with a worse respiratory evolution and if they persist for a week after the procedure, it may raise suspicion of ipsilateral diaphragmatic paralysis. What is known: • Lung ultrasound evaluates lung aeration and predicts respiratory outcomes in premature infants. What is new: • Follow-up based on lung ultrasound in congenital heart diseases postoperative period is associated with respiratory evolution and length of admission. [ABSTRACT FROM AUTHOR]

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

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

Background: The challenging transition to parenthood affects both mothers and fathers; yet, the strain intensifies with a premature birth in the neonatal intensive care unit (NICU), underscoring the importance of acknowledging and addressing potential differences in parental roles. Purpose: This paper aimed to investigate how parental role conflicts among mothers and fathers of preterm-born infants hospitalized in German NICUs manifest and investigated potential parental resources. Methods: Twenty-four participants, 17 mothers, and seven fathers of very low birth-weight infants were interviewed. A thematic content analysis was performed at a semantic level. Results: Fathers feel pressured to fulfill the role expectations, often leading to the suppression of paternal feelings and needs. For mothers, deviating from societal expectations regarding their expressive roles can be distressing, as they worry that such deviation might hinder their infants from having a successful start in life. Consulting with healthcare professionals shows to ease challenges for both parental roles. Implications for Practice and Research: Maternal and paternal challenges are often rooted in expectations placed on their societal roles. Highlighting these challenges can be essential for increasing awareness and effectively addressing them. Tailored nursing practices may have the potential to facilitate individuals' navigation of uncertainties and fulfillment of caregiving roles. [ABSTRACT FROM AUTHOR]

Background: Due to the geographical distance, work obligations, and parenting responsibilities, it is often difficult for parents to visit the neonatal intensive care unit (NICU). Limited parent presence might also constrain updates about infant status thus increasing anxiety, which potentially leads to a stronger necessity for visitation. Purpose: Examine the evidence for use of electronic visit (eVisit) technology for parents of newborns in NICU, for example, do eVisits decrease anxiety and are there other factors that demonstrate effectiveness. Data Sources: Seven databases were used to search for evidence from 1 January 2000 to 13 November 2023. Study Selection: Studies were included with terms related to eHealth, NICU, infant, parent and 41 eligible studies were assessed. Data Extraction: Data were extracted by 2 reviewers with a systematic-staged review approach. Results: Eight studies with a total of 1450 cases were included. Results of meta-analysis showed that eVisit technology improved anxiety compared with conventional visitation (MD = − 5.04, 95% CI [−5.92, − 4.17], P < .01) and hospitalization satisfaction (RR = 1.09, 95% CI [1.05, 1.13], P < .01), but the effect was not significant with regard to reduction in infant length of stay (MD = − 1.07, 95% CI [−5.39, 3.25], P = .63). Implications for Practice and Research: A large sample, high-quality, multi-centered randomized controlled study needs to be conducted to validate the effect of eVisit technology on the psychological state of parents, implications for nursing practice as well as potential newborn affects to improve future ease of use. Available for more insights from the authors. This video shows the concept, current status, significance, and implications for practice and research of eVisit technology. Video 1 Meta-Analysis of eVisit Technology on Psychological Anxiety and Factors Influencing the Parents of NICU Newborns Video 1. Meta-Analysis of eVisit Technology on Psychological Anxiety and Factors Influencing the Parents of NICU Newborns 1_xiq2ztc3 Kaltura [ABSTRACT FROM AUTHOR]

Purpose of Review: Newborns and infants in the neonatal intensive care unit (NICU) may be at uniquely high risk of developing delirium. Because there is a dearth of NICU-focused literature, providers must rely on evidence derived from older children and infants in other care settings to guide management. The literature was rigorously reviewed to highlight evidence specific to newborns and infants and is summarized here. Recent Findings: Delirium likely occurs in newborns and infants at similar or higher rates than what is seen in other care settings. Recent literature calls particular attention to the lack of assessment tools validated in a NICU setting. Summary: Evidence for the evaluation and management of delirium in the NICU is lacking. More study specific to the NICU is needed to build consensus toward best practice. [ABSTRACT FROM AUTHOR]

Background: The World Health Organisation states that newborns should receive colostrum as soon as possible after birth. However, among newborns needing neonatal intensive care, initiation of lactation and access to colostrum might be delayed. At the centre of this study, a tertiary care hospital in Sweden (10,000 deliveries/year), few admitted infants received colostrum within the day of birth, warranting a quality improvement. In order to reduce the time from birth to first colostrum received by infants admitted to the Neonatal Intensive Care Unit (NICU), a new clinical routine including a colostrum-kit, was implemented as standard care in June 2018. The colostrum-kit contained information about hand expression of breastmilk as well as material for collecting, labelling and transporting the colostrum. The kit should be handed to all birthing parents with infants admitted to the NICU. Methods: Data on time in minutes from birth to first colostrum administered to the infant (oral mouth care, oral feeding or gavage feeding) was retrieved for all infants born between 1 September 2016 and 31 October 2023, admitted to the NICU within 1h from birth. Infants were divided into four time-cohorts, compared with nonparametric ANOVA. Results: The study included 3618 infants born at 22 + 0 – 43 + 0 weeks gestational age, of whom 2814 (78%) had available data on time to colostrum. Median (IQR) time in hours was 35 (20–36) pre-implementations, followed by 18 (7–38), 11 (4–26) and 8 (3–22) in the subsequent follow-up cohorts, p < 0.001. Subgroups of mode of delivery had median (IQR) pre-implementation of 30 (19–54) for vaginal and 47 (23–72) for caesarean section that reached 7 (2–18) and 9 (3–26) in the last follow-up. Subgroups of gestational age (< 28, 28–31, 32–36, > 36 weeks) had a pre-implementation time of 48 (26–80), 46 (23–73), 33 (20–60) and 32 (19–57), that in the last follow-up was reduced to 4 (2–20), 7 (2–29), 9 (2–33) and 9 (4–19). Conclusions: Implementing a colostrum-kit for infants admitted to the NICU significantly reduced the time to first colostrum administered to the infant in all gestational ages. The difference between subgroups of gestational age or mode of delivery was reduced. The effect persisted over time. [ABSTRACT FROM AUTHOR]

Background: Intrapartum hypoxia causes fetal suffocation, acidosis, newborn brain damage, long-term morbidity, and mortality.1 As a result, intrapartum fetal monitoring is performed to detect early indicators of fetal hypoxia and to take appropriate action as soon as possible to avoid fetal hypoxia complications. Objectives: 1. To study the correlation between fetal Doppler ultrasound and umbilical cord blood gas analysis in detecting fetal academia. 2. To identify the maternal and obstetric determinants associated with fetal acidemia. MATERIAL & METHODS: Study Design: Hospital-based prospective observational study. Study area: The study was conducted in the Department of Obstetrics and Gynaecology. Study Period: 1 year. Sample size: Using a sample size calculator, expecting a correlation coefficient of r=0.300, the required sample size was calculated to be 85. Study population: During the study period, a total of 92 pregnant women with abnormal fetal Doppler ultrasound findings, meeting the below-mentioned inclusion and exclusion criteria were eventually recruited into this study. Sampling Technique: Simple Random technique. Study tools and Data collection procedure: The institutional ethical committee clearance was obtained. The design and nature of the clinical study were explained to the patients and significant relatives of the patients. Informed consent was obtained from patients. The sociodemographic data was collected and recorded in the specially designed proforma. The socioeconomic class was assessed using the Socio-Economic Status Schedule. The obstetric history data was gathered and recorded in the proforma. All the patients in the sample group (n=92) were subjected to thorough clinical examination which included general physical, systemic examination and pelvic examination. Maternal blood samples for routine laboratory investigations (including tests for acidosis) were sent. Results: There was a significant correlation between gestational age and fetal acidemia (p value=0.0096). A gestational age of 41 weeks or more has a lesser incidence of fetal acidemia. Middle cerebral artery pulsatility index (MCAPI) was significantly associated with fetal academia (p-value of <0.0001). The umbilical artery pulsatility index (UAPI) had a highly significant correlation (p <0.0001) with the umbilical cord blood gas analysis. Conclusion: Based on the statistical analysis of the data, it is safe to assume that fetal Doppler ultrasound can predict the development of fetal acidemia. Two indicators, the Middle cerebral artery pulsatility index and the Umbilical artery pulsatility index, are strong predictors of fetal acidemia. Similarly, determinants like obstetric score, medical comorbidity, general physical examination and status of labour per vaginal examination were also not found to be significantly associated with fetal acidemia. [ABSTRACT FROM AUTHOR]

Background:Numerous negative outcomes are linked to the existence of patent ductus arteriosus (PDA) in neonates. There is a lack of information regarding the proper diagnosis and pathophysiologyin relation to long-term outcomes. We aimed to investigate the role of targeted neonatal echocardiography (TNE) in hemodynamically unstable neonates for diagnosis of neonatal PDA that may help in changing the management plan and improving the survival outcome. Methods: This cohort study was conducted at the Pediatric Neonatology and Cardiology Units at Pediatrics Department, Faculty of Medicine, Zagazig University on 85 neonates who were clinically suspected to have PDA. We performed TNE for all patients and cases with confirmed PDA were followed up every 3 days to assess changes in management plan till improvement or death. Results: Out of 85 cases examined, 43 were confirmed to have patent ductus arteriosus (PDA). Therapeutic interventions were provided, and Post treatment echo revealed that PDA was closed in 34.9% of patients, 25.6% still had PDA, and39.5% died. Comparing pre- to postechocardiographic analysis, there was statistically significant decrease in the mean of TR pressure gradient, pulmonary artery pressure, LT atrial/aortic ratio and LVESV also there was statistically significant decrease in LV output. Conclusions: We concluded that TNE can help in diagnosis of neonatal PDA. We recommend considering TNE as an early detector of PDA to achieve better outcomes. [ABSTRACT FROM AUTHOR]

Background: Blood draws for laboratory investigations are essential for patient management in neonatal intensive care units (NICU). When blood samples clot before analysis, they are rejected, which delays treatment decisions and necessitates repeated sampling. Aim: To decrease the incidence of rejected blood samples taken for laboratory investigation as a result of clotted sample. Study Design: This retrospective observational study used routine data on blood draws from preterm infants collected between January 2017 and June 2019 in a 112‐cot NICU in Qatar. Quality improvement interventions to reduce the rate of clotted blood samples included: awareness raising and safe sampling workshops with NICU staff, involvement of the neonatal vascular access team, development of a complete blood count (CBC) sample collection pathway, review of sample collection equipment, introducing the Tenderfoot® heel lance, establishment of benchmarks and provision of dedicated blood extraction equipment. Results: First attempt blood draw occurred in 10 706 cases, representing a 96.2% success rate. In 427 (3.8%) cases, the samples were clotted requiring repeat collection. The overall rate of clotted specimens decreased from 4.8% in 2017 and 2018 to 2.4% in 2019, with odds ratios of 1.42 (95% confidence interval [CI] 1.13–1.78, p =.002), 1.46 (95% CI 1.17–1.81, p <.001) and 0.49 (95% CI 0.39–0.63, p <.001), respectively. The majority (87%–95%) of blood samples were by venepuncture using an intravenous (IV) catheter or the NeoSafe™ blood sampling device. Heel prick sampling was the second (2%–9%) most common method. Clotted samples were most frequently associated with needle use, 228 of 427 (53%), and IV cannula, 162 of 427 (38%), with odds ratios of 4.14 (95% CI 3.34–5.13, p <.001) and 3.11 (95% CI 2.51–3.86, p <.001), respectively. Conclusions: Our interventions over 3 years were associated with reduced rates of sample rejection due to clotting, and this led to improved patient experience through fewer repeated samplings. Relevance to Clinical Practice: The insights gained from this project can help to improve patient care. Interventions that reduce the rate of blood sample rejection by clinical laboratories can lead to economic savings, timelier diagnostic and treatment decisions, and contribute to an improved quality care experience for all critical care patients, irrespective of age, by reducing the need for repeated phlebotomy and the risk of related complications. [ABSTRACT FROM AUTHOR]

Parents may experience altered psychological well-being and sleep following the discharge of their preterm infant. They also perceive a lack of information from healthcare professionals. This study aims to describe the educational needs of parents regarding their psychological well-being and their sleep quality following their infant's discharge from the neonatal unit. This descriptive quantitative study uses an online survey to assess parental information needs. Multiple parents (n = 87) completed the survey. Descriptive statistics were conducted to report the results of the survey. According to parents, the most helpful information given by health professionals to reduce the stress felt during this period concerned the follow-up of the infant after hospitalization and access to a health professional in case of questions (n = 12; 31.6%). Few parents (n = 17; 19.5%) reported seeing a health professional about their sleep in the past six months. According to 54.8% of parents, none of the information received by health professionals when preparing for their infant's transition home helped improve their sleep quality. After discharge, parents have several information needs that may impact their psychological well-being and the quality of their sleep. Healthcare professionals must address these informational needs before and after discharge from the neonatal unit to enhance the experience of parents during the transition of their preterm infant in the family environment. • Few parents received information about their sleep quality at the neonatal unit. • Parents have questions about their preterm infant's sleep following discharge. • Parents have information needs about prematurity and associated particularities. [ABSTRACT FROM AUTHOR]

Background: Mothers of high‐risk neonates experience tremendous stress during neonatal intensive care unit (NICU) admission. This stress has a negative impact on mothers' participation in neonatal care activities, psychological health and coping skills in the NICU. Objective: To determine the impact of interventional strategies to reduce maternal stress and enhance coping skills during neonatal admission to the NICU. Design: A scoping review was carried out following the methodological framework outlined by Arksey and O'Malley. Methods: This scoping review was conducted as per the Joanna Briggs Institute guidelines, including a quality appraisal checklist for randomised and nonrandomised controlled trials. Patterns, advances, gaps, evidence for practice and research recommendations from the review (PAGER framework) were used to report the results. The following international databases were used to search for primary articles: Medline via PubMed, EBSCOhost via CINAHL, Scopus, Web of Science and the ProQuest Medical Library. Original studies published in English between January 2011 and January 2023 from low‐ and middle‐income countries (LMICs) that assessed maternal stress and coping skills during neonatal NICU admission were included in the review. Results: The review included 15 articles from LMICs, of which 60% were from middle‐income, 25% were from lower‐middle‐income and 15% were from low‐income countries. Interventional strategies were described under five categories. Maternal stress decreased significantly across all three subscales of the PSPS: 'sight and sound', 'baby looks and behavior' and 'parental relationship with baby and role alteration' during neonatal NICU admission. Interventional strategies involving family‐centred care and emotional and psychological supportive care have been reported to have a consistently positive impact on alleviating maternal stress and enhancing coping skills in the NICU. Conclusion: Healthcare professionals, especially nurses, are pivotal in promptly recognising maternal stress and NICU stressors. The participation of mothers in neonatal care, such as through family‐centred care and emotional support interventions, significantly reduces maternal stress and enhances coping skills. [ABSTRACT FROM AUTHOR]

Background/Objectives: Kangaroo Care (KC) has been proven to enhance physiological stability, growth, and bonding in preterm, low-birthweight infants. Despite its benefits, KC is underutilized in Level IV Neonatal Intensive Care Units (NICUs) due to challenges in managing medical equipment. This study introduces the Kangarobe™, a novel garment designed to facilitate safe, comfortable, and efficient KC for medically fragile infants in high-acuity NICUs. Methods: From 2021 to 2023, a feasibility study was conducted involving 25 infant-parent dyads in a Level IV NICU. The Kangarobe™ was designed using human-centered design principles and tested on infants dependent on respiratory support. Surveys employing a 5-point Likert scale were administered to parents and nursing staff to assess safety, comfort, ease of use, and procedural access. Results: Survey results showed positive feedback from both parents and nursing staff, particularly in the areas of safety and comfort. For example, 72–80% of parents and nurses responded positively regarding ease and comfort. High level of agreement (76%) on the security of medical line management, with minimal negative feedback. In addition, parents using the Kangarobe™ held their infants for an average of 171 min per session, with a notable increase compared to the typical 75 min, indicating enhanced comfort and feasibility for extended KC sessions. The Kangarobe™ successfully enabled the secure management of medical lines and tubes, with the vertical access window improving procedural efficiency without interrupting KC. Conclusions: The Kangarobe™ demonstrates promise in addressing barriers to KC in high-acuity NICUs. By enhancing safety, comfort, and ease of use, it supports wider adoption of KC practices, potentially improving patient safety, staff efficiency, and family-centered care. [ABSTRACT FROM AUTHOR]

Background: The reported data on European universal neonatal hearing screening (UNHS) practices tend to be scarce, despite the fact that the European Union project, EUScreen, collected unofficial data from 38 collaborating European institutions. The objectives of this systematic review were as follows: (a) to identify the most recent (in a 20-year span) literature information about UNHS programs in Europe and (b) to provide data on the procedures used to assess the population, the intervention policies, and on the estimated prevalence of congenital hearing loss with emphasis on the bilateral hearing loss cases. Methods: Queries were conducted via the Pubmed, Scopus and Google Scholar databases for the time period of 2004–2024. The Mesh terms used were "OAE", "Universal Neonatal Hearing Screening", "congenital hearing loss" and "well babies". Only research articles and review papers of European origin were considered good candidates. The standard English language filter was not used, in order to identify information from non-English-speaking scientific communities and groups. Results: Very few data and reports were identified in the literature search. Eleven manuscripts were identified corresponding to eight UNHS programs. Except in Poland, most of the data refer to regional and not national programs. The screening coverage estimates of all programs exceed 90%; infants were mostly assessed by a three-stage protocol (TEOAE + TEOAE + AABR), followed by a clinical ABR test. The average prevalence (i.e., from well babies AND NICU infants) of bilateral hearing loss ranged from 0.5 to 20.94 per 1000 (Zurich sample). Infants presenting unilateral or bilateral hearing losses were first rehabilitated by hearing aids and consequently (>15 mo) by cochlear implants. Conclusions: Even though UNHS programs are well-established clinical practices in the European States, the amount of information in the literature about these programs is surprising low. The existing data in the timespan 2004–2024 corroborate the international UNHS data in terms of coverage and bilateral hearing loss prevalence, but there is a strong need to supplement the existing information with the latest developments, especially in the area of hearing loss rehabilitation. [ABSTRACT FROM AUTHOR]

Abstract Background Involving parents in decisions about the care of their infant is common practice in most neonatal intensive care units. However, involvement is less common in neonatal research and a gap appears to exist in understanding the process of patient and public involvement. The aim of this study was to explore parents and researchers’ experiences of patient and public involvement in a neonatal research project. Methods A qualitative design was employed, consisting of two focus group interviews, one dyadic interview, and four individual interviews with parents and researchers. The interviews followed a semi-structured guide specific to both parents and researchers. Data were analysed using content analysis as described by Graneheim and Lundman. Results A total of nine parents and four researchers participated in the study. Seven themes were consolidated into three core concepts: Embracing the ethos and pathos of patient and public involvement, Finding the path to maximise meaningful involvement, and Becoming skilled in engaging patients and the public in research. The core concepts highlighted both similarities and differences, as well as challenges and facilitators, of the experiences of the patient and public involvement process. Conclusion Patient and public involvement in research was a mutually beneficial process, facilitating learning and reflective opportunities for parents and researchers. However, there were challenges that emphasised the need for rapport building between parents and researchers, valuing everyone’s unique perspective and expertise, with clear communication and well-defined roles and goals. These insights offer a contribution for future patient and public involvement in health research.