Editorial

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3 pages, 178 KiB

Open AccessEditorial

Practical Issues in the Treatment of Preterm Infants

by Shmuel Arnon

Children 2023, 10(5), 849; https://doi.org/10.3390/children10050849 - 08 May 2023

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Abstract

Each year, an estimated 15 million babies are born too early; more than 1 in 10 babies [...] Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

Research

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10 pages, 251 KiB

Open AccessArticle

The Effect of SSRI Exposure in Pregnancy on Early Respiratory and Metabolic Adaptation in Infants Born Preterm

by Ayala Gover, Kareen Endrawes, Michal Molad, Karen Lavie-Nevo and Arieh Riskin

Children 2023, 10(3), 508; https://doi.org/10.3390/children10030508 - 04 Mar 2023

Cited by 1 | Viewed by 1914

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are increasingly used for maternal depression during pregnancy; however, their use has been linked to adverse effects in newborns. Respiratory and feeding problems, jaundice, metabolic and temperature dysregulation and hypoglycemia have been described in term infants. However, scarce [...] Read more.

Selective serotonin reuptake inhibitors (SSRIs) are increasingly used for maternal depression during pregnancy; however, their use has been linked to adverse effects in newborns. Respiratory and feeding problems, jaundice, metabolic and temperature dysregulation and hypoglycemia have been described in term infants. However, scarce data exists on early neonatal adaptation in exposed infants born prematurely. We aimed to assess the effects of SSRI exposure on early neonatal adaptation measures in infants born prematurely. Data from preterm infants exposed to maternal SSRIs during pregnancy and from matched controls were retrospectively collected. Forty-two infants comprised the final cohort: 21 infants with SSRI exposure and 21 matched controls. 1 min Apgar score was significantly lower in the exposed group compared to the non-exposed group (p = 0.043). No differences were found in 5 min Apgar scores, cord pH, need for delivery room resuscitation, rate of hypoglycemia, hyponatremia, hyperbilirubinemia, need for phototherapy, temperature stability and maximal oxygen requirements. No differences were found in the total time of respiratory support, time to reaching full enteral feeds, length of stay and complications of prematurity. Unlike studies in term infants, no significant differences were found in adaptation and short-term outcomes between preterm infants with and without SSRI exposure in pregnancy. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

13 pages, 919 KiB

Open AccessArticle

Impact of Delayed Time to Antibiotics in Medical and Surgical Necrotizing Enterocolitis

by Katherine E. Chetta, Katherine G. Vincent, Bresney Fanning, Ashley B. Klumb, Justin A. Chetta, Allison M. Rohrer, Leslie H. Spence and Jeanne G. Hill

Children 2023, 10(1), 160; https://doi.org/10.3390/children10010160 - 14 Jan 2023

Cited by 4 | Viewed by 2431

Abstract

This study investigated whether delayed receipt of antibiotics in infants with necrotizing enterocolitis (NEC) is associated with disease severity. In this retrospective, single-center cohort study of infants diagnosed with NEC over 4 years, we compared the timing of antibiotic administration in infants (time [...] Read more.

This study investigated whether delayed receipt of antibiotics in infants with necrotizing enterocolitis (NEC) is associated with disease severity. In this retrospective, single-center cohort study of infants diagnosed with NEC over 4 years, we compared the timing of antibiotic administration in infants (time order placed to time of receipt) in medical and surgical NEC. Cases were independently reviewed, then various clinical factors were compared. Of 46 suspected cases, 25 were confirmed by a panel of radiologists with good interrater reliability (ICC 0.657; p < 0.001). Delays in antibiotic receipt were 1.7× greater in surgical than medical NEC cases (p = 0.049). Every hour after order entry increased the adjusted odds of surgical NEC by 2.4 (1.08–5.23; p = 0.032). Delayed antibiotic receipt was more common in infants with surgical than medical NEC. Larger studies will be needed to investigate if optimizing antibiotic expediency could improve intestinal outcomes. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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11 pages, 1070 KiB

Open AccessArticle

Gentle Touch and Sucrose for Pain Relief during Suctioning in Preterm Newborns—A Randomized Clinical Trial

by Nayara Rodrigues Gomes de Oliveira, Cibelle Kayenne Martins Roberto Formiga, Bruna Abreu Ramos, Rafaela Noleto dos Santos, Nayara Nubia de Sousa Moreira, Patricia Gonçalves Evangelista Marçal and Waldemar Naves do Amaral

Children 2023, 10(1), 158; https://doi.org/10.3390/children10010158 - 13 Jan 2023

Cited by 2 | Viewed by 1825

Abstract

Pain management is challenging in neonatal care. We aimed to compare the effects of gentle touch and sucrose on pain relief during suctioning in premature newborns (PTNB). This crossover randomized clinical trial enrolled PTNBs with low birth weight, hemodynamically stable, and requiring suctioning [...] Read more.

Pain management is challenging in neonatal care. We aimed to compare the effects of gentle touch and sucrose on pain relief during suctioning in premature newborns (PTNB). This crossover randomized clinical trial enrolled PTNBs with low birth weight, hemodynamically stable, and requiring suctioning during hospitalization in the neonatal intensive care unit. PTNBs underwent three different suctioning procedures. The first was performed without intervention (baseline). Right after, PTNBs were randomly allocated (sucrose and gentle touch or vice versa) to the next two suctioning procedures. Two validated scales assessed pain: the Neonatal Infant Pain Scale (NIPS) and the Premature Infant Pain Profile-Revised (PIPP-R). We evaluated 50 PTNBs (mean of 28 weeks) with a mean low birth weight of 1050 g; most were under continuous positive airway pressure 37 (74%) and mechanical ventilation 41 (82%). Gentle touch was efficacious for pain relief since NIPS (p = 0.010) compared to baseline. Sucrose was also effective in reducing pain NIPS and PIPP-R (p < 0.001). Although the two interventions reduced pain, no difference was observed between gentle touch and sucrose. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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11 pages, 249 KiB

Open AccessArticle

Improving Communication with Parents in the NICU during the COVID-19 Pandemic, a Study and Review of the Literature

by Arieh Riskin, Shlomit Shlezinger, Lital Yonai, Frida Mor, Limor Partom, Elinor Monacis-Winkler, Keren Odler, Maria Goroshko and Ayala Gover

Children 2022, 9(11), 1739; https://doi.org/10.3390/children9111739 - 11 Nov 2022

Cited by 2 | Viewed by 1737

Abstract

Background: Communication with parents of sick premature and term infants in the NICU is complicated and challenging. Multiple efforts have been made to improve it, including the introduction of new electronic-based measures. Aim: We aimed to study the influence of implementation of a [...] Read more.

Background: Communication with parents of sick premature and term infants in the NICU is complicated and challenging. Multiple efforts have been made to improve it, including the introduction of new electronic-based measures. Aim: We aimed to study the influence of implementation of a new communication technology on parents’ satisfaction with care in the NICU during the COVID-19 pandemic. Methods: Infants were video-recorded in their incubators or cots without being disturbed. These short films, with voice updates on the infant’s condition, were sent on a daily basis to their parents via a WhatsApp application. Results: Parents who chose to join the new communication project (study group) were older, and their infants were more premature. Parents were satisfied with this new communication modality. Satisfaction scores in both study and control groups were high, but not significantly different. Conclusions: Although the implementation of the new communication project was successful, we could not demonstrate significant improvement in satisfaction scores that were high in study and control groups, reflecting baseline high satisfaction. Further studies are needed employing other assessment tools in order to evaluate other aspects of parents’ satisfaction with new modalities of communication introduced to the NICU, and their effects on parents’ bonding with their infants. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

11 pages, 546 KiB

Open AccessArticle

The Effects of Rudeness on NICU Medical Teams Studied by a New Tool for the Assessment of Decision-Making Group Dynamics

by Yarden Riskin, Arieh Riskin, Hussein Zaitoon, Clair Habib, Einav Blanche, Ayala Gover and Alex Mintz

Children 2022, 9(10), 1436; https://doi.org/10.3390/children9101436 - 21 Sep 2022

Cited by 2 | Viewed by 1187

Abstract

Background: Group decision-making can be placed on a continuum of group dynamics, between Groupthink and Polythink. Objective: To present a new assessment tool for the characterization of medical teams’ decision-making group dynamics, and test it to study the effects of exposure to rudeness [...] Read more.

Background: Group decision-making can be placed on a continuum of group dynamics, between Groupthink and Polythink. Objective: To present a new assessment tool for the characterization of medical teams’ decision-making group dynamics, and test it to study the effects of exposure to rudeness on various types of group dynamics. Methods: Three judges who watched videotapes of critical care simulations evaluated 24 neonatal intensive care unit teams’ decision-making processes. Teams were rated using the new assessment tool, especially designed for this quantitative study, based on items adapted from symptoms of Polythink and Groupthink. Results: Measures of reliability, inter-rater agreement and internal consistency, were reasonably good. Confirmatory factor analysis refined the tool and verified that the symptoms in each category (Polythink or Groupthink) of the refined 14 items’ assessment tool were indeed measures of the construct. The average General Score was in the range of the balanced dynamic on the continuum, and without tendency towards one of the extremities (Groupthink or Polythink). No significant effect of exposure to rudeness on group dynamics was found. Conclusions: This is a first attempt at using quantitative methods to evaluate decision-making group dynamics in medicine, by adapting symptoms of Groupthink and Polythink as items in a structured assessment tool. It suggests a new approach to understanding decision-making processes of medical teams. The assessment tool seems to be a promising, feasible and reasonably reliable research tool to be further studied in medicine and other disciplines engaged in decision-making. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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10 pages, 496 KiB

Open AccessArticle

An Observational Study on the Use of Peripheral Intravenous Lines vs. Central Lines in a Neonatal Intensive Care Unit

by Arieh Riskin, Adir Iofe, Donia Zidan, Irit Shoris, Arina Toropine, Rasha Zoabi-Safadi, David Bader and Ayala Gover

Children 2022, 9(9), 1413; https://doi.org/10.3390/children9091413 - 18 Sep 2022

Cited by 1 | Viewed by 1699

Abstract

Background and Objectives: There is a debate regarding the preferred intravenous (IV) access for newborns. Our aim was to study practices regarding the choice of vascular access and outcomes. Methods: A seven-month prospective observational study on IV lines used in all newborns admitted [...] Read more.

Background and Objectives: There is a debate regarding the preferred intravenous (IV) access for newborns. Our aim was to study practices regarding the choice of vascular access and outcomes. Methods: A seven-month prospective observational study on IV lines used in all newborns admitted to Bnai Zion Medical Center’s neonatal intensive care unit (NICU). Results: Of 120 infants followed, 94 required IV lines. Infants born at ≤32 weeks gestation, or with a head circumference ≤29 cm were more likely to require two or more IV lines or a central line for the administration of parenteral nutrition or medications for longer periods. However, central lines (umbilical or peripherally inserted central catheters (PICC)) were not associated with better nutritional status at discharge based on weight z-scores. Only one complication was noted—a central line-associated bloodstream infection in a PICC. Conclusions: Our data suggest preferring central IV access for preterm infants born at ≤32 weeks or with a head circumference ≤29 cm. We encourage other NICUs to study their own data and draw their practice guidelines for preferred IV access (central vs. peripheral) upon admission to the NICU. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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16 pages, 568 KiB

Open AccessArticle

Staff Perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A Multicenter Cross-Sectional Study

by Immacolata Dall’Oglio, Rachele Mascolo, Anna Portanova, Angela Ragni, Patrizia Amadio, Martina Fiori, Marco Tofani, Orsola Gawronski, Simone Piga, Gennaro Rocco, Emanuela Tiozzo, Jos M. Latour and on behalf of the FCC Italian NICUs Study Group

Children 2022, 9(9), 1401; https://doi.org/10.3390/children9091401 - 15 Sep 2022

Cited by 5 | Viewed by 2131

Abstract

Family Centered Care (FCC) in Neonatal Intensive Care Units (NICUs) included family involvement in the care process of newborns and infants. Staff perceptions of FCC may influence clinical practice and management strategies in NICUs, with an impact on quality and humanization of the [...] Read more.

Family Centered Care (FCC) in Neonatal Intensive Care Units (NICUs) included family involvement in the care process of newborns and infants. Staff perceptions of FCC may influence clinical practice and management strategies in NICUs, with an impact on quality and humanization of the care. The Family-Centred Care Questionnaire-Revised (FCCQ-R) was adapted for the NICU setting, therefore the FCCQ-R@it-NICU was developed and used for the present study in 32 Italian NICUs. We calculated internal consistency using Cronbach’s alpha correlation between Current and Necessary dimensions of the scale using the Pearson correlation coefficient. Furthermore, we investigated which characteristics could influence staff perceptions of FCC in NICUs. 921 NICU professionals participated in the study. The FCCQ-R@it-NICU revealed good internal consistency (0.96) and good correlation between dimensions (p < 0.05). Statistical and significant differences in Current and Necessary dimensions were found and some demographic characteristics were found predictable on FCC practice. The FCCQ-R@it-NICU is a valid tool to investigate staff perceptions about FCC in NICU settings. Profession, education level and work experience seem to positively influence the perception of what is required for FCC practice within NICUs. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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12 pages, 564 KiB

Open AccessArticle

Music Therapy Intervention in an Open Bay Neonatal Intensive Care Unit Room Is Associated with Less Noise and Higher Signal to Noise Ratios: A Case-Control Study

by Shmuel Arnon, Shulamit Epstein, Claire Ghetti, Sofia Bauer-Rusek, Riki Taitelbaum-Swead and Dana Yakobson

Children 2022, 9(8), 1187; https://doi.org/10.3390/children9081187 - 08 Aug 2022

Cited by 2 | Viewed by 2314

Abstract

Background: Noise reduction in the Neonatal Intensive Care Unit (NICU) is important for neurodevelopment, but the impact of music therapy on noise is not yet known. Objective: To investigate the effect of music therapy (MT) on noise levels, and whether individual MT (IMT) [...] Read more.

Background: Noise reduction in the Neonatal Intensive Care Unit (NICU) is important for neurodevelopment, but the impact of music therapy on noise is not yet known. Objective: To investigate the effect of music therapy (MT) on noise levels, and whether individual MT (IMT) or environmental MT (EMT) increases meaningful signal-to-noise ratios (SNR). Study design: This case-control study was conducted in a level III NICU. Noise levels were recorded simultaneously from two open bay rooms, with a maximum of 10 infants in each room: one with MT and the other without. MT sessions were carried out for approximately 45 min with either IMT or EMT, implemented according to the Rhythm Breath and Lullaby principles. Noise production data were recorded for 4 h on 26 occasions of EMT and IMT, and analyzed using R version 4.0.2 software. Results: Overall average equivalent continuous noise levels (Leq) were lower in the room with MT as compared to the room without MT (53.1 (3.6) vs. 61.4 (4.7) dBA, p = 0.02, d = 2.1 (CI, 0.82, 3.42). IMT was associated with lower overall Leq levels as compared to EMT (51.2 vs. 56.5 dBA, p = 0.04, d = 1.6 (CI, 0.53, 1.97). The lowest sound levels with MT occurred approximately 60 min after the MT started (46 ± 3.9 dBA), with a gradual increase during the remaining recording time, but still significantly lower compared to the room without MT. The SNR was higher (18.1 vs. 10.3 dBA, p = 0.01, d = 2.8 (CI, 1.3, 3.86)) in the room with MT than in the room without MT. Conclusion: Integrating MT modalities such as IMT and EMT in an open bay NICU room helps reduce noise. Both MT modalities resulted in higher SNR compared to the control room, which may indicate that they are meaningful for the neurodevelopment of preterm infants. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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10 pages, 428 KiB

Open AccessArticle

Body Weight Gain Status during the Incubator Weaning Process in Very Low Birth Weight Premature Infants

by Chung-Wei Lin, Hsiang-Yun Ko, Chih-Chi Huang, Chiu-Yu Yeh, Yen-Chun Chiu and Hsiu-Lin Chen

Children 2022, 9(7), 985; https://doi.org/10.3390/children9070985 - 30 Jun 2022

Cited by 1 | Viewed by 2461

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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9 pages, 462 KiB

Open AccessArticle

Vitamin D Levels in Pregnant Women Do Not Affect Neonatal Bone Strength

by Orly Levkovitz, Elena Lagerev, Sofia Bauer-Rusak, Ita Litmanovitz, Eynit Grinblatt, Gisela Laura Sirota, Shachar Shalit and Shmuel Arnon

Children 2022, 9(6), 883; https://doi.org/10.3390/children9060883 - 13 Jun 2022

Cited by 4 | Viewed by 1579

Abstract

Vitamin D plays a key role in regulating calcium and phosphate metabolism. However, whether maternal vitamin D levels affect fetal bone strength is unclear. This study assessed correlations between maternal 25(OH)D status and neonatal bone strength 25(OH)D levels, these were measured in the [...] Read more.

Vitamin D plays a key role in regulating calcium and phosphate metabolism. However, whether maternal vitamin D levels affect fetal bone strength is unclear. This study assessed correlations between maternal 25(OH)D status and neonatal bone strength 25(OH)D levels, these were measured in the maternal and infant cord blood of 81 mother–infant dyads. Bone strength was measured using a quantitative ultrasound (QUS) of tibial bone speed of sound (SOS). Maternal vitamin D intake, medical history and lifestyle were evaluated from questionnaires. Maternal 25(OH)D levels were deficient (<25 nmol/L) in 24.7%, insufficient (25–50 nmol/L) in 37% and sufficient (>50 nmol/L) in 38.3%. The maternal and cord blood 25(OH)D levels correlated (r = 0.85, p < 0.001). Cord blood levels (57.9 ± 33.5 nmol/L) were higher than the maternal blood levels (46.3 ± 23.2: p < 0.001). The mean SOS was 3042 ± 130 m/s. The neonatal SOS and 25(OH)D levels were not correlated. The mean bone SOS levels were comparable in the three maternal and cord blood 25(OH)D groups. No correlation was found between the maternal 25(OH)D levels and the neonatal anthropometrics. Although the 25(OH)D levels were higher in Jewish mothers than they were in Muslim mothers (51.1 ± 22.6 nmol/L vs. 24 ± 14.7 nmol/L, respectively: p = 0.002) and in those who took supplemental vitamin D, the bone SOS levels were comparable. In conclusion, maternal vitamin D levels correlate with cord levels but do not affect bone strength or growth parameters. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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Review

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12 pages, 482 KiB

Open AccessReview

Emotional Regulation Interventions on Developmental Course for Preterm Children: A Systematic Review of Randomized Control Trials

by Vincenza Dell’Aversana, Marco Tofani and Donatella Valente

Children 2023, 10(3), 603; https://doi.org/10.3390/children10030603 - 22 Mar 2023

Cited by 2 | Viewed by 1698

Abstract

Children born preterm (<37 weeks of gestation) are at increased risk of socio-emotional difficulties. This study aims to determine the effects of rehabilitation intervention on the emotional regulation of children born preterm through a systematic review. We conducted a systematic review according to [...] Read more.

Children born preterm (<37 weeks of gestation) are at increased risk of socio-emotional difficulties. This study aims to determine the effects of rehabilitation intervention on the emotional regulation of children born preterm through a systematic review. We conducted a systematic review according to PRISMA guidelines. The literature screening was carried out on PUBMED, SCOPUS and WEB OF SCIENCE in August 2022. An author identified eligible studies based on predefined inclusion criteria and extracted the data. RCT quality was assessed using the JADAD and PEDro scales. We selected five RCTs for qualitative synthesis, having the common objective of evaluating the changes in emotional regulation after a rehabilitation intervention. Evidence of benefits was found after parent training intervention (PCIT; p < 0.05). Moreover, there was an improvement in day-to-day executive life and fewer behavioral problems after mindfulness intervention. Clinical, but not statistical, efficacy was found for the group-based physiotherapy intervention. In conclusion, parent training and mindfulness interventions can be helpful rehabilitation techniques, but the relatively small sample limited statistical power, so the discovery needs to be interpreted cautiously. Further research on these aspects is recommended. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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Other

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9 pages, 234 KiB

Open AccessPerspective

Effect of Small Volume Blood Sampling on the Outcomes of Very Low Birth Weight Preterm Infants

by Pin-Chun Su, Hao-Wei Chung, Shu-Ting Yang and Hsiu-Lin Chen

Children 2022, 9(8), 1190; https://doi.org/10.3390/children9081190 - 08 Aug 2022

Cited by 4 | Viewed by 1498

Abstract

Very low birth weight (VLBW) preterm infants universally experience anemia of prematurity (AOP) while growing up. The effects of reduced blood sample volume on AOP, packed red blood cell (PRBC) transfusion, and outcome in VLBW preterm infants were examined in this study. To [...] Read more.

Very low birth weight (VLBW) preterm infants universally experience anemia of prematurity (AOP) while growing up. The effects of reduced blood sample volume on AOP, packed red blood cell (PRBC) transfusion, and outcome in VLBW preterm infants were examined in this study. To reduce blood loss due to phlebotomy, we set up a small volume blood sampling procedure in VLBW infants. In this retrospective study, we compared the VLBW infants who had undergone standard blood sampling (control group, n = 20) with those who underwent small volume blood sampling (study group, n = 84), with both groups receiving PRBC transfusion under restrictive criteria. Blood loss from phlebotomy and PRBC transfusion volume over 30 days was significantly lower in the study group than in the control group. Compared to the control group, hematocrit, reticulocyte, and iron levels were significantly higher in the study group. There were no significant differences in the proportion of patent ductus arteriosus, severe intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia between the two groups. The small volume blood sampling resulted in lower PRBC transfusion volume, less severe anemia, and greater bone marrow function at 30 days of age. This strategy can reduce potential adverse effects of PRBC transfusion in VLBW preterm infants. Full article

(This article belongs to the Special Issue Practical Issues in Treatment of Preterm Infants)

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