About 16,000 infants die in the neonatal intensive care unit (NICU) each year with many experiencing invasive medical treatments and high number of symptoms.
To inform better management, we ...characterized diagnoses, symptoms, and patterns of care among infants who died in the NICU.
Retrospective electronic medical record (EMR) review of 476 infants who died following admission to a large regional level IV NICU in the United States over a 10-year period. Demographic, symptom, diagnosis, treatment, and end-of-life characteristics were extracted.
About half of infants were male (55.9%,
= 266), average gestational age was 31.3 weeks (standard deviation SD = 6.5), and average age at death was 40.1 days (SD = 84.5; median = 12; range: 0-835). Race was documented for 65% of infants, and most were White (67.0%). One-third of infants (
= 138) were seen by fetal medicine. Most infants experienced pain through both the month and week before death (79.6%), however, infants with necrotizing enterocolitis had more symptoms in the week before death. Based on EMR, infants had more symptoms, and received more medical interventions and comfort measures during the week before death compared with the month prior. Only 35% (
= 166) received a palliative care referral.
Although the medical profiles of infants who die in the NICU are complex, the overall number of symptoms was less than in older pediatric populations. For infants at high risk of mortality rate, providers should assess for common symptoms over time. To manage symptoms as effectively as possible, both timely and continuous communication with parents and early referral to palliative care are recommended.
Previous studies suggest that maternal postpartum mental health issues may have an impact on parenting and child development in preterm infants, but have often not measured symptomatology in the ...neonatal intensive care unit (NICU) or followed families through early childhood. This study examines how maternal depressive symptoms and stress in the NICU are related to parenting behaviors at age 5 years, in mothers of children born very preterm (at ≤30 weeks' gestation).
This longitudinal study followed a diverse sample of 74 very preterm children and their mothers. Maternal depression and stress were assessed in the NICU. At age 5, mother-child dyads were observed and coded for maternal intrusiveness, negativity, sensitivity, and positivity. Other covariates, including maternal and child intelligence, maternal education, income-to-needs ratio, maternal depression at age 5 years, and child sex were included in multivariate analyses.
The interaction between maternal NICU stress and NICU depression for intrusiveness and negativity indicates that greater NICU depression was associated with more intrusiveness under medium or high levels of NICU stress, and more negativity under high levels of NICU stress. Furthermore, greater NICU depression was associated with less sensitivity, over and above other covariates.
Findings suggest that early maternal peripartum depression and stress in the NICU can have lasting impacts on multiple parenting behaviors, highlighting the need for screening and targeted interventions in the NICU.
Background
Healthcare workers (HCWs) wash their hands with tap water (TW) and soap. However, hard TW causes dermatitis.
Objectives
The present study aimed to compare the effects of ultra‐pure soft ...water (UPSW) with those of TW on the hands of HWCs.
Methods
The present study was a prospective randomized trial with a crossover design. All the nurses in the neonatal intensive care unit (NICU) at the study centre were divided into Sequence 1 (UPSW to TW) or 2 (TW to UPSW) and washed their hands with TW or UPSW in alternating 4‐week periods with a 4‐week washout period. Trans‐epidermal water loss (TEWL) and stratum corneum hydration (SCH) were evaluated. Skin condition was self‐assessed.
Results
Twenty‐one and 22 nurses were assigned to Sequence 1 and Sequence 2, respectively. USPW increased SCH to a significantly greater degree than TW (mean: 26.3 μS ± 12.3 SD; 95% confidence interval: 1.12–51.54; p = 0.041) although it did not affect TEWL. UPSW use significantly improved the subjects' skin condition, as reflected in an overall increase in the assessment scores.
Conclusions
UPSW improved SCH and the condition of hand skin. Prolonged USPW use may increase nurses' comfort during work and hand hygiene compliance.
Stratum corneum hydration (SCH) in the hands of NICU nurses significantly increased after washing with ultra‐pure soft water (UPSW) compared to tap water (TW). Hand skin dryness improved 1 week after the start of UPSW use, though self‐assessment.
•Infant's NICU stay provided an emotional rollercoaster ride to the parents.•Moments together as a family in the NICU represented normal parenthood.•Infant's reciprocal behaviour was significant to ...parents’ closeness experiences.•Stored closeness sustained parents through the unavoidable separation.
To identify and understand how parents develop a close bond to their infants in the neonatal intensive care unit (NICU).
A qualitative descriptive study; closeness and separation stories recorded in a smartphone application by the parents were analyzed using thematic analysis.
Twenty-three parents of nineteen infants who were taken care of in a level III NICU in Finland.
Bonding moments and a disrupted dyadic parent-infant relationship continuously alternated as in a rollercoaster ride during the hospital stay. Transitions from closeness to separation and vice versa were the most emotional stages on the journey. Parents had a natural desire to be close and create a bond with their infants; however, they accepted the separation as part of NICU care.
The findings indicate that closeness with their infant was the power that parents stored and that led them through unavoidable separation to normal parenthood.
Bonding and attachment will occur naturally if parents are close to their infants and permitted privacy and time with their infants. NICU staff should create a peaceful and calming environment that enables and supports this bonding process.
Increasing evidence has shown that the COVID-19 pandemic has had a profound negative impact on vulnerable populations and a significant effect on maternal and neonatal health. We observed an increase ...in the percentage of infants admitted to NICU from 8% to 10% in the first year of the pandemic. This study aimed to compare the delivery room outcomes, NICU admissions and interventions, and neonatal outcomes two years before and during the pandemic.
This was a retrospective study in a public hospital between pre-COVID-19 (April 2018-December 2019) and COVID-19 (April 2020-December 2021). Data were obtained from all live births at ≥35 weeks gestation (GA). Maternal and neonatal demographics, delivery room (DR), and NICU neonatal outcomes were compared between the study periods using simple bivariable generalized estimating equations (GEE) regression. Multivariable GEE logistic regression analysis was performed to adjust for the effects of baseline differences in demographics on the outcomes.
A total of 9,632 infants were born ≥35 weeks gestation during the study period (pre-COVID-19
= 4,967, COVID-19
= 4,665). During the COVID-19 period, there was a small but significant decrease in birth weight (33 g); increases in maternal diabetes (3.3%), hypertension (4.1%), and Hispanic ethnicity (4.7%). There was a decrease in infants who received three minutes (78.1% vs. 70.3%,
< 0.001) of delayed cord clamping and increases in the exclusive breastfeeding rate (65.9% vs. 70.1%,
< 0.001), metabolic acidosis (0.7% vs. 1.2%,
= 0.02), NICU admission (5.1% vs. 6.4%,
= 0.009), antibiotic (0.7% vs. 1.7%,
< 0.001), and nasal CPAP (1.2% vs. 1.8%,
= 0.02) use. NICU admissions and nasal CPAP were not significantly increased after adjusting for GA, maternal diabetes, and hypertension; however, other differences remained significant. Maternal hypertension was an independent risk factor for all these outcomes.
During the COVID-19 pandemic period, we observed a significant increase in maternal morbidities, exclusive breastfeeding, and NICU admissions in infants born at ≥35 weeks gestation. The increase in NICU admission during the COVID-19 pandemic was explained by maternal hypertension, but other adverse neonatal outcomes were only partly explained by maternal hypertension. Socio-economic factors and other social determinants of health need to be further explored to understand the full impact on neonatal outcomes.
Background Pregnancy in kidney disease is considered high risk, but the degree of this risk is unclear. We tested the hypothesis that kidney disease in pregnancy is associated with adverse maternal ...and fetal outcomes. Study Design Retrospective study comparing pregnant women with and without kidney disease. Setting & Participants Using data from an integrated health care delivery system from 2000 through 2013, a total of 778 women met the criteria for kidney disease. Using a pool of 74,105 women without kidney disease, we selected 778 women to use for matches for the women with kidney disease. These women were matched 1:1 by age, race, and history of diabetes, chronic hypertension, liver disease, and connective tissue disease. Predictor Kidney disease was defined using the NKF-KDOQI definition for chronic kidney disease or International Classification of Diseases, Ninth Revision codes prior to pregnancy or serum creatinine level > 1.2 mg/dL and/or proteinuria in the first trimester. Outcomes & Measurements Maternal outcomes included preterm delivery, delivery by cesarean section, preeclampsia/eclampsia, length of stay at hospital (>3 days), and maternal death. Fetal outcomes included low birth weight (weight < 2,500 g), small for gestational age, number of admissions to neonatal intensive care unit, and infant death. Results Compared with women without kidney disease, those with kidney disease had 52% increased odds of preterm delivery (OR, 1.52; 95% CI, 1.16-1.99) and 33% increased odds of delivery by cesarean section (OR, 1.33; 95% CI, 1.06-1.66). Infants born to women with kidney disease had 71% increased odds of admission to the neonatal intensive care unit or infant death compared with infants born to women without kidney disease (OR, 1.71; 95% CI, 1.17-2.51). Kidney disease also was associated with 2-fold increased odds of low birth weight (OR, 2.38; 95% CI, 1.64-3.44). Kidney disease was not associated with increased risk of maternal death. Limitations Data for level of kidney function and cause of death not available. Conclusions Kidney disease in pregnancy is associated independently with adverse maternal and fetal outcomes when other comorbid conditions are controlled by matching.
Neonatal care for preterm babies is prolonged and expensive. Our aim was to analyze and report costs associated with common preterm diagnoses during NICU stay.
We analyzed data from the Ontario ...healthcare data service. Diagnoses were collated by discharge ICD codes, and categorized by gestational age. We calculated typical non parametric statistics, and for each diagnosis we calculated median shifts and generalized linear mode.
We included data on 12,660 infants between 23 and 30 weeks gestation in 2005-2017. Calculated cost increment with diagnosis were: Intestinal obstruction: $94,738.08 (95%CI: $70,093.3, $117,294.2), Ventriculoperitoneal shunt: $86,456.60 (95%CI: $60,773.7, $111,552.2), Chronic Lung Disease $77,497.70 (95%CI: $74,937.2, $80,012.8), Intestinal perforation $57,997.15 (95%CI:$45,324.7, $70,652.6), Retinopathy of Prematurity: $55,761.80 (95%CI: $53,916.2, $57,620.1), Patent Ductus Arteriosus $53,453.70 (95%CI: $51,206.9, $55692.7, Post-haemorrhagic ventriculomegaly $41,822.50 (95%CI: $34,590.4, $48,872.4), Necrotizing Enterocolitis $39,785 (95%CI: $35,728.9, $43,879), Meningitis $38,871.85 (95%CI: $25,272.7, $52,224.4), Late onset sepsis $32,954.20 (95%CI: $30,403.7, 35.515), Feeding difficulties $24,820.90 (95%CI: $22,553.3, $27,064.7), Pneumonia $23,781.70 (95%CI: $18,623.8, $28,881.6), Grade >2 Intraventricular Haemorrhage $14,777.38 (95%CI: $9,821.7, $20,085.2). Adjusted generalized linear model of diagnoses as coefficients for cost confirmed significance and robustness of the model.
Cost of care for preterm infant is expensive, and significantly increases with prematurity complication. Interventions to reduce those complications may enable resource allocation and better understanding of the needs of the neonatal health services.
Mother's own milk (MOM) is the preferred nutrition for premature infants, particularly for the very low birth-weight (VLBW) cohort. Benefits are well documented; yet, numerous barriers exist for ...provision of MOM in the neonatal intensive care unit (NICU). Lactation consultants (LCs) can optimize breastfeeding support for NICU mothers; however, understanding of the impact of NICU-dedicated LCs is limited.
Evaluate the effectiveness of NICU-dedicated LCs in improving breastfeeding outcomes and MOM provision in VLBW infants.
A retrospective chart review of 167 VLBW infants comparing breastfeeding outcomes between 2 NICUs, one with NICU-dedicated LCs (hospital A; n = 48) and one without (hospital B; n = 119). Primary outcome measures included feeding percentages of MOM received by infants at 3 intervals, throughout hospitalization, and number of direct breastfeeding events. Secondary outcome measures included number of days to first enteral feed, days to reach full feeds, days of nil per os, days on total parenteral nutrition, and length of stay.
Neonatal intensive care unit-specific lactation support increased the number of direct breastfeeding events on day of discharge (P = .048). No statistical significance was found at each of the 3 time intervals, or throughout hospitalization (week 1: P = .18; midpoint: P = .40; discharge: P = .16; total hospitalization: P = .19). No statistical significance was demonstrated in secondary outcome measures (days to first enteral feed: P = .22; days to full feeds: P = .25; nil per os days: P = .27; total parenteral nutrition days: P = .34; length of stay: P = .01). Length of stay not found to be significant after correcting for confounding variables.
Increased direct breastfeeding events on day of discharge with exposure to NICU-dedicated LCs in the VLBW population.
Prospective studies regarding NICU-specific lactation support with larger samples are warranted.
There is increasing evidence that sleep plays a major role in the development of neural pathways in the neonatal brain. Several studies have suggested evidence-based approaches to improve sleep for ...infants admitted to the neonatal intensive care unit (NICU); however, in many neonatal centers very few of these strategies seem to be implemented in routine care.
To systematically review the literature to determine interventions promoting neonatal sleep on the NICU, in order to develop key guidelines to improve neonatal sleep.
A systematic search was conducted according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for conducting and reporting systematic reviews. The search was performed in Pubmed, CINAHL and the Cochrane Library on 19 September 2016 and again on 28 January 2017.
In total, fourteen studies were included (10 RCT's and three quasi-experimental study designs): four studies were of high quality, eight of moderate quality and two of low quality. Two studies investigating kangaroo care reported significant effect on infant sleep behavior, two studies comparing Yakson and Gentle Human Touch (GHT) found significant effect on behavioral states and one study reported an increase in sleep behavior using different sleep surfaces. One study showed a significant effect on sleep patterns using music as an intervention and one study showed no significant effect using music. Two studies showed no significant effect on infant sleep using cycled light and different types of LED-light and one study showed significant effect of cycled lightning. There were no effects of Neonatal Individualized Developmental Care Program (NIDCAP) or massage therapy.
Although many different interventions have been reported to promote sleep in infants who require intensive care, there is great heterogeneity across studies: the methods of sleep assessment, the targeted sleep behaviors, and the study populations vary significantly across published reports. Based on the results there seems to be insufficient evidence to recommend any new intervention to promote neonatal sleep on the NICU. However because of the importance of sleep for the development of the neonatal brain we do suggest some key guidelines based on moderate evidence, expert opinion and parental values to improve sleep on the NICU and to direct future neonatal sleep studies.
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