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PubMedDate not supplied

Accuracy of primary bedside neonatal nurse-generated score for neonatal acute physiology (SNAP) scores.

OBJECTIVE: To determine whether 24-hour SNAP scores generated from data gathered by primary bedside nurses agreed with the SNAP scores of one trained research nurse. STUDY DESIGN: Primary bedside nurses (n = 50) in a level III private nursery collected data necessary for generating 24-hour SNAP scores on 60 consecutively admitted inborn neonates who lived at least 24 hours. The amount of time required for data collection and scoring was also determined. SNAP scores and the time required to generate them were compared with the unit research nurse's SNAP scores and time required to generate them on the same 60 patients. The Wilcoxon rank test and Spearman's rank correlation were used for statistical analyses. RESULTS: SNAP scores generated from primary bedside nursing data did not differ from those of the research nurse's SNAP scores (11.7 +/- 0.8 vs 11.4 +/- 0.9 [mean +/- SEM], p = 0.7), and they correlated well over a wide range of SNAP scores (r = 0.93, p = 0.0001). Primary bedside nurses required more time (15 +/- 0.7 vs 3.0 +/- 0.08 minutes, p = 0.0001) to generate SNAP scores than the research nurse. CONCLUSION: Primary bedside level III nurses can accurately obtain data for SNAP scores during 8- to 12-hour shifts.

Data Collection↗
PubMed1977

Toxicity to bilirubin in neonates: infant development during first year in relation to maximum neonatal serum bilirubin concentration.

Neurologic and developmental performance during the first year of life was correlated with maximum neonatal serum bilirubin levels for 27,000 infants in the Collaborative Perinatal Project. The infants were grouped by race and by five birth weight/gestational age categories to control for the effect of these factors on hyperbilirubinemia and developmental outcome. Low mean eight-month motor scores and delayed one-year motor development were associated with serum bilirubin levels in the range of 10 to 14 mg/dl and above. This relationship was strongest for low-birth-weight/short-gestational-period infants. A persistent association of developmental outcome with hyperbilirubinemia was found over and above the variation of maturity within the birth weight/gestational age categories.

Bilirubin↗
PubMed2006

Use of polymerase chain reaction as a diagnostic tool for neonatal sepsis can result in a decrease in use of antibiotics and total neonatal intensive care unit length of stay.

OBJECTIVE: To retrospectively determine if a negative 16S ribosomal RNA (rRNA) polymerase chain reaction (PCR) (PCR(-)) could lead to a decrease in the number of antibiotic doses and neonatal intensive care unit (NICU) length of stay (LOS) for infants admitted to the NICU for presumed early-onset sepsis (EOS) with negative blood culture results (BC(-)). STUDY DESIGN: Analysis included 419 infants, greater than 35 weeks gestational age, with PCR(-), BC(-) and LOS > 48 h. Both the investigators and clinical care team were unaware of the PCR results. The actual number of antibiotic doses (AAD) administered was compared to an estimated number of antibiotics doses (EAD) that would have been given until PCR(-) results were available by 18 h. The number of antibiotic doses saved was calculated as (AAD-EAD). The actual NICU LOS in hours (aLOS) for a subset of infants who remained in the hospital primarily for antibiotic therapy was compared to an estimated LOS (eLOS) if infants with PCR(-) were discharged from the NICU when clinically stable. The number of hours saved was calculated as (aLOS-eLOS). RESULTS: Approximately eight antibiotic doses and 85 NICU hours per infant could be saved using PCR(-) results available at 18 h. CONCLUSIONS: Use of 16S rRNA PCR could decrease the number of antibiotics doses and NICU LOS for infants admitted for EOS. This may facilitate: (1) earlier NICU discharge; (2) parental satisfaction; and (3) decreased health care costs.

Anti-Bacterial Agents↗
PubMed2004

Molecular epidemiology of gram-negative bacilli from infected neonates and health care workers' hands in neonatal intensive care units.

We sought to characterize the molecular epidemiology of gram-negative bacilli (GNB) causing infections in infants and associated with carriage on nurses' hands after hand hygiene was performed. From March 2001 to January 2003, GNB caused 192 (34%) of 562 hospital-acquired infections in the 2 participating neonatal intensive care units (NICUs) and were isolated from the hands of 45 (38%) of 119 nurses. Five species--Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens and Enterobacter cloacae, all of which were typed by pulsed-field gel electrophoresis--caused 169 (88%) of 192 of GNB infections. Overall, 58% of infections were caused by unique strains not cultured from other infants or nurses, and 31% of infections were part of unrecognized molecular clusters. In contrast, only 9% of strains that caused infections were cultured from nurses' hands. These data suggest that practices in addition to hand hygiene are needed to prevent horizontal transmission of GNB in the NICU.

Adult↗
PubMed2001

Correlation between clinical diagnoses at the time of death and autopsy findings in critically sick neonates at a regional neonatal intensive care unit in India.

This study was carried out to examine the correlation between clinical diagnoses at the time of death and autopsy findings in newborn babies who died in the regional Neonatal Intensive Care Unit (NICU) of King Edward VII Memorial Hospital affiliated to Bombay University. A consecutive sample of 240 newborns that died during the study period constituted the study cohort. Of these 240 (172 born in the hospital and 68 born outside) newborns who died during the study period, 197 (82.1 per cent) had autopsies performed. The mean Rushton's score for all the autopsies was 307+/-25.8 (range 300-400). There were 24 cases (12.2 per cent) where autopsy revealed a major finding (class I) that, if known prior to death, would have altered clinical management and could have resulted in cure or prolonged survival. In 53 patients (26.9 per cent) the autopsy revealed a major finding (class II) that, if known prior to death, would not have altered clinical management because specific therapy was unavailable or the patient had received appropriate therapy. It is concluded that a good quality autopsy continues to yield valuable and unsuspected information in a substantial number of newborn deaths.

Autopsy↗
PubMed1994

Variations in family visiting policies in neonatal intensive care units in eleven EC countries. EC Study Group of Parental Involvement in Neonatal Care.

The paper addresses the lack of information concerning parental visiting in neonatal intensive care units (NICU) across European Community (EC) countries. It reports on a study involving 11 EC countries and 38 units carried out under the auspices of a Concerted Action project. Information gathered from the 38 units yields data on the parental and family visiting policies. The study reveals a wide variation in the policies from considerable parental access to the infant in the NICU to restricted visiting. Policies concerned with unit facilities and unit support staff reflect the orientation of the overall unit policy with regard to visiting.

Attitude of Health Personnel↗
PubMed1993

Surfactant replacement therapy in neonates less than 32 weeks gestation: effect on neonatal intensive care resource utilization.

The effect of synthetic surfactant (Exosurf) replacement on complications from hyaline membrane disease (HMD) in infants < 32 weeks gestation and their resource utilization within a neonatal intensive care unit was studied in 1991-92. A control group was selected from infants admitted to the same unit during the preceding 3 years when Exosurf was not available. The infants were controlled for gestation, weight and severity of HMD. Infants given Exosurf had a significant reduction in the incidence of pulmonary interstitial emphysema (PIE), and a marginal decrease in the incidence of pneumothorax. They required fewer days on the ventilator and consumed less of the scarce financial resources. There was no difference in the mortality rate among the two groups. The changes seen were more evident among those infants between 30 and 31 weeks gestation, compared to those < 28 weeks.

Case-Control Studies↗
PubMed1997

Neonatal care of very-low-birthweight infants in special-care units and neonatal intensive-care units in Stockholm. Early nasal continuous positive airway pressure versus mechanical ventilation: gains and losses.

Very-low-birthweight (VLBW) infants are usually intubated at birth and mechanically ventilated at neonatal intensive-care units (NICUs). The objectives of this study were to evaluate the use of early nasal continuous positive airway pressure (NCPAP) in a regional cohort and to determine to what extent VLBW infants need transfer to a regional NICU from special-care units (SCUs) that primarily use early NCPAP for respiratory care. We compared the outcome for infants at SCUs and NICUs in Stockholm County, Sweden, from 1988 to 1993. All infants with birthweights of less than 1501 g were included in this study (n = 687). Fifty-nine per cent of the infants (400/687) were supported using only supplemental oxygen or NCPAP. Of these, 170 (25%) received only supplemental oxygen and 230 (34%) were supported only by NCPAP. A total of 350 (51%) infants received early NCPAP. Of these infants, 120 (34%) later required mechanical ventilation. Only 167 (24%) infants received mechanical ventilation from the beginning Failure of NCPAP was significantly associated with the presence of respiratory distress syndrome. A total of 161/412 (39%) infants were transferred from SCUs to NICUs. Of infants < or = 26 weeks' gestation and infants > 26 weeks, 71% and 34% were transferred, respectively. Total mortality was 16%. The mortality for transfers was 20% compared to an overall mortality in SCU and NICU infants of 9% and 15%, respectively. The overall incidence of intraventricular haemorrhage (IVH), grade III-IV was 8%, periventricular leucomalacia (PVL) grade I-IV was 7%, retinopathy of prematurity (ROP) requiring cryotherapy was 4.3% and chronic lung disease (CLD) was 14%. There were significant differences in the incidence IVH, PVL, CLD and ROP between SCU and NICU infants in matched gestational age groups. In conclusion, infants with a gestational age of 27 weeks or more may often be adequately cared for at SCUs without mechanical ventilation by using early NCPAP. However, infants with a gestational age of 26 weeks or less should be transferred to tertiary-care centres preferably before birth, because they will often require mechanical ventilation.

Gestational Age↗
PubMed1998

Persistence of clones of coagulase-negative staphylococci among premature neonates in neonatal intensive care units: two-center study of bacterial genotyping and patient risk factors.

From 1 January 1995 until 1 January 1996, we studied the molecular epidemiology of blood isolates of coagulase-negative staphylococci (CoNS) in the Neonatal Intensive Care Units (NICUs) of the Sophia Children's Hospital (SCH; Rotterdam, The Netherlands) and the Wilhelmina Children's Hospital (WCH; Utrecht, The Netherlands). The main goal of the present study was to detect putatively endemic clones of CoNS persisting in these NICUs. Pulsed-field gel electrophoresis was used to detect the possible presence of endemic clones of clinical significance. In addition, clinical data of patients in the SCH were analyzed retrospectively to identify risk factors for the acquisition of positive blood cultures. In both centers, endemic CoNS clones were persistently present. Thirty-three percent of the bacterial isolates derived from blood cultures in the SCH belonged to a single genotype. In the WCH, 45% of all bacterial strains belonged to a single clone. These clones were clearly different from each other, which implies that site specificity is involved. Interestingly, we observe that the clonal type in the SCH differed significantly from the incidentally occurring strains with respect to both the average pH and partial CO2 pressure of the patient's blood at the time of bacterial culture. We found that the use of intravascular catheters, low gestational age, and a long hospital stay were important risk factors for the development of a putative CoNS infection. When the antibiotic susceptibility of the bacterial isolates was assessed, a clear correlation between the nature of the antibiotics most frequently used as a first line of defense versus the resistance profile was observed. We conclude that the intensive use of antibiotics in an NICU setting with highly susceptible patients causes selection of multiresistant clones of CoNS which subsequently become endemic.

Anti-Bacterial Agents↗
PubMed1990

A comparison of two stress-reduction treatments for mothers of neonates hospitalized in a neonatal intensive care unit.

Thirty mothers of preterm infants requiring neonatal intensive care unit (NICU) hospitalization were assigned randomly to one of three groups to assess differences in treatment effectiveness of facilitating parental adaptation to the NICU stresses. Groups consisted of: (a) a treatment group receiving videotape training in active problem-focused coping strategies; (b) a treatment group receiving videotape training in emotion-focused strategies to help manage anxiety; and (c) a control group receiving promotional information about the hospital and the NICU. On pretreatment measures most of the mothers exhibited little distress, a finding unlike those for the majority of NICU studies. On posttreatment follow-up both the problem-focused and emotion-focused treatment groups were significantly less anxious than the controls and lower levels of depression were observed for the emotion-focused group. Findings suggest that the coping interventions examined were cost efficient and appear promising in facilitating mothers' coping with NICU stresses.

Adaptation, Psychological↗
PubMed2005

[Anxiety and depression symptoms assessment in pre-term neonates' mothers during and after hospitalization in neonatal intensive care unit].

OBJECTIVE: To identify clinical level of anxiety, dysphoria and depression symptoms of pre-term infants' mothers between two moments, during and after hospitalization in Neonatal Intensive Care Unit (NICU). METHODS: Previously, mothers with psychiatric background were excluded of the study. Forty-three pre-term and very low birthweight infants' mothers were assessed through State-Trait Anxiety Inventory and Beck Depression Inventory. The assessments were done during and after hospitalization, respectively. RESULTS: In the first assessment, 44% mothers showed clinical level in one or more of the emotional symptoms, such as anxiety, dysphoria or depression. After infants' discharge, the number of mothers with clinical level of emotional symptoms decreased significantly (26%) in comparison of the first assessment (p< or =0.008). The anxiety-state level decreased significantly from the first to the second assessment (from 35% to 12%; p< or =0.006). No difference in depression and dysphoria symptoms between two assessments were found. CONCLUSION: The pre-term infants' mothers presented situational anxiety and required emotional support to cope with the infants' hospitalization.

Adult↗
PubMedDate not supplied

A neuropathologic analysis of neonatal deaths occurring in a single neonatal unit over a 20-year period.

This study presents an overview of 2515 consecutive autopsies performed on newborn infants who died during the first 28 days of life at The Hospital for Sick Children, Toronto, during the period 1970-89. The infants were grouped into two categories according to their gestational age, then subdivided into groups of early (0-6 days) and late (7-28 days) neonatal death. Trends in the occurrence of neuropathologic observation were documented. For each 5-year period and each gestational group, the following diagnoses were recorded: hypoxic-ischemic neuronal changes, periventricular leukomalacia, infarction, kernicterus, meningitis, and hemorrhage (subependymal, parenchymal, choroidal). Over these 20 years, our results show that death in preterm infants decreased because of a drop in the incidence of subependymal hemorrhage/intraventricular hemorrhage, kernicterus, and meningitis but increased in term infants as a result of a higher frequency of hypoxic-ischemic neuronal necrosis and choroid plexus hemorrhage.

Cerebral Hemorrhage↗
PubMed2026

Severe Suprasystemic Refractory Pulmonary Hypertension in a Neonate with St&#xfc;ve-Wiedemann Syndrome Associated with Biallelic LIFR Variants: Molecular Insights and a Neonatal Case Report.

St&#xfc;ve-Wiedemann syndrome (SWS) is an ultra-rare autosomal recessive skeletal dysplasia caused by loss-of-function variants in the leukemia inhibitory factor receptor (LIFR) gene. While characterized by bone deformities and dysautonomia, severe persistent pulmonary hypertension of the newborn (PPHN) significantly contributes to high early mortality. We report a neonate with genetically confirmed SWS who presented with severe, suprasystemic PPHN refractory to standard pulmonary vasodilators, including inhaled nitric oxide. This case provides a detailed longitudinal hemodynamic characterization of severe suprasystemic PPHN in genetically confirmed SWS, including serial assessment of pulmonary pressures, shunt direction, and right ventricular function during treatment. Rather than identifying PPHN as a novel manifestation of SWS, it extends the phenotypic and hemodynamic characterization of pulmonary vascular involvement in this rare disorder.

Humans↗
PubMed1999

[Neonatal screening for sickle cell anemia in metropolitan France. For the group for neonatal screening of sickle cell anemia of the French Association for Screening and Prevention of Infant Handicaps (AFDPHE)].

An experimental neonatal screening program for sickle cell disease (SCD) was set up in continental France in 1990. The screening strategy was fine-tuned based on results of screening programs in the French West Indies and of pilot studies in several regions of continental France. Since early 1994, sickle cell disease screening is done in combination with screening for phenylketonuria, hypothyroidism, and congenital adrenal hyperplasia but is restricted to infants identified by maternity units as belonging to high-risk ethnic groups. Cost has proved acceptable, and rates of false-positive and false-negative tests have been very low. The management of infants with a positive screening test has been defined. All cases detected to date have been included in a prospective study. SCD is currently being extended to the entire country, an endeavor that will require considerable education efforts and careful surveillance.

Anemia, Sickle Cell↗
PubMed1997

Rapid retrieval of neonatal outcomes data: the Kaiser Permanente Neonatal Minimum Data Set.

Although neonatal intensive care units are known to be expensive, much of what happens inside such units in managed care organizations is not known. One reason for this lack of knowledge is that existing database systems were not designed to capture information in modern critical care units. This article describes the development of a dedicated outcomes database and wide area network linking six level III intensive care nurseries in the Kaiser Permanente Medical Care Program's Northern California Region. This database can be considered a hybrid, in that it combines attributes of research and operational systems.

California↗
PubMedDate not supplied

The Neonatal Bowel Output Study: indicators of adequate breast milk intake in neonates.

PURPOSE: This study describes the bowel habits of neonates who were exclusively breastfed during the first 14 days following birth to determine whether bowel output (frequency and character) could be used as a proxy measure for adequate breast milk intake. STUDY DESIGN: A prospective, descriptive study was conducted. During the 14-day study period, mothers kept a log of their infants' daily naked weight, number of feedings, number of daily bowel movements, and color of all bowel movements. PARTICIPANTS: One hundred thirty-one participants were enrolled in the study; 73 participants completed the study. FINDINGS: Findings indicate that more bowel movements per day during the first 5 days following birth were significantly associated with less initial weight loss, earlier transition to yellow bowel movements, earlier return to birth weight, and heavier weight at 14 days. CONCLUSIONS: These findings suggest that scant bowel output during the first 5 days following birth, or delayed transition of bowel movements to yellow, warrant weighing the infant in a health care professional's office.

Body Weight↗
PubMed1991

[Newborn infant of drug-addicted mother: maternal, perinatal, neonatal aspects, and neonatal abstinence syndrome].

Maternal drug addiction has increased in an alarming way over the last ten years. Therefore, the withdrawal syndrome in the newborn has also increased. 53% of the newborns (of chemical dependent mother) studied from 1985 to 1989 in HCP have presented this syndrome. We have analysed: perinatal, neonatal and maternal factors, and their clinical features and treatment: There is a great incidence of perinatal asphyxia, acidosis, premature rupture of the fetal membranes, etc. The newborns are usually premature or of low birth weight for their gestational age. They present diverse pathology: syphilis, HBsAg +, HIV +, gonorrhea, congenital malformations, etc. The mothers are often prostitutes, belong to a low socioeconomic status, have had previous abortions and have had no control of the actual pregnancy, etc. The syndrome of abstinence presents with: jitteriness, sweating, high-pitched or continuous crying, vomits, diarrhea, and even seizures. The neurological and digestive manifestations are the most difficult to treat. The treatment consists of general measures (little stimulation dim light, etc.), phenobarbital, and chlorpromazine.

Adult↗
PubMedDate not supplied

Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group.

There are few blood pressure (BP) data reported for premature and term newborn infants after 24 hours of age. To determine BP levels and BP trends in a representative population of infants admitted to neonatal intensive care units (NICUs), this study was conducted in 14 NICUs in the greater Philadelphia area. All infants admitted to the 14 NICUs during a 3-month period were entered into the study. BP data, along with data on clinical conditions and therapeutic interventions (independent variables), were prospectively collected by a uniform protocol. Systolic BP (SBP) and diastolic BP (DBP) were measured indirectly by oscillometry and recorded every 8 hours. Data from 608 infants followed up for 1 to 99 days after delivery generated 9911 infant-day records and 24,052 individual BP measurements. On day 1, birth weight and gestational age were strong correlates of SBP (r = 0.68, p < 0.0001 and r = 0.66, p < 0.0001, respectively) and DBP (r = 0.48, p < 0.0001 and r = 0.47, p < 0.001, respectively). During the first 5 days of life there was a progressive rise in SBP (2.23 to 2.67 mm Hg/day) and DBP (1.58 to 2.02 mm Hg/day) regardless of gestational age or weight at birth. After day 5 there was a more gradual increment in the daily SBP (0.24 to 0.27 mm Hg/day) and DBP (0 to 0.15 mm Hg/day). Stepwise linear multiple regressions were used to examine the multiple correlations among the independent variables and to build a regression model for BP. Gestational age and day of life emerged in the first two steps of the multiple regression analysis (multiple R = 0.463 and 0.655, respectively; p < 0.0001 for both). The multiple R values for day of life and gestational age were virtually identical to that for postconceptional age (day of life + gestational age at birth). Although other common diagnosis and treatment variables contributed a small amount to the total variance in BP, postconceptional age was the primary determinant of BP in this population of infants.

Birth Weight↗