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Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents. Explore fathers' perceptions and interactions with nurses during their preterm infants' stay in a NICU. Qualitative study using ethnographic data collection techniques. Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis. Analysis revealed five primary themes: (i) communication and clarity about infants' health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers' satisfaction with nurses' support for mother, (iv) nurses' personal attention to the babies, and (v) nurses' varied personalities. Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant's hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial. Nurses play a critical role in shaping the fathers' experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities. Adherence to the COREQ guidelines. [ABSTRACT FROM AUTHOR]

Abstract: Most newborns are born vigorous and do not require neonatal resuscitation. However, about 10% of newborns require some type of resuscitative assistance at birth. Although the vast majority will require just assisted lung aeration, about 1% requires major interventions such as intubation, chest compressions, or medications. Recently, new evidence has prompted modifications in the international cardiopulmonary resuscitation (CPR) guidelines for both neonatal, paediatric and adult patients. Perinatal and neonatal health care providers must be aware of these changes in order to provide the most appropriate and evidence-based emergency interventions for newborns in the delivery room. The aim of this article is to provide an overview of the main recommended changes in neonatal resuscitation at birth, according to the publication of the international Liaison Committee on Resuscitation (ILCOR) in the CoSTR document (based on evidence of sciences) and the new 2010 guidelines released by the European Resuscitation Council (ERC), the American Heart Association (AHA), and the American Academy of Pediatrics (AAP). [Copyright &y& Elsevier]

Abstract: Cardiopulmonary resuscitation (CPR) is necessary in about 1–2% of all newly born infants in their first minutes of life. However, CPR may also be needed in newborns beyond the time of birth, particularly in high risk categories of infants admitted in the NICU or in other less specialised units. In all these scenarios, the role of nurses is essential for several aspects, including early recognition of a deteriorating infant, with the aim to prevent cardiac arrest, as well as the starting of immediate basic life support manoeuvres at the bedside, whenever needed. Furthermore, nurses have a special part in family care during cardiopulmonary resuscitation. [Copyright &y& Elsevier]

We report a 1-year-old child born with agenesis of the right lung who sustained an episode of acute respiratory failure related to a postpneumonectomy-like syndrome, with severe mediastinal shift and subsequent stretching and stenosis of the left main bronchus. The insertion of an expandable prosthesis in the right empty pleural space markedly improved the patient''s clinical condition. [Copyright &y& Elsevier]

This report presents the long-term (36 months) neurologic outcome in 12 neonates and 9 children who survived after extracorporeal membrane oxygenation and attempts to identify its prognostic indicators through a prospective study in the pediatric intensive care unit of a university hospital. Outcome assessment, neurodevelopmental tests, electroencephalogram, auditory evoked potentials, visual evoked potentials, and somatosensory evoked potentials, cerebral sonography, or cerebral tomography were evaluated at the end of bypass and at 6, 12, 24, and 36 months after extracorporeal membrane oxygenation. “Before extracorporeal membrane oxygenation” variables (oxygenation index, pH, oxygen arterial partial pressure) and “during extracorporeal membrane oxygenation” variables (pH, oxygen arterial partial pressure, duration of bypass, clotting activated time, electroencephalogram) were also analyzed. A negative neurologic outcome (Glasgow Outcome Score different from “good recovery” or neurodevelopmental score less than 70) 12 months after extracorporeal membrane oxygenation was documented in 8.3% of neonates and in 30% of children who survived. There was no further change in subsequent evaluations (24 and 36 months follow-up). The most abnormal electroencephalogram during extracorporeal membrane oxygenation, the first electroencephalogram, neuroimaging score, and somatosensory evoked potentials after extracorporeal membrane oxygenation treatment were associated with negative neurologic outcome. The study documented that neonates and children treated with extracorporeal membrane oxygenation require long-term follow-up; electroencephalogram, neuroimaging score, and somatosensory evoked potentials have prognostic value for abnormal neurologic outcome. [Copyright &y& Elsevier]

This study sought to compare point-of-care ultrasound (POCUS) and conventional X-rays for detecting fractures in children. This was a prospective, non-randomized, convenience-sample study conducted in five medical centers. It evaluated pediatric patients with trauma. POCUS and X-ray examination results were treated as dichotomous variables with fracture either present or absent. Descriptive statistics were calculated in addition to prevalence, sensitivity, specificity, positive predictive value and negative predictive value, including 95% confidence intervals (CIs). The Cohen κ coefficient was determined as a measurement of the level of agreement. A total of 554 examinations were performed with POCUS and X-ray. On physical examination, swelling, localized hematoma and functional limitation were found in 66.73%, 33.78% and 53.74% of participants, respectively. The most-studied areas were limbs and hands/feet (58.19% and 38.27%), whereas the thorax was less represented (3.54%). Sensitivity of POCUS was 91.67% (95% CI, 76.41-97.82%) for high-skill providers and 71.50 % (95% CI, 64.75-77.43%) for standard-skill providers. Specificity was 88.89% (95% CI, 73.00-96.34%) and 82.91% (95% CI, 77.82-87.06%) for high- and standard-skill providers, respectively. Positive predictive value was 89.19% (95% CI, 73.64-96.48%) and 75.90% (95% CI, 69.16-81.59%) for high- and standard-skill providers, respectively. Negative predictive value was 91.43% (95% CI, 75.81-97.76%) and 79.44% (95% CI, 74.21-83.87%) for high- and standard-skill providers, respectively. The Cohen κ coefficient showed very good agreement (0.81) for high-skill providers, but moderate agreement (0.54) for standard-skill providers. We noted good diagnostic accuracy of POCUS in evaluating fracture, with excellent sensitivity, specificity, and positive and negative predictive value for high-skill providers. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To compare the accuracy of procalcitonin (PCT) in early-onset neonatal sepsis (EOS) using standard cut-off values and a multilevel probabilistic approach. Design and methods: A retrospective study of PCT was performed in 149 newborns at risk of EOS, including preterm or prolonged rupture of membranes, chorioamnionitis or maternal infection, GBS colonization and signs of fetal distress. PCT values were analysed according to time of assay, i.e. at birth and at 24 and 48 h. We estimated sensitivity, specificity, positive (LR+) and negative likelihood ratio (LR−), diagnostic odds ratio (DOR) and number needed to diagnose (NND) using traditional and optimal (derived from ROC analysis) PCT cut-off values. Results: Using optimal cut-off, the LR+, DOR and NND at birth were 10, 18.9 and 2.2, at 24 h they were 5.3, 11.2 and 2.1, and at 48 h they were 5.6, 18.1 and 1.7, respectively. The multilevel analysis generated three post-test probabilities for each time of assay. At 24 h post-test probabilities of EOS were 78% for PCT >90, 11% for PCT 10.1–90 and 3% for PCT <10.1 mg/L, respectively. Similar results were found in the other time points, with a wide range of intermediate PCT concentrations that did not change the post-test probability. Conclusions: The multilevel probabilistic approach was more effective in assessing the diagnostic power of PCT in EOS, showing that a wide range of intermediate PCT values was not able to discriminate between presence and absence of infection. [Copyright &y& Elsevier]

Background:: Preterm infants are at high risk of oxidative stress-induced damage and diseases, including severe multifactorial outcomes of prematurity such as ROP, NEC and BPD. Human milk feedings of preterms is speculated having a protective role towards these diseases, namely against ROP and NEC. The carotenoids (lutein, b-carotene, and zeaxanthin) are a family of polyene, lipophilic molecules found in human milk but not in formulas. These molecules might account for the protective role of human milk, providing protection against both light-induced and metabolic oxidative damages in the retina and in other developing tissues. Objective:: The aim of this study was to evaluate the relationships of supplemented carotenoids (lutein and zeaxanthin) with the outcomes of preterm infants, namely ROP, NEC and BPD. Design/methods:: We report the preliminary data of a multicentre RCT conducted in three tertiary NICUs of Italy. All VLBW infants <33 wks g.a. were eligible. They were randomized to lutein/zeaxanthin supplementation (14 drops, i.e. 0.5 ml, meaning 0.14 mg of lutein and 0.0006 mg of zeaxanthin; LuteinOfta gtt, NEOOX Division of SOOFT Italia s.p.a., Montegiorgio, Italy; group A) or placebo (same amount of glucose solution; group B) from birth till the 36th wk g.a. corrected age. Drugs and placebo were administered in a single oral daily dose. The primary outcomes were ROP (threshold and all-stage), NEC (>2nd stage) and BPD (defined as the need for oxygen supplementation at 36 wks of age). Surveillance for detection of these diseases, as well as for intolerance/adverse effects was performed till discharge. Measurements of serum liver enzyme values were performed at 4 wks of age. Preliminary results:: This preliminary analysis included 107 infants. Their clinical and demographical characteristics did not differ between the two groups. Overall, threshold ROP incidence tended to be lower in 54 treated (9.4%) vs. 53 not-treated (13.0%) infants (p =0.39). The same occurred for BPD (3.8% vs. 13.0%; p =0.08) and NEC (2.1 vs. 4.8%; p =0.45). Of note, treatment was associated with less need of mechanical ventilation (8 vs. 14 days), lower peak levels of bilirubinemia (9 mg% vs. 10 mg%), and less days of stay in NICU (38 vs. 42 days). No adverse effects putatively attributable to the treatment were documented. Conclusions:: Based on these preliminary data from an RCT, lutein/zeaxanthin supplementation in VLBW infants was well tolerated and associated with a trend towards lower incidences of threshold ROP, NEC and BPD. These trends need to be confirmed and to achieve significance on larger sample sizes. We speculate that carotenoids are important nutrients in decreasing the severity of oxidative stress-related diseases of prematurity. [Copyright &y& Elsevier]