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Background and objective Excessive noise in the neonatal intensive care unit (NICU) may lead to serious long-term effects on hearing and sensory development in newborns. As such, the maximum allowed noise level is 45 A-weighted decibels (dBA). Studies regarding noise exposure to ventilated preterm infants show inconsistent results; however, these studies also vary considerably in their methodology in terms of noise ascertainment. We hypothesized that the study methodology can significantly influence data quality when measuring noise levels. In this study, we aimed to investigate whether the variations in ventilator noise levels in NICUs could be a result of methodological differences in study designs. Methods A ventilator circuit was set up using nasal continuous positive airway pressure (nCPAP) and high-frequency (HF) modes with nasal prongs. Noise levels were measured using a commercially calibrated noise meter. Three different scenarios were tested: (1) measurements were taken at different angles (0° to 180°), with 180° facing the end of the nasal prongs, without a mannequin, with the membrane/orifice of the noise meter placed 2 mm laterally from the prongs; (2) noise levels were measured at 180° at distances of 0-20 mm from the nasal prongs; (3) measurements were taken in the oral cavity of a life-size intubation mannequin of a newborn baby. Results Overall, the noise levels produced at different settings varied significantly, ranging from 45.7 dB to 82.2 dB. The average environmental background noise was 44.4 dB. Noise levels typically increased as the angle increased, with the highest noise level recorded at 180° for both HF and nCPAP modes, at 58.4 dB and 58.2 dB, respectively. Noise levels recorded at HF were slightly higher than nCPAP values. Furthermore, with regard to distance, the highest mean value, 82.2 dB, was recorded with the noise meter approximately 3 mm from the nasal prongs, and the lowest mean value, 47.6 dB, was recorded at ~20 mm. During trials with the mannequin, the lowest value, 50.1 dB, was recorded at the entrance of the mouth with slightly higher values being recorded within the oral cavity. Conclusion The results indicate that small changes in experimental settings, such as positioning and distance from the nasal prongs, can greatly influence noise levels, particularly above the recommended levels for neonates. These differences may be attributed to wind-generated noise. In summary, some study results are potentially influenced more by the study design than the device type or ventilator setting. We recommend further research and detailed reporting in the NICU to gain deeper insights into the topic.

Background:Preterm pain is common in the Neonatal Intensive Care Unit (NICU), with multiple invasive procedures occurring daily.Objective:To review the psychosocial and neurobiological vulnerabilities of preterm infants and to provide an updated overview of non-pharmacological strategies for acute procedural pain in hospitalized preterm infants.Methods:We utilized a narrative review methodology, which also included a synthesis of key pieces of published systematic reviews that are relevant to the current work.Results and Conclusions:Preterm infants are uniquely susceptible to the impact of painful procedures and prolonged separation from caregivers that are often inherent in a NICU stay. Non-pharmacological interventions can be efficacious for mitigating procedural pain for preterm infants. Interventions should continue to be evaluated with high quality randomized controlled trials, and should endeavor to take into account the neurobiological and psychosocial aspects of preterm vulnerability for pain prevention and management strategies.

Background: Parents play a vital role in the assessment and management of pain. There is limited knowledge about parental viewpoint or their participation in the pain management of the neonates admitted to the intensive care units. The present study aimed to assess the viewpoints of mothers about the pain management of neonates/ infants admitted to Tabriz hospitals. Methods: It was a descriptive cross-sectional study. A total of 255 mothers whose infants had been admitted to Neonatal Intensive Care Units (NICU) were recruited by convenience sampling method from September 2016 to August 2017. The required data were collected using a demographic questionnaire and PAIN questionnaire-Neonatal Intensive Care. The obtained data were analyzed using descriptive statistics in SPSS. Results: The Mean±SD age of the mothers was 28.38±6.10 years, and the majority of them (39%) had diploma. Among the mothers, 73% believed that their infants had experienced pain during admission to NICU. However, only 19% of the mothers stated that nurses tried to find the signs of pain in their infants; the majority of mothers (80%) indicated that to some extent, they were satisfied with the information they received from the treatment team regarding pain control for their newborns. Conclusion: Despite the prevalence of pain phenomenon in neonates, mothers’ education for the symptoms of pain in their infants was inadequate. It seems that the mothers’ participation in the pain management of their newborns makes them more capable of caring after discharge from the hospital. The study makes important findings available for future research.

Introduction: The evacuation of hospitals has special complications and sensitivities in terms of the presence of patients. Since, infants are the youngest and most vulnerable patients in the hospital, the readiness of the neonatal intensive care unit (NICU) to respond appropriately and evacuate at the time of disasters is very important. This article examines the emergency evacuation of neonatal intensive care units during disasters. Method: The present systematic review was done based on the PRISMA guidelines for systematic review studies. Accordingly, all English-language articles published in this field were extracted by the end of January 2020, through searching Web of Science, Pubmed, Scopus, and Science Direct, as well as Google Scholar Web Search. The search and screen of the articles were conducted independently by the research team members and the content of included articles were analyzed thematically. Findings: After the final evaluation, 11 articles were subjected to content analysis, which were divided into seven thematic categories: command, training and maneuver, manpower, communication, equipment, transportation, support. Conclusion: Considering that infants are the most vulnerable preparing the staff of the (NICU) along with providing them with the specialized and technical support is suggested. By preparing and implementing response and preparedness plans, it is possible to prevent high complications and mortality among infants admitted to the hospital pre-disasters.

Background Despite ongoing advances in the field of neonatology, the survival outcomes among critically ill preterm surgical neonates remain unfavorable. Intrahospital transport is one of the major risk factors associated with early mortality (within 30 days) in these newborns. To overcome this, the approach of performing bedside surgeries is being followed. We aim to assess the safety and feasibility of performing bedside neonatal surgeries by analyzing our archives. Methods The study focused on retrospective evaluation of all the newborns who have undergone surgical procedures in the neonatal intensive care unit (NICU) at our center from August 2015 through February 2021. Newborns were operated within the NICU if they had very low birth weight or other risk factors making their transport to the operation room risky. The outcomes of surgeries were assessed in terms of postoperative complications, one-month survival, and overall survival. Results Thirteen children (M:F=9:4) underwent twenty-two surgical procedures. The median (range) gestational age and birth weight of our cohort were 30 (26-36) weeks and 1200 (500-2860) grams, respectively. One-month and overall survival rates in our cohort were 84% (11/13) and 77% (10/13), respectively. No major postoperative complications were observed. The requirement of multiple inotropes and/or high-frequency oscillatory ventilation (HFOV) was the only factor having a significant association with unfavorable survival outcomes. Conclusions Bedside surgery is a safe and feasible alternative to surgeries within the operation room for at-risk newborns. In the present study, the requirement of multiple inotropes and/or HFOV was the only factor significantly associated with early mortality.

Having an infant in the neonatal intensive care unit (NICU) elicits maternal anxiety, which may hamper parent−child bonding. We performed a prospective cohort study to describe anxiety in mothers of infants born before 30 weeks of gestation during NICU stay in The Netherlands, and investigated the influence of infant stress and gestational age. Second, we performed a randomized-controlled live-performed music therapy trial (LPMT trial) to investigate whether music therapy applied to the infant alleviated maternal anxiety. The relation between infant stress, gestational age, and maternal anxiety was measured in 45 mother−infant dyads, using the Neonatal Infant Stressor Scale and the State-Trait Anxiety Inventory (STAI). The effect of LPMT on anxiety was assessed in 21 mothers whose infants were assigned to either LPMT (n = 12) or waitlist (n = 9). Mothers completed the STAI before and after this period. Maternal anxiety decreased over time in all mothers, and was strongly related with infant stress (r = 0.706, p &lt, 0.001), but not with gestational age. Anxiety scores decreased by 12% after LMPT, and increased by 1% after a waitlist period (p = 0.30). Our results indicate that LPMT in the weeks after birth may accelerate the reduction of maternal anxiety. Further research should focus on the effects on mother−child bonding.

Introduction A meta-analysis showed that 63.6% of the Saudi population have vitamin D deficiency, including many pregnant women. Studies showed that maternal vitamin D deficiency during pregnancy is a risk factor for low birth weight (LBW) in neonates. Neonatal LBW is a risk factor for multiple neonatal complications including respiratory distress syndrome, necrotizing enterocolitis, chronic renal disorders, seizures, and sepsis. Our objective in this study is to determine a correlation between low maternal vitamin D level and neonatal LBW in Saudi Arabia. Methods Neonates (n = 119) were divided based on their gestational age (GA) into full-term neonates (≥37 weeks) and preterm neonates (< 37 weeks) and based on birth weight into normal birth weight neonates (full-term = 2,500-3,500 g or preterm > 10th percentile) and LBW neonates (full-term < 2,500 g or preterm < 10th percentile). Vitamin D deficiency is defined as 25- hydroxyvitamin D level less than 50 nmol/L. Results Correlating neonatal birth weight with maternal vitamin D level during pregnancy was statistically insignificant for both full-term neonates and preterm neonates. In contrast, comparing the mean maternal vitamin D levels in each neonatal group showed that the mean were higher in mothers of neonates with normal birth weight. Conclusion Because 87.4% of mothers had low vitamin D levels during their pregnancy, correlation between maternal vitamin D level and LBW in neonates could not be found. However, mean maternal vitamin D levels were higher in mothers with normal birth weight neonates. Therefore, further detailed studies are required to establish local guidelines about the treatment of vitamin D deficiency during pregnancy.

Background Perinatal asphyxia is one of the main causes of preterm infant mortality. Some studies have shown that The Urinary Uric Acid / Cr (UUA/Cr) ratio may be used as an additional marker for perinatal asphyxia.This study intend to investigate the relationship of this ratio with outcomes of preterm infants admitted to NICU. Methods This case–control study was carried on 102 preterm newborn infants with gestational age of 30 weeks to 33 weeks and 6 days admitted in the neonatal intensive care unit.The case group, consisted of 51 premature neonates with a history of intubation, cardiopulmonary resuscitation, mechanical ventilation and Nasal continuous positive airway pressure (NCPAP) at birth, were compared with 51 matched neonates. The UUA/Cr ratio was measured in the first 24 h after birth. Complications during hospitalization, duration of hospitalization, and final outcome were evaluated. Results The mean level of UUA/Cr ratio in case and control group were 5.4 ± 4.1 and 3.6 9 ± 2.9 respectively and this difference was statistically significant (p = 0.014). The UUA/Cr ratio were significantly higher in females, cesarean section delivery, Apgar score ≥ 8, neonates without any complication and neonates with less than 10 days of hospitalization. However, this ratio has no predictive value for the incidence of complications during hospitalization and long-term hospital stay for infants of the case group. Conclusions The Urinary Uric Acid / Cr ratio in the first 24 h after birth in preterm neonates who underwent intubation, NCPAP or cardiopulmonary resuscitation was higher than healthy neonates.

Background Central line-associated bloodstream infections (CLABSI) are a main focus of infection prevention and control initiatives in neonatal care. Standardised surveillance of neonatal CLABSI enables intra- and interfacility comparisons which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands and several criteria are used for local monitoring of CLABSI incidence rates. To achieve standardised CLABSI surveillance we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria (SC). Methods A modified Delphi consensus procedure for the development of nationwide neonatal CLABSI SC was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of three expert panel rounds. Results The expert panel achieved consensus on Dutch neonatal CLABSI SC. Neonatal CLABSI is defined as a bloodstream infection occurring more than 72 h after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by one or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: 1. a bacterial or fungal pathogen is identified from one or more blood cultures; 2. the patient has clinical symptoms of sepsis and 2A) a common commensal is identified in two separate blood cultures or 2B) a common commensal is identified by one blood culture and C-reactive protein level is above 10 mg/L in the first 36 h following blood culture collection. Conclusions The newly developed Dutch neonatal CLABSI SC are concise, specified to the neonatal population and comply with a single blood culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI SC is needed to identify best practices for infection prevention and control.

Preterm birth and the subsequent hospitalization in the Neonatal Intensive Care Unit (NICU) is a challenging life event for parents and babies. Stress, anxiety, and depressive symptoms, limitations in holding or touching the baby, and medical complications during the NICU stay can negatively affect parental mental health. This can threaten the developing parent-infant relationship and might adversely impact child development. Music therapy in the NICU is an internationally growing field of clinical practice and research and is increasingly applied to promote relationship building between parents and babies. The two most commonly used concepts describing the early parent-infant relationship are ‘attachment’ and ‘bonding’. While frequently used interchangeably in the literature, they are actually not the same and describe distinctive processes of the early relationship formation. Thus, it is important to discuss the overlaps and differences between attachment and bonding and the implications for music therapy clinical practice and research. Whereas providing examples and possible scenarios for music therapists working on either bonding or attachment, the distinction between both concepts is relevant for many health care professionals concerned with early parenting interventions in the NICU. This will hopefully lead to a more precise use of theory, and ultimately, to a more informed clinical practice and research.

Background Neonates admitted in a tertiary neonatal intensive care unit (NICU) require multiple blood transfusions because of extended NICU stay and repeated sampling. The rookie organ systems and miniature blood volumes in the neonate call for regular audits in neonatal blood transfusion practice. Sharing component usage data with the blood bank will prepare them to store components according to demand, thus limiting wastage of components as well as make banks ready to face a shortage in case of ramped up requirements. Objective Auditing neonatal blood transfusion indications and identifying the most commonly used component. Methodology This retrospective cohort study was conducted by the department of pediatrics over 22 months from February 20, 2017, to December 30, 2018. Any preterm and term neonates admitted to the NICU and Neonatal Intermediate Care Unit (NIMC) and receiving any transfusion, i.e., fresh frozen plasma (FFP), red cell concentrate (RCC), platelets, and exchange transfusion were included in our study. We collected data from the medical records of NICU and NIMC admitted patients receiving blood component transfusions from 2011 to 2016. Patients were categorized according to the classification of neonatal conditions by the International Classification of Diseases 11th Revision (ICD-11). There were no exclusion criteria. A descriptive statistical analysis was done, and a Chi-square test was applied. Results Out of 340 neonates, 249 (73.2%) were low birth weight, 139 (40.9%) were small for gestational age (SGA), and 277 (81.5%) neonates required transfusion during the first week of life. The majority of neonates require multiple transfusions. Fourteen(4.12%) neonates required up to 10 transfusions, two neonates required up to 22 transfusions, and 58 neonates required more than five blood transfusions. The majority required transfusion due to neonatal sepsis, Disseminated intravascular coagulopathy, low birth weight, respiratory distress syndrome, and unconjugated hyperbilirubinemia. Thirty-seven point eighty-two percent (37.82%) transfusions were fresh frozen plasma, 31.34% transfusions were red cell concentrate, 28.14% transfusions were platelet concentrate, and 2.70% were whole blood. Out of 340 neonates, 317 survived and were discharged. Conclusion The most commonly transfused component was fresh frozen plasma, the indication was neonatal sepsis, and the group was preterm. Whole blood is still being used and needs to be stopped.

To increase the knowledge about S. capitis in the neonatal setting, we conducted a nationwide 3-month survey in 38 neonatal intensive care units (NICUs) covering 56.6% of French NICU beds. We demonstrated 14.2% of S. capitis BSI (S.capBSI) among nosocomial BSIs. S.capBSI incidence rate was 0.59 per 1000 patient-days. A total of 55.0% of the S.capBSIs were late onset catheter-related BSIs. The S. capitis strains infected preterm babies (median gestational age 26 weeks, median birth weight 855 g). They were resistant to methicillin and aminoglycosides and belonged to the NRCS-A clone. Evolution was favorable in all but one case, following vancomycin treatment.

BACKGROUND EFM was introduced into Obstetric practice during late 1960 on the premise that it would facilitate early detection of abnormal foetal heart patterns thought to be associated with hypoxia thus allowing early intervention to prevent foetal neurological damage or death. 1 In this study, we aim to evaluate the effect of CTG on perinatal outcome in low risk and high-risk population and determine the cost-effective reliable method of foetal monitoring that is applicable to low risk and high-risk population. 2 MATERIALS AND METHODS A prospective randomized study conducted on 200 pregnant women in labour who were admitted to labour room in the department of OBGY, Niloufer Hospital. The Duration of study is one year. These women were divided into two groups, groupA & group-B. RESULTS The demographic features parity and gestational age in both the groups were comparable. The mean age group of the patient is 23 years and mean gestational age is 37.77 weeks. In this study, 125 (62.5%) belong to high risk group and 75(37.5%) belong to low risk group. In the present study normal CTG was seen in 59.5%, suspicious CTG in 11% and pathological CTG in 29.5% in low risk group and in high risk group normal CTG was seen in 51.2%, suspicious CTG in 9.6% and pathological CTG in 39.2%. Incidence of MSL was more in women with abnormal CTG finding in both low and high risk women. 3 NICU admissions were 55.9% in patient with abnormal CTG as compare to 1.7% in normal CTG patterns. 4 The sensitivity, specificity, PPV and NPV of CTG in Prediction of low APGAR score at 5 minutes was 93.75%, 80.13%, 50.84% and 98.31% respectively. CONCULSION Continuous CTG monitoring identifies conditions causing foetal compromise at an early stage of labour so that timely intervention can be taken. 5 Present study had shown that the abnormal CTG finding were associated with significantly increased incidence of LSCS, low mean APGAR scores, increased NICU admissions.

Background: Tremendous difficulties are imposed on families with preterm and premature babies, both at birth and during their lifetime. The present study aimed at evaluating the potential economic impact of preterm and premature birth in Iran. Methods: In this descriptive cross-sectional study (2014-2015), we studied preterm and premature newborns, who have been subjected to hospitalization in Ali-Asghar hospital. We followed social perspective to estimate the economic consequences of preterm and premature birth in 3 categories of direct medical, direct non-medical, and indirect costs. Required data were collected from documents in the NICU, and studying medical records, and interviewing their parents. Data were analyzed by Microsoft Excel. Results: Direct medical, direct non-medical and indirect affairs were 84%, 6%, and 10% of the total cost, respectively. The estimated social costs were 373, 529, 189; 508, 774, 181; and 529, 481, 996 US dollars (according to their corresponding incidence of 5.8%, 7.9%, and 9.9%). We also found that 75% of the direct medical costs of initial hospitalization were due to intensive care beds. Conclusion: The economic burden of preterm and premature birth in Iran is considerable and to decrease the costs, it is necessary to implement preventive programs for preterm and premature newborns and to provide management care and support for families dealing with this problem.

Background Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. Methods Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. Results Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). Conclusions Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.

&ldquo, Children are not tiny adults&rdquo, is an adage commonly used in pediatrics to emphasize the fact that children often have different physiological responses to sickness and trauma compared to adults. However, despite widespread acceptance of this concept, diagnostic blood testing is an excellent example of clinical care that is not yet customized to the needs of children, especially newborns. Cumulative blood loss resulting from clinical testing does not typically impact critically ill adult patients, but can quickly escalate in children, leading to iatrogenic anemia and related comorbidities. Moreover, the tests prioritized for rapid, near-patient testing in adults are not always the most clinically relevant tests for children or newborns. This report describes the development of a digital microfluidic testing platform and associated clinical assays purposely curated to address current shortcomings in pediatric laboratory testing by using microliter volumes (&lt, 50 &micro, L) of samples. The automated platform consists of a small instrument and single-use cartridges, which contain all reagents necessary to prepare the sample and perform the assay. Electrowetting technology is used to precisely manipulate nanoliter-sized droplets of samples and reagents inside the cartridge. To date, we have automated three disparate types of assays (biochemical assays, immunoassays, and molecular assays) on the platform and have developed over two dozen unique tests, each with important clinical application to newborns and pediatric patients. Cell lysis, plasma preparation, magnetic bead washing, thermocycling, incubation, and many other essential functions were all performed on the cartridge without any user intervention. The resulting assays demonstrate performance comparable to standard clinical laboratory assays and are economical due to the reduced hands-on effort required for each assay and lower overall reagent consumption. These capabilities allow a wide range of assays to be run simultaneously on the same cartridge using significantly reduced sample volumes with results in minutes.

Neonatal sepsis is a leading cause of morbidity and mortality in developing countries. This study aimed to assess the proportion of culture-confirmed sepsis, bacteriological pathogen profile, culture report turnaround times, antibiotic susceptibility patterns, and treatment outcomes of all with neonatal sepsis admitted in two tertiary care hospitals in Yangon, Myanmar, 2017–2019. This was a cross sectional study utilizing a standardized electronic database and paper-based records. Bacteriological profiles and associated factors were analyzed with descriptive statistics and Poisson Regression. Of those with suspected sepsis, 42% were bacteriologically confirmed and 74% of confirmed sepsis was resistant to at least first-line antibiotics. Neonates with late onset sepsis (LOS) (aPR: 1.2 (95% CI: 1.1–1.4, p = 0.008)) were more likely to have bacteriologically confirmed sepsis (45%) versus early onset sepsis (38%). Gram-negative organisms were most commonly isolated (63%), associated with multidrug-resistant organisms and with a high case-fatality rate (64%). These findings suggest that enhanced national guidance regarding infection control and prevention, antibiotic stewardship, and first-line antibiotic choices need to be provided. The link between LOS with infection and prevention protocols needs to be further explored in this context to decrease sepsis risk, neonatal mortality, and reduce further antimicrobial resistance.

Background: The parents of preterm infants face major mental health challenges in the Neonatal Intensive Care Unit (NICU). Family-centered music therapy actively integrates and empowers parents in their infants&rsquo, care. With the aim to better understand and address parental needs separately from their babies&rsquo, needs, a music therapy (MT) self-care group was implemented as part of clinical practice at the hospital Cl&iacute, nica de la Mujer, in Bogot&aacute, Colombia. Methods: The group was provided for both parents, twice a week, in the NICU. Music guided relaxations, breathing techniques, and self-expression were at the center of the MT group sessions. The parents completed a pre/post self-administered Numeric Rating Scale (NRS), including anxiety levels, stress levels, mood and motivation. Results: The parents highly valued the MT self-care group in the NICU. On average, there was a 37% improvement in anxiety levels, 28% improvement in stress levels, and 12% improvement in mood, restfulness and motivation. Being able to relax, to distract themselves from their worries and having time for themselves are amongst the most frequently mentioned benefits. Conclusions: Addressing parents&rsquo, needs separately from their babies&rsquo, treatment, with culturally sensitive interventions aimed at improving parental mental health, is essential for continuing the development of family-centered music therapy interventions in the NICU.

AiM: The objective of this study is to show the alterations in frequency and cost of antibiotic use in neonatal and pediatric intensive care units of a state hospital after it started to service as an education and research hospital. We also aimed to raise an awareness related to rational antibiotic use. METHODS: The surveillance of antibiotic use and comparison of costs were evaluated in 392 patients in between August 2013-January 2014. The rate and cost of antibiotic use during last 90 days before the protocol of state hospital to research and education hospital and the first 90 days after protocol were evaluated. Antibiotics were assessed according to the treatment protocols of the Committee of Rational Drug Use, Infection Control Committee and Antibiotic Control Committee. Antibiotics were provided from administrative system and the data related to costs were obtained from Ministry of Health and Ministry of Finance. The demographic data and the data related to indication for admission to intensive care units, antibiotic dosages and pathogens causing infections were also obtained. For statistical analysis, SPSS program was used and descriptive analysis were made. In comparison of the groups, Mann Whitney U and chi-square tests were used. The data were evaluated within a 95% confidence interval. RESULTS: In first and second period, 143 patients were hospitalized for 3.18+/-1.13 days and 105 patients were hospitalized for 2.69+/-4.14 days in pediatric intensive care unit(PICU); 79 patients were hospitalized for 17.29+/-3.61 days and 65 patients stayed for 21.29+/-3.29 days in neonatal intensive care unit(NICU), respectively. In the first and second period, cost of antibiotics in PICU was found 341.81+/-744.49 (med:14.91) and 585.35+/-796.62 (med:256.44) (p=0.02) Turkish Liras (TL); in NICU 137.92+/-178.78 (med:14.59) and 247.40+/-370.13(med:19.23) (p=0.76) TL respectively. CONCLUSiON: In the second period, in PICU, duration of hospitalization was found to decrease and costs of antibiotics were higher. In NICU, the duration of hospitalization was longer and although statistically insignificant, costs of antibiotics were slightly higher. Differences between the two periods in term of cost showed that, PICUs and ICUs should revisit their antibiotic preferences from the viewpoint of a pediatric infectious disease physician. [TAF Prev Med Bull 2015; 14(2.000): 107-112]

Background Although electronic health records (EHRs) have the potential to provide a foundation for quality and safety algorithms, few studies have measured their impact on automated adverse event (AE) and medical error (ME) detection within the neonatal intensive care unit (NICU) environment. Objective This paper presents two phenotyping AE and ME detection algorithms (ie, IV infiltrations, narcotic medication oversedation and dosing errors) and describes manual annotation of airway management and medication/fluid AEs from NICU EHRs. Methods From 753 NICU patient EHRs from 2011, we developed two automatic AE/ME detection algorithms, and manually annotated 11 classes of AEs in 3263 clinical notes. Performance of the automatic AE/ME detection algorithms was compared to trigger tool and voluntary incident reporting results. AEs in clinical notes were double annotated and consensus achieved under neonatologist supervision. Sensitivity, positive predictive value (PPV), and specificity are reported. Results Twelve severe IV infiltrates were detected. The algorithm identified one more infiltrate than the trigger tool and eight more than incident reporting. One narcotic oversedation was detected demonstrating 100% agreement with the trigger tool. Additionally, 17 narcotic medication MEs were detected, an increase of 16 cases over voluntary incident reporting. Conclusions Automated AE/ME detection algorithms provide higher sensitivity and PPV than currently used trigger tools or voluntary incident-reporting systems, including identification of potential dosing and frequency errors that current methods are unequipped to detect.

The brainstem, critical for motor function, autonomic regulation, and many neurocognitive functions, undergoes rapid development from the third trimester. Accordingly, we hypothesized it would be vulnerable to insult during this period, and that a difficult clinical course in the neonatal intensive care unit (NICU) would affect development, and be reflected through atypical shape. Our study population consisted of 66 neonates – all inpatients from the NICU at Victoria Hospital, London Health Sciences Centre, ON, Canada, of which 45 entered the final analysis. The cohort varied in gestational age (GA) and ranged from neurologically healthy to severely brain-injured. Structural MRI was used to quantify brainstem shape at term-equivalent age. From these images, brainstems were semi-automatically segmented and co-registered across subjects. The anterior-posterior dimensions on a sagittal maximum intensity projection were used as the basis for shape comparison. Factor analysis was used to summarize variation in shape and in clinical course to determine three shape factors and three clinical factors, and their relationship assessed using correlation. A factor driven by low GA and associated complications correlated with alterations in the posterior medulla, while a factor driven by complications independent of GA correlated with alterations in the midbrain. Additionally, single clinical measures most representative of their respective clinical factor (days in NICU; days on ventilation) predicted the changes. Thus, different clinical courses in the NICU may have different effects on the shape of the brainstem, and may mediate some of the distinct neurodevelopmental profiles observed in premature and brain-injured neonates., Highlights • Gestational age & complications correlated with posterior medulla alterations • Complications independent of gestational age correlated with midbrain alterations • Single clinical measures representative of their clinical factor predicted changes • Different NICU clinical courses found to have distinct effects on brainstem shape

Background Patent ductus arteriosus (PDA) is a common cause of morbidity. The aim of this study was to compare the efficacy of oral Acetaminophen and oral Ibuprofen for the closure of patent ductus arteriosus (PDA) in preterm infants. Objectives This study demonstrated that, there was no significant difference between treatment of PDA with either oral Acetaminophen or oral Ibuprofen in preterm neonates. Patients and Methods This clinical trial, randomized study, enrolled 120 infants, with a gestational age of < 37 weeks, who were admitted in neonatal intensive care unit of Afzalipour hospital, Kerman, Iran, in 2014. PDA was confirmed echocardiographically. The trial was registered in Iranian registry of clinical trials (Reg. No. 25542). Sixty-seven infants received oral Acetaminophen (15mg/kg every six hours for three days) and 62 infants received Ibuprofen (an initial dose of 20 mg/kg, followed by 10 mg/kg at 24 and 48 hours). To evaluate the efficacy of the treatment, a second echocardiography was done after completing the treatment. Results After the first course of the treatment, PDA closed in 55 (82.1 %) patients who received oral Acetaminophen vs. 47 (75.8 %) of those given oral Ibuprofen (P = 0.38). After the second course of treatment, PDA closed in 50 % of oral Acetaminophen group and 73.3% of oral Ibuprofen group (P = 0.21). Conclusions This study demonstrated that, there was no significant difference between treatment of PDA with either oral Acetaminophen or oral Ibuprofen in preterm neonates. Oral Ibuprofen can effectively close PDA but is unfortunately associated with some adverse effects limiting its utility thus we studied an alternative drug with similar efficacy and less adverse effects. This study has recommends Acetaminophen with minimal complications for the treatment of PDA in preterm neonates instead of Ibuprofen.

Pain management of neonates is much debated topic in the medical field. Pain and particularly chronic pain may affect the development of the brain and cause permanent injuries. Neonates being non-verbal are unable to express their pain and thus are exposed to various painful procedures without adequate pain relief. This lack of self-report, inadequate pain assessment tool, lack of awareness and concern amongst the care providers and non-availability of standard protocols lead to inadequate pain relief in neonates. The communication of infant pain is identified through validated tools such as: Premature Infant Pain Profile (PIPP), Neonatal Facial Coding System (NFCS), and the Neonatal Infant Pain Scale (NIPS). The most popular means of reducing minor procedural pain is oral glucose solution, music therapy, cuddling the neonates, breast feeding and use of topical anaesthetic agents. Topical anaesthetic agents that are commonly used like EMLA are not far from side effects. EMLA is known to cause methemoglobinemia in preterm babies. Recently a study has been conducted using 4% Liposomal Lidocaine at a tertiary care centre in India by Kaur et al which has found this agent to be useful to relieve minor procedural pain like Venepuncture and found it to be free from side effects of methaemoglobinaemia.[18] In nutshell, effective management of pain is an ethicals well as a scientific issue. Is it not humane to think about providing adequate pain relief to such tiny non-verbal human beings? Effective pain assessment and management in infants correlates with the quality of healthcare provided and the professionalism shown by healthcare providers. As part of comprehensive pain prevention program, each neonatal unit should develop strategies to provide effective pain relief for all procedures.

Aims: The study explored fathers’ experience of premature birth during the hospitalization of their infants, analyzing levels of depressive and anxiety symptoms as compared with mothers. Moreover the Italian version of the Clinical Interview for Parents of High-Risk Infant (CLIP) was tested through Confirmatory Factor Analysis. Methods: Couples of parents (N = 64) of preterm infants (gestational age < 37 weeks) were administered a socio-demographic questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory and the CLIP after the admission to the Neonatal Intensive Care Unit (NICU). Results: Significant levels of anxiety and depressive symptoms and high percentages of subjects above the corresponding risk thresholds were found among fathers and mothers with higher scores among the latters. Confirmatory Factor Analysis of the CLIP showed an adequate structure, with better fit for mothers than for fathers. Conclusions: Results highlighted the importance for nurses and clinicians working in the NICU to consider not only the maternal difficulties but also the paternal ones, even if these are often more hidden and silent. In addition the CLIP may be considered an useful interview for research and clinical purposes to be used with parents of high-risk infants.

Monitoring the status of preterm infants in the Neonatal Intensive Care Unit (NICU) provides a unique and challenging environment for the design, function and use of sensor-based monitoring equipment. This article presents an overview of sensor-based instrumentation used in the NICU for physiological and chemical status monitoring, and discusses some of the key sensing principles currently in use. The clinical demand for reliable patient data at acceptable cost is driving the development of new types of monitoring technologies, in particular for continuous blood-chemistry analysis. We describe some of the new sensor- based products finding their way into the NICU, together with a review of the more promising emerging sensor technologies that might eventually be incorporated into routine neonatal monitoring practice.

Objective: To describe characteristics and outcomes of Jordanian newborns admitted to a large governmental neonatal intensive care unit (NICU). Methods: Newborns born at the government hospital, Al Bashir, in Amman, Jordan were prospectively enrolled. The study focused on newborns admitted to the NICU and a retrospective chart review was performed. Abstraction included in-hospital mortality, antibiotic days, ventilation, oxygen use, and CRP levels. Rank sum and chi-squared tests were used to compare across outcomes. Logistic regression of hypothesized risk factors with death adjusted for gestational age. Results: Of the 5,466 neonates enrolled from 2/10-2/11, medical records were available for 321/378(84.9%) infants admitted to the NICU. The median gestational age was 36 weeks, median birth weight was 2.3 kg, and 28(8.7%) infants died. The two most common reasons for admission and mortality were respiratory distress syndrome and prematurity. Low Apgar scores and positive CRP were predictors of mortality. Risk factors associated with increased use of antibiotics, oxygen hood, and mechanical ventilation included lower gestational age and prematurity. Conclusion: Infants admitted to the Jordanian NICU have significantly higher median gestational age and birth weights than in developed countries and were associated with significant morbidity and mortality. Continuations of global efforts to prevent prematurity are needed.

This article reports the results of a three-arm mixed methods pilot study of music therapy with premature infants and their caregivers in a Neonatal Intensive Care Unit (NICU) in Bogotá, Colombia. The study included 19 medically stable babies born between the 30th and 37th week of gestation and their caregivers. Two intervention groups were compared with a control group.The objectives were to find out whether music therapy could help the neonates to stabilize their physiological states and help mothers to reduce anxiety and strengthen the relationship with their baby.The data collection included the babies´ weight gain, heart rate, oxygen saturation, size, cephalic perimeter and length of hospitalization. Mothers filled out the State-Trait Anxiety Inventory (STAI-C) and the Mother-to-Infant Bonding Scale (MIBS) before the first and after the last intervention. Thematic analysis was used to analyze the qualitative data obtained through questionnaires.A trend towards an increased weight gain for both intervention groups and a shorter length of hospitalization for one of the intervention groups was noticed. Anxiety and bonding in mothers appears not to follow linear trends, as new challenges arise for parents at different stages during hospitalization. Mothers stated that music therapy was helpful for them, their baby and their relationship with the baby. Mothers across the groups think that music therapy should be a regular offer in the NICU and that music therapy helps to humanize the NICU environment.

Background : Cardiac output (CO) measurement in low (LBW) and very low (VLBW) birth weight infants is difficult. Hitherto, sporadical transthoracic echocardiography (TTE) is the only non-invasive measurement method. Electrical velocimetry (EV) has been evaluated as an alternative in normal weight newborns. Objectives: The study was designed to evaluate if EV could even be interchangeable with TTE in LBW and VLBW infants. Methods: In 28 (17 LBW, 11 VLBW) premature newborns, n = 228 simultaneous TTE (transaortic Doppler) and EV measurements (134 LBW, 94 VLBW) of stroke volume (SV) and heart rate (HR) were performed, thereof calculating body weight indexed SV (= SV*) and CO (= CO*) for all patients and the subgroups. Method comparison was performed by Bland-Altman plot, method precision expressed by calculation of the coefficient of variation (CV). Results: Mean CO* in all patients was 256.4 ± 44.8 (TTE) and 265.3 ± 48.8 (EV) ml/kg/min. Bias and precision were clinically acceptable, limits of agreement within the 30% criterion for method interchangeability (Critchley and Critchley, 1999). According to their different anatomic dimensions and pathophysiology, there were significant differences of SV(*), HR and CO* for LBW and VLBW infants as well for inotropic treatment and ventilation mode.Conclusions: Extending recent publications on EV/TTE comparison in newborns, this study suggests that EV is also applicable in LWB/VLBW infants as a safe and easy to handle method for continuous CO monitoring in the NICU and PCICU.

Cytomegalovirus (CMV) infection is the most common congenital infection, affecting 0.4% to 2.3% newborns. Most of them are asymptomatic at birth, but later 10% develop handicaps, mainly neurological disturbances. Our aim was to determine the prevalence of CMV shed in urine of newborns from a neonatal intensive care unit using the polymerase chain reaction (PCR) and correlate positive cases to some perinatal aspects. Urine samples obtained at first week of life were processed according to a PCR protocol. Perinatal data were collected retrospectively from medical records. Twenty of the 292 cases (6.8%) were CMV-DNA positive. There was no statistical difference between newborns with and without CMV congenital infection concerning birth weight (p=0.11), gestational age (p=0.11), Apgar scores in the first and fifth minutes of life (p=0.99 and 0.16), mother's age (p=0.67) and gestational history. Moreover, CMV congenital infection was neither related to gender (p=0.55) nor to low weight (

OBJETIVOS: conhecer o cotidiano no alojamento de mães, cujas crianças estão internadas em uma Unidade de Terapia Intensiva Neonatal. MÉTODOS: pesquisa qualitativa realizada no Hospital Sofia Feldman, em Belo Horizonte, Minas Gerais, Brasil. Os dados foram obtidos por meio de observação participante e grupo focal, e os instrumentos utilizados para registro dos dados foram os diários de campo, gravadores e fitas. Para análise dos dados utilizou-se a análise de conteúdo. RESULTADOS: ao decidir permanecer no alojamento materno a mãe se sente dividida entre atender as necessidades do filho hospitalizado, as demandas da família e as suas próprias necessidades. A vivência no ambiente hospitalar exige que a mãe se adapte a uma nova dinâmica, determinada pelas rotinas e normas institucionais. A permanência no alojamento materno, ao mesmo tempo em que surge como uma possibilidade das mães estabelecerem relações de amizade e solidariedade, é um espaço de relações conflituosas entre elas. CONCLUSÕES: na adaptação da mãe ao novo cotidiano, revelou-se importante a convivência entre as mães, a família e os profissionais de saúde. O estudo aponta para a importância do profissional de saúde aproximar-se da realidade vivenciada pelas mães, para facilitar sua adaptação. OBJECTIVES: to investigate the daily routine of mothers rooming-in at the Neonatal Intensive Care Unit. METHODS: qualitative research carried out at the Sofia Feldman Hospital in Belo Horizonte, in the State of Minas Gerais, Brazil. The data was obtained by way of participant observation and a focus group and the instruments used to record the data were field diaries, recorders and tapes. Content analysis was used to analyze the data. RESULTS: when deciding to room in, the mothers feel divided between meeting the needs of the hospitalized child, the demands of the family and their own needs. Living in a hospital environment requires that mothers become detached from her daily routine and adapt to a new pattern which is determined by the institutional routines and norms. Rooming presents mothers with the opportunity to establish relationships of friendship and solidarity, but it is also a time of conflicting relations for them. CONCLUSIONS: the relationships between the mothers, and with their families and health workers were shown to be important for adaptation to the rooming-in process. The study showed the importance for health workers to get more involved in the real-life situation of the mothers in order to facilitate their adaptation to the new daily routine.

Objective: to assess the significance of increased serum transaminase levels in neonates admitted to a Neonatal Intensive Care Unit and its relationship with blood transfusion. Methods: follow-up prospective study of 209 patients; 177 completed follow-up, of whom 129 were transfused and 48 were not; 57 were born after full gestation and 120 were born prematurely. The activity of serum levels of ALT, AST, and GGT was measured monthly up to six months of age, and until six months after the last transfusion. At the end of follow-up, and whenever an increase in serum transaminase levels was detected, the viral agents of hepatitis A, B, C, G, TT, cytomegalovirus, Epstein-Barr, and herpes 1 and 2, and toxoplasma were studied. Viral serology was also carried out in mothers and in donors when children tested positive. Results: one hundred twenty nine neonates (73%) received 461 U red blood cell transfusions (3.6 ± 3 U/patient). ALT levels increased in 54 (30.5%) patients, of whom 46 (36%) were transfused and eight (17%) were not (p < 0.05). The independent variables were ‘infection by G virus' and ‘parenteral nutrition for more than 12 days'; the variable ‘transfusion' was close to the limit for statistical significance. Twenty patients (11.3%) had increased serum ALT levels 2.5 times above the normal value: 18 (14%) were transfused and two (4%) were not (p = 0.106). Only the G and TT viruses were related with transfusion; patients remained asymptomatic, although most neonates were chronically infected. Conclusion: follow-up showed that increased serum ALT levels are common among severely ill neonates. Blood transfusions are safe concerning most hepatotropic viruses, but transmission of viruses G and TT is possible.

Introduction: Late preterm neonates have been defined as those born between 34 completed weeks to 3 6 weeks and 6 days of gestation. Late preterm neonates though bear close resemblance to full-term neonates in appearance and birth weights; are a special group because they are still physiologically immature and vulnerable. Despite the increase in their numbers, there is limited data concerning problems of late preterm neonates in India. The objective of this study is to compare morbidities of late preterm neonates with term neonates. Study design: Retrospective study conducted at a Level 3 NICU of a tertiary care hospital in Mumbai between Oct 2011 to Sep 2 0 1 3 . Late preterm neonates formed the cases and equal number of matched term neonates formed the controls. Maternal risk factors and neonatal morbidities were compared among the two groups. Results: Late preterm neonates formed a major share of preterm births. Significantly more number of late preterm neonates had the maternal risk factors (as defined) and also required more NICU admissions. Late preterm neonates had lower birth weights compared to term neonates. There was a statistically significant difference in the incidence of respiratory distress consequently requiring more ventilator support in late preterm neonates. Average length of NICU stay was more for late preterm neonates. Conclusion: Late preterm neonates have more neonatal morbidities compared to term neonates.

Background Bloodstream infection (BSI) is one of the most common causes of nosocomial infection in neonatal intensive care units (NICU). The aim of the present study was to determine bacterial agents and their susceptibility patterns to antibiotics and to investigate the risk factors associated with BSI. Methods This was a nested case–control study carried out from September 2009 to June 2010 in the NICU wards in Sanandaj hospitals western Iran. Cases were patients with BSI and controls were other patients who had negative blood culture. Bacteriologic diagnosis and antibiotic susceptibility pattern was performed based on the Edward & Ewings and the National Committee of Clinical Laboratory (NCCL) Standards. Results Of 472 patients who hospitalized in NICU, 6.4% had BSI (n = 30) including 17girls (56.7%) and 13 boys (43.3%). Enterobacter SPP was the predominant isolated bacteria from blood culture (36.7%). The maximum antibiotic resistance and sensitivity were observed by Tetracycline and Ciprofloxacin respectively. Risk factors associated with BSI were age ≤ 7 days (p = 0.001), previous antibiotic consumption (p = 0.013), and low birth weight (LBW), (p = 0.001). Conclusions Gram negative bacteria and Entrobacter in particular are the most common pathogens. Improving prenatal health care, standards of infection control and choosing accurate antibiotics are recommended to avoid BSI in neonatal intensive care units.