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This study was conducted to determine the missed nursing care and to compare missed nursing care with descriptive characteristics of nurses during the COVID-19 period. The study was conducted with 182 nurses as a descriptive design working in seven public hospitals with a level III neonatal intensive care unit in Istanbul between April and July 2021. The study used an introductory information form for nurses and the Misscare survey-Pediatric version. Missed nursing care included "mouth care," "full documentation of all necessary data," and "communication of all relevant information during shift change or handover" in the first three ranks (n = 179, 98.35%). It was found that the highest score among reasons for missed nursing care was in the communication sub-dimension (2.50 ± 0.74). It was found that the reasons for missing care for nurses between the ages of 26–30 and with 6–10 years of professional experience (p <.05) were material resources-related, while the reasons for missing care for nurses with 11 years or more of professional experience (p <.05) and caring for 4 sick newborns in a shift (p <.01) were communication problems. It was concluded that nurses were unable to provide at least one nursing care in the last shift, and this was primarily due to communication-related problems. Training and policies for the development of communication skills can be suggested to reduce missed nursing care. [ABSTRACT FROM AUTHOR]

Background: Moral distress is common in neonatal intensive care unit (NICU) nurses. Purpose: The purpose of this study was to evaluate the relationships between NICU nurses' moral foundations, moral emotions, and moral distress. Research design and method: This is an observational cross-sectional self-report questionnaire study. Participants and research context: One hundred and forty-two (24%) of 585 Level 3–4 NICU nurses completed pen-and-paper self-report measures of moral foundations (harm, fairness, ingroup, authority, and purity) (Moral Foundations Questionnaire-20), proneness to self-conscious moral emotions (guilt and shame) (modified Personal Feelings Questionnaire-2), and moral distress (futile care, compromised care, and untruthful care) (modified Revised Moral Distress Scale). Ethical considerations: Participation was voluntary and anonymous. The ethics committees of the participating hospitals approved the study protocol (HREC Reference: LNR/18/SCHN/316). Results: Non-parametric statistical analyses showed medium to large correlations between moral foundations and moral emotions. Moral foundations and moral emotions had trivial to small correlations with moral distress. Using a liberal p- value of <.10 for statistical significance because of the small sample size, harm (r s = 0.22) and fairness (r s = 0.16) predicted futile care, ingroup predicted compromised care (r s = 0.19) and untruthful care (r s = 0.15), and purity predicted untruthful care (r s = 0.15). Guilt-proneness predicted futile care (r s = 0.15). Shame-proneness did not predict moral distress. Conclusion: The correlations between moral foundations and moral emotions were significant. Moral foundations and guilt-proneness predicted one or more dimensions of moral distress. The smaller than expected effect sizes may have been owing to how moral foundations, moral emotions, and moral distress were conceptualized and measured, or to moral disengagement, including NICU nurses' possible reluctance to countenance aversive but morally warranted feelings of guilt and especially shame. Understanding the nature of these relationships may complement the efforts of NICU administrators, educators, counsellors, and nurses themselves to mitigate moral distress. [ABSTRACT FROM AUTHOR]

Purpose: Opioids are frequently used to treat pain in neonatal intensive care units (NICU) with fentanyl, morphine and sufentanil being mainly used agents. Equianalgesic potency between opioids is not clearly described in the neonatal population. The aim of this study was to compare theoretical and actual equipotent conversion ratios between morphine, sufentanil and fentanyl based on prescriptions. Methods: In this observational, multicentric, pharmacoepidemiologic study, prescriptions' data (doses, duration of use, patients' characteristics) were collected and analyzed for all neonates hospitalized in one of the 30 Level III French NICUs using the same prescription software (Logipren®) and who received at least one prescription of morphine, sufentanil or fentanyl as continuous infusion during a 6-year period (2014–2020). Results: Among 65,555 neonates, 8361 (12.8%) received a prescription of continuous opioid infusion in one of the 30 French NICUs: 5054 (60.4%) received sufentanil, 2413 (28.9%) morphine and 894 (10.7%) fentanyl. After conversion to equipotent morphine doses using theoretical conversions ratios of 50:1 for morphine/fentanyl ratio and 500:1 for morphine/sufentanil ratio, prescribed mean maintenance doses of fentanyl and sufentanil were two times and five times higher than morphine doses, respectively. In this cohort, potency conversion ratios between the different opioids were 20:1 for morphine/fentanyl ratio and 100:1 for morphine/sufentanil ratio, and 4:1 for fentanyl/sufentanil ratio (theoretical conversion ratio of 7: 1). Conclusion: In a large cohort of neonates treated with continuous opioids in NICU, fentanyl and sufentanil doses used were significantly higher than morphine doses when using theoretical conversion ratios. [ABSTRACT FROM AUTHOR]

Neonatal abstinence syndrome (NAS) is a public health issue that affected more than 2% of live births in Kentucky in 2017. We analyzed data from Kentucky's early intervention (EI) program and the mandatory statewide NAS registry to learn more about how families of children with NAS utilize EI services. Out of 1,113 children in the study, 32% were referred to EI and 9% enrolled. Gaps in the intake process include low referral rates, low screening rates among referred children (36%), and lag in the time from referral to enrollment. Because 79% of screened children qualified for EI and 95% of qualifying children enrolled, this sample demonstrated some need for and interest in services. We are using these findings to inform policy recommendations that could help EI agencies experiencing an influx of potential clients with a history of NAS. [ABSTRACT FROM AUTHOR]

Patients admitted to neonatal intensive care units are up to eight times more likely to experience medication errors than patients admitted to adult intensive care units. Prescribing errors account for up to 74% of medication errors. Electronic prescribing has been postulated as a tool to reduce errors. The objective was to analyse prescribing errors with the e-prescribing system and risk factors. All patients who were admitted for at least 24 h and who received active pharmacological treatment during the study period were included. Prescriptions were made using electronic assisted prescription software integrated into the medical record system. Treatment was reviewed daily by a pharmacist, and errors were graded according to taxonomic criteria. A total of 240 patients were included, 13,876 prescriptions were reviewed and 455 errors were found (3.3% of prescriptions were wrong). Prescribing errors were concentrated in 40 drugs/nutritional products. The most frequent error was a discrepancy between the prescription and the associated text-free field (n = 196). The drugs with the most errors were Lactobacillus acidophilus, caffeine citrate, acetaminophen, gentamycin and cholecalciferol. Patients with a birth weight from 1000 to 1500 g were 82% more likely to experience an error than those with an extremely low birth weight (< 1000 g) (OR = 1.81, 95% CI = 1.42–2.89, p < 0.05). Patients at the highest risk were those with gestational ages from 28 to 32 weeks, with a 29.80% greater risk of prescribing errors than those with gestational ages less than 28 weeks (OR = 1.29, 95% CI = 1.02–1.65, p < 0.05). Prescribing errors occur due to complex dosing rules based on patient characteristics and free-text use, highlighting process issues rather than specific medication risks. [ABSTRACT FROM AUTHOR]

Background: Neonates admitted to neonatal intensive care units (NICUs), as well as maternity nurseries, typically undergo painful invasive procedures during their hospital stay. We aim to report on current bedside analgesia/sedation and pain assessment practices, 10 years after the previous Italian survey. Methods: This study employed a cross-sectional electronic survey. A 21-item questionnaire was distributed to directors of birth centers and NICUs to ascertain the policy for pain assessment and management in their respective units. A separate questionnaire was dispatched to neonatologists and nurses registered with the Italian Society of Neonatology. They reported on the analgesic strategies implemented for various painful bedside procedures. Both non-pharmacological and pharmacological analgesia interventions, as well as pain assessment, were analyzed. A regression model was utilized to identify factors that predict pain management practices. Results: Data on pain management practices were collected from the directors of 153 NICUs and birth centers. Of these, 88.9% reported pain control following guidelines and 47.7% confirmed the presence of a local pain specialist promoting pain management in their unit. A minority, ranging from 16.3% to 41.8%, reported the use of a pain scale, a finding corroborated by the 200 doctors and 239 nurses who responded. At least one non pharmacological intervention (i.e., pacifier, sweet solution, or sensory saturation) was reported in 97.8% of the heel lances performed in the NICU and 96.5% in the maternity nursery, meanwhile for intramuscular injections in 73.8% and 70.3%, respectively. Additionally, it was reported that 22.9% of laryngoscopies were still performed without analgesia. Observations were made over 297 mechanical ventilation and 277 non-invasive ventilation courses, with non-pharmacological analgesia administered in 56.4% and 86.9% and the use of analgesic or sedative drugs in 81.7% and 17.1% of the cases, respectively. Furthermore, routine pain assessment was only undertaken in 68.0% and 64.9% of the cases. Conclusions: We found a largely common propensity among Italian directors, neonatologists, and nurses to perform analgesic interventions for the most frequently encountered invasive neonatal painful procedures, though the practices are still highly variable. The availability of written guidelines and local pain specialists are confirmed as factors that contribute to the proper management of pain. However, pain assessment is still inadequate and urgently needs to be implemented to allow for tailored pain and stress control and prevention in all infants. [ABSTRACT FROM AUTHOR]

Introduction: Long QT syndrome (LQTS) is a potentially lethal medical condition that might never be diagnosed and cause sudden cardiac death. It is mainly caused by mutation in electrolyte transporter genes. Due to the significant difference in the treatment approach of heart block and other rhythm disorders that mimic this condition, it is necessary to discriminate these conditions. The occurrence of pseudo-block in electrocardiography features but without disturbance in the function of the conduction system can mask the definite diagnosis of the real underlying disorder, and this issue leads to the selection of an unfavorable treatment protocol and sometimes the sudden death of the patient. Case presentation: We described an infant who showed evidence of atrioventricular (AV) block in initial electrocardiography (ECG) on his first day, but in further evaluations, the final diagnosis of LQTS was raised. The patient recovered after performing the treatment protocol, which included Mexiletine and beta-blockers. After the genetic test of the parents and the patient, it was determined that a defective allele of the gene had caused the condition. Conclusion: Our report shows the importance of timely differentiation between heart block and LQTS in neonates and choosing the correct treatment approach to faster patient recovery and prevent sudden death. Clinical key message: Primary diagnosis of LQTS in neonates might not be a straightforward process due to resembling AV pseudo-block and can cause misleading diagnosis and treatment. Long QT syndrome has several nonspecific presentations. They might be asymptomatic until adulthood and be diagnosed after sudden cardiac death. Preventive measures such as timely initiation of medications, ICD or PPM implantation, and continuous observation by caregivers are the mainstay of survival and quality of life improvement. The family tree shows the genes that have caused this condition in the parents and the patient. [ABSTRACT FROM AUTHOR]

Background: Neonatal hyperbilirubinemia is a potentially fatal condition that has toxic effects on the brain and may have negative effects. Humanized care is a comprehensive approach that focuses on the nutritional, therapeutic and hygienic needs of neonates, which helps in the resolution of hyperbilirubinemia. Method: A quasi-experimental design was utilized in this study to evaluate the effect of humanized nursing care application on the clinical outcomes of neonates with hyperbilirubinemia. It was carried out at the Neonatal Intensive Care Unit at Tanta Main University Hospital. A total of 120 neonates with hyperbilirubinemia who fit the inclusion criteria were randomly assigned to both the study and control groups. The data were collected using the biosocial-demographic characteristics of the studied neonates and neonatal clinical outcome measures for humanized care. Results: On the seventh day after receiving humanized care, total bilirubin levels in the study group decreased to 4.03 ± 1.48 compared to 10.21 ± 2.08 in the control group; there was also a decline in the time of jaundice regression with a mean of 3.966 ± 1.09 in the study group compared to 4.66 ± 1.29. in the control group. The mean days of phototherapy were 1.83 ± 0.73 in the study group and 2.41 ± 1.01 in the control group. Additionally, oxygen saturation increased significantly on the 7th day in the study group compared to the control group; the mean amount of daily milk intake was 752.8 ± 262.9 ml in the study group compared with 600.76 ± 290.31 ml in the control group. Conclusion: Applying humanized care improved neonatal clinical outcomes, including O2 saturation, jaundice regression, enhanced newborn feeding and decreased duration of phototherapy. [ABSTRACT FROM AUTHOR]

Background: The timely initiation of trophic feeding (TF) is crucial for premature newborns, but challenging due to immaturity, respiratory instability, abdominal distension, resource scarcity, and healthcare worker expertise. Moreover, there is a dearth of information on predictors of full trophic feeding time. Therefore, this retrospective cohort study aimed to investigate the time it takes and its predictors to initiate minimal enteral feeding in preterm neonates in Southern Oromia, Ethiopia. Method: A facility-based retrospective follow up study was conducted among 434 randomly selected preterm neonates admitted to NICU of Bule Hora University Teaching Hospital and Yabello General Hospital from January 1, 2021 to December 30, 2022. Data were extracted by a pretested structured checklist, entered into Epidata 3.1 and then transferred to Stata version 17 for analysis. Kaplan Meier survival curve and log rank test were used to estimate survival time and a statistical comparison respectively. Bivariable and multivariable cox proportional hazard model was fitted to identify predictors of time to initiate TF and their outputs are presented using Adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CIs). Result: The overall incidence density of TF initiation was reported as 43.6 per 100 neonate-days. Moreover, the median (IQR) time to initiate TF was found to be 2 (1–4) days. Neonates delivered vaginally had a higher likelihood of early TF initiation (AHR: 1.64, CI: 1.26, 2.13), while those born between 32 and 34 weeks (AHR: 0.61, CI: 0.46, 0.81), VLBW neonates (AHR: 0.45, CI: 0.34, 0.60), neonates without KMC (AHR: 0.59, CI: 0.46, 0.79), and those in level II hospitals were less likely to start TF promptly (AHR: 0.78, CI: 0.62, 0.99). Furthermore, neonates with sepsis (AHR: 1.76, CI: 1.36, 2.28) and hypothermia (AHR: 1.51, CI: 1.19, 1.93) had delayed TF initiation. Conclusion: We observed a significant low rate of early TF initiation and higher death rate of preterm newborn in our study as compared to the global. Preterm neonates with lower GA, no KMC, and a VLBW are more likely to have a delayed initiation. Our results highlight that staff training on identifying neonates suitable for TF, and ensuring adequate resources for KMC in all NICU levels should be considered. [ABSTRACT FROM AUTHOR]

Introduction: Paediatric Critical Care (PCC) supports the recovery of children with severe illness. In the UK, there are 30 PCC units with a total of approximately 400 beds. There is constant demand for these beds with a mean five-day length of stay and admissions increasing at a greater rate than age-specific population growth. Prolonged stay patients account for approximately half of all PCC patient bed days. Children with complex critical illness (CCI) need input from multiple different teams alongside support for their family. CCI often become prolonged PCC-stay patients too. Internationally, there is variation in the definition of CCI, this creates service variation and tensions around what resources can be provided including discharge planning, provision, and support. Objective: The face of Paediatric Critical Care, in the UK and internationally has changed over the last ten years with a growing cohort of complex critically ill patients. This systematic review aims to look at current nomenclature, criteria, and outcome measures of priority in this undefined patient population. Methods and materials: Inclusion criteria: All types of studies examining children with complex critical illness (age <18 years) admitted to any paediatric critical care. The review is registered on Prospero. Medline, Embase, Maternity and Infant care, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Trip database will be searched from 2014 to May 2024. The search was limited to ten years as children with complex critical illness are a relatively new concept within PCC. Therefore, the timeline was limited to increase the accuracy and applicability of the review. Search limits included all languages, excluded the setting of neonatal intensive care, and age>18 years old. The final search strategy was developed in Medline and peer-reviewed by a health research librarian not involved in the study. This was translated to other databases as appropriate. Four independent reviewers will screen citations for eligible studies and perform data extraction. Discussion: A systematic review methodology has been used to develop a broad understanding of the literature which will be used to develop further work in this area. Using a rigorous and stepwise approach, the whole spectrum of scientific publications on children with complex critical illness in paediatric intensive care will be reviewed, ensuring this study is as comprehensive as possible. This includes quantitative, qualitative, theoretical, and grey literature. A limitation of this systematic review is the use of many terms to describe children with complex critical illness in the literature resulting in a high number of publications on this topic. [ABSTRACT FROM AUTHOR]

Background: Working in neonatal intensive care units (NICUs) or pediatric intensive care units (PICUs) entails making difficult decisions about children at the end of their lives that raise significant ethical issues. This review identified the ethical content of the papers containing expert guidelines and recommendations in relation to end-of-life decision-making in NICUs and PICUs, by analyzing ethical positions and ethical principles behind them. Methods: Systematic search was limited to the period from 1990 to 2023 and encompassed 6 bibliographic databases (Medline, PubMed, CINAHL, APA PsycINFO, Web of Science Core Collection, and Scopus), grey literature sources and relevant reference lists. The international, national, or institutional papers providing expert guidelines and recommendations comprehensively addressing either withholding/withdrawing of life sustaining treatment, palliative care, and/or intentional life terminating actions in NICUs and PICUs were included in analysis. Also, only papers published in English language were considered. Papers that were not developed by intensive care expert communities and those that were either too narrow (e.g., dealing with specific issues or specific patient groups) or broad (e.g., addressing issues of interest on general and abstract level) were excluded. The search data were gathered and deduplicated, partly by Mendeley software. Titles and abstracts were screened by three independent reviewers, and full-text papers further reviewed and assessed for eligibility. Subsequently, data of interest were extracted, and qualitative analysis was performed. Results: Initial search retrieved 6784 papers from bibliographic databases and 363 from other utilized sources. Titles and abstracts from 2827 papers were screened. 17 full texts were further assessed resulting in a total number of 9 papers (6 from bibliographic databases and 3 from other sources) which met the inclusion criteria and were included for analysis. The papers were published from 2001 to 2021. Four papers primarily focus on NICU setting, while five on PICU. A total of 38 ethical positions were identified and were grouped under 5 themes according to the content of the positions, relating to: patients, parents, medical team, decision-making and treatment options. A total of 12 ethical principles were mentioned in the papers. The principle of beneficence emerged as the most prominent one. It was explicitly mentioned in all included papers except one. Conclusions: This review has shown that papers containing guidelines and recommendations on end-of-life decision-making in the NICU and PICU promote similar stances. The ethical principle of beneficence is at the core of the decision-making process, and all decisions are made focusing on the child's best interests. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa is one of the main causes of hospital infections that are difficult to manage because of multidrug resistance (MDR). The aim of this study was to describe a molecular investigation on 19 clinical and 14 isolates from the environment in the Hub hospital of the Molise region, central Italy. Antimicrobial susceptibility was evaluated using BD Phoenix™ Automated Microbiology System. Pulsed-field gel electrophoresis (PFGE) with SpeI , enterobacterial repetitive intergenic consensus (ERIC-PCR), and random amplified polymorphic DNA-PCR were performed for genotyping. All 33 P. aeruginosa showed MDR phenotype. PFGE had 0.99 discriminatory power, underlining high heterogeneity among the strains. The genetic relatedness between two human isolates (H12 and H15) from neonatal intensive care (NICU) and one environmental strain (E1) collected from siphon of sink in the delivery room was noticeable, as well as between one strain from faucet in NICU (E2) and siphon sink (E5) from delivery room. The link between H12, H15, and E1 strains was corroborated by ERIC-PCR showing epidemiological concordance, although with a lower discriminatory power. The study findings strengthened the critical correlation between clinical P. aeruginosa and environment, according to previous molecular surveys on outbreaks occurred in Italy. [ABSTRACT FROM AUTHOR]

Twin pregnancies are associated with higher risks of adverse maternal and neonatal outcomes compared to singleton pregnancies. This retrospective nationwide cohort study analyzed trends in twin pregnancy outcomes in Finland from 2008 to 2023 using data from the Finnish Medical Birth Register. Outcomes assessed included perinatal mortality, stillbirths, neonatal mortality, neonatal intensive care unit (NICU) admissions, and hospitalization rates at one week of age. A total of 23,588 twin births were included, with an overall stillbirth rate of 9.0 per 1000 and a perinatal mortality rate of 16.0 per 1000. Neonatal mortality rates declined significantly, with term twins showing a rate of 0.9 per 1000 and preterm twins 4.6 per 1000 in the latest years of 2022–2023. NICU admission rates remained stable for preterm twins but showed an increasing trend for term twins. The rate of hospitalized neonates at the age of seven days decreased over time. Conclusion: These trends align with improved antenatal care and Finland’s reputation for low neonatal mortality. However, increasing maternal age and obesity rates may contribute to rising NICU admissions in term twins. The study highlights the need for continuous monitoring of neonatal outcomes to ensure high standards of care in the context of declining fertility and delivery rates in Finland. What is Known: • Twin pregnancies are associated with higher risks of adverse maternal and neonatal outcomes compared to singleton pregnancies. • Finland has one of the lowest neonatal mortality rates globally. What is New: • Neonatal mortality rates declined significantly both in term and preterm twins from 2008 to 2023. • NICU admission rates remained stable for preterm twins but showed an increasing trend for term twins. [ABSTRACT FROM AUTHOR]

Background: Clinical empathy is an essential part of healthcare, and patient-centered care models require clinical empathy to be established. Despite this, little is known about its measurement in the neonatal scenario. Research Aim: To measure clinical empathy in health professionals who work with medium and high-risk neonates and build a construct of this empathy. Research Design: Single-center survey study. Participants and Research Context: The Jefferson Scale of Empathy for Health Professionals questionnaire was applied to health professionals who work in an intensive care unit and a medium-risk unit, in Brazil. Analysis was done using descriptive statistics and a factor analysis model, to build the construct of empathy. Overall empathy was calculated, and the domains' punctuations were analyzed and compared to the maximum punctuation possible. The study followed the STROBE checklist. Ethical Considerations: This study was approved by the Research Ethics Committee of the institution. All participants signed the informed consent form. Participants' confidentiality and anonymity were protected. Findings: Median empathy was 117 (IQR 113–124). The domain of Walking in the Patient's Shoes had lower scores and represented 77.6% of the maximum punctuation possible. The factor analysis included three factors named Understanding, Experiences, and Treatment, and Emotional Relationships, explaining 64.3% of the overall variance. The domain Walking in the Patient's Shoes was not included in the model. Conclusions: In this scenario, clinical empathy should improve. There is a need to improve the domain of Walking in the Patient's Shoes, in this case, the neonate, and provide more empathic care to them. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to determine the effect of supplemental nursing system on, sucking success, weight gain findings and bilirubin levels in newborns. Design and methods: The study was conducted as a randomized controlled trial. The population of the research consisted of 71 infants who received care and treatment at the Neonatal Intensive Care Clinic of the hospital located in a province in eastern Turkey between February and June 2023. In the study, the "Infant Follow-up Form" to access the birth-related characteristics of infants and mothers, the "LATCH Breastfeeding Diagnostic Scale," to diagnose the process of switching to full breastfeeding and the "Mother-Infant Communication Form" were used. The body weights of the infants were monitored using a Charder baby scale and bilirubin levels were measured using a Drager brand transcutaneous bilirubin measuring device. Results: The difference between the groups in terms of the mean sucking success, weight gain findings and bilirubin levels scores was statistically significant (p < 0.05). Conclusions: Feeding an infant with the supplemental nursing system had a positive effect on sucking success, weight gain findings and bilirubin levels. [ABSTRACT FROM AUTHOR]

Objective This study aimed to determine whether administration of a late preterm (34–36 weeks) course of antenatal corticosteroids (ACS) is associated with improved short-term neonatal outcomes among pregnancies complicated with hypertensive disorders of pregnancy (HDP) who delivered in the late preterm period. Study Design A single tertiary center retrospective cohort study, including pregnant individuals with singleton fetuses who delivered between 34.0 and 36.6 weeks following an HDP diagnosis. Exclusion criteria were major fetal anomalies and treatment with ACS before 34 weeks. Cases were divided into two groups: exposed group, consisting of individuals treated with a late ACS course, and nonexposed group, receiving no ACS. The primary outcome was a composite adverse neonatal outcome, including intensive care unit admission, oxygen treatment, noninvasive positive pressure ventilation, mechanical ventilation, respiratory distress syndrome, transient tachypnea, or apnea of prematurity. Secondary neonatal outcomes included birth weight, Apgar score, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, surfactant use, hypoglycemia, hyperbilirubinemia, sepsis, and neonatal death. Multivariable regression models were used to determine adjusted odds ratio (aOR)and 95% confidence intervals (CIs). Results Of 7,624 preterm singleton deliveries during the study period, 438 (5.7%) were diagnosed with HDP and delivered between 34.0 and 36.6 weeks. Infants who received ACS were diagnosed more commonly with fetal growth restriction (16.0 vs. 5.6%, p < 0.01) and were delivered at an earlier gestational age (GA) (mean GA: 35.6 vs. 36.3 weeks, p < 0.01). The composite neonatal morbidity did not differ between the groups after adjustments (aOR: 0.97, 95% CI: 0.47, 1.98). Neonatal hypoglycemia and hyperbilirubinemia were more common in the exposed group than in the nonexposed group (46.9 vs. 27.4%; aOR: 2.27; 95% CI: 1.26, 4.08 and 64.2 vs. 46.5%; aOR: 2.08; 95% CI: 1.16, 3.72 respectively). Conclusion In people with HDP, a course of ACS given in the late preterm period did not improve neonatal morbidity. Key Points In people with HDP, a late preterm ACS course did not improve neonatal morbidity. Respiratory morbidity rate was similar between infants who received late ACS and those who did not. Neonatal hypoglycemia and hyperbilirubinemia were more common in infants who received late ACS. [ABSTRACT FROM AUTHOR]

Objective Identifying underlying social risk factors for neonatal intensive care unit (NICU) admission is important for designing interventions to reduce adverse outcomes. We aimed to determine whether a patient's exposure to community-level stressors as measured by the social vulnerability index (SVI) is associated with NICU admission. Study Design Retrospective cohort study (2014–2018) of patients delivering a liveborn ≥ 22 weeks' gestation at a quaternary care center. Patient addresses were used to assign each individual a composite SVI and theme score. The primary exposure was a composite SVI score categorized into tertiles. The primary outcome was NICU admission. Secondary outcomes included NICU length of stay and neonatal morbidity composite. Multivariable logistic regression was performed to estimate the association between composite SVI and outcomes (low SVI as referent). We secondarily compared mean composite and theme SVI scores; individual components of each theme were also compared. Results From 2014 to 2018, 13,757 patients were included; 2,837 (21%) had a neonate with NICU admission. Patients with higher SVI were more likely to self-identify as Black race and have medical comorbidities. Living in areas with moderate or high SVI was not associated with NICU admission (moderate SVI adjusted odds ratio [aOR]: 1.13, 95% confidence interval [CI]: 0.96–1.34; high SVI aOR: 1.12, 95% CI: 0.95–1.33). Moderate SVI was associated with increased neonatal morbidity (aOR: 1.18, 95% CI: 1.001–1.38). In an analysis of SVI as a continuous variable, mean SVI scores were significantly higher in individuals who had an infant admitted to the NICU. Those requiring NICU admission lived in areas with lower per capita income and a higher number of mobile homes (p < 0.001). Conclusion Patients living in areas with moderate or high SVI were not shown to have higher odds of having a neonate admitted to the NICU. Neonatal morbidity was higher in those living in areas with moderate SVI. Increased access to social services may improve neonatal outcomes. Key Points Mean SVI scores are higher in those with a neonate admitted to the NICU. There was no observed association between moderate and high SVI scores and NICU admission. Moderate SVI is associated with an increased odds of overall neonatal morbidity. Greater exposure to low income may be associated with NICU admission. [ABSTRACT FROM AUTHOR]

Objective For many health care providers, an umbilical venous catheter (UVC) may be a contraindication for skin-to-skin contact (SSC). Our aim was to compare the frequency of adverse events between preterm infants who were on SSC with UVC and those who remained in an incubator. Study Design Prospective observational study in newborns less than 35 weeks gestation. UVC-related adverse events were compared between neonates who performed SSC and those who did not. The incidence of catheter-related displacement, leak, loss, hemorrhage, malfunction, and bloodstream infection was studied. Results From 226 patients, 171 performed SSC with UVC. Their first contact was earlier than in those who remained in an incubator (SSC-UVC, 29 hours [interquartile range (IQR): 21–53] vs. no SSC-UVC, 132 hours [IQR: 96–188]; p < 0.001). Both groups were similar in gestational age (SSC-UVC, 30 weeks vs. no SSC-UVC, 30.3 weeks; p = 0.331) and birth weight (SSC-UVC, 1,285 g vs. no SSC-UVC, 1,355 g; p = 0.2). Studied complications were not more frequent in patients who performed SSC. In fact, although it was not statistically significant, a lower overall incidence of adverse events (SSC-UVC, 13.5% vs. no SSC-UVC, 20%; p = 0.237) and catheter-related bloodstream infection (SSC-UVC, 4.7% vs. no SSC-UVC, 10.9%; p = 0.111) was observed in this group. Conclusion SSC with a UVC is a safe procedure and there are no more complications in newborns who perform SSC compared to those who remain in the incubator. Due to its demonstrated benefits, SSC should be promoted in premature newborns regardless of the presence of a UVC. Key Points SSC in preterm infants with UVCs is safe. Early SSC does not increase UVC-related bloodstream infection. Early SSC should be promoted in stable patients regardless of the presence of a UVC. [ABSTRACT FROM AUTHOR]

Objective This study aimed to implement a point-of-care ultrasound (POCUS) program into a large neonatal intensive care unit (NICU) to enhance care by improving (1) umbilical venous catheter (UVC) tip identification and (2) central placement. Study Design A POCUS program was established with core providers who received training from external and internal experts. A prospective study (n = 94) compared the accuracy of UVC identification between neonatology-performed ultrasound (NeoUS) and X-ray relative to a referent of radiology-interpreted ultrasound. Finally, an ultrasound-guided UVC insertion protocol was introduced to rescue noncentral traditionally placed catheters (n = 37). Results Program implementation trained six providers for a total cost of approximately $10,500 USD. NeoUS was more accurate than X-ray at identifying UVC location (81.9 vs. 60.6%) with improved sensitivity and specificity (80.0 and 84.6 vs. 52.5 and 66.7%, respectively). POCUS guidance was able to rescue 89.2% of catheters that were originally noncentral. Conclusion POCUS implementation in a large NICU is feasible, affordable, and can improve quality of care. Key Points POCUS implementation is feasible and affordable. POCUS is more accurate than X-ray at monitoring UVCs. Central UVC placement can be increased with POCUS. [ABSTRACT FROM AUTHOR]

Objective Perinatal mood and anxiety disorders (PMADs) affect many neonatal intensive care unit (NICU) parents and are a significant risk factor for maternal suicide. Lack of screening and treatment interferes with infant development and bonding, compounding risks in fragile infants. We aim to describe PMAD screening in level IV NICUs across the Children's Hospitals Neonatal Consortium (CHNC) and to determine the relationship between standardized screening and mental health professionals (MHPs) presence. Study Design We surveyed experts at 44 CHNC NICUs about PMADs screening practices and presence of NICU-specific MHPs. Kruskal–Wallis test was used to examine relationships. Results Of 44 centers, 34 (77%) responded. Fourteen centers (41%) perform screening with validated tools. Thirteen (38%) centers have NICU-dedicated psychologists. Formally screening centers tend to have higher cumulative MHPs (p = 0.089) than informally screening centers. Repeat screening practices were highly variable with no difference in the number of cumulative MHPs. Conclusion Screening practices for PMADs vary across CHNC centers; less than half have additional MHPs beyond social workers. Creating a sustainable model to detect PMADs likely requires more MHPs in NICUs. Key Points PMADs affect many NICU parents. Systematic screening for PMADs is limited in level IV children's hospital NICUs. Additional MHPs may contribute to enhanced screening and support of parents. Hospitals should prioritize funds for NICU-specific MHPs to optimize outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on navigating the care of maternal/fetal dyads with bilateral renal agenesis (BRA) after the Renal Anhydramnios Fetal Therapy (RAFT) trial. Topics include the evolving approach to BRA management, comparisons with other pediatric conditions like trisomy 13/18 and hypoplastic left heart syndrome, and the outcomes of the RAFT trial in supporting survival and long-term care for affected infants.

Parents of infants requiring neonatal intensive care unit (NICU) hospitalization often experience increased rates of distress, trauma, and perinatal mood disorders. Untreated parental mental health conditions have short- and long-term effects for infants and families. While some NICUs provide varying degrees of mental health supports for NICU families, these services are not universally or systematically integrated in US NICUs. Multiple factors contribute to this gap in care, including mental health stigma, funding constraints, and lack of staff training and capacity. In an effort to address this gap, we used a participatory action research approach, guided by a Patient and Stakeholder Engagement model, to partner with graduate NICU parents and patient-facing NICU staff to identify parental mental health needs and ideas to address them. Through efforts to mitigate power differentials and engage parents as research and program development partners, our work shaped NICU practices, programming, and subsequent research. [ABSTRACT FROM AUTHOR]

Background: Finding an accurate and simple method of thermometry in the neonatal intensive care unit is important. The temporal artery thermometer (TAT) has been recommended for all ages by the manufacturer; however, there is insufficient evidence for the use of TAT in infants, especially to detect hypothermia. Purpose: To assess the accuracy of the TAT in hypothermic neonates in comparison to a rectal thermometer. Methods: This study was a naturalistic, quantitative, and observational study. Temporal artery temperatures (using Exergen TemporalScanner 5000) were compared to rectal temperatures in critically ill infants in the neonatal intensive care unit undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy. Temperatures were taken during a 72-hour cooling period at 33.5 °C and a 6-hour rewarming period to normothermia of 36.5 °C. Nineteen patients and 1280 temperature measurements were included in this study. Results: During the cooling period, TAT and rectal temperatures had a weak correlation (r = 0.34, P < .001). The correlation during the rewarming period was much stronger (r = 0.70, P < .001), indicating less variability in measures, but not agreement. On average, regardless of period, the TAT temperatures read 0.43 °C (95% confidence interval, 0.37-0.49, P < .001) warmer than the rectal temperatures. The cooling or warming period had no effect on this difference between temperatures. Implications for Practice and Research: This study found that temperatures obtained with a TAT are generally warmer than the accepted standard core rectal temperature in hypothermic neonates, and we do not recommend its use in critically ill neonates who require accurate temperature readings. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic affected the maternal-infant dyad, especially due to visitation restrictions in neonatal units. These changes may impact the psychological, physical, and developmental health of mothers and newborns. Purpose: This systematic review evaluates the impact of enforced separation and restrictive visitation policies in neonatal units during the pandemic, focusing on the maternal-infant dyad. Data Sources: Data sources include CINAHL, MEDLINE, Web of Science, APA PsycINFO, Academic Search Ultimate, and Embase, covering studies published between 2020 and 2024. Study Selection: A detailed search was conducted using terms related to COVID-19, maternal and neonatal health, and visitation restrictions in neonatal units. Articles were included if they were peer-reviewed, written in English, and focused on the impact of visitation restrictions on maternal and neonatal health. Data Extraction: The data extraction process began with 789 references. After removing duplicates, we screened titles and abstracts. We then conducted a full-text assessment of the remaining studies, selecting 14 that met the inclusion criteria. Results: The analysis showed significant emotional, psychological, and developmental impacts on mothers and newborns due to pandemic-induced separation and inconsistent policies. It highlighted depressive symptoms, stress, bonding disruptions, and the effectiveness of virtual bonding. Implications for Practice and Research: The review emphasizes the need for family-centered care, coping strategies, and virtual bonding in neonatal units. It calls for culturally sensitive policies to support mothers and infants during crises. The review also highlights the importance of studying the long-term effects of pandemic-induced separations and improving support for future health emergencies. [ABSTRACT FROM AUTHOR]

Background: Neonates with complex medical needs (NCMNs) are a small proportion of neonatal intensive care unit admissions but are high healthcare utilizers. Since 2018, NCMNs at our hospital have been cared for by the Neonatal Complex Care Team. This model has yet to be evaluated. Purpose: To inform the evaluation of our care model, we examined literature on care practices for the management of NCMNs and utilized that to define outcome measures. Data Sources: MEDLINE and Cumulated Index to Nursing and Allied Health Literature were searched. Inclusion dates: January 1, 1993, until July 15, 2023. Study Selection: The PRISMA extension for scoping reviews was used. The population was neonates in the neonatal intensive care unit, the concept was models of care, and the context was medical complexity. Two reviewers performed the title/abstract screening and full-text review. A total of 148 articles were screened, 17 fully reviewed, and 5 articles included. Data Extraction: Data extraction was completed by one reviewer utilizing resources from the Joanna Briggs Institute. Results: Care practices ranged from structured discharge meetings with families to an inpatient care model. Few reported new clinical models, and long-term health outcome data were limited. Multidisciplinary care teams emerged as crucial to in-hospital care and smooth discharge. Length of stay and readmission were identified as key outcomes for clinical program evaluation. Implications for Practice and Research: There is limited literature on this topic; however, we identified themes and outcomes that are useful for clinical program evaluation. Long-term evaluation of novel models of care is needed. [ABSTRACT FROM AUTHOR]

Background: Neonatal advanced practice providers (APPs) often work prolonged hours in high-acuity neonatal intensive care units (NICUs). It is imperative to understand how fatigue affects the APP's ability to react quickly following long shifts. There is a lack of data on the effects of shift length and fatigue on neonatal APP job performance and clinical decision-making. Purpose: The purpose of this study was to describe the variation in shift length, knowledge-based competency, personal well-being, and behavioral alertness for neonatal APPs. Methods: This study evaluated neonatal APPs before and after a clinical shift. Provider well-being was assessed during the pre-survey. Pretest-posttest surveys evaluated neonatal APP's psychomotor vigilance skills and knowledge. Participants completed an online, anonymous questionnaire to answer a series of knowledge-based questions before and after their shift, along with a psychomotor vigilance test (PVT). A paired t test analysis evaluated the pre- and post-shift PVT values and knowledge-based test scores. Results: Overall, 61 pre-surveys and 42 post-surveys were completed; 36 were matched by participants pre- to post-survey. The mean between pre- and post-knowledge-based questions was statistically significant, with higher posttest scores. There was no statistical difference noted in the paired t test analysis of the PVT values. Implications for Practice and Research: The small sample size may limit the generalizability of findings, but these results may indicate that shift length does not affect psychomotor vigilance or knowledge-based competency. It is vital that future work assess the associations between APP shift length, fatigue, and critical decision-making. [ABSTRACT FROM AUTHOR]

Background: In the neonatal intensive care unit (NICU), nurses care for premature and critically ill neonates, interact with parents, and make clinical decisions regarding the treatment of neonates in life-threatening conditions. The challenges of managing unstable conditions and resuscitation decisions can cause moral distress in nurses. Purpose: This study aims to determine the relationship between clinical decision-making and moral distress in NICU nurses. Methods: This cross-sectional, multicenter, descriptive correlational study involved 190 nurses working in 7 NICUs across hospitals in Khorramabad and Semnan in 2023. Data were collected using demographic questionnaires, the Clinical Decision-Making Laurie Scale (2001), and the Moral Distress Scale-Revised (MDS-R). Results: All nurses in these NICUs were female. No significant correlation was found between clinical decision-making and moral distress (r = −0.03, P = .684). The moral distress score was low. In decision-making, 57.9% of nurses exhibited intuitive analysis (understanding without a rationale). Multiple linear regression analysis revealed that age, education level, and job position were significantly related to clinical decision-making; and being married and having children were inversely correlated with moral distress. Implications for Practice: 20% of nurses exhibited interpretive intuitive clinical decision-making, which involves care complexities, cognitive understanding, and task-based decisions. Nursing managers should focus on refining these decision-making strategies for NICU nurses. Implications for Research: Given the importance of clinical decision-making in the NICU, future research should use quantitative and qualitative methods to explore the decision-making processes and moral distress in NICU nurses. [ABSTRACT FROM AUTHOR]