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Background: In recent years, the use of music as a therapeutic and developmental tool for infants, especially within neonatal intensive care units (NICUs), has seen a surge in interest. Despite a growing body of research underscoring the potential benefits of music therapy and music medicine in enhancing infant development and aiding medical practices, the specific characteristics of music that maximize these benefits remain poorly understood. Objectives: This scoping review aims to provide a comprehensive foundation by mapping the existing literature on passive music listening and identifying gaps, trends, and patterns that are crucial precursors to the development of best practices. Methods: Following the PRISMA guidelines, a comprehensive literature search was conducted, covering studies published up until December 2022. The focus was on passive music listening, with a deliberate exclusion of active music interventions. Out of the initial pool of studies, 56 met the inclusion criteria, determined by the PICO framework, focusing on passive music exposure among full-term and preterm infants. Starting with a descriptive analysis approach, the study employed Non-negative Matrix Factorization (NMF) and Latent Dirichlet Allocation (LDA) to identify key themes, including the physiological impacts of music, its role in pain management, effects on sleep and stress, and influences on feeding and weight gain. Results: The review revealed a predominance of quantitative research methods, a significant concentration of studies from the United States, suggesting potential geographical bias, and a notable clinical setting bias. These findings indicate a critical need for methodological diversity and a more culturally inclusive and interdisciplinary approach to research. They also point to the necessity for standardized music intervention protocols to optimize therapeutic and developmental outcomes for this vulnerable population. Future research should aim to bridge the methodological gaps identified, integrating both qualitative and quantitative approaches to provide a comprehensive understanding of music's impact on infant development and medical practices in a global, culturally nuanced context. [ABSTRACT FROM AUTHOR]

Abstract Background In recent years, the use of music as a therapeutic and developmental tool for infants, especially within neonatal intensive care units (NICUs), has seen a surge in interest. Despite a growing body of research underscoring the potential benefits of music therapy and music medicine in enhancing infant development and aiding medical practices, the specific characteristics of music that maximize these benefits remain poorly understood. Objectives This scoping review aims to provide a comprehensive foundation by mapping the existing literature on passive music listening and identifying gaps, trends, and patterns that are crucial precursors to the development of best practices. Methods Following the PRISMA guidelines, a comprehensive literature search was conducted, covering studies published up until December 2022. The focus was on passive music listening, with a deliberate exclusion of active music interventions. Out of the initial pool of studies, 56 met the inclusion criteria, determined by the PICO framework, focusing on passive music exposure among full-term and preterm infants. Starting with a descriptive analysis approach, the study employed Non-negative Matrix Factorization (NMF) and Latent Dirichlet Allocation (LDA) to identify key themes, including the physiological impacts of music, its role in pain management, effects on sleep and stress, and influences on feeding and weight gain. Results The review revealed a predominance of quantitative research methods, a significant concentration of studies from the United States, suggesting potential geographical bias, and a notable clinical setting bias. These findings indicate a critical need for methodological diversity and a more culturally inclusive and interdisciplinary approach to research. They also point to the necessity for standardized music intervention protocols to optimize therapeutic and developmental outcomes for this vulnerable population. Future research should aim to bridge the methodological gaps identified, integrating both qualitative and quantitative approaches to provide a comprehensive understanding of music’s impact on infant development and medical practices in a global, culturally nuanced context.

Background and Objectives Materials and Methods Results Conclusion Routine coagulation screens at birth are still standard in some European neonatal intensive care units (NICUs), although interpretation of these results is complex in preterm infants. It is unclear to what extent local coagulation assay results agree with published reference ranges when using different analysers and reagents. We aimed to assess coagulation assay results on day 1 of life in very preterm infants admitted to the NICU.We included all preterm infants born below 32 weeks gestational age (GA) admitted to the Leiden University Medical Center between 2004 and 2020 in whom coagulation assays (prothrombin time [PT] and activated partial thromboplastin time [APTT]) were obtained during the first 24 h of life. Infants either diagnosed with major intraventricular haemorrhage or who received plasma transfusion before coagulation assay were excluded. We assessed coagulation assay results and compared the results between <28 weeks (extremely preterm) and 28–32 weeks (very preterm) GA groups.Coagulation assays were obtained at birth in 144 infants (144/2577; 5.5%) of whom 104 fulfilled the inclusion criteria. We found similar median PT and APTT values for extremely and very preterm infants (PT: 18.1 vs. 18.7 s [p‐value = 0.400]; APTT: 44.2 vs. 47.7 s [p‐value = 0.252], respectively).We found similar coagulation assay results at birth for extremely and very preterm infants; however, results deviated considerably from some of the published reference ranges. This may be due to differences between analysers and reagents, underlining the need for reference ranges calibrated to the equipment used per NICU. [ABSTRACT FROM AUTHOR]

In neonates admitted to the neonatal intensive care unit (NICU), arterial and venous thromboembolism is a major cause of morbidity and death which could be attributed to multiple risk factors exposure. This study aimed to evaluate the clinical characteristics, laboratory and radiological assessments, predisposing risk factors, and outcomes of thrombosis in neonates admitted to NICU. This prospective cohort study was conducted at NICU, Minia, and Alexandria University Children's Hospital. Screening of 886 patients admitted to NICU over one year with different clinical presentations, patients were classified into the thrombotic and non-thrombotic groups based on the presence or absence of thrombosis. Thrombosis was diagnosed based on clinical, laboratory and different radiologic assessments. Genetic testing for factor V Leiden mutations G1691A, prothrombin mutation G20210A, protein C, protein S, and antithrombin III gene mutations were performed for patients with a family history of thrombosis. Out of a total of 886 neonatal admissions, 36 patients were diagnosed with evident thrombosis (40 per 1000 NICU admissions). The sites of venous thrombosis detection were Portal vein thrombosis in 11 patients (30.6%), superior vena cava thrombosis in 7 patients (19.4%), deep venous thrombosis in 5 patients (13.9%), central venous thrombosis in 5 patients (13.9%), intra-cardiac thrombosis in 3 patients (8.3%) and necrotic skin patches in one patient (2.8%). Only 69% of enrolled thrombosis patients showed genetic mutations the most common of which was factor V Leiden mutation (52.3%). Sepsis, central venous line (CVL) insertion, C reactive protein (CRP), and duration of NICU admission were significantly more common in the thrombotic group (p < 0.001) and were associated with a higher risk of thrombosis (ORs: 1.02, 7.7, and 1.11, respectively) (p < 0.001). Higher mortality occurred in thrombosis neonates compared with a non-thrombotic group (52.8% versus 17.4%) (p < 0.001). NICU-admitted neonates are exposed to multiple overlapped risk factors, the detection of which is important for preventing potential thrombosis and improving the patient's outcomes. The complexity of sepsis pathogenesis and management could potentiate multiple acquired risk factors. inherited thrombophilia detection is required for prevention of further morbidities. [ABSTRACT FROM AUTHOR]

Family-centered care is vital in neonatal intensive care units (NICUs), where family involvement is linked with improved patient outcomes. However, collaborating with patient families presents unique challenges for medical teams. The purpose of this research is to identify behaviors NICU teams use to promote family-centered teamwork. This study used qualitative data from observations of 320 patient rounding events. Results were analyzed using content analysis. Observed behaviors were categorized into five themes, which captured medical team members’ efforts to include patient families in teamwork: inviting families to participate in teamwork, developing a shared mental model of goals and plans, empowering family caregiving in the hospital and preparing family for discharge, coordinating communication between family and medical team, and developing positive relationships with patient families. The findings from this study emphasize that providers can include patient families in the NICU team, despite challenges associated with doing so. [ABSTRACT FROM AUTHOR]

Background Intracranial hemorrhage (ICH) is a critical concern in preterm neonates, impacting long-term neurological outcomes. Traditional cranial ultrasound (US) has been essential for detecting ICH, but transcranial ultrasound (TUS) offers enhanced imaging capabilities. TUS utilizes high-frequency sound waves to provide detailed visualization of the brain structures, particularly valuable in preterm infants with more pliable skulls. This advanced imaging technique improves the detection of hemorrhagic events, differentiates between stages of bleeding, and guides timely interventions. Objective: To determine the incidence of intracranial haemorrhage in preterm neonates and correlate ultrasound finding with clinical profile in intracranial haemorrhage in preterm neonates and also to correlate gestational age with grades of IVH in preterm neonates. Methods: A prospective observational study was conducted in the Department of Radiodiagnosis at M.G.M. Medical College & M.Y. Hospital, Indore, Madhya Pradesh, India, from July 2023 to June 2024. The study included 790 preterm neonates referred for transcranial ultrasound between January 2020 and October 2023. Transcranial ultrasound was performed using a7 – 15 Mhz probe, with images analyzed using Papille et al. classification for intraventricular hemorrhage. Results: Out of total 790 preterm neonates on transcranial ultrasound, 161 (20.25%) preterm neonates were diagnosed to have IVH. The incidence of intraventricular haemorrhage in our study was 20.25%. Out of 161 preterm neonates, majority of preterm neonates 57.5% having grade 1 IVH were born between 31 - 32 weeks of gestation. Majority of preterm neonates 28.9% having grade 2 IVH were born between 29 - 30 weeks of gestation. Majority of preterm neonates 21% having grade 3 IVH were born between 29 – 30 weeks of gestation. Conclusion: In conclusion, transcranial ultrasound (TUS) significantly enhances the evaluation of intracranial hemorrhage (ICH) in preterm neonates. [ABSTRACT FROM AUTHOR]

Neonatal medical data holds critical information within the healthcare industry, and it is important to analyze this data effectively. Machine learning algorithms offer powerful tools for extracting meaningful insights from the medical data of neonates and improving treatment processes. Knowing the length of hospital stay in advance is very important for managing hospital resources, healthcare personnel, and costs. Thus, this study aims to estimate the length of stay for infants treated in the Neonatal Intensive Care Unit (NICU) using machine learning algorithms. Our study conducted a two-class prediction for long and short-term lengths of stay utilizing a unique dataset. Adopting a hybrid approach called Classifier Fusion-LoS, the study involved two stages. In the initial stage, various classifiers were employed including classical models such as Logistic Regression, ExtraTrees, Random Forest, KNN, Support Vector Classifier, as well as ensemble models like AdaBoost, GradientBoosting, XGBoost, and CatBoost. Random Forest yielded the highest validation accuracy at 0.94. In the subsequent stage, the Voting Classifier—an ensemble method—was applied, resulting in accuracy increasing to 0.96. Our method outperformed existing studies in terms of accuracy, including both neonatal-specific length of stay prediction studies and other general length of stay prediction research. While the length of stay estimation offers insights into the potential suitability of the incubators in the NICUs, which are not universally available in every city, for patient admission, it plays a pivotal role in delineating the treatment protocols of patients. Additionally, the research provides crucial information to the hospital management for planning such as beds, equipment, personnel, and costs. [ABSTRACT FROM AUTHOR]

Background: Enhancing the current breast pump sanitization method may improve maternal satisfaction and increase a mother's likelihood of providing human milk for their hospitalized infants in the Neonatal Intensive Care Unit (NICU). Other than Centers for Disease Control (CDC) data, there is lack of studies on sanitization practices. Currently, the only option in the hospital setting for breast pump equipment cleaning is a steam sanitization plastic bag. Purpose: Using the Q. Basin will increase participant satisfaction compared to the steam sanitization bag. Methods: A multi-phased pilot study was conducted in our quaternary care NICU to test the Q. Basin, a novel design developed to wash, dry, and safely steam sanitize breast pump equipment compared to the standard steam bag. A bacterial study was conducted on breast pump equipment from 10 mothers by swabbing the equipment immediately at hour zero and 24 hours. Twenty NICU mothers concurrently evaluated their satisfaction via a 3-question survey comparing the Q. Basin and the steam sanitization plastic bag method. Results: The results showed a 20% increase in satisfaction with Q. Basin compared to the steam bag method. Implications for Practice and Research: Data analysis from the satisfaction survey concludes that mothers pumping preferred the Q. Basin as a quicker, faster, and more environmentally friendly method for breast pump part sanitization. Additional safety and materials studies are required before using the Q. Basin in the clinical environment. [ABSTRACT FROM AUTHOR]

Background/Objectives: Rapid genome-wide sequencing (rGWS) continues to transform the care provided to infants with genetic conditions in neonatal intensive care units (NICUs). Previous research has demonstrated that rGWS has immense benefits on patient care; however, little is known about non-genetic healthcare providers' (HCPs) experiences and perspectives of working with rGWS and supporting families through the rGWS testing process in Canadian NICU facilities. To address this gap, we surveyed and conducted semi-structured interviews with non-genetic HCPs of diverse professions from NICUs in British Columbia. Methods: An interpretive description approach was used to analyze interview transcripts to identify patterns and variations in non-genetic HCPs' experiences and perceptions with rGWS. Results: Participants had varying degrees of exposure to rGWS and levels of comfort with the testing process. Numerous barriers affecting the implementation of rGWS were identified, including low levels of comprehension of rGWS, longer turn-around times than expected, and having to apply for provincial government approval to access testing. Participants desired more education on rGWS, clear guidelines on the use of rGWS in NICUs, and resources for non-genetic HCPs and parents to support implementation. Conclusions: The results from this study can inform the development of workflows and educational resources on the use of rGWS in NICUs, helping to ensure that the NICU team is supported to optimize rGWS implementation. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the diverse etiologies leading to the need for mechanical ventilation in neonates and to analyze the outcomes associated with this intervention. Materials and Methods: A prospective observational study was conducted on a cohort of 60 neonates admitted to the neonatal intensive care unit (NICU) at Gandhi Hospital during a specified period. Data were collected from medical records, including demographic information, clinical presentation, and diagnostic findings. Etiologies necessitating mechanical ventilation were categorized, and relevant clinical parameters were assessed. Outcomes such as survival rates, duration of ventilation, and potential complications were analyzed. Results: The study included a total of 60 neonates who required mechanical ventilation during the study period. The primary etiologies identified encompassed a range of conditions including respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), congenital anomalies, sepsis, and neurological disorders. Each etiology was further analyzed for its contribution to the need for mechanical ventilation and associated outcomes. The outcomes revealed varying survival rates among different etiological groups. Additionally, the duration of mechanical ventilation was assessed, and potential complications such as ventilator-associated pneumonia, bronchopulmonary dysplasia, and intraventricular hemorrhage were investigated. Conclusion: This study sheds light on the intricate web of etiological factors leading to mechanical ventilation in neonates and provides valuable insights into the associated outcomes. Understanding the diverse challenges faced by neonates requiring mechanical ventilation is crucial for improving clinical management strategies and ultimately enhancing the overall care and survival rates of this vulnerable population. The findings of this study contribute to the existing body of knowledge on neonatal care and may guide future research and clinical practices in the field of neonatology [ABSTRACT FROM AUTHOR]

Background: Neonatal hyperbilirubinemia (NH) affects over 80% of premature babies & 60% of fullterm babies in the first week of life. There are two forms of neonatal hyperbilirubinemia: conjugated & unconjugated. Unconjugated forms can cause bilirubin encephalopathy & kernicterus in extreme cases, while conjugated forms are thought to be a result of a systemic sickness. Babies born prematurely are at a higher risk of hyperbilirubinemia due to bilirubin-induced brain damage compared to their term counterparts. Aim and objectives: The study aims to assess the effect of phototherapy on liver enzymes, renal functions, in NH patients before and after phototherapy. Subjects and methods: This was an observational cross-sectional study that was performed at neonatal intensive care unit (NICU) Al-Hussein university hospital. It included 100 term infants of both sex that received phototherapy for management of neonatal indirect hyperbilirubinemia. When indicated according to Bhutani Nomogram curve. Result: There is no statistically significant difference was found between group I that treated by conventional phototherapy only and group II that treated by intensive then conventional phototherapy regarding maternal age, ABO blood groups and Rh status maternal comorbidities like gestational HTN or diabetes, gestational age, onset of jaundice. Also Both therapy groups reduced total and direct bilirubin significantly (Paired sample t test, P = 0.000). Group II had a greater total bilirubin reduction than group I (Independent sample t test, P = 0.001). Both therapy groups had significant ALT, AST, ALP, urea and creatinine reductions (Paired sample t test, P = 0.000). Conclusion: As regard the effect of Phototherapy on liver enzymes and kidney functions, our results showed a statistically significant reduction in ALT, AST, ALP, urea and creatinine in both treated groups. [ABSTRACT FROM AUTHOR]

Background: Drug-related problems (DRPs) are widespread in hospitalized neonates, but studies on the prevalence of DRPs in this population are limited. The presence of clinical pharmacists on multidisciplinary teams helps prevent and reduce DRPs. Aim: This investigation aimed to identify and classify the incidence of DRPs in the neonatal intensive care unit (NICU), to determine the determining factors associated with DRPs and to document clinical pharmacists' interventions, outcomes, acceptance rates and clinical significance. Method: A prospective descriptive hospital study was conducted from August to November 2023 at the NICU of Children's University Hospital, Assiut University, Egypt. DRPs were classified using the Pharmaceutical Care Network of Europe (PCNE) classification V9.1. Results: Three hundred sixteen neonates were included in the study, with a mean gestational age of 34 ± 4 weeks and a mean birth weight of 2.03 ± 0.85 kg. A total of 1723 DRPs occurred among 283 neonates (89.6%), an average of 5.5 ± 5.1 DRPs per patient. The main types were treatment effectiveness (P1) (799, 46.4%), followed by others (P3) (469, 27.2%), and treatment safety (P2) (455, 26.4%). The leading causes were dose selection (C3) (1264, 61.9%) and "other domain" (C9) (543, 26.6%). Of the 2149 interventions introduced by pharmacists, 98.8% were accepted and 93% were accepted, and fully implemented. As a result, 92% of the DRPs were resolved. Both length of hospital stay and number of medications were significantly associated with DRPs. Conclusion: DRPs are common in the NICU; this study demonstrated the crucial role of clinical pharmacists in identifying and resolving DRPs. [ABSTRACT FROM AUTHOR]

IntroductionWeekly head circumference (HC) measurements using a measuring tape is the current standard for longitudinal brain growth monitoring of preterm infants. The MONITOR3D (M3D) 3D scanner has been developed to measure both HC and cranial volume (CrV) of preterm infants within incubators. The M3D’s usability, accuracy and precision were validated in a simulated setting in a neonatal intensive care unit (NICU).Materials and methodsDuring a simulated routine care moment, NICU nurses conducted M3D scans of a preterm doll simulating an extreme low birthweight preterm (ELBW; BW < 1,000 g) infant, followed by manual HC measurements using a measuring tape. Usability was quantified by percentage of successful HC and CrV measurements from scans. HC and CrV were calculated by marking anatomical landmarks on the 3D image. Measurements were compared to the real, ground truth (GT) values of the doll’s head, defined by an accurate medical scanner. Measurement accuracy was assessed using mean or median absolute measurement error (ME), and precision by the spread of ME, represented by the 95% interval of the ME range. ME intervals were compared with preterm weekly growth increases to assess clinical usability.ResultsRegarding usability, 56 M3D scan sessions resulted in 25 successful (44.6%) HC and CrV measurements, with incomplete 3D data being the primary cause of unsuccessful scans. Accuracy of the measuring tape for HC was 0.2 cm (proportional 0.9% of GT), and precision was 1.6 cm (6.3%). M3D’s accuracy of HC was 0.4 cm (1.5%), and precision was 0.7 cm (2.9%). For CrV, M3D’s accuracy was 8.0 mL (3.8%) and precision 22.6 mL (10.8%).ConclusionThe M3D scanner is suitable for measuring HC and CrV in ELBW infants. However, current scan success rate is too low for practical usability. The M3D’s accuracy and precision are clinically sufficient, while the precision of the current measuring tape method is inadequate for preterm infants. This makes the M3D a promising alternative for HC, offering less disturbance to the infant. In the future, the M3D technique could facilitate the creation of CrV growth reference charts for ELBW infants, enhancing the accuracy of clinical growth monitoring for preterm infants.

AimTo compare volume-driven and cue-based feeding of low birth weight preterm infants, regarding short-term outcomes, including transition to oral feeds, weight gain, and length of stay.MethodsThis was a retrospective cohort study. Feeding and weight gain outcomes were compared between infants fed by volume-driven and cue-based feeds. The groups were subdivided by birth weight categories.ResultsThe study group included 240 low birth weight preterm infants born before 34 weeks of gestation, 120 infants fed by volume-driven feeding were compared to 120 infants fed by cue-based feeding. The groups were sub-analyzed by birth weight categories:

Background: Drug related problems (DRPs) can interfere with the desired therapeutic outcomes. Neonates are susceptible for DRP occurrence due to clinical heterogeneity, inappropriate formulations, complexity of drug regimens and polypharmacy. Thus, the objective of this study was to characterize the DRP, their resolutions and associated risk factors among neonates in the Neonatal Intensive Care Unit (NICU). Methods: A cross-sectional study was carried out in NICU ward at tertiary care teaching hospital for 18 months. Clinical pharmacists participated on daily basis to collect patient information and assess their medication therapy for DRPs. DRPs were classified into problems and their causes according to Pharmaceutical Care Network Europe (PCNE) Version 9.1. Clinical pharmacist implicated evidence-based interventions to resolve DRPs. SPSS V.25 was used for the statistical analysis. Univariate logistic regression analysis was used for the determination of risk factors for DRPs, with a p-value

BACKGROUND AND OBJECTIVE: Among the unique challenges for parents in the transition of infant care from neonatal intensive care unit (NICU) to home are the medical complexity of their babies and the psychological burden of caring for this special patient population. Despite the increased use and accessibility of smartphones, mobile applications (apps) intended for use by families during this transition remain underdeveloped and understudied. Apps to support parents of infants in the NICU represent an accessible potential solution to mitigate existing disparities in follow up. Through this Narrative Review, we intend to describe the characteristics of and development process for apps intended to address the challenges parents with NICU babies may face, and to provide recommendations for further development of apps for this purpose. METHODS: We conducted a review of articles published between November 2012 to November 2022. This search spanned three major databases, PubMed, Embase, and CINAHL, using a controlled vocabulary and keywords for mobile apps and the NICU. These three databases generated 473 articles for review. Utilizing the online primary screening and data extraction tool Covidence, we ultimately included eight articles in this narrative review. KEY CONTENT AND FINDINGS: There are few existing mobile apps intended to ease the transition home for parents of babies in the NICU. There are even fewer apps that have been critically evaluated using acceptable methods and produced with contribution from healthcare practitioners. Among the existing articles on app solutions to benefit education and socioemotional support for parents, many emphasized the importance of including key stakeholders during the app development process and highlighted both qualitative and quantitative measures for assessing relative success of these apps in a clinical setting. CONCLUSIONS: Although the experiences of parents with infants admitted to the NICU have been well-studied, there remain relatively few existing apps to provide educational and socioemotional support to this population. Future studies should focus on an iterative process of app development whereby both parents and providers are closely involved, in combination with critical appraisal of the app to assess for appropriate support and education of caregivers.

Abstract Background The hospitalization of infants in the neonatal intensive care unit (NICU) is an ethically challenging situation. A limited number of studies have extended the concept of moral distress to parents of infants hospitalized in the NICU. This topic requires further investigation. Methods The present prospective qualitative study was conducted from February 2023 to May 2023. Data were collected through semistructured in-depth interviews, which were conducted in-person with fifteen parents of infants who were hospitalized in the NICU at the time of the interviews. Purposive sampling was used. The data were classified and analyzed using thematic analysis. Results Three themes emerged from the data analysis performed for this empirical study. One intrapersonal dimension featuring two aspects (one dynamic and one static) and another interpersonal dimension focusing on parental moral distress emerged from the data analysis. Furthermore, seven subthemes emerged across these themes: (1) self-directed negative feelings were experienced by parents due to their inability to fulfill their caregiving/parental roles; (2) intense internal conflict was experienced by parents in response to a moral dilemma that was difficult, which was perceived as irresolvable; (3) objectively unjustified, self-directed negative feelings of guilt or failure were experienced by parents; (4) parents experienced moral distress due to the poor image of the ill infants; (5) inadequate information may predispose parents to experience moral distress (6) neonatologists’ caring behaviors were unduly perceived by parents as paternalistic behaviors; (7) reasonable or justified institutional rules were unduly perceived by parents as constraint. Conclusions In general, the results of this study support the integrated definition of parental moral distress proposed by Mooney-Doyle and Ulrich. Furthermore, the present study introduces new information. The study distinguishes between the dynamic and static aspects of the intrapersonal dimension of the phenomenon of parental moral distress. Moreover, participants experienced moral distress because they unduly perceived certain situations as causing moral distress. In addition, inadequate information may predispose parents to experience moral distress. The findings of this study may contribute promote family-centered care in the NICU context.

Abstract Background There is a lack of data on the characteristics of overlap between acquired antimicrobial resistance and virulence factors in Klebsiella pneumoniae in high-risk settings, especially with the inclusion of surveillance isolates along with the clinical. We investigated K. pneumoniae isolates, from a neonatal intensive care unit (NICU) in Nepal, for the presence of both accessory virulence factors and acquired antimicrobial resistance. Methods Thirty-eight clinical and nineteen surveillance K. pneumoniae isolates obtained between January 2017 and August 2022 in the NICU of Siddhi Memorial Hospital, Bhaktapur, Nepal were investigated with antimicrobial susceptibility testing, PCR-based detection of β-lactamases and virulence factors, and genetic similarity by ERIC–PCR. Results K. pneumoniae was found positive in 37/85 (43.5%) blood culture-positive neonatal bloodstream infections, 34/954 (3.6%) patient surveillance cultures, and 15/451 (3.3%) environmental surveillance samples. Among 57 isolates analyzed in this study, we detected multidrug resistance in 37/57 (64.9%), which was combined with at least one accessory virulence factor in 21/37 (56.8%). This overlap was mostly among β-lactamase producing isolates with accessory mechanisms of iron acquisition. These isolates displayed heterogenous ERIC–PCR patterns suggesting genetic diversity. Conclusions The clinical significance of this overlap between acquired antimicrobial resistance and accessory virulence genes in K. pneumoniae needs further investigation. Better resource allocation is necessary to strengthen infection prevention and control interventions in resource-limited settings.

Background: The hospitalization of infants in the neonatal intensive care unit (NICU) is an ethically challenging situation. A limited number of studies have extended the concept of moral distress to parents of infants hospitalized in the NICU. This topic requires further investigation. Methods: The present prospective qualitative study was conducted from February 2023 to May 2023. Data were collected through semistructured in-depth interviews, which were conducted in-person with fifteen parents of infants who were hospitalized in the NICU at the time of the interviews. Purposive sampling was used. The data were classified and analyzed using thematic analysis. Results: Three themes emerged from the data analysis performed for this empirical study. One intrapersonal dimension featuring two aspects (one dynamic and one static) and another interpersonal dimension focusing on parental moral distress emerged from the data analysis. Furthermore, seven subthemes emerged across these themes: (1) self-directed negative feelings were experienced by parents due to their inability to fulfill their caregiving/parental roles; (2) intense internal conflict was experienced by parents in response to a moral dilemma that was difficult, which was perceived as irresolvable; (3) objectively unjustified, self-directed negative feelings of guilt or failure were experienced by parents; (4) parents experienced moral distress due to the poor image of the ill infants; (5) inadequate information may predispose parents to experience moral distress (6) neonatologists' caring behaviors were unduly perceived by parents as paternalistic behaviors; (7) reasonable or justified institutional rules were unduly perceived by parents as constraint. Conclusions: In general, the results of this study support the integrated definition of parental moral distress proposed by Mooney-Doyle and Ulrich. Furthermore, the present study introduces new information. The study distinguishes between the dynamic and static aspects of the intrapersonal dimension of the phenomenon of parental moral distress. Moreover, participants experienced moral distress because they unduly perceived certain situations as causing moral distress. In addition, inadequate information may predispose parents to experience moral distress. The findings of this study may contribute promote family-centered care in the NICU context. [ABSTRACT FROM AUTHOR]

Background: Infant neonatal intensive care unit (NICU) hospitalization increases maternal risk for psychological distress. However, no universal screening standards exist and predicting maternal risk remains challenging. Reconceptualizing maternal distress in relation to differences between parenting expectations and NICU experiences may illuminate commonalities across a range of experiences. Purpose: This study explored parenting expectation--experience differences (EEDs) among NICU mothers and assessed correlations between EED scores and psychological outcomes 1 to 5 years post-NICU hospitalization. Methods: A 3-phase explanatory sequential mixed-methods design was used. Pearson's correlation coefficients were used to measure relationships between EED scores and maternal psychological outcomes. Reflexive thematic analysis of one-on-one, semi-structured interviews contextualized EED scores. Results: Most participants (92.9%) reported negative EED scores, indicating NICU experiences fell short of parenting expectations. Significant inverse correlations were found between EED scores and maternal outcomes, including depression (r = -0.25, P < .01), anxiety (r = -0.25, P < .01) and posttraumatic stress disorder symptoms (r = -0.41, P < .001), and perceived parenting self-efficacy (r = -0.28, P < .01). Major qualitative themes included unexpected versus prepared, lost parenting experiences, and surviving and thriving. Data synthesis contextualized EED scores and revealed key differences in meaning ascribed to unmet parenting expectations. Implications for Practice and Research: Preparing mothers for infant NICU hospitalization and creating a NICU parenting environment, which better supports mothers and their engagement in parenting tasks, may help to reduce differences between parenting expectations and NICU experiences. Further research is needed to elucidate the impacts of parenting EEDs in this population. [ABSTRACT FROM AUTHOR]

Traditionally echocardiography was used by pediatric cardiologists to diagnose congenital heart defects in neonates. Formalized neonatal hemodynamic fellowships have been established where neonatologists acquire advanced echocardiographic skills to gain anatomical, physiological, and hemodynamic information in real time and utilize this information in making a timely and accurate physiology-based clinical decision. Differences between a comprehensive formal structural echocardiography, neonatologist performed targeted echocardiography and limited assessment on point-of-care-ultrasonography for specific indications have been covered. This article is focused at providing a comprehensive review of the status of echocardiography in the neonatal units, recent advancements and its future prospects in the neonatal intensive care units. Comprehensive guidelines providing the scope of practice, a framework for training, and robust clinical governance process for the neonatologist performed targeted echocardiography have been established. In the last decade, echocardiography has emerged as essential vital bedside diagnostic tool in providing high-quality care to the sick infants in the neonatal units, and it has proved to improve the outcomes in neonates. It is now being considered as a modern hemodynamic monitoring tool. Advances in technology, machine learning, and application of artificial intelligence in applications of echocardiography seem promising adjunct tools for rapid assessment in emergency situations. [ABSTRACT FROM AUTHOR]

Background: foetal movements are one straightforward indicator of foetal health. The evidence, however, is still insufficient to warrant the inclusion of reduced foetal movements in national recommendations as part of a more comprehensive evaluation. The study objective was to determine perinatal outcome in women presenting with reduced foetal movement at term gestation. Methods: A prospective, observational study was conducted in Hamdard University Hospital Karachi during January 2021 to June 2021, 216 pregnant women with reduced foetal movement at term were recruited from outpatient clinics, wards and labour room triage. Data was collected regarding demographic and clinical features of mothers. Neonatal outcomes were also investigated. Results: Findings of the study revealed that 60.6% women had one episode and 39.4% women had two episodes of reduced foetal movements. 1/4th of the neonates were low birth weight, 1/5th of the babies had Apgar score less than 7 in five minutes, 9.3% neonates had cord around the neck and 1/3rd of the neonates were admitted to the NICU. Chi square test of association revealed that maternal factors such as maternal age, BMI, gravidity were significantly associated with reduced foetal movements. foetal outcomes such as NICU admission and presence of meconium were significantly associated. Conclusion: The present study analyzed that Episodes of RFM were significantly associated with age, BMI, gravidity of mother. RFM episodes was associated with increased risk of cord around neck among neonates of mother with repeated RFM episodes whereas NICU likelihood was higher among neonates of mother with single RFM episode. [ABSTRACT FROM AUTHOR]

Objectives: To determine the utility of NTS as a clinical tool for identification of new-borns in the Postnatal ward requiring medical intervention in the ward and admission to Neonatal Intensive Care Unit (NICU) and to study the outcome of neonates triggered by NTS. Study Design: Prospective observational study Participants: All neonates delivered and admitted in postnatal wards of rural tertiary care Hospital, Kolar during January 2018 to December 2018. Intervention: NTS observation and scoring chart was applied on neonates. Scores were obtained every 2 hours after birth till 12 hours and then every 4hours until 48 hours old. Results: NTS was applied on a total of 1495 neonates who fulfilled the inclusion criteria. 152 neonates triggered the NTS chart of which 21 neonates did not require any medical intervention while 131 required intervention (53 in Postnatal ward& 78 in NICU). The area under the ROC curve for the NTS was 0.997 with NTS score of 2 or more predicting admission to NICU (78.57% sensitivity, 99.80% specificity). A score of 0 was strongly predictive of being well enough to remain in the postnatal ward without intervention (P<0.001) and a score of 1 or more predicted need for intravenous antibiotics (76.92% sensitivity, 100% specificity). Conclusions: Results from this study shows that NTS observation chart acts well as an adjunct to clinical assessment in the postnatal ward, with its simplicity allowing for the successful and safe use by non-specialists. [ABSTRACT FROM AUTHOR]

(1) Background: Missed nursing care, an omission error characterized by delayed or omitted nursing interventions, poses significant risks to patients’ safety and quality of car.; (2) Methods: This is a quantitative cross-sectional study on 151 nurses who work in NICUs in three main networks in the Eastern Health Province, Saudi Arabia: Dammam (n = 84), Qatif (n = 53), and Jubail (n = 14). The study uses a self-reported questionnaire (MISSCARE) and applies the 5-point Likert Scale. Statistical analysis data were analyzed using SPSS version 23.0. (3) Results: The primary reasons for missed care were shortage of nursing staff and unbalanced patient assignments. Missed nursing care negatively affects job satisfaction and was positively correlated with nurses’ intentions to quit their jobs. Inadequate equipment, supplies, and breakdowns in communication between nurses and other healthcare professionals were also significant factors contributing to missed care. (4) Conclusions: Missed nursing care is associated with overwork, nursing shortages, and lower job satisfaction, impacting the quality of care provided in the NICU. Improving working conditions, nurse staffing, and patient assignment planning should be prioritized to address this issue effectively.

ObjectiveThis study aims to assess the comparative effectiveness of a conventional splitting needle or a peelable cannula vs. the modified Seldinger technique (MST) by utilizing a dedicated micro-insertion kit across various clinically significant metrics, including insertion success, complications, and catheter-related infections.MethodsWe conducted a retrospective observational cohort study using an anonymized data set spanning 3 years (2017–2019) in a large tertiary-level neonatal intensive care unit in Qatar.ResultsA total of 1,445 peripherally inserted central catheter (PICC) insertion procedures were included in the analysis, of which 1,285 (89%) were successful. The primary indication for insertion was mainly determined by the planned therapy duration, with the saphenous vein being the most frequently selected blood vessel. The patients exposed to MST were generally younger (7 ± 15 days vs. 11 ± 26 days), but exhibited similar mean weights and gestational ages. Although not statistically significant, the MST demonstrated slightly higher overall and first-attempt insertion success rates compared to conventional methods (91 vs. 88%). However, patients undergoing conventional insertion techniques experienced a greater incidence of catheter-related complications (p

Background: Drug-related problems (DRPs) are widespread in hospitalized neonates, but studies on the prevalence of DRPs in this population are limited. The presence of clinical pharmacists on multidisciplinary teams helps prevent and reduce DRPs.Aim: This investigation aimed to identify and classify the incidence of DRPs in the neonatal intensive care unit (NICU), to determine the determining factors associated with DRPs and to document clinical pharmacists’ interventions, outcomes, acceptance rates and clinical significance.Method: A prospective descriptive hospital study was conducted from August to November 2023 at the NICU of Children’s University Hospital, Assiut University, Egypt. DRPs were classified using the Pharmaceutical Care Network of Europe (PCNE) classification V9.1.Results: Three hundred sixteen neonates were included in the study, with a mean gestational age of 34 ± 4 weeks and a mean birth weight of 2.03 ± 0.85 kg. A total of 1723 DRPs occurred among 283 neonates (89.6%), an average of 5.5 ± 5.1 DRPs per patient. The main types were treatment effectiveness (P1) (799, 46.4%), followed by others (P3) (469, 27.2%), and treatment safety (P2) (455, 26.4%). The leading causes were dose selection (C3) (1264, 61.9%) and “other domain” (C9) (543, 26.6%). Of the 2149 interventions introduced by pharmacists, 98.8% were accepted and 93% were accepted, and fully implemented. As a result, 92% of the DRPs were resolved. Both length of hospital stay and number of medications were significantly associated with DRPs.Conclusion: DRPs are common in the NICU; this study demonstrated the crucial role of clinical pharmacists in identifying and resolving DRPs.

This dataset offers an insight into the neurodevelopmental trajectories of preterm infants, encapsulating a wide array of neonatal and maternal factors. The data variables include demographic details alongside a detailed account of maternal health during pregnancy, encompassing aspects and other complications. Furthermore, the dataset documents neonatal health conditions. It also records critical indicators of neonatal health. The dataset is enriched with data on medical interventions and hospitalization details. It also contains information on the mother's drug usage during pregnancy and sonography results. A significant portion of the dataset is dedicated to the developmental assessment of the infants, utilizing the Bayley Scales to evaluate various domains such as cognitive, language, perceptual, fine motor, and coarse motor skills. The data are categorized to denote normal and abnormal outcomes in these domains, providing a detailed view of the developmental progress of the infants.The reuse potential of this dataset is substantial, serving as a rich resource for researchers and clinicians aiming to delve deeper into the multifaceted influences on preterm infant development. It can significantly contribute to the formulation of early intervention strategies, fostering a better understanding and enhancement of developmental outcomes in preterm infants.

Intraabdominal cystic lesions diagnosed during antenatal period are uncommon. They are found to have varying origins, with renal tract being the most common site. Rarely, a large unilateral cystic lesion of renal origin is caused by Pelviureteric junction obstruction, crossing the midline, leading to compression of the contralateral kidney. We present a case of a neonate who was diagnosed with a large abdominal cyst in the antenatal period. The cyst persisted and crossed the midline causing hydronephrosis on the contralateral side. This is an unusual presentation of a commonly occurring condition, usually such large cyst at birth origins from alimentary tract rather renal system. It is important to understand unusual presentations of intraabdominal lesions and the associated pathology. It is mandatory to rule out renal obstruction, if there is any decompression of renal function, it is mandatory to save renal function till the time of definitive surgery. [ABSTRACT FROM AUTHOR]

(1) Background: Missed nursing care, an omission error characterized by delayed or omitted nursing interventions, poses significant risks to patients' safety and quality of car.; (2) Methods: This is a quantitative cross-sectional study on 151 nurses who work in NICUs in three main networks in the Eastern Health Province, Saudi Arabia: Dammam (n = 84), Qatif (n = 53), and Jubail (n = 14). The study uses a self-reported questionnaire (MISSCARE) and applies the 5-point Likert Scale. Statistical analysis data were analyzed using SPSS version 23.0. (3) Results: The primary reasons for missed care were shortage of nursing staff and unbalanced patient assignments. Missed nursing care negatively affects job satisfaction and was positively correlated with nurses' intentions to quit their jobs. Inadequate equipment, supplies, and breakdowns in communication between nurses and other healthcare professionals were also significant factors contributing to missed care. (4) Conclusions: Missed nursing care is associated with overwork, nursing shortages, and lower job satisfaction, impacting the quality of care provided in the NICU. Improving working conditions, nurse staffing, and patient assignment planning should be prioritized to address this issue effectively. [ABSTRACT FROM AUTHOR]

Background/Objectives: Rapid genome-wide sequencing (rGWS) continues to transform the care provided to infants with genetic conditions in neonatal intensive care units (NICUs). Previous research has demonstrated that rGWS has immense benefits on patient care; however, little is known about non-genetic healthcare providers’ (HCPs) experiences and perspectives of working with rGWS and supporting families through the rGWS testing process in Canadian NICU facilities. To address this gap, we surveyed and conducted semi-structured interviews with non-genetic HCPs of diverse professions from NICUs in British Columbia. Methods: An interpretive description approach was used to analyze interview transcripts to identify patterns and variations in non-genetic HCPs’ experiences and perceptions with rGWS. Results: Participants had varying degrees of exposure to rGWS and levels of comfort with the testing process. Numerous barriers affecting the implementation of rGWS were identified, including low levels of comprehension of rGWS, longer turn-around times than expected, and having to apply for provincial government approval to access testing. Participants desired more education on rGWS, clear guidelines on the use of rGWS in NICUs, and resources for non-genetic HCPs and parents to support implementation. Conclusions: The results from this study can inform the development of workflows and educational resources on the use of rGWS in NICUs, helping to ensure that the NICU team is supported to optimize rGWS implementation.

Background & Objective: The maintenance of an appropriate weight before and during pregnancy has a significant effect on pregnancy outcomes. Therefore, this study attempts to explore the relationship between pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in the Indian antenatal population. This was a prospective study. Materials & Methods: This study was conducted on a total of 301 pregnant women who fulfilled the inclusion criteria booked from the first trimester till delivery in the department of Obstetrics and Gynecology, SGRRIM & HS, from January 2020 to June 2021. The weight and height of the participants were recorded at their first visit to the antenatal clinic using standard protocol. BMI was recorded and GWG was calculated at each antenatal clinic visit. BMI and GWG were correlated with antepartum, intrapartum and postpartum complications with the application of appropriate statistical tests. Results: In our study, higher pre-pregnancy BMI and GWG significantly increased the risk of perinatal adverse outcomes. Increased rates of cesarean section (57.1%), operative vaginal delivery (9.5%), gestational diabetes mellitus (9.5%), and preeclampsia (28.6%) were observed in obese women as compared to women with normal pre-pregnancy BMI and gestational weight gain. These were found to be statistically significant (p-value <0.001). Conclusion: Appropriate nutrition prior to and throughout the pregnancy plays an important role in determining the health of both mother and fetus. There is a positive correlation between early pregnancy BMI and GWG, and the course of pregnancy, and its outcome. [ABSTRACT FROM AUTHOR]

Purpose: The appropriate use of color in healthcare settings has been a topic of interest for designers and researchers, and the need for evidence-based standards evident. The purpose of this article is to summarize recent research on color as applicable to neonatal intensive care units and to propose standards for color in these settings. Background: Research on this topic is limited due to difficulties associated with constructing research protocols, challenges in setting parameters for the independent variable (color), and the need to simultaneously address infants, families, and caregivers. Methods: For our literature review, the following research question was developed: Does the use of color in the design of the neonatal intensive care units (NICUs) impact health outcomes in newborn infants, families, and/or staff? Using Arksey and O'Malley's framework for conducting a structured literature review, we (1) identified the research question, (2) identified relevant studies, (3) selected studies, and (4) collated and summarized the results. Only four papers were found regarding NICUs, so the search was expanded to include related healthcare and authors reporting on best practice. Results: Overall, the primary research focused on behavioral or physiological outcomes including the role of wayfinding and art, the impact of lighting on color, and tools for evaluating the impact of color. Best practice recommendations sometimes reflected the primary research but occasionally provided contradictory advice. Conclusions: Based on the reviewed literature, five topics are addressed: palette malleability; the use of the primary colors, blue, red, and yellow; and the relationship between light and color. [ABSTRACT FROM AUTHOR]

Background: Lactation support is an important measure of Family-Centered Care (FCC) in the Neonatal Intensive Care Unit (NICU). Life-limiting conditions (LLCs) raise complex ethical care issues for providers and parents in the NICU and represent a key and often overlooked population for whom FCC is particularly important. We investigated healthcare disparities in FCC lactation support quality in infants with LLCs. Methods: A retrospective cohort of inborn infants with or without LLCs admitted to the NICU between 2015–2023 included 395 infants with 219 LLC infants and 176 matched non-LLC infants and were compared on LLC supports. Results: The LLC cohort experienced greater skin-to-skin support, but less lactation specialist visits, breast pumps provided, and human milk oral care use. LLC infants also experienced less maternal visitation, use of donor milk (LLC: 15.5%, non-LLC: 33.5%), and breastfeeds (LLC: 24.2%, non-LLC: 43.2%), with lower mean human milk provision (LLC: 36.6%, non-LLC: 67.1%). LLC infants who survived to discharge had similar human milk use as non-LLC infants (LLC: 49.8%, non-LLC: 50.6%). Conclusion: Lactation support was significantly absent for families and infants who presented with LLCs in the NICU, suggesting that policies can be altered to increase lactation support FCC quality for this population. [ABSTRACT FROM AUTHOR]

Abstract Background Neonatal intensive care unit (NICU) admission among term neonates is a rare event. The aim of this study was to study the association of the NICU admission of term neonates on the risk of long-term childhood mortality. Methods A single-center case–control retrospective study between 2005 and 2019, including all in-hospital ≥ 37 weeks’ gestation singleton live-born neonates. The center perinatal database was linked with the birth and death certificate registries of the Israeli Ministry of Internal Affairs. The primary aim of the study was to study the association between NICU admission and childhood mortality throughout a 15-year follow-up period. Results During the study period, 206,509 births were registered; 192,527 (93.22%) term neonates were included in the study; 5292 (2.75%) were admitted to NICU. Throughout the follow-up period, the mortality risk for term neonates admitted to the NICU remained elevated; hazard ratio (HR), 19.72 [14.66, 26.53], (p

Background: The neonatal intensive care unit (NICU) stay following the birth of a preterm infant can be stressful and traumatic for families. During the COVID-19 pandemic, the NICU environment changed precipitously as infection control and visitor restriction measures were implemented. Purpose: Our study aimed to examine the impact of the pandemic policies on the experiences of mothers of preterm infants during their stay in the NICU. Methods: Semistructured interviews were conducted with mothers of preterm infants hospitalized in a Canadian tertiary-level NICU. Informed by interpretive description methodology, interview content was transcribed and analyzed using a thematic analysis approach. The identified themes were validated, clarified, or refined using investigator triangulation. Results: Nine English-speaking mothers, aged 28 to 40 years, were interviewed. Four themes emerged from the analysis of their experiences: (1) disrupted family dynamic, support, and bonding; (2) physical and emotional isolation; (3) negative psychological impact compounded by added concerns, maternal role change, and survival mode mentality; and (4) positive aspects of the pandemic management measures. Implications for Practice: During the pandemic, the way that care was provided in the NICU changed. This study helps to explore how neonatal clinicians can foster individual and organizational resilience to keep patients and families at the center of care, even when the healthcare system is under intense stress. Implications for Research: : Our results show that these changes heightened mothers' distress, but also had a modest positive impact. Further research about long-term consequences of pandemic policies on the mother and preterm infant after NICU discharge is warranted. [ABSTRACT FROM AUTHOR]

There is an increased awareness of how the quality of the acoustic environment impacts the lives of human beings. Several studies have shown that sound pollution has adverse effects on many populations, from infants to adults, in different environments and workplaces. Hospitals are susceptible environments that require special attention since sound can aggravate patients' health issues and negatively impact the performance of healthcare professionals. This paper focuses on Neonatal Intensive Care Units (NICU) as an especially sensitive case representing a hostile acoustic environment in which healthcare professionals have little awareness of how unwanted sounds impact the perceived quality of the soundscape. We performed a semi-systematic review of scientific literature on sound assessment studies in NICU from 2001. A thematic analysis was performed to identify emerging themes that informed the analysis of 27 technological solutions for the assessment of sound quality in indoor and outdoor environments. Solutions were categorized by functions and evaluation methods and grouped according to the characteristics of the design components, i.e., acquisition, computation, and communication strategies. Results highlight a lack of solutions to assess the qualitative characteristics of indoor environments such as NICU and forecast the footprint that different sound sources have on the indoor soundscape. Such solutions are urgently needed to empower healthcare professionals, and especially nurses, to actively modify and prevent the negative impact of unwanted sounds on NICU and critical care soundscape.

Introduction: Perinatal hypoxia is one of the leading causes of perinatal mortality in developing countries. Birth asphyxia is an important cause of static developmental and neurological handicap both in term and preterm infants (in 3 to 13% of infants with cerebral palsy (CP) have evidence of intrapartum asphyxia). Though there are more and more studies and understanding of the mechanisms leading to birth asphyxia, early determination of tissue damages due to birth asphyxia are still lacking. Methods: This is a Hospital based Case Control study carried out in -Neonatal ICU, DEPARTMENT OF PEDIATRICS, Surat Municipal Institute of Medical Education and Research, Surat City. Study was conducted for period of 12 months and data analysis was conducted over the period of 12 months. Sample size was 56 patients of birth asphyxia admitted in NICU and compared against 56 controls admitted in NICU for some other disease. Results: In this study, Mean UA/Cr ratio among cases was 2.58±1.15 as compared to control group where the ratio was 0.71±0.21. This difference was statistically significant. (p<0.00001). Conclusion: Mean UA/Cr ratio among asphyxiated newborns was high and statistically significant and hence the ratio can be used as early, cost effective, simple, quick and noninvasive parameter, a supportive tool to the diagnosis of birth asphyxia using Apgar score. [ABSTRACT FROM AUTHOR]

Purpose: Understand how the interior design of single-family rooms (SFRs) in neonatal intensive care units (NICUs) can support family engagement behaviors. Background: Family members are integral contributors to infant care in NICUs, impacting infant development. While at the NICU, parents are encouraged to participate in a process called family engagement, where they are expected to move from passive to active caregivers, in preparation for their role after discharge. While family engagement is affected by the built environment, no studies have investigated this relationship in any depth. NICU settings morphed to involve families through the SFR design model, but the interior environment of SFRs have not been sufficiently explored as a resource to support specific family engagement behaviors. Methods: We interviewed family and staff and observed family engagement behaviors in SFRs at two NICUs. Behaviors were observed and described in terms of their location, number of people, and design elements involved. Built environment characteristics were collected through physical assessments, and interviews elicited participants' perceptions about design factors impacting family behaviors inside SFRs. Data analysis followed grounded theory segments and pattern matching. Results: Three behavioral patterns and five themes were identified showing how SFRs' private bathrooms, family storage, family zone partitions, positive distractions, and information boards can support families' home-like, educational, collaborative, and infant care behaviors. Conclusions: The interior design of SFRs can be a resource to family engagement in the NICU. Future research should operationalize SFR features found in our study to measure and validate their impact on family engagement outcomes. [ABSTRACT FROM AUTHOR]

To examine the relationship between NICU stress exposure and the neurodevelopmental outcomes of preterm infants. A multicenter, prospective cohort study was conducted between May 2021 and June 2022. Preterm infant participants (28–34 weeks gestational age) were recruited at birth from three NICUs of three tertiary hospitals by convenience sampling. The NICU stress includes acute NICU stress and chronic NICU stress which were measured over the total NICU hospitalization for each infant using the Neonatal Infant Stressor Scale (NISS). Neurodevelopmental outcomes of preterm infants were assessed at 3 months corrected age (CA) using the Ages and Stages Questionnaire, Third Edition (ASQ-3). Of one hundred and thirty preterm infant participants, 108 preterm infants were included into analysis. Results showed that acute NICU stress exposure significantly predicted the neurodevelopmental abnormalities in communication function (RR : 1.001, 95% CI : 1.000–1.001, p =.011), while chronic NICU stress exposure was significantly associated with the problem-solving function (RR : 1.003, 95% CI : 1.001–1.005, p =.002) at 3 months CA. No significant associations were found between NICU stress exposure and other dimensions of neurodevelopmental outcomes, including gross motor, fine motor, and personal-social functions. NICU stress exposure demonstrated a significant predicting relationship with abnormalities in communication and problem-solving functions of preterm infants at 3 months CA. During the NICU hospitalization, neonatal health caregivers should systematically monitor the NICU stress exposure to prevent neurodevelopmental problems in preterm infants. • The incidence of neurodevelopmental abnormalities in preterm infants remains high. • NICU stress exposure was associated with neurodevelopmental abnormalities in communication and problem-solving functions. • Systematic monitoring of NICU stress exposure is needed for preterm infants to prevent neurodevelopmental problems. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is the most common complication of extreme prematurity. Its etiology is multifactorial and is attributed to genetic susceptibility to prenatal and postnatal factors. As advancements in neonatology have led to the increased survival of premature infants, a parallel increase in the incidence of BPD has occurred. Over time, the definition and diagnostic criteria for BPD have evolved, as have management strategies. However, challenges continue to exist in the management of these infants, which is not surprising given the complexity of the disease. We summarize the key diagnostic criteria and provide insight into the challenges related to various aspects of BPD definitions, data comparisons, and clinical care implementation. [ABSTRACT FROM AUTHOR]

Background: Necrotizing enterocolitis (NEC) is one of the most challenging diseases in neonates. Prematurity alone is believed to be a major risk factor for NEC. Feeding intolerance can be the first clinical presentation of NEC, it can progress rapidly into fulminating disease. Therefore, identification of new strategies for prevention of NEC is needed. Objective: The aim of this study was to evaluate the preventive effect of enteral N-acetylcysteine (NAC) on the development of necrotizing enterocolitis (NEC) in preterm neonates with feeding intolerance. Patient and Methods: The study was a double blinded randomized controlled trial that was conducted on preterm neonates with feeding intolerance at Neonatal intensive care unit (NICU) department, Ain Shams University. Hundred and eight preterm neonates with feeding intolerance were randomly divided into two groups, intervention group and control group. The intervention group received enteral NAC by a dose (20mg/kg/6h) while the control group received placebo distilled water (1cc/6h) for either 10 days or when all signs and symptoms of feeding intolerance resolve, whichever comes first. Both groups were monitored clinically for improvement or progression to NEC. Results: Our findings showed that there was a significant decrease in the incidence of NEC in the intervention group, who received enteral NAC, in comparison to the control group (n = 8 vs n = 26), with p value (<0.01). As well as significant reduction in the time needed to reach half, two-third and full enteral feeding, in the intervention group in comparison to the control group. Conclusion: Enteral administration of N-acetylcysteine might reduce the incidence of NEC in preterm neonates with feeding intolerance. [ABSTRACT FROM AUTHOR]

Neonatal vascular access continues to pose challenges. Recent times have seen considerable innovations in practice and the design and manufacture of materials used to provide infusion-based therapies with the intent of reducing the incidence and severity of vascular access-related complications. However, despite these efforts, vascular access-related complication rates remain high in this patient group and research evidence remains incomplete. In neonates, a medical-grade formulation of cyanoacrylate adhesive is widely used to secure percutaneously inserted central venous catheters and is beginning to establish a role in supporting the effective securement of other devices, such as umbilical and peripheral intravenous catheters. This Perspective article considers issues specific to the removal of cyanoacrylate used to secure vascular access devices from neonatal skin before its bonding releases due to natural skin exfoliation processes. The aim of this information is to ensure the safe and effective removal of octyl-cyanoacrylate adhesive-secured vascular access catheters from neonatal skin and stimulate professional discussion.

In the last decades, the advancement of knowledge in analgesia and sedation for critically ill pediatric patients has been conspicuous and relevant. Many recommendations have changed to ensure patients' comfort during their intensive care unit (ICU) stay and prevent and treat sedation-related complications, as well as improve functional recovery and clinical outcomes. The key aspects of the analgosedation management in pediatrics have been recently reviewed in two consensus-based documents. However, there remains a lot to be researched and understood. With this narrative review and authors' point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field. Conclusion: With this narrative review and authors' point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field. What is Known: • Critically ill pediatric patients receiving intensive care required analgesia and sedation to attenuate painful and stressful stimuli. •Optimal management of analgosedation is a challenge often burdened with complications such as tolerance, iatrogenic withdrawal syndrome, delirium, and possible adverse outcomes. What is New: •The new insights on the analgosedation treatment for critically ill pediatric patients delineated in the recent guidelines are summarized to identify strategies for changes in clinical practice. •Research gaps and potential for quality improvement projects are also highlighted. [ABSTRACT FROM AUTHOR]

In any healthcare setting, it is important to monitor and control airflow and ventilation with a thermostat. Computational fluid dynamics (CFD) simulations can be carried out to investigate the airflow and heat transfer taking place inside a neonatal intensive care unit (NICU). In this present study, the NICU is modeled based on the realistic dimensions of a single-patient room in compliance with the appropriate square footage allocated per incubator. The physics of flow in NICU is predicted based on the Navier–Stokes conservation equations for an incompressible flow, according to suitable thermophysical characteristics of the climate. The results show sensible flow structures and heat transfer as expected from any indoor climate with this configuration. Furthermore, machine learning (ML) in an artificial intelligence (AI) model has been adopted to take the important geometric parameter values as input from our CFD settings. The model provides accurate predictions of the thermal performance (i.e., temperature evaluation) associated with that design in real time. Besides the geometric parameters, there are three thermophysical variables of interest: the mass flow rate (i.e., inlet velocity), the heat flux of the radiator (i.e., heat source), and the temperature gradient caused by the convection. These thermophysical variables have significantly recovered the physics of convective flows and enhanced the heat transfer throughout the incubator. Importantly, the AI model is not only trained to improve the turbulence modeling but also to capture the large temperature gradient occurring between the infant and surrounding air. These physics-informed (Pi) computing insights make the AI model more general by reproducing the flow of fluid and heat transfer with high levels of numerical accuracy. It can be concluded that AI can aid in dealing with large datasets such as those produced in NICU, and in turn, ML can identify patterns in data and help with the sensor readings in health care. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic may have had an impact on healthcare-associated infection (HAI) rates. In this study, we analyzed the occurrence of HAIs in a neonatal intensive care unit (NICU) of the Umberto I teaching hospital in Rome before and during the pandemic. All infants admitted from 1 March 2018 to 28 February 2022 were included and were divided into four groups according to their admission date: two groups before the pandemic (periods I and II) and two during the pandemic (periods III and IV). The association between risk factors and time-to-first event was analyzed using a multivariable Cox regression model. Over the four-year period, a total of 503 infants were included, and 36 infections were recorded. After adjusting for mechanical ventilation, birth weight, sex, type of delivery, respiratory distress syndrome, and previous use of netilmicin and fluconazole, the multivariable analysis confirmed that being hospitalized during the pandemic periods (III and IV) was the main risk factor for HAI acquisition. Furthermore, a change in the etiology of these infections was observed across the study periods. Together, these findings suggest that patient management during the pandemic was suboptimal and that HAI surveillance protocols should be implemented in the NICU setting promptly. [ABSTRACT FROM AUTHOR]

Background: Preterm infants have known impairments in language development relative to infants born at full term, and the language-poor environment of the neonatal intensive care unit (NICU) is a contributing factor. Adapting outpatient literacy programs for the NICU is a potential evidence-based intervention to encourage adult speech exposure to infants through reading sessions during NICU hospitalization.Purpose: To evaluate implementation of a 10-day NICU Read-a-Thon and potential barriers and facilitators of a year-round program aimed at increasing reading sessions for NICU patients.Methods: We established an implementation team to execute a Read-a-Thon and evaluated its impact utilizing quantitative and qualitative approaches. Quantitative methodology was used to report number of donated books and infant reading sessions. Qualitative methodology inclusive of interviews, surveys, and source document reviews was used to evaluate the Read-a-Thon.Results: We received approximately 1300 donated books and logged 663 reading sessions over the 10-day Read-a-Thon. Qualitative evaluation of the Read-a-Thon identified 6 main themes: motivation, emotional response to the program, benefits and outcomes, barriers, facilitators, and future of literacy promotion in our NICU. Our evaluation informed specific aims for improvement (eg, maintaining book accessibility) for a quality improvement initiative to sustain a year-round reading program.Implications For Practice and Research: Neonatal units can leverage Read-a-Thons as small tests of change to evaluate barriers, facilitators, and change processes needed to implement reading programs. Process maps of book inventory and conducting a 5 W's, 2 H's (who, what, when, where, why, how, how much) assessment can aid in program planning. [ABSTRACT FROM AUTHOR]