Karen D. Hendricks-Muñoz

A neonatal nurse training program in kangaroo mother care (KMC) decreases barriers to KMC utilization in the NICU.

OBJECTIVEnThis study assessed the impact of a nurse simulation training program on perception of kangaroo mother care (KMC) value and transfer skill competency.nnnSTUDY DESIGNnAn 8-item Likert scale skill survey tool and a 24-item Likert developmental care survey tool were used in a prospective cohort study to analyze perceptions of 30 neonatal nurses who underwent a comprehensive KMC simulation-based training program. Competency skills were evaluated pretraining and tracked by direct observation for 6 months posttraining. Pre- and postsurvey data were analyzed and KMC utilization for preterm infants born atu2009≤u200934 weeks gestation was determined.nnnRESULTSnNurses competency in infant transfer improved, especially in infants receiving nasal continuous positive airway pressure or ventilator support, from 30 to 93% or 10 to 50%, respectively, pu2009<u20090.0001. Neonatal nurses perceived KMC value increased from 50 to 100%, pu2009<u20090.001, and parent KMC utilization increased from 26.5 to 85.9%, pu2009<u20090.0001. Nurses support for parental visitation improved from 38 to 73%, pu2009<u20090.001; discussion of KMC with parents on the 1st day increased from 5 to 45%, pu2009<u20090.001; and initial day of KMC provision improved from 18.0u2009±u20092.7 to 5.6u2009±u20091.2 days, pu2009<u20090.001.nnnCONCLUSIONSnA comprehensive simulation-based KMC education program improved nurses perception of KMC value, their competency and comfort in infant transfer for KMC care, and successfully promoted KMC parent utilization for the preterm infant in the neonatal intensive care unit.

Incidence and Etiology of Late Preterm Admissions to the Neonatal Intensive Care Unit and Its Associated Respiratory Morbidities When Compared to Term Infants

OBJECTIVEnTo determine etiology of neonatal intensive care unit (NICU) admission and acute morbidities in late preterm (LPT) neonates.nnnMETHODSnNeonates admitted at New York University Langone Medical Centers NICU were grouped as follows: period 1: all LPT neonates with gestational age between 34(0)/(7) and 36(6)/(7) weeks and born between January 2006 and June 2007; period 2: all term neonates born between January 2007 and June 2008. Neonatal and maternal data were collected from both the groups and compared.nnnRESULTSnThirty-three percent of LPT births were admitted to the NICU, compared with 7% of term births (p < 0.05). LPT neonates had an increased incidence of low birth weight, hypoglycemia, hypothermia, and hyperbilirubinemia as an admission diagnosis (p < 0.001). The overall incidence of respiratory distress syndrome (RDS) was 9%, 4%, 3%, 0.7%, 0.2% and 0% in 34-week, 35-week, 36-week, 37-week, 38- to 39-week, and 40-week gestational age neonates (p < 0. 001).There was an increased incidence of RDS and persistent pulmonary hypertension, along with an increased need for surfactant replacement therapy, continuous positive airway pressure, and ventilator support in the LPT group when compared with the term neonates (p < 0.001).nnnCONCLUSIONSnLPT neonates are at increased risk for hypothermia, hypoglycemia, hyperbilirubinemia, and respiratory morbidity requiring increased respiratory support when compared with term neonates.

Skin-to-Skin Care and the Development of the Preterm Infant Oral Microbiome

OBJECTIVEnThe oral cavity represents an initial entry way for oral and gut indigenous colonization. Skin-to-skin (STS) care, in which the mother holds the diaper clad naked preterm (PT) infant between her breasts, is associated with improved digestive function, decreased stress, and improved survival. This study evaluated the development of oral microbial colonization repertoires and health characteristics in PT infants with or without STS exposure.nnnMETHODSnSaliva from 42 PT infants (<32 weeks of gestation at birth) was collected prospectively at 1u2009month and/or at discharge. High-throughput 16S rRNA sequencing identified microbial diversity and prevalence of bacterial signatures correlated with clinical STS or non-STS care.nnnRESULTSnCorrected for gestational age (CGA) at sampling, bacterial taxa demonstrated increased Streptococcus as a signature of oral repertoire maturation. STS was associated with increased Streptococcus (pu2009<u20090.024), while non-STS was associated with greater Corynebacterium (pu2009<u20090.023) and Pseudomonas (pu2009<u20090.019) in infantsu2009≤u200932 weeks CGA. In infantsu2009>u200932 weeks CGA, Neisseria and Acinetobacter were more prevalent, 50 vs. 16.7% and 40 vs. 0%, respectively. STS care was associated with shorter hospitalization (pu2009<u20090.039).nnnCONCLUSIONnSTS care during earlier gestation was associated with a distinct microbial pattern and an accelerated pace of oral microbial repertoire maturity.

Early Detection Tool of Intestinal Dysfunction: Impact on Necrotizing Enterocolitis Severity

OBJECTIVEnThe aim of this study is to determine the use of an early clinical signs and symptoms warning tool in early identification of intestinal dysfunction as a clinical strategy to decrease necrotizing enterocolitis (NEC) severity.nnnDESIGNnUsing signs and symptoms of 297 infants, of which 33 infants were diagnosed with stage II and III EC intestinal dysfunction, a five clinical category scoring tool (Neonatal Necrotizing Enterocolitis Early Detection Score [NeoNEEDS]) and strategy with abdominal X-ray alert was developed. The categories included behavior, cardiac, respiratory, gastrointestinal, and feeding tolerance. The strategy was tested in a prospective cohort of 72 infantsu2009<u20091,500u2009g, utilizing 532 observations between 10/2012 and 9/1/2013. The statistical analysis utilized the Statistical Analysis Software (SAS).nnnRESULTSnThe earliest signs and symptoms of intestinal dysfunction (Stage I NEC) were cardiorespiratory baseline changes, pu2009<u20090.001. Abdominal distension and/or feeding intolerance were late findings associated with stage II or III NEC. Tool scoresu2009≥u20095 predicted intestinal dysfunction (pu2009<u20090.00). Sensitivity was high (95%) with specificity of 82% and positive and negative predictive values of 76% and 95%, respectively. Use of the tool during the study period was associated with decreased NEC severity rates (Bell NEC stage II and III).nnnCONCLUSIONnCardiorespiratory symptoms precede gastrointestinal symptoms of intestinal dysfunction. Targeting signs and symptoms in an early warning tool to identify intestinal dysfunction can impact NEC severity progression.

Cerebral, renal, and splanchnic tissue oxygen saturation values in healthy term newborns.

OBJECTIVEnTo determine cerebral regional tissue oxygen saturation (CrSO2), renal regional tissue oxygen saturation (RrSO2), and splanchnic regional tissue oxygen saturation (SrSO2) values in healthy term infants.nnnSTUDY DESIGNnNear-infrared spectroscopy was used to simultaneously measure CrSO2, RrSO2, and SrSO2 continuously for a 1-hour period on the first and second days of life.nnnRESULTSnu2003A total of 41 subjects were monitored out of which complete data were available for 38 subjects. Mean CrSO2 was 78.2 u2009±u20097.9% on first day; 78.3u2009±u20096.1% on second day (pu2009=u20090.95). Mean RrSO2 was 92.1u2009±u20095.3% on first day; 88.9u2009±u20095.9% on second day (pu2009<u20090.01). Mean SrSO2 was 69.9u2009±u200912.1% on first day and 75.3u2009±u200912.4% on second day (pu2009=u20090.02).nnnCONCLUSIONnThere appears to be consistency in rSO2 values in healthy newborns. CrSO2 was similar on both days. Differences observed in RrSO2 and SrSO2 between days may represent a shift in somatic blood flow distribution taking place during the first day of life.

Biomarkers for neonatal sepsis: recent developments

As a leading cause of neonatal morbidity and mortality, neonatal sepsis remains a significant global health challenge. Despite recent advances in the management of neonatal sepsis, including use of more potent antibiotics, timely identification continues to be a frequent and challenging problem in the management of the newborn or high-risk neonate in the neonatal intensive care unit. Lack of specific early objective diagnostic evaluations or specific signs and symptoms, especially in the preterm infant, impedes early identification. However, emerging technologies linked with enhanced understanding of the immature and developing neonatal immune system responses to early infection provide an opportunity to develop critically needed biomarkers to improve early identification in this high-risk population. This review will focus on the field of neonatal sepsis biomarker development, identifying current promising biomarkers that have been investigated and widely utilized, as well as provide insight into recent advances and the rapidly evolving technologies that are being exploited in biomarker development to improve diagnosis, treatment, and prognosis in neonatal sepsis.

Splanchnic-cerebral oxygenation ratio (SCOR) values in healthy term infants as measured by near-infrared spectroscopy (NIRS)

PurposeThe splanchnic-cerebral oxygenation ratio (SCOR) is a measurement comparing regional tissue oxygen saturation of splanchnic organs and brain tissue. SCOR has been previously proposed as a marker of clinical conditions associated with gut ischemia. Our goal was to determine SCOR values in healthy neonates in their first and second days of life.MethodsProspective observational study measuring SCOR in term neonates in the nursery using near-infrared spectroscopy (NIRS).ResultsForty-five subjects with a mean gestational age of 39.4xa0±xa01.3xa0weeks were included. Mean SCOR on the first day was 0.90xa0±xa00.16 and 0.97xa0±xa00.16 on the second day, pxa0=xa00.02 (nxa0=xa045). No correlation was found between SCOR and gestational age; however, we did find a positive correlation between hour of life and SCOR values (rxa0=xa00.28, r2xa0=xa00.08, pxa0<xa00.01, two tails); SCOR appears to stabilize by 36xa0h.ConclusionsOur findings demonstrate SCOR values in healthy neonates consistent with those previously theorized and help to validate it as a diagnostic measure. In addition, we have demonstrated that SCOR values may normally be lower in infants during their first days of life, and this information may be helpful to clinicians using NIRS as a diagnostic tool.

Supporting Play Exploration and Early Development Intervention From NICU to Home: A Feasibility Study.

Purpose: To determine the feasibility of completing a clinical trial of Supporting Play Exploration and Early Development Intervention (SPEEDI) that blends early and intense intervention with family support during the transition from the neonatal intensive care unit (NICU) to home and the community. Methods: Ten infants born preterm were randomly assigned to intervention or usual care groups. Data on intervention frequency and parent feedback were used to determine the feasibility of SPEEDI. Effect sizes were calculated for motor and problem-solving outcome measures at the end of the intervention, 3 months adjusted age. Results: Infants received on average 96.4% and 100.3% of anticipated NICU and home intervention. Only 28% of infants were receiving early intervention services during the SPEEDI period. Effect sizes were large and in the anticipated direction. Conclusions: SPEEDI is a feasible intervention and appropriate for future clinical trials. Video Abstract: For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A83.

Parental influence on clinical management during neonatal intensive care: a survey of US neonatologists

Abstract Objective: Family-centered care (FCC), which includes involving parents in conversations about medical management, is increasingly employed in the neonatal intensive care unit (NICU). Our aim was to determine which care decisions are discussed by neonatologists with families most frequently and the percentage of clinicians influenced by such conversations. Methods: Anonymous web-based survey provided to 2137 neonatologists assessing information sharing and parental involvement. Results: Thousand and two neonatologists responded in which 893 fully completed the surveys. 88% practice FCC. Topics most frequently discussed with parents were blood transfusion, steroids for lung disease and patent ductus arteriosus (PDA) surgery, each being reported and discussed by more than 90% of respondents. Many therapies, including aminoglycoisdes, total parenteral nutrition, and phototherapy, were discussed with parents by far fewer clinicians. Additionally, parents had most influence on clinicians in two categories, blood transfusion and steroids, with more than 70% reporting that their practice was influenced by parental opinion if communicated. For some topics, such as PDA surgery and central line placement, conversations impacted few clinicians. Conclusions: FCC appears to have an impact on NICU clinical decision-making processes, some more than others. Further investigation in this area may provide information on how to best communicate with families and run effective, efficient FCC rounds.

Maternal antenatal treatments influence initial oral microbial acquisition in preterm infants.

OBJECTIVEnThe purpose of this study was to analyze the association of maternal antenatal therapy on initial preterm infant oral microbial acquisition of gut metabolically important bacteria: Firmicutes, Bacteroidetes, Lactobacillus, Bifidobacterium, and Bacteroides species.nnnSTUDY DESIGNnInfant oral samples were collected prefeeding at 24 hours and analyzed using group-specific primers by real-time 16S rRNA quantitative polymerase chain reaction with analysis of variance and logistic regression to evaluate effect of antenatal exposure.nnnRESULTSnSixty-five infants < 34 weeks gestational age (GA) were evaluated; mean GA was 28.6 ± 2.6 (standard deviation) weeks. Infants unexposed to antenatal treatment (n = 5) acquired < 1% Firmicutes, which was composed of 100% Lactobacillus species with no detectable Bifidobacterium, Bacteroidetes, or Bacteroides species. Infants exposed to antibiotics (n = 7), acquired fivefold less total bacterial density (TBD) with 45% Firmicutes 1.3% Lactobacillus species, 23.5% Bacteroidetes and rare Bacteroides. Compared with unexposed infants, steroids (n = 26) or steroid and antibiotics (n = 27) exposure led to an eightfold increase in TBD with < 1% Lactobacillus species and Bacteroides species 100% and 30%, respectively (p < 0.04). Bifidobacterium was undetectable in all groups.nnnCONCLUSIONnPreterm infant exposure to routine maternal antenatal treatments influence early oral microbial acquisition during the primary hours related to establishment of gut commensal bacteria.