Neonatal Intensive Care Unit (neonatal + intensive_care_unit)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Anxiety affects the relationship between parents and their very low birth weight infants

INFANT MENTAL HEALTH JOURNAL, Issue 3 2007
Phyllis Zelkowitz
The goal of this study was to examine the medical and sociodemographic factors associated with parental anxiety following the birth of a very low birth weight infant (VLBW, below 1500 g), and to determine the impact of anxiety on the behavior of parents with their VLBW infants in the Neonatal Intensive Care Unit (NICU). The parents of 88 VLBW infants were recruited through the NICU of a tertiary-care hospital, approximately 2 weeks following delivery. Parents completed self-report questionnaires measuring anxiety, marital quality, and social support. Prior to discharge, each parent was observed twice during a feeding interaction with the infant. Maternal anxiety was greater when their infants were smaller in terms of birth weight and younger in gestational age. Maternal education, marital status, and country of origin, as well as social support and marital quality, were also associated with anxiety. Paternal anxiety was not related to socioeconomic status or infant medical risk, but was associated with country of origin, social support, and marital quality. For both mothers and fathers, anxiety was a better predictor of parental behavior than was infant medical risk. These findings suggest the need to intervene with anxious parents in order to promote satisfactory parent-infant relationships. [source]


Content Validation of Parental Role Conflict in the Neonatal Intensive Care Unit

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2006
Elenice Valentim Carmona MN
PURPOSE.,To validate the content of the nursing diagnosis parental role conflict made by neonatal intensive care (NICU) nurses and researchers in the field and to identify the related major and minor defining characteristics. METHOD.,Fehring's Diagnostic Content Validation model using 59 neonatal specialists. FINDINGS.,Nineteen defining characteristics were validated for use in NICUs: four were considered major and 15 as minor. There was no correlation between nurse profiles and defining characteristic scores. CONCLUSIONS.,In this study, parental role conflict was validated for use in neonatal units but defining characteristics must be described in a clearer and more objective manner. NURSING IMPLICATIONS.,Validation studies in different healthcare settings are required so that the specificities of each clientele are met. NANDA diagnoses must be tested and validated at neonatal units, because this setting has developed few studies and their use in practice is a potential way to improve nursing care. [source]


Nursing Diagnoses Identified During Parent Group Meetings in a Neonatal Intensive Care Unit

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3-4 2005
Ianę Nogueira Do Vale RN
PURPOSE.,To identify nursing diagnoses in the reports of parents obtained during parent support group meetings in a neonatal intensive care unit. METHODS.,An explorative descriptive study using records obtained during 29 meetings over a period of 11 months with parents and family members. FINDINGS.,Six NANDA-approved nursing diagnoses were identified from parent group data: fear, risk for impaired parent/infant attachment, parental role conflict, risk for ineffective breastfeeding, impaired home maintenance, and risk for caregiver role strain. Diagnoses were not validated with parents. DISCUSSION.,Support groups helped the parents express their thoughts and feelings and provided nurses with opportunities to identify nursing diagnoses and interventions. The identification of nursing diagnoses showed that nursing interventions that are focused on improved parent outcomes should be implemented for parents and other family members. IMPLICATIONS.,Nursing care in neonatal units should focus on interventions for parents and other family members in addition to providing the necessary care of newborns. [source]


Two outbreaks of Burkholderia cepacia nosocomial infection in a neonatal intensive care unit

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2008
Jimmy KF Lee
Background: An outbreak of Burkholderia cepacia septicaemia occurred in our neonatal unit over a 9-week period in 2001, affecting 23 babies and two died. A second outbreak lasting 8 days occurred a year later, affecting five babies. Setting: Neonatal Intensive Care Unit, Kuala Terengganu Hospital. Aim: To review the patient characteristics and the risk factors for septicaemia in the first outbreak. Methods: Retrospective review of records and in the first outbreak a case,control analysis with 23 matched controls for risk factors for septicaemia. Results: In the first outbreak, median birthweight was 1670 g (range 860,3760) and median gestational age was 32 weeks (range 27,41). There were 32 episodes of septicaemia, and five and two patients had two and three episodes, respectively. The mortality rate was 6.3% per septicaemic episode. Multiple logistic regression showed the presence of a prior long line was associated with first septicaemic episode (OR 7.07, 95% CI 1.37,36.47 with P = 0.019) but not prior assisted ventilation. The organism was isolated from the water of an oxygen humidifier in the delivery room, three ventilator water traps and one humidifier water trap in the neonatal unit. In the second outbreak, six episodes of septicaemia occurred in five neonates with median birthweight 2060 g and median gestational age 32.5 weeks. The organism was isolated from two ventilator water traps. Conclusion: These two outbreaks of Burkholderia cepacia subsided with general infection control measures. The sources of these two outbreaks were not identified. [source]


Clinical significance of polymicrobial bacteremia in newborns

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2005
Piyush Gupta
Objective: To identify whether polymicrobial bacteremia in newborns is associated with any predisposing factors, distinguishing clinical features, or higher mortality. Methods: Results of blood cultures obtained over a period of 1 year from neonates admitted to the paediatric ward and Neonatal Intensive Care Unit of a tertiary care hospital were retrospectively analysed. The study group included all cases with polymicrobial bacteremia (isolation of two or more organisms). Controls (double the number of study cases) were randomly selected from the monomicrobial group. Case records of included cases were retrieved and scrutinized. Results: Of 770 positive cultures during the study period, 52 (6.8%) cultures were positive for more than one organism. Complete case records were retrieved for 40 polymicrobial and 78 monomicrobial cases. The two groups were comparable for maternal and neonatal parameters including: maternal and obstetric complications; period of gestation; mode of delivery; birthweight and perinatal asphyxia; clinical symptomatology; invasive therapeutic interventions; and mortality. Conclusions: Isolation of more than one organism from the blood culture of a suspected septic newborn is not rare. It does not always represent a true invasion by multiple organisms. Polymicrobial isolation per se should not be the criterion for hastily changing the therapeutic decisions. [source]


Plasma ADMA concentrations at birth and mechanical ventilation in preterm infants: A prospective pilot study

PEDIATRIC PULMONOLOGY, Issue 12 2008
Milan C. Richir MD
Abstract Rationale Nitric oxide (NO) produced in the lung is an important mediator of normal lung development, vascular smooth muscle relaxation, and ventilation perfusion matching. NO is synthesized from arginine by the action of NO-synthase (NOS). Asymmetric dimethylarginine (ADMA), an endogenous derivate of arginine, inhibits NOS and is thereby a determinant of NO synthesis. We compared ADMA and arginine levels in preterm infants requiring mechanical ventilation with preterm infants who did not require mechanical ventilation and determined the relation between ADMA and the length of mechanical ventilation in these infants. Methods Thirty preterm infants, mean (SD) gestational age 29.3 (1.7) weeks and birth weight 1,340 (350) gram, of the Neonatal Intensive Care Unit of the VU University Medical Center were included. ADMA and arginine were measured in umbilical cord blood and the length of mechanical ventilation (days) was registered. Results Gestational age and birth weight were significantly smaller in infants requiring mechanical ventilation, but were not significantly correlated with plasma ADMA concentration after birth. Plasma ADMA concentrations were significantly higher in infants who required mechanical ventilation than in infants who did not require mechanical ventilation (1.53,±,0.23 and 1.37,±,0.14 µmol/L, respectively; P,=,0.036). ADMA concentration was significantly related to length of mechanical ventilation (B,=,3.4; 95% CI: 1.1,5.6; P,=,0.006), also after adjustment for gestational age (B,=,2.3; 95% CI: 0.4,4.2; P,=,0.024). Conclusions Preterm infants who require mechanical ventilation have increased ADMA levels compared to non-ventilated preterm infants. ADMA levels at birth are related to the length of mechanical ventilation. An increased ADMA concentration could reduce NO synthesis, which could lead to insufficient gas exchange and, consequently, a longer period of mechanical ventilation. Pediatr. Pulmonol. 2008; 43:1161,1166. © 2008 Wiley-Liss, Inc. [source]


High levels of CXCL8 in tracheal aspirate samples taken at birth are associated with adverse respiratory outcome only in preterm infants younger than 28 weeks gestation

PEDIATRIC PULMONOLOGY, Issue 3 2007
Jozef De Dooy PhD
Abstract We investigated the relation between perinatal endotracheal colonization, the associated cytokine response and respiratory outcome in ventilated preterm neonates. Between September 1999 and March 2002, a cohort of 141 neonates with a gestational age <31 weeks requiring ventilation directly after birth, were followed prospectively. All were admitted to the Neonatal Intensive Care Unit, University Hospital of Antwerp, Belgium. A tracheal aspirate (TA) sample was collected soon after birth and was processed for microbiological examination, leukocyte count, and cytokine analysis (interleukines [IL] IL-1,, IL-6, CXCL8 (formerly called IL-8), IL-10, IL-12p70 and tumor necrosis factor alpha [TNF-,]). Together with the prospectively registered patient's comorbidities and severity of disease, these inflammatory parameters were analyzed in a multivariate Cox proportional hazards model with time of extubation and duration of oxygen therapy as main outcome measures. Of the 141 patients included, 31 (22%) died before discharge from the unit and 37 (26%) had a positive TA culture. Independent predictors of duration of mechanical ventilation were: gestational age <28 weeks, degree of respiratory distress syndrome (RDS) at birth, significant patent ductus arteriosus (PDA), the SNAP-score, and high levels of CXCL8 (>4,153 pg/ml) in TA only in neonates with a gestational age <28 weeks. Variables associated with extended duration of oxygen therapy were gestational age <28 weeks, birth weight <1,000 g, degree of RDS at birth, and duration of mechanical ventilation. Pediatr Pulmonol. 2007; 42:193,203. © 2007 Wiley-Liss, Inc. [source]


Readmission with respiratory syncytial virus (RSV) infection among graduates from a Neonatal Intensive Care Unit

PEDIATRIC PULMONOLOGY, Issue 4 2002
Jonathan McCormick MRCPCH
Abstract We evaluated the incidence of readmission with respiratory syncytial virus (RSV) infection among the graduates of a regional Neonatal Intensive Care Unit (NICU), and characterized those who were rehospitalized. These data were used as a predictive tool to estimate the number of babies likely to suffer readmission with RSV for the year 2000 cohort. Using the published efficacies of palivizumab, the costs and benefits of protecting this cohort were assessed. Retrospective analysis of 2,507 NICU inpatient records from January 1, 1994,December 31, 1999 from the Royal Maternity Hospital, Belfast, were compared with data on positive RSV samples from 1,790 patients between January 1, 1995,December 31, 1999 from the Northern Ireland Regional Virus Laboratory. The analysis yielded 136 (7.6%) ex-NICU patients among the positive RSV samples over this 5-year period. Characteristic seasonal peaks of RSV infection with interseasonal variability were observed. Of those readmitted, 86.9% were hospitalized with RSV before their first birthday. A calculated readmission rate of 5.4% for all NICU graduates, and 6.4% for those ,35 weeks, was found, leading to an expectation of 36 readmissions from the 668 NICU graduates in the year 2000 over the next 1,2 years, 20 of whom would be ,35 weeks and 12 would be ,32 weeks. A cost of Ł1.3 million would be required to protect the ,35-week year 2000 cohort and prevent 11 readmissions. This equals Ł120,000 per admission prevented, or 28.2 patients treated to prevent 1 readmission. A readmission rate of 6.4% may differ from other studies, as it represents analysis of a greater number of RSV seasons. Using economic arguments alone, the cost of routine administration of Palivizumab to ex-NICU ,35-week infants is prohibitive. A selective practice of immunizing those with chronic lung disease with a background of extreme prematurity over the November to March RSV season may be more cost-effective. Pediatr Pulmonol. 2002; 34:262,266. © 2002 Wiley-Liss, Inc. [source]


When a graph is poorer than 100 words: A comparison of computerised natural language generation, human generated descriptions and graphical displays in neonatal intensive care

APPLIED COGNITIVE PSYCHOLOGY, Issue 1 2010
Marian van der Meulen
Volunteer staff from a Neonatal Intensive Care Unit (NICU) were presented with sets of anonymised physiological data recorded over approximately 45,minute periods from former patients. Staff were asked to select medical/nursing actions appropriate for each of the patients whose data were displayed. Data were shown in one of three conditions (a) as multiple line graphs similar to those commonly shown on the ward, or as textual descriptions generated by (b) expert medical/nursing staff or (c) computerised natural language generation (NLG). An overall advantage was found for the human generated text, but NLG resulted in decisions that were at least as good as those for the graphical displays with which staff were familiar. It is suggested that NLG might offer a viable automated approach to removing noise and artefacts in real, complex and dynamic data sets, thereby reducing visual complexity and mental workload, and enhancing decision-making particularly for inexperienced staff. Copyright © 2008 John Wiley & Sons, Ltd. [source]


Zone-I retinopathy of prematurity, progression and scheduling of treatment

ACTA OPHTHALMOLOGICA, Issue 2009
I AKKOYUN
Purpose To evaluate the progression celerity and scheduling of suitable treatment time for Zone-I Retinopathy of Prematurity (ROP). Methods Records of 36 eyes (18 infants) with Zone-I ROP, which were screened for ROP at the Neonatal Intensive Care Unit of Baskent University, Ankara, Turkey, between January 2004-March 2009, were evaluated retrospectively. Birth weight ranged between 480-1000g, gestational age ranged from 24-28 weeks. First fundus examination was performed at 29-31 weeks gestational age, and was repeated once or more per week. The first treatment was performed using laser photocoagulation and the progression criteria for laser photocoagulation treatment were: (1) Zone-I ROP less than stage-3 with plus disease (ETROP-type 1); (2) Zone-I stage 3 ROP with or without plus disease (ETROP-type 1). Results Twenty eyes of 10 infants showed criterion (1) and 16 eyes of 8 infants criterion (2). Corneal opacity, pupillary rigidity, tunica vasculosa lentis and vitreous haze were observed until 31-33 weeks gestational age. The time period for the progression of stage-1 to stage-3 retinopathy ranged between 0.7-3.7 weeks. The mean age at the first treatment was 33 weeks (range 30-35 weeks). The mean time between the development of stage-1 retinopathy and the laser treatment was 9.8 days in mean (5-23 days), and 69.3 % of the infants were treated within 12 days after the diagnosis of stage-1 ROP. Additional treatments were performed in 7 eyes, scleral buckling+cryotherapy in 5 eyes, vitrectomy in 2 eyes. Thirty-two eyes had favorable and 4 eyes had unfavorable outcomes. Conclusion The diagnosis of Zone-I ROP requires close-meshed follow-up and immediate treatment. [source]


Parents, siblings and grandparents in the Neonatal Intensive Care Unit A survey of policies in eight European countries

ACTA PAEDIATRICA, Issue 11 2009
Gorm Greisen
Abstract Objective:, To describe policies towards family visiting in Neonatal Intensive Care Units (NICU) and compare findings with those of a survey carried out 10 years earlier. Methods:, A questionnaire on early developmental care practices was mailed to 362 units in eight European countries (Sweden, Denmark, the UK, the Netherlands, Belgium, France, Spain and Italy). Of them 78% responded, and among those responded, 175 reported caring for at least 50 very low birth weight infants every year and their responses were analysed further. Results:, A majority of all units allowed access at any time for both parents. This was almost universal in northern Europe and the UK, whereas it was the policy of less than one-third of NICU in Spain and Italy, with France in an intermediate position. Restrictions on visiting of grandparents, siblings and friends, as well as restricting parents' presence during medical rounds and procedures followed the same pattern. A composite visiting score was computed using all the variables related to family visiting. Lower median values and larger variability were obtained for the southern countries, indicating more restrictive attitudes and lack of national policy. Conclusions:, The presence of parents and other family members in European NICUs has improved over a 10-year period. Several barriers, however, are still in place, particularly in the South European countries. [source]


Promoting shorter duration of ventilator treatment decreases the number of painful procedures in preterm infants

ACTA PAEDIATRICA, Issue 11 2009
A Axelin
Abstract Aim:, To investigate whether promoting shorter ventilator treatment decreases the number of painful procedures and the use of analgesics in preterm infants. Methods:, Retrospective patient chart review of all preterm infants in one Neonatal Intensive Care Unit (NICU) was carried out in 2000 (n = 240) and 2005 (n = 206). Between these cohorts, early nasal continuous positive airway pressure (nCPAP) application and early extubation policy were introduced. Results:, Fewer infants were intubated (22 vs. 32%, p = 0.03), the duration of ventilator treatment decreased (6.7 SD 11.3 vs. 9.0 SD 11.1 days, p < 0.001) and nCPAP treatment became more common (41 vs. 25%, p < 0.001) in 2005 than in 2000. Similarly, the infants' exposure to painful procedures did not decrease significantly (61.9 SD 98.5 vs. 67.1 SD 104.3 procedures, p = 0.32) but the procedures related to respiratory support were fewer (45.2 SD 79.5 vs. 68.9 SD 91.1 procedures, p < 0.001) in 2005 than in 2000. In addition, the amount of pain medication used was significantly lower in 2005 than in 2000. One day on a ventilator included more painful procedures than a day on nCPAP (11.2 95% CI: 11.0,11.5 vs. 4.2 95% CI: 4.1,4.4 procedures, p < 0.001) during both study years. Conclusion:, Early nCPAP and early extubation policies were successfully implemented in an NICU resulting in less invasive respiratory support. This was associated with fewer painful procedures and less pain medication in the preterm infants who required respiratory support. Despite this positive effect, the number of painful procedures in all preterm infants stayed at the same level. Our results provide further support for the use of nCPAP in preterm infants. [source]


Nosocomial infection in a Danish Neonatal Intensive Care Unit: a prospective study

ACTA PAEDIATRICA, Issue 8 2009
Anne L Olsen
Abstract Aim:, The aim of this study was to estimate the incidence and identify independent risk factors for nosocomial infections in a Danish Neonatal Intensive Care Unit and to compare these findings with international results. Methods:, The study was performed prospectively from January 1, 2005 to December 31, 2005 in the Neonatal Intensive Care Unit at Rigshospitalet, Copenhagen. Specific criteria for blood stream infection and respiratory tract infection adapted for neonates in our ward were worked out. Results:, Six hundred and eighty-three patients were included. The overall incidence of nosocomial infection was 8.8/1000 hospital days. Blood stream infection was the most frequent type of infection, with an incidence of 5.1/1000 hospital days. Multivariate analysis showed gestational age and heart disease to be significant independent risk factors for both first time blood stream infection and respiratory tract infection, and central venous catheter and parenteral nutrition risk factors for first time blood stream infection. Conclusion:, This first prospective study of nosocomial infection in a Danish Neonatal Intensive Care Unit found an overall incidence of 8.8/1000 hospital days, which is low or similar compared to other studies. Further Danish multicentre studies are needed, and we suggest that procedures related to central venous catheters should be a future focus area. [source]


Long hospitalization is the most important risk factor for early weaning from breast milk in premature babies

ACTA PAEDIATRICA, Issue 6 2009
Lieselotte Kirchner
Abstract Aim: To identify certain variables related to the infants' course that might have an impact on the mothers' decision to breastfeed. Patients and Method: Retrospective survey including all patients <1500 g birth weight (BW) treated between January 1, 2000 and December 31, 2005 at the Neonatal Intensive Care Unit of the Medical University of Vienna who were not transferred to another hospital. Multiple regression analysis of the following variables was carried out: gestational age (GA), BW, length of stay (LOS), parity, singleton or multiple gestation, sex and severe morbidity. Results: Of the 239 patients included, 142 (60%) were fed breast milk at the time of final discharge, 97 (40%) were fed formula. LOS was significantly correlated with the probability of being breastfed: the shorter it was, the higher was the probability of being breastfed at the time of final discharge (p = 0.0064 for singletons, p = 0.001 for multiples). Lower GA also increased the probability of being breastfed, but this was only statistically significant for multiples (p = 0.001). Conclusion: This study shows clearly that the most important influencing factor on the mothers' decision to continue breastfeeding is the LOS. Thus more emphasis should be put on encouraging mothers to continue lactation throughout their babies' hospital stay. [source]


Developmental disorders of glucose metabolism in infants

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2002
R. Hume
Abstract Background Developmental failures to adequately control postnatal blood glucose levels are common in the transition from fetal to infant life and can persist for many months. The standard method of functionally measuring hepatic glucose production and/or disordered glucose production is the response to a glucagon tolerance test. Method We adapted the standard glucagon tolerance test used for children and adults for use in preterm infants. 79 consecutive preterm infants gestational age range 25,36 weeks (mean 32.2 weeks), mean birth weight 1.66 kg admitted to the Neonatal Intensive Care Unit, Ninewells Hospital, Dundee and who survived to discharge home were recruited into the study. At the time of discharge home the characteristics of the group were as follows: adjusted mean gestational age 36.7 weeks, mean discharge weight 2.23 kg. Results In this study of preterm infants the maximal increase in plasma glucose following administration of a glucagon tolerance test is 1.39 ± 07 mmol/L, n = 78 (range 0,3.98 mmol/L). Conclusions An increase in plasma glucose of less than 4 mmol/L is considered abnormal in adults following administration of a fasting glucagon tolerance test. The responses of preterm infants and adults to glucagon are clearly different. The attenuated response to glucagon in the preterm infants is consistent with the low levels of hepatic glucose-6-phosphatase activity in premature infants as glucose-6-phosphatase is the terminal step of the two main pathways of liver glucose production. [source]


The outcome in newborns with congenital diaphragmatic hernia in a Norwegian region

ACTA PAEDIATRICA, Issue 1 2009
S Fredly
Abstract Aim: To evaluate the therapeutic strategies used in neonates with congenital diaphragmatic hernia (CDH) during the last 15 years in our department. Method: A retrospective study of 27 neonates with CDH treated at the Neonatal Intensive Care Unit at Ullevaal University Hospital between 1992 and 2006. Since 1992 we have used delayed operative repair and high-frequency ventilation (HFV). Because surfactant replacement and inhaled nitric oxide (iNO) therapy have been used since 1997, we divided the patients into two groups; group 1 from 1992 to 1996 (9 patients) and group 2 from 1997 to 2006 (18 patients). Results: The overall survival was 70%. Group 1 had an exceptionally good outcome, 100% survival versus 56% in the last group. Conclusion: Pulmonary hypoplasia and pulmonary hypertension are still the most challenging factors in treatment of neonates with CDH, despite novel therapeutic modalities, such as HFV, surfactant and iNO. Delayed surgery in CDH allows pre-operative stabilization. Extracorporeal membrane oxygenation must be considered in the most severe cases. [source]


Causes of near misses in critical care of neonates and children

ACTA PAEDIATRICA, Issue 3 2008
O Tourgeman-Bashkin
Abstract Aim: The primary goal of this study was to examine the nature and causes of medical errors known as almost adverse events (AAEs) and potential adverse events (PAEs) in intensive care units. Methods: Observations were conducted in the Neonatal Intensive Care Unit and in the Pediatric Intensive Care Unit in a large hospital in Israel. The AAEs and PAEs were classified into three main categories: environmental, system and human factors. Data encoding and analysis was based on a Bayesian model previously developed to analyse causes of traffic accidents, and the categories were based on systems and ergonomics approaches. Results: ,Workload' (a system factor) was the main cause of AAEs and ,communication failures' (a human factor) was the second main cause of AAEs. Among the environmental factors, ,failures in medical devices' was the most cited cause of AAEs. Environmental factors accounted for most of PAEs and among them ,form failures' was the most ,AAE'-prone factor. Conclusions: Environmental factors (mainly ,failures in medical device') and system factors (mainly ,workload') accounted for most of AAEs in the intensive care units studied. The systems and the ergonomics approaches to error analysis can be useful in creating a comprehensive error management programme in order to minimize the gap between work demands and individual capabilities. [source]


A parent as a vector of Salmonella brandenburg nosocomial infection in a neonatal intensive care unit

CLINICAL MICROBIOLOGY AND INFECTION, Issue 6 2003
G.-L. Cartolano
A newborn baby was admitted to the Neonatal Intensive Care Unit (NICU) of St Germain en Laye Hospital (France) because of premature birth. On day 12, he contracted gastroenteritis due to Salmonella brandenbourg. The salmonellosis led to a septic shock syndrome with a brief cardiopulmonary arrest. He was treated with intravenous ceftriaxone and gentamicin, and the evolution was favorable. Microbiological investigations revealed that the mother was the vector for this nosocomial infection. S. brandenbourg was isolated from the feces of the baby, despite recent recommendations on managing stool specimens from patients hospitalized for more than three days: according to these recommendations, these stools should be processed for viruses and Clostridium difficile toxin only. [source]


State of the art and recommendationsKangaroo mother care: application in a high-tech environment

ACTA PAEDIATRICA, Issue 6 2010
KH Nyqvist
Abstract Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent,infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow-up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents' role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability. Conclusion:, Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue. [source]


Risk indicators for hearing loss in infants treated in different Neonatal Intensive Care Units

ACTA PAEDIATRICA, Issue 3 2010
P Van Dommelen
Abstract Aim:, To assess which infants' characteristics and specialized procedures are risk indicators for unilateral or bilateral hearing loss (HL) and to evaluate whether these risk indicators are associated with variation in prevalence of HL between Neonatal Intensive Care Units (NICUs). Methods:, For 2002,2005, data from the NICU hearing screening database in the Netherlands were matched with the national neonatology database in which all NICU infants with their patient characteristics and specialized procedures are registered. Multivariate logistic regression analyses were performed to assess risk indicators for HL and to explain differences in prevalence rates between NICUs. Results:, A total of 10 830 infants were available for analyses. The prevalence of HL was 1.8% and ranged from 0.7 to 3.7% between NICUs. Infants' characteristics that significantly increased the risk of HL were the presence of craniofacial anomalies, chomosomal/syndromal anomalies, central nervous system conditions, circulatory system conditions and intra-uterine infections. The specialized procedures involving ,12 days of intensive care and high frequency oxygenation ventilation were independent risk indicators for HL. Approximately 20% of the variance can be explained by the studied risk indicators. Differences in prevalence rates between NICUs were slightly reduced after adjustment for these risk indicators. NICUs with the highest prevalence rates of HL were situated in the largest cities in the Netherlands with a mixed population because of immigration. Therefore, ethnicity may be a risk indicator. Conclusions:, Several independent risk indicators for HL were found, but they could not explain all differences in prevalence rates of HL between NICUs. [source]


Parents, siblings and grandparents in the Neonatal Intensive Care Unit A survey of policies in eight European countries

ACTA PAEDIATRICA, Issue 11 2009
Gorm Greisen
Abstract Objective:, To describe policies towards family visiting in Neonatal Intensive Care Units (NICU) and compare findings with those of a survey carried out 10 years earlier. Methods:, A questionnaire on early developmental care practices was mailed to 362 units in eight European countries (Sweden, Denmark, the UK, the Netherlands, Belgium, France, Spain and Italy). Of them 78% responded, and among those responded, 175 reported caring for at least 50 very low birth weight infants every year and their responses were analysed further. Results:, A majority of all units allowed access at any time for both parents. This was almost universal in northern Europe and the UK, whereas it was the policy of less than one-third of NICU in Spain and Italy, with France in an intermediate position. Restrictions on visiting of grandparents, siblings and friends, as well as restricting parents' presence during medical rounds and procedures followed the same pattern. A composite visiting score was computed using all the variables related to family visiting. Lower median values and larger variability were obtained for the southern countries, indicating more restrictive attitudes and lack of national policy. Conclusions:, The presence of parents and other family members in European NICUs has improved over a 10-year period. Several barriers, however, are still in place, particularly in the South European countries. [source]


Effects of Maternal Depressive Symptoms and Infant Gender on the Interactions Between Mothers and Their Medically At-Risk Infants

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2008
June Cho
ABSTRACT Objective:, To examine the effects of maternal depressive symptoms and infant gender on interactions between mothers and medically at-risk infants. Design:, Longitudinal, descriptive secondary analysis. Setting:, Neonatal intensive care unit, intermediate care unit, and infectious disease clinic of the tertiary medical centers in the Southeast and East. Participants:, One hundred and eight preterm infants and their mothers, 67 medically fragile infants and their mothers, and 83 infants seropositive for HIV and their primary caregivers were studied in their homes between 6 and 24 months. Main Outcome Measures:, Observation and the Home Observation for Measurement of the Environment Inventory were used to assess the interactions of mothers and their medically at-risk infants. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results:, The level of depressive symptoms did not differ between the mothers of boys and mothers of girls in the three groups. Mothers of medically fragile infants had higher levels of depressive symptoms than mothers of preterm infants at 6 months corrected age and similar levels of depressive symptoms as HIV-positive mothers at 12 months. Mothers of medically fragile infants with elevated depressive symptoms were less attentive and more restrictive to their infants. HIV-positive mothers with elevated depressive symptoms were less attentive to their infants. The effects of gender on mother-infant interactions were not moderated by maternal depressive symptoms. Conclusion:, Maternal depressive symptoms had a somewhat negative effect on the interactions of mothers and medically at-risk infants. [source]


Pain management in French Neonatal intensive care units

ACTA PAEDIATRICA, Issue 7 2002
J Schollin
No abstract is available for this article. [source]


Patent ductus arteriosus and cystic periventricular leucomalacia in preterm infants

ACTA PAEDIATRICA, Issue 3 2001
P Pladys
Aim: To test the association between early disturbances in hemodynamics induced by left-to-right shunting through the duct and cystic periventricular leucomalacia. Patients: Forty-six preterm infants (27,32 wk) admitted to the neonatal intensive care unit with risk criteria. Methods: Patent ductus arteriosus was evaluated on days 1 and 4, and was significant (sPDA) in cases of absent or reversed end diastolic flow in the subductal aorta. Resistance index was measured in the anterior cerebral artery and in the subductal aorta. Main outcome: Diagnosis of cystic periventricular leucomalacia between day 10 and day 50. Results: The 12 infants who developed cystic periventricular leucomalacia were compared with those who did not. On day 1, sPDA was more frequent (64% vs 26%; p= 0.03) in the cystic periventricular leucomalacia group, left ventricular output was higher (median = 341 vs 279mlkg -1.min -1; p= 0.005), and rescue surfactant was more frequently used (83% vs 47%; p= 0.03). This latter association was confirmed by multivariate analysis. Resistance index in the anterior cerebral artery was increased in cases of significant patent ductus arteriosus (p < 0.01) and was correlated with resistance index in the subductal aorta. Conclusion: On day 1 in this selected population, sPDA has an effect on blood flow velocity waveform in cerebral arteries and is associated with an increase in the emergence of cystic periventricular leucomalacia. This association could be casual rather than causal. [source]


Corrected head circumference centiles as a possible predictor of developmental performance in high-risk neonatal intensive care unit survivors

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2005
François V Bolduc MD FRCPC
The aim of this study was to evaluate the predictive value of corrected head circumference (HC) centiles at 2 years of age with respect to developmental performance in a series of high-risk neonatal intensive care unit (NICU) survivors with microcephaly. The study used a retrospective review of the clinical files of children seen in a clinic devoted to the follow-up of all high-risk survivors of a hospital's level III NICU. All children with microcephaly (occipital-frontal circumference below the 2nd centile for sex) at 2 years of age were identified. The HC obtained at 2 years was corrected to the ages for which the absolute HC corresponded to either the 50th or 2nd centile for the child's sex. Of 312 high-risk patients followed, 38 (12.2%) were microcephalic. Fifteen performed below the 50th age-corrected HC centile (severe developmental delay), 12 performed between the 50th and 2nd age-corrected HC centile (moderate developmental delay), and 11 performed above the 2nd age-corrected HC centile (mild developmental delay). The absolute value of HC measurement was not a predictor of developmental performance. Of all clinical factors evaluated, only coexisting epilepsy was found to be a significant predictor of less than the 50th age-corrected HC centile developmental performance (Chi2=6.134, p=0.01). We conclude that in a high-risk population, the presence of microcephaly implies developmental impairment, though neither the absolute HC measurement nor the corrected HC centile is predictive. Coexisting epilepsy in this context appears to worsen developmental outcome. [source]


Heart rate variability in response to pain stimulus in VLBW infants followed longitudinally during NICU stay

DEVELOPMENTAL PSYCHOBIOLOGY, Issue 8 2009
Nikhil S. Padhye
Abstract The objective of this longitudinal study, conducted in a neonatal intensive care unit, was to characterize the response to pain of high-risk very low birth weight infants (<1,500,g) from 23 to 38 weeks post-menstrual age (PMA) by measuring heart rate variability (HRV). Heart period data were recorded before, during, and after a heel lanced or wrist venipunctured blood draw for routine clinical evaluation. Pain response to the blood draw procedure and age-related changes of HRV in low-frequency and high-frequency bands were modeled with linear mixed-effects models. HRV in both bands decreased during pain, followed by a recovery to near-baseline levels. Venipuncture and mechanical ventilation were factors that attenuated the HRV response to pain. HRV at the baseline increased with post-menstrual age but the growth rate of high-frequency power was reduced in mechanically ventilated infants. There was some evidence that low-frequency HRV response to pain improved with advancing PMA. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 638,649, 2009 [source]


Reducing nosocomial infection in neonatal intensive care: An intervention study

INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2009
Raijah Hj A Rahim MN RN SCM BScN
Nosocomial infection is a common cause of morbidity and mortality for hospitalized neonates. This report describes measures taken to reduce the prevalence of nosocomial infection within a 34-bed neonatal intensive care unit in Malaysia. Interventions included a one-to-one education programme for nursing staff (n = 30); the education of cleaners and health-care assistants allocated to work in the unit; and the introduction of routine (weekly) screening procedure for all infants with feedback given to staff. The education programme for nurses focused on the application of standard precautions to three common clinical procedures: hand washing, tracheobronchial suctioning and nasogastric tube feeding. These were evaluated using competency checklists. The prevalence of nosocomial blood and respiratory tract infections declined over the 7-month study period. This study highlights the importance of education in contributing to the control of nosocomial infection in the neonatal intensive care unit. [source]


Nursing Diagnoses Identified During Parent Group Meetings in a Neonatal Intensive Care Unit

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3-4 2005
Ianę Nogueira Do Vale RN
PURPOSE.,To identify nursing diagnoses in the reports of parents obtained during parent support group meetings in a neonatal intensive care unit. METHODS.,An explorative descriptive study using records obtained during 29 meetings over a period of 11 months with parents and family members. FINDINGS.,Six NANDA-approved nursing diagnoses were identified from parent group data: fear, risk for impaired parent/infant attachment, parental role conflict, risk for ineffective breastfeeding, impaired home maintenance, and risk for caregiver role strain. Diagnoses were not validated with parents. DISCUSSION.,Support groups helped the parents express their thoughts and feelings and provided nurses with opportunities to identify nursing diagnoses and interventions. The identification of nursing diagnoses showed that nursing interventions that are focused on improved parent outcomes should be implemented for parents and other family members. IMPLICATIONS.,Nursing care in neonatal units should focus on interventions for parents and other family members in addition to providing the necessary care of newborns. [source]


Clinical and Economic Outcomes of Infants Receiving Breast Milk in the NICU

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2001
Amy J. Barton
ISSUES AND PURPOSE. This study compared clinical and economic outcomes for infants who were exclusively fed breast milk and infants who were fed commercial formula. DESIGN AND METHODS. A retrospective medical record review from a regional neonatal intensive care unit (N = 80) using consultation logs from the lactation coordinator and a matched sample of formula-fed infants. RESULTS. Neither clinical (weight gain, length of stay, days of parenteral nutrition) nor economic outcomes (direct variable costs, net revenue) differed significantly between the groups. PRACTICE IMPLICATIONS. While it may not be possible to demonstrate sufficient cost savings while the infant resides within the NICU to justify a lactation coordinator, long-term clinical and economic outcomes may be sensitive to this specialized nursing service. [source]


The conceptual structure of transition to motherhood in the neonatal intensive care unit

JOURNAL OF ADVANCED NURSING, Issue 1 2007
Hyunjeong Shin
Abstract Title. The conceptual structure of transition to motherhood in the neonatal intensive care unit Aim., This paper is a report of a concept analysis of transition to motherhood for mothers with infants in a neonatal intensive care unit. Background., Mothers with infants in a neonatal intensive care unit have more difficulty in their transition to motherhood compared with mothers of healthy infants. The concept of transition to motherhood in the neonatal intensive care unit is not well-understood in nursing, often being confused with mothers' psychological responses in the neonatal intensive care unit. Methods., The concept analysis combined Rodgers' evolutionary method with Schwartz-Barcott & Kim's Hybrid method. Thirty-eight studies were reviewed and a purposive sample of 10 Korean mothers with infants in a neonatal intensive care unit was interviewed. Findings., Three critical attributes of transition to motherhood in the neonatal intensive care unit were identified: (1) time-dependent process, (2) psycho-emotional swirling and (3) hovering around the edge of mothering. These are caused by the antecedents (1) unexpected outcome of pregnancy, (2) awareness of the situation and (3) mother,infant separation. The consequences were: (1) delayed motherhood and (2) developing a sense of meaning concerning family and life. Additionally, five influencing factors to be alleviated were identified: (1) negative meaning attribution, (2) uncertainty, (3) social prejudice, (4) lack of opportunities to make contact with the infant and (5) the neonatal intensive care unit environment. Conclusions., This concept analysis should help nurses to understand the process of becoming a mother in a neonatal intensive care unit and plan appropriate interventions for mothers with special needs. [source]