Influenza in the neonatal intensive care unit.

Influenza has historically been an uncommon illness in the newborn period, although epidemic outbreaks in neonatal intensive care units have been described. There is currently significant concern about the possibility of a new pandemic of influenza in the near future. During a pandemic neonates are likely to be exposed, with significant illness more likely in pre-term newborns due to reduced levels of passively transferred protective maternal antibodies. While newer therapies have been shown to be effective in reducing the severity of illness in adults and children, such therapies are untried in neonates. Supportive care and measures to contain and prevent spread of infection may well be the most important measures in the event of a neonate acquiring influenza, including the avian variety.     

Ethics in neonatal intensive care

Work summarises current data ideas of problems of ethical thinking and decision making in neonatology. Primary objective ethical questions of administration resuscitative and intensive care are outlined, as well as administration of care for babies, delivered on limit of viability, in the same way for children with high probability of serious damage in case of survival. Role of parents in decision making about to other administration care is discussed, some recommendation and instructions for communication with parents are handed up. Findings of extensive european study named EURONIC are shortly mentioned, study concerns problems of ethical dilemmas in neonatology in 8 European countries. Finally the categorization of newborns in ethical thinking is mentioned and present circumstances in Czech republic are remarked.     

Primary palliative care in neonatal intensive care

This article explores the 2014 Institute of Medicine׳s recommendation concerning primary palliative care as integral to all neonates and their families in the intensive care setting. We review trends in neonatology and barriers to implementing palliative care in intensive care settings. Neonatal primary palliative care education should address the unique needs of neonates and their families. The neonatal intensive care unit needs a mixed model of palliative care, where the neonatal team provides primary palliative care and the palliative subspecialist consults for more complex or refractory situations that exceed the primary team׳s skills or available time.     

Cost-effectiveness analysis of Malaysian neonatal intensive care units.

OBJECTIVE: To perform a cost-effective analysis on the care of infants between 1000 and 1500 g birthweight (the study group), where outcomes are measured as survival to 1 year of age. METHODOLOGY: This was a multicenter observational study to determine the outcome, cost and cost-effectiveness of neonatal intensive care provided by Ministry of Health (MOH) Pediatric services. A total of 333 patients enrolled were eligible for analysis according to the inclusion and exclusion criteria of this study. RESULTS: Overall survival probability of the study group infants at 1 year of age was 78%. Survival at 1-year of age was 77% for infants with birth weight 1000 to 1249 g, 79% for 1250 to 1499 g. Survival at 1 year of age for the sample group was 53% for 22 to 27 weeks gestation, 80% for 28 to 36 weeks. The average cost-effectiveness ratio (CER) of neonatal intensive care for the study group infants was US$3979 [corrected] per survivor at 1 year of age (95% confidence interval US$3411, 5160). CONCLUSION: There was variability in the outcome and cost-effectiveness between the neonatal units, which need to be further assessed. However, neonatal intensive care services provided for the study group infants were cost-effective compared to that in developed countries.     

Pulse oximetry in neonatal intensive care

Pulse oximetry, a noninvasive technique of measuring oxygen saturation continuously, is being used increasingly in the intensive care setting. This article provides information regarding physiologic basis and practical aspects of clinical usage of pulse oximetry in the neonate, both in medical and surgical units.     

Serum troponin in neonatal intensive care

Cardiac troponins have a major role in screening and diagnosis of myocardial ischaemia in adults and children. Their introduction has redefined the diagnosis of myocardial infarction in adults and provided valuable prognostic information. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication, and can be used as predictors of subsequent cardiac recovery and mortality. This review discusses the current established reference values in term and preterm infants and demonstrates their potential use in neonatology. They may serve as a useful adjunct in the assessment of the magnitude of myocardial injury in respiratory distress syndrome and asphyxia. They may also benefit centres without on-site echocardiography with some evidence showing good correlation with echo-derived markers of myocardial function. The use of troponins in the neonatal unit remains a research tool. More work is needed to explore their prognostic role and monitoring response to treatment following cardioprotective strategies. In preterm infants the effect of inotropes on myocardial function needs further study and troponin may form an integral part of this research.     

Oral care in a neonatal intensive care unit

Objective: Compare the oral colonization profile of premature infants admitted at NICU before and after doing oral care routine with sterile water versus no intervention.

Methods: It was a randomized clinical trial composed of 37 premature infants admitted at the Neonatal Intensive Care Unit (NICU) with a birth weight (BW) <1500?g. They were distributed in two groups: the study group (SG) with 15 patients who received an oral hygiene with sterile water; and a control group (CG) (no intervention) formed by 22 patients. Primary outcome was oral colonization profile before and after doing oral care.

Result: In the study group, the number of patients colonized by the Gram-positive bacteria at the beginning of the study was 53% versus 40% at the end (p=0.10). For Gram negative, 40% at the study’s beginning versus 60% at the end (p=0.18). In the control group, the number of colonized patients for the Gram-positive bacteria at the onset of the study was 54.5% versus 32% patients at the end (p=0.24). For Gram negative, 32% patients at the start of the study versus 77% at the end (p?=?0.003).

Conclusion: There is a significant increase of the Gram-negative flora in those patients without oral care.     

Measuring developmentally appropriate practice in neonatal intensive care units.

OBJECTIVE: Neonatal intensive care units (NICUs) impose stressors on development. Comparative studies have focused mostly on the units' medical qualities and less on their developmental 'ecology'. The aim of the study was to develop a tool for measuring the various domains of a developmentally appropriate practice in the NICU environment, and to assess its implementation in Israel. STUDY DESIGN: A questionnaire, designed for NICU senior staff members, was completed by 76 respondents representing 24 NICUs in Israel. The tool that measures developmentally appropriate practice as applied in the NICU environment includes the following three domains: (a) parental and family involvement, (b) environmental control and (c) individualized care and assessment. These measures jointly produce the developmentally appropriate neonatal intensive-care practice (DANIP) index. RESULT: High variability was found in the application of procedures and programs considered developmentally appropriate. Units with a relatively large multidisciplinary team scored high. Overall, the NICUs in Israel did not consistently follow an integrated form of the developmental care as provided by the Neonatal Individualized Developmental Care and Assessment Program. It was found that individualized care and assessment was significantly and positively linked to control of the environment (r=0.53, P<0.01) and to parental and family involvement (r=0.76, P<0.01); the latter two scales were not associated. Of the three DANIP domains, parental involvement was salient. Although the staff highly appreciated the importance of environmental control and individualized care, application was limited. CONCLUSION: The DANIP index provides a good starting point for comparative studies.     

An evaluation of intra-hospital transport outcomes from tertiary neonatal intensive care unit

Introduction: Patient transport has more important side effects in patients in the newborn age group than in other age groups. This study was performed to evaluate the intra-hospital transport of infants in the neonatal intensive care unit(NICU).

Methods: A total of 284 babies hospitalized in the neonatal unit and transported inside the hospital were divided into three groups based on their weights at the time of transport. Their places of transport and important changes in the vital functions of the newborn that might have been caused by transport were recorded with a view to understand the vital effects of intra-hospital transport on the newborn.

Results: In our unit, the primary reasons for transport were determined to be echocardiography and radiology (26.4% and 25.7%, respectively). In our study, hyperglycemia and hypothermia were among the statistically most significant side effects associated with transport (p?<?0.05). It was found that 19% and 27% of the patients had hyperglycemia and hypothermia, respectively. There was a significant difference in the blood sugar levels and the body temperature between pre- and post-transport (p < 0.05). There were no significant differences in the pH, blood gas CO₂, heart rate and breath rate values between pre- and post-transport (p?>?0.05). As expected, the complication rate was higher in babies with low weight.

Conclusions: Current weight is useful for assessing the risks of untoward outcomes associated with intra-hospital transport. Protecting patients from hypothermia during the time spent outside of the NICU would reduce the risk of complications.     

Eosinophilia in the neonatal intensive care unit

Although common in the neonatal intensive care unit, eosinophilia is often overlooked or ignored. The latter might be, at least in part, because evaluating the neonate with eosinophilia can be a complex process. This article reviews the physiologic features of eosinophilia, reference ranges, and clinical conditions associated with eosinophilia in the neonate. Recommendations for the evaluation of the neonate with eosinophilia are presented.     

Ethical issues in neonatal intensive care units

On one hand, advances in neonatal care and rescue technology allow for the healthy survival or prolonged survival time of critically ill newborns who, in the past, would have been non-viable. On the other hand, many of the surviving critically ill infants have serious long-term disabilities. If an infant eventually cannot survive or is likely to suffer severe disability after surviving, ethical issues in the treatment process are inevitable, and this problem arises not only in developed countries but is also becoming increasingly prominent in developing countries. In addition, ethical concerns cannot be avoided in medical research. This review article introduces basic ethical guidelines that should be followed in clinical practice, including respecting the autonomy of the parents, giving priority to the best interests of the infant, the principle of doing no harm, and consent and the right to be informed. Furthermore, the major ethical concerns in neonatal intensive care units (NICUs) in China are briefly introduced.     

急诊床旁超声心动图在新生儿重症监护病房的应用价值

目的 探讨急诊床旁超声心动图在新生儿重症监护病房的应用价值. 方法 2007年1月至2011年7月,应用急诊床旁超声心动图(索诺声公司Micromax 1型便携式超声诊断仪或飞利浦iE33型彩色多普勒超声诊断仪)对668例有心脏病理性杂音、皮肤紫绀、气促等临床表现的患儿进行探查,以手术结果为金标准,评价急诊床旁超声心动图的诊断准确性及其在新生儿重症监护病房中的应用价值. 结果 668例患儿中男347例,女321例;足月儿309例,平均胎龄(39.1±0.6)周(37.0～42.1周);早产儿359例,平均胎龄(33.7±0.91)周(28.9～36.9周).患儿平均日龄为(7.2±1.3)d.共检出心血管异常507例,其中动脉导管未闭268例(早产儿232例,足月儿36例),先天性心脏病115例,持续胎儿循环99例,心律不齐25例.共54例行外科手术治疗,1例行介入手术治疗;手术成功51例,4例死亡.这55例手术患儿术前未进一步行CT、磁共振或创伤性心导管造影检查,直接行手术治疗.其余452例患儿经药物及时治疗后好转出院392例,无明显好转26例,死亡14例,放弃治疗20例.以手术结果为金标准,便携式超声诊断仪诊断先天性心脏病的准确率为94.5％ (52/55),iE33型彩色多普勒超声诊断仪诊断准确率为96.4％(53/55). 结论 急诊床旁超声心动图能迅速评价危重患儿心脏结构功能及肺动脉压力,具有较高的临床价值.     

Reducing nosocomial infections in neonatal intensive care

Background.?Nosocomial infection is a common problem in neonatal intensive care. A pilot quality improvement initiative focussing on hand hygiene and aimed at reducing nosocomial infection in very low birth weight (VLBW) infants was introduced in five Neonatal Intensive Care Units.

Methods.?Line associated laboratory confirmed bloodstream infection (LCBSI) and ventilator associated pneumonia (VAP) were chosen as main outcome measures.

Results.?In VLBW infants, the rate of line associated LCBSI per 1000 central venous catheter days fell by 24%. The rate of VAP per 1000 ventilator days in VLBW infants fell by 38%. Pre- and post-intervention questionnaires showed a statistically significant increase in use of alcohol-based gels and increased knowledge of hand hygiene.