The effect of foot reflexology before suctioning on pain and SPO2 in neonates under nasal CPAP hospitalized in the NICU

IntroductionSuctioning procedures in neonates under nasal CPAP and the use of reflexology as a non-invasive method are inevitable. Accordingly, this study aims to determine the effect of foot reflexology before suctioning on pain and SPO2 in neonates under nasal CPAP, who were admitted to the neonatal intensive care unit (NICU).MethodsThis quasi-experimental crossover study was conducted among 40 neonates under nasal CPAP, who were admitted to the NICU of Ali Ibn Abitaleb Hospital in Rafsanjan, Southeastern Iran. The neonates were divided into one of two groups (A and B), according to the inclusion criteria. Neonates in group A received foot reflexology for 3 min during the first suctioning. The second round of suctioning was performed without the reflexology intervention in this group. In group B, the order of applying reflexology was opposite to that in the group A. Before and after suctioning, SPO2 was recorded as shown by the monitor. During the suctioning procedure, pain was assessed using the NIPS tool. In addition, data were analyzed using SPSS Software.ResultsBased on the results, the mean score of pain was lower in the two groups after suctioning with reflexology (the paired t-test, p < 0.05). Although suctioning improved SPO2, reflexology had no effect on this indicator (p > 0.05).ConclusionReflexology before suctioning is effective in reducing pain in neonates. Additional studies are recommended on changing the time and duration of reflexology and examining the effects.     

Hypoglycemia Emergencies: Factors Associated with Prehospital Care,Transportation Status,Emergency Department Disposition,and Cost

Objectives: The objectives of this study were to evaluate demographic/clinical characteristics and treatment/transportation decisions by emergency medical services (EMS) for patients with hypoglycemia and link EMS activations to patient disposition, outcomes, and costs to the emergency medical system. This evaluation was to identify potential areas where improvements in prehospital healthcare could be made. Methods: This was a retrospective analysis of the National Emergency Medical Services Information System (NEMSIS) registry and three national surveys: Nationwide Emergency Department Sample (NEDS), National Hospital Ambulatory Medical Care Survey (NHAMCS), and Medical Expenditure Panel Survey (MEPS) from 2013, to examine care of hypoglycemia from the prehospital and the emergency department (ED) perspectives. Results: The study estimated 270,945 hypoglycemia EMS incidents from the NEMSIS registry. Treatments were consistent with national guidelines (i.e., oral glucose, intravenous [IV] dextrose, or glucagon), and patients were more likely to be transported to the ED if the incident was in a rural setting or they had other chief concerns related to the pulmonary or cardiovascular system. Use of IV dextrose decreased the likelihood of transportation. Approximately 43% of patients were not transported from the scene. Data from the NEDS survey estimated 258,831 ED admissions for hypoglycemia, and 41% arrived by ambulance. The median ambulance expenditure was $664?±?98. From the ED, 74% were released. The average ED charge that did not lead to hospital admission was $3106?±?86. Increased odds of overnight admission included infection and acute renal failure. Conclusions: EMS activations for hypoglycemia are sizeable and yet a considerable proportion of patients are not transported to or are discharged from the ED. Seemingly, these events resolved and were not medically complex. It is possible that implementation and appropriate use of EMS treat-and-release protocols along with utilizing programs to educate patients on hypoglycemia risk factors and emergency preparedness could partially reduce the burden of hypoglycemia to the healthcare system.     

新生儿低血糖脑损伤的MRI表现

目的 探讨新生儿低血糖脑损伤的MRI特征及其发病机制。方法 回顾性分析34例临床确诊的新生儿低血糖患儿的临床及MRI资料,低血糖诊断标准为血糖值<2.6 mmol/L。结果 低血糖脑损伤主要累及顶枕部,占94.12%(32/34),其中双侧顶枕叶61.76%(21/34);胼胝体压部损伤亦较为常见,占64.71%(22/34);额叶损伤占32.35%(11/34),11例中有6例为弥漫性脑损伤累及额叶。脑损伤主要表现为皮髓质交界不清,呈稍低T1稍高T2信号,DWI上病变均呈明显高信号。结论 新生儿低血糖脑损伤具有一定特征性,以双侧顶枕叶伴随胼胝体压部损伤最为常见,严重时可表现为弥漫性脑损伤;DWI更有利于辨别病灶。     

Positioning Effects for Procedural Pain Relief in NICU: Systematic Review

ObjectivesTo systematically review the literature regarding the effectiveness of different positioning methods for procedural pain relief in neonates admitted to the Neonatal Intensive Care Unit (NICU).DesignA systemized search of the literature was carried out by means of two independent evaluators through the systematic search of electronic index databases.Data sourcesA search for relevant studies was performed in four databases (Medline, Web of Science, Scopus, and BVS-BIREME).Review/Analysis methodsManual searches were conducted on suitable references from the included articles, and 1,941 publications were eligible for the analysis. The flowchart for the articles’ selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and in relation to bias risks according to the Physiotherapy Evidence Database (PEDro) scale.ResultsBased on the inclusion criteria, only 20 publications remained. According to the PEDro scale, 75% of the studies presented good methodological quality, with scores between 6 and 8, and 5% scored ≤4 points. None of them were blinded in relation to the therapies, but all of them performed intergroup statistical comparisons. According to the results of this review, we recommend facilitated tucking by parents (FTP) in NICU of at least 30 minutes duration, starting 15 minutes before, during the painful procedure, and 15 minutes after to relieve pain and to stabilize the physiological, hormonal, and behavioral responses of the newborns.ConclusionsPositioning should be used as a nonpharmacological strategy for procedural pain relief in newborns. This review showed that facilitated tucking by parents for 30 minutes was the best position for pain relief in premature newborns during procedures in the NICU. Positioning is recommended as a nonpharmacological method for pain relief; FTP of at least 30 minutes duration should be the first positioning choice during procedures in the NICU.     

A cohort study of the universal neonatal urine screening for congenital cytomegalovirus infection

ObjectivesThis prospective cohort study aimed to evaluate the efficacy of the universal neonatal urine screening, followed by diagnosis, workup and antiviral therapy for symptomatic congenital cytomegalovirus (CMV) infection to reduce neurological impairments and sequelae.MethodsNeonates born in three facilities underwent the universal urine screening of PCR analyses for CMV-DNA. Neonates with symptomatic congenital CMV infection (cCMV) received oral valganciclovir (VGCV) of 32 mg/kg/day for six weeks or six months, and were evaluated for neurological outcomes including developmental quotient (DQ) and hearing function at around 18 months of corrected age.ResultscCMV was diagnosed in 56 (0.48%) of 11,736 neonates, consisting of 23 neonates with symptomatic and 33 with asymptomatic cCMV. The incidence of cCMV in the general perinatal medical center (0.69%) was higher than that in the primary maternity hospital (0.23%, p<0.01%). Twenty of the 23 infants with symptomatic cCMV received VGCV therapy, and 19 underwent neurological assessment. Eight neonates (42%) had severe sequelae of DQ < 70, bilateral hearing dysfunction, and/or epilepsy. Four neonates (21%) had mild sequelae of DQ 70–79 or unilateral hearing dysfunction only, and seven (37%) showed normal development without any impairment.ConclusionsThis study on a large scale demonstrated that a series of universal neonatal urine screening, diagnosis, workup, and VGCV therapy for neonates with symptomatic cCMV may decrease neurological impairments, because 58% of the treated infants had normal development or mild sequelae. The universal urine screening likely identifies subclinical symptomatic cCMV. Mothers with fetuses of cCMV seem to be selectively transferred to perinatal medical centers before deliveries.     

Nurse-Driven Initiative to Increase Exclusive Human Milk Feeding by Using Pasteurized Donor Human Milk to Treat Hypoglycemic Term Neonates

ObjectiveTo increase exclusive breastfeeding by offering pasteurized donor human milk (PDHM) to newborns with hypoglycemia.DesignQuality improvement project.Setting/Local ProblemA Baby-Friendly Hospital Initiative–designated urban academic medical center in the northeastern United States serving a diverse population where, by policy, virtually all newborns with hypoglycemia received supplemental infant formula. Approximately 85% of women cared for at this center initiate breastfeeding, but many struggle with exclusive breastfeeding during the hospital stay.ParticipantsAll staff members in the labor and delivery unit and the mother/baby unit, including registered nurses, unit clerks, patient care technicians, and lactation consultants. Term, breastfed newborns identified as being hypoglycemic per our guidelines were eligible to receive PDHM.Intervention/MeasurementsRegistered nurses provided education about PDHM to parents of newborns who were hypoglycemic, obtained consent, and initiated the order. We offered PDHM instead of infant formula when mother’s own milk was not available in sufficient quantity per our hypoglycemia guidelines. We measured newborns’ glucose levels and monitored breastfeeding outcomes, including continued breastfeeding.ResultsDuring the 4-month trial, 83 newborns were eligible for PDHM. Of those, 76% of parents opted for PDHM rather than formula. Most newborns in both groups were still breastfeeding at discharge, and 53% of those who received PDHM were fed human milk exclusively during their hospital stays.ConclusionA nurse-driven protocol offering PDHM to otherwise healthy newborns with hypoglycemia is a viable option for increasing exclusive breast milk feeding during the hospital stay.     

Asociación entre el vínculo madre-hijo y los síntomas depresivos en madres de la Unidad de Cuidados Intensivos Neonatales: estudio caso-control

ObjectivesMaternal perinatal depression has been associated with impaired mother-infant bonding. The adverse effect of this impaired bonding has been reported. This study aimed to investigate and compare the posnatal depressive symptoms and the mother-infant bonding in a Neonatal Intensive Care Unit (NICU) and of mothers with healthy newborns respectively. Secondly, was to explore the association between depressive symptomatology and bonding in both groups.MethodsIn this case study, mothers in the early pospartum period who gave birth in the same perinatal center of Greece were recruited to participate. The cases consisted of 88 mothers of neonates who were hospitalized in the NICU and controls were 100 mothers of full-term healthy neonates. For the collection of the data questionnaires including demographics and perinatal variables were used. For the bonding and posnatal assessment, the Mother to Infant Bonding Scale, the Postpartum Bonding Questionnaire, and the Hospital Anxiety and Depression Scale were used.ResultsThere was a significant difference between the mean of bonding scores of NICU mothers and the control group (t = -2.696, P=.008). NICU mothers presented lower scores in bonding with the newborn compared to the control group and presented higher depression scores compared to those of controls (χ² = 28.588, P=.000). The depression scores were correlated with bonding scores in both groups.DiscussionA NICU admission has an impact on bonding and in some way interacts with maternal pospartum mental health, therefore more research is needed.ConclusionsNICU mothers have been presented as more vulnerable than mothers of healthy infants since they expressed a lower mother-infant bonding and higher depression scores. The support of these vulnerable mothers and the facilitation of mother-infant bonding by the NICU staff is of utmost importance.     

Predictors of factors affecting rate of change of temperature of preterm/LBW neonates from delivery to admission to NICU: Use of a continuous temperature monitoring device (Helyxon fever watch)

BackgroundHypothermia is an important contributor to neonatal morbidity and mortality, more so in the preterm and extreme low birth weight infants.MethodsStudy was conducted over a period of 3 months from 1st January to 31^st March 2018 with an aim of evaluating rate of change of temperature of newborn neonates from delivery to NICU admission and factors effecting rate of change of temperature in these neonates. A unique compact continuous temperature monitoring device was used for this study. Temperature changes in the baby were monitored with a help of smart phone where temperature is updated every 5 s.ResultsThirty neonates with mean gestation of 31 ± 3 weeks were enrolled for study. Mean temperature at admission to NICU was 35.34 ± 0.74 °C. There was no temperature loss while stabilization of neonate under radiant warmer or during transport to NICU. Maximum temperature loss happened before baby reached to radiant warmer. Delivery room temperature and gestation were found to be most important factors effecting admission temperature to NICU.ConclusionSignificant proportion of neonates after birth is hypothermic at admission to NICU. Low delivery room temperature and prematurity are associated with neonatal hypothermia. Implementing WHO recommendation of increasing delivery room temperature to 25 °C and above can help in reducing the incidence of neonatal hypothermia.     

Efectividad del uso de la sucrosa en la prevención del dolor durante la punción venosa en neonatos

ObjectiveTo evaluate the effectiveness of sucrose use in the prevention of pain during venipuncture in neonates.MethodDouble blind randomized control trial. The population consisted of hospitalized neonates subjected to venipuncture. Sample size was calculated with a 95% confidence level, 80% power, minimum proportion of neonates with pain 40% in the study group and 70% in the control group. The minimum sample size was 49 newborns per group.Five minutes before venipuncture, the neonates received 1cc of oral solution of 12% sucrose (study group) or distilled water (control group). During the procedure the pain level was evaluated with NIPS (Neonatal Infant Pain Scale). A data base was created, and the information processed and analysed using the SPSS program.ResultsA total of 111 neonates were analysed, (55 in study group and 56 in control group). Bivariate analysis showed a smaller NIPS score in the group that received sucrose. Linear regression model explained that the significant variables for pain during the procedure were: hours since birth and the absence of non-nutritious suction, not being related to the sucrose administration.ConclusionNeonates that received the oral solution of sucrose before venipuncture had an average pain score lower than the placebo controlled group.     

Systematic Review of Factors Influencing Non–Medically Indicated Formula Supplementation of Newborns in the Hospital Setting

ObjectiveTo examine maternal and newborn factors that influence non–medically indicated (NMI) formula supplementation of newborns in the hospital setting.Data SourcesElectronic databases CINAHL and Ovid MEDLINE were searched for peer-reviewed articles published in English between January 1, 2000, and September 30, 2017.Study SelectionA total of 616 studies were returned from the search. After removal of duplicates, 558 studies remained, 531 of which were excluded based on factors of not being related to term newborns, not being published in a peer-reviewed journal, or study not completed in a hospital setting. Five studies were included that met the inclusion and exclusion criteria.Data ExtractionData from the five studies were extracted and compiled into a summary table.Data SynthesisSynthesis indicated that maternal ethnicity, educational level, and income influence the decision to provide NMI formula supplementation to newborns. First-time mothers and those with cesarean birth, no previous breastfeeding experience, female newborns, and large-for-gestational-age newborns were at greater risk for NMI formula supplementation. Neonates born at night are more likely to receive NMI formula supplementation, and NMI formula supplementation increases during the night hours and during the first 24 hours after birth.ConclusionIdentification of newborn/maternal risk factors, continuous breastfeeding support, and provision of consistent breastfeeding education to women are factors that influence NMI formula supplementation of newborns. With collaboration among hospital physicians, midwives, nurse practitioners, nurses, and lactation consultants to identify at-risk newborns, the goal of decreasing NMI formula supplementation of newborns in the hospital can be achieved.     

A Pilot Randomized Controlled Trial of Outcomes Associated with Parent-Nurse Controlled Analgesia vs. Continuous Opioid Infusion in the Neonatal Intensive Care Unit

PurposeProspectively compare parent/nurse controlled analgesia (PNCA) to continuous opioid infusion (COI) in the post-operative neonatal intensive care unit (NICU) population.Design/MethodsA randomized controlled trial compared neonates treated with morphine PNCA to those treated with morphine COI. The primary outcome was average opioid consumption up to 3 post-operative days. Secondary outcomes included 1) pain intensity, 2) adverse events that may be directly related to opioid consumption, and 3) parent and nurse satisfaction.ResultsThe sample consisted of 25 post-operative neonates and young infants randomized to either morphine PNCA (n = 16) or COI (n = 9). Groups differed significantly on daily opioid consumption, with the PNCA group receiving significantly less opioid (P = .02). Groups did not differ on average pain score or frequency of adverse events (P values > .05). Parents in both groups were satisfied with their infant's pain management and parents in the PNCA group were slightly more satisfied with their level of involvement (P = .03). Groups did not differ in nursing satisfaction.ConclusionsPNCA may be an effective alternative to COI for pain management in the NICU population. This method may also substantially reduce opioid consumption, provide more individualized care, and improve parent satisfaction with their level of participation.Clinical ImplicationsPatients in the NICU represent one of our most vulnerable patient populations. As nurses strive to provide safe and effective pain management, results of this study suggest PNCA may allow nurses to maintain their patients' comfort while providing less opioid and potentially improving parental perception of involvement.Study TypeTreatment study.Level of EvidenceI.     

The effect of late-onset sepsis on mortality across different gestational ages in a neonatal intensive care unit: A historical study

ObjectivesLate-onset sepsis is a frequent complication in neonatal intensive care units. This study aims to understand the effect of late-onset sepsis on mortality in hospitalised neonatal patients across different gestational ages.DesignThis is a single-centre, historical cohort study including neonates admitted to hospital during a 10-year period (2002 – 2011). Neonates were stratified by gestational age: extremely preterm (<28 weeks), very preterm (28 to 32 weeks), late preterm (33 to 36 weeks), full term (>37 weeks).SettingTertiary NICU in Ghent, Belgium.Main Outcome MeasuresLogistic regression analysis was used to assess adjusted relationships between late-onset sepsis and mortality, reported as odds ratio (OR) and 95% confidence interval (CI).ResultsA total of 4928 neonates were included, of which 2071 were term (42.0%), 1425 were late preterm (28.9%), 1165 very preterm (23.6%) and 264 were extremely preterm neonates (5.4%). 40 neonates developed late-onset sepsis (8.2 episodes/1000 patient days). Overall, in-hospital mortality was 5.4%. Late-onset sepsis was an independent risk factor for mortality in the total cohort (OR = 2.41; 95% CI = 1.46–3.96). However, when gestational age groups were considered separately, late-onset sepsis was associated with mortality in very preterm neonates (OR = 2.45; 95% CI = 1.03–5.84) and in the late preterm neonates (OR = 3.92; 95% CI = 1.41–10.87), but not in other neonates. Comorbidities burdening neonatal hospital survival include acute lung disease, brain damage, periventricular leukomalacia, surgery, and broncho-pulmonary dysplasia.ConclusionLate-onset sepsis is an independent risk factor for mortality in very preterm and late preterm neonates. Understanding how late-onset sepsis among other factors impact mortality enables a patient and family-centred approach to nursing care including the anticipation of realistic milestones.Implications for clinical practiceLate-onset sepsis is especially detrimental to preterm neonates and this could be taken into consideration by nurses when communicating with families in the perinatal period.     

Anxiety,depression, and quality of life in mothers of newborns admitted to the neonatal intensive care unit: A follow-up study from birth to the first two years of life

AimThere is evidence that the Neonatal Intensive Care Unit (NICU) environment can have a negative impact on maternal psychological well-being, especially in low- and middle-income settings. However, most studies on distress and quality of life in mothers of newborns who needed intensive medical care have measured patient-centered outcomes at only one time-point. Here, we evaluated the levels of anxiety, depression, and quality of life in mothers of newborns admitted to the NICU with follow-up throughout the first 2 years of the child's life.MethodsWe performed a longitudinal study in a region with the worst socioeconomic indicators in Brazil. We included mothers who had newborns admitted to the NICU. Our primary outcome of interest was quality of life, as measured by the WHOQOL-BREF instrument. Secondary endpoints included anxiety levels (Spielberger's State-Trace Anxiety Inventory) and depressive symptoms (Beck Depression Inventory).ResultsFifty-four mothers were included. During the first 48 h after NICU admission, the median quality of life score was 62.5 (IQR 56.3–68.8), and severe levels of state anxiety were observed in 61.1% of mothers. A positive relationship was observed between levels of state anxiety (p = 0.003), depressive symptoms (p < 0.001), and length of stay in the NICU. A significant improvement in the mothers' global quality of life score was observed only 12 months after the child's birth, which remained unchanged at the 24-month assessment.ConclusionsOur findings suggested that the admission of newborns to the NICU may have a long-term impact on maternal mental health.     

Scenario-based clinical simulation: Bridging the gap between intern-students’ anxiety and provision of holistic nursing care for preterm neonates

AimThis study aimed to determine the effect of Scenario-Based Clinical Simulation (SBCS) on nursing students’ anxiety and skills related to providing holistic nursing care for preterm neonates.BackgroundNursing students who are caring for preterm neonates experience high level of anxiety that might negatively influence their clinical performance. Clinical nurse educators face the challenge of preparing skilful and competent students within the constraints of limited orientation time in the Neonatal Intensive Care Unit (NICU). The application of SBCS provides students with opportunities to practice critical thinking, problem-solving and communication skills, pose questions and remediate their clinical deficiencies in non-threatening learning enviroment.DesignA quasi-experimental, two groups, pre-post test study was carried out in the NICU of Specialized Hospital at Smouha, Alexandria.MethodSixty students completed a baseline skills assessment, as students' clinical skills were scored on a 148-item checklist and participants rated their anxiety. All participants received a didactic lecture and demonstrated nursing procedures. Research team facilitated an interactive SBCS session for the intervention group focused on the holistic care of preterm neonates and the common health problems affecting them. Two weeks later, two independent raters re-assessed the students' skills on the admitted preterms, and participants completed the anxiety questionnaire again.ResultsIt is revealed that all participants in the intervention group (100%) had good skills after two weeks of SBCS compared to 20% of the control group (P < 0.001). Moreover, 43.3% of the nursing students in control group experienced severe anxiety compared to only 6.7% of those in the intervention group who attended the SBCS (P < 0.001).ConclusionThe application of SBCS in NICU provided an interactive learning experience, improved and sustained students' clinical skills. They reflected on their performance and remediated their skills in a conducive environment. So, they encountered less anxiety while providing holistic care for preterm neonates.     

The impact of telenursing on hope and perceived self-efficacy of the mothers of premature infants after discharge from the NICU

ObjectivesThis study aimed to investigate the impact of telenursing on the hope and perceived self-efficacy of the mothers of premature infants after discharge from the neonatal intensive care unit.MethodThe study method was a clinical trial. The research population consisted of all the mothers with premature infants whose neonates had recently been discharged from NICU. Seventy subjects were selected through convenience sampling and randomly assigned to intervention and control groups. The intervention group subjects received telenursing training for four weeks, while in the control group, no intervention was offered. The data collection tools included the Perceived Maternal Parenting Self-Efficacy Questionnaire (PMPS-Q) and the Hope Scale of Mothers of Premature Neonates Admitted to the Intensive Care Unit. Data analysis was performed using an independent t-test, two-way repeated-measures ANOVA, and one-way repeated measures ANOVA.ResultsThe results showed that telenursing improves hope (P < 0.05) and perceived self-efficacy (P < 0.05) in the mothers of premature infants after discharge from the NICU.ConclusionAccording to the obtained results, it is suggested that the necessary measures be taken to establish distance nursing in the neonatal intensive care unit. As a result, mothers of premature infants and the country's health system can benefit from the advantages as mentioned earlier.     

Continuous Octreotide Infusion for Sulfonylurea-Induced Hypoglycemia in a Toddler

Background

Ingestion of a sulfonylurea by toddlers can cause profound hypoglycemia and neurologic sequelae. Although mild cases can be managed with dextrose and boluses of octreotide, optimal management of patients with severe hypoglycemia and cerebral injury has not been well established.

Objective

Our objective was to report the use of continuous infusion octreotide for tight glucose control after accidental sulfonylurea ingestion with severe neurologic dysfunction.

Case Report

A 17-month-old child presented to the emergency department with marked hypoglycemia, cerebral edema, and persistent seizures after ingestion of an unknown amount of glipizide. Hypoglycemia was refractory to i.v. dextrose bolus/infusion and subcutaneous octreotide. Continuous i.v. octreotide was utilized in conjunction with low-volume/high-concentration dextrose infusion as treatment, allowing for tight glucose and fluid management in the setting of cerebral edema.

Conclusions

Continuous infusion of octreotide resulted in rapid stabilization of blood glucose levels while maintaining fluid-restriction goals. Our patient demonstrated reversibility of diffuse cerebral edema in this setting with near complete recovery of neurologic function. Octreotide administration by continuous infusion may be preferable to subcutaneous bolus administration for the treatment of severe sulfonylurea-induced hypoglycemia with associated neurologic injury.     

A pilot study of Biotene OralBalance® gel for oral care in mechanically ventilated preterm neonates

BackgroundNeonatal ventilator-associated pneumonia (VAP) is associated with increased morbidity and mortality. In adults on mechanical ventilation, timed oral care decreases the frequency of VAP, but this approach has not been studied in neonates.ObjectivesTo evaluate the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel and estimate the required sample size for such a trial.MethodsInfants were eligible for enrollment if they were born before 28 weeks of gestation, and were mechanically ventilated between 7 and 10 postnatal days. Infants were randomized to receive timed oral care with Biotene OralBalance® gel or sterile water. All subjects were treated with a standard bundle of procedures to reduce the risk of VAP.ResultsWe enrolled 41 of 46 eligible infants (89%). Compliance with timed oral care protocol was 97%. No local oral side effects of Biotene OralBalance® gel were observed. There were no significant group differences in mortality or short-term outcomes, except length of hospital stay which was significantly shorter in the Sterile water group (p = 0.02). A lower rate of VAP was found in the Biotene group, although the difference was not statistically significant (9/1000 ventilator-days versus 17/1000 ventilator-days in the Sterile water group, respectively; p = 0.16).ConclusionsThe results of this pilot study support the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel for prevention of VAP in mechanically ventilated neonates.     

The Effect of Maternal Voice on Venipuncture Induced Pain in Neonates: A Randomized Study

BackgroundVenipuncture is a common procedure in the neonatal intensive care unit (NICU) and causes significant pain for neonates.AimTo evaluate the effect of maternal voice on pain caused by venipuncture (including peripheral venipuncture and femoral venipuncture) in neonates hospitalized in the NICU.DesignExperimental, randomized controlled study.SettingThe study was conducted in the NICU of two hospitals in China from November 2017 to January 2019.MethodsOne hundred and sixteen neonates were randomly assigned to the maternal voice or routine care groups. The maternal voice group received recorded maternal voice intervention before, during, and after venipuncture. Three phases of procedures were videotaped. Neonatal Infant Acute Pain Assessment Scale (NIAPAS) was assessed by the same evaluator at different phases.ResultsThe study showed that NIAPAS scores, behavioral indicator scores, and physiological indicator scores in the maternal voice group were significantly lower compared with those in the routine care group.ConclusionRecorded maternal voice can improve pain caused by venipuncture in neonates. These are simple, rapid, and cost-effective methods that nurses can implement during venipuncture in neonates.