Influenza vaccination rates of expectant parents with neonatal intensive care admission

Objectives.?To ascertain the rate of influenza immunization in pregnant couples whose infants required neonatal intensive care unit (NICU) admission, and to clarify predictors for trivalent inactivated influenza vaccine (TIV) use in this targeted parent population.

Study design.?During the 2005–07 influenza seasons, parents of NICU patients at two level III centers were surveyed about TIV after their infant's NICU admission. Data on immunization history, location of immunization, and other risk factors for influenza were assessed. Infant data including birth weight, gestational age, and multiple births were also obtained.

Results.?Seven hundred and eighty-six parents had infants in the NICU. Five hundred and forty-seven (69.5%) were surveyed. The overall parental rate of vaccination was 23.2% (127/547). The parental vaccination rate did not differ between years (23.2% vs. 23.2%). Mothers were less likely to have received TIV prior to delivery than fathers (17.0% vs. 28.4%; p < 0.02). Of the population, 19.3% received immunization from their OB/GYN. A concordance rate of 8.9% was noted between married couples receiving TIV. More parents received TIV in January and February of the influenza seasons than November and December (p < 0.05, Student's t-test). Influenza immunization rate in NICU parents was unrelated to infant's gestational age, parental age, total number of risk factors for TIV, hospital length of stay, multiple gestation, or need for high risk obstetrical care.

Conclusions.?TIV rates among high-risk pregnant parents whose infants are admitted to NICU are lower than expected compared with the general population. Patient refusal of influenza vaccine is not a major obstacle toward acceptance.     

Separation anxiety disorder increases among neonatal intensive care unit graduates

Aim: To evaluate whether separation anxiety disorder (SAD) develops in the later life of the infants, who were separated from their mothers in relation to being in neonatal intensive care unit (NICU). Methods: A group of 57 children, ages over 6 years old who were cared in NICU has been evaluated retrospectively by using the SAD diagnostic scale which is adapted according to DSM-IV. Another age and sex matched 50 children who admitted to the outpatient unit were selected as control group. Results: We found that the scores and incidence of SAD were increased among children who were cared in the NICU and both were correlated with the duration of stay in the NICU. Conclusion: The NICU should be arranged to support the development of the baby. Families should be informed about the necessity of sustaining an early mother-infant interaction. By supporting mother-infant interaction, it will be provided that the baby will establish a more secure relation with his/her mother, develop more healthy and have less behavior problems in the future life.     

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.     

Predictors of needs in mothers with infants in the neonatal intensive care unit

Forty‐six mothers with infants in an urban hospital's neonatal intensive care unit (NICU) were asked to rate the importance of having various needs met in five categories: (1) support (the need for interpersonal emotional support); (2) comfort (the need for personal physical comfort); (3) information (the need to obtain realistic information about the infant); (4) proximity (the need to remain near the infant); and (5) assurance (the need to feel confident about the infant's outcome). Overall, mothers viewed needs in the area of assurance as most important and needs in the area of support as least important to have fulfilled. Multiple regression analyses revealed significant predictive relationships between annual household income and mothers' needs in the area of support, and infant length of stay in the NICU and mothers' information needs. The findings from this study can be used by professionals when interacting with families, as well as during the design and implementation of parent support programs in the NICU.     

Stress and anxiety among mothers of premature infants in a Malaysian neonatal intensive care unit

Objective: This study aims to determine maternal stress and anxiety as perceived by mothers whose premature infants were admitted to the neonatal intensive care unit (NICU) and to identify maternal stress and its relationship with maternal and infant characteristics and anxiety.

Background: Vulnerable premature infants commonly require special care in the NICUs. In most cases, prolonged hospitalization results in stress and anxiety for the mothers.

Methods: A non-probability convenience survey was used in a public hospital, with 180 mothers completing the 26-item Perceived Stress Scale (PSS) and a 40-item State-Trait Anxiety Inventory (STAI).

Results: 56.5% of mothers had high levels of stress, 85.5% of mothers had a high level of state-anxiety and 67.8% of mothers had a high level of trait-anxiety. The stress experienced by these mothers had a significant relationship with anxiety, and was found to be associated with state and trait anxiety levels, but not with maternal and infant characteristics.

Conclusion: Mothers in this setting revealed high levels of stress and anxiety during their premature infants’ NICU admission. An immediate interventional programme focusing on relieving mothers’ anxiety and stress is needed to prevent maternal stress and anxiety at an early stage.     

The significance and the necessity of routinely performing lung ultrasound in the neonatal intensive care units

Various lung diseases are the most common conditions and the leading cause of hospital admission and death in newborns. Historically, the diagnosis and differential diagnosis of lung diseases primarily relied on conventional chest X-ray and computed tomography (CT) scans, however, chest X-ray and CT scans suffer from obvious limitations, while lung ultrasound has many kinds of advantages for the diagnosis and differential diagnosis of lung diseases. The significance and the necessity of lung ultrasound in the diagnosis of neonatal lung diseases will be introduced in this paper.     

Admission volume is associated with mortality of neonatal respiratory failure in emerging neonatal intensive care units

Objective: The aim of this survey was to explore the relationship between admission volume and mortality of neonates with hypoxemic respiratory failure (NRF) in emerging neonatal intensive care units (NICUs).

Methods: NRF from 55 NICUs were retrospectively included with death risk as the major outcome. Perinatal comorbidities, underlying disease severity, respiratory support, facility utilization, and economic burden in the early postnatal period were compared among five NICU admission volume categories defined by NRF incidence, with score for neonatal acute physiology perinatal extension II (SNAPPE-II) also assessed as initial severity.

Results: Compared to NICUs with NRF?p?r?=?.282, p?p?Conclusions: Neonates in NICUs with smaller NRF admission volume and decreased magnitude of ventilator use had a higher risk of death as assessed by SNAPPE-II, which should be targeted in the quality improvement of newly established, resource-limited NICUs.     

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.     

The admission rate in neonatal intensive care units of newborns born to adolescent mothers

Aim.?Although the effect of adolescent pregnancy on perinatal mortality and morbidity is known, data on the neonatal hospitalization rate in these deliveries have not been reported. We aimed to assess the possible effects of adolescent pregnancies on the hospital outcomes of the newborns.

Methods.?Three hundred adolescent mothers under 17 years of age and their singleton newborns were enrolled in this retrospective study. The major outcomes of the study were the rates of prematurity and intrauterine growth retardation, and the admission rate of newborns to the neonatal intensive care unit.

Results.?Twenty-nine percent of the newborns were premature, and the intrauterine growth retardation rate was 1%. Forty-one newborns (13.6%), of whom 38 (92.6%) were preterm, were admitted to the neonatal intensive care unit. The admission rate of the study population was higher than the overall newborn neonatal intensive care unit admission rate for our hospital of 9.7% (p?<?0.05).

Conclusion.?The rates of prematurity and neonatal intensive care unit admission were higher in adolescent mothers. This study is the first to demonstrate that the high NICU admission rate was related to premature deliveries in this group.     

Dealing with pandemic influenza A during postpartum and early neonatal period in a busy family-centered neonatal intensive care unit

Although most infections with the current pandemic H1N1 virus have been self-limited, the risk of influenza complications is higher in some subpopulations. Pregnant women had an increased risk of influenza complications in two past epidemics (1918–1919 and 1957–1958). Since neonates do not have a well-developed immune system, they are also vulnerable to viral infections and its complications. This article reports the interventions and health care planning strategies for pandemic influenza A, and its seasonal results in a tertiary perinatal care center with annually 20,000 deliveries.     

Short-term outcome of brainstem auditory function in term infants after discharge from the neonatal intensive care unit

Objectives: To examine short-term outcome of brainstem auditory function in term infants after discharge from the neonatal intensive care unit (NICU).

Methods: Brainstem auditory evoked response (BAER) was recorded and analysed at various click rates at 2–4?months of age in 43 term NICU graduates. The data were compared with those in age-matched normal controls.

Results: The threshold of BAER in the NICU graduates was marginally elevated. The graduates also showed an increase in wave III latency at 91/s and wave V latency at all 21–91/s. The I–V interval was increased at 51 and 91/s, whereas the I–III and III–V intervals were slightly increased, with no significant differences from normal controls at any click rates. The amplitudes of waves I and V in the NICU graduates were moderately reduced at all click rates. Wave III amplitudes were reduced at 51 and 91/s. None of the slopes of BAER variables-rate functions in the NICU graduates differed significantly from normal controls.

Conclusions: The BAER was moderately abnormal in the NICU graduates, suggesting that brainstem auditory function is moderately impaired at 2–4?months of age after discharge. There is a need to monitor postnatal auditory and neural development for NICU graduates.     

Effects of implementing family-centered rounds (FCRs) in a neonatal intensive care unit (NICU)

Objectives: (1) Evaluate impact of FCR on provider satisfaction and collaboration. (2) Evaluate impact of FCR on parent satisfaction with provider communication. Methods: Collaboration and Satisfaction about Care Decisions (CSACD) questionnaire was given to staff on 4 patients 2 days a week for 5 weeks prior to and 6 months after implementation of FCR. Parents received a Parents Stress Scale and Neonatal Instrument of Parent Satisfaction before discharge, prior to and 6 months after starting FCR.Results: 278/288 (97%) staff surveys were completed, 142 pre and 136 post. On the CSACD survey NNPs and fellows showed increased (p?<?0.05) collaboration and satisfaction post FCR. No group had decreased satisfaction. Twenty-eight of 45 (62%) parent surveys were completed, 12 pre and 16 post. Parents’ satisfaction scores increased (p?<?0.01) pre vs. post on survey items regarding communication, meeting with physicians, and obtaining information about their infants. Conclusions: FCR was associated with enhanced collaboration among team members for NNPs and fellows. Parents’ satisfaction scores increased post FCR on survey items regarding communication. Since NNPs and fellows are the primary communicators with parents, the increased satisfaction may reflect improved communication due to FCR. This added opportunity for open dialogue may also contribute to the increased parent satisfaction.     

Stillbirth, neonatal death and reproductive rights in Indonesia

Globally, newborn deaths account for two-thirds of all deaths in the first year of life and 40% of under-five mortality. As infant mortality declines, the proportion of neonatal deaths has been increasing because of the failure to address the causes. The data in this paper derive from a longitudinal study of motherhood and emotional well-being of women in Indonesia; 488 women were interviewed in late pregnancy, and 290 at six weeks post-partum. This paper reports on in-depth interviews with four women who reported a stillbirth and six who reported a neonatal or infant death. They were asked about their understanding of why their baby had died and the information, care and support given to them. The study suggests that maternal and child health clinics fail to protect and fulfill pregnant women's reproductive rights, specifically the right to information and care for themselves and their infants, informed consent, counselling and to be treated with respect. This can be achieved through training and education for health professionals and policymakers, and by educating women about their rights as patients. It is essential that countries with high infant and maternal mortality provide post-partum care that includes support for those who experience stillbirth and neonatal death, including information, counselling and home visits.     

Major determinants of survival and length of stay in the neonatal intensive care unit of newborns from women with premature preterm rupture of membranes

Objective: To assess the predictors of outcome in terms of length of stay in the neonatal intensive care unit (NICU) and survival of neonates from women with preterm premature rupture of membranes (PPROM).

Methods: A population-based retrospective study including 331 singleton pregnant women with PPROM at 24–34 gestational weeks between January 2013 and December 2015 was conducted. Gestational age at delivery, birth weight, route of delivery, newborn gender, maternal age, oligohydramnios, premature retinopathy (ROP), necrotising enterocolitis (NEC), sepsis, fetal growth retardation (FGR), intracranial hemorrhagia (ICH), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), primary pulmonary hypertension (PPH), congenital cardiac disease (CCD), patent ductus arteriosus (PDA), use of cortisol (betamethasone) and maternal complications including gestational diabetes, preeclampsia and chorioamnionitis were used to predict neonatal outcomes in terms of length of stay in the NICU and survival.

Results: In linear regression analyses, birth weight, ROP, CCD, BPD, PDA, NEC and preeclampsia were significant confounders for length of stay in the NICU. Among them, birth weight was the most powerful confounder for prolongation of the NICU stay (t: ?6.43; p?In multivariate logistic regression analyses, birth weight, PDA, ROP and PPH were significantly correlated with neonatal survival. PPH was the most powerful confounder in neonatal survival (β: 7.22; p?=?0.005).

Conclusion: Prematurity-related complications are the most important problems for which precautions should be taken. Therefore, premature deliveries should be avoided to prevent infection and to prolong the latent period in cases of PPROM in order to decrease prematurity-related outcomes.     

Discharge breastmilk feeding rates in asymptomatic term newborns admitted to the neonatal intensive care unit for maternal chorioamnionitis

Purpose: To compare discharge breastmilk feeding rates among asymptomatic term newborns receiving 48-hour versus >48-hour antibiotics in the neonatal intensive care unit (NICU) and a cohort of well-baby nursery (WBN) newborns.

Materials and methods: This retrospective review included asymptomatic term neonates admitted to the NICU due to maternal chorioamnionitis and a comparison group of WBN neonates between January 2012 and December 2015. Demographic, birth, feeding, and lactation consultant visit data were analyzed in univariate and multivariate models.

Results: Among 272 NICU neonates, 237 (87%) received 48-hour antibiotics versus 35 (13%) who received >48-hour (h) antibiotics; a cohort of 428 WBN neonates was studied for comparison. Exclusive breastmilk feeding was seen in 14% of NICU versus 35% of WBN neonates (p?48?h antibiotics was not associated with altered discharge breastmilk feeding (14 versus 14%; p?=?.89). On multivariate logistic regression analysis among NICU subjects, older maternal age (p?p?=?.02), first-feed breastmilk (p?p?=?.012) were associated with increased discharge breastmilk feeding.

Conclusions: NICU admission for presumed early-onset sepsis due to maternal chorioamnionitis was associated with reduced discharge breastmilk feeding in asymptomatic term neonates, but prolonged antibiotic exposure was not. We speculate that demographic factors, such as maternal age and parity, may aid in focusing lactation consultant efforts to potentially improve NICU exclusive discharge breastmilk feeding rates.     

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.     

Big infants in the neonatal intensive care unit

OBJECTIVE: This study was undertaken to identify risk factors for prolonged neonatal intensive care unit (NICU) stay in macrosomic (> or = 4000 g) neonates. STUDY DESIGN: A population-based case-control study in which 799 cases of macrosomic neonates with a prolonged NICU stay were compared with macrosomic neonates without a prolonged stay (n = 1598). RESULTS: Significant risk factors included: 5-minute Apgar score less than 7: odds ratio (OR) = 43.1; fetal distress: OR = 3.0; birth length less than 20 inches: OR = 2.2; birth weight more than 5000 g: OR = 2.6; maternal diabetes: OR = 3.0; gestational age 37 to 38 weeks: OR = 2.2; cephalopelvic disproportion: OR = 2.5; primary cesarean: OR = 2.6; forceps/vacuum: OR = 1.7. No significant association was seen with labor induction/augmentation or dysfunctional/prolonged labor. CONCLUSION: Prolonged stay in macrosomic neonates was related to fetal distress measures and less to factors related to prolonged labor. Attention to intrapartum fetal status during labor with suspected macrosomia appears to be especially warranted.