Referrals to a regional neonatal intensive care unit.

Over a three year period 444 requests for the neonatal transfer of babies with acute medical problems were received at this regional neonatal medical unit. Despite an increase in available resources in the North Western Health Region the provision of intensive care remained inadequate with 38% of requests declined, and babies had to be referred elsewhere including to neighbouring health regions. The survival of those babies who had to remain at the hospital of birth (49%) was significantly lower than for those transferred to the regional centre (71%). Those babies declined admission had significantly lower gestational ages and birth weights than those accepted. For those babies with respiratory failure and birth weights of less than 1500 g within these two groups, however, there were no significant differences in birth weight, gestational age, or gender yet survival was significantly better for those transferred. Babies from multiple pregnancies caused particular problems if neonatal transfer was required.     

Visitation to a neonatal intensive care unit

Preterm newborns may experience extended periods of hospitalization which disrupt the normal early contact between the newborn and its family. Variations in the frequency of visits to 164 preterm neonates in a neonatal intensive care unit were examined in relation to infant and family status variables and compliance with follow-up appointments at 3 months postterm. The mean number of visitors decreased from day 2 to day 12 of hospitalization and then remained stable through day 21. There was a corresponding increase in the number of days with no visitors through day 12, and then stabilization. Neonates who had intraventricular hemorrhages, whose parents did not live together, and who were not firstborn had the most days with no visitors. While the mother was hospitalized herself, her condition was the only variable related to percentage of no-visitor days. The sicker the mother, the more likely the newborn had no visitors. The greater the number of days with no visitors, the poorer the likelihood that the infant was brought to a 3-month follow-up clinic appointment.     

Cup feeding: an alternative to bottle feeding in a neonatal intensive care unit.

Cup feeding has been suggested as an alternative to bottle feeding to help promote breastfeeding by avoiding nipple confusion. To demonstrate the possibility and utility of cup feeding, records of 59 preterm and low birthweight babies (born before 37 weeks' gestation) admitted to a neonatal intensive care unit (NICU) from May 1995 to April 1996 were analyzed. Feeding was initiated on cup if swallowing was present and cup feeding was possible as early as 29 weeks' gestational age with a birthweight of 900 g. In the case of five infants (38 per cent) in the gestational age group 28-30 weeks, 19 infants (52 per cent) in the 31-34 weeks' gestation group, and six (56 per cent) in the 35-37 weeks' gestation group, feeding could be commenced directly with a cup. Out of 59 infants, 33 infants (56 per cent) could be discharged on exclusive breastfeeding. It was concluded that cup feeding is a useful alternative to bottle feeding and an effective method of feeding preterm and small infants in NICU. Cup feeding allows successful breastfeeding without causing 'nipple confusion'.     

新生儿危重症护理管理质量评价指标体系的初步构建

目的 构建NICU护理质量评价指标体系,促进NICU全面质量的持续改进,提升危重新生儿救治成功率和生命质量。方法 基于“结构-过程-结果”理论模型搭建NICU护理质量评价指标逻辑关系,结合我国医院管理的相关政策法规和NICU建设管理标准,参考儿童、成人和危重症护理质量评价指标并结合新生儿疾病特点,初步建立NICU护理质量评价指标并进行定义,咨询专家以咨询计分法采取不记名2轮护理质量评价指标问卷咨询,提出删除、拆分、添加、修改和合并的意见,取第2轮问卷咨询指标赋分值,构建判断矩阵,确定护理质量评价指标的权重关系。结果 来自中国9省市12所三级甲等妇幼保健院或儿童专科医院48名专家应邀参与了问卷咨询,2轮问卷咨询均得到了100%的回复。根据“结构-过程-结果”理论模型建立并定义了67个评价指标（结构19个,过程18个,结果30个）,第1轮问卷咨询中,删除8个、拆分1个、添加4个、修改4个、合并2个指标;第2轮问卷咨询中,删除5个指标,无拆分、添加、修改和合并指标,对3个一级、14个二级、58个评价指标（结构16个,过程18个,结果24个）权重和组合权重计算结果显示,一、二和三级指标重要性赋值均数分别为4.6~4.9、4.1~4.9和3.7~5.0,满分频率分别为60.4%~88.6%、25.6%~90.7%和6.3%~97.9%,呈现一、二和三级指标重要性赋值均数和满分频率范围值逐渐宽泛的趋势。一、二和三级指标一致性系数均<0.1,均具有满意的一致性。结论 以“结构-过程-结果”为理论基础搭建的58个三级NICU护理质量评价指标,取得了咨询专家一致的认同,为更深入的相关研究鉴定了重要基础。     

儿科重症监护病房革兰阴性菌耐药防治对策

1 革兰阴性菌耐药1.1 产超广谱β-内酰胺酶菌株的出现 1983年德国、1988年美国先后分离出产超广谱β-内酰胺酶(ESBLs)革兰阴性菌的菌株\     

Anaerobic bacteremia in a neonatal intensive care unit: an eighteen-year experience

A review of anaerobic bacteremia in the Neonatal Intensive Care Unit identified 29 episodes of clinically significant bacteremia occurring over the past 18 years. This experience suggested that certain clinical settings were associated with specific anaerobic infections. Although Gram-positive and Gram-negative anaerobes were isolated with similar frequency, 8 of 12 infants bacteremic within the first 48 hours of life were infected with Gram-positive, penicillin G-susceptible organisms whereas 11 of 17 infants older than 2 days were bacteremic with Gram-negative, penicillin G-resistant anaerobes. Eleven of 17 infants with anaerobic bacteremia associated with necrotizing enterocolitis were bacteremic with Gram-negative anaerobes. Five of 6 infants with anaerobic bacteremia associated with chorioamnionitis were bacteremic with Gram-positive anaerobes. These observations should be considered in making decisions regarding empiric therapy for the newborn at highest risk for anaerobic bacteremia.     

Septicaemia in an Austrian neonatal intensive care unit: a 7-year analysis

The results of blood cultures and clinical data of 101 neonates with 110 episodes of septicaemia during a 7-y study period were reviewed. The overall incidence of culture-proven sepsis within the study period was 6.0 per 100 neonatal intensive care unit admissions and the mortality rate was 14%. Three groups of pathogens accounted for 70% of all isolates: coagulase-negative staphylococci (27%), aerobic Gram-negative rods (24%) and Enterococcusfaecalis (19%). Group B streptococcus was the major pathogen of very early-onset septicaemia (within 24 h of birth), whereas late-onset infections were most commonly caused by coagulase-negative staphylococci. Birthweight <1500g, gestational age <30 weeks of gestation and early onset of symptoms within the first week of life were associated with poor prognosis. In addition, the case fatality rate of episodes caused by Gram-negative organisms was significantly higher than that of Gram-positive bacteraemia.     

Retrolental fibroplasia--controlled study of 4 years' experience in a neonatal intensive care unit.

During the 4 years 1977-80, 14 infants developed retrolental fibroplasia (RLF) in the neonatal unit at this medical centre. All were very low birthweight (VLBW) infants who weighed 1500 g or less at birth. The incidence of RLF was 3.5% for all VLBW infants admitted for neonatal intensive care and 4.7% for VLBW survivors. The mean birthweight of the affected infants was 970 (range 730-1310) g and mean gestational age 26 (range 24-29) weeks. Seven of the affected infants (2.4% of VLBW survivors) had significant scarring with temporal dragging of the optic disc and retinal detachment. Each of the 14 infants was matched with 2 control infants in order to see whether any factors predisposing to the development of RLF, including those related to oxygen therapy and monitoring, could be identified. The only factor associated with RLF was a higher volume of blood given with replacement transfusions. The occurrence of RLF was unrelated to an increase in requirement for or duration of oxygen therapy, arterial oxygen tensions as determined by intermittent sampling, or the availability of transcutaneous oxygen monitoring. The care taken in oxygen therapy may have been responsible for failure to show a quantitative association between hyperoxaemia and RLF. Although the problem of oxygen therapy in preterm infants is far from being resolved, current neonatal intensive care methods have limited the occurrence of RLF to VLBW infants. This study demonstrated a lower incidence of RLF in VLBW infants despite an improved survival rate compared with that previously reported.     

Acinetobacter meningitis: acquired infection in a neonatal intensive care unit.

A cluster of 4 cases of meningitis due to Acinetobacter calcoaceticus var anitratus occurred during a 5-day period in a neonatal intensive care unit. Three of the infants were preterm and all had a history of other medical problems. Initiation of intravenous therapy with carbenicillin was accompanied by clinical recovery and a bacteriological cure. Intensive bacteriological investigation failed to show a common source for the infections.     

Sibling visiting in a neonatal intensive care unit

The effect of sibling visiting in a neonatal intensive care unit was studied. Sixteen siblings of 13 infants were randomly assigned to a visiting or nonvisiting group. Behavioral patterns were measured by questionnaires administered to the parents and by direct observation and interviews with the children. There were no significant changes in the behavior of the children following the birth of their sibling, and there was no significant difference between the behavior scores of the two groups 1 week after the experimental (or control) intervention. The visiting children did not show signs of fear or anxiety during the visit. These data suggest that sibling visiting to a neonatal intensive care unit is not likely to be harmful and might be beneficial to the siblings and their families.     

Infants in a neonatal intensive care unit: parental response

OBJECTIVE: To compare the psychosocial functioning of the parents (mother and father) of infants admitted to a neonatal intensive care unit (NICU) with the parents of infants born at term and not admitted to the NICU. DESIGN: Random sample of NICU parents and term non-NICU parents were assessed across a variety of psychiatric and psychosocial measures shortly after the birth of their infant. SETTING: Christchurch Women's Hospital, New Zealand. Labour ward and level III NICU. PARTICIPANTS: A total of 447 parents (242 mothers; 205 fathers) with an infant admitted to a regional NICU during a 12 month period; 189 parents (100 mothers; 89 fathers) with infants born at term and not requiring NICU admission. MAIN OUTCOME MEASURES: Depression and anxiety symptoms, psychosocial functioning. RESULTS: Overall, levels of anxiety and depression were low in both parent groups. Compared with control parents, a higher percentage of NICU parents had clinically relevant anxiety and were more likely to have had a previous NICU admission and be in a lower family income bracket. Infant prematurity was associated with higher levels of symptomatology in both NICU mothers and fathers. CONCLUSIONS: Specific interventions are not needed for most parents who have an infant admitted to the NICU as they appear to adapt relatively successfully. Infant prematurity impacts negatively on the father as well as the mother. Consequently these parents may benefit from increased clinical attention.     

Reactions of sixty parents allowed unrestricted contact with infants in a neonatal intensive care unit

The prolonged and total separation of a premature infant from its parents in a Neonatal Intensive Care Unit is an additional element of anxiety in a family already upset by the premature birth itself. However, while encouraging parents to participate in the care of their child lessens some problems, it also tends to create others. The environment of intensive care and continuous contact with the nursing of the infant may give rise to distress, and parental reactions may interfere with the running of the department. We report some results from 60 semistructured interviews between a clinical psychologist and 30 couples whose preterm infants had spent at least 10 days in the Neonatal Intensive Care Unit (NICU) of the 2nd School of Medicine of Naples. For more than 4 years we have encouraged parents to take care of their infants, to touch them, change them and feed them. The results of our study appear to suggest that allowing parents unrestricted access to the Unit stimulates paternal interest in the child.     

Extended-spectrum beta lactamase-producing gram-negative bacteria: clinical profile and outcome in a neonatal intensive care unit

BACKGROUND & AIMS: Multidrug-resistant extended-spectrum 3 lactamase-producing bacteria (ESBL) have emerged as a common problem globally. However, data regarding clinical profile and outcome in neonates infected with ESBL-producing gram-negative bacteria are sparse. METHODS: A retrospective study was undertaken of all neonates admitted between April 2002 and May 2003 to the neonatal intensive care unit, Safdarjang Hospital, New Delhi who had blood cultures positive for gram-negative bacteria. The clinical profile and outcome in each patient was obtained from the case notes. The mortality and morbidity of the ESBL (cases) and non-ESBL groups were compared. Data were analysed using the chi(2) and Student's t-tests. RESULTS: There were 75 cases of gram-negative septicaemia, 46 newborns (61.3%) were infected with ESBL-producing strains and 63 case records were available. ESBL production was associated with prematurity (24/38 vs 9/25, p=0.03), prolonged rupture of membranes (14/38 vs 2/25, p=0.01) and previous antibiotic administration to the infant (15/38 vs 1/25, p=0.002). Fifty per cent of infants with early-onset sepsis and 82.1% with late-onset sepsis were infected with ESBL strains. Newborns with ESBL sepsis were more likely to manifest persistent thermal instability (13/38 vs 3/25, p=0.04) and pre-feed gastric aspirates (18/38 vs 3/25, p=0.004). More than 90% of ESBL isolates were susceptible to carbapenems, cefperazone-sulbactam and piperacillin-tazobactam. The mean length of nursery stay (15.8 vs 10.7, p=0.02) and mortality (23.6 vs 4.0%, p= 0.07) were higher in the ESBL group and onset of feeds was delayed (7.6 vs 3.9 days, p=0.007) in this group. CONCLUSIONS: Isolation of ESBL in cases of early-onset sepsis indicates that ESBL producers might have percolated into the community. Early suspicion of ESBL-producing isolates in cases of neonatal sepsis can facilitate prompt institution of appropriate empirical therapy and lead to an improved outcome.     

Urinary cyclic AMP in infants admitted to a neonatal intensive care unit.

The urinary excretion of cyclic AMP was studied during the first 3 days of life in 46 randomly selected infants admitted to a neonatal intensive care unit. The data were compared with those of normal newborn infants. Urinary cyclic AMP concentrations were significantly correlated with gestational age (all patients), and with birth weight (all patients except infants of diabetic mothers (IDMs)). The urinary cyclic AMP/creatine ratio increased from day 1 to day 3 in normal newborns and in IDMs, and tended to increase also in small-for-gestational age (SGA), low birth weight (LBW), and sick, term infants, although the changes in the latter groups were not statistically significant. Four infants studied with parallel determinations showed increased cyclic AMP/creatinine ratio from day 1 to day 3 both in plasma and urine. All urinary cyclic AMP/creatine ratios were lower than the corresponding ratios found in plasma. In LBW infants, there was an inverse relationship between urinary cyclic AMP and serum calcium. In IDMs a positive correlation was observed between urinary cyclic AMP and blood glucose concentration. In conclusion, the excretion of cyclic AMP in sick newborn infants is influenced by the following factors: gestational age, postnatal age, birth weight, and derangements of serum calcium and blood glucose concentrations.