Does skin-to-skin contact reduce stress during diaper change in preterm infants?

Background

Skin-to-skin contact reduces pain response in preterm infants subjected to minor painful procedures, such as heel lance. Diaper change is a procedure performed several times daily in hospitalized preterm infants. Routine care giving tasks such as diaper change may be stressful for the infant.

Aims

The purpose of this study was to investigate whether diaper change induces stress and if skin-to-skin contact could reduce such stress, measured by changes in skin conductance.

Study design

This was a randomized crossover pilot study in 19 preterm infants with gestational age between 28 and 34 weeks. The diaper change procedure was done twice in each infant, once during skin-to-skin contact, and once in incubator or bed with the mother present.

Outcome measures

During diaper change heart rate (HR), peripheral oxygen saturation (SpO₂), and changes in skin conductance (SC) peaks per sec, using the Skin Conductance Algesimeter (SCA), were registered.

Results

The mean SC peaks/sec increased/decreased significantly under/after change of diapers which thereby underpins that this is a stressful procedure for the preterm infant.Skin-to-skin contact (SSC) entails significantly lower stress levels (p < 0.05) compared to diaper changed in an incubator/bed measured by the SCA.

Conclusions

Diaper change is a stressful procedure for preterm infants and may be ameliorated by skin-to-skin contact.     

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??Objective To analyze the clinical characteristics of critical values in NICU and help to make the proper diagnosis and treatment plans of NICU. Methods Retrospective analysis was performed on all the critical values in NICU collected from July 1st??2012 to November 30th??2012 in Children′s Hosptial of Chongqing Medical University. The gestional ages and birth weights of these babies?? consitituent ratio of critical index?? distribution of report time and clinical response and the impact on treatment were analyzed. Results There were 212 newborns with 369 items of time critical values?? and the rate of positive impact on management was 65.04%. Imaging tests??81 cases??22.0%????blood glucose??79 cases??21.4%?? and routine coagulation tests??77 cases??20.9%??were the most common critical values. Sample quality was the common cause of false positive critical values. Conclusion Periodically analyzing and summarizing critical values data could help to make a more reasonable critical value system and improve clinical work efficiency and quality.     

Brainstem auditory electrophysiology is supressed in term neonates with hyperbilirubinemia

BackgroundWhether hyperbilirubinemia suppresses electrophysiological activity of the neonatal auditory brainstem remains to be investigated.AimTo determine whether hyperbilirubinemia suppresses the brainstem auditory electrophysiology in term neonates.MethodsMaximum length sequence brainstem auditory evoked response (MLS BAER) was recorded shortly after confirming hyperbilirubinemia in 58 term neonates. Wave amplitudes of the response were analyzed in detail.ResultsCompared with age-matched term controls, the neonates with hyperbilirubinemia showed a significant reduction in the amplitudes of MLS BAER waves III and particularly V at all click rates 91–910/s. The reduction tended to be more significant at higher than lower rates. Wave I amplitude was reduced at 910/s. V/I amplitude ratio was decreased at all click rates. Therefore, the amplitudes of MLS BAER, particularly later, waves were all reduced. The amplitudes of all MLS BAER waves tended to be reduced with the increase in total serum bilirubin level. All wave amplitudes were correlated with the level of total serum bilirubin at some or most click rates.ConclusionsBrainstem auditory electrophysiology is suppressed in neonates with hyperbilirubinemia, which related to the severity of hyperbilirubinemia. Wave amplitudes are valuable BAER variables to detect functional impairment of the brainstem and auditory pathway in neonatal hyperbilirubinemia, and are recommended to be used in assessing bilirubin neurotoxicity to the neonatal brain.     

Kinematics of 2 Reciprocating Endodontic Motors: The Difference between Actual and Set Values

Introduction

The aim of this study was to evaluate the kinematics of 2 reciprocating motors and compare it with manufacturers' declared values.

Methods

VDW Silver (VDW, Munich, Germany) and ATR Tecnika (Tecnika, Pistoia, Italy) were used in the study in 5 working modes: continuous rotation at 400 rpm on VDW Silver and ATR Tecnika and reciprocating motion on ATR Tecnika at 400 rpm and on VDW Silver in Reciproc and WaveOne mode. The polishing disk with an optical target was inserted in the contra-angle and recorded with a 1000–frames per second video camera. The direction and the amount of rotation were analyzed by computer, and the following kinematics parameters were calculated: engaging and disengaging angles, cycle rotational speeds, engaging and disengaging rotational speeds, net cycle angle, total cycle angle, and number of cycles to complete full rotation. One-way analysis of variance followed by planned pair-wise comparisons was used to compare kinematics parameters. The alpha error was set to 0.05.

Results

Analysis of variance revealed a difference between actual and set values of all 3 reciprocating modes in all kinematics parameters (P < .001). No significant difference between the actual engaging angle of Reciproc and that of the WaveOne mode was found. For reciprocating motion on the ATR Tecnika at 400 rpm, the actual engaging and disengaging angles were 8- and 9-fold greater, respectively, compared with set angles (P < .001).

Conclusions

The kinematics of reciprocating instrumentation is more complex than it seems as described only with angles and rotational speed. Actual kinematics values differ from manufacturers' declared values.     

Prognosis of acute renal failure: an evaluation of proposed consensus criteria

Objectives To validate the recently proposed criteria for acute renal injury (ARI), acute renal failure syndrome (ARFS) and severe acute renal failure syndrome (SARFS) and to evaluate the significance of other prognostic factors.Design and setting Retrospective analysis of the Riyadh ICU Program database of patients admitted to 22 ICUs in UK and Germany between 1989 and 1998.Patients Included in the study were 41,972 patients, of whom 7,522 (17.9%) had ARI, 2,641 (6.3%) had ARFS and 1,747 (4.2%) had SARFS.Results Patients with ARI, ARFS or SARFS had a hospital mortality of 29.5%, 49.2% or 63.0%, respectively, compared to 10.3% among patients without acute renal failure. In the presence of contemporaneous failure of any other organs on the day of acute renal failure, hospital mortality increased to 73.3%, 76.2%, 72.1% and 18%, respectively. Multivariate analysis showed that non-surgical admission, need for emergency surgery, development of acute renal failure during stay in ICU, need for mechanical ventilation and the number of other failed organ systems had a greater impact on prognosis than the need for renal replacement therapy.Conclusions The proposed criteria for ARI, ARFS and SARFS correlated with mortality, but other factors had a greater impact on prognosis. Renal replacement therapy did not increase the risk of hospital mortality among patients with acute renal failure.     

Utilization of analgesics, sedatives, and pain scores in infants with a prolonged hospitalization: A prospective descriptive cohort study

Aim

Describe the utilization of analgesic and sedative medications and documentation of pain scores in a cohort of critically ill infants in a neonatal intensive care unit.

Method

A prospective, longitudinal, cohort study of infants with a predicted length of stay ≥28 days. Dosages and routes of administration of analgesic and sedative medications and documentation of pain scores were collected on a daily basis.

Results

55 infants were enrolled into the study. Oral sucrose was administered to all 55 infants, 51 infants (93%) were administered enteral acetaminophen and 50 (91%) infants were administered morphine during their hospitalization. Sedatives were administered to 42 infants (76%); 36 (65%) were administered chloral hydrate and 32 (58%) were administered intravenous midazolam. With the exception of the first week of admission, when there was highest utilization of opioids and lower use of sucrose, acetaminophen and sedatives, the pattern of administration of analgesic and sedative agents remained relatively constant throughout the hospitalization. Pain scores were documented for 36 (65%) infants during their hospitalisation, however for these 36 infants, pain scores were infrequently recorded.

Conclusion

There was substantial and varied analgesic and sedative use in this cohort of infants, yet infrequent documentation of pain assessment scores. These practices highlight important clinical implications for sick infants requiring careful consideration of pain and distress management.     

Ventricular Arrhythmia Factors in Mitral Valve Prolapse

To assess tbe prevalence of ventricular arrhythmias and late potentials (LPs) in mitral valve prolapse (MVP) and to identify clinical, ECG, and echocardiographic markers of spontaneous ventricular arrhythmias, we studied 58 consecutive patients (mean age 46.6 ± 17.8 years; 29 males, 29 females) with MVP diagnosed by echocardiography. Patients underwent ambulatory ECG recording (n = 58), exercise stress test (n = 56), signal-averaged ECG (n = 58), and programmed ventricular stimulation (n = 52). Ten patients (17.2%) had spontaneous nonsustained ventricular tachycardia (NSVT), 26 patients (44.8%) had premature ventricular contractions (PVGs), Lown grade ≥ 3 during 24-hour EGG, and 19 had Lown grade ≥ 3 PVCs during exercise stress test; 13 patients had LPs (22.4%). We provoked sustained VT in one case and NSVT in ten cases. Patients with complex ventricular arrhythmias during 24-hour EGG and exercise stress test were older and more often had mitral regurgitation. There was a statistical correlation between the presence of LPs and spontaneous VT (46.1 % vs 8.9%; P < 0.005) and induced ventricular arrhythmias (50% vs 12.8%; P < 0.005). No correlation was found between spontaneous ventricular arrhythmias and thickness or posterior displacement of the mitral valve. In conclusion, complex ventricular arrhythmia (especially VT) and LPs are frequent in MVP. Patient age and mitral regurgitation seem to be determinant factors of complex ventricular arrhythmias in MVP. On signal-averaged EGG, absence of LPs seems to be a good additional marker to identify MVP patients without spontaneous VT. On the other hand, programmed ventricular stimulation does not appear valuable in determining a MVP subgroup with a high risk of ventricular arrhythmias.     

神经行为学检测和改良BBB运动功能评定在脑瘫大鼠运动功能评定中的应用

目的:探讨脑瘫大鼠运动功能评价的最佳方法。方法:采用孕鼠腹腔注射LPS制备脑瘫动物模型,随机选取对照组(A组)足月仔鼠60只,LPS组足月仔鼠120只分为早期干预组(B1组)和非干预组(B2组)各60只。各组于生后25d进行神经行为学检测,B1组中检测出的CP鼠(B1CP组)继续早期干预,B2组中检测出的CP鼠(B2CP组)常规饲养,A组中随机选取10只鼠作为对照组(A′组);A′组、B1CP组和B2CP组仔鼠分别于25d及42d进行神经行为学检测和运动功能评定。结果:①25dB1组鉴定出7只CP鼠,B2组13只CP鼠,A组中无CP鼠。②B1CP组第25天与第42天各项检测结果比较:悬吊试验、斜坡试验、旷场实验、拒俘反应及改良的BBB运动功能评分均有显著性差异(P﹤0.01);B2CP组和A′组大鼠25d与42d各项检测结果比较无显著性差异(P﹥0.05)。结论:①神经行为学检测可有效鉴定CP大鼠的运动功能。②改良BBB运动功能评定适用于CP大鼠的运动功能评定。③联合应用神经行为学检测与改良BBB运动功能评定可全面反映CP大鼠运动功能状况。