Improving Communication with Parents in the NICU during the COVID-19 Pandemic, a Study and Review of the Literature.

BACKGROUND: Communication with parents of sick premature and term infants in the NICU is complicated and challenging. Multiple efforts have been made to improve it, including the introduction of new electronic-based measures. AIM: We aimed to study the influence of implementation of a new communication technology on parents' satisfaction with care in the NICU during the COVID-19 pandemic. METHODS: Infants were video-recorded in their incubators or cots without being disturbed. These short films, with voice updates on the infant's condition, were sent on a daily basis to their parents via a WhatsApp application. RESULTS: Parents who chose to join the new communication project (study group) were older, and their infants were more premature. Parents were satisfied with this new communication modality. Satisfaction scores in both study and control groups were high, but not significantly different. CONCLUSIONS: Although the implementation of the new communication project was successful, we could not demonstrate significant improvement in satisfaction scores that were high in study and control groups, reflecting baseline high satisfaction. Further studies are needed employing other assessment tools in order to evaluate other aspects of parents' satisfaction with new modalities of communication introduced to the NICU, and their effects on parents' bonding with their infants.

[CAN FOOD THICKENING IMPROVE THE ABILITY OF PREMATURE INFANTS TO ACQUIRE FULL ORAL FEEDING EARLIER? A PILOT STUDY].

BACKGROUND: Acquiring oral feeding skills can take longer in preterm infants and can lengthen their hospital stay. OBJECTIVE: To study whether food thickening could improve preterm infants' ability to reach full oral feeding earlier. METHODS: This is a prospective randomized trial for which 15 infants were recruited upon showing signs of oral feeding readiness. Eight infants fed on human milk were controls. Of the 7 infants fed on formula, five infants were randomized to food thickening with corn flour starch and two infants were given another un-thickened control. RESULTS: Mean gestational age was 29.0 ± 2.3 weeks and mean birth-weight was 1174 ± 325 g. Food thickening had no effect on the time to reach full oral feeding (17.4 ± 6.7 days with thickened formula vs. 18.0 ± 7.0 on un-thickened formula and 12.1 ± 9.5 on human milk) or on the length of stay (66.8 ± 26.0 days vs. 52.5 ± 17.7 and 56.2 ± 25.3, respectivey). Multivariate analysis showed that time to full oral feeding and length of stay were only associated with gestational age or birth-weight and respiratory morbidity, as expressed in the number of ventilation and supplemental oxygen days. Weight gain was faster in those given thickened formula (36.0 ± 7.1 g/day) compared to those on human milk (28.5 ± 6.5 g/day). CONCLUSIONS: Food thickening with corn flour did not shorten the time to reach full oral feeding in preterm infants. This type of food thickening was associated with extra weight gain. Larger blinded prospective studies are needed to confirm our findings.

A randomized pilot study comparing heated humidified high-flow nasal cannulae with NIPPV for RDS.

OBJECTIVE: To compare the requirement for endotracheal ventilation in preterm infants treated with heated, humidified high-flow nasal cannula (HHHFNC) with those treated with nasal intermittent positive pressure ventilation (NIPPV) for the primary treatment of respiratory distress syndrome (RDS). STUDY DESIGN: Randomized, controlled, prospective, single-center pilot study. Infants (gestational age [GA] <35 weeks, birth weight [BW] >1,000 g) with RDS were randomly assigned to receive HHHFNC (38 infants) delivered by Vapotherm® device (Precision Flow™ or 2000 i, Vapotherm Inc., Stevensville, MD), at flows between 1.0 and 5.0 L/min, or NIPPV (38 infants) delivered by the SLE 2000 or 5000. Surfactant was administered as rescue therapy. Analysis was done by intention-to-treat. RESULTS: Infant's characteristics ([mean ± SD] GA 31.8 ± 2.3 vs. 32.0 ± 2.3 weeks) and cardio-respiratory status at study entry (FiO2 0.25 ± 0.05 vs. 0.26 ± 0.07; SpO2 90 ± 6% vs. 87 ± 12; PCO2 54.4 ± 10.4 vs. 52.6 ± 8.0 mmHg) were comparable for the HHHFNC and NIPPV groups. There was no significant difference in the need for endotracheal ventilation (28.9% vs. 34.2%) between HHHFNC and NIPPV groups. One infant failed HHHFNC and succeeded on NIPPV. The rate of neonatal morbidities (pneumothorax, bronchopulmonary dysplasia, intra-ventricular hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, and nasal trauma) was comparable in both groups. Duration of nasal support was longer with HHHFNC compared with NIPPV (5.4 ± 4.0 vs. 2.6 ± 1.9 days, P = 0.006) but the duration of endotracheal ventilation, time to full feeds, and length of stay were comparable. CONCLUSIONS: Our pilot study suggests that HHHFNC maybe as effective as NIPPV in preventing endotracheal ventilation in the primary treatment of RDS in premature infants (<35 weeks GA and BW >1,000 g).

The effects of lactulose supplementation to enteral feedings in premature infants: a pilot study.

OBJECTIVE: To assess the safety and prebiotic effects of lactulose in preterm infants. STUDY DESIGN: This was a prospective, double-blinded, placebo-controlled, single-center study in 23- to 34-weeks premature infants. The study group received 1% lactulose, and control infants received 1% dextrose in all feeds (human milk or formula). RESULTS: Twenty-eight infants participated (15 lactulose, 13 placebo). Small doses of lactulose appeared to be safe and did not cause diarrhea. Premature infants on lactulose had more Lactobacilli-positive stool cultures that appeared earlier with larger number of colonies. The lactulose group tended to have less intolerance to enteral feedings, to reach full oral feeds earlier, and to be discharged home earlier. They also tended to have fewer episodes of late-onset sepsis, lower Bell stage necrotizing enterocolitis, and their nutritional laboratory indices were better, especially calcium and total protein. CONCLUSIONS: This pilot study supports the safety of supplementing preterm infants' feeds with low doses of lactulose. It also demonstrated trends that may suggest positive prebiotic effects.

Reflectance pulse oximetry from core body in neonates and infants: comparison to arterial blood oxygen saturation and to transmission pulse oximetry.

OBJECTIVE: To compare pulse oximetry oxygen saturation (SpO(2)) measured by a novel reflectance method from core body to arterial oxygen saturation (SaO(2)) in neonates and infants. Transmission pulse oximetry (TPO) was measured for comparison. STUDY DESIGN: We monitored 18 infants by the two pulse oximeters simultaneously. The reflectance pulse oximetry (RPO) (PRO2, ConMed, Utica, NY) was measured on the upper back or chest, while the TPO (N395-Nellcor, Pleasanton, CA) was measured from the finger of the infant on the left hand or feet. Data from the two methods were compared to functional SaO(2) derived from blood sample drawn from arterial line for patient care and measured by a Co-oximeter (Ilex, Instrument Lab. Lexington, MA). The potential advantage of the RPO is demonstrated in a case of a premature infant with hypovolemic shock, where SaO(2) or TPO could not be obtained but oximetry was available from the RPO. RESULTS: We used for analysis 56 RPO and 32 TPO measurements. SpO(2) obtained from the RPO was 88.3+/-9.8%, from the TPO 84.2+/-10.1%, and functional SaO(2) was 88.2+/-11.7%, with correlation coefficient of 0.93 and 0.88, respectively (p<0.0001). The mean difference (bias) and standard deviation of the differences (precision) between the RPO and the TPO compared to functional SaO(2) were -0.09+/-4.5% and 1.26+/-5.9% and the absolute errors were 3.2+/-3.1%, and 4.4+/-4.0%, respectively. The accuracy of both RPO and TPO was diminished when SaO(2) was <85%, but only the RPO remained correlated with the functional SaO(2). CONCLUSIONS: Reflectance pulse oximetry measured from core body of neonates and infants is accurate and reliable and is comparable to the transmission SpO(2) when compared to functional SaO(2). We speculate that the reflectance method might be advantageous in cases of poor peripheral perfusion in neonates and infants.