Can Mozart Improve Weight Gain and Development of Feeding Skills in Premature Infants? A Randomized Trial.

OBJECTIVE: The study aimed to assess in a prospective randomized study the effect of Mozart's music on time to regain birth weight (BW) and development of oral feeding skills in babies born between 280/7 and 316/7 weeks of gestation. STUDY DESIGN: Healthy premature infants born between 280/7 and 316/7 completed weeks of gestation were randomized within 3 days of birth to either music or no music exposure. Infants in the music group were exposed to Mozart's double piano sonata twice per day for 14 days. The primary outcome was time to regain birth weight. The secondary outcome was development of oral feeding skills as evaluated by a speech/language pathologist blinded to the intervention. We hypothesized that exposure to Mozart's double piano sonata would decrease time to regain BW and improve feeding skills. A total of 32 newborns were needed to detect a 3-day difference in time to regain BW. RESULTS: Forty infants were enrolled and randomized. There were no significant differences between the two groups regarding the time to regain BW (p = 0.181) and the time to achievement of full oral feeds (p = 0.809). CONCLUSION: Exposure to Mozart's double piano sonata for 14 days after birth did not significantly improve time to regain BW or time to achieve full oral feedings in very premature infants. It is possible that Mozart's music has no effect or that the duration of music exposure was not sufficient to have a physiologic effect on growth and oral feeding skills. KEY POINTS: · Classical music improves the medical condition of adults.. · Music decreases neonatal resting energy expenditure.. · Music exposure did not significantly impact weight gain.. · This clinical relevance warrants further evaluation..

Use of a Modified Early-Onset Sepsis Risk Calculator for Neonates Exposed to Chorioamnionitis.

OBJECTIVE: To validate the recently modified Kaiser Permanente early-onset sepsis (EOS) calculator with a higher baseline incidence in chorioamnionitis exposed neonates. STUDY DESIGN: This is a retrospective study of chorioamnionitis-exposed neonates born at ≥35 weeks of gestation with a known EOS incidence of 4.3/1000. The risk and management categories were calculated using the calculator with an incidence of 4/1000. The results were compared with a previous analysis of the same cohort that used an EOS incidence of 0.5/1000. RESULTS: In our sample, the EOS calculator recommends at least a blood culture in 834 of 896 (93.1%) and empiric antibiotics in 533 of 896 (59.5%) chorioamnionitis-exposed neonates when using an EOS incidence of 4/1000. This captures 5 of 5 neonates (100%) with EOS. When using a baseline EOS incidence of 0.5/1000, the calculator recommends at least a blood culture in only 289 of 896 (32.2%) and empiric antibiotics in only 209 of 896 (23.3%) neonates, but fails to recommend empiric antibiotics in 2 of 5 neonates with EOS (40%). CONCLUSIONS: When using an EOS risk of 4 of 1000 in infants exposed to mothers with chorioamnionitis, the EOS calculator has the ability to capture an increased number of neonates with culture-positive EOS. However, this change also leads to nearly a 3-fold increase in the use of empiric antibiotics and an evaluation with blood culture in almost all infants born to mothers with chorioamnionitis.

Neonatal intensive care unit admissions before and after the adoption of the baby friendly hospital initiative.

BACKGROUND: The Baby Friendly Hospital initiative (BFHI) is a global initiative of the World Health Organization developed in 1991 to promote and support successful breastfeeding. It has led to increased rates of exclusive breastfeeding. Exclusive breastfeeding may increase risk for hypoglycemia, hyperbilirubinemia, and dehydration requiring higher level of neonatal care. OBJECTIVE: To determine if there was a change in admissions to the Neonatal Intensive Care Unit (NICU) from the newborn nursery after the adoption of BFHI in a large urban hospital. METHODS: This is a retrospective analysis of all neonates admitted to the NICU from the newborn nursery between January 2007 and December 2016 at Thomas Jefferson University Hospital, in Philadelphia, PA, USA. Demographics, clinical characteristics and primary diagnosis for admission were compared between those admitted before (January 2007 to December 2011) and after (January 2012 to December 2016) the initiation of BFHI. RESULTS: A total of 20,124 infants were born and 3,684 infants (18.3%) were admitted to NICU. 570 infants (2.8% of live birth) were admitted to the NICU from the newborn nursery, 282 (49.5%) were born before and 288 (50.5%) born after BFHI. There was no significant difference in the number of infants admitted from the newborn nursery either as a percentage of total deliveries (2.8 versus 2.9%, p = .6) or percentage of total NICU admissions (15.5 versus 15.5%, p = 1.0) before and after the BFHI. Additionally, there was no difference in number of infants admitted with a diagnosis of possible sepsis, hypoglycemia, neonatal abstinence syndrome (NAS) and hyperbilirubinemia between the two groups. However, significantly more infants admitted with hypoglycemia required IV fluids for hypoglycemia after the initiation of BFHI (8 out of 27 versus 21 out of 28, p .001). The age of admission was higher and the duration of NICU stay was shorter in infants admitted after the initiation of the BFHI. CONCLUSIONS: The BFHI has not led to a significant change in the number of infants admitted to NICU from the newborn nursery or reasons for their admissions. However, since its adoption, there has been an increase in the use of IV fluids for treatment of hypoglycemia. These findings suggest a role for additional treatments other than formula to prevent IV fluid use, such as glucose gel. Change in NICU guidelines for the management of possible sepsis and NAS may have impacted the duration of hospitalization in infants born after BFHI.

A comparison of Triple I classification with neonatal early-onset sepsis calculator recommendations in neonates born to mothers with clinical chorioamnionitis.

OBJECTIVE: To compare the early-onset sepsis (EOS) calculator recommendations for infants born to mothers with clinical chorioamnionitis with those made by the Triple I classification. STUDY DESIGN: Retrospective analysis of chorioamnionitis-exposed neonates ≥35 weeks. EOS risk was calculated with baseline risks of 0.5/1000 and 4/1000. Mothers were retrospectively categorized using the Triple I classification. Calculator recommendations were compared with the Triple I classification recommendations. RESULTS: We included 687 chorioamnionitis-exposed neonates. With a baseline risk of 0.5/1000, the calculator recommended no evaluation in 68.4% of infants of mothers with confirmed Triple I. With a baseline risk of 4/1000, 62.3% of infants of mothers with confirmed Triple I and 57.1% of infants born to mothers who did not meet fever criteria would have received evaluation. CONCLUSIONS: The EOS calculator with either baseline risk does not recommend evaluation in a large number of infants born to mothers with confirmed Triple I.