The Effect of Oral Motor Stimulation on the Transition to Full Oral Feeding, Breastfeeding, and Length of Hospital Stay in Preterm Infants.

Objective: To determine the effect of oral motor stimulation (OMS) applied to preterm infants on their sucking and swallowing abilities to establish a successful and safe oral feeding experience. Methods: A pre-post intervention study was conducted between December 2019 and December 2020, which included preterm infants born at <35 weeks of gestational age and admitted to the neonatal intensive care unit. Patients with major congenital abnormalities (including cardiac, facial, and jaw deformities), severe NEC, stage 3-4 IVH were excluded from the study. Patients who received OMS by a speech and language therapist between June 2020 and December 2020 were assigned to Group 1, while patients who received no intervention between December 2019 and May 2020 were assigned to Group 2. The time to achieve full oral feeding (FOF), acquisition of breastfeeding rates at discharge, and the length of hospital stay (LOS) were compared between the groups. Results: A total of 62 patients were included in the study (31 in Group 1 and 31 in Group 2). There were no significant differences in birth weight and demographic data between the groups. The mean time to achieve FOF was found to be significantly shorter in Group 1 (31 ± 23.6 and 46.7 ± 22.3 days, respectively, p = 0.013). The mean LOS was also found to be shortened with a mean duration of 10 days in Group 1, without statistical significance (56.4 ± 35.3 days versus 66.0 ± 42.9 days, respectively, p = 0.34). Acquisition of breastfeeding rates was significantly higher in the intervention group (p < 0.05) Conclusions: OMS accelerates the transition to FOF in preterm infants and increases the rates of acquiring breastfeeding skills at discharge.

Point-of-Care Ultrasound for the Tip of the Endotracheal Tube: A Neonatologist Perspective.

OBJECTIVE: Point-of-care ultrasound (POCUS) has been reported to reduce radiation exposure and has been shown to be a reliable bedside technique to confirm endotracheal tube (ETT) placement, but evidence in neonates is still limited. The aim of this study was to compare the effectiveness and reliability of POCUS performed by a neonatologist, as an alternative to chest radiography (CXR) for the optimal position of ETT. STUDY DESIGN: Newborns who underwent intubation were included in this prospective observational study. The CXR was used to evaluate the position of the ETT tip and categorized into three groups: above the T1, between the T1 and T3, and below the T3 vertebra. An experienced neonatologist measured the distance between the ETT tip and the upper border of the aortic arch from the suprasternal notch with ultrasonography (US). A 5 to 10 mm measurement was considered as the optimal distance, and the position was classified into three categories: correct, high, and deep. RESULTS: Among 91 measurements performed on 63 intubated patients with US, 73 (80%) were within the 5 to 10 mm range (correct position). Of these, 61 (92.4%) were determined to be between T1 and 3 vertebrae in CXR. There was no significant difference between the two methods, and the US had an excellent ability to distinguish the correct position of the ETT. The distance measured by the US for the ETT tip to be located between the T1 and T3 vertebrae on CXR should range between 6.17 and 9.0 mm. CONCLUSION: This study showed that the US by an experienced neonatologist is an easy and feasible alternative to determine the position of the ETT in the neonatal intensive care unit. KEY POINTS: · POCUS has been reported to reduce radiation exposure, and it is areliable bedside technique.. · Evidence for confirmation of ETT placement in neonates is limited.. · POCUS can be used for determination of ETT position in NICU's by experienced neonatologists..

A Comparison of Slow Infusion Intermittent Feeding versus Gravity Feeding in Preterm Infants: A Randomized Controlled Trial.

BACKGROUND: The transition to full enteral feeding is important for ensuring adequate growth in preterm infants. AIMS: The aim of this study was to investigate the effects of two different intermittent feeding methods on the transition to full enteral feeding in preterm infants. STUDY DESIGN: A prospective, randomized controlled study was conducted in a neonatology and perinatology center. SUBJECTS: Preterm infants with a gestational age between 24 + 0/7 and 31 + 6/7 were included in this study. They were divided into two groups: the SIF (slow infusion feeding) group and the IBF (intermittent bolus feeding) group. In the SIF group, feed volumes were administered over one hour using an infusion pump through an orogastric tube, with feeding occurring every three hours. The IBF group received enteral feeding using a gravity-based technique with a syringe through an orogastric tube, completed within 10 to 30 min. OUTCOME MEASURES: The primary outcome was the achievement of full enteral feeding and the occurrence of feeding intolerance. RESULTS: A total of 103 infants were enrolled in the study (50 in SIF and 53 in IBF). The time to achieve full enteral feeding did not differ significantly between the two groups (p = 0.20). The SIF group had significantly fewer occurrences in which gastric residual volume exceeded 50% (p = 0.01). Moreover, the SIF group had a significantly shorter duration of non-per-oral (NPO) status than the IBF group (p = 0.03). CONCLUSIONS: It is our contention that the use of the SIF method as an alternative feeding method is appropriate for infants with feeding intolerance and those at high risk of feeding intolerance.

Point-of-Care Ultrasound versus Chest X-Ray for Determining Lung Expansion Based on Rib Count in High-Frequency Oscillatory Ventilation.

INTRODUCTION: Chest X-ray (CXR) is the most prevalent method for evaluating lung expansion in high-frequency oscillatory ventilation (HFOV). The purpose of this study was to compare the accuracy of chest radiography with point-of-care ultrasound (POCUS) in determining lung expansion. METHODS: This prospective study included newborns who required HFOV and were monitored in a neonatal intensive care unit. A single neonatologist assessed lung expansion with CXR and POCUS to measure the costal level of the right hemidiaphragm and compared the results. RESULTS: A neonatologist performed 55 measurements in 28 newborns with a gestational age of 32 (23.2-39.4) weeks, followed by HFOV. The rib counts obtained from anterior chest ultrasonography and posterior CXR showed a statistically high concordance (r = 0.913, p < 0.001). CONCLUSION: Lung ultrasonography is a reliable method for the evaluation of lung expansion based on rib count in patients with HFOV.

The associations between caffeine treatment and common preterm morbidities: a retrospective cohort analysis.

Introduction: Caffeine is one of the most used drugs in the neonatal intensive care units (NICUs). It is widely regarded as beneficial in preventing many morbidities by reducing apnea of prematurity and improving respiratory functions. Methods: Premature infants with gestational ages >25 and <32 weeks who were hospitalized in the NICU between 2008 and 2013 and survived up to discharge were retrospectively analyzed. Infants treated with prophylactic caffeine were compared with historical controls born in 2008 and did not receive caffeine treatment. Maternal and neonatal characteristics and common neonatal morbidities were recorded. Results: A total of 475 patients were analyzed. The patients receiving caffeine were classified as Group 1 (n = 355), and the patients not receiving caffeine were classified as Group 2 (n = 120). Despite the higher incidence of respiratory distress syndrome requiring surfactant therapy and a longer duration of respiratory support in Group 2, the rates of bronchopulmonary dysplasia (BPD) and most other common morbidities were quite comparable. The frequency of apnea was statistically lower in the group that received caffeine prophylaxis (p < 0.01). Conclusion: In this retrospective cohort analysis, we found that caffeine prophylaxis significantly decreased apnea attacks however does not prevent respiratory morbidity such as BPD.

Pain during PICC insertion in preterm infants: the needle is not the only problem.

OBJECTIVE: To evaluate whether warm povidone-iodine (PI) application before peripherally inserted central catheter (PICC) placement eased pain related to the procedure in premature infants and reduced the duration of the procedure and the number of attempts. METHODS: A prospective randomized controlled trial was conducted with infants born before 32 weeks of gestation who required the first placement of the PICC. Skin disinfection was performed with warm PI before the procedure in the warm PI(W-PI) group, whereas PI kept at room temperature was used in the regular PI(R-PI) group. NPASS scores of the infants were evaluated three times: at baseline(T0), during skin preparation(T1), and during needle insertion(T2). RESULTS: Fifty-two infants (26 in the W-PI group,26 in the R-PI group) were enrolled in the study. The perinatal and baseline demographic characteristics did not significantly differ between the two groups. While the median NPASS scores at T0 and T2 were similar between the groups, the median T1 score was significantly higher in the R-PI group(p = .019). While the median NPASS scores at T1 and T2 were similar in the R-PI group, there was a significant difference in the W-PI group, with NPASS scores being significantly lower at T1 compared to T2. The results demonstrate that skin disinfection was just as painful as needle insertion in the R-PI group. The duration of the procedure and the number of needle insertions were significantly lower in the W-PI group. CONCLUSIONS: Before invasive interventions, such as PICC insertion, we recommend warm PI as a part of non-pharmacological pain management.

Effect of withholding feeds on transfusion-related acute gut injury in preterm infants: a pilot randomized controlled trial.

Background: Several retrospective studies have reported an increase in necrotizing enterocolitis (NEC) during the 48 h following red blood cell (RBC) transfusion. Whether withholding enteral feeding during transfusion decreases the risk of transfusion-associated acute gut injury (TRAGI) in preterm infants is unclear.Study design and methods: In this pilot study, 112 preterm infants with gestational age ≤32 weeks and/or birth weight ≤1500 g were randomly assigned to withholding (NPO) or continuance of feeding (FED) during RBC transfusion. Primary outcome measure was development of NEC (stage ≥ 2) within 72 h of a transfusion and the change in abdominal circumference.Results: One hundred fifty-four transfusion episodes (74 NPO and 80 FED) were analyzed. Demographic characteristics were found to be similar in both groups. There was no difference in rates of NEC (0 versus 3.4%; p = .49) between the NPO and FED groups. The incidence of feeding intolerance was higher in the FED group; however, it was statistically insignificant (1.9 versus 6.8%, p = .36). Abdominal circumference remained similar in both groups in all three consecutive days following transfusion (p>.05).Conclusion: This pilot study does not support withholding feedings during transfusion but is not adequately powered to test the hypothesis that NPO decreases NEC rates. Adequately powered well-designed multicenter trials are still required.