[Towards an ideal environment in neonatology]. / Vers un environnement idéal en néonatalogie.

The establishment of sensory systems occurs gradually along a transnatal continuum. During premature birth, hospitalization in neonatology, through its atypical sensory stimulations, can disrupt the development of the baby's still immature brain. To promote harmonious development in children, caregivers and parents must learn to take into account their sensory expectations in order to create the most suitable environment possible for their development.

[Nidcap behavioral observation]. / L'observation comportementale Nidcap.

Who says Neonatal Individualized Developmental Care and Assessment Program (Nidcap) says observation of the baby's behavior. But what is a Nidcap observation? Who are the professionals who can use this method and what are their objectives? How does an observation of this type take place? How do professionals approach their analyzes with parents? Which babies benefit from it? What does this practice bring to the caregiver who uses it? So many questions that are important to address to better understand the Nidcap observation.

[Morphological changes in the epithelium of the auditory tube with prolonged respiratory support in children of the first year of life]. / Morfologicheskie izmeneniya epiteliya slukhovoi truby pri dlitel'noi respiratornoi podderzhke u detei pervogo goda zhizni.

OBJECTIVE: To analyze the condition of the epithelium of the cartilaginous part of the auditory tube in premature and full-term infants with prolonged respiratory support using noninvasive assisted ventilation (continuous positive airway pressure - CPAP) and artificial lung ventilation (ventilator). MATERIAL AND METHODS: All the obtained material is distributed relative to the gestation period into the main and control groups. The main group (25 children) is represented by premature and full-term live-born children who were on respiratory support for a period of several hours to 2 months, the average gestation period of which was 30 weeks and 40 weeks, respectively. The control group (8 children) is represented by stillborn newborns with an average gestation period of 28 weeks. The study was conducted posthumously. RESULTS: Prolonged use of respiratory support in premature and full-term children, regardless of the type (CPAP or ventilator), leads to a violation of the row of cilia of the ciliated epithelium, various inflammatory processes, as well as to the expansion of the ducts of the mucous glands of the epithelium of the auditory tube, which affects its drainage system. CONCLUSION: Prolonged respiratory support causes destructive changes in the epithelium of the auditory tube, which make it difficult to evacuate the mucous discharge from the tympanic cavity. This negatively affects the ventilation function of the auditory tube and in the future may lead to the development of chronic exudative otitis media.

[André Bullinger's contributions to the management of prematurity in neonatology]. / Les apports d'André Bullinger à la prise en charge de la prématurité en néonatologie.

Between 30 and 50 % of very premature babies have disorders that can affect their schooling, training and future life. Their origin is often multifactorial, and environmental, socioeconomic and family factors can influence the subsequent development of these children. Among these factors, the neonatal environment, which is generally very noisy and bright, as well as the numerous tactile solicitations, have been blamed. In 1978, the kangaroo method transformed this reality by improving the parent-baby relationship and reducing neonatal mortality. Since then, a trend has developed around developmental care with the Neonatal Individualized Developmental Care Assessment Program and the approach of André Bullinger.

Soins du corps et développement de l'enfant prématuré.

Body care and development of the premature infant. The observation of newborns' reactions to different stimulations enables their behaviour to be interpreted and the support provided to be adjusted. Developmental care such as swaddling, tucked posture and skin-to-skin contact favours the harmonious development of premature infants and encourages the parents to become involved in their care as early as possible.

Cardiac catheterisation in infants weighing less than 2500 grams.

OBJECTIVES: The aim of the study was to report the outcome of cardiac catheterisation in low-weight patients. BACKGROUND: Data regarding cardiac catheterisation in infants weighing <2500 g are scarce. METHODS: We reviewed all cardiac catheterisations performed in infants weighing <2500 g between January 2000 and May 2016. An analysis with respect to the type of procedure, the complexity of procedure (procedure type risk), and haemodynamic vulnerability index was finally carried out. We report the occurrence of deaths and complications using the adverse event severity score. RESULTS: A total of 218 procedures were performed on 211 patients. The mean age and weight were, respectively, 15 ± 26 days (range, 0-152) and 2111 ± 338 g (range, 1000-2500). Procedures were interventional and diagnostic, respectively, in 174 (80%) and 44 (20%) patients. Out of 218, 205 (94%) were successful. Eleven complications (5%) occurred - six with an adverse event severity score of 4 and five with an adverse event severity score of 3. Ten patients (91%) showed a favourable outcome, and one died (stent thrombosis few hours after patent ductus arteriosus stenting). No correlation was found between lower weight and occurrence of death (p = 0.68) or complications (p = 0.23). The gravity scores (procedure type risk and haemodynamic vulnerability index) were not predictive of complications. CONCLUSIONS: Cardiac catheterisation in infants weighing <2500 g appears feasible and effective with low risk. The weight should not discourage from performing cardiac catheterisation in this population.

A Preemie Outcome That Is Truly Inspiring.

An expected complex outcome of a premature infant need not be assumed completely life limiting. Take Erik Zimmerman, an adult born early 40+ years ago that did end up with cerebral palsy. Yet he chose the gifts that the diagnosis provides and proves many people wrong in terms of what he can and cannot do. The result is a wonderful interview with an inspiring individual and tips for neonatal nurses that will inform them in the NICU as they carry forward wisdom to new families facing the same challenges.

[Skin-to-skin practice and bonding in neonatal intensive care]. / Pratique du peau à peau et attachement en réanimation néonatale.

Neonatal intensive care is an emotionally charged unit. In addition to delivering specific care to the premature newborn, the role of the caregivers is to support the parents in their new role and to include them in the care. The creation of the bond between the parents and the premature infant in this context is specific. The children's nurse, through touch and the practice of skin-to-skin contact, can help them establish these first bonds.

Cortisol and blood pressure levels decreased in fathers during the first hour of skin-to-skin contact with their premature babies.

AIM: Premature birth is an extremely stressful experience. In 2013 to 2014, we explored the physiological stress responses of fathers during their first skin-to-skin contact (SSC) with their new baby. METHODS: We recruited 49 fathers whose partners had given birth to a premature baby of up to 33 weeks and three days. The study, in the neonatal intensive care unit (NICU) of a Quebec hospital, measured the physiological stress responses of the fathers before and after they first experienced SSC with their new baby. Cortisol levels and blood pressure were measured, and a generalised estimating equation was used for the data analysis. RESULTS: The fathers' cortisol levels decreased from 10.55 nmol/L, with a 95% confidence interval (95% CI) of 9.61-11.59 at the beginning of the experiment to 8.26 nmol/L (95% CI: 7.51-9.07) after 75 minutes. Meanwhile, their systolic blood pressure decreased from 135.16 mmHg (95% CI: 130-140) to 125.25 mmHg (95% CI: 121-129). CONCLUSION: Fathers who held their baby in SSC for the first time showed a significant reduction in physiological stress responses. Our findings support hospital practices that enable fathers to experience their first intimate contact with their newborn infant in the NICU.

Real Awareness in the NICU and Through the Lifespan.

Awareness of prematurity goes well beyond the birth and the NICU stay. It is a life span matter, one that the neonatal field needs to re-think in terms of helping better the outcomes in babies. Deb Discenza tells the all-too-real scenario of her daughter's fate and how that is driving her passion of advocating for preemies and their families to a whole new level.

The Top Ten Things Parents Want to Hear From You in the NICU.

Connecting with a family is a huge challenge for nurses as they are more focused on the technical aspects of caring for the premature infant in the NICU. In this column, the top ten things parents want to hear from nurses in a variety of scenarios help to provide insight into the patient family mind-set and how to best work with them.

The Other Side of the Incubator: A Preemie Turns 40 Years Old.

Deb Discenza interviews Geoff, a preemie born almost 40 years ago, and gets unique insight into his birth, his NICU stay, and life afterward.

Bilirubin Uridine Diphosphate-glucuronosyltransferase Polymorphism as a Risk Factor for Prolonged Hyperbilirubinemia in Japanese Preterm Infants.

OBJECTIVE: To determine whether a variant of the bilirubin uridine diphosphate-glucuronosyltransferase gene (UGT1A1*6) is a risk factor for prolonged hyperbilirubinemia in preterm infants. STUDY DESIGN: UGT1A1 genotypes in 46 Japanese preterm infants (<37 weeks of gestation) were compared with UGT1A1 genotypes in 38 control infants, using polymerase chain reaction-direct sequencing. Prolonged unconjugated hyperbilirubinemia was defined as serum total bilirubin concentration of >150 µmol/L (8.77 mg/dL) beyond 14 days of life. RESULTS: In the case group, 41 of 46 infants (89.1%) had a polymorphic variant, c.211G>A, p.G71R (UGT1A1*6). In the control group, 7 of 38 (18.4%) had UGT1A1*6. The allele frequency of UGT1A1*6 was 0.641 in the prolonged hyperbilirubinemia group, which was significantly higher than in the control group (0.092; P < .001). In total, 39 of 46 infants in the case group were breast fed, and only 10 infants in the control group were breast fed. CONCLUSIONS: These data suggest that UGT1A1*6 is a risk factor for prolonged unconjugated hyperbilirubinemia in preterm infants in Japan. Given the different rate of breast feeding in this study, additional data are necessary for drawing a definitive conclusion.

The effect of individualised developmental care practices on the growth and hospitalisation duration of premature infants: the effect of mother's scent and flexion position.

AIM AND OBJECTIVE: To assess the effect of individualised developmental care practices on the growth and hospitalisation duration of premature infants. BACKGROUND: It is known that individualised developmental care practices enable premature infants to have enhanced weight gain, decreased intensive care complications, and earlier discharge from the hospital. DESIGN: The study used an experimental design. METHODS: The study was carried out with premature infants who received treatment and care in the newborn intensive care unit (n = 97). Infants were randomised into three groups: mother's scent, flexion and control. Infants were monitored each day until discharge and the measurements were recorded. The data obtained were analysed by t-test, percentage distributions, means, chi-square test, analysis of variance and Bonferroni test. RESULTS: There was a significant difference between experimental and control groups in terms of means of their discharge weight and height, and this difference was associated with the mother-scent group (p < 0·05). While the within-group difference between hospitalisation and discharge weight means was significant only in the mother-scent group (p < 0·05), the within-group difference between hospitalisation and discharge height means was significant in all three groups (p < 0·05). Even though the within-group difference between means of hospitalisation duration of premature infants was insignificant (p > 0·05), means in the experimental groups were determined to be lower than the means in the control group. CONCLUSION: As the methods of mother's smell and flexion position interventions support premature infants' growth and shorten their hospitalisation duration, it is important to use them routinely at newborn intensive care unit. RELEVANCE TO CLINICAL PRACTICE: Newborn intensive care unit nurses may nurse premature infants in the flexion position to enable them to sense their mother's scent and this may to accelerate their growth and shorten their hospitalisation duration.

Placement of transurethral urinary drainage catheter using microwire in a newborn with posterior urethral valve: A better alternative to suprapubic catheterization.

Posterior urethral valves (PUV) present significant challenges in neonatal urinary management, often indicating the use of a suprapubic catheter (SPC). However, complications associated with SPC, coupled with specific contraindications call for alternative approaches. Here, we present a case of successful transurethral catheterization in a 1-day-old premature male infant with PUV, utilizing bedside Ultrasound without anesthesia, effectively alleviating the need for a SPC. The procedure involved careful wire insertion and subsequent catheter placement, facilitating urine drainage, and enabling a micturating cystourethrogram (MCUG) using the same access point. By avoiding SPC-related risks and allowing for essential diagnostic procedures, this approach presents itself as a less invasive and possibly better initial option, particularly in cases where SPC may pose complications. Our findings suggest that ultrasound-guided transurethral catheterization offers a minimally invasive and effective alternative to SPC, proving its potential to enhance patient care and outcomes in challenging PUV cases.

The Added Effect of Music-Assisted Kangaroo Care Applied to Mothers with Premature Babies in the Intensive Care Unit on the Amount of Breast Milk, the Initiation Time of Breastfeeding, and Anxiety Level.

Background: The aim of this study is to determine the effect of music-assisted kangaroo care, applied to mothers with premature babies in the intensive care unit on the amount of breast milk, the initiation time of breastfeeding, and the level of anxiety. Methods: The study was carried out with mothers whose premature babies were hospitalized in the neonatal intensive care unit. The sample size of the study was 99 mothers. Results: 85.5% of the mothers were aged >35 years, 30.1% were high school graduates, 38.6% had equal income and expenses and 77.1% had a cesarean section. The state and trait anxiety levels of the mothers in the music assisted kangaroo care (MAKC), kangaroo care (KC), and control (C) groups decreased after the first day according to the follow-up times. The trait anxiety levels of the mothers in the MAKC group experienced on the first and sixth days were lower than those of the mothers in the KC and C groups, with the statistically significant differences (p < 0.05). It was found that the mothers in the MAKC group started breastfeeding earlier than those in the KC and C groups, and the difference was statistically significant (p < 0.05). Conclusion: A significant difference was found between the MAKC and KC groups and the control group in terms of an increase in the amount of milk, a decrease in trait anxiety levels, and early initiation of breastfeeding (p < 0.05).

Circadian Variation of Immune Cell Populations in Preterm Human Milk: A Preliminary Study.

Introduction: Breast milk contains both nutritional and non-nutritional components for the newborn, with some of the latter exhibiting marked diurnal variations in concentration. This study aimed to analyze the circadian behavior of specific immune cell populations and proinflammatory cytokines present in the transitional milk of premature infants. Methods: The study quantified cellular components, including stem and immune cells, using flow cytometry. Additionally, ELISA assays were employed to measure proinflammatory cytokine concentrations. Results: Flow cytometry analyses revealed a diurnal rise in the percentage of CD23+, CD32+, CD36+, CD2+, and Tγδ cell populations. Conversely, nocturnal increases were observed in the percentage of CD16+, CD19+, and CD4+ populations. Notably, CD3+ and CD8+ populations did not exhibit any rhythmic variations. Proinflammatory cytokine concentrations were found to be higher in daytime milk samples compared to those collected at night. Conclusion: This study demonstrates rhythmic fluctuations in both immune cell populations and proinflammatory cytokine concentrations within the transitional milk of premature mothers.

Longitudinal study for the early detection of autism in children with very preterm birth.

INTRODUCTION: Very preterm birth is an important risk factor for autism spectrum disorder (ASD). The aim of this study is the early detection of ASD risk, using a follow-up protocol, in children weighing less than 1500 g at birth or born before 32 weeks of gestation. METHODS: This is a prospective longitudinal study in which a total of 133 very premature babies were monitored to the age of 2 years with the M-CHAT autism screening test and, in the event of a positive result, the Autism Diagnostic Observation Schedule (ADOS-2). RESULTS: 53 cases (4 out of 10) screened positive, and the rest negative. Among the positives, the ADOS-2 was administered in 50 cases, of which 24 scored above the ASD cutoff point. The average age of detection was 25.39 months. The results suggest an estimated prevalence of ASD in the very premature population of 18.46 %. CONCLUSIONS: The application of the follow-up protocol in the very premature population is effective for early detection of ASD.

Closure of patent ductus arteriosus in children, small infants, and premature babies with Amplatzer duct occluder II additional sizes: multicenter study.

OBJECTIVES: To evaluate safety and efficacy of closure of patent ductus arteriosus (PDA) with Amplatzer duct occluder II Additional Sizes (ADO II AS) and to report early and midterm results of the device in children and very young symptomatic infants. METHODS: Retrospective analysis of angiographic data of 60 children from four pediatric cardiology centers. RESULTS: The median patient age and weight were 6.5 (0.5-168) months and 6.8 (1.19-57) kg, respectively. In the study, 26 children had a body weight of ≤ 6 kg. Of these 26 children, 9 had a body weight of ≤ 3 kg. The median narrowest diameter of PDA was 2 (1.2-4) mm. Ductal anatomy was Type A in 29, Type B in 2, Type C in 11, Type D in 1, and Type E in 16 patients, and a residual PDA after surgery in 1 patient. Closure with ADO II AS was achieved in 58 (96.6%) of 60 attempted cases. In two infants, the device was not released because of significant residual shunt. ADO II was used in one, and the other was sent to surgery. Complete closure was observed in all ADO II AS deployed children by the next day on echocardiography. Median follow-up was 12 (1-18) months. Neither death nor any major complications occurred. CONCLUSIONS: Our study shows that closure of medium and small sized PDA by using ADO II AS device is effective and safe in children. The use of the device will expand the field of application of PDA closure in small infants.

Vaccination against pertussis in Latin American preterm and low-birth weight infants: experts opinion position for a neglected childhood age group.

BACKGROUND: Pertussis remains as one of the oldest leading vaccine-preventable diseases of childhood, despite many decades of primary vaccine doses' and boosters' implementation. Although the epidemiology is well understood in infants and children, premature babies and low-birth weight infants remain a special group where the disease incidence is unknown, severity of the disease is considerable, and specific vaccination recommendations are scarce. RESEARCH DESIGN AND METHODS: A retrospective review of the available evidence of pertussis vaccination in premature and low birth weight infants was analyzed from January 2000 to December 2022 in six selected countries: Argentina, Mexico, Colombia, Panamá, Costa Rica, and Chile. RESULTS: Chile had reports of adverse effects associated with vaccination of premature infants with the pentavalent vaccine, and their rationale to switching to the hexavalent vaccine. Colombia had reports of the justification for the use of hexavalent vaccine in prematures in the Neonatal Units and Kangaroo Mother Programs throughout the country. Mexico had selected publications of the vaccination status in prematures and low-birth weight infants. CONCLUSION: Despite its importance, increased morbidity, and highest risk of complications in premature babies, there is a paucity of information of vaccine recommendations and coverage rates among selected Latin American infants.