Prevalence and Clinical Significance of Urinary Tract Infection among Neonates Presenting with Unexplained Hyperbilirubinemia in Lebanon: A Retrospective Study.

BACKGROUND: Neonatal jaundice is commonly seen in term and preterm newly born babies. It could be either physiologic or secondary to multiple underlying pathologies like urinary tract infection (UTI). Our main objective was to confirm the relationship between neonatal jaundice without apparent cause like hemolysis and the presence of UTI. MATERIALS AND METHODS: We, retrospectively over a period extended from 2017 to 2020, included 496 babies admitted for elevated indirect hyperbilirubinemia for whom demographic, clinical, laboratory, and therapeutic data were collected through a detailed questionnaire. RESULTS: Our study included 496 neonates and showed a prevalence of UTI in 8.9% of neonates. The two most common microorganisms in urine culture were Escherichia coli (65.9%) and Klebsiella pneumoniae (25.0%). A multivariate logistic analysis showed that UTI was associated with male neonates (odds ratio [OR] = 2.366, 95% confidence interval [CI]: 1.173 - 4.774; P = 0.016), history of prenatal UTI (OR = 5.378, 95% CI: 2.369 - 12.209; P <0.001), poor feeding (OR = 3.687, 95% CI: 1.570 - 8.661; P = 0.003), and positive urine culture in catheter (OR = 2.704, 95% CI: 1.255 - 5.826; P = 0.011). The mean length of stay was higher in patients with positive UTI (Median = 216 hours) compared to patients with negative UTI (Median = 48 hours) (P <0.001). CONCLUSION: Neonatal sreening for UTI should be recommended whenever there is unexplaind early or prolonged hyperbilirubinemia with no evidence of alloimmune hemolysis or blood group incompatibility and to prevent the morbidity of urosepsis and congenital kidneys malformations.

Promoção das competências alimentares do recém-nascido: intervenções centradas no neurodesenvolvimento / Promoting newborn feeding skills: interventions focused on neurodevelopment

A evolução científica e tecnológica na área de enfermagem, tem ganho um destaque no cuidado ao recém-nascido, sendo que nas unidades de cuidados intensivos neonatais se tem assistido a uma mudança de cultura na promoção de cuidados holísticos e de intervenções neuroprotetoras. Apesar dos avanços científicos e tecnológicos os recém-nascidos pré-termo mantêm-se vulneráveis às consequências da prematuridade, nomeadamente no que diz respeito à otimização da nutrição. Um dos desafios dos enfermeiros é potenciar o desenvolvimento de competências do RN na transição para a alimentação oral, de forma segura e eficaz, promovendo a autonomia alimentar. O presente Relatório de Estágio pretende evidenciar o desenvolvimento e aquisição das competências de Enfermeiro Especialista em Enfermagem de Saúde Infantil e Pediátrica durante o percurso de formação, sob a temática escolhida: promoção das competências alimentares no recém-nascido. O processo formativo foi suportado numa metodologia crítica e reflexiva, baseada na evidência científica e no Modelo de Sistemas de Betty Neuman, enquanto referencial teórico de enfermagem, nos Cuidados Centrados na Família e nos Cuidados Não Traumáticos enquanto pilares de enfermagem pediátrica e ainda no modelo dos Cuidados para o Desenvolvimento, baseados na Teoria Sinativa de Desenvolvimento de Als. Das atividades desenvolvidas destacam-se a realização de duas sessões de formação sobre as competências alimentares do recém-nascido e a apresentação a escala de avaliação das competências oromotoras através da escala Early Feeding Skills Versão Modificada.

The scientific and technological development in nursing has gained prominence in newborn care and neonatal intensive care units have witnessed a change of culture in the promotion of holistic care and neuroprotective interventions. Despite scientific and technological advances, preterm newborns remain vulnerable to the consequences of prematurity, particularly regarding the optimisation of nutrition. One of the main challenges nurses face is to promote the development of the newborn's skills in the transition to oral feeding, by safely and effectively promoting feeding autonomy. This Report aims to highlight the development and acquisition of skills as Specialist Nurse in Child Health and Paediatric Nursing, during the reflective practice, under the main problematic: promotion of feeding skills in newborns. This learning process is based on a critical and reflective methodology, supported by scientific evidence and Betty Neuman's Systems Model, as a nursing theoretical framework. It is also sustained by Family Centred Care and Non-Trauma Care, as pillars of paediatric nursing, and backed by Developmental Care Model, based on Als´s Synactive Theory of development. Among the activities developed, two training sessions stand out regarding the feeding skills of the newborn and the presentation of oromotor skills, using the Early Feeding Skills Modified Version asessment scale.

Bullous lesions following phototherapy in a newborn

ABSTRACT A male infant presented with progressive jaundice immediately after birth. Fecal acholia and choluria associated with extensive bullous skin lesions in his trunk, abdomen, and upper and lower limbs developed during phototherapy. Several diagnostic hypotheses were presented, including neonatal porphyria, hemochromatosis, Alagille syndrome, and neonatal lupus. A 24-hour urine sample for the dosage of urinary porphyrins was collected, showing high results (1823.6µg in 100mL). At 50 days of life, fluorescence spectroscopy using a Wood's lamp revealed simultaneous bright red fluorescence of urine-stained diapers and sample blood. A definitive diagnosis of congenital erythropoietic porphyria was made following identification of a mutation of the uroporphyrinogen synthetases III gene on genetic testing. The patient was subsequently maintained in a low light environment since then, resulting in improvement of the lesions. Congenital erythropoietic porphyria is a disease of the group of porphyrias that presents shortly after birth with blistering occurring in regions exposed to the sun or other ultraviolet light. Atrophic scars, mutilated fingers, and bright red fluorescence of the urine and teeth may also be observed. There is no specific treatment, and prophylaxis comprising a total avoidance of sunlight is generally recommended. A high degree of suspicion is required for diagnosis. An early diagnosis can lead to less damage. Here, we present the case of a newborn with congenital erythropoietic porphyria diagnosed after presenting with bullous lesions secondary to phototherapy.

Cuidados de enfermagem aos recém-nascidos submetidos a fototerapia em unidades neonatais: um protocolo de scoping review / Nursing care for newborns undergoing phototherapy in neonatal units: a scoping review protocol

Objetivo: Mapear a produção do conhecimento sobre os principais cuidados de enfermagem realizados aos recém-nascidos submetidos a fototerapia em unidades neonatais. Método: Trata-se de um protocolo de revisão de escopo, realizado de acordo com a metodologia do Joanna Briggs Institute e checklist do Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), seguindo as seguintes etapas: seleção da questão de pesquisa; busca por estudos relevantes; seleção dos estudos; extração e análise dos dados; e, agrupamento, resumo e apresentação dos resultados. Para identificar os documentos as seguintes bases de dados bibliográficas serão pesquisadas: Medical Literature Analysis and Retrievel System Online, Cumulative Index to Nursing & Allied Health Literature, Web of Science, SciVerse Scopus, Base de Dados de Enfermagem, Literatura Latino-Americano e do Caribe em Ciências da Saúde, Scientific Electronic Library Online, Cochrane Library, Catálogo de Teses e Dissertações da Capes e Google Acadêmico. O resultado do fluxo de seleção, desta etapa metodológica, será apresentado em forma de figura, conforme o Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Resultados: O mapeamento dos dados permitirá o agrupamento dos cuidados além de evidenciar a necessidade destes para os recém-nascidos submetidos à fototerapia. Conclusão: Espera-se salientar a indispensabilidade dos cuidados de enfermagem a este público e reforçar a necessidade de educação continuada aos profissionais.

Objetivo: Mapear la producción de conocimiento sobre los principales cuidados de enfermería brindados a las criaturas recién nacidas sometidas a fototerapia en unidades neonatales. Revisión: Se trata de un protocolo de revisión del alcance realizado, según la metodología del Instituto Joanna Briggs y la lista de verificación Elementos de informe preferidos para revisiones sistemáticas y extensión de metaanálisis para revisiones de alcance (PRISMA-ScR). Lo anterior, siguiendo los siguientes pasos: selección de la pregunta de investigación, buscar estudios relevantes, selección de estudios, extracción y análisis de datos y, agrupar, resumir y presentar los resultados. Para identificar los documentos, se buscará literatura en las siguientes bases de datos: Sistema de recuperación y análisis de literatura médica en línea, Índice acumulativo de enfermería y Literatura relacionada con la salud, Web of Science, SciVerse Scopus, base de datos de Enfermería, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Scientific Electronic Library Online, Cochrane Library, Capes Theses and Dissertations Catalog y Google Scholar. El resultado del flujo de selección de este paso metodológico se presentará en forma de figura, de acuerdo con PRISMA-ScR. Resultados: El mapeo de datos permitirá la agrupación de cuidados, además, resaltar la necesidad de estos para las criaturas recién nacidas sometidas a fototerapia. Conclusión: Se espera resaltar la indispensabilidad del cuidado de enfermería para este público y reforzar la necesidad de educación continua para las personas profesionales en esta área.

Objective: To map the production of knowledge on the main nursing care provided to newborns undergoing phototherapy in neonatal units. Method: This is a scoping review protocol carried out following the Joanna Briggs Institute methodology and the Preferred checklist Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The following the following steps were followd: selection of the research question, search for relevant studies, selection of studies, data extraction and analysis, and, grouping, summarizing and presenting the results. The following databases will be consulted to identify the documents: Medical Literature Analysis and Retrievel System Online, Cumulative Index to Nursing & Allied Health Literature, Web of Science, SciVerse Scopus, Database of Nursing, Latin American and Caribbean Literature in Health Sciences, Scientific Electronic Library Online, Cochrane Library, Capes Theses and Dissertations Catalog, and Google Scholar. The result of this methodological step's selection flow will be presented in figure form as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: The data mapping will allow the grouping of care and it will also highlight the need for care in newborns undergoing phototherapy. Conclusion: It is expected to highlight the indispensableness of nursing care for this public and reinforce the need for continuing education in professionals.

Desfechos maternos e neonatais em servidoras públicas estaduais de São Paulo com idade materna avançada / Maternal and neonatal outcomes in state public servants of São Paulo with advanced maternal age

Objetivo: Caracterizar a população das gestantes em diferentes faixas etárias; avaliar desfechos maternos e neonatais em pacientes com idade materna avançada; determinar a faixa etária a partir da qual os desfechos adversos foram mais prevalentes. Métodos: Parturientes atendidas no Hospital do Servidor Público Estadual de São Paulo entre junho/2019 e maio/2020 foram divididas em três grupos ­ 20 a 34 anos; 35 a 39 anos; 40 anos ou mais ­ e analisadas quanto a diversas variáveis. Resultados: Entre as gestantes do Serviço, 44,2% tinham idade materna avançada. A amostra foi composta por 927 pacientes, a maioria com relacionamento conjugal estável (75,2%) e ensino de nível superior (74,7%). Independentemente do grupo etário, foram observados elevados índices de obesidade (25,9%), sobrepeso (39,7%) e cesariana (76,4%). A frequência de iteratividade, diabetes gestacional e doença hipertensiva específica da gestação foi maior a partir dos 35 anos, e a frequência de hipertensão arterial crônica foi maior a partir dos 40 anos. Neonatos de pacientes com 40 anos ou mais tiveram maiores índices de baixo peso ao nascer, óbito neonatal, Apgar de quinto minuto < 7 e necessidade de reanimação neonatal. Conclusão: Pacientes com idade materna avançada representaram porcentagem expressiva da população e tiveram maior frequência de desfechos adversos. Complicações obstétricas foram mais prevalentes a partir dos 35 anos, com destaque para diabetes gestacional e distúrbios hipertensivos. Resultados neonatais desfavoráveis, como baixo peso ao nascer e óbito neonatal, foram mais prevalentes a partir de 40 anos.

Objective: Featuring the population of pregnant women in different age groups; assessing maternal and neonatal outcomes in patients at advanced maternal age; determining the threshold age for the potential prevalence of adverse outcomes. Methods: Women in labor assisted at Hospital do Servidor Público Estadual de São Paulo between June/2019 and May/2020 were divided into three age groups ­ 20 to 34 years; 35 to 39 years; over 40 years ­, who were assessed for several variables. Results: 44.2% of pregnant women in this Service were at advanced maternal age. The sample counted on 927 patients, most of them declared stable marital relationships (75.2%) and College degree (74,7%). High obesity levels (25.9%), overweight (39.7%) and cesarean delivery (76.4%) were observed, regardless of age group. Maternal request was the main indication for cesarean surgery. Iteration frequency, gestational diabetes and pregnancy-specific hypertensive disease was higher from the age of 35 years, on. Chronical high blood pressure was higher in the age group over 40 years. Newborns from patients older than over 40 years presented higher low weight at birth index, neonatal death, 5th minute Apgar score < 7 and the need of neonatal resuscitation. Conclusion: Patients at advanced maternal age recorded higher obstetric adversity frequency in the age group over 35 years, with emphasis on gestational diabetes and high blood pressure. Unfavorable neonatal outcomes related to low weight at birth and neonatal death were more prevalent in the age group over 40 years.

Effect of pediatric Tuina combined with nerve growth factor therapy on neural function of children with acute ischemic hypoxic encephalopathy / 国际中医中药杂志

Objective:To explore the effect of pediatric massage combined with nerve growth factor treatment on the neurological function of children with acute ischemic hypoxic encephalopathy (HIS).Methods:A total of 96 children with HIS who were treated in Hubei Maternal and Child Health Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from February 2017 to October 2019 were selected for the study. The children were divided into 2 groups using a random number table method, with 48 cases in each group. The control group was treated with nerve growth factor on the basis of conventional treatment, and the observation group was treated with pediatric massage on the basis of the control group. The clinical efficacy, neurobehavior, intelligence index, EEG index, cerebral blood flow and hematology index were compared between the two groups.Results:The total effective rate of the observation group was 95.84%, which was higher than 81.25% of the control group, and the difference between the two groups was statistically significant ( χ2=5.03, P=0.025). The 28-day NBNA score ( t=-2.55, P=0.012) and three-month MDI and PDI of the observation group were significantly higher than those of the control group ( t values were -3.43, -2.65, all Ps<0.01). After treatment, the EEG spike wave amplitude of the two groups of children decreased significantly, and the decrease was greater in the observation group[(35.02 ± 4.16) mV vs. (46.92±5.81)mV, t=11.54]. After treatment, the cerebral blood flow of the two groups of children increased significantly, and the increase was more significant in the observation group [(179.36 ± 22.25) ml/(100 g?min) vs. (158.30±14.92) ml/(100 g?min), t=-5.45]. After treatment, the levels of MBP, NSE and VEGF in the two groups of children decreased significantly, but the decrease in the observation group was greater ( t values were 3.29, 4.07, 8.17, all Ps<0.01). Conclusion:Pediatric massage combined with nerve growth factor alone can improve the curative effect of children with HIS, improve neurobehavioral and intelligent indicators, increase cerebral blood flow, and reduce EEG spike wave amplitude and MBP, NSE and VEGF levels.

Correlation of transcutaneous bilirubin level of shielded skin and total serum bilirubin level after phototherapy in premature infants / 中国新生儿科杂志

Objective:To study the correlation between transcutaneous bilirubin (TcB) level measured from shielded skin and total serum bilirubin (TSB) level after phototherapy in premature infants.Methods:From July 2019 to July 2021,preterm infants with jaundice admitted to the Department of Neonatology of our hospital and received phototherapy were prospectively enrolled in the study. The infants were assigned into 26~31w group, 32~34w group and 35~36w group according to their gestational ages. During phototherapy, the forehead, the chest and the perineum were shielded. TcBs were measured at the above mentioned areas three times each before and after phototherapy and TSB was measured from venous blood samples.Results:A total of 306 premature infants were included, with 51 cases in 26~31w group, 126 cases in 32~34w group and 129 cases in 35~36w group. Before phototherapy, TcBs of the forehead, the chest and the perineum of all infants were correlated with TSB ( r=0.699, 0.913, 0.734, P<0.001) with TcB of the chest showed the best correlation. A linear regression equation was established using the TSB before phototherapy and the TcB of the chest: TSB=0.634+0.912TcB. After phototherapy, TcBs of the forehead, the chest and the perineum of all infants were also correlated with TSB ( r=0.586, 0.879, 0.690, P<0.001) with TcB of the chest showed the best correlation and the linear regression equation was TSB=1.910+0.736TcB. Conclusions:For preterm infants with gestational age of 26~36w, TcB of the shielded chest skin after phototherapy is correlated with TSB and a linear regression model can be established.

Twelve-section ultrasonic screening diagnosis method for neonatal complex congenital heart disease in primary hospitals at county level / 中华围产医学杂志

Objective:To investigate the feasibility of "twelve-section ultrasonic screening diagnosis method" in screening for neonatal complex congenital heart disease (CHD) in primary hospitals.Methods:This is a prospective study. A total of 71 580 newborns were screened for CHD using the "twelve-section ultrasonic screening diagnosis method" from four pilot units in Hebei province, which were Bo'ai Hospital of Huanghua Development Zone, Traditional Chinese Medicine Hospital of Fengning County, Maternity & Child Healthcare Hospital of Tang Country, and Maternity & Child Healthcare Hospital of Rongcheng Country, from November 2015 to December 2019. Another 262 children with CHD were enrolled, including 39 with complex CHD. These cases received ultrasonography at four pilot units above and then were transferred to CHD Screening Diagnosis and Treatment Center of Hebei Children's Hospital (our center) prior to the implementation of "twelve-section ultrasonic screening diagnosis method" from June 2012 to June 2014, who were all confirmed by surgery. Set the diagnosis results of our center as the gold standard, the sensitivity, specificity, and diagnostic consistency rate in screening for complex CHD cases were calculated. Receiver operating characteristic (ROC) analysis and Chi-square test were used to compare and analyze the sensitivity for screening neonatal complex CHD before and after implementing the method. The screening results of complex CHD after implementing the method between the pilot units and our center as well as between the four pilot units were compared and analyzed using Chi-square test. Results:A total of 553 (0.77%) CHD cases were detected by the "twelve-section ultrasound screening diagnosis method", including 66 cases of complex CHD and 487 cases simple CHD. Among the cases screened using the method, there were three false negative cases (one case with total anomalous pulmonary venous drainage, one with abnormal coronary artery originating from pulmonary artery, and one with atresia of distal to the left subclavian artery, aortic arch and left aortic arch of double-arch), one false positive case (false echo loss of aortopulmonary septal that was misdiagnosed as aortopulmonary septal defect), five cases of misdiagnosis (one common pulmonary venous atresia case that was misdiagnosed as total anomalous pulmonary venous drainage, one persistent stenosis of the fifth aortic arch that was misdiagnosed as coarctation of aorta, one pulmonary artery sling that was misdiagnosed as absence of left pulmonary artery, one severe coarctation of aorta that was misdiagnosed as interruption of aortic arch, and one aortic isthmus atresia that was misdiagnosed as coarctation of aorta), and all were complex CHD cases. A total of 68 cases (12.3%) of complex CHD were confirmed by our center. The overall sensitivity, specificity, and diagnostic consistency rate of screening were 95.6% (65/68), 99.8% (484/485), and 86.8% (59/68), respectively and the area under ROC curve was 0.98. Before the implementation, the overall sensitivity, specificity, and diagnostic coincidence rates of ultrasonic screening for complex CHD were 69.2%(27/39), 95.5%(213/223), and 61.5% (24/39), respectively, and the area under ROC curve was 0.82. The sensitivity of complex CHD screening was significantly increased after implementing the method ( χ2=14.28, P<0.05). There was no significant statistical significance in the sensitivity for screening complex CHD after the implementation between the pilots and our center or between the four pilots (all P>0.05). Conclusions:"Twelve-section ultrasonic screening diagnosis method" is suitable for the screening of neonatal complex CHD in hospitals at the county level. However patients with some special types of complex CHD are recommended to be transferred for a more accurate diagnosis.

Hemolytic disease in a neonate caused by anti-c antibody / 中华围产医学杂志

We report a case of hemolytic disease of the newborn (HDN) caused by anti-c antibody. The baby boy presented progressive jaundice on his face and trunk one hour after birth. Total bilirubin of 168.1 μmol/L was detected six hours after birth and positive results of direct antiglobulin test, serum free antibody test, and erythrocyte releasing antibody test were obtained. His blood type was O and RhDCcEe, while his mother was A and RhDCCee. IgG anti-c antibodies were identified in the maternal blood serum with the titer of 1∶4. After phototherapy, immunoglobulin infusion, and medication, the boy was recovered and discharged from the hospital. The boy was normal in both physical and neurobehavioral development at one and three months after discharge.

Glucose and reflexology for pain relief during arterial puncture in neonates: a protocol / Glucosa y reflexoterapia para alivio del dolor durante la punción arterial en neonatos: un protocolo / Glicose e reflexoterapia para alívio da dor durante punção arterial em neonatos: um protocolo

ABSTRACT Objective To present a study protocol to compare glucose and reflexology in pain relief in neonate intensive care during arterial punctures. Methods A randomized, controlled, double-blind clinical trial protocol will be carried out at a teaching hospital maternity, with30 newborns admitted to neonate intensive care who are to undergo blood collection by arterial puncture. They will be randomly assigned to a control group (25% glucose) or an intervention group (foot reflexology). The primary outcome will be neonate pain scores during and after arterial puncture. Secondary outcomes will be crying time and variation in neonates' vital signs during and after the arterial puncture procedure. Registration number RBR-639bff. Discussion The results of this trial will provide new insights into the most appropriate intervention for the relief of neonate pain during painful procedures.

RESUMEN Objetivo Presentar un protocolo de estudio para comparar glucosa y reflexología en el alivio del dolor en cuidados intensivos neonatales durante la punción arterial. Método Protocolo de ensayo clínico aleatorizado, controlado, doble ciego, en 30 recién nacidos en cuidados intensivos neonatales en la maternidad de un hospital escuela, que necesiten extracción de sangre por punción arterial. Serán asignados aleatoriamente a un grupo control (25% de glucosa) o a un grupo de intervención (reflexología podal). El resultado primario serán los escores de dolor neonatal durante y después de la punción arterial. Los resultados secundarios serán el tiempo de llanto y la variación en los signos vitales de los recién nacidos durante y después del procedimiento de punción arterial. Número de registro RBR-639bff. Discusión Los resultados de este ensayo proporcionarán nuevos conocimientos sobre la intervención más adecuada para el alivio del dolor neonatal durante los procedimientos dolorosos.

RESUMO Objetivo Apresentar um protocolo de estudo para comparar a glicose e reflexoterapia no alívio da dor em terapia intensiva neonatal durante a punção arterial. Método Protocolo de ensaio clínico randomizado, controlado, duplo-cego, será realizado em 30recém-nascidos internados em terapia intensiva neonatal de uma maternidade escola que apresentem indicação de coleta de sangue por punção arterial. Serão distribuídos aleatoriamente em grupo controle (glicose 25%) ou grupo intervenção (reflexoterapia podal). O desfecho primário será escores de dor neonatal durante e após a punção arterial. Os desfechos secundários serão o tempo de choro e variação nos sinais vitais dos neonatos durante e após o procedimento da punção arterial. Número do registro RBR-639bff. Discussão Os resultados deste ensaio fornecerão novos conhecimentos sobre a intervenção mais adequada para o alívio da dor neonatal durante procedimentos dolorosos.

Nutritional management in newborn babies receiving therapeutic hypothermia: two retrospective observational studies using propensity score matching.

BACKGROUND: Therapeutic hypothermia is standard of care for babies with moderate to severe hypoxic-ischaemic encephalopathy. There is limited evidence to inform provision of nutrition during hypothermia. OBJECTIVES: To assess the association during therapeutic hypothermia between (1) enteral feeding and outcomes, such as necrotising enterocolitis and (2) parenteral nutrition and outcomes, such as late-onset bloodstream infection. DESIGN: A retrospective cohort study using data held in the National Neonatal Research Database and applying propensity score methodology to form matched groups for analysis. SETTING: NHS neonatal units in England, Wales and Scotland. PARTICIPANTS: Babies born at ≥ 36 gestational weeks between 1 January 2010 and 31 December 2017 who received therapeutic hypothermia for 72 hours or who died during treatment. INTERVENTIONS: Enteral feeding analysis - babies who were enterally fed during therapeutic hypothermia (intervention) compared with babies who received no enteral feeds during therapeutic hypothermia (control). Parenteral nutrition analysis - babies who received parenteral nutrition during therapeutic hypothermia (intervention) compared with babies who received no parenteral nutrition during therapeutic hypothermia (control). OUTCOME MEASURES: Primary outcomes were severe and pragmatically defined necrotising enterocolitis (enteral feeding analysis) and late-onset bloodstream infection (parenteral nutrition analysis). Secondary outcomes were survival at neonatal discharge, length of neonatal stay, breastfeeding at discharge, onset of breastfeeding, time to first maternal breast milk, hypoglycaemia, number of days with a central line in situ, duration of parenteral nutrition, time to full enteral feeds and growth. RESULTS: A total of 6030 babies received therapeutic hypothermia. Thirty-one per cent of babies received enteral feeds and 25% received parenteral nutrition. Seven babies (0.1%) were diagnosed with severe necrotising enterocolitis, and further comparative analyses were not conducted on this outcome. A total of 3236 babies were included in the matched enteral feeding analysis. Pragmatically defined necrotising enterocolitis was rare in both groups (0.5% vs. 1.1%) and was lower in babies who were fed during hypothermia (rate difference -0.5%, 95% confidence interval -1.0% to -0.1%; p = 0.03). Higher survival to discharge (96.0% vs. 90.8%, rate difference 5.2%, 95% confidence interval 3.9% to 6.6%; p < 0.001) and higher breastfeeding at discharge (54.6% vs. 46.7%, rate difference 8.0%, 95% confidence interval 5.1% to 10.8%; p < 0.001) rates were observed in enterally fed babies who also had a shorter neonatal stay (mean difference -2.2 days, 95% confidence interval -3.0 to -1.2 days). A total of 2480 babies were included in the matched parenteral nutrition analysis. Higher levels of late-onset bloodstream infection were seen in babies who received parenteral nutrition (0.3% vs. 0.9%, rate difference 0.6%, 95% confidence interval 0.1% to 1.2%; p = 0.03). Survival was lower in babies who did not receive parenteral nutrition (90.0% vs. 93.1%, rate difference 3.1%, 95% confidence interval 1.5% to 4.7%; p < 0.001). LIMITATIONS: Propensity score methodology can address imbalances in observed confounders only. Residual confounding by unmeasured or poorly recorded variables cannot be ruled out. We did not analyse by type or volume of enteral or parenteral nutrition. CONCLUSIONS: Necrotising enterocolitis is rare in babies receiving therapeutic hypothermia, and the introduction of enteral feeding is associated with a lower risk of pragmatically defined necrotising enterocolitis and other beneficial outcomes, including rates of higher survival and breastfeeding at discharge. Receipt of parenteral nutrition during therapeutic hypothermia is associated with a higher rate of late-onset infection but lower mortality. These results support introduction of enteral feeding during therapeutic hypothermia. FUTURE WORK: Randomised trials to assess parenteral nutrition during therapeutic hypothermia. TRIAL REGISTRATION: Current Controlled Trials ISRCTN474042962. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 36. See the NIHR Journals Library website for further project information.

Every year, approximately 1200 babies in the UK suffer a lack of oxygen to the brain around birth. This is called hypoxic­ischaemic encephalopathy and can lead to brain injury or death. To treat hypoxic­ischaemic encephalopathy, babies receive cooling treatment in which their body temperature is lowered. Doctors do not know the best way to give nutrition to babies receiving cooling treatment. Babies can either be fed milk into their stomach (enteral nutrition) or be given nutrients through their veins (parenteral nutrition). We compared babies who were fed milk while they were being cooled with babies from whom milk was withheld while they were being cooled to see if there was a difference in the frequency of necrotising enterocolitis, a severe gut disease. In addition, we compared babies who received parenteral nutrition while they were being cooled with babies who did not to see if there was a difference in infections. Finally, we looked at other outcomes, including survival and breastfeeding. We used the National Neonatal Research Database, which holds de-identified (i.e. no baby can be identified) information on all babies who have received NHS neonatal care. We used a statistical approach to match babies in each group (i.e. fed babies and not fed babies) as closely as possible so that any difference in outcomes was because of different nutrition and not because of other differences. We included > 6000 babies with hypoxic­ischaemic encephalopathy. Approximately one in three babies received milk feeds and one in four babies received parenteral nutrition during cooling. Necrotising enterocolitis was very rare. More babies who were fed milk during cooling had good outcomes (e.g. being breastfed at discharge) and fewer had necrotising enterocolitis. Most of these babies received only a small amount of milk in the first 3 days. More babies given parenteral nutrition had infections, but also more survived. This suggests that it is probably safe and may be beneficial to feed babies milk during cooling. More research should look at milk feeding and parenteral nutrition during cooling.

Effect of acupressure on procedural pain before heel lancing in neonates.

OBJECTIVE: To investigate the effect of acupressure applied to UB60 and K3 acupuncture points in order to relieve the procedural pain caused by heel lancing blood sampling process in the term newborns. METHODS: The data were collected by using the Information Form and the Neonatal Infant Pain Scale. Acupressure applied for 3 min before heel lancing blood sampling in the newborns in the experimental group (n = 31). No intervention was applied to newborns in the control group (n = 32). RESULTS: A significant difference was found between mean scores of the newborns in the control and acupressure group in favor of the acupressure group in terms of heart rate during and after the procedure, oxygen saturation before, during and after the procedure, duration of crying during and after the procedure (P < 0.05). It was found that there was a significant difference between groups in terms of Neonatal Infant Pain Scale mean scores during (P = 0.001) and after the procedure (P < 0.05), and the difference was found to be in favor of the acupressure group. CONCLUSION: As a result, acupressure was found to be an effective method in relieving pain caused by heel lancing blood sampling in newborns.

Primeira recomendação brasileira de fisioterapia para estimulação sensório-motora de recém-nascidos e lactentes em unidade de terapia intensiva / First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit

RESUMO Objetivo: Apresentar as diretrizes de estimulação sensório-motora para recém-nascidos e lactentes em unidade de terapia intensiva., Métodos: Trata-se de um método de delineamento misto com revisão sistemática da literatura e recomendações com base na evidência científica e opiniões de fisioterapeutas especialistas em fisioterapia neonatal de estudos publicados entre 2010 e 2018 nas bases de dados MEDLINE® e Cochrane, que incluiu recém-nascidos (pré-termo e a termo) e lactentes (entre 28 dias e 6 meses de idade) admitidos à unidade de terapia intensiva e submetidos a métodos de estimulação sensório-motora. Os estudos encontrados foram classificados segundo o escore GRADE por cinco fisioterapeutas em diferentes regiões do país e apresentados em oito congressos científicos para discussão das diretrizes de práticas clínicas., Resultados: Foram incluídos 89 artigos para construir as diretrizes de práticas clínicas. Estimulação auditiva, gustatória e contato pele a pele se destacaram por melhorar os sinais vitais, e a massagem terapêutica, assim como a estimulação multimodal tátil-cinestésica por melhorar o peso ou a sucção., Conclusão: Embora todas a modalidades tenham boas avaliações para controle da dor ou do estresse, é recomendado que os procedimentos de estimulação sensório-motora sejam adaptados às necessidades específicas da criança, e as intervenções sejam realizadas por profissionais experientes.

Abstract Objective: To present guidelines on sensory motor stimulation for newborns and infants in the intensive care unit. Methods: We employed a mixed methods design with a systematic review of the literature and recommendations based on scientific evidence and the opinions of physiotherapists with neonatal expertise. The research included studies published between 2010 and 2018 in the MEDLINE® and Cochrane databases that included newborns (preterm and term) and infants (between 28 days and 6 months of age) hospitalized in the intensive care unit and submitted to sensory motor stimulation methods. The studies found were classified according to the GRADE score by five physiotherapists in different regions of Brazil and presented at eight Scientific Congresses held to discuss the clinical practice guidelines. Results: We included 89 articles to construct the clinical practice guidelines. Auditory, gustatory and skin-to-skin stimulation stand out for enhancing vital signs, and tactile-kinesthetic massage and multisensory stimulation stand out for improving weight or sucking. Conclusion: Although all modalities have good ratings for pain or stress control, it is recommended that sensory motor stimulation procedures be tailored to the infant's specific needs and that interventions and be carried out by expert professionals.

Selection of second stage operation after enterostomy in 35 neonates / 中华实用儿科临床杂志

Objective:To explore the strategy of selecting the second stage operation after neonatal enterostomy.Methods:Clinical data of 35 cases admitted to the Department of Pediatric Surgery of Henan Provincial People′s Hospital for enterostomy in neonatal period and radical operation in the second stage from May 2014 to December 2019 were subject to retrospective analysis.They were inquired about the medical history in detail before the operation, and received barium enema and colonoscopy, 24-hour delayed radiography, anorectal manometry and other examinations.During the operation, a multi-point intestinal biopsy and rapid frozen pathological examination were performed accor-ding to the individual′s condition, and the specific surgical method was determined in combination with intraoperative exploration.Postoperative observations were conducted for such complications as anastomotic leakage, intestinal obstruction, and abdominal infection, as well as such medium and long-term outcomes as intestinal function recovery, defecation, and nutritional status.Results:Nine cases were diagnosed with neonatal necrotizing enterocolitis (NEC) and received ostomy closure.Sixteen cases were diagnosed with NEC concomitant with intestinal stenosis and received the narrow bowel enterectomy and anastomosis combined with ostomy closure; 10 cases were diagnosed with Hirschsprung′s disease, including 5 cases of total colonic aganglionosis treated with Soave radical operation, 3 cases of long-segment Hirschsprung′s disease treated with subtotal colectomy, inverted ascending coloanal anastomosis with Deloyers method and second enterostomy, and 2 cases of normal-segment Hirschsprung′s disease treated with pull-through operation combined with ostomy closure.After the operation, 1 case had anastomotic leakage and septic shock, 1 case had incision dehiscence, 3 cases had adhesive intestinal obstruction and 1 case occurred left lung consolidation.During a follow-up period of 3-36 months, their recovery condition was acceptable.Conclusions:For those neonates receiving enterostomy, detailed medical history should be enquired before the second stage operation.The combination of barium enema and colonoscopy, 24-hour delayed radiography and multi-point intestinal biopsy with intraoperative exploration conduced to selecting appropriate individualized surgical schemes and reducing surgical complications, thus improving the long-term quality of life of children.

Analysis of clinical cross-control trial results of an smartphone application in screening neonatal jaundice / 中华实用儿科临床杂志

Objective:To evaluate the correlation, consistency and safety of an smartphone application (APP) in screening neonatal jaundice using the smartphone based on the image-based bilirubin (IBB) and transcutaneous bilirubin (TcB).Methods:From July to October 2018, neonates with the age ≤28 d and gestational age ≥35 weeks who were admitted to Department of Neonatal and Obstetrics, Xuzhou Central Hospital without blue light phototherapy were recruited.They were randomly divided into two groups to measure the jaundice value of skin in front of sternum by a cross-control analysis.Jaundice level in group Ⅰ was first measured using the Nezhabaobei? APP in iPhone 6, and then measured using the JM-103 transcutaneous jaundice instrument as the control device.In group Ⅱ, jaundice level was sequencially measured by the control device and the Nezhabaobei? APP.Sex, age, gestational age, birth weight and the mean value of three consecutive tests were recorded.The Pearson′s correlation analysis, Bland-Altman plots consistency analysis, t test and receiver operating characteristic (ROC) curve were used for statistical analysis. Results:A total of 185 eligible neonates were enrolled, including 99 males and 86 females, with the median age of 5 d (3-8 d), gestational age of (37.6 ± 1.7) weeks, and birth weight of (2 950 ± 645) g. There were good correlation ( r=0.860, P<0.05) and consistency (95.1% of the samples fall within the 95% consistency interval) between IBB and TcB.Good correlation and consistency were also yielded in subgroup analyses based on the sex, age, gestational age and birth weight.The consistency was better in subgroups of ≤7 d, >37 weeks and>2 500 g. The ability of IBB to predict TcB>256.5 μmol/L was better than that of TcB>171.0 μmol/L.The area under the ROC curve was 0.93, the cut-off value was 232.6 μmol/L, the sensitivity was 96.7%, and the specificity was 82.6%.The difference of the mean values of IBB and TcB detected for 3 times was significantly lower than that obtained in the first measurement of IBB and TcB [(12.0 ± 34.4) μmol/L vs.(14.4 ± 38.6) μmol/L, P=0.038]. There were no adverse events and no defects in the device itself. Conclusions:There are good correlation and consistency between IBB and TcB.The ability of IBB to predict TcB>256.5 μmol/L is better than that of TcB>171.0 μmol/L, which is safe in clinical use.

Effects of vitamin d supplementation during pregnancy on newborns and infants: an integrative review / Efeitos da suplementação de vitamina d durante a gestação no recém-nascido e lactente: uma revisão integrativa

ABSTRACT Objective: To identify the effects of vitamin D supplementation during pregnancy on newborns and infants. Data sources: The present study is an integrative review of literature based on clinical trials published in journals indexed in the PubMed and Web of Science databases. Two searches were carried out, starting with the association (and) of the health term "vitamin D" with "pregnancy". In the search for information, selection criteria were established, and there was no language limitation and year of publication. Data synthesis: The final selection resulted in 44 clinical trials, most of which were randomized and double blind, which were carried out in outpatient clinics, referral hospitals and universities, mainly in Europe. The samples studied were predominantly of newborns. In these 44 trials, 23 types of different doses of vitamin D during pregnancy, with different doses, regimens and times of use, and 14 different outcomes were studied in newborns (NB) and infants. Of the 44 studies performed, 35 showed statistically significant beneficial effects of vitamin D supplementation during pregnancy on newborns and infants compared to control groups. Conclusions: Vitamin D supplementation during pregnancy for at least three months before delivery has the potential of positively influencing calcium metabolism, physical growth and immune system development in newborns and infants. However, there is insufficient knowledge to define the optimal dose and to guarantee the absence of possible long-term adverse effects.

RESUMO Objetivo: Identificar os efeitos da suplementação de vitamina D durante a gestação no recém-nascido e lactente. Fontes de dados: Revisão integrativa da literatura baseada em ensaios clínicos publicados em revistas indexadas nas bases de dados PubMed e Web of Science. Foi realizada uma busca em cada base de dados, que partiu da associação (and) dos descritores de saúde vitamin D e pregnancy. Na busca pelas informações, foram estabelecidos critérios de seleção e não houve limitação de idioma nem de ano de publicação. Síntese de dados: A seleção final resultou em 44 ensaios clínicos - a maioria randomizada e duplo-cego -, que foram realizados em ambulatórios, hospitais de referência e universidades sobretudo da Europa. As amostras estudadas foram predominantemente de recém-nascidos. Nesses 44 ensaios, foram testadas 23 formas de suplementação de vitamina D na gestação, com diferentes doses, regimes e tempos de uso, e estudaram-se 14 desfechos diferentes nos recém-nascidos e lactentes. Dos 44 estudos, 35 demonstraram efeitos benéficos da suplementação de vitamina D durante a gestação nos recém-nascidos e lactentes de forma estatisticamente significante, quando comparados aos do grupo controle. Conclusões: A suplementação de vitamina D na gestação, por no mínimo três meses antes do parto, potencialmente influencia de forma positiva o metabolismo do cálcio, o crescimento físico e o desenvolvimento do sistema imunológico dos recém-nascidos e lactentes, entretanto não há conhecimento suficiente para a definição da dose ideal nem para garantir a inexistência de possíveis efeitos adversos em longo prazo.

Massagem no alívio da dor neonatal em unidades de terapia intensiva: scoping review / Massage for neonatal pain relief in intensive care units: a scoping review

RESUMO Objetivo mapear o uso da massagem no alívio da dor neonatal durante os procedimentos realizados em Unidades de Terapia Intensiva. Métodos revisão de escopo realizada em 11 fontes de dados, seguindo recomendações do Instituto Joanna Briggs. Questionou-se: qual é o conhecimento sobre o uso da massagem no alívio da dor de recém-nascidos durante procedimentos dolorosos em unidade de terapia intensiva neonatal? Selecionaram-se 12 estudos para os resultados. Resultados a massagem terapêutica em neonatos mostra-se positiva na redução da pontuação em escalas de dor, diminuição das frequências cardíaca e respiratória, aumento na saturação de oxigênio, melhorias no estado comportamental, ganho de peso, desenvolvimento neurológico, menor tempo de choro e realização do procedimento doloroso. Conclusão a massagem/reflexoterapia mostra-se efetiva na redução da dor neonatal em unidades de terapia intensiva, sendo realizada em membros inferiores, calcanhar, dorso ou no local do procedimento, com pressão leve a moderada e duração média de cinco minutos.

ABSTRACT Objective to map the use of massage to relieve neonatal pain during procedures performed in Intensive Care Units. Methods a scoping review conducted in 11 data sources, following the Joanna Briggs Institute recommendations. The question was: what is the knowledge about the use of massage to relieve pain in newborns during painful procedures in a neonatal intensive care unit? 12 studies were selected for the results. Results therapeutic massage in newborns is positive in reducing the score on pain scales, decreasing heart and respiratory rates, increasing oxygen saturation, improvements in behavioral status, weight gain, neurological development, shorter crying time and performing the painful procedure. Conclusion massage/reflexotherapy is effective in reducing neonatal pain in intensive care units, being performed on lower limbs, heel, back or at the procedure site, with light to moderate pressure and an average duration of five minutes.

Hemolytic Disease of Fetus and Newborn in a Primigravida with Multiple Alloantibodies Involving Anti-Jka and Anti-E: A Case Report.

The majority of hemolytic disease of the fetus and newborn (HDFN) reported in the literature is due to ABO and rhesus incompatibility. However, there are also other minor blood groups that have been identified as a cause of HDFN, although the occurrence is much rarer. The antibody screening program for D negative mother and the anti-D immunoglobulin treatment showed a significant reduction of the occurrence of HDFN secondary to anti-D. In a developed country, the screening for red blood cell antibody in the pregnant mother other than anti-D reduced the possibility of HDFN occurrence hence reduced the fetal morbidity and subsequently increased the fetal well being during pregnancy and after the postnatal period. In this case report, we discuss HDFN in a primigravida patient secondary to multiple alloantibodies (anti-Jka and anti-E). The baby developed jaundice with bilirubin levels approaching the exchange transfusion level. However, with extensive phototherapy and immunoglobulin treatment, the child did not require exchange transfusion. We also included the importance of the routine antenatal antibody screening program. This practice will help the transfusion center to find the antigen negative blood in a timely manner and reduce the morbidities and mortalities of HDFN among the newborns.

Hipotermia terapêutica na encefalopatia hipóxico-isquêmica neonatal: revisão integrativa / Therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: integrative review / Hipotermia terapéutica em la encefalopatía hipóxico-isquémica neonatal: revisión integrativa

Objetivo: identificar evidências acerca do uso seguro da hipotermia terapêutica em recém-nascidos. Método: revisão integrativa realizada entre junho e julho de 2018, em fontes eletrônicas da Biblioteca Virtual de Saúde e PubMed, por meio da pergunta:"Que evidências podem subsidiar o cuidado de enfermagem voltado para a redução de sequelas em recém-nascidos submetidos à hipotermia terapêutica?".Foram eleitos nove artigos para análise, sendo oito internacionais e um nacional. Resultados:o resfriamento deve acontecer por 72 horas, com hipotermia leve. As indicações para inclusão no protocolo foram: primeiras seis horas de vida, idade gestacional maior que 35 semanas e acidose na primeira hora de vida.São cuidados essenciais: monitoração hemodinâmica, observação da pele, controle térmico retal, vigilância do Eletroencefalograma de Amplitude Integrada. Conclusão: a terapêutica apresenta benefícios, porém sua aplicação depende de protocolo institucional e treinamento das equipes com foco nas potenciais complicações.

Objective: to identify the evidence on safe use of therapeutic hypothermia in newborns. Method: integrative review of the literature, conducted between June and July of 2018, in electronic sources from the Virtual Health Library and PubMed, through the question: "What evidence can support nursing care aimed at reducing sequelae in newborns undergoing therapeutic hypothermia?". Analysis was conducted for nine selected article, being eight from international literature and one from Brazilian national literature. Results: cooling should occur for 72 hours with mild hypothermia. Indications for inclusion in the protocol were: first six hours of life, gestational age greater than 35 weeks and acidosis in the first hour of life. Essential care includes hemodynamic monitoring, skin observation, rectal thermal control, Integrated Amplitude Electroencephalogram surveillance. Conclusion: the therapy has benefits, but its application depends on institutional protocol and team training focusing on potential complications.

Objetivo: identificar la evidencia sobre el uso seguro de la hipotermia terapéutica en recién nacidos. Método: revisión integradora de la literatura, realizada entre junio y julio de 2018, en fuentes electrónicas de la Biblioteca Virtual de Salud y PubMed, a través de la pregunta: "¿Qué evidencia puede apoyar la atención de enfermería dirigida a reducir las secuelas en los recién nacidos que sufren hipotermia terapéutica?". Se realizaron análisis para nueve artículos seleccionados, ocho de literatura internacional y uno de literatura nacional brasileña. Resultados: el enfriamiento debe ocurrir durante 72 horas con hipotermia leve. Las indicaciones para la inclusión en el protocolo fueron: primeras seis horas de vida, edad gestacional mayor de 35 semanas y acidosis en la primera hora de vida. El cuidado esencial incluye monitoreo hemodinámico, observación de la piel, control térmico rectal, vigilancia integrada de electroencefalograma de amplitud. Conclusión: la terapia tiene beneficios, pero su aplicación depende del protocolo institucional y del entrenamiento del equipo, enfocándose en posibles complicaciones.

Predictive Models for Neonatal Follow-Up Serum Bilirubin: Model Development and Validation.

BACKGROUND: Hyperbilirubinemia affects many newborn infants and, if not treated appropriately, can lead to irreversible brain injury. OBJECTIVE: This study aims to develop predictive models of follow-up total serum bilirubin measurement and to compare their accuracy with that of clinician predictions. METHODS: Subjects were patients born between June 2015 and June 2019 at 4 hospitals in Massachusetts. The prediction target was a follow-up total serum bilirubin measurement obtained <72 hours after a previous measurement. Birth before versus after February 2019 was used to generate a training set (27,428 target measurements) and a held-out test set (3320 measurements), respectively. Multiple supervised learning models were trained. To further assess model performance, predictions on the held-out test set were also compared with corresponding predictions from clinicians. RESULTS: The best predictive accuracy on the held-out test set was obtained with the multilayer perceptron (ie, neural network, mean absolute error [MAE] 1.05 mg/dL) and Xgboost (MAE 1.04 mg/dL) models. A limited number of predictors were sufficient for constructing models with the best performance and avoiding overfitting: current bilirubin measurement, last rate of rise, proportion of time under phototherapy, time to next measurement, gestational age at birth, current age, and fractional weight change from birth. Clinicians made a total of 210 prospective predictions. The neural network model accuracy on this subset of predictions had an MAE of 1.06 mg/dL compared with clinician predictions with an MAE of 1.38 mg/dL (P<.0001). In babies born at 35 weeks of gestation or later, this approach was also applied to predict the binary outcome of subsequently exceeding consensus guidelines for phototherapy initiation and achieved an area under the receiver operator characteristic curve of 0.94 (95% CI 0.91 to 0.97). CONCLUSIONS: This study developed predictive models for neonatal follow-up total serum bilirubin measurements that outperform clinicians. This may be the first report of models that predict specific bilirubin values, are not limited to near-term patients without risk factors, and take into account the effect of phototherapy.