Increasing utilisation of a rebound hyperbilirubinaemia calculator in two newborn nurseries.

Neonatal hyperbilirubinaemia requiring phototherapy treatment is a common problem impacting the length of hospital stay and rates of hospital readmission. Previous guidelines included guidance for initiating phototherapy treatment but not for discontinuing phototherapy treatment during initial newborn admission.In response to dissatisfaction from trainees, staff and families regarding the variable approach to discontinuing phototherapy among attending nursery providers, we used quality improvement methodologies to increase utilisation of a rebound hyperbilirubinaemia calculator as a more consistent method for guiding the timing of phototherapy discontinuation. The aim was to increase utilisation of the rebound hyperbilirubinaemia calculator for newborns treated with phototherapy in two newborn nurseries to >90% within 2 years.Sequential interventions focused on increasing provider awareness of the rebound hyperbilirubinaemia calculator and making the calculator simple to access and use.At the university medical centre nursery, the use of the calculator increased from 8.7% to 100%, exceeding the project goal. In the community hospital nursery, there was a statistically significant increase in the rate of utilisation from 3.7% to 79.4%, but this fell slightly below the goal of >90%.Electronic Health Record integration, along with education and addition of prompts to providers, increased utilisation of a rebound hyperbilirubinaemia calculator as a consistent approach for guiding decisions about discontinuing phototherapy treatment in newborns.

Admission and Care Practices in United States Well Newborn Nurseries.

OBJECTIVES: Late preterm and term infants comprise 97.3% of annual births in the United States. Admission criteria and the availability of medical interventions in well newborn nurseries are key determinants of these infants remaining within a mother-infant dyad or requiring a NICU admission and resultant separation of the dyad. The objective of this study was to identify national patterns for well newborn nursery care practices. METHODS: We surveyed a physician representative from each nursery in the Better Outcomes through Research for Newborns Network. We described the admission criteria and clinical management of common newborn morbidities and analyzed associations with nursery demographics. RESULTS: Of 96 eligible nursery representatives, 69 (72%) completed surveys. Among respondents, 59 (86%) used a minimal birth weight criterion for admission to their well newborn nursery. The most commonly used criteria were 2000 g (n = 29, 49%) and 1800 g (n = 19, 32%), with a range between 1750 and 2500 g. All nurseries used a minimal gestational age criterion for admission; the most commonly used criterion was 35 weeks (n = 55, 80%). Eleven percent of sites required transfer to the NICU for phototherapy. Common interventions in the mother's room included dextrose gel (n = 56, 81%), intravenous antibiotics (n = 35, 51%), opiates for neonatal abstinence syndrome (n = 15, 22%), and an incubator for thermoregulation (n = 14, 20%). CONCLUSIONS: Wide variation in admission criteria and medical interventions exists in well newborn nurseries. Further studies may help identify evidence-based optimal admission criteria to maximize care within the mother-infant dyad.

Children Receiving a Nutrition and High-Quality Early Childhood Education Intervention Are Associated with Greater Math and Fluid Intelligence Scores: The Guatemala City Municipal Nurseries.

Background: About 47% of children < 5 years of age are stunted in Guatemala. In this study, the investigators aimed to compare growth and cognitive outcomes between children in second grade that attended five Guatemala City Municipal Nurseries (GCMN) vs. same sex, grade, and age-matched children. Methods: A cross-sectional design nested in a retrospective cohort was implemented between 2015 and 2019. Children that attended the GCMN and matched controls completed a math test and validated receptive language and fluid intelligence tests. The primary caregivers completed a sociodemographic survey. General and generalized linear mixed effect models were used to compare children that attended the GCMN vs. controls. The models were adjusted by maternal education, sex, asset score, and other relevant covariates. Results: Children that attended the GCMN exhibited greater math and fluid intelligence scores relative to the controls in the adjusted models (ß = 6.48; 95% CI (2.35−10.61)) and (ß = 1.20; 95% CI (0.12−2.29)), respectively. Lower odds of stunting were significant for children who went to any early childcare institution (AOR = 0.28; 95% CI (0.09−0.89)). Conclusions: The importance of integrating nutrition and high-quality early childhood education interventions in cognitive and growth outcomes is highlighted in this study. The GCMN model may be a scalable model in similar low-resource settings.

The use of spent coffee grounds in growing media for the production of Brassica seedlings in nurseries.

Large quantities of spent coffee grounds (SCG) are generated the last decades, and their recycling is of research interest challenge. In the present study, SCG was tested to substitute peat (P) in substrate mixtures for the production of Brassica seedlings. Seeds of cauliflower, broccoli, and cabbage were placed in substrate mixtures containing 0-2.5-5-10% SCG. The mixture of SCG with peat affected several physicochemical characteristics of the growing media, providing also considerable amount of mineral elements for the seedling growth needs. Seed emergence was stimulated in 2.5-5% of SCG for cauliflower and at 2.5% of SCG for cabbage, while 10% of SCG decreased the percentage and increased the mean emergence time of the examined species. Plant biomass and leaf number were increased at 2.5% SCG for broccoli and cabbage but maintained at cauliflower when compared with control. The SCG at 10% decreased stomatal conductance of broccoli and cabbage (including 2.5-5% SCG in cauliflower) while chlorophyll content was increased at 10% of SCG media. The incorporation of SCG impacted the mineral content accumulated in plants with increases in nitrogen, potassium, and phosphorus and decreases in magnesium and iron content. Total phenolics and antioxidant activity (DPPH, FRAP) decreased at ≥ 5% SCG at cauliflower and cabbage or unchanged for broccoli when compared with the control. The cabbage seedlings grown in 10% SCG media subjected to stress with increases in the production of hydrogen peroxides and lipid peroxidation, and reflected changes in the antioxidant enzymatic metabolism (catalase, superoxide dismutase). The present study demonstrates that SCG (up to 5%) can be used for seed germination biostimulants and/or partially substitute the peat for Brassica seedling production.

Supplementation Practices and Donor Milk Use in US Well-Newborn Nurseries.

BACKGROUND AND OBJECTIVES: Guidelines encourage exclusive breastfeeding for healthy newborns but lack specificity regarding criteria for medically indicated supplementation, including type, timing, and best practices. We set out to describe practice patterns and provider perspectives regarding medically indicated supplementation of breastfeeding newborns across the United States. METHODS: From 2017 to 2018, we surveyed the Better Outcomes through Research for Newborns representative from each Better Outcomes through Research for Newborns hospital regarding practices related to medically indicated supplementation. We used descriptive statistics to compare practices between subgroups defined by breastfeeding prevalence and used qualitative methods and an inductive approach to describe provider opinions. RESULTS: Of 96 providers representing discrete hospitals eligible for the study, 71 participated (74% response rate). Practices related to criteria for supplementation and pumping and to type and caloric density of supplements varied widely between hospitals, especially for late preterm infants, whereas practices related to lactation consultant availability and hand expression education were more consistent. The most commonly reported criterion for initiating supplementation was weight loss of ≥10% from birth weight, and bottle-feeding was the most commonly reported method; however, practices varied widely. Donor milk use was reported at 20 (44%) hospitals with ≥81% breastfeeding initiation and 1 (4%) hospital with <80% breastfeeding initiation (P = .001). CONCLUSIONS: Strategies related to supplementation vary among US hospitals. Donor milk availability is concentrated in hospitals with the highest prevalence of breastfeeding. Implementation of evidence-based management of supplementation among US hospitals has the potential to improve the care of term and late preterm newborns.

Types of Milk and/or Its Substitutes Are Given to Children (6⁻36 Months) in Nurseries in Poland: Data from the Research and Education Project "Eating Healthy, Growing Healthy".

The purpose of the study was to evaluate the types of milk and/or its substitutes given to children (aged 6⁻36 months) in nurseries in Poland. Methods: The study was conducted in 211 nurseries across Poland. The supply of milk and its substitutes was checked in ten-day menus and inventory documents. In total, 211 ten-day menus and 2110 daily inventory reports were analyzed. Additionally, data were obtained by interviews with day-care center (DCC) directors and/or staff responsible for nutrition. Results: Compared to non-public nurseries, public ones were characterized by a higher average number of children, most often maintained their own kitchens, and charged a lower financial fee. Public DCCs also more often employed dietitians. The type of milk and its substitutes offered to children in nurseries was dependent on the age of the children and type of DCC. In a larger percentage of public DCCs infants received a milk formula, and in smaller percentage they received breast milk. This regularity also occurred in older children's diets (13⁻36 months). In toddlers' diets in public nurseries, cow's milk was more common. The share of other milk substitutes in the nutrition of children from both age groups was negligible. Conclusion: The types of milk given to children in nurseries in Poland varied and depended on the age of children and the type of DCCs. It is necessary to provide education to DCC staff regarding the type of milk recommended for children under one year of age.

Effectiveness of different interventions in public nurseries based on food and nutrition education: promoting breast-feeding and healthy complementary feeding.

OBJECTIVE: Food practices in the early years of life are important to form healthy eating habits; therefore, it is essential for the caregivers of infants to receive appropriate guidance. The present study aimed to investigate the effectiveness of different nutritional interventions on complementary feeding practices in municipal nurseries. DESIGN: Non-randomized controlled intervention study with education professionals and parents of infants (<2 years). Participants were divided into: control group (CG), standard food and nutrition education in writing; and intervention group (IG), the same information as the CG and face-to-face meetings (professionals, 8 h; parents, 5 h). Changes in professionals' knowledge on the subject and alterations in parents' beliefs, attitudes and intentions were assessed using questionnaires before and after the educational activities. SETTING: Ten public nurseries in Nova Lima, Belo Horizonte, Minas Gerais, Brazil, 2015. SUBJECTS: Ninety professionals (fifty in CG; forty in IG) and 169 parents (ninety-seven in CG; seventy-two in IG). RESULTS: After the intervention, there was a significant increase in the mean number of correct responses given by professionals in the IG (12·2 v. 10·7; P=0·001). In addition, there were improvements among the parents of the IG in relation to beliefs (soups and broths do not nourish my child: P=0·012), attitudes (offer meat from the sixth month: P=0·032) and intentions (do not offer soups and broths: P=0·003; offer vegetables: P=0·018; offer meat: P<0·001). CONCLUSIONS: Face-to-face nutritional intervention had a significantly greater effect on the parameters evaluated, indicating the importance of adequate guidance in childcare services to support the introduction of complementary feeding.

Identification of risk for neonatal haemolysis.

AIM: To identify neonates at risk of haemolytic hyperbilirubinaemia through near-concurrent measurements of total serum/plasma bilirubin (TB) or transcutaneous bilirubin (TcB) and end-tidal breath carbon monoxide (CO), corrected for ambient CO (ETCOc), an index of bilirubin production and haemolysis. METHODS: Paired TB/TcB (mg/dL) and ETCOc (ppm) measurements were obtained in newborns (n = 283) at 20 to <60 hours of age in five nurseries. TB/TcB values were assigned TB/TcB percentile risk values using the Bhutani hour-specific nomogram. In infants having two serial TB/TcB measurements (n = 76), TB rate of rise (ROR, mg/dL/h) was calculated. RESULTS: For the entire cohort (n = 283), 67.1% and 32.9% had TB/TcB<75th and ≥75th percentile, respectively. TB/TcB (5.79 ± 1.84 vs 9.14 ± 2.25 mg/dL) and ETCOc (1.61 ± 0.45 vs 2.02 ± 1.35 ppm, p = 0.0002) were different between the groups. About 36.6% of infants with TB/TcB ≥75th percentile had ETCOc ≥ 2.0 ppm. In the subcohort of infants with serial TB/TcB measurements (n = 76), 44.7% and 55.3% had TB/TcB<75th and ≥75th percentile, respectively. TB/TcB (5.28 ± 1.97 vs 9.53 ± 2.78 mg/dL), ETCOc (1.72 ± 0.48 vs 2.38 ± 1.89 ppm, p = 0.05) and TB ROR (0.011 ± 0.440 vs 0.172 ± 0.471 mg/dL/h) were different between the groups. CONCLUSION: The combined use of TB/TcB percentile risk assessments and ETCOc measurements can identify infants with haemolytic hyperbilirubinaemia. The addition of TB ROR can identify those infants with elimination disorders.

Comparison of perinatal outcomes in late preterm birth between singleton and twin pregnancies

OBJECTIVE: To determine whether late preterm twin neonates have a more favorable perinatal outcome than singleton late preterm neonates. METHODS: We studied 401 late preterm births between 34+0 and 36+6 weeks of gestation, from January 2011 to December 2014 in our institution. We compared the maternal and neonatal characteristics and perinatal outcomes between singleton and twin pregnancies. Perinatal outcomes included Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery, duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). RESULTS: A total of 289 neonates were in the singleton group and 112 in the twin group. The twin group showed smaller mean birth weight despite of longer gestational age at delivery. In addition, there were significant differences in the indication of delivery and cesarean section rate between the 2 groups. Overall, the risk of composite morbidity was similar between 2 groups (odds ratio, 1.4; 95% confidence interval, 0.8 to 2.4). CONCLUSION: Our findings suggest that late preterm twins do not show a more favorable outcome than singleton late preterm births.

The history of neonatology in Korea

Neonatology in pediatrics became a part of medical school curricula in Korea in 1954-1959. Specific treatments and procedures in the neonatal field were adopted around this period, for example, antibiotics, oxygen therapy, and the exchange transfusion procedure were established in 1950-1960. Usage of an infant incubator was implemented along with the establishment in 1960. The trend of separation between a premature infant care unit and newborn nursery room enabled the specialized treatment of high-risk infants in the 1970s. Assisted ventilation with continuous positive airway pressure and phototherapy was initiated in 1978. The recent concept of a neonatal intensive care unit was established in 1980, and it made so-called neonatal intensive care such as mechanical ventilation and intensive monitoring available. The Korean Society of Neonatology was founded in 1993. The usage of pulmonary surfactant in the 1990s, accelerated the improvement of respiratory distress syndrome survival, and it resulted in the nationwide opening of neonatal intensive care unit in hospitals. The high frequency ventilator and inhaled nitric oxide were introduced in the 2000s. The Korean Neonatal Network was commenced as a nationwide systemic database for very low birth weight infant registry in 2010. Accordingly, the history of Korean neonatology can be summarized as 50 years in total, and 35 years in a narrow sense. During this era, neonatal care in Korea has improved remarkably and has achieved a great survival rate for high-risk neonates, preterm infants, and micro-premies. In this review, we intend to provide an overview of the history, efforts, and outcomes of Korean neonatology activity that have led to these achievements.

Factors Influencing on Perinatal Outcomes of Asian Marriage Immigrant Women: Ten-year Experience in a Single Center / 대한주산의학회잡지

PURPOSE: We aimed to analyze the maternal and perinatal factors associated with perinatal outcomes by examining families comprised of Korean fathers, Asian immigrant mothers, and their newborns. METHODS: Medical records of newborn infants admitted to Jeonju Jesus Hospital nursery or ne-onatal intensive care unit (NICU) from January 2004 to June 2013 and their Asian immigrant mothers were reviewed retrospectively. The newborns were divided into two groups depending on whether they were admitted NICU or not, and factors influencing on perinatal outcomes were compared between the two groups. The newborn were divided into the two groups, including those who did not receive inpatient care and those treated in the NICU. The differences between the two groups were analyzed. RESULTS: The study included 180 newborns and 172 mothers, and 94 (52.3%) and 86 (47.7%) newborns were classified as the nursery group and the NICU group, respectively. There were no statistically significant differences between the two groups in terms of the mothers' nationality, maternal age, maternal education level, maternal occupation, residential area, maternal height and weight, maternal weight gain during pregnancy, maternal hepatitis B antigen positivity, maternal parity, paternal age, and age gap between spouses. However, underweight maternal prepregnancy body mass index (BMI) and hemoglobin level over 11.0 g/dL were significantly more frequent in the NICU group in the comparative analysis. The NICU group showed significantly more frequent no iron supplements during pregnancy (OR=4.06) and gestational disease (OR=3.81). CONCLUSION: In cases where married immigrant mothers had underweight prepregnancy BMI, gestational disease, or no iron supplements during pregnancy, their newborns were more likely to have NICU care. Therefore, married immigrant women should have appropriate perinatal care including education about a balanced diet to maintain an appropriate body weight with ensuring an adequate iron supplements intake.

Erros alimentares na dieta de crianças frequentadoras de berçários em creches públicas no município de São Paulo, Brasil / Dietary errors in the diet of children attending nurseries of public daycare centers in São Paulo city, Brazil

OBJETIVO: Descrever os erros alimentares presentes na introdução da alimentação complementar e na oferta de leite não materno em crianças frequentadoras de creches públicas do município de São Paulo (SP). MÉTODOS: Estudo descritivo transversal, composto por 255 crianças, com faixa etária entre cinco e 29 meses. Os questionários estruturados e pré-codificados, com perguntas abertas e fechadas, foram elaborados para a coleta de dados, que ocorreu entre abril e novembro de 2007. Estes foram transcritos e analisados no programa estatístico Epi-Info 2000. As variáveis avaliadas foram a introdução de leite não materno, a introdução de alimentos e a consistência inicial da alimentação complementar. RESULTADOS: A introdução do leite não materno ocorreu em 40 por cento das crianças até três meses e em 78 por cento até seis meses. Aos três meses, aproximadamente 50 por cento recebiam líquidos não lácteos e 15 por cento, papas de frutas, legumes, verduras e carnes. Na introdução do leite não materno, 68 por cento dos bebês receberam leite de vaca e 31 por cento, fórmulas infantis. Fígado e peixe foram os alimentos mais tardiamente oferecidos. Quanto à consistência das refeições oferecidas, 49 por cento foram inadequadas. CONCLUSÕES: O fato de as crianças serem frequentadoras de creches públicas aponta para a importância da capacitação dos profissionais que nelas atuam e que, eventualmente, são os responsáveis pela introdução da alimentação complementar.

OBJECTIVE: To describe the dietary errors occurring when supplementary feeding is introduced and non-maternal milk is offered to children attending public daycare centers in the city of São Paulo, Brazil. METHODS: Cross-sectional and descriptive study of 255 children aged between five to 29 months. Pre-coded and structured questionnaires with open and closed questions were developed for data collection that occurred between April and November 2007. Such data were transcribed and analyzed by Epi-Info 2000 statistical software. The analyzed variables were the introduction of non-maternal milk, the introduction of foods and the initial solidity of supplementary feeding. RESULTS: The introduction of non-maternal milk occurred in 40 percent of children aged up to three months and in 78 percent up to six months. By the age of three months, approximately 50 percent received non-dairy liquids and 15 percent, strained fruits, vegetables, greens and meat. Regarding the introduction of non-maternal milk, 68 percent of babies received cow milk and 31 percent, infant formulas. Liver and fish were the latest foods to be offered. Regarding solidity of meals, 49 percent were inadequate. CONCLUSIONS: The fact that children attend public daycare centers points out the importance to properly qualify the professionals who work in such places and are eventually responsible for introducing the supplementary feeding.

OBJETIVO: Describir los errores alimentares presentes en la introducción de la alimentación complementar y en la oferta de leche no materna en niños frecuentadores de guarderías públicas en el municipio de São Paulo. MÉTODOS: Estudio descriptivo transversal, compuesto de 255 niños en la franja de edad entre 5 y 29 meses. Los cuestionarios estructurados y precodificados, con preguntas abiertas y cerradas, fueron elaborados para la recolección de datos, que tuvo lugar entre abril y noviembre de 2007. Éstos fueron transcriptos y analizados en el programa estadístico Epi-Info 2000. Las variables evaluadas fueron la introducción de leche no materna, introducción de alimentos y la consistencia inicial de la alimentación complementaria. RESULTADOS: La introducción de la leche no materna ocurrió en 40 por ciento de los niños hasta 3 meses y en 78 por ciento de los niños hasta 6 meses. A los 3 meses de edad, un 50 por ciento recibía líquidos no lácteos y un 15 por ciento papillas de frutas, legumbres, verduras y carnes. En la introducción de la leche no materna, 68 por ciento de los bebés recibieron leche de vaca y 31 por ciento, fórmulas infantiles. Hígado y pescado fueron los alimentos más tardíamente ofrecidos. Respecto a la consistencia de las comidas ofrecidas, el 49 por ciento fue inadecuada. CONCLUSIONES: El hecho de que los niños son frecuentadores de guarderías públicas señala la importancia de la capacitación de los profesionales que ahí actúan, y que eventualmente son los responsables de la introducción de la alimentación complementar.

Glucose-6-phosphate dehydrogenase deficiency in Filipino neonates with jaundice

OBJECTIVES: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common of all clinically significant enzyme defects of red blood cells. It has a high rate of prevalence in the Philippines. Concern about hemolytic anemia and jaundice due to unrecognized G6PD deficiency led us to determine the prevalence of G6PD deficiency among jaundiced neonates in the Philippine General Hospital, a tertiary referral hospital in the Philippines. It was hypothesized that G6PD deficiency was more prevalent in neonates with jaundice than in the normal population. We also compared the clinical presentation and course (hospital stay and days of phototherapy requirement) for G6PD deficient and G6PD normal neonates. MATERIALS AND METHODS: We studied 102 clinically jaundiced neonates admitted to the nursery of the Philippine General Hospital. Blood samples in individual microtainers were quantitatively tested for G6PD activity using a commercial G6PD assay kit. The clinical presentation and hospital courses of patients were statistically compared using the t-test for single proportions. RESULTS: G6PD deficiency was diagnosed in 17 of 102 cases[16.7% (95% CI: 10.0 to 25.3)], which is significantly higher than the normal population (p CONCLUSION: The prevalence of G6PD deficiency among jaundiced neonates was found to be higher than the normal population thus, early detection of this enzymopathy, regardless of sex, and close surveillance of the affected newborns is important in reducing the risk of severe hyperbilirubinemia.

Short-term clinical outcomes of late preterm infants / 소아과

PURPOSE: To identify the short-term clinical outcomes of late preterm infants and to test the hypothesis that late preterm infants have more clinical problems during the early postnatal period than term infants. METHODS: One hundred late preterm infants [gestational age (GA) 34(+0)-36(+6) weeks] and the same number of term infants (GA 37(+0)-41(+6) weeks) were randomly selected from 289 late preterm infants and 825 term infants born in the Seoul National University Bundang Hospital between January 2007 and December 2007, and their electronic medical records were reviewed and analyzed. RESULTS: Compared to term infants, late preterm infants had significantly more medical problems such as temperature instability (odds ratio [OR] 8.7), hypoglycemia (OR 17.5), intravenous fluid infusion (OR 10.2), evaluation for sepsis (OR 9.4), respiratory problems (OR 7.5), apnea and bradycardia (OR 8.6), phototherapy for jaundice (OR 3.6), and feeding intolerance (OR 10.0). Hospital stay was also significantly longer in late preterm infants. CONCLUSION: Late preterm infants had significantly more medical problems and increased length of hospital stay compared to term infants. More attention should be given to caring for these late preterm infants in newborn nursery during the early postnatal period.

Evaluation of fat sources (lecithin, mono-glyceride and mono-diglyceride) in weaned pigs: Apparent total tract and ileal nutrient digestibilities

This study was conducted to investigate the effects of lecithin, mono-glyceride and mono-diglyceride on apparent total tract and ileal nutrient digestibilities in nursery pigs. Twenty [(Landrace x Yorkshire) x Duroc] barrows were surgically fitted with simple T-cannulas. Dietary treatments included 1) CON (basal diet: soy oil), 2) LO (lecithin 0.5%), 3) MO (mono-glyceride 0.5%), 4) MG (mono-glyceride 1.0%) and 5) MDG (mono-diglyceride 1.0%). In apparent total tract nutrient digestibility, dry matter (DM) and gross energy (GE) digestibilities of MDG treatments were higher than LO and MG treatments (p<0.05). In nitrogen (N) digestibility, LO treatment showed the lowest compared to others (p<0.05). The digestibility of crude fat was higher in MDG treatment than CON and LO treatments (p<0.05). In apparent ileal nutrient digestibility, DM digestibility was higher in MDG treatment than LO and MG treatments (p<0.05). GE digestibility was higher in MDG treatment than LO, MO and MG treatments (p<0.05). N digestibility of MDG treatment was greater than LO treatment (p<0.05). Also, the digestibility of crude fat was higher in MDG treatment than CON and LO treatments (p<0.05). In conclusion, mono-diglyceride can increase apparent total tract nutrient and apparent ileal nutrient digestibilities of DM, GE, N and crude fat.

Prenatal, perinatal and neonatal stimulation: a survey of neonatal nurseries.

A recent survey was conducted on stimulation of mothers and babies during pregnancy and the neonatal period. The survey was responded to by 82 neonatology staff members from Neonatal Intensive Care Units (NICUs) at hospitals in the United States. Some forms of stimulation were extremely common including (1) skin-to-skin following birth in the delivery room (83% of hospitals); (2) containment (swaddling and surrounded by blanket rolls) in the NICU (86%); (3) music in the NICU (72%); (4) rocking in the NICU (85%); (5) kangaroo care (98%); (6) non-nutritive sucking during tubefeedings in the NICU (96%); and (7) breastfeeding in the NICU (100%). Other forms of stimulation occurred less frequently including (1) pregnancy massage (19%); (2) labor massage (30%); (3) the Doula (assistant who comforts during labor and delivery) (30%); (4) waterbeds in the NICU (23%); and (5) preterm infant massage in the NICU (38%).

Experience of High-Dose Intravenous Immune Globulin Therapy for Neonatal Immune Hemolytic Jaundice due to ABO Incompatibility

PURPOSE: Neonatal immune hemolytic jaundice due to blood group incompatibility is important to treat properly because of an early rise and a high peak of serum bilirubin level and a risk of kernicterus. The conventional therapeutic modalities for neonatal immune hemolytic jaundice due to blood group incompatibility are phototherapy and exchange transfusion. We evaluated the effect of intravenous immune globulin (IVIG) therapy on hyperbilirubinemia due to ABO incompatibility. METHODS: This study included 6 infants with hyperbilirubinemia due to ABO incompatibility who were admitted to the nursery of Eulji Medical Center, Nowon Hospital, from January 2000 to February 2001. All 6 infants had a positive direct Coombs test. Their serum bilirubin levels were above 12 mg/dl within 24hours of age and above 20 mg/dl after 24hours of age. They were treated with intensive phototherapy and IVIG. RESULTS: We classified the effective group when a decline in serum bilirubin level was more than 2 mg/dl in 3-4 hours after IVIG therapy, and the ineffective group when there was a decline in serum bilirubin level less than 2 mg/dl, a re-rise after the initial response to IVIG, or a decline after the combined therapy with intensive phototherapy and IVIG equal or less than that after intensive phototherapy alone. In the effective group (n=2), the average decline in serum bilirebin level was 4.1 mg/dl in 3-4 hours and 8.1 mg/dl in 12-16 hours after IVIG therapy, while in the ineffective group (n=4), the average decline was 1.9 mg/dl and 2.7 mg/dl, respectively. Five among 6 infants were treated with IVIG therapy and 1 infant was treated with exchange transfusion. No serious side effect was detected during and after IVIG therapy. CONCLUSION: We demonstrated the effectiveness of IVIG therapy in 2 infants out of six who were treated with intensive phototherapy and IVIG for hyperbilirubinemia due to ABO incompatibility. IVIG therapy could be considered if hyperbilirubinemia due to ABO incompatibility does not respond to intensive phototherapy alone. Further prospective and randomized studies would be needed.

Promoçäo de saúde: uma experiência baseada na antroposofia: o caso da favela Monte Azul / Health promotion: an experience based on Anthroposofy: the case of Monte Azul slum

Objetivo: Analisa a Associaçäo Comunitária Monte Azul (ACOMA), uma organizaçäo näo governamental (ONG), quanto ao referencial teórico verificando se suas estratégias de promoçäo humana, promovem saúde. Métodos: Análise institucional, metodologia de pesquisa qualitativa, de base empírica, que é pesquisa e intervençäo. Fontes de dados: a) estudo do referencial teórico da ACOMA; b) acompanhamento e observaçäo do cotidiano do berçário e das creches da ACOMA; c) realizaçäo de entrevistas semi-estruturadas e grupos focais com os pais das crianças atendidas pela ACOMA; "mäes de creche"; dirigentes e colaboradores envolvidos na coordenaçäo pedagógica e na assistência médica. Resultados: A análise do cotidiano do berçário e das creches da ACOMA revela a reproduçäo na prática, das idéias pedagógicas baseadas na antroposofia e que esta é promotora de saúde. As atividades desenvolvidas com as crianças säo promotoras de saúde. Falha apontada: ausência de um trabalho com os pais das crianças. Os pais näo revelam consciência acerca da filosofia que orienta os serviços prestados pela ACOMA, sendo saúde "ausência de doença". Conclusöes: As idéias antroposóficas foram compreendidas e adotadas, sendo as açöes coerentes com a mesma

Clinical Course and Treatment of Early Neonatal Hypocalcemia

PURPOSE: The clinical findings of early neonatal hypocalcemia are variable and it is difficult to find relationship between the symptoms and hypocalcemia due to complex causes. The purpose of this study is to establish the relationship between early neonatal hypocalcemia and clinical manifestations and to propose a guideline for appropriate treatment of early neonatal hypocalcemia, especially in asymptomatic cases. METHODS: Study subjects were all sick babies admitted to nursery and NICU and randornly selected 43 healthy babies at Sun General Hospital from January 1996 to December 1996. We examined serum calcium level within 72 hours after birth. Then we evaluated prospectively clinical findings according to each disease category in hypocalcemic cases and analysed the relationship of time course of clinical findings with hypocalcemia and compared serum calcium concentration followed by each therapy after 3 days. RESULTS: The results were as follows. 1) The incidence of early neonatal hypocalcernia was high in premature infants, low birth weight infants, infants with neonatal asphyxia, hyaline membrane disease and transient tachypnea. 2) Tremor, seizure, apnea, dyspnea, abdominal distension, cyanosis, and vomiting were frequently presented symptoms in early neonatal hypocalcemia. 3) In the cases of early hypocalcemia with symptoms, these symptoms persisted continuously after norrnalization of serum calcium concentration. 4) Among asymptomatic hypocalcernic group, mean serum calcium levels changed from 6.7 mg/dL to 8.7 mg/dL in 23 cases of no treatment, from 5.4 mg/dL to 10.3 mg/dL in 4 cases of calcium gluconate infusion, and from 6.3 mg/dL to 8.7 mg/dL in 7 cases of feeding low phosphorus containing milk. None persisted in hypocalcemic state irrespective of treatment methods. CONCLUSION: It is difficult to regard these symptoms as a rule to treatment because these symptoms were present after normalizaton of serum calcium concentration. In addition, asymptomatic hypocalcemia was improved shortly without any treatment without any problem. We conclude that for asymptomatic hypocalcemia, withholding dangerous calcium gluconate infusion would be perrnissible.