Exploring physiological stability of infants in Kangaroo Mother Care position versus placed in transport incubator during neonatal ground ambulance transport in Sweden.

BACKGROUND: The positive effects of Kangaroo mother care in NICU's are well documented but, to a lesser extent, explored during inter-hospital neonatal transport. Inter-hospital transport, with the infant placed in a transport incubator, increases the risk of separation while infants in Kangaroo mother care position implies that the parents accompany the transport. There exists limited knowledge if physiological stability differs when transported in Kangaroo mother care position compared to transport in a transport incubator. AIMS: The aim of this study was to compare physiological stability of infants transported via ground ambulance in either Kangaroo mother care position or positioned in a transport incubator. METHOD: In total, 24 infants were recruited to be transported between hospitals in either a Kangaroo mother care position (n = 16) or in a transport incubator (n = 8). Inclusion criteria were; current weight >1500 g; current gestational age above 31+ 0  weeks; no central catheter; no respiratory support and no planed painful or distressing interventions during the 48-h follow-up period post-transport. Exclusion criteria were; infants whose parents did not speak or understand Swedish or English and infants with a current weight above 4500 g for the KMC group. Physiological stability was obtained during transport and for a 48-h follow-up period by measuring body temperature, respiratory and heart rate, oxygen saturation, pain score, transport risk assessment and number of interventions during transport and 48-h post-transport. Cost-effectiveness and adverse events were also evaluated. RESULTS: Both groups had comparable background characteristics and physiological stability during transport and for the 48-h follow-up period after transport. Transporting in Kangaroo mother care position was more cost-effective. STUDY LIMITATION: A small sample size in both groups. CONCLUSION: Transporting an infant in Kangaroo mother care position can be regarded as a choice of transport mode when the infant fulfils the set criteria.

The impact of an individualised neonatal parent support programme on parental stress: a quasi-experimental study.

AIM: To evaluate the impact on parental stress of an individualised neonatal parent support programme. METHOD: A quasi-experimental design. Parents of preterm infants, at a level II NICU, were consecutively assigned to a control group (n = 130) and to an intervention group (n = 101). The programme focused on person-centred communication and consisted of four individual nurse-parent dialogues during the infants' hospitalisation. The Swedish version of the Parental Stressor Scale: Neonatal Intensive Care Unit was used to assess parental stress. RESULT: The total stress scores did not vary significantly between the control and intervention groups either for mothers or for fathers. However, on item-level, some items were significantly more distressed for mothers in the control group compared to the intervention group; other sick babies being cared for in the room (p = 0.016); my baby's unusual or abnormal breathing patterns (p = 0.025); not being able to hold my baby (p = 0.014); sometimes forgetting what my baby looks like (p = 0.042); being afraid of touching or holding my baby (p = 0.030); feeling the staff is closer to my baby than I am (p = 0.006). Comparing stress between mothers and fathers in the control group demonstrated a significant higher overall stress level for mothers compared to fathers (p < 0.005). The same result was found in the subscales Infant's behaviour and appearance (p = 0.016) as well as Parental role alteration (p = 0.001). No significant differences revealed between parents in the intervention group except for one item not being able to feed the babies themselves. It was significantly more distressed for mothers (p < 0.001). CONCLUSION: In this study, there was a decreased stress experience on item level in different subscales amongst mothers, but the study did not demonstrate any impact of the intervention on total stress experience either for mothers or for fathers.

Medical services of a multicultural summer camp event: experiences from the 22nd World Scout Jamboree, Sweden 2011.

BACKGROUND: Prevention and treatment of medical issues are the main task of a health service at a youth camp. However, only few reports about organisation and implementation of camp health care are available. This makes it difficult for future camp directors to plan and estimate the health care needed for a certain camp size. We summarize the experience in planning and running health care for the 22nd World Scout Jamboree (WSJ) 2011 in Sweden. METHODS: During the WSJ, 40,061 participants from 146 nations were gathered in southern Sweden to a 12 day summer camp. Another 31,645 people were visitors. Members for the medical service were 153 volunteering medical professionals with different language and cultural backgrounds from 18 different countries. RESULTS: Of 40,061 participants 2,893 (7.3%) needed medical assistance. We found an equal distribution of cases to approximately one third surgical, one third medical and one third unspecified cases. Much energy was spent on health prevention, hygiene measures and organizing of psychological support. CONCLUSIONS: A youth camp with a multicultural population and a size of a small city demands flexible staff with high communication skills. Special attention should be paid in prevention of contagious diseases and taking care of psychological issues.

No evidence of intrauterine transmission of hepatitis A virus from a mother to a premature infant.

AIM: To determine whether or not an intrauterine transmission of hepatitis A virus (HAV) occurred from an infected mother to her premature infant delivered by caesarean section. METHODS: The mother and her child were tested for HAV by serology and reverse transcription PCR. RESULTS: An outbreak of HAV infection was seen among children and a 33-year-old day-care teacher, pregnant in third trimester, at a day-care centre in southern Sweden. Due to premature labour and diminished foetal movements a caesarean section was performed and a premature girl in gestational weeks 33 + 1 was born. During the 3-week postnatal hospitalization period the child presented no clinical symptoms of HAV infection and anti-HAV IgM antibodies remained undetectable at day 14 and 109 after birth. Furthermore HAV RNA remained undetectable by reverse transcription PCR in the child's blood at birth and in throat and faeces for the first 3 and 4 weeks of life respectively. HAV RNA in the mother's blood was detected at 6 days prior to and at 17 days after delivery. HAV RNA was undetectable in breast milk when tested on day 3 after delivery. CONCLUSION: There was no evidence of intrauterine transmission of hepatitis A virus from a viraemic mother to her premature child delivered at gestational week 33 + 1 by caesarean section.

[Swedish guidelines for prevention and treatment of pain in the newborn infant]. / Svenska riktlinjer för prevention och behandling av smärta hos nyfödda.

A Swedish national consensus statement concerning prevention and management of pain in the newborn infant has been prepared by members of the Swedish Paediatric Pain Society (Svensk Barnsmärtförening, SBSF). The document is based on the Consensus Statement for the Prevention and Management of Pain in the Newborn Infant by Anand et al [1].

A premature infant with fulminant meningococcal septicaemia.

The case is described of a 10-week-old preterm infant, a twin boy born at 34 weeks of gestational age. The day after a hernia operation he had a rapidly progressive fulminant Neisseria meningitidis serogroup B septicaemia, of which he died despite immediate and adequate treatment. No secondary cases occurred among other infants on the neonatal intensive care unit. Epidemiological investigation revealed that of 185 bacterial throat cultures performed on 17 infants on the ward, 37 close relatives to the infants and 131 medical personnel in contact with the deceased patient, 4 (2.2%) were asymptomatic carriers of N. meningitidis. Serotyping and pulsed-field gel electrophoresis of the genomic DNA of the N. meningitidis isolates revealed that the infant and his father had closely related strains.

N-acetylcysteine does not prevent bronchopulmonary dysplasia in immature infants: a randomized controlled trial.

OBJECTIVE: To evaluate whether N-acetylcysteine (NAC) infusion during the first week of life reduces the risk of death or bronchopulmonary dysplasia (BPD) in infants with extremely low birth weight. Study design In a Nordic multicenter, double-blind trial, infants (n=391) weighing 500 to 999 g and on ventilator or nasal continuous positive airway pressure were randomized before the age of 36 hours to receive NAC 16 to 32 mg/kg/d (n=194) or placebo (n=197) intravenously for 6 days. Primary end points were death or BPD, defined as supplementary oxygen requirement at 36 weeks' gestational age. RESULTS: There was no difference in the combined incidence of the primary end points death or BPD, 51% vs. 49%, between the NAC group and control group. Also similar was the incidence of BPD in survivors at 36 weeks' gestational age, 40% vs. 40%, and the mean oxygen requirement at the age of 28 days, 31.2% vs. 30.7%, respectively. The severity of BPD was similar in both groups. CONCLUSIONS: A 6-day course of intravenous N-acetylcysteine at the dosage used does not prevent BPD or death in infants with extremely low birth weight.