Actuarial Survival Based on Gestational Age in Days at Birth for Infants Born at <26 Weeks of Gestation.

OBJECTIVE: To provide comprehensive, contemporary information on the actuarial survival of infants born at 22-25 weeks of gestation in Canada. STUDY DESIGN: In a retrospective cohort study, we included data from preterm infants of 22-25 weeks of gestation admitted to neonatal intensive care units participating in the Canadian Neonatal Network between 2010 and 2017. Infants with major congenital anomalies were excluded. We calculated gestational age using in vitro fertilization date, antenatal ultrasound dating, last menstrual period, obstetrical estimate, or neonatal estimate (in that order). Infants were followed until either discharge or death. Each day of gestational age was considered a category except for births at 22 weeks, where the first 4 days were grouped into one category and the last 3 days were grouped into another category. For each day of life, an actuarial survival rate was obtained by calculating how many infants survived to discharge out of those who had survived up to that day. RESULTS: Of 4335 included infants, 85, 679, 1504, and 2067 were born at 22, 23, 24, and 25 weeks of gestation, respectively. Survival increased from 32% at 22 weeks to 83% at 254-6/7 weeks. Graphs of actuarial survival developed for the first 6 weeks after birth in male and female children indicated a steep increase in survival during the first 7-10 days postnatally. CONCLUSIONS: Survival increased steadily with postnatal survival and was dependent on gestational age in days and sex of the child.

Outcomes at 18 to 22 Months of Corrected Age for Infants Born at 22 to 25 Weeks of Gestation in a Center Practicing Active Management.

OBJECTIVE: To assess the outcomes in actively managed extremely preterm infants after admission to a neonatal intensive care unit. STUDY DESIGN: Retrospective cohort of 255 infants born at 22-25 weeks of gestation between 2006 and 2015 at a single study institution. Infants were excluded for congenital anomaly, death in delivery room, or parental request for palliation (n = 7). Neurodevelopmental outcomes were analyzed for 169 of 214 survivors (78.9%) at 18-22 months of corrected age. Outcomes were evaluated using the Mann-Whitney U, χ2, or Fisher exact test, where appropriate. In addition, cognitive scores of the Bayley Scales of Infant-Toddler Development (3rd edition) were assessed using generalized estimating equations. RESULTS: Seventy infants born at 22-23 weeks of gestation (22 weeks, n = 20; 23 weeks, n = 50) and 178 infants born at 24-25 weeks of gestation (24 weeks, n = 79; 25 weeks, n = 99 infants) were included. Survival to hospital discharge of those surviving to NICU admission was 78% (55/70; 95% CI, 69%-88%) at 22-23 weeks and 89% (159/178; 95% CI, 84%-93% at 24-25 weeks; P = .02). No or mild neurodevelopmental impairment in surviving infants was 64% (29/45; 95% CI, 50%-77%) at 22-23 weeks and 76% (94/124; 95% CI, 68%-83%; P = .16) at 24-25 weeks. CONCLUSIONS: Although survival was lower in infants born at 22-23 weeks than at 24-25 weeks of gestation, the majority of survivors in both groups had positive outcomes with no or mild neurodevelopmental impairments. Further evaluation of school performance is warranted.

Retinopathy of prematurity prevention, screening and treatment programmes: Progress in South America.

Retinopathy of prematurity (ROP) is the main cause of blindness and visual impairment in Latin America and prevention, detection and treatment have been a priority in the Region in the last two decades. There is progress in the number of eligible babies screened and treated in at least half of the countries with strong regulations on ROP, but screening is not yet available in all provinces in most. More effort is needed to increase national protocols and legislation, strengthening of services and human resources to cover all national provinces; telemedicine might be a promising strategy.

Intervenciones de enfermería en neonatos con presión positiva continua / Nursing Intervention in Neonates with Continuous Positive Pressure / Intervenções de enfermagem em neonatos com pressão positiva contínua

Objetivo: describir las intervenciones de enfermería en neonatos con presión positiva continua con prongs, hospitalizados en una unidad neonatal mexicana. Métodos: corte transversal en una muestra no aleatoria por conveniencia, conformada por veinticinco enfermeras que tenían bajo sus cuidados a recién nacidos con sistema de presión positiva con prongs. La recolección de datos fue realizada con un cuestionario autoplicado. El análisis fue descriptivo, y se obtuvieron medidas de tendencia central de las variables cuantitativas que mostraron una distribución normal. Las variables cualitativas se describen con valores relativos. Se respetaron aspectos éticos según la reglamentación vigente mexicana. Resultados: participaron veinticinco enfermeras con grado académico: el 88% con licenciatura y solo el 24% especialistas neonatólogas. Los neonatos usan la presión positiva continua: el 52% de 3 a 5 días; el 20% de 6 a 7 días y el 28% de 8 a 12 días. El nivel de lesión nasal y los resultados con prongs, mediante el cuidado constante de la enfermera sobre la aparición de estas, evidenciaron que el 60% de los neonatos presentó lesión leve; el 36%, moderada, y el 4%, severa. Conclusiones: las intervenciones de cuidado del neonato deben dirigirse a minimizar las lesiones de piel y tabique nasal para contribuir con las normas internacionales de seguridad del neonato.

Objective: To describe nursing interventions in neonates with continuous positive airway pressure with prongs, Mexican hospitalized in neonatal unit. Methods: Cross-section in a nonrandom convenience sample, composed of 25 nurses who were under their care to newborns, positive pressure system with prongs. Data collection was performed with self-administered survey. Data analysis was descriptive, measures of central tendency for quantitative variables that showed a normal distribution were obtained. The qualitative variables are described in relative values. Ethical aspects were respected as required by regulations. Results: 25 nurses participated degree: 88% graduate and only 24% neonatologist specialists, Infants use continuous positive airway pressure: 52% of 3-5 days 20% of 6-7 days and 28% of 8-12 days with respect to the level of nasal lesions, results with prongs, through constant care nurse about the appearance of these, 60% of neonates presented mild injury, 36% moderate and 4% severe. Conclusions: It requires nursing care interventions careful of the newborn to minimize skin lesions and nasal septum and contribute to international safety standards neonate.

Objetivo: describir as intervenções de enfermagem em neonatos com pressão positiva contínua com prongs, internados em uma unidade neonatal mexicana. Métodos: de corte transversal em uma amostra por conveniência não aleatória, composta por 25 enfermeiros que dão cuidados ao recém-nascido com sistema de pressão positiva com prongs. A coleta de dados foi realizada com um questionário autoaplicável. A análise dos dados foi descritiva, foram obtidas medidas de tendência central para variáveis quantitativas que apresentaram distribuição normal. As variáveis qualitativas são descritos em valores relativos. Aspectos éticos foram respeitados conforme exigidos pelos regulamentos mexicanos. Resultados: 25 enfermeiros com grau académico: 88% licenciatura e apenas 24% neonatologas especialistas. Os neonatos com o uso da pressão positiva contínua: 52% de 3-5 dias, o 20% de 6-7 dias e o 28% de 8-12 dias, com respeito ao nível de lesões nasais, os resultados com prongs, o 60% de neonatos apresentou lesão leve, 36% moderada e 4% grave. Conclusões: as intervenções de cuidado devem ser encaminhadas a minimizar lesões de pele e septo nasal e contribuir com as normas de segurança internacionais do neonato.

Needs assessment to improve neonatal intensive care in Mexico.

BACKGROUND: At the time of the research, Dr Weiss was a clinical fellow in neonatal-perinatal medicine at Baylor College of Medicine, Texas Children's Hospital. Dr Profit was on faculty at Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Section of Neonatology. He held a secondary appointment in the Department of Medicine, Section of Health Services Research and conducted his research at the VA Health Services Research and Development Center of Excellence where he collaborated with Dr Kowalkowski.: Improving the quality of neonatal intensive care is an important health policy priority in Mexico. A formal assessment of barriers and priorities for quality improvement has not been undertaken. AIM: To provide guidance to providers and policy makers with regard to addressing opportunities for better care delivery in Mexican neonatal intensive care units. OBJECTIVE: To conduct a needs assessment regarding improvement of quality of neonatal intensive care delivery in Mexico. METHODS: Spanish-language survey administered to a volunteer sample of Mexican neonatal care providers attending a large paediatric conference in Mexico in June 2011. Survey domains included institutional context of quality improvement, barriers, priorities, safety culture, and respondents' characteristics. Results were analysed using descriptive analyses of frequencies, proportions and percentage positive response (PPR) rates. RESULTS: Of 91 respondents, the majority identified neonatology as their primary specialty (n = 48, 65%) and were physicians (n = 55, 73%). Generally, providers expressed a desire to improve quality of care (PPR 69%) but reported notable deterrents. Respondents (n, %) identified family inability to pay (38, 48%), overcrowded work areas (38, 44%), insufficient financial reimbursement (25, 36%), lack of availability of nurses (26, 30%), ancillary staff (25, 29%), and subspecialists (22, 25%) as the principal barriers. Respiratory care (27, 39%)--reduction of mechanical ventilation and initiation of nasal continuous positive airway pressure--and reduction in frequency of late-onset infections (19, 28%) were selected as top clinical priorities. There were substantial opportunities for improving safety (PPR 48%) and teamwork climate (PPR 58%). CONCLUSION: These findings may guide efforts to improving quality of care delivery in Mexican neonatal intensive care units.

Red blood cell transfusion is not associated with necrotizing enterocolitis: a review of consecutive transfusions in a tertiary neonatal intensive care unit.

OBJECTIVE: To explore the association between red blood cell transfusion and necrotizing enterocolitis (NEC) in a neonatal intensive care unit with liberal transfusion practices. STUDY DESIGN: A retrospective cohort study was conducted for all infants weighing <1500 g who received at least 1 packed red blood cell transfusion between January 2008 and June 2013 in a tertiary neonatal intensive care unit. The primary outcome was NEC, defined as Bell stage II or greater. The temporal association of NEC and transfusion was assessed using multivariate Poisson regression. RESULTS: The study sample included 414 very low birth weight infants who received 2889 consecutive red blood cell transfusions. Twenty-four infants (5.8%) developed NEC. Four cases of NEC occurred within 48 hours of a previous transfusion event. Using multivariate Poisson regression, we did not find evidence of a temporal association between NEC and transfusion (P = .32). CONCLUSION: There was no association between NEC and red blood cell transfusion. Our results differ from previous studies and suggest that the association between NEC and transfusion may be contextual.

Restrictive guideline reduces platelet count thresholds for transfusions in very low birth weight preterm infants.

BACKGROUND AND OBJECTIVES: Platelet transfusions are performed almost entirely according to expert experience. This study assessed the effectiveness of a restrictive guideline to reduce platelet transfusions in preterm infants. METHODS: A retrospective cohort of preterm infants with a birth weight of <1500 g had been born in 2 periods. In Period 1, a transfusion was indicated for a platelet count of <50,000/ml in clinically stable neonates or <100,000/ml in bleeding or clinically unstable infants. In Period 2, the indications were restricted to <25,000/ml in clinically stable neonates, or <50,000/ml in newborns who were either on mechanical ventilation, subject to imminent invasive procedures, within 72 h following a seizure, or extremely premature and <7 days old. A count of <100,000/ml was indicated for bleeding or major surgery. RESULTS: Periods 1 and 2 comprised 121 and 134 neonates, respectively. The rates of ventricular haemorrhage and intrahospital death were similar in both periods. The percentage of transfused infants, the odds of receiving a platelet transfusion, the mean platelet count before transfusion and the percentage of transfusions with a platelet count >50,000/ml were greater in Period 1. Among thrombocytopenic neonates, the percentage of transfused neonates and the number of transfusions were similar in both groups. CONCLUSION: The restrictive guideline for platelet transfusions reduced the platelet count thresholds for neonatal transfusions without increasing the rate of ventricular haemorrhage.

Participación de las madres en el cuidado de los recién nacidos internados en un servicio de neonatología que aplica el modelo de maternidad centrada en la familia / Participation of mothers in the care of newborns admitted to a neonatal model applying family-centered maternity

La participación activa de las madres en las unidades de terapia intensiva neonatales es beneficiosa para sus recién nacidos, mejora su crecimiento, disminuye el riesgo de infecciones y se asocia con mayor producción de leche humana. El objetivo de este estudio fue cuantificar las actividades que desarrollan las madres dentro de la unidad y estimar la reducción del tiempo de enfermería atribuible a su presencia. Diseño: Transversal, descriptivo. Resultados: Durante una semana las madres realizaron 798 prácticas a las que se les podrían atribuir 75 horas y 23 minutos (percentilos 10-90: 16 -123 hs) de trabajo de enfermería. Conclusión: Este estudio permitió conocer y cuantificar las principales actividades asociadas al cuidado de las madres de los niños internados y se logró una reducción en la carga de trabajo de enfermería equivalente a más de 12 turnos de enfermería de 6 hs en una semana.

Active mothers participation in the neonatal intensive care units (NICU) is beneficial for their babies, improving body growth, reducing the risk of infections and is associated with increased production of human milk. The objective of this study was to quantify the activities that mothers do within the unit in the care of their babies and to estimate the reduction of nursing time attributable to their presence. Design: Descriptive, cross section. Results: During a week, mothers conducted 798 practices with an estimate of 75 hours and 23 minutes (Percentiles 10-90: 16 -123 hours) of nursing work. Conclusion: This study allowed us to know and quantify the main activities that mothers perform in the care of their own babies staying in the NICU, This activities represent a reduction in nursing workload equivalent to more than 12 nursing shifts of 6 hours in a week.

Risk factors for neonatal transfers from the Sapopemba free-standing birth centre to a hospital in São Paulo, Brazil.

OBJECTIVE: to identify risk factors associated with neonatal transfers from a free-standing birth centre to a hospital. DESIGN: epidemiological case-control study. SETTING: midwifery-led free-standing birth centre in São Paulo, Brazil. PARTICIPANTS: 96 newborns were selected from 2840 births between September 1998 and August 2005. Cases were defined as all newborns transferred from the birth centre to a hospital (n=32), and controls were defined as newborns delivered at the same birth centre, during the same time period, and who had not been transferred to a hospital (n=64). MEASUREMENTS AND FINDINGS: data were collected from medical records available at the birth centre. Univariate and multivariate analyses were performed using logistic regression. The multivariate analysis included outcomes with p<0.25, specifically: smoking during pregnancy, prenatal care appointments, labour complications, weight in relation to gestational age, and one-minute Apgar score. Of the foregoing outcomes, those that remained in the full regression model as a risk factor associated with neonatal transfer were: smoking during pregnancy [p=0.009, odds ratio (OR)=4.1, 95% confidence interval (CI) 1.03-16.33], labour complications (p<0.001, OR=5.5, 95% CI 1.06-28.26) and one-minute Apgar score ≤ 7 (p<0.001, OR=7.8, 95% CI 1.62-37.03). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: smoking during pregnancy, labour complications and one-minute Apgar score ≤ 7 were confirmed as risk factors for neonatal transfer from the birth centre to a hospital. The identified risk factors can help to improve institutional protocols and formulate hypotheses for other studies.

The participation of parents in the care of premature children in a neonatal unit: meanings attributed by the health team.

This qualitative study aims to identify and analyze the meanings the health team attributes to the parents' participation in the care of premature children hospitalized at a public hospital. Data were recorded and collected through semi-structured interviews performed with 23 professionals. The results show that parents' participation in the care of these children is still in an initial stage at the hospital's neonatal unit. However, there is interest from the health team to implement it because its importance is recognized in improving the clinical stability, the growth and development process of premature children. In addition to allowing for mother-child interaction and affective bonding, it prepares the mother for the child's discharge. The presence of the mother helps the nursing team by giving maternal care to the hospitalized child. On the other hand, the parents' presence interferes in the environment of the neonatal unit. It affects the work dynamics and creates insecurity among team workers, who feel supervised. Besides, there is concern regarding hospital infection. Thus, in accordance with other studies from different countries, these meanings entail reflections on the need to base the premature care in terms of collectively building a care philosophy that restores concepts of human rights, citizenship, bonding and mother-child attachment, pediatric psychology and also expands the concept of training for a participative health education.

Nursing diagnoses identified during parent group meetings in a neonatal intensive care unit.

PURPOSE: To identify nursing diagnoses in the reports of parents obtained during parent support group meetings in a neonatal intensive care unit. METHODS: An explorative descriptive study using records obtained during 29 meetings over a period of 11 months with parents and family members. FINDINGS: Six NANDA-approved nursing diagnoses were identified from parent group data: fear, risk for impaired parent/infant attachment, parental role conflict, risk for ineffective breastfeeding, impaired home maintenance, and risk for caregiver role strain. Diagnoses were not validated with parents. DISCUSSION: Support groups helped the parents express their thoughts and feelings and provided nurses with opportunities to identify nursing diagnoses and interventions. The identification of nursing diagnoses showed that nursing interventions that are focused on improved parent outcomes should be implemented for parents and other family members. IMPLICATIONS: Nursing care in neonatal units should focus on interventions for parents and other family members in addition to providing the necessary care of newborns.