Implementing Higher Phototherapy Thresholds for Jaundice in Healthy Infants 35 Plus Weeks.

OBJECTIVES: To determine the impact of higher bilirubin thresholds on testing and treatment of healthy infants during the neonatal period. METHODS: This quality improvement study included infants born at ≥35 weeks gestation and admitted to the well-baby nursery between July 2018 and December 2020. We assessed the transition from infants treated according to the 2004 AAP guidelines (pregroup) with those following the Northern California Neonatal Consortium guidelines (postgroup). We examined the proportion of infants receiving phototherapy and total serum bilirubin (TSB) assessments as outcome measures. We examined critical hyperbilirubinemia (TSB above 25 mg/dL or TSB within 2 mg/dL of threshold for exchange transfusion), exchange transfusion, and readmission for jaundice as balancing measures. We compared the differences in outcomes over time using Statistical Process Control p charts. Balancing measures between the pre and postgroups were compared using χ square tests and t-tests. RESULTS: In our population of 6173 babies, there was a significant shift in the proportion receiving phototherapy from 6.4% to 4%. There were no significant changes in incidences of bilirubin >25 mg/dL (0 of 1472 vs 7 of 4709, P = .37), bilirubin within 2 mg/dL of exchange transfusion thresholds (4 of 1472 vs 5 of 4709, P = .15), exchange transfusion (0 of 1472 vs 1 of 4709, P = .70) or readmission for phototherapy (2.9% versus 2.4%, P = .30), between the 2 groups. CONCLUSIONS: Higher thresholds for phototherapy treatment of neonatal hyperbilirubinemia can decrease the need for phototherapy without increasing critical hyperbilirubinemia or readmission rate.

Gratitude endures while indebtedness persuades: investigating the unique influences of gratitude and indebtedness in helping.

What is the temporal course of gratitude and indebtedness and how do these feelings influence helping in the context of reciprocity? In an online-game tapping real-life behaviour, Study 1 (N = 106) finds that while gratitude towards a benefactor remains elevated after an opportunity to reciprocate, indebtedness declines along with helping. Yet, indebtedness rather than gratitude better predicts real-life helping of a benefactor. Using a vignette-based experiment, Study 2 (N = 217) finds that after reciprocation indebtedness and likelihood of helping a benefactor reset to a baseline level while gratitude endures. Furthermore, the decrease in helping after reciprocation is better explained by indebtedness than by gratitude. Study 3 (N = 217) assessed the unique influences of gratitude and indebtedness on helping by comparing contexts in which gratitude is at a baseline level but indebtedness is elevated (e.g. before a monetary payment for a service received) to contexts in which indebtedness is at a baseline level but gratitude is elevated (e.g. after reciprocation of benefits freely given by a friend). People are more likely to help in the former compared to latter context, and this difference is better explained by indebtedness rather than by gratitude. We discuss the interrelated and understudied relationships between gratitude, indebtedness, and reciprocity.

Norm-based spontaneous categorization: Cultural norms shape meaning and memory.

When cultures have different norms for the same situation, does culture affect memory by influencing the weight individuals assign to information or also by affecting the meaning of information itself, influencing memory via categorization? We present 4 experiments showing that, in relying on contrasting cultural norms of reciprocity (Studies 1 and 2) and spiritual purity (Studies 3 and 4), Indians and Americans differ in their interpretation of and memory for identical information. Studies 1 (N = 123) and 3 (N = 78), utilizing cued-recall, and Studies 2 (N = 143) and 4 (N = 79), utilizing multiple-choice incidental-memory tests, show cultural differences in memory and categorization in culturally relevant normative domains. In Studies 1 and 2 Americans, applying their own culture-specific reciprocity norms, were more likely than Indians to interpret gifts given after receiving help as implying reciprocity. Hence, Americans (and not Indians) tended to categorize information about gifts in terms of whether it was norm-consistent or inconsistent, evidenced by memory that reflected greater within-category confusions. In Studies 3 and 4 Indians, applying their own culture-specific norms of purity, were more likely than Americans to interpret images of shoes on sacred objects as implying spiritual impurity. Thus, Indians (and not Americans) tended to categorize information about shoes in terms of whether it was norm-violating or nonviolating, evidenced by memory that reflected greater within-category confusions. Applying culturally variable norms to the same situation leads to different understandings of the same behavior, resulting in memory that reflects norm-based spontaneous categorization. We highlight the role that culture-specific norms play in cognitively predisposing individuals to organize information in the environment. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Screening for symptoms of postpartum traumatic stress in a sample of mothers with preterm infants.

There are no established screening criteria to help identify mothers of premature infants who are at risk for symptoms of emotional distress. The current study, using data obtained from recruitment and screening in preparation for a randomized controlled trial, aimed to identify potential risk factors associated with symptoms of depression, anxiety and posttraumatic stress in a sample of mothers with premature infants hospitalized in a neonatal intensive care unit. One hundred, thirty-five mothers of preterm infants born at 26-34 weeks of gestation completed three self-report measures: the Stanford Acute Stress Reaction Questionnaire, the Beck Depression Inventory (2nd ed.), and the Beck Anxiety Inventory to determine their eligibility for inclusion in a treatment intervention study based on clinical cut-off scores for each measure. Maternal sociodemographic measures, including race, ethnicity, age, maternal pregnancy history, and measures of infant medical severity were not helpful in differentiating mothers who screened positive on one or more of the measures from those who screened negative. Programs to screen parents of premature infants for the presence of symptoms of posttraumatic stress, anxiety, and depression will need to adopt universal screening rather than profiling of potential high risk parents based on their sociodemographic characteristics or measures of their infant's medical severity.

Reduction in red blood cell transfusions using a bedside analyzer in extremely low birth weight infants.

BACKGROUND: Preterm infants typically experience heavy phlebotomy losses from frequent laboratory testing in the first few weeks of life. This results in anemia, requiring red blood cell (RBC) transfusions. We recently introduced a bedside point-of-care (POC) blood gas analyzer (iSTAT, Princeton, NJ) that requires a smaller volume of blood to replace conventional Radiometer blood gas and electrolyte analysis used by our neonatal intensive care unit (NICU). The smaller volume of blood required for sampling (100 vs 300-500 microl), provided an opportunity to assess if a decrease in phlebotomy loss occurred and, if so, to determine if this resulted in decreased transfusions administered to extremely low birth weight (ELBW) infants. OBJECTIVE: We hypothesized that the use of the POC iSTAT analyzer that measures pH, PCO(2), PO(2), hemoglobin, hematocrit, serum sodium, serum potassium and ionized calcium would result in a significant decrease in the number and volume of RBC transfusions in the first 2 weeks of life. DESIGN/METHODS: A retrospective chart review was conducted of all inborn premature infants with birth weights less than 1000 g admitted to the NICU that survived for 2 weeks of age during two separate 1-year periods. Blood gas analysis was performed by conventional laboratory methods during the first period (designated Pre-POC testing) and by the iSTAT POC device during the second period (designated post-POC testing). Data collected for individual infants included the number of RBC transfusions, volume of RBCs transfused, and the number and kind of blood testing done. There was no effort to change either the RBC transfusion criteria applied or blood testing practices. RESULTS: The mean (+/-SD) number of RBC transfusions administered in the first 2 weeks after birth was 5.7+/-3.74 (n=46) in the pre-POC testing period to 3.1+/-2.07 (n=34) in the post-POC testing period (p<0.001), a 46% reduction. The mean volume of RBC transfusions decreased by 43% with use of the POC analyzer, that is, from 78.4+/-51.6 ml/kg in the pre-POC testing group to 44.4+/-32.9 ml/kg in the Post-POC testing group (p<0.002). There was no difference between the two periods in the total number of laboratory blood tests done. CONCLUSIONS: Use of a bedside blood gas analyzer is associated with clinically important reductions in RBC transfusions in the ELBW infant during the first two weeks of life.

Frequency and timing of symptoms in infants screened for sepsis: effectiveness of a sepsis-screening pathway.

To determine the frequency and timing of symptoms and to evaluate the effectiveness of a sepsis-screening pathway in term and near-term infants, data were collected prospectively for a period of 1 year from December 1, 2000, to November 30, 2001. Results confirmed that a sepsis-screening pathway using a combination of at least 2 serial complete blood cell count and C-reactive protein measurements in both symptomatic and asymptomatic infants is a safe, simple strategy that prevents unnecessary treatment of infants with risk factors with antibiotics. However, most infants with presumed or suspected early-onset sepsis are symptomatic. Routine treatment of asymptomatic infants with risk factors or prior treatment with intrapartum antibiotics is unnecessary. A combined approach of screening in the presence of risk factors and /or symptoms of sepsis and adequate follow-up for infants discharged at less than 72 hours of age may help reduce unnecessary treatment of infants with antibiotics.

Effect of position on sleep, heart rate variability, and QT interval in preterm infants at 1 and 3 months' corrected age.

OBJECTIVE: Prone sleeping position has a strong link to sudden infant death syndrome (SIDS), and the "Back to Sleep" campaign has played an important role in reducing SIDS. We tested the hypothesis that the mechanism of the sleep position effect is based on changes in sleep, arousal, heart rate variability (HRV), and the QT interval of the electrocardiogram. STUDY DESIGN: We studied 16 premature infants longitudinally, at 1 and 3 months' corrected age. Videosomnography recordings were made during the infants' normal daytime naps. Each infant was recorded in both supine and prone positions. The recordings were analyzed in 30-second epochs, which were classified as awake, active sleep (AS), quiet sleep (QS), or indeterminate sleep. Electrocardiogram data were sampled with an accuracy of 1 millisecond. Time domain analysis of HRV was measured by standard deviation of all R-R intervals and by the square root of the mean of the sum of the squares of the differences between adjacent R-R intervals. Frequency domain analysis was done for low frequency (0.04-0.14 Hz) and high frequency (0.15-0.5 Hz) HRV. We measured QT, JT, and R-R intervals during AS and QS for each position. RESULTS: We found no significant differences between supine and prone position, either in total sleep time or in percentage of QS. Percentage of AS was significantly lower in the supine position, but only at 1 month corrected age. The incidence of short, spontaneous, sleep transitions was significantly higher in supine, also only at 1 month corrected age. Time domain analysis of HRV showed a significantly lower variability in prone, but only during QS. Frequency domain analysis of HRV showed no differences between the 2 sleeping positions. Both QT and JT intervals were significantly longer in prone during QS, but only at 1 month corrected age. CONCLUSIONS: Despite the commonly held belief, prone position did not substantially increase total sleep at these ages. On the other hand, prone sleeping decreased the number of sleep transitions at 1 month corrected age, increased QT and JT intervals, and reduced HRV, thereby potentially increasing the vulnerability for SIDS. This study supports "Back to Sleep" as the position of choice not only for term but also for preterm infants after discharge home.