Accuracy of the StatStrip versus SureStep Flexx glucose meter in neonates at risk of hypoglycemia.

The study was performed to evaluate the accuracy of the StatStrip (SS) and SureStep Flexx (SF) glucose meters compared to plasma glucose in infants at risk for neonatal hypoglycemia and to determine the effect of bilirubin and hematocrit on the results. A prospective cross-sectional study was conducted on 172 venous blood glucose samples from infants who had initial low point-of-care (POC) glucose tests measured simultaneously by SS and SF. Plasma glucose levels were compared to both POC instruments, and the effect of bilirubin and hematocrit levels on mean glucose differences were analysed. Mean (SD) plasma glucose was 2.12 (0.45) mmol/L; (range, 1.11-3.06 mmol/L). Mean (1.96SD) glucose differences of the SS versus SF were 0.21 (0.70) mmol/L and -0.04 (0.78) mmol/L, respectively. SS sensitivity was 94.7 % with an 86.1 % negative predictive value (NPV) at 2.8 mmol/L, while the SF had a 100 % sensitivity and NPV at the same cut-off level. No correlations were identified between mean glucose differences and either hematocrit or bilirubin levels in both glucose meters. Both the SS and SF glucose meters have limited use when compared to plasma glucose. Hence, they can only be employed as screening tools in at-risk neonates with an appropriate, predetermined cut-off level. Hematocrit and bilirubin levels did not affect the accuracy of both devices.

Effectiveness of conventional phototherapy versus Super light-emitting diodes phototherapy in neonatal hyperbilirubinemia.

BACKGROUND: Neonatal hyperbilirubinemia is very common. Phototherapy has been used for decades to prevent severe hyperbilirubinemia, which can cause kernicterus. OBJECTIVE: To compare the effectiveness of two phototherapy devices in reducing plasma bilirubin and duration of phototherapy in non-severe hyperbilirubinemia. MATERIAL AND METHOD: This was an open-label randomized controlled trial. Forty healthy infants aged between 1 and 5 days with non-severe hyperbilirubinemia, but to the level requiring phototherapy, were recruited. The phototherapy unit used in the "blue-light" group was the Siriraj Phototherapy Lamp with 6 special blue fluorescent tubes. The phototherapy unit used in the "light-emitting diodes (LEDs)" group was the Bilitron 3006 with 5 super LEDs. RESULTS: Twenty infants were included in each group. Demographic data and baseline clinical characteristics of infants in both groups were comparable. Median rate (25%, 75%tile) ofplasma bilirubin decreasing during phototherapy in the "blue light" was significantly higher than in the "LEDs" group [0.16 (0.09, 0.25) and 0.10 (0.02, 0.17) mg/dL/hour, respectively; p = 0.03]. Duration of phototherapy in "blue light" group was shorter than in "LEDs" group but was not statistically significant. CONCLUSION: A locally invented phototherapy device with special blue fluorescent tubes can be more effective than the more expensive commercial super LEDs phototherapy device in decreasing plasma bilirubin.

Safety of initiating early enteral feeding with slow volume advancement in preterm infants.

OBJECTIVE: To determine the safety of enteral feeding within 24 hours of life with slow volume increase on the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS). DESIGN: Prospective descriptive study. MATERIAL AND METHOD: Between January 1998 and December 2001, 117 preterm infants with birth weight < or =1750 g were recruited prospectively, 102 in the human-milk-fed group (HMG) and 15 in the formula-fed group (FG). Feeds were advanced by increments of 10 mL/kg/d, aimed at 150 mL/kg/d in 15 days. Charts of 146 preterm infants admitted during 1996-1997 were reviewed for pre-study incidences of NEC and LOS. RESULTS: NEC developed 3.92% in HMG and 20% in FG (p =.044). LOS developed 2.94% in HMG and 13.33% in FG (p = 0.122). The overall incidence of NEC was almost similar (5.98% vs. 6.16%) while that of LOS was lower (4.27% vs. 12.32%) when compared to the pre-study incidences. CONCLUSION: The present study provides a practice that seems to reduce LOS risk without increasing NEC risk and confirms the protective effect of human milk against NEC.

The nurses' experience of barriers to safe practice in the neonatal intensive care unit in Thailand.

OBJECTIVE: To describe barriers nurses experienced in providing safe practice in the neonatal intensive care unit and to investigate area of errors commonly affected when nurses confronted the barriers. DESIGN: Qualitative descriptive method. SETTING: Randomly selected 4 large neonatal intensive care units in Thailand. PARTICIPANTS: Twenty-seven neonatal intensive care unit nurses. MAIN OUTCOME MEASURES: A semistructured interview of the nurses' experience of neonatal intensive care unit error, factors forming barriers to safe practice, and neonatal outcome. RESULTS: Of 245 error events, neonates were identified to suffer 126 (55.5%) adverse events. Five themes emerged as common factors obstructing nurses from incorporating safety processes into their caring roles: human susceptibility to error, system operating care weakness, problematic medical devices, poor team communication, and situational provocation. Multiple barriers were largely associated with understaffing, a sudden increase in patient acuity, multiple assignments, and an inadequate knowledge of safety in neonatal critical care, which often interacted and influenced their performance when processed to a single error occurrence. CONCLUSION: A focus on management of the potential barriers in a system-related human error approach could prevent and intercept future errors in this vulnerable population.

Thai healthy newborns have a higher risk.

Kernicterus is a preventable but devastating neurologic disorder with life long complications. It is caused by severe and inadequately treated hyperbilirubinemia during the newborn period. In the present paper potential causes and risk factors for the occurrence of kernicterus related to the Thai health system that are responsible for the care of newborn infants before and after discharge are discussed. Potential risk reduction strategies for the Thai health system are purposed Some efforts to improve the quality of Thai newborn care particularly newborns with jaundice that have been made are mentioned. An adherence to the American Academy of Pediatrics clinical guideline for management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation for those strategies that are feasible to follow will help reduce the prevalence of severe hyperbilirubinemia and bilirubin encephalopathy.

Assessment of cereal-grain warming pad as a heat source for newborn transport.

OBJECTIVE: The study assessed warming pad (WP) filled with either mung beans or dry corn used in feeding livestocks as a heat source for newborn transport. Its use was to compensate for lack of transport incubator or to employ as a supplemental heat source for warming the infant or incubator when transport made in cold weather. MATERIAL AND METHOD: The WP was made of a strong-cotton-cloth bag (the fabric for making jeans) with a size of A4 paper sheet. The bag was filled with one kilogram of either mung beans or dry corn (used in feeding livestocks). The WP was heated in a 800-watts microwave oven for 2 minutes with grains thoroughly mixed inside to distribute heat evenly and put in a disposable A4-size brown envelope. The temperature at the surface of the brown envelope with the WP inside was recorded every 5 minutes for 120 minutes to assess which cereal grain could emit more heat and keep the heat longer Then the WP was heated in the microwave oven for 1, 1 1/2 and 2 minutes, placed in the same size of brown envelope and covered with two towels. The temperatures at the surface of the brown envelope and each layer of towels were recorded with the same frequency and duration. RESULTS: The cereal-grain WPs, both mung beans and dry corn, were equally effective in producing heat when warmed in the microwave oven. The mean maximal temperatures at the surface of brown envelope were too high for direct application to newborns. The mean maximal temperatures of towels covering the paper envelope with WP heated in the microwave oven for 1 minute were as followed. At the first towel, which was close to the WP, the mean temperature reached 42 degrees C (107.6 degrees F) in 10 minutes after warming and was maintained > or = 42 degrees C for 10 minutes. All temperature measurements at the first towel was < or = 42 degrees C at 35 minutes. At 2 hours the mean temperature of the first towel was 35.6 degrees C (96.1 degrees F) which was higher than room temperature by 5.3 degrees C (41.5 degrees F). The maximal mean temperature measured at the second towel, representing the infant's skin contact surface, was 39.7 degrees C (103.5 degrees F) at 15 minutes of which the peak temperature was 41.0 degrees C (105.8 degrees F). CONCLUSION: The cereal-grain WP, when used along with traditional nursing interventions as a heat source during newborn transport, should be safe with careful handling. It should be heated in the microwave oven exactly for one minute. A towel is placed above an A4-size brown envelope with the WP inside and the bundled infant is placed on it. Remove the towel at 35 minutes and lay the bundled infant on the brown envelope. It should be effective and safe in providing a warm transport for at least 2 hours since the temperature of the WP at the towel representing skin contact surface is not higher than 42 degrees C (107.6 degrees F) and there is no risk for hot water leakage.