[Noise level in the NICU: Impact of monitoring equipment]. / Nuisances sonores en réanimation néonatale : impact d'un outil de monitorage.

BACKGROUND: The sound level in the neonatal intensive care unit (NICU) may induce adverse effects for neonates, their family, and the staff. This study evaluated the sound level in a NICU before and after the implementation of an educational program. MATERIAL AND METHODS: A baseline audit determined the most exposed area of the NICU and the most exposed periods over 24 h. Then an educational program started, including sound level measurement methods, side effects for neonates, results from the baseline audit, and new visual monitoring equipment (SoundEar®). Sound levels were measured before, 1, 2, and 3 months after starting the educational program and the use of SoundEar®. The NICU staff was blind to the periods of sound level measurements. RESULTS: The base noise level was high, especially near the central part of the NICU and during transmission time (mean Leq: 60.6±3.6dB(A); sound peaks: 94.8±6.8dB(A)). A decrease in the sound level (P<0.001) was found 1 and 2, but not 3 months after starting the educational program. It remained high compared to the guidelines. CONCLUSION: Human activity was responsible for most of the sound level. An educational program was effective in reducing the sound level, but did not reach the guideline's target. The continuous use of sound-monitoring equipment after starting the project reduced the sound level for 2 months, but no longer. Therefore, a continuous educational program about the sound level in the NICU including feedback monitoring every 2-3 months should be encouraged.

[Evaluation of the measurement of hemoglobin by the Hemocue System® in the preterm neonate less than 28 days old]. / Évaluation de la mesure du taux d'hémoglobine par Hémocue® chez le nouveau-né prématuré de moins de 28 jours de vie.

BACKGROUND: Hemoglobin (Hb) measurement is essential for the monitoring of anemia in preterm neonates to assess if any bleeding (pulmonary, cerebral, digestive) is present. EDTA samples require 500 µL vs. 10 µL for the Hemocue(®) system. This system has been evaluated and validated in adults and children but not in preterm neonates with fetal hemoglobin. The aim of the study was to compare Hb measurement with the Hemocue(®) system vs. the EDTA laboratory system on fetal Hb in preterm neonates. MATERIALS AND METHODS: This was a prospective study conducted in the preterm intensive care unit in the Amiens Hospital. Preterm neonates, before 28 days of life, requiring EDTA (Hb) measurement were included. Two Hemocues(®) were performed at the same time. Postnatal age (correlated to the fetal hemoglobin level decrease), blood sample site, and other factors that could influence the Hb result were evaluated. RESULTS: Seventy-six EDTA and 152 Hemocue(®) samples from 38 preterm neonates were included. The term was 28.1±3.7 weeks of gestation, the birth weight was 1215.5±657 g. We found a good correlation between the Hemocue(®) and EDTA samples (Hemocue(®)=EDTA*0.94-0.4; R(2)=0.63; P<0.001). The influence of confounding factors was insignificant. CONCLUSION: The use of the Hemocue(®) system showed a good correlation with the EDTA measurement of fetal Hb, with a moderate bias (-0.2±1.5 g/dL), which remained stable for the first 28 days of life.

A mean body temperature of 37°C for incubated preterm infants is associated with lower energy costs in the first 11 days of life.

AIM: This randomised trial compared the energy costs of providing incubated preterm infants born before 32 weeks of gestation with homeothermia using either air temperature control (ATC) or skin servocontrol (SSC). METHODS: We studied 38 incubated preterm infants for the first 11 days of life, calculating the frequency of hypothermia (<36.0°C), hyperthermia (>37.5°C) and thermal challenge, together with energy costs, based on a change in incubator air temperature of 2°C above or below thermoneutrality. RESULTS: The daily mean incubator air temperature was higher in ATC than SSC (p < 0.05) for the first 6 days, and the mean body temperature was higher in ATC (37.0 ± 0.03°C) than SSC (36.8 ± 0.02; p < 0.01) over the whole study period. The frequency of moderate hyperthermia was higher in ATC (p < 0.001), whereas warm and cold thermal challenges were higher in SSC (p < 0.001). The two groups did not differ in terms of energy costs. The time to recover birthweight was shorter in ATC (p < 0.05). CONCLUSION: In incubators using ATC, a body temperature of 37°C was associated with lower energy costs and greater weight gain at 11 days of life for preterm infants. Future studies should test SSC shielded abdominal skin temperature set to 37°C.