[Average prematurity: medical and developmental aspects]. / Prématurité moyenne : aspects médicaux et développementaux.

Children born with moderate prematurity are at increased risk of neonatal morbidity, rehospitalization during the first year, and subsequent medical and neurodevelopmental disorders. Care in a specialized environment, at best without separation of mother and child, is necessary. Early developmental support, particularly through skin-to-skin contact, breastfeeding and couplet care, is recommended.

Bibliometric analysis with reference publication year spectroscopy showed how key programmes drove developmental care in newborn infants.

AIM: We investigated the historical origins of developmental care for newborn infants using Reference Publication Year Spectroscopy (RPYS), an innovative method of bibliometric analysis. METHODS: A Web of Science search query that combined infant and intervention-related synonyms was performed on 2 February 2022. RPYS analysis was performed on this dataset to identify the most referenced historical publications for developmental care in newborn infants. Median deviation analysis identified the peak publication years, including the most cited historical references. Landmark publications were defined as those belonging to the top 10% of the most frequently referenced publications for at least 20 years. RESULTS: The RPYS peaks showed an early phase (1936-1986), during which infant development was studied and analysed, leading to a conceptualisation of developmental care for newborn infants. The following years (1987-2020), showed an explosion of interest in developmental care and highlighted two main programmes. The Neonatal Individualized Developmental Care Assessment Program (NIDCAP) and the Infant Health and Development Program (IHDP) inspired numerous publications during those years, which strove to demonstrate evidence of their clinical benefits. CONCLUSION: Developmental care has become increasingly important, thanks to the implementation of NIDCAP and IHDP.

Father's perceptions and care involvement for their very preterm infants at French neonatal intensive care units.

Objectives: We aimed to evaluate (1) fathers' perceptions and care involvement for their very premature infants and their views of the hospitalization period based on parental reports and (2) their evolution over time. Methods: We used an online parental survey to assess answers from parents of very preterm infants who were successfully discharged from French neonatal units. We analysed answers from February 2014 to January 2019 to an anonymous internet-based survey from the GREEN committee of the French Neonatal Society. Responses were compared for period 1 (P1, 1998 to 2013) and period 2 (P2, 2014 to 2019). Results: We analyzed 2,483 surveys, 124 (5%) from fathers and 2,359 (95%) from mothers. At birth, 1,845 (80%) fathers were present in the hospital, but only 879 (38%) were near the mother. The presence of fathers in the NICU increased from P1 to P2 (34.5% vs. 43.1%, p = 0.03). Nearly two thirds of fathers accompanied their infants during transfer to the NICU (1,204 fathers, 60.6%). Fathers and mothers had similar perceptions regarding relationships with caregivers and skin-to-skin contact with their infants. However, more fathers than mothers felt welcome in the NICU and in care involvement regarding requests for their wishes when they met their infant (79% vs. 60%, p = 0.02) and in the presentation of the NICU (91% vs. 76%; p = 0.03). Mothers and fathers significantly differed in the caring procedures they performed (p = 0.01), procedures they did not perform but wanted to perform (p < 0.001), and procedures they did not perform and did not want to perform (p < 0.01). Conclusion: Most fathers were present at the births of their very preterm infants, but fewer fathers were near the mother at this time. Less than two thirds of fathers accompanied their infants to the NICU. There should be further changes to better meet the specific needs of the fathers of infants requiring care in the NICU. Continuing assessment with an online questionnaire may be useful to monitor changes over time in father's involvement in NICUs.

Prematurity has no impact on the quality of parents' sleep 6 months after birth.

AIM: Due to the stress that is classically associated with the premature birth of a child, these parents may be prone to sleep disorders. The aim of this study was to compare sleep quality of preterm infants' parents with that of term infants' parents. METHODS: Prospective observational cohort study conducted at the University Hospital of Brest between January 2019 and January 2021. The primary outcome criterion was the score obtained by the parents on the Pittsburg Sleep Quality Index (PSQI) 6 months after their child's birth. Each parent was recruited in the days following their child's birth and completed the PSQI online. RESULTS: Overall, 316 parents were included. The median gestational age at birth was 34.3 (31.6-35.5) weeks in the preterm infant group and 39.7 (38.6-40.7) weeks in the term infant group. Of the 948 expected questionnaires, 771 were completed and collected. On average, 59% of the parents obtained a PSQI global score >5. Six months after birth, no differences were reported between parents of preterm and full-term infants. CONCLUSION: This study did not reveal any difference between sleep quality of preterm infants' parents and term infants' parents.

Perceptions and expectations of parents regarding their position in a French NICU: quantitative and qualitative approaches.

OBJECTIVES: To assess perceptions, expectations, and concerns of parents of preterm infants regarding their position during hospital admission in the neonatal intensive care unit. DESIGN: Data were analysed from two studies, using complementary methods (quantitative and qualitative). Study I surveyed parents via a questionnaire, and study II was a reanalysis of interviews with fathers, collected in a previous study. SETTING: Neonatology department in a French tertiary care university hospital that promotes the Newborn Individualised Care and Assessment Program (NIDCAP). PARTICIPANTS: In both studies, participants had a premature child admitted for any level of care in the neonatal intensive care unit. RESULTS: For study I, about half (33) of eligible families participated in the questionnaire survey, and for study II, we reanalysed interviews with 20 fathers. In both analyses, parents were satisfied overall with their involvement in the care of their child. In both studies, however, they expressed that they had expected to be better informed about their child's condition and more involved in medical decision-making. Parents also reported relational issues with some healthcare practitioners who made them feel judged, unheard or not competent to discuss their child's case. These concerns were not reported for NIDCAP staff. Respondents in both studies also described insufficient contact with physicians and an inability to obtain rest in the room with their child. CONCLUSION: Provision of training to healthcare practitioners regarding information that parents request and doing so respectfully might be keys to fulfilling parent-reported needs. Such improvements could facilitate parental empowerment and involvement.

Optimising homeothermy in neonates: a systematic review and clinical guidelines from the French Neonatal Society.

AIM: Thermal instability is harmful on the newborn infant. We sought to draw up practical guidelines on maintaining homeothermy alongside skin-to-skin contact. METHODS: A systematic analysis of the literature identified relevant studies between 2000 and 2021 in the PubMed database. Selected publications were evaluated, and their level of evidence were graded, in order to underpin the development of clinical guidelines. RESULTS: We identified 7 meta-analyses and 64 clinical studies with a focus on newborn infants homeothermy. Skin-to-skin contact is the easiest and most rapidly implementable method to prevent body heat loss. Alongside skin-to-skin contact, monitoring the newborn infant's body temperature with a target of 37.0°C is essential. For newborn infants <32 weeks of gestation, a skullcap and a polyethylene bag should be used in the delivery room or during transport. To limit water loss, inhaled gases humidification and warming is recommended, and preterm infants weighing less than 1600 g should be nursed in a closed, convective incubator. With regard to incubators, there are no clear benefits for single vs. double-wall incubators as well as for air vs. skin servo control. CONCLUSION: Alongside skin-to-skin contact, a bundle of practical guidelines could improve the maintenance of homeothermy in the newborn infant.

Practical recommendations on room sizes for hospitalised newborn infants and their families based on a systematic review of the literature.

AIM: Neonatal unit design may affect the neurodevelopment of hospitalised neonates and the well-being of parents and healthcare staff (HCS). We aimed to provide recommendations regarding the minimum area required for a hospital room for a single neonate and their family. METHODS: We searched PubMed and Web of Science for relevant articles published from 1 January 2011 to 1 May 2021 by using the keywords NICU and facility design. Recommendations were developed after internal and external review by a multidisciplinary group including 15 professionals and parent representatives. RESULTS: We identified 314 studies and developed six recommendations from four eligible studies. Recommendations for room size were developed according to three perspectives: opinions of users, who emphasised the need for a spacious room; proposals of organisations by HCS, which advocated for a minimum floor area of 11.2-18 m2 in a single non-family room and 15.3-24 m2 in a single-family room; and simulation methods indicating that the minimum floor area in the neonatal unit should be 18.5-24 m2 . CONCLUSION: Units need to provide a minimum room size to allow for optimal newborn development and a better experience for parents and caregivers.

A review of the characteristics, mechanisms and clinical significance of habituation in foetuses and newborn infants.

Habituation has been a topic of interest since the early 20th century. We summarise the characteristics of habituation, the proposed habituation mechanisms, the associated cortical responses and the link between habituation and cognitive development. Behavioural and neuroimaging studies have highlighted the early sensory abilities of foetuses and newborn infants, with preterm newborn infants exhibiting decreased habituation and dishabituation capabilities that increase their environmental vulnerability. Habituation provides a foundation for the learning and cognition on which higher functions are constructed. It has been suggested that it is efficient for predicting cognitive developmental outcomes in term and preterm newborn infants.

The newborn infant parasympathetic evaluation index for acute procedural pain assessment in preterm infants.

BACKGROUND: Accurate assessments of pain in hospitalized preterm infants present a major challenge in improving the short- and long-term consequences associated with painful experiences. We evaluated the ability of the newborn infant parasympathetic evaluation (NIPE) index to detect acute procedural pain in preterm infants. METHODS: Different painful and stressful interventions were prospectively observed in preterm infants born at 25 + 0 to 35 + 6 weeks gestation. Pain responses were measured using the composite Premature Infant Pain Profile Revised (PIPP-R) scale, the NIPE index, and skin conductance responses (SCR). Outcome measures were correlations between the NIPE index, the PIPP-R score, and the SCR. Sensitivity/specificity analyses tested the accuracy of the NIPE index and SCR. RESULTS: Two hundred and fifty-four procedures were recorded in 90 preterm infants. No significant correlation was found between PIPP-R and the NIPE index. PIPP-R and SCR were positively correlated (r = 0.27, P < 0.001), with stronger correlations for painful procedures (r = 0.68, P < 0.001) and especially for skin-breaking procedures (r = 0.82, P < 0.001). The NIPE index and SCR had high sensitivity and high negative predictive values to predict PIPP-R > 10, especially for skin-breaking painful procedures. CONCLUSIONS: We found no significant correlation between the NIPE index and PIPP-R during routine painful or stressful procedures in preterm infants. IMPACT: Exposure to repetitive pain can lead to neurodevelopmental sequelae. Behavior-based pain scales have limited clinical utility, especially for preterm infants. New devices for monitoring physiological responses to pain have not been validated sufficiently in preterm infants. This study found that the NIPE index was not significantly correlated to the validated PIPP-R scale during acute procedural pain. Secondary analysis of this study showed that NIPE index and SCRs may help to exclude severe pain in preterm infants. In clinical practice, measurements of physiological parameters should be combined with behavior-based scales for multidimensional pain assessments.

The vocal repertoire of preterm infants: Characteristics and possible applications.

We investigated infants' capacities to express themselves orally at very early developmental stages. Most reports focus on crying when in pain or hungry. We evaluated young preterm infants' spontaneous vocal production in non-painful contexts. We identified a vocal repertoire composed of nine types of vocalisations. High-pitched sounds were associated with relaxed postures, implying a positive valence, whereas long low-pitched vocalisations, associated more with grimaces and muscle tensions, appeared to have a more negative valence. Infants' vocalisations were useful indicators of their internal state in two situations (when exposed to clothing constraints and environmental noises).

Promoting attachment between parents and neonates despite the COVID-19 pandemic.

Social distancing is the only option available during the COVID-19 pandemic until a vaccine is developed. However, this is having a major impact on human relationships and bonding between parents and neonates is a major concern. Separation during this health emergency could have lifelong consequences for offspring, and there are even greater concerns if newborn infants are sick or vulnerable and need intensive care. We look at how bonding can be safely supported and maintained without risking infecting neonates, by comparing the international guidelines and proposing safe actions within those frameworks.

A novel, short and easy-to-perform method to evaluate newborns' social olfactory preferences.

Humans' early olfactory perception has been studied mainly within the framework of mother-offspring interactions and only a few studies have focused on newborns' abilities to discriminate body odors per se. The aim of this study was to develop a method to evaluate olfactory social preferences of infants at term-equivalent age. Twenty dyads of infants (10 born preterm and 10 born at term) at term-equivalent age and their mothers were included. We analyzed the behavioral reactions of infants to their mother's upper-chest odor (that bears social, non-food related information). The two impregnated gauzes and a control gauze were presented to the infants for 10 s each, in a random order. We compared two durations of gauze impregnation: 30 min and 12 h. This study reveals that mothers' upper chest emits sufficient olfactory information to induce reactions in infants born full-term or born preterm and that a short impregnation is preferable to evaluate their perception of body odors, notably for those born preterm.

Higher tactile sensitivity in preterm infants at term-equivalent age: A pilot study.

Despite a growing body of research on perinatal sensory abilities, data on the extent of tactile sensitivity and more particularly passive touch (i.e. sensitivity to a stimulation imposed on the skin) are relatively limited, and the development and processing of tactile function are still thus little known. This question is particularly of high importance for infants with atypical early development such as those born prematurely who are exposed to many sensory (including tactile) stimulations (being in a hospital setting) during a critical period of brain development and those born at early term whose birth occurs at the precise time of cortical reorganization, in particular in the sensory areas. Some parents and health-care providers have for instance reported that children born prematurely exhibit atypical (e.g. higher) sensitivity to "benign" tactile stimuli. In the present study, we hypothesized that preterm and early-term infants may show altered tactile sensitivity. We compared the behavioral responses around term-equivalent age of infants born either pre-term, early-term or at term to the application of a light (0.008 grams) mechanical stimulus. We found that almost all preterm infants perceive this tactile stimulus, contrarily to the two other groups of infants. This extreme tactile sensitivity may be due to experiential, maturational or more likely both processes. We also compared the tactile sensitivity of these infants to that of adults. We found that adults were irresponsive to the light mechanical stimulus. This finding opens not only new insights in understanding development of tactile processing, but also new lines of thought about the particular sensory world of premature and early-term infants and hence about the potential impact of early care practices.

Pneumocystis primary infection in infancy: Additional French data and review of the literature.

Data on features of Pneumocystis primary infection in infancy are still fragmented. To study Pneumocystis primary infection, 192 infants who were monitored for acute pulmonary disease or fever over a 40-month period were retrospectively investigated. P. jirovecii detection on archival nasopharyngeal aspirates was performed using a qPCR assay. Factors associated with P. jirovecii were assessed using univariate and multivariate analyses. P. jirovecii genotypes in infants and a control group of adults contemporaneously diagnosed with Pneumocystis pneumonia were identified using unilocus, bilocus, and multilocus sequence typing (MLST). P. jirovecii was detected in 35 infants (18.2%). The univariate analysis pointed out four factors: viral infection (P = .035, OR [IC 95], 2.2 [1.1-4.7]), lower respiratory tract infection (P = .032, OR [IC 95], 2.5 [1.1-5.9]), absence of hospital discharge after birth (P = .003, OR (IC 95), 0.1 (0.02-0.5]), and the 63-189-day group (P < .001, OR [IC 95], 42.2 [5.4-332]). The multivariate analysis confirmed these two latter factors (P = .02, OR [IC 95], 0.1 [0.02-0.72]; P = .005, OR [IC 95], 11.5 [2.1-63.5]). Thus, P. jirovecii acquisition mostly takes place in the community. A comparison of these data with those of previously published studies showed that median and interquartile range of positive-infant ages were close to those observed in Chile, Denmark, and Peru, highlighting similar characteristics. Common unilocus or bilocus genotypes were identified in infants and adults, whereas no MLST genotypes were shared. Therefore, a common reservoir made up of infected infants and adults is still hypothetical. Finally, primary infection is a worldwide phenomenon occurring at the same time in childhood regardless of geographical location, rather than an incidental event.

Multi-modal pain assessment: are near-infrared spectroscopy, skin conductance, salivary cortisol, physiologic parameters, and Neonatal Facial Coding System interrelated during venepuncture in healthy, term neonates?

BACKGROUND: Improving pain and stress assessments in neonates remains important in preventing the short- and long-term consequences. We aimed to identify the relationships between different pain assessment parameters by simultaneously measuring changes in cortical, autonomic, hormonal, physiological, and behavioral evoked responses to venepuncture in healthy, full-term neonates. METHODS: This observational, prospective study (ancillary to the ACTISUCROSE trial) included 113 healthy, 3-day old, full-term neonates who underwent venepuncture for systematic neonatal screening, from July to October 2013, in a tertiary-level maternity ward of a university hospital. During venepuncture, we simultaneously measured the cortical single-channel near-infrared spectroscopy (NIRS) signals, foot skin conductance, salivary cortisol, physiological responses, and behavioral (Neonatal Facial Coding System [NFCS]) evoked responses. RESULTS: Regarding the NIRS analysis, the highest correlation was between the NFCS at venepuncture and the change in NIRS integrated values of total hemoglobin (r=0.41, P<0.001) or oxygenated hemoglobin (r=0.27, P<0.001). The NFCS at venepuncture was moderately positively correlated with changes in salivary cortisol (r=0.42, P<0.001) and skin conductance (r=0.29, P<0.001). Salivary cortisol and skin conductance changes were not correlated; the latter parameters were not correlated with heart rate, respiratory rate, or SpO2. CONCLUSION: During venepuncture, NFCS was mildly or moderately correlated with salivary cortisol, skin conductance, and cortical NIRS changes.

Recommendations on the environment for hospitalised newborn infants from the French neonatal society: rationale, methods and first recommendation on neonatal intensive care unit design.

AIM: Hospitalised newborn infants may be stressed due to inappropriate sensory stimuli and early separation from their families, that can negatively impact their neurodevelopment. The French Group of Reflection and Evaluation of the Environment of Newborns (GREEN) issues guidelines based on environmental neonatology and family-centred care. The first recommendation focuses on private family rooms versus large shared rooms. METHODS: These guidelines are based on a systematic evaluation of the literature providing different grades of evidence. Internal and external reviews by multidisciplinary experts examined the scientific evidence of all recommendations. The literature search was performed for the period January 1, 2000 to January 1, 2016 with the keywords 'single room' or 'private room' and 'neonatal intensive care unit'. RESULTS: A total of 25 studies were retained. Most studies reported a positive impact of private rooms on the health of newborn infants and satisfaction of families. Private rooms could lead to sensory deprivation if there is low parental involvement with limited presence and to reduced interaction among caregivers. CONCLUSION: We recommend that neonatal units should mostly have private rooms. With this architectural design, we recommend supporting the staff's needs for changes in the organisation and philosophy of care and to provide improved family support.

Cortical Pain Response of Newborn Infants to Venepuncture: A Randomized Controlled Trial Comparing Analgesic Effects of Sucrose Versus Breastfeeding.

OBJECTIVE: Sucrose administration and breastfeeding decrease behavioral expressions of pain in neonates. However, recent studies indicated that there is a persistent cortical response with sucrose. This study compared the efficacy of sucrose administration versus breastfeeding to decrease cortical responses to pain during venepuncture. PATIENTS AND METHODS: A randomized, prospective, controlled trial was conducted in a tertiary level maternity ward. Healthy, 3-day-old term neonates, undergoing venepuncture for neonatal screening, were randomly assigned to receive sucrose solution or be breastfed before venepuncture. Variations in the total hemoglobin concentration [HbT] in the contralateral somatosensory cortex were assessed with near infrared spectroscopy. The Neonatal Facial Coding System (NFCS) was used to assess reactions. RESULTS: There were 114 term neonates included, with 102 included for the primary outcome (breastfed group: 48; sucrose group: 54). Similar maximum increases in [HbT] were observed in both groups (mean±SD: sucrose group: 31.2±58.1 µmol/L; breastfed group: 38.9±61.4 µmol/L; P=0.70). Breastfed neonates presented more behavioral expressions that indicated pain compared with sucrose-administered neonates (46.8% vs. 26.8% of NFCS ≥1, P=0.04). The maximum increase in [HbT] was persistent, although newborn infants who did not express behavioral signs of pain had lower concentrations than neonates who did (mean±SD: 21.2±29.1 vs. 60.0±89.8 µmol/L, P<0.01). DISCUSSION: There was no difference in the cortical responses to pain during venepuncture in newborn infants who were administered sucrose versus those who were breastfed.