Effects of sublingual colostrum application on oral and intestinal flora of extremely low birth weight infants.

BACKGROUND: The aim of this study is to analyze the effects of colostrum application on the establishment of normal flora in the intestinal tracts and oral cavities of extremely low birth weight infants (ELBWI). METHODS: A prospective cohort study design was adopted following the STROBE guidelines (Supplementary File 1). Colostrum was administered immediately after obtaining maternal breast milk using a special sterile cotton swab. There were no specific treatments for infants who did not receive colostrum. This experiment was completed on day 5 post-birth and the patients were divided into the colostrum and control groups, corresponding to whether or not colostrum was administered. Throat swabs and stool samples were collected on days 1 and 5 post-birth. RESULTS: Using the conventional bacteria cultivation technique, the detection rate of bacteria in 98 cases of meconium at birth was 15.31%. On day 5, the detection rates of Staphylococcus in the colostrum and control groups were 36.54% and 34.78%, with no significant difference between them (P = 0.856), and that of Enterococcus was 26.92% and 13.04%, respectively, with no statistically significant difference (P = 0.089). Likewise, at birth, the detection rate of bacteria in 98 cases of throat swabs was 27.55%. On day 5, the detection rate of Streptococcus in the colostrum and control groups was 78.85% and 50.00%, respectively, recording a statistically significant difference this time (P = 0.003). CONCLUSION: Colostrum application had limited effects on intestinal flora colonization but contributes to physiological oral flora colonization.

What influences the implementation of kangaroo mother care? An umbrella review.

BACKGROUND: Kangaroo mother care (KMC) is an evidence-based intervention that reduces morbidity and mortality in preterm infants. However, it has not yet been fully integrated into health systems around the world. The aim of this study is to provide a cogent summary of the evidence base of the key barriers and facilitators to implementing KMC. METHODS: An umbrella review of existing reviews on KMC was adopted to identify systematic and scoping reviews that analysed data from primary studies. Electronic English databases, including PubMed, Embase, CINAHL and Cochrane Library, and three Chinese databases were searched from inception to 1 July 2022. Studies were included if they performed a review of barriers and facilitators to KMC. Quality assessment of the retrieved reviews was performed by at least two reviewers independently using the Joanna Briggs Institute (JBI) critical appraisal checklist and risk of bias was assessed with the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) tool. This umbrella review protocol was documented in the PROSPERO registry (CRD42022327994). RESULTS: We generated 531 studies, and after the removal of duplicates and ineligible studies, six eligible reviews were included in the analysis. The five themes identified were environmental factors, professional factors, parent/family factors, access factors, and cultural factors, and the factors under each theme were divided into barriers or facilitators depending on the specific features of a given scenario. CONCLUSIONS: Support from facility management and leadership and well-trained medical staff are of great significance to the successful integration of KMC into daily medical practice, while the parents of preterm infants and other family members should be educated and encouraged in KMC practice. Further research is needed to propose strategies and develop models for implementing KMC.

Study on improving collection feeding safety and quality of colostrum for very (extremely) low birth weight infants.

Objective: This study aims to explore the difficulties related to fresh colostrum feeding for very (extremely) low birth weight infants (VLBWI/ELBWI) and optimize the colostrum administration process. Methods: The VLBWI/ELBWI who were admitted in the neonatal intensive care unit from January to December 2021, were enrolled as the experimental group, and an optimized colostrum feeding process was adopted. The VLBWI/ELBWI admitted from January to December 2020 were enrolled as the control group, and a conventional feeding process was adopted. The general situation of colostrum supply, number of adverse feeding events, maternal breastfeeding rate at the critical time points. Results: There were no significant differences between the baseline charatcteristics of the 2 groups. In the experimental group, compared with the control group, the time to first colostrum collection was significantly shorter (64.8% vs. 57.8% p < 0.05), and the rates of colostrum feeding (44.1% vs. 70.5% p < 0.001), and of maternal breastfeeding at 2 weeks after birth (56.1% vs. 46.7%, p < 0.05) and on the day of discharge (46.2% vs. 37.8%, p < 0.05) were significantly higher. Before and after process optimization, the average total time required for the time for nurses to receive the colostrum in the NICU reduced from 7.5 min/time to 2 min/time, and no feeding-related adverse events occurred. Conclusion: Fresh colostrum feeding process optimization for VLBWI/ELBWI, improves the colostrum feeding rate, shortens the time to first colostrum collection, saves the working time of nurses, and improves the maternal breastfeeding rate at key time points.

Development of a peer review process to reduce maternal and infant adverse events associated with midwifery.

OBJECTIVES: The aim of this study was to establish a midwifery peer review (MPR) process to continuously improve and standardize the midwifery delivery process, thereby reducing maternal and infant adverse events. MATERIAL AND METHODS: First, the MPR committee (MPRC) was established. The co-chairs of our MPRC were the Head of the Nursing Department and the Nursing Director of the Obstetrics Department. Peer review targets included preventing the occurrence of nursing adverse events, improving nursing quality, and optimizing nursing management. We have established a specially digitized case submission system. All cases that met the evaluation criteria formed corresponding midwifery process improvement measures after a discussion at the meeting to continuously improve the level of midwifery. RESULTS: Between 2014 and 2017, a total of 240 referrals were received by our committee, 211 of which met the criteria for peer review. Our analysis showed that the proportion of adverse events evaluated gradually decreased over time. The percentage of reviewed cases in 2014 was 7.543% of all deliveries (n = 63), which decreased to 6.747% in 2015 (n = 46). The rates in 2016 and 2017 were 5.310% (n = 51) and 5.280% (n = 51), respectively, and the MPRC recommendations resulted in positive practice changes. After reviewing more than 200 cases, the committee recommended the implementation of 20 new rules and regulations through summary and discussion, thus reducing or preventing many problems that are easily ignored during clinical service. CONCLUSIONS: MPR could be an effective tool to improve obstetric quality and midwifery skills. The implementation of MPR promoted a safer environment for mothers and infants and led to a decrease in adverse events related to midwifery.

Impact of relocation and environmental cleaning on reducing the incidence of healthcare-associated infection in NICU.

BACKGROUND: Hospital environment remains a risk for healthcare-associated infections (HAIs). This was a prospective study to evaluate the comprehensive impact of relocating a neonatal intensive care unit (NICU) to a new facility and improved environmental cleaning practice on the presence of methicillin-resistant Staphylococcus aureus (MRSA) on inanimate surfaces and the incident rate of HAIs. METHODS: New environmental cleaning measures were adopted after the NICU was moved to a new and better-designed location. The effect of moving and the new environmental cleaning practice was investigated by comparing the positive number of MRSA on ward surfaces and the incidence density of HAIs between the baseline and intervention periods. RESULTS: Only 2.5% of environmental surfaces were positive for MRSA in the intervention period compared to 44.0% in the baseline period (P<0.001). Likewise, the total incident rate of HAIs declined from 16.8 per 1000 cot-days to 10.0 per 1000 cot-days (P<0.001). CONCLUSION: The comprehensive measures of relocating the NICU to a new facility design with improved environmental cleaning practice are effective and significantly reduce the incidence of HAIs.

Is there a difference in cognitive development between preschool singletons and twins born after intracytoplasmic sperm injection or in vitro fertilization?

OBJECTIVE: To explore whether there exist differences in cognitive development between singletons and twins born after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). METHODS: A total of 566 children were recruited for the study, including 388 children (singletons, n=175; twins, n=213) born after IVF and 178 children (singletons, n=87; twins, n=91) born after ICSI. The cognitive development was assessed using the Chinese-Wechsler Intelligence Scale for Children (C-WISC). RESULTS: For all pre-term offspring, all the intelligence quotient (IQ) items between singletons and twins showed no significant differences no matter if they were born after IVF or ICSI. There was a significant difference in the cognitive development of IVF-conceived full-term singletons and twins. The twins born after IVF obtained significantly lower scores than the singletons in verbal IQ (containing information, picture & vocabulary, arithmetic, picture completion, comprehension, and language), performance IQ (containing maze, visual analysis, object assembly, and performance), and full scale IQ (P<0.05). The cognitive development of full-term singletons and twins born after ICSI did not show any significant differences. There was no significant difference between the parents of the singletons and twins in their characteristics where data were collected, including the age of the mothers, the current employment status, the educational backgrounds, and areas of residence. There were also no consistent differences in the duration of pregnancy, sex composition of the children, age, and height between singletons and twins at the time of our study although there existed significant differences between the two groups in the sex composition of the full-term children born after ICSI (P<0.05). CONCLUSIONS: Compared to the full-term singletons born after IVF, the full-term twins have lower cognitive development. The cognitive development of full-term singletons and twins born after ICSI did not show any significant differences. For all pre-term offspring, singletons and twins born after IVF or ICSI, the results of the cognitive development showed no significant differences.

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a neonatal intensive care unit.

BACKGROUND: A molecular epidemiological survey was conducted on an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBLKp) infection in our neonatal intensive care unit (NICU) from February to June 2008. METHODS: Cultures of clinical samples from neonates in the NICU, the hands of healthcare workers and the environment of the NICU were subjected to ESBLKp isolation. Pulsed-field gel electrophoresis was performed to determine Klebsiella pneumoniae strains (type A-D). RESULTS: In 1439 neonates, 38 (2.6%) had infections and 65 (4.5%) had colonizations with ESBLKp. Microbiological sampling of the NICU environment yielded 33 (14.9%) ESBLKp isolates from 222 samples. Clone A was found in 88.2% of the infected neonates, 66.7% of the colonized neonates, 69.7% of the environmental samples, and the hands of a healthcare worker. CONCLUSIONS: The detection rate of ESBLKp is high in environmental samples, especially those from frequently touched surfaces. Since ESBLKp was identified on the hands of a healthcare worker in the present study, hand and environmental hygiene is mandatory for infection control in neonatal intensive care units.

The social adaptation of children born after ICSI compared with IVF-conceived children: a study from China.

We compared the social adjustment among Chinese children born after intracytoplasmic sperm injection (ICSI) vs those after in vitro fertilisation (IVF) and identify factors related to the adjustment. The social adaptation of 86 ICSI and 165 IVF conceived children of 4-6 years of age was assessed using the Infants-Junior Middle School Students' Social-Life Abilities Scale. There was no significant difference between the ICSI and IVF-conceived groups on the item of communication, self-dependence, locomotion, work skills, socialisation, self-management and total scores. Compared with routine IVF, ICSI does no harm to the social adaptation of children conceived through this technology.