Global longitudinal strain is an informative index of left ventricular performance in neonates receiving intensive care.

Echocardiographic assessment of left ventricular function is crucial in NICU. The study aimed to compare the accuracy and agreement of global longitudinal strain (GLS) with conventional measurements. Real-life echocardiograms of neonates receiving intensive care were retrospectively reviewed. Shortening fraction (SF), ejection fraction (EF) and S' measurements were retrieved from health records. GLS was calculated offline from stored images. The association with stroke volume indexed for body weight (iSV) was evaluated by regression analysis. The diagnostic ability to identify uncompensated shock was assessed by ROC curve analysis. Cohen's κ was run to assess agreement. 334 echocardiograms of 155 neonates were evaluated. Mean ± SD gestational age and birth weight were 34.5 ± 4.1 weeks and 2264 ± 914 g, respectively. SF, EF, S' and GLS were associated with iSV with R2 of 0.133, 0.332, 0.252 and 0.633, (all p < .001). Including all variables in a regression model, iSV prediction showed an adjusted R2 of 0.667, (p < .001). GLS explained 73% of the model variance. GLS showed a better ability to diagnose uncompensated shock (AUC 0.956) compared to EF, S' and SF (AUC 0.757, 0.737 and 0.606, respectively). GLS showed a moderate agreement with EF (κ = .500, p < .001) and a limited agreement with S' and SF (κ = .260, p < .001, κ = .242, p < .001). GLS was a more informative index of left ventricular performance, providing the rationale for a more extensive use of GLS at the cotside.

The impact of the COVID-19 pandemic on antenatal care provision and associated mental health, obstetric and neonatal outcomes.

OBJECTIVES: The COVID-19 pandemic imposed many challenges on pregnant women, including rapid changes to antenatal care aimed at reducing the societal spread of the virus. This study aimed to assess how the pandemic affected perinatal mental health and other pregnancy and neonatal outcomes in a tertiary unit in Queensland, Australia. METHODS: This was a retrospective cohort study of pregnant women booked for care between March 2019 - June 2019 and March 2020 - June 2020. A total of 1984 women were included with no confirmed cases of COVID-19. The primary outcome of this study was adverse maternal mental health defined as an Edinburgh Postnatal Depression Scale score of ≥13 or an affirmative response to 'EPDS Question 10'. Secondary outcomes were preterm birth <37 weeks and <32 weeks, mode of birth, low birth weight, malpresentation in labour, hypertensive disease, anaemia, iron/vitamin B12 deficiency, stillbirth and a composite of neonatal morbidity and mortality. RESULTS: There were no differences in the primary perinatal mental health outcomes. The rates of composite adverse neonatal outcomes (27 vs. 34 %, p<0.001) during the pandemic were higher; however, there was no difference in perinatal mortality (p=1.0), preterm birth (p=0.44) or mode of delivery (p=0.38). CONCLUSIONS: Although there were no adverse consequences on maternal mental health during the pandemic, there was a concerning increase in neonatal morbidity potentially due to the altered model of maternity care implemented in the early COVID-19 pandemic.

Learning from parental experience in a neonatal surgical unit: a qualitative service evaluation.

Objectives: Patient experience is directly related to health outcomes, and parental experience can be used as a proxy for this in neonatal care. This project was designed to assess parental experience of neonatal surgical care to inform future service developments and improve the care we provide. Methods: This was a qualitative study using rapid qualitative analysis. The study was carried out in a large neonatal surgical intensive care unit in the UK. Parents of infants treated by the neonatal surgical team between March 2020 and February 2021, during the COVID-19 pandemic were included. Purposive sampling was used to ensure that a representative range of parents were interviewed. A semistructured interview was created and tested in a previous phase of work. This questionnaire was used to ask parents open questions about different aspects of their infants' healthcare journey from the antenatal phase through to discharge from the neonatal unit (NUU). Results: Rapid qualitative analysis was employed, and parental experiences were grouped into five main categories: before admission to the NNU, initial admission to NNU, information and support, COVID-19 and discharge. Within these five groups, we highlighted positive experiences to be fed back to the healthcare teams to reinforce good practice, areas that warranted improvement and suggestions for service development. Conclusions: The wealth of data generated from the interviews has been summarized and shared with healthcare teams who are putting the service improvement suggestions into practice. The tool is available for services that wish to measure parental experience.

Call for a More Specific Diagnosis of Infant of a Diabetic Mother to Optimize Neonatal Care.

Hyperglycemia is the diagnostic feature of diabetes mellitus (DM), and during pregnancy, hyperglycemia has numerous serious implications for organogenesis and fetal growth. Each type of DM has different neonatal implications based on pathogenesis, length of disease, and comorbidities. Currently, limited attention is given to the woman's type of DM when evaluating risks for neonates. The diagnosis of infant of a diabetic mother is not sufficient because of the varying pathophysiology of diabetes classifications and associated neonatal outcomes. By expanding the diagnosis to include the woman's classification and glucose control, maternity and neonatal care providers could develop plans of care based on potential neonatal outcomes, including anticipatory guidance for families. In this commentary, we propose a more specific diagnosis, rather than infant of a diabetic mother, to better serve these infants.

Residency Experience With Physical Examination- and Ultrasound-Indicated Cerclage: A Single Center Retrospective Study.

Background: Cervical insufficiency, the dilation of the cervix in the absence of contractions or labor, can cause second-trimester pregnancy loss or preterm birth. Cervical cerclage is a common treatment for cervical insufficiency and has 3 indications for placement: history, physical examination, and ultrasound. The purpose of this study was to compare pregnancy and birth outcomes for physical examination- and ultrasound-indicated cerclage. Methods: We conducted a retrospective observational descriptive review of second-trimester obstetric patients with transcervical cerclage performed by residents at a single tertiary care medical center from January 1, 2006, to January 1, 2020. We present data on all patients and compare outcomes between the 2 study groups: patients who received physical examination-indicated cerclage vs those who received ultrasound-indicated cerclage. Results: Cervical cerclage was placed on 43 patients at a mean gestational age of 20.4 ± 2.4 weeks (range, 14 to 25 weeks) and with a mean cervical length of 1.53 ± 0.5 cm (range, 0.4 to 2.5 cm). With a latency period of 11.8 ± 5.7 weeks, mean gestational age at delivery was 32.1 ± 6.2 weeks. Fetal/neonatal survival rates were comparable: 80% (16/20) for the physical examination group compared to 82.6% (19/23) for the ultrasound group. No differences were found between groups for gestational age at delivery-31.5 ± 6.8 in the physical examination group vs 32.6 ± 5.8 in the ultrasound group (P=0.581)-or for preterm birth <37 weeks-65.0% (13/20) in the physical examination group vs 65.2% (15/23) in the ultrasound group (P=1.000). Rates of maternal morbidity and neonatal intensive care unit morbidity were similar between the groups. No cases of immediate operative complications or maternal deaths occurred. Conclusion: Pregnancy outcomes for physical examination- and ultrasound-indicated cerclage placed by residents at a tertiary academic medical center were similar. Fetal/neonatal survival and preterm birth rates were favorable for physical examination-indicated cerclage when compared to other published studies.

Características clínicas e fonoaudiológicas de neonatos hospitalizados em uma Unidade de Tratamento Intensivo neonatal com suspeita de doença genética / Clinical and speech-language pathology characteristics of neonates hospitalized in a neonatal Intensive Care Unit with suspected genetic disease / Características clínicas y de patología del habla y lenguaje de neonatos hospitalizados en una Unidad de Cuidados Intensivos neonatales con sospecha de enfermedad genética

Introdução: A prematuridade é um fator de risco para o crescimento e o desenvolvimento dos neonatos. Objetivo: Analisar as características clinicas e fonoaudiológicas de neonatos hospitalizados na unidade de tratamento intensivo (UTI) neonatal com suspeita de doença genética. Material e Método:Estudo transversal descritivo, conduzido em um hospital na região sul do Brasil com coleta de dados entre novembro de 2020 e setembro de 2021. Todos os neonatos que se encontravam internados na UTI, atendidos pelo Sistema Único de Saúde e que apresentavam suspeita de etiologias genéticas foram acompanhados pela equipe de Fonoaudiologia. Foram analisados todos os prontuários dos recém-nascidos com suspeita de alteração genética, extraindo-se os dados médicos e fonoaudiológicos. Resultados:A amostra foi constituída por 14 neonatos prematuros com média de idade gestacional de 36 semanas e 5 dias e uma média de tempo de nascimento, no momento da avaliação fonoaudiológica, de 14,6 dias de vida. No que se refere às comorbidades, 71,4% dos recém-nascidos apresentavam alguma malformação, sendo múltiplas na maior parte dos casos (64,29%). Todos os neonatos estavam fazendo uso de via enteral de alimentação durante a avaliação fonoaudiológica. Na avaliação de reflexos orais, observou-se que houve um predomínio de pacientes com reflexo de procura débil, sendo que a maior parte apresentava reflexo de sucção presente. Conclusões: Pode-se afirmar que, neste estudo, a amostra foi composta por pacientes principalmente prematuros que apresentavam malformações múltiplas e que todos faziam uso de via alternativa de alimentação sugerindo, assim, a necessidade de atendimento fonoaudiológico como parte da assistência multidisciplinar desses neonatos. (AU)

Introduction: Prematurity is a risk factor for the growth and development of neonates. Objective: To analyze clinical and speech therapy characteristics of neonates hospitalized in the neonatal intensive care unit with suspected genetic disease. Method: Descriptive cross-sectional study conducted in a hospital in southern Brazil with data collection between November 2020 and September 2021. All neonates who were hospitalized in the ICU attended by the public health system and who were suspected of having genetic etiologies were followed up by the Speech-Language Pathology team. All newborn`s medical records with suspected genetic alterations were analyzed and the medical and the speech-language pathology data were analyzed. Results: The sample consisted of 14 premature neonates with a mean gestational age of 36 weeks and 5 days and a mean time of birth, at the time of the speech-language pathology assessment, of 14.6 days of life. Regarding to comorbidities, 71.4% of newborns had some malformation, being multiple in most cases (64.29%). All neonates were using enteral feeding at the time of the speech-language evaluation. At the oral reflexes evaluation it was observed that there was a predominance of patients with a weak rooting reflex and most of them had a present sucking reflex. Conclusions: In this study the sample consisted of mainly premature patients who had multiple malformations and all of them used an alternative feeding route, thus suggesting the demand for speech therapy as part of the multidisciplinary care of these neonates. (AU)

Introducción: La prematuridad es un factor de riesgo para el crecimiento y desarrollo de los recién nacidos. Objetivo: Analizar las características clinicas y de terapia del habla de recién nacidos hospitalizados en la unidad de cuidados intensivos neonatales (UCI) con sospecha de enfermedad genética. Método: Estudio transversal descriptivo realizado en un hospital en la región del Sur de Brasil. Todos los recién nacidos que fueron hospitalizados en la UTI y que tenían sospecha de tener etiologías genéticas, fueron atendidos por el equipo de Patología del Habla y Lenguaje. Se analizaron todas las historias clínicas de los recién nacidos con sospecha de alteraciones genéticas, extrayéndose datos médicos y de patología del habla y del lenguaje. Resultados: La muestra estuvo constituida por 14 neonatos prematuros con una edad gestacional media de 36 semanas. En cuanto a las comorbilidades, el 71,4% de los recién nacidos presentó alguna malformación, siendo múltiples en la mayoría de los casos (64,29%). Con respecto a los datos de la evaluación de la patología del habla y el lenguaje, todos los recién nacidos estaban usando alimentación enteral. En la evaluación de los reflejos orales, se observó que hubo un predominio de pacientes con reflejo de búsqueda débil, y la mayoría de ellos tenían presente el reflejo de succión. Conclusiones: Se puede decir que en este estudio la muestra estuvo compuesta principalmente por pacientes prematuros, que presentaban plurimalformaciones y que todos utilizaban una vía alternativa de alimentación, sugiriendo así, la necesidad de la fonoaudiología como parte del cuidado multidisciplinario de estos neonatos. (AU)

Tecnologias para manutenção do Cateter Central de Inserção Periférica em neonatos: revisão integrativa / Tecnologías para el mantenimiento del Catéter Central de Inserción Periférica en neonatos: revisión integrativa / Technologies for maintenance of Peripherally Inserted Central Catheter in neonates: an integrative review

Objetivo: analisar a literatura científica acerca das tecnologias e cuidados para posicionamento e reposicionamento do cateter central de inserção periférica (PICC) em neonatos. Método: revisão integrativa, com busca realizada em fevereiro de 2022 em quatro bases de dados. Resultados: incluíram-se 32 estudos que abordam uso de tecnologias para verificação da localização do PICC, procedimentos para seu posicionamento e manobras para reposicionamento. Para posicionamento adequado deve-se atentar para seleção do vaso, mensuração correta do dispositivo e manutenção do bem-estar do recém-nascido. Frente ao mal posicionamento sugere-se a movimentação do membro, flush, tração do cateter, e conduta expectante. A verificação da localização da ponta é rotineira, por meio de radiografia, ultrassonografia ou eletrocardiograma. Conclusão: recomenda-se a adoção de tecnologias não invasivas para o posicionamento e reposicionamento do PICC em neonatos. As evidências apontam para competência profissional na tomada de decisão para o cuidado seguro e de qualidade, e prevenção de eventos adversos.

Objective: to analyze the scientific literature on technologies and care for positioning and repositioning of the peripherally inserted central catheter (PICC) in neonates. Method: integrative review, with search conducted in February 2022 in four databases. Results: 32 studies were included that address the use of technologies to verify the location of the PICC, procedures for its positioning and maneuvers for repositioning. For proper positioning should pay attention to the selection of the vessel, correct measurement of the device and maintenance of the well-being of the newborn. In the face of poor positioning, it is suggested limb movement, flush, catheter traction, and expectant management. The verification of the tip location is routine, by radiography, ultrasonography or electrocardiogram. Conclusion: the adoption of non-invasive technologies for the positioning and repositioning of PICC in neonates is recommended. The evidence points to professional competence in decision making for safe and quality care and prevention of adverse events.

Objetivo: analizar la literatura científica acerca de las tecnologías y cuidados para posicionamiento y reposicionamiento del catéter central de inserción periférica (PICC) en neonatos. Método: revisión integrativa, con búsqueda realizada en febrero de 2022 en cuatro bases de datos. Resultados: se incluyeron 32 estudios que abordan el uso de tecnologías para verificar la localización del PICC, procedimientos para su posicionamiento y maniobras para reposicionamiento. Para un posicionamiento adecuado se debe prestar atención a la selección del recipiente, la medición correcta del dispositivo y el mantenimiento del bienestar del recién nacido. Frente al mal posicionamiento se sugiere el movimiento de la extremidad, color, tracción del catéter, y conducta expectante. La verificación de la localización de la punta es rutinaria, por medio de radiografía, ultrasonido o electrocardiograma. Conclusión: se recomienda la adopción de tecnologías no invasivas para el posicionamiento y reposicionamiento del PICC en neonatos. La evidencia apunta a la competencia profesional en la toma de decisiones para el cuidado seguro y de calidad, y la prevención de eventos adversos.

Higher maternal age is associated with higher occurrence of cleft lip/palate in neonates under intensive care

Aim: To assess the prevalence of cleft lip and/or cleft palate (CL/P) and associated variables in neonates admitted to neonatal intensive care units (ICU). Methods: Medical charts for neonates born and admitted to the ICU between 2012 and 2018 were reviewed. Obstetric and neonatal variables were collected by a trained researcher. In the case group, all neonates with CL/P were included. The control group was formed by matching sex, prematurity and month of birth using random number generation. Neonates with congenital malformations were excluded from the control group. Adjusted logistic regression was used (p<0.05). Results: The prevalence of CL/P was 0.43% (n=15). Five cases were excluded, as pairing was not possible. Twenty neonates were included in the control group. In the final multivariate model, CL/P was only associated with increased maternal age. For each year of increase in maternal age, neonates had a 35.2% higher chance of presenting CL/P (95% confidence interval: 1.021­1.792). Conclusions: Higher maternal age was associated with higher occurrence of CL/P in neonates admitted to the ICU. No other neonatal or maternal independent variables were associated with CL/P. Due to missing data, interpretation of study results must be approached with caution

Value of short-time transcutaneous carbon dioxide and oxygen pressure monitoring in critically ill preterm infants / 中华围产医学杂志

Objective:To investigate the value of short-time transcutaneous carbon dioxide pressure (TcPCO 2) and transcutaneous oxygen pressure (TcPO 2) monitoring in critically ill preterm infants. Methods:From January to December 2018, 62 critically ill neonates receiving respiratory support at Guangzhou Women and Children's Medical Center were retrospectively enrolled. A total of 348 sets of paired data including TcPCO 2/TcPO 2 and arterial carbon dioxide pressure (PaCO 2)/arterial oxygen partial pressure (PaO 2) were analyzed. The patients were divided into different groups based upon birth weight (23 cases>1 000 g-≤1 500 g, 129 sets of paired data; 18 cases≤1 000 g, 130 sets of paired data) and gestational age (16 cases born at ≤28 gestational weeks, 127 sets of paired data; 29 cases born at 28-34 gestational weeks, 159 sets of paired data) and the differences between groups were compared. The correlation and consistency of TcPCO 2/TcPO 2 and PaCO 2/PaO 2 were evaluated using Pearson's correlation and Blan-Altman scatter plots. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic efficacy of TcPCO 2 in neonates with hypercapnia. Results:There was a positive correlation between TcPCO 2 and PaCO 2 in all patients ( r=0.913, 95% CI:0.894-0.929, P<0.05). In patients whose birth weight was>1 000 g-≤1 500 g or≤1 000 g, TcPCO 2 and PaCO 2 were positively correlated and the consistency were good ( r=0.909, 95% CI:0.874-0.935; r=0.934, 95% CI:0.908-0.953; both P<0.05), and the same finding was also observed in patients born at≤28 gestational weeks or 28-34 weeks of gestation ( r=0.938, 95% CI:0.913-0.956; r=0.871, 95% CI: 0.827-0.904; both P<0.05). The sensitivity, specificity and area under curve of TcPCO 2 in the diagnosis of hypercapnia were 90.91%, 85.85%, and 0.942, respectively. There was a poor correlation between TcPO 2 and PaO 2 in all patients and those with birth weight >1 000 g-≤1 500 g or gestational age 28-34 weeks (all r<0.75, all P<0.05). There was no correlation between TcPO 2 and PaO 2 in the birth weight ≤1 000 g and gestational age ≤28 weeks groups (both P>0.05). Conclusions:Short-time TcPCO 2 monitoring can accurately assess PaCO 2 in critically ill neonates requiring respiratory support and is of high diagnostic value for hypercapnia. However, TcPO 2 has limitation in evaluating PaO 2 and other indicators may need to be involved.

Neonatal pneumothorax in congenital diaphragmatic hernia: Be wary of high ventilatory pressures.

Background: Patients with congenital diaphragmatic hernia (CDH) require invasive respiratory support and higher ventilator pressures may be associated with barotrauma. We sought to evaluate the risk factors associated with pneumothorax in CDH neonates prior to repair. Methods: We retrospectively reviewed newborns born with CDH between 2014 and 2019 who developed a pneumothorax, and we matched these cases to patients with CDH without pneumothorax. Results: Twenty-six patients were included (n=13 per group). The pneumothorax group required extracorporeal life support (ECLS) more frequently (85% vs 54%, p=0.04), particularly among type A/B defects (31% vs 7%, p=0.01). The pneumothorax group had higher positive end-expiratory pressure (PEEP) within 1 hour of birth (p=0.02), at pneumothorax diagnosis (p=0.003), and at ECLS (p=0.02). The pneumothorax group had a higher mean airway pressure (Paw) at birth (p=0.01), within 1 hour of birth (p=0.01), and at pneumothorax diagnosis (p=0.04). Using multiple logistic regression with cluster robust SEs, higher Paw (OR 2.2, 95% CI 1.08 to 3.72, p=0.03) and PEEP (OR 1.8, 95% CI 1.15 to 3.14, p=0.007) were associated with an increased risk of developing pneumothorax. There was no difference in survival (p=0.09). Conclusions: Development of a pneumothorax in CDH neonates is independently associated with higher Paw and higher PEEP. A pneumothorax increases the likelihood of treated with ECLS, even with smaller defect.

Postoperative apnea after pyloromyotomy for infantile hypertrophic pyloric stenosis.

Objective: Infantile hypertrophic pyloric stenosis (IHPS), which causes gastric outlet obstruction and hypochloremic hypokalemic metabolic alkalosis, could pose a risk of postoperative apnea in patients. The aim of this study is to evaluate the incidence of postoperative apnea in babies admitted to a tertiary-level pediatric surgical center in Milano, Italy with diagnosis of IHPS in 2010-2019. The secondary objective is to evaluate the risk factors for postoperative apnea. Methods: This is a single-center, retrospective, observational cohort study. All patients admitted to our institution with diagnosis of IHPS during the study period were enrolled. Demographic and surgical variables, along with blood gas parameters, were obtained from the population. Postoperative apnea was defined as a respiratory pause longer than 15 s or a respiratory pause lasting less than 15 s, but associated with either bradycardia (heart rate <120 per minute), desaturation (SatO2 <90%), cyanosis, or hypotonia. Occurrence was obtained from nursing charts and was recorded as a no/yes dichotomous variable. Results: Of 122 patients, 12 (9.84%) experienced apnea and 110 (90.16%) did not. Using univariate analysis, we found that only postoperative hemoglobin was significantly different between the groups (p=0.03). No significant multivariable model was better than this univariate model for prediction of apnea. Conclusions: Postoperative anemia, possibly due to hemodilution, increased the risk of postoperative apnea. It could be hypothesized that anemia can be added as another apnea-contributing factor in a population at risk due to metabolic changes.

Comprimento de inserção de sonda gástrica em recém-nascidos: práticas dos enfermeiros / Length of gastric tube insertion in newborn: nurse's practices / Longitud de inserción de sonda gástrica en neonatos: prácticas de enfermería

Objetivo: avaliar a prática de enfermeiros que atuam em unidade neonatal sobre a mensuração do comprimento de sondas gástricas. Método: estudo transversal, realizado em quatro unidades neonatais públicas do Recife. Os dados foram coletados por meio de questionário e submetidos à análise estatística descritiva e analítica. Protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. Resultados: a medida orelha-nariz-xifoide apareceu como a mais frequente para sondagem orogástrica (28,4%) e a medida nariz-orelha-xifoide para sondagem nasogástrica (35,8%); 7,5% dos enfermeiros declararam usar as estratégias de medição de sonda atualmente recomendadas tanto para via oral quanto para nasogástrica. Não houve associação significativa entre a escolha das estratégias de medição adequadas e tempo de formação, tempo de experiência em neonatologia, formação complementar ou unidade de atuação. Conclusão: a prática de sondagem gástrica em recém-nascido, da maior parte dos profissionais, está desalinhada com as atuais evidências que recomendam o uso da medida nariz-orelha-metade da distância entre xifoide e cicatriz umbilical.

Objective: to evaluate the practice of nurses from a neonatal unit on measuring the length of gastric tubes. Method: cross-sectional study, carried out in four public neonatal units from Recife. Data were collected through a questionnaire and submitted to descriptive and analytical statistical analysis. Research protocol approved by the Research Ethics Committee. Results: the ear-nose-xiphoid measurement appeared as the most frequent for orogastric tube (28.4%) and the nose-ear-xiphoid measurement for nasogastric tube (35.8%); 7.5% of nurses reported using the currently recommended tube measurement strategies for both the oral and nasogastric routes. There was no significant association between the choice of appropriate measurement strategies and training time, length of experience in neonatology, additional training or unit of work. Conclusion: the practice of perform gastric tube in newborns, by most professionals, is out of line with current evidence that recommends the use of nose-ear-half the distance between xiphoid and umbilicus.

Objetivo: evaluar la práctica de los enfermeros que actúan en una unidad neonatal en cuanto a la medición de la longitud de las sondas gástricas. Método: estudio transversal, realizado en cuatro unidades neonatales públicas de Recife. Los datos se recolectaron a través de un cuestionario y se sometieron a análisis estadístico descriptivo y analítico. El Comité de Ética en Investigación aprobó el protocolo de investigación. Resultados: la medida oído-nariz-xifoideo apareció como siendo la más frecuente en cuanto a la sonda orogástrica (28,4%) y la medida nariz-oído-xifoideo respecto a la sonda nasogástrica (35,8%); el 7,5% de los enfermeros informó que utilizan las estrategias de medición de sonda actualmente recomendadas tanto para la vía oral y como para la nasogástrica. No hubo asociación significativa entre la elección de estrategias de medición apropiadas y el tiempo de formación, la duración de la experiencia en neonatología, la formación adicional o la unidad de trabajo. Conclusión: la práctica del sondaje gástrico en recién nacidos, por la mayoría de los profesionales, no se ajusta con la evidencia actual que recomienda el uso de la medida nariz-oreja- mitad de la distancia entre el xifoides y la cicatriz umbilical.

Impact of introducing a lactation consultant into a neonatal unit.

AIM: Benefits of mothers' own milk (MOM) for premature and sick neonates are well documented. To increase access, many neonatal units have a lactation consultant (LC) on staff. This study aimed to assess the impact of a permanent LC on (i) maternal access to LC support; (ii) staff confidence in providing Breast Feeding (BF) education and (iii) provision of MOM. METHODS: Study included a staff survey and chart audit. Questions provided feedback on access to lactation support and meeting maternal needs. Audit data included: gestational age, birthweight, intention to breastfeed, documentation of LC appointment, provision of MOM at 12 hours, days 3, 7, 28 and discharge. Student's t-tests were used for numerical data and chi-squared tests for categorical variables. RESULTS: Ninety-one staff surveys were returned, (pre 35/75 (47%), post 56/85 (66%) with staff reporting organising an LC appointment was significantly easier (P < 0.0001). Staff perceived maternal lactation needs and confidence to breastfeed post-discharge had significantly improved post-LC. The chart audit showed a significant increase in maternal access to LC appointments (15% vs. 80%; P < 0.01), breast pump education by day 3 (65% vs. 81%; P < 0.01), and an increase in MOM provision by 12 h (46% vs. 61%; P < 0.01) post-LC but not at days 7, 28 or discharge. CONCLUSION: A dedicated LC increases staff and maternal access to lactation education and support, improving provision of early MOM. Further research is required to assess the effect of LCs in improving breastfeeding rates in neonatal units.

Exploring factors which contribute to the resilience of nurses working in the neonatal care unit: A grounded theory study.

OBJECTIVES: This study aimed to produce a theoretical model to understand factors which affect the resilience of neonatal nurses. Nurses experience high levels of burnout due to the occupational stress they are exposed to. Burnout negatively affects both staff and patient outcomes, and in this population would likely affect the establishment of crucial early caregiver-infant relationships in the neonatal unit. Research suggests that increasing nurses' resilience can protect them against burnout, thus understanding factors that affect resilience in this population is critical. RESEARCH METHODOLOGY: The study adopted a constructivist grounded theory design. SETTING AND PARTICIPANTS: All participants were qualified registered nurses employed on a permanent basis in a Level 3 neonatal unit. Thirteen registered nurses attended one individual semi-structured interview. A constructivist grounded theory approach was used to analyse the subsequent verbatim transcripts. FINDINGS: The resulting model identified that individuals working as nurses in the neonatal unit function within different systemic contexts: the nursing team; the family unit; the broader neonatal team; the National Health Service and their world outside the unit. Each context presents different practical, emotional and ethical challenges. These challenges are navigated through a combination of contextual, interpersonal and intrapersonal strategies. CONCLUSIONS: The model is contextually embedded and extends existing literature pertaining to resilience of healthcare staff in other contexts. Suggestions are made in terms of adaptations to the organisational, social and individual contexts to benefit nursing resilience. Implications of the findings are also considered within the context of the ongoing Covid-19 pandemic.

Manutenção do cateter central de inserção periférica em neonatos: prática de profissionais e proposta de curso virtual / Maintenance of the peripherally inserted central catheter in neonates: professional practice and virtual course proposal

Introdução: O cateter central de inserção periférica (PICC) tem como finalidade a promoção da terapia intravenosa prolongada, principalmente, indicada para administração de soluções, pois garante a preservação da rede venosa, diminuindo complicações causadas por múltiplas venopunções. A manutenção do PICC é um cuidado no qual a/o enfermeira/o realiza o planejamento, mas que, também, tem a participação dos técnicos de enfermagem na sua manipulação. Objetivos: analisar as práticas de manutenção do cateter central de inserção periférica realizada pelos enfermeiros e gestores que atuam na UTIN; identificar as barreiras e os facilitadores de manutenção do cateter central de inserção periférica pelos enfermeiros e gestores na UTIN; descrever o inventário de valores organizacionais em relação aos aspectos real e o aspecto desejável (aplicado a gestores) dos profissionais de enfermagem envolvidos nas práticas de manutenção do cateter central de inserção periférica dos profissionais de enfermagem nas unidades de terapia intensiva neonatal; propor um curso em ambiente virtual de aprendizagem para atualização sobre as práticas de manutenção do cateter central de inserção periférica para enfermeiros que atuam na unidade neonatal com base nos resultados obtidos. Referencial Teórico: O modelo estrutural The Promoting Action on Research Implementation in Health Services integrated (I-PARIHS), que fornece uma maneira de implementar a pesquisa na prática e auxiliar a implementação da tradução do conhecimento para a incorporação das práticas baseadas em evidência na manutenção do PICC em recém-nascidos. Método: Trata-se de uma pesquisa de abordagem quantitativa, descritiva e transversal, tipo survey sob a orientação da estrutura do modelo i-PARIHS. Foi realizada em uma UTIN de um hospital terciário no Estado do Rio de Janeiro, com 24 enfermeiros e teve a amostragem não probabilística. A coleta de dados ocorreu no período de janeiro a dezembro de 2021 por meio de dois questionários: um para enfermeiros e outro para gestores. Os dados foram coletados eletronicamente. O trabalho está em conformidade com as Diretrizes e Normas Regulamentadoras de Pesquisas Envolvendo Seres Humanos ­ Resolução 466/2012 e foi submetido e aprovado pelo Comitê de Ética e Pesquisa (CEP). Para a análise dos dados, foi utilizado o Programa SPSS (Statistical Package for Social Sciences). Resultados: Os participantes dessa pesquisa foram 24 enfermeiros (21 enfermeiros e três enfermeiros no cargo de Gestão). Foi possível identificar o diagnóstico situacional do contexto interno da UTIN quanto às práticas de manutenção do PICC em neonatos, descrever o inventário dos valores organizacionais dos profissionais da gestão e, ainda, identificar as principais barreiras e facilitadores dos enfermeiros em relação às práticas. O curso virtual elaborado pela proposta foi intitulado: Curso de atualização sobre as práticas de manutenção do PICC para profissionais de enfermagem na UTIN. Discussão: As práticas de manutenção do PICC, também, são de considerável responsabilidade para os enfermeiros, uma vez que a manutenção de uma terapia infusional segura envolve significativa complexidade devido às particularidades da clientela neonatal. Esse profissional precisa ter conhecimentos específicos como, por exemplo: a necessidade de reconhecimento das características fisiológicas; seleção do conjunto de administração que envolve, inclusive, a seleção do aparelho de bomba de infusão, limitações com referência à idade, altura, peso ou área de superfície corporal. As práticas estão, em sua maioria, respaldadas na literatura científica, sendo o enfermeiro o profissional responsável legalmente e que possui competência clínica para o manuseio do PICC. Conclusão. Para uma efetiva mudança da prática, são necessárias outras ações que envolvam não somente o Contexto, mas, também, o conhecimento da cultura institucional, dos processos de tomada de decisão, da análise das barreiras/facilitadores e da adaptação das evidências para o contexto local, para que as práticas de manutenção do PICC em neonatos possam ser inseridas através do curso virtual, diminuindo, assim, as lacunas do conhecimento da teoria e prática. Implicações para a enfermagem neonatal: podem-se associar as práticas baseadas em evidência e a sua implementação por meio do curso a um conteúdo programático que seja de fácil acesso, compreensível e acessível para atualizar os enfermeiros da UTIN.

Introduction: The peripherally inserted central catheter (PICC) aims to promote prolonged intravenous therapy, mainly indicated for the administration of solutions, because it ensures the preservation of the venous network, reducing complications caused by multiple venipunctures. The maintenance of the PICC is a care in which the nurse does the planning, but also has the participation of nursing technicians in its handling. Objectives: To analyze the maintenance practices of peripherally inserted central catheters performed by nurses and managers working in the NICU; to identify the barriers and facilitators of maintaining peripherally inserted central catheters performed by nurses and managers in the NICU; To describe the inventory of organizational values in relation to the real aspects and the desirable aspect (applied to managers) of nursing professionals involved in the maintenance practices of the peripherally inserted central catheter by nursing professionals in neonatal intensive care units; to propose a course in a virtual learning environment for updating on the maintenance practices of the peripherally inserted central catheter for nurses working in the neonatal intensive care unit based on the results obtained. Theoretical Framework: The Promoting Action on Research Implementation in Health Services integrated (I-PARIHS) framework model, which provides a way to translate research into practice and support the implementation of knowledge translation for the incorporation of evidence-based practices in neonatal PICC maintenance. Method: This is a quantitative, descriptive, and cross-sectional survey research under the guidance of the i-PARIHS model structure. It was conducted in a NICU of a tertiary hospital in the state of Rio de Janeiro, with 24 nurses and had a non-probability sampling. Data collection took place from January to December 2021, using two questionnaires: one for nurses and another for managers. The data were collected electronically. The work was submitted to and approved by the Research Ethics Committee (CEP- in Portuguese), in accordance with the Guidelines and Regulatory Standards for Research Involving Human Subjects - Resolution 466/2012. The SPSS (Statistical Package for Social Sciences) program was used for data analysis. Results: The participants of this research were 24 nurses (21 nurses and three nurses in management position). It was possible to identify the situational diagnosis of the internal context of the NICU regarding PICC maintenance practices in neonates, describe the inventory of organizational values of management professionals, and also identify the main barriers and facilitators of nurses regarding the practices. The virtual course developed from the proposal was entitled: Refresher Course on PICC Maintenance Practices for nursing professionals in the NICU. Discussion: PICC maintenance practices are also a significant responsibility for the nurse, as maintaining safe infusion therapy is a complex task due to the specificities of the neonatal clientele. This professional must have specific knowledge, such as: the need to recognize physiological characteristics; the selection of the administration set, which includes the selection of the infusion pump device; limitations related to age, height, weight, or body surface area. These practices are largely supported by the scientific literature, and the nurse is the professional who is legally responsible and clinically competent to handle the PICC. Conclusion. For an effective change in practice, other actions are needed that include not only the context, but also the knowledge of the institutional culture, the decision-making processes, the analysis of barriers/facilitators, and the adaptation of evidence to the local context, so that the practices of PICC maintenance in neonates can be inserted through the virtual course, thus reducing the knowledge gaps between theory and practice. Implications for neonatal nursing: Evidence-based practices and their implementation through the course can be combined with programmatic content that is easily accessible, understandable, and affordable to update NICU nurses.

Introducción: El catéter central de inserción periférica (PICC) tiene como objetivo promover la terapia intravenosa prolongada, principalmente indicada para la administración de soluciones, ya que garantiza la preservación de la red venosa, reduciendo las complicaciones causadas por múltiples venopunciones. El mantenimiento del PICC es un cuidado en el que la enfermera realiza la planificación, pero que también cuenta con la participación de técnicos de enfermería en su manejo. Objetivos: analizar las prácticas de mantenimiento del catéter central insertado periféricamente realizadas por los profesionales de enfermería y gestores que trabajan en la UCIN; identificar las barreras y facilitadores del mantenimiento del catéter central insertado periféricamente por los profesionales de enfermería y gestores en la UCIN; describir el inventario de valores organizativos en relación con los aspectos reales y deseables (aplicados a los gestores) de los profesionales de enfermería implicados en las prácticas de mantenimiento del catéter central insertado periféricamente por los profesionales de enfermería en las unidades de cuidados intensivos neonatales; proponer un curso en un entorno virtual de aprendizaje para la actualización sobre las prácticas de mantenimiento del catéter central insertado periféricamente para los profesionales de enfermería que trabajan en la unidad neonatal a partir de los resultados obtenidos. Marco teórico: El modelo marco Promoting Action on Research Implementation in Health Services integrated (I-PARIHS), que proporciona una forma de implementar la investigación en la práctica y ayudar a la implementación de la traducción de conocimientos para la incorporación de prácticas basadas en la evidencia en el mantenimiento del PICC en recién nacidos. Método: Se trata de una investigación cuantitativa, descriptiva y transversal, tipo encuesta bajo la orientación de la estructura del modelo i-PARIHS. Se realizó en una UCIN de un hospital terciario del estado de Río de Janeiro, con 24 enfermeros y tuvo un muestreo no probabilístico. La recogida de datos se realizó de enero a diciembre de 2021 mediante dos cuestionarios: uno para enfermeras y otro para gestores. Los datos se recogieron electrónicamente. El estudio cumple con las Directrices y Normas Reguladoras para la Investigación con Seres Humanos - Resolución 466/2012 y fue sometido y aprobado por el Comité de Ética en Investigación (CEP). Para el análisis de los datos, se utilizó el programa SPSS (Statistical Package for Social Sciences). Resultados: Los participantes en esta investigación fueron 24 enfermeros (21 enfermeros y tres enfermeros en el puesto de Dirección). Fue posible identificar el diagnóstico situacional del contexto interno de la UCIN en relación a las prácticas de mantenimiento del PICC en neonatos, describir el inventario de los valores organizacionales de los profesionales de gestión, y también identificar las principales barreras y facilitadores de los enfermeros en relación a las prácticas. El curso virtual desarrollado por la propuesta se tituló: Curso de actualización en prácticas de mantenimiento de PICC para profesionales de enfermería de la UCIN. Discusión: Las prácticas de mantenimiento del PICC también son una responsabilidad considerable del personal de enfermería, ya que mantener una terapia de infusión segura implica una complejidad significativa debido a las particularidades de la clientela neonatal. Este profesional necesita tener conocimientos específicos, tales como: la necesidad de reconocer las características fisiológicas; la selección del set de administración, que también implica la selección del dispositivo de la bomba de infusión, las limitaciones con referencia a la edad, la altura, el peso o la superficie corporal. La mayoría de las prácticas están avaladas por la literatura científica, y la enfermera es el profesional legalmente responsable y clínicamente competente para la manipulación del PICC. Conclusión. Para un cambio efectivo de la práctica, son necesarias otras acciones que involucren no sólo el Contexto, sino también el conocimiento de la cultura institucional, los procesos de toma de decisión, el análisis de barreras/facilitadores y la adaptación de la evidencia al contexto local, para que las prácticas de mantenimiento de PICC en neonatos puedan ser insertadas a través del curso virtual, reduciendo así las lagunas de conocimiento de la teoría y la práctica. Implicaciones para la enfermería neonatal: las prácticas basadas en la evidencia y su implementación a través del curso pueden asociarse a un contenido programático fácilmente accesible, comprensible y asequible para la actualización de las enfermeras de la UCIN.

The role of skin-to-skin contact in exclusive breastfeeding: a cohort study

ABSTRACT OBJETIVE To understand the role of exposure to skin-to-skin contact and its minimum duration in determining exclusive breastfeeding at hospital discharge in infants weighing up to 1,800g at birth. METHODS A multicenter cohort study was carried out in five Brazilian neonatal units. Infants weighing ≤ 1,800g at birth were eligible. Skin-to-skin contact time was recorded by the health care team and parents on an individual chart. Maternal and infant data was obtained from maternal questionnaires and medical records. The Classification Tree, a machine learning method, was used for data analysis; the tree growth algorithm, using statistical tests, partitions the dataset into mutually exclusive subsets that best describe the response variable and calculates appropriate cut-off points for continuous variables, thus generating an efficient explanatory model for the outcome under study. RESULTS A total of 388 infants participated in the study, with a median of 31.6 (IQR = 29-31.8) weeks of gestation age and birth weight of 1,429g (IQR = 1,202-1,610). The exclusive breastfeeding rate at discharge was 61.6%. For infant's weighting between 1,125g and 1,655g, exposed to skin-to-skin contact was strongly associated with exclusive breastfeeding. Moreover, infants who made an average > 149.6 min/day of skin-to-skin contact had higher chances in this outcome (74% versus 46%). In this group, those who received a severity score (SNAPPE-II) equal to zero increased their chances of breastfeeding (83% versus 63%). CONCLUSION Skin-to-skin contact proved to be of great relevance in maintaining exclusive breastfeeding at hospital discharge for preterm infants weighing 1,125g-1,655g at birth, especially in those with lower severity scores.

A study on the status quo and influencing factors of neonatal palliative care attitude among NICU nurses / 中国实用护理杂志

Objective:To understand the status quo of neonatal palliative care attitude of nurses in neonatal intensive care unit (NICU) and analyze the influencing factors, in order to provide reference and direction for hospital management to improve the neonatal palliative care attitude of NICU nurses.Methods:A total of 237 NICU nurses in 9 hospitals in Shijiazhuang, Hebei Province were selected by cluster sampling method from November to December 2021, and the questionnaire was conducted using General Data Survey, Neonatal Palliative Care Attitude Scale (NiPCAS), the Jefferson Scale of Empathy (JSE) and Coping with Death Scale (CDS). And analyze the results.Results:The total score of the NICU nurses′ neonatal palliative care attitude was 89.35 ± 18.86. The average score of each dimension from high to low was belief, work experience, resources, organization, and obstacle; and the total score of neonatal palliative care attitude was positively correlated with empathy ability ( r=0.653, P<0.01) and death coping ability ( r=0.597, P<0.01), in addition the factor of barrier was negatively correlated with empathy and death coping ability ( r=-0.602, -0.526, both P<0.01) Multiple linear regression analysis showed that educational background, whether nursing dying infants, frequency of attending hospice nursing education in hospitals, empathy ability and death coping ability were the influencing factors of neonatal palliative care attitude, which could explain 47.3% of the total variation. Conclusions:NICU nurses′ neonatal palliative care attitude was generally at a moderate level, and affected by five factors such as education. It is suggested that hospital management should provide to improve empathy ability and death response ability as the premise of personalized, diversified education training support, multiple ways, multi-level improve its empathy ability and death coping ability, improve neonatal palliative care attitude, and then improve the quality of nursing service.

An Early Collaborative Intervention Focusing on Parent-Infant Interaction in the Neonatal Period. A Descriptive Study of the Developmental Framework.

Moderate to late preterm infants are at risk of developing problems later in life. To support attachment and infants' development, high quality parent-infant interaction is important. Parent-infant interaction is known to improve through intervention programs but since no such intervention program is addressed directly to moderate to late preterm infants, a tailor-made intervention was developed. The aim was to describe the rationale, development, framework and practical provision of a new early collaborative intervention program. This study has a descriptive design and the intervention is described using the Template for Intervention Description and Replication. During an intervention-session, the preterm infant's cues are made visible to the parents as they perform an everyday care-taking procedure. Instant feedback is delivered to give the parents the opportunity to notice, interpret and respond to cues immediately. The infant's response to the parent's action is discussed in a dialogue to instantly guide parents´ awareness of the preterm infant's subtle cues. This study describes a new early collaborative intervention, developed to support interaction between parents and their moderate to late preterm infants starting in the neonatal intensive care unit. Clinical studies evaluating parental experiences as well as the effects of the early intervention are ongoing, ClinicalTrials.gov NCT02034617.

Prevenção e controle de infecções relacionadas à assistência à saúde em unidades / Prevention and control of infections related with health care in neonatal units / Prevención y control de infecciones relacionadas a la asistencia de la salud en unidades neonatales

Objetivo: Realizar uma busca sistemática na literatura sobre a assistência de enfermagem no desenvolvimento das estratégias para prevenção e controle das infecções relacionadas à assistência à saúde nas Unidades Neonatais. Método: Trata-se de uma revisão sistemática da literatura, que seguiu os procedimentos metodológicos descritos na literatura, a qual utiliza uma metodologia sistemática e explícita para identificar, selecionar e avaliar criticamente as pesquisas já publicadas acerca da temática, entre os anos de 2008 a 2018, nos idiomas português e inglês. Resultados: A amostra final da revisão foi composta por 07 artigos. Os principais resultados encontrados foram classificados em fatores extrínsecos que contribuem e dificultam a redução das infecções relacionadas a assistência à saúde. Conclusão: As infecções relacionadas à assistência à saúde que acometem os recém-nascidos em Unidades Neonatais, podem ser prevenidas e controladas através de estratégias simples, relacionadas a medidas administrativas, assistenciais e educativas

Objective: To carry out a systematic search in the literature on nursing care in the development of strategies to prevent and control the Infections Related to Health Care at Neonatal Units. Methods: It is about a systematic literature review using original articles published between 2008 and 2018, in Portuguese and in English, available at BVC. This review covered the following data bases: LILACS, BDENF and MEDLINE. Results: the final sample of the review was composed of seven articles. The studies aimed to cover newborn babies who are in a Neonatal Intensive Care Unit, nurses and the nursing team. The main results found were classified in extrinsic factors which contribute and make it difficult to reduce IRAS. Conclusion: the infections related to health care, which affected the newborn babies in Neonatal Units, can be prevented and controlled through simple strategies related to administrative, caring and educational measures

Objetivo: Realizar una búsqueda sistemática en la literatura sobre cuidados de enfermería en el desarrollo de estrategias para la prevención y el control de infecciones relacionadas con la salud en unidades neonatales. Métodos: Esta es una revisión sistemática de la literatura, que siguió los procedimientos metodológicos descritos en la literatura, que utiliza una metodología sistemática y explícita para identificar, seleccionar y evaluar críticamente la investigación publicada sobre el tema, desde 2008 hasta 2018, en los idiomas portugués e inglés. Resultados: La muestra de revisión final consistió en 07 artículos. Los principales resultados encontrados se clasificaron en factores extrínsecos que contribuyen y dificultan la reducción de las infecciones relacionadas con la atención médica. Conclusión: Las infecciones relacionadas con la atención médica que afectan a los recién nacidos en las unidades neonatales se pueden prevenir y controlar mediante estrategias simples relacionadas con medidas administrativas, de atención y educativas