A National Survey of Neonatologists' Perspectives on Probiotics Use in Neonatal Intensive Care Units in the U.S.A.

Introduction: Most recent clinical reports from the American Academy of Pediatrics (AAP) concluded current evidence does not support routine universal administration of probiotics to preterm infants, particularly those with birth weight <1000 grams. Despite this, the use of probiotics is increasing in US neonatal intensive care units (NICU).Objectives: Collaborating with the Perinatal Neonatal Medicine of AAP, we conducted a national survey to obtain neonatologist opinion on probiotics use.Methods: Survey questionnaires were sent to 3000 neonatologists via email.Results: Of 3000 potential respondents, 249 (8.3 %) completed the survey. Seventy-five (30%) neonatologists working in 23 different NICUs reported using probiotics in their practice, while 168 (70%) neonatologists working in 54 different NICUs reported not using probiotics. Of those not currently use probiotics, 49% indicated they would consider using probiotics in the future vs. 12% indicating they would not use probiotics. The most common indication for probiotics use was average gestational age < 32 weeks and mean birth weight < 1500 grams. Probiotics were discontinued at mean gestational age of 35 weeks. Respondents who prescribe probiotics were more likely to work in a setting without fellowship or residency training (48% vs 20%). Probiotics users were more often from the West (29 % vs 7%) and less often from Northeast (5% vs 34%) compared to non-users. The proportion of those using probiotics did not significantly differ by NICU size, NICU level, or years working in a NICU. Similac Tri-Blend, Evivo, and Culturelle were the top three probiotics used in the respondent's NICU.Conclusion: Though a majority of respondents are not currently using probiotics in their NICU, a large number of nonusers are interested in using probiotics in the future. Differences continue to exist in the brand of probiotics used in US NICUs.

Factors Affecting the Implementation and Acceptance of the Cocoon Strategy in the NICU in a Tertiary Center in Türkiye.

Pertussis is an important cause of mortality and morbidity in infancy. It is recommended that close contacts of the baby be vaccinated with Tdap, and this practice is called the cocoon strategy. This study aimed to investigate the applicability of the cocoon strategy and to determine the factors affecting the process. Mothers of babies who were hospitalized in the neonatal intensive care unit were included in the study. In the first stage, a face-to-face questionnaire was given to the mothers to measure their level of knowledge about whooping cough and its vaccine. In the second stage, written and verbal information about the cocoon strategy was given, and then vaccination intentions for Tdap were learned. In the third stage, all mothers were contacted 3 weeks after and asked whether they had received a Tdap vaccination and why. Of these mothers, 68% could not answer any questions about pertussis disease and vaccines correctly. After the information, 35% (n = 78) of the mothers stated that they were considering getting vaccinated, while only 2% (n = 5) of the mothers were able to get the Tdap vaccine. The most important reasons for not getting vaccinated were a lack of time (24%) and the cost of vaccination (23%). It is predicted that Tdap vaccination rates may increase if the cost of vaccine, availability of vaccine, and the access of mothers to the vaccine application are facilitated.

Facilitators and constraints to family integrated care in low-resource settings informed the adaptation in Uganda.

AIM: Family Integrated Care (FICare) was developed in high-income countries and has not been tested in resource-poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda. METHODS: Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints. RESULTS: Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task-shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer-to-peer support to other mothers. CONCLUSION: Uganda FICare shares the core values of FICare but was adapted to be feasible in low-resource settings.

Acompañar una doble hospitalización en pandemia: la experiencia de padres con bebés hospitalizados mientras las madres se encuentran hospitalizadas por COVID-19 / Supporting a double hospitalization during the pandemic: The experience of fathers whose infants were hospitalized while their mothers were also hospitalized due to COVID-19

Introducción. La hospitalización de un hijo en la unidad de pacientes críticos neonatal puede ser altamente estresante para padres y madres, lo cual se intensificó en el contexto de la pandemia por COVID-19. A la fecha, no se han encontrado estudios que describan la experiencia de padres que vivieron la doble hospitalización simultánea de su pareja y de su hijo/a al nacer, durante la pandemia por COVID-19. Objetivos. Explorar la vivencia de los padres de tener a sus hijos/as hospitalizados en Neonatología mientras su pareja se encontraba hospitalizada por agravamiento de COVID-19. Población y método. Cuatro entrevistas semiestructuradas fueron realizadas y analizadas mediante un análisis interpretativo fenomenológico. Resultados. Se identificaron cuatro momentos cuando surgieron emociones específicas: a) inicio del contagio, b) hospitalización de la pareja, c) nacimiento del bebé y d) hospitalización del bebé. Culpa, miedo, angustia de muerte, soledad e incertidumbre aparecen muy tempranamente y luego se combinan con emociones como felicidad y empoderamiento, entre otras. La falta de contacto físico con sus parejas e hijos, y las fallas en la comunicación con los equipos de salud se destacan como factores que obstaculizan el ejercicio del rol paternal, mientras que una comunicación fluida con el equipo y una participación activa en los cuidados del bebé son factores protectores. Los padres cumplen una multiplicidad de roles, en la que prima el rol protector. Conclusiones. La comunicación y la atención centrada en la familia, y la participación activa en los cuidados de los bebés tienen el potencial de proteger contra el impacto de esta experiencia compleja de doble hospitalización.

Introduction. The hospitalization of a baby in the neonatal intensive care unit may be highly stressful for both mothers and fathers, and this was even more intense in the context of the COVID-19 pandemic.To date, no studies have been found that describe the experience of fathers who underwent the simultaneous hospitalization of their partner and newborn infant during the COVID-19 pandemic. Objectives. To explore the experience of fathers who had their babies hospitalized in the Neonatal Unit while their partner were hospitalized due to worsening of COVID-19. Population and method. Four semi-structured interviews were conducted and analyzed using an interpretative phenomenological analysis. Results. Four moments were identified when specific emotions arose: a) onset of infection, b) partner hospitalization, c) baby birth, and d) baby hospitalization. Guilt, fear, death anxiety, loneliness, and uncertainty appear very early and are later combined with emotions such as happiness and empowerment, among others. The lack of physical contact with their partners and babies and failures in communication with the health care team stand out as factors that hinder the exercise of the paternal role, while an effective communication with the health care team and active participation in the baby's care are protective factors. Fathers fulfill multiple roles, the most important of which is their role as protectors. Conclusions. Family-centered communication and care and active involvement in baby care may potentially protect against the impact of this complex experience of double hospitalization.

Parents' experiences of palliative care decision-making in neonatal intensive care units: An interpretative phenomenological analysis.

AIM: This work explores the experiences and meaning attributed by parents who underwent the decision-making process of withholding and/or withdrawing life-sustaining treatment for their newborn. METHODS: Audio-recorded face-to-face interviews were led and analysed using interpretative phenomenological analysis. Eight families (seven mothers and five fathers) whose baby underwent withholding and/or withdrawing of life-sustaining treatment in three neonatal intensive care units from two regions in France were included. RESULTS: The findings reveal two paradoxes within the meaning-making process of parents: role ambivalence and choice ambiguity. We contend that these paradoxes, along with the need to mitigate uncertainty, form protective psychological mechanisms that enable parents to cope with the decision, maintain their parental identity and prevent decisional regret. CONCLUSION: Role ambivalence and choice ambiguity should be considered when shared decision-making in the neonatal intensive care unit. Recognising and addressing these paradoxical beliefs is essential for informing parent support practices and professional recommendations, as well as add to ethical discussions pertaining to parental autonomy and physicians' rapport to uncertainty.

Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study.

BACKGROUND: Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana. AIM: To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers. DESIGN: The study employed a descriptive qualitative design. METHODS: The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist. RESULTS: Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes. CONCLUSION: The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice. RELEVANCE TO CLINICAL PRACTICE: Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.

Supporting a double hospitalization during the pandemic: The experience of fathers whose infants were hospitalized while their mothers were also hospitalized due to COVID-19. / Acompañar una doble hospitalización en pandemia: la experiencia de padres con bebés hospitalizados mientras las madres se encuentran hospitalizadas por COVID-19.

Introduction. The hospitalization of a baby in the neonatal intensive care unit may be highly stressful for both mothers and fathers, and this was even more intense in the context of the COVID-19 pandemic. To date, no studies have been found that describe the experience of fathers who underwent the simultaneous hospitalization of their partner and newborn infant during the COVID-19 pandemic. Objectives. To explore the experience of fathers who had their babies hospitalized in the Neonatal Unit while their partner were hospitalized due to worsening of COVID-19. Population and method. Four semi-structured interviews were conducted and analyzed using an interpretative phenomenological analysis. Results. Four moments were identified when specific emotions arose: a) onset of infection, b) partner hospitalization, c) baby birth, and d) baby hospitalization. Guilt, fear, death anxiety, loneliness, and uncertainty appear very early and are later combined with emotions such as happiness and empowerment, among others. The lack of physical contact with their partners and babies and failures in communication with the health care team stand out as factors that hinder the exercise of the paternal role, while an effective communication with the health care team and active participation in the baby's care are protective factors. Fathers fulfill multiple roles, the most important of which is their role as protectors. Conclusions. Family-centered communication and care and active involvement in baby care may potentially protect against the impact of this complex experience of double hospitalization.

Introducción. La hospitalización de un hijo en la unidad de pacientes críticos neonatal puede ser altamente estresante para padres y madres, lo cual se intensificó en el contexto de la pandemia por COVID-19. A la fecha, no se han encontrado estudios que describan la experiencia de padres que vivieron la doble hospitalización simultánea de su pareja y de su hijo/a al nacer, durante la pandemia por COVID-19. Objetivos. Explorar la vivencia de los padres de tener a sus hijos/as hospitalizados en Neonatología mientras su pareja se encontraba hospitalizada por agravamiento de COVID-19. Población y método. Cuatro entrevistas semiestructuradas fueron realizadas y analizadas mediante un análisis interpretativo fenomenológico. Resultados. Se identificaron cuatro momentos cuando surgieron emociones específicas: a) inicio del contagio, b) hospitalización de la pareja, c) nacimiento del bebé y d) hospitalización del bebé. Culpa, miedo, angustia de muerte, soledad e incertidumbre aparecen muy tempranamente y luego se combinan con emociones como felicidad y empoderamiento, entre otras. La falta de contacto físico con sus parejas e hijos, y las fallas en la comunicación con los equipos de salud se destacan como factores que obstaculizan el ejercicio del rol paternal, mientras que una comunicación fluida con el equipo y una participación activa en los cuidados del bebé son factores protectores. Los padres cumplen una multiplicidad de roles, en la que prima el rol protector. Conclusiones. La comunicación y la atención centrada en la familia, y la participación activa en los cuidados de los bebés tienen el potencial de proteger contra el impacto de esta experiencia compleja de doble hospitalización.

Early-onset neonatal sepsis as a risk factor for peri-intraventricular hemorrhage in premature infants / Sepse precoce como fator de risco para hemorragia peri-intraventricular em prematuros

ABSTRACT Objective: To assess early-onset sepsis as a risk factor of peri-intraventricular hemorrhage in premature infants born at less than or equal to 34 weeks' gestation and admitted to a neonatal intensive care unit (NICU). Methods: This retrospective cohort study included premature patients born at less than or equal to 34 weeks' gestation who were admitted to the NICU of a tertiary hospital in southern Brazil, and born from January 2017 to July 2021. Data were collected from patients' medical records. Early-onset sepsis was measured according to the presence or absence of diagnosis within the first 72 hours of life, whereas the outcome, peri-intraventricular hemorrhage, was described as the presence or absence of hemorrhage, regardless of its grade. Results: Hazard ratios were calculated using Cox regression models. A total of 487 patients were included in the study, of which 169 (34.7%) had some degree of peri-intraventricular hemorrhage. Early-onset sepsis was present in 41.6% of the cases of peri-intraventricular hemorrhage, which revealed a significant association between these variables, with increased risk of the outcome in the presence of sepsis. In the final multivariate model, the hazard ratio for early-onset sepsis was 1.52 (95% confidence interval 1.01-2.27). Conclusion: Early-onset sepsis and the use of surfactants showed to increase the occurrence of the outcome in premature children born at less than or equal to 34 weeks' gestation. Meanwhile, factors such as antenatal corticosteroids and gestational age closer to 34 weeks' gestations were found to reduce the risk of peri-intraventricular hemorrhage.

RESUMO Objetivo: O objetivo do presente trabalho foi avaliar a sepse precoce como fator de risco para hemorragia peri-intraventricular (HPIV) em prematuros com 34 semanas ou menos, admitidos em Unidade de Terapia Intensiva (UTI) Neonatal. Métodos: Este estudo de coorte retrospectivo incluiu pacientes prematuros com 34 semanas ou menos, que receberam alta da UTI Neonatal de hospital terciário, no sul do Brasil, nascidos no período de janeiro de 2017 a julho de 2021. Os dados foram coletados por meio dos prontuários desses pacientes. A sepse precoce foi mensurada conforme a presença ou a ausência do diagnóstico nas primeiras 72 horas de vida. Já o desfecho, hemorragia peri-intraventricular, foi descrito conforme a presença ou ausência da hemorragia, independentemente do grau. Resultados: Hazard ratios (HR) foram calculados por meio de modelos de regressão de Cox. Foram incluídos no estudo 487 pacientes. Destes, 169 (34,7%) apresentaram algum grau de hemorragia peri-intraventricular. A sepse precoce esteve presente em 41,6% dos casos de hemorragia peri-intraventricular e apresentou associação significativa, elevando o risco do desfecho quando presente. No modelo multivariável final, o HR para a sepse precoce foi de 1,52 (intervalo de confiança de 95% — IC95% 1,01-2,27). Conclusão: Sepse precoce e uso de surfactante demonstraram aumentar a ocorrência do desfecho em crianças prematuras até 34 semanas, enquanto fatores como corticoide antenatal e idades gestacionais mais próximas a 34 semanas mostraram reduzir o risco de ocorrência hemorragia peri-intraventricular.

Nurses' perception of medication administration errors and factors associated with their reporting in the neonatal intensive care unit.

Medication administration is a complex process, and nurses play a central role in this process. Errors during administration are associated with severe patient harm and significant economic burden. However, the prevalence of under-reporting makes it challenging when analysing the current landscape of medication administration error (MAE) and hinders the implementation of improvements to the existing system. The aim of this study is to describe the reasons for the occurrence of MAEs and the reasons behind the under-reporting of MAEs, to determine the estimated percentage of MAE reporting and to identify factors associated with them from the nurses' perspective. This cross-sectional study was conducted using a validated self-administered questionnaire. The questionnaire contained 65 questions which were divided into three sections: (i) reasons for the occurrence of MAEs, which consisted of 29 items; (ii) reasons for not reporting MAEs, which consisted of 16 items; and (iii) percentage of MAEs actually reported, which consisted of 20 items. It was distributed to 143 nurses in the neonatal intensive care units of five public hospitals in Malaysia. Multivariable logistic regression was used to identify the factors associated with MAE reporting. The estimated percentage of MAE reporting was 30.6%. The most common reasons for MAEs were inadequate nursing staff (5.14 [SD 1.25]), followed by drugs which look alike (4.65 [SD 1.06]) and similar drug packaging (4.41 [SD 1.18]). The most common reasons for not reporting MAEs were that nursing administration focuses on the individual rather than looking at the systems as a potential cause of the error (4.56 [SD 1.32]) and that too much emphasis is placed on MAEs as a measure of the quality of nursing care (4.31 [SD 1.23]). Factors statistically significant with MAE reporting were administration response (adjusted odds ratio [AOR] = 6.90; 95% confidence interval (CI) = 2.01-23.67; P = 0.002), reporting effort (AOR = 3.67; 95% CI = 1.68-8.01; P = 0.001), and nurses with advanced diploma (AOR = 0.29; 95% CI = 0.13-0.65; P = 0.003). Our findings show that under-reporting of MAEs is still common and less than a third of the respondents reported MAEs. Therefore, to encourage error reporting, emphasis should be placed on the benefits of reporting, adopting a non-punitive approach, and creating a blame-free culture.

A nomogram for predicting death for infants born at a gestational age of <28 weeks: a population-based analysis in 18 neonatal intensive care units in northern China.

Background: In China, the number of preterm infants is the second largest globally. Compared with those in developed countries, the mortality rate and proportion of treatment abandonment for extremely preterm infants (EPIs) are higher in China. It would be valuable to conduct a multicenter study and develop predictive models for the mortality risk. This study aimed to identify a predictive model among EPIs who received complete care in northern China in recent years. Methods: This study included EPIs admitted to eighteen neonatal intensive care units (NICUs) within 72 hours of birth for receiving complete care in northern China between January 1, 2015, and December 31, 2018. Infants were randomly assigned into a training dataset and validation dataset with a ratio of 7:3. Univariate Cox regression analysis and multiple regression analysis were used to select the predictive factors and to construct the best-fitting model for predicting in-hospital mortality. A nomogram was plotted and the discrimination ability was tested by an area under the receiver operating characteristic curve (AUROC). The calibration ability was tested by a calibration curve along with the Hosmer-Lemeshow (HL) test. In addition, the clinical effectiveness was examined by decision curve analysis (DCA). Results: A total of 568 EPIs were included and divided into the training dataset and validation dataset. Seven variables [birth weight (BW), being inborn, chest compression in the delivery room (DR), severe respiratory distress syndrome, pulmonary hemorrhage, invasive mechanical ventilation, and shock] were selected to establish a predictive nomogram. The AUROC values for the training and validation datasets were 0.863 [95% confidence interval (CI): 0.813-0.914] and 0.886 (95% CI: 0.827-0.945), respectively. The calibration plots and HL test indicated satisfactory accuracy. The DCA demonstrated that positive net benefits were shown when the threshold was >0.6. Conclusions: A nomogram based on seven risk factors is developed in this study and might help clinicians identify EPIs with risk of poor prognoses early.

Modifications in family centered developmental care and in neonatal intensive care during the COVID-19 pandemic in a hospital in Spain: A qualitative study.

INTRODUCTION: Family centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC. OBJECTIVES: To understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19. METHODS: A qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses' narratives and discourses. RESULTS: Three open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1) changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2) changes in interpersonal relationships in the context of a pandemic, and 3) transition to normality. CONCLUSIONS: The nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

The association between plasma osmolality and in-hospital mortality in the first 24†h after neonatal intensive care unit admission.

Background: Perturbation of osmolality is associated with increased mortality in adults and children in critically ill conditions. However, it is still unclear whether osmolality imbalance impacts the prognosis of critically ill infants. This study aimed to investigate the relationship between plasma osmolality and prognosis in critically ill infants within 24 h of admission. Methods: This retrospective study enrolled 1,042 infants who had plasma osmolality data from 2010 to 2018. The initial plasma osmolality (within 24 h after admission) was extracted from the pediatric intensive care database (PIC V1.1). The locally weighted scatter-plot smoothing (LOWESS) and restricted cubic splines (RCS) methods were used to explore the approximate relationship between plasma osmolality and in-hospital mortality. Univariate and multivariate logistic regression analyses were used to further analyse this relationship. Kaplan-Meier analysis was applied to estimate the probability of hospital mortality within 90 days of admission. Subgroup analysis was employed to assess the impact of potential confounders (including postnatal days, gender, and gestational age). Results: An approximately"U"-shaped relationship between plasma osmolality and mortality was detected. In the logistic regression model, plasma osmolality <270 mmol/L (low osmolality group) was significantly associated with in-hospital mortality (P < 0.05; OR 2.52; 95% CI, 1.15-5.06). Plasma osmolality >300 mmol/L (high osmolality group) was also significantly associated with mortality (P < 0.05; OR 3.52; 95% CI, 1.16-8.83). This association remained even after multivariable adjustments. The 90-day survival rate was lower in the abnormal plasma osmolality group (including high or low osmolality groups) than in the intermediate group (log-rank test, P < 0.05). The abnormal plasma osmolality group had a significantly higher incidence of all-cause mortality in the 0-7 postnatal days subgroup (high osmolality group, P < 0.05; OR 5.25; low osmolality group, P < 0.05; OR 3.01). Infants with abnormal osmolality had a significantly higher mortality rate in the female group (P < 0.05). High osmolality was associated with a higher mortality rate in the preterm group (P < 0.05). Conclusions: Both hypoosmolality and hyperosmolality were shown to be independently associated with increased risk of in-hospital infant mortality in NICUs.

Video-Based versus On-Site Neonatal Pain Assessment in Neonatal Intensive Care Units: The Impact of Video-Based Neonatal Pain Assessment in Real-World Scenario on Pain Diagnosis and Its Artificial Intelligence Application.

BACKGROUND: Neonatal pain assessment (NPA) represents a huge global problem of essential importance, as a timely and accurate assessment of neonatal pain is indispensable for implementing pain management. PURPOSE: To investigate the consistency of pain scores derived through video-based NPA (VB-NPA) and on-site NPA (OS-NPA), providing the scientific foundation and feasibility of adopting VB-NPA results in a real-world scenario as the gold standard for neonatal pain in clinical studies and labels for artificial intelligence (AI)-based NPA (AI-NPA) applications. SETTING: A total of 598 neonates were recruited from a pediatric hospital in China. METHODS: This observational study recorded 598 neonates who underwent one of 10 painful procedures, including arterial blood sampling, heel blood sampling, fingertip blood sampling, intravenous injection, subcutaneous injection, peripheral intravenous cannulation, nasopharyngeal suctioning, retention enema, adhesive removal, and wound dressing. Two experienced nurses performed OS-NPA and VB-NPA at a 10-day interval through double-blind scoring using the Neonatal Infant Pain Scale to evaluate the pain level of the neonates. Intra-rater and inter-rater reliability were calculated and analyzed, and a paired samples t-test was used to explore the bias and consistency of the assessors' pain scores derived through OS-NPA and VB-NPA. The impact of different label sources was evaluated using three state-of-the-art AI methods trained with labels given by OS-NPA and VB-NPA, respectively. RESULTS: The intra-rater reliability of the same assessor was 0.976-0.983 across different times, as measured by the intraclass correlation coefficient. The inter-rater reliability was 0.983 for single measures and 0.992 for average measures. No significant differences were observed between the OS-NPA scores and the assessment of an independent VB-NPA assessor. The different label sources only caused a limited accuracy loss of 0.022-0.044 for the three AI methods. CONCLUSION: VB-NPA in a real-world scenario is an effective way to assess neonatal pain due to its high intra-rater and inter-rater reliability compared to OS-NPA and could be used for the labeling of large-scale NPA video databases for clinical studies and AI training.

Psychometric evaluation of the Persian version of the Hospital Survey on Patient Safety Culture Questionnaire (HSOPSC) in neonatal intensive care units: a methodological study.

BACKGROUND: A valid and reliable tool compatible with the culture is needed to evaluate the safety culture as one of the vital and promotional components in improving the quality of safety and health care. This study aimed to investigate the psychometric properties of the Persian version of the "Hospital Survey on Patient Safety Culture (HSOPSC)" in physicians and nurses working in Neonatal Intensive Care Units. METHODS: In this methodological research, the qualitative face, content validity, and construct validity were performed by Confirmatory Factor Analysis to the psychometric evaluation of the HSOPSC questionnaire. Based on convenience sampling and the inclusion criteria, 360 individuals completed the questionnaire. Internal consistency and stability were measured. Data analysis was performed using SPSS 21 and LISREL. RESULTS: In examining the construct validity, fit indices were not appropriate for the 12-dimension model of the Persian version. According to T-value, six heterogeneous items and a dimension were omitted. The 11-dimension model with 36 items showed an appropriate fit with the data. Cronbach's alpha was evaluated at 0.79, and the stability was 0.82 (p˂0.001). CONCLUSION: The Persian version of HSOPSC with 11 dimensions and 36 items has favorable validity and reliability and can be used in NICUs.

Parents' experiences with interprofessional collaboration in neonatal pain management: A descriptive qualitative study.

AIM: To describe parents' experiences with interprofessional collaboration (IPC) in neonatal pain management. BACKGROUND: Neonatal care should be based on IPC, and non-pharmacological pain-relieving methods are recommended to be used primarily that enables parental participation. However, there is a lack of knowledge about pain management on IPC from the parent's viewpoint. DESIGN: A descriptive qualitative study. METHOD: The research involved a purposive sample of parents (n = 16) whose infant had been treated at a neonatal intensive care unit in Finland. Interviews were conducted with participants from all over Finland who were recruited through the national association for premature infants. Parents discussed their experiences during semi-structured interviews which were guided by the subareas of IPC, partnership, cooperation and coordination. The data were analysed using deductive-inductive content analysis. The reporting of results followed COREQ guidelines. RESULTS: Based on the parent's experiences the partnership involved themes of understanding the neonatal pain management context, being able to influence the pain management, and feeling valued. Cooperation included themes of identifying different roles and equality. Coordination was described through the sharing of knowledge, skills and expertise, as well as feeling supported by professionals. CONCLUSION: Parental involvement on IPC should be developed through interventions that involve training around pain assessment and non-pharmacological pain-relief methods. RELEVANCE FOR CLINICAL PRACTICE: Professionals involved in neonatal care should act in a goal-oriented and unified manner to promote a culture of care that allows for active parental participation. NO PATIENT OR PUBLIC CONTRIBUTION: The research has been carried out in accordance with good scientific practice. Only the research team has been involved in the design, conduct, analysis and drafting of the manuscript.

Using adenosine triphosphate bioluminescence level monitoring to identify bacterial reservoirs during two consecutive Enterococcus faecium and Staphylococcus capitis nosocomial infection outbreaks at a neonatal intensive care unit.

INTRODUCTION: This study aimed to assess the role of adenosine triphosphate (ATP) bioluminescence level monitoring for identifying reservoirs of the outbreak pathogen during two consecutive outbreaks caused by Enterococcus faecium and Staphylococcus capitis at a neonatal intensive care unit (NICU). The secondary aim was to evaluate the long-term sustainability of the infection control measures employed one year after the final intervention measures. METHODS: Two outbreaks occurred during a 53-day period in two disconnected subunits, A and B, that share the same attending physicians. ATP bioluminescence level monitoring, environmental cultures, and hand cultures from healthcare workers (HCW) in the NICU were performed. Pulsed-field gel electrophoresis (PFGE) typing was carried out to investigate the phylogenetic relatedness of the isolated strains. RESULTS: Four cases of E. faecium sepsis (patients A-8, A-7, A-9, B-8) and three cases of S. capitis sepsis (patients A-16, A-2, B-8) were diagnosed in six preterm infants over a span of 53 days. ATP levels remained high on keyboard 1 of the main station (2076 relative light unit [RLU]/100 cm2) and the keyboard of bed A-9 (4886 RLU/100 cm2). By guidance with the ATP results, environmental cultures showed that E. faecium isolated from the patients and from the main station's keyboard 1 were genotypically indistinguishable. Two different S. capitis strains caused sepsis in three patients. A total 77.8% (n = 7/9) of S. capitis cultured from HCW's hands were genotypically indistinguishable to the strains isolated from A-2 and A-16. The remaining 22.2% (n = 2/9) were genotypically indistinguishable to patient B-8. Three interventions to decrease the risk of bacterial transmission were applied, with the final intervention including a switch of all keyboards and mice in NICU-A and B to disinfectable ones. Post-intervention prospective monitoring up to one year showed a decrease in blood culture positivity (P = 0.0019) and catheter-related blood stream infection rate (P = 0.016) before and after intervention. CONCLUSION: ATP monitoring is an effective tool in identifying difficult to disinfect areas in NICUs. Non-medical devices may serve as reservoirs of pathogens causing nosocomial outbreaks, and HCWs' hands contribute to bacterial transmission in NICUs.

Epidemiology of nosocomial Staphylococcus epidermidis and Acinetobacter baumannii infections in a neonatal intensive care unit.

Background and Objectives: This study aimed to investigate epidemiology of Staphylococcus epidermidis (S. epidermidis) and Acinetobacter baumannii (A. baumannii) infections in neonatal intensive care unit (NICU) in a period of 8 years. Materials and Methods: This retrospective cohort study was conducted on 46 cases of nosocomial infection by S. epidermidis, and 44 neonates with A. baumannii in NICU of Valiasr hospital, Iran. Results: The trend of A. baumannii and S. epidermidis infection were as follows: 1 and 7 in 2014, 11 and 7 in 2015, 20 and 11 in 2016, 1 and 4 in 2017, 4 and 6 in 2018, 4 and 4 in 2019, 0 and 1 in 2020, and 3 and 6 in 2021-March 2022 respectively. Mortality proportion (%) in neonates with S. epidermidis and A. baumannii infection was at 8.3 and 32.1, respectively. There was a strong positive correlation between number of infected neonates in month and average of prescribed antibiotics before incidence of infection in every baby in that month. Fluconazole prescription before incidence of infection were associated with the A. baumannii infection in month too. Amikacin prescription had adjusted correlation on increasing of A. baumannii and S. epidermidis infection in month. Conclusion: It seems reducing of hospitalization duration and medication prescriptions management plays an important role in reducing of nosocomial infections.

Effect of additional dead space using end-tidal CO2 measurement on ventilating preterm infants: An experimental study.

BACKGROUND: Dead space is the part of the airway where no gas exchange takes place. Any increase in dead space volume has a proportional effect on the required tidal volume and thus on the risk of ventilation-induced lung injury. Inserts that increase dead space are therefore not used in small preterm infants. This includes end-tidal CO2 measurement. OBJECTIVE: The aim of this study was to investigate the effect of the end-tidal CO2 measurement adapter on ventilation. METHODS: In an experimental setup, an end-tidal CO2 measurement adapter, three different pneumotachographs (PNT-A, PNT-B, PNT-Neo), and a closed suction adapter were combined in varying set-ups. The time required for CO2 elimination by a CO2-flooded preterm infant test lung was measured. RESULTS: PNT-A prolonged CO2 elimination time by 0.9 s (+3.3%), Neo-PNT by 3.2 s (+11.6%) and PNT-B by 9.0 s (+32.7%). The end-tidal CO2 measurement adapter prolonged the elimination time by an additional second without the pneumotachograph (+3.6%) and in combination with PNT-A (+3.1%) and PNT-Neo (+3.1%). In conjunction with PNT-B, the end-tidal CO2 measurement adapter reduced the elimination time by 0.3 seconds (-1%). The use of a closed suction adaptor increased the CO2 elimination time by a further second with PNT-Neo (+3.1%) and by an additional two seconds with no flow sensor (+6.9%), with PNT-A (+6.4%) and with PNT-B (+5.5%). CONCLUSION: The flow sensor had the greatest influence on ventilatory effort, while end-tidal CO2 measurement had only a moderate effect. The increased ventilatory effort levied by the CO2 measurement was dependent on the flow sensor selected. The use of closed suctioning more negatively impacted ventilatory effort than did end-tidal CO2 measurement.

Impact of Technology on Neonatal Intensive Care Unit Admissions and Length of Stay: A Retrospective Study.

Background Neonatal intensive care units (NICU) provide essential medical care to neonates; however, they are associated with hospital-acquired infections, less maternal-newborn bonding, and high costs. Implementing strategies to lower NICU admission rates and shorten NICU length of stay (LOS) is essential. This study uses causal-inference methods to evaluate the impact of care managers using new technology to identify and risk stratify pregnancies on NICU admissions and NICU LOS. The NICU LOS will decrease as a result of the use of new technology by care managers. Study design This retrospective study utilized delivery claims data of pregnant women from the CareFirst BlueCross BlueShield Community Health Plan District of Columbia from 2013 to 2022, which includes the pre-intervention period before the use of new technology by care managers and the post-intervention period with the use of new technology by care managers. Our sample had 4,917 deliveries whose maternal comorbidities were matched with their neonate's outcomes. Methods To evaluate the impact of the technological intervention, both Generalized Linear Models (GLMs) and Bayesian Structural Time-Series (BSTS) models were used. Results Our findings from the GLM models suggest an overall average reduction in the odds of NICU admissions of 29.2% and an average decrease in NICU LOS from 7.5%-58.5%. Using BSTS models, we estimate counterfactuals for NICU admissions and NICU LOS, which suggest an average reduction in 48 NICU admissions and 528 NICU days per year. Conclusion Equipping care managers with better technological tools can lead to significant improvements in neonatal health outcomes as indicated by a reduction in NICU admissions and NICU LOS.

The effect of patient volume on mortality and morbidity of extremely low birth weight infants in Taiwan.

BACKGROUND: To assess whether the number of extremely low birth weight (ELBW) infants treated annually in neonatal intensive care units (NICUs) in Taiwan affects the mortality and morbidity of this patient population. METHODS: This retrospective cohort study included preterm infants with ELBW (≤1000 g). NICUs were divided into three subgroups according to the annual admissions of ELBW infants (low, ≤10; medium, 11-25; and high, >25). Perinatal characteristics, mortality, and short-term morbidities were compared between groups. RESULTS: A total of 1945 ELBW infants from 17 NICUs were analyzed (low-volume, n = 263; medium-volume, n = 420; and high-volume, n = 1262). After risk adjustments, infants from NICUs with low patient volumes were at a higher risk of death. The risk-adjusted odds ratios (aOR) for mortality were 0.61 (95% CI, 0.43-0.86) in the high-volume NICUs and 0.65 (95% CI, 0.43-0.98) in medium-volume NICUs, compared with infants admitted to low-volume NICUs. Infants in medium-volume NICUs had the lowest incidence of prenatal steroid exposure (58.1%, P < 0.001) and were associated with the highest risk of necrotizing enterocolitis (aOR, 2.35 [95% CI, 1.48-3.72]), severe intraventricular hemorrhage (aOR, 1.55 [95% CI, 1.01-2.28]), and bronchopulmonary dysplasia (aOR, 1.61 [95% CI, 1.10-2.35]). However, survival without major morbidity did not differ between the groups. CONCLUSION: The mortality risk was higher among ELBW infants admitted to NICUs with a low annual patient volume. This may emphasize the importance of systematically referring patients from these vulnerable populations to appropriate care settings.