Interface leakage during neonatal CPAP treatment: a randomised, cross-over trial.

OBJECTIVE: To determine leakage for two neonatal continuous positive airway pressure (CPAP) interfaces and evaluate leak-corrective manoeuvres. DESIGN: The ToNIL (Trial of NCPAP Interface Leakage) study was a randomised, clinical, cross-over trial with data collection between August 2018 and October 2019. The primary outcome was blinded to the treating staff. SETTING: One secondary, 8-bed neonatal intensive care unit (NICU) and three larger (>15 beds), academic NICU referral centres. PATIENTS: Newborn infants with CPAP were screened (n=73), and those with stable spontaneous breathing, low oxygen requirement, postmenstrual age (PMA) over 28 weeks and no comorbidities were eligible. In total, 50 infants were included (median PMA 33 completed weeks). INTERVENTIONS: Leakage was measured for both prongs and nasal mask, before and after leak-corrective manoeuvres. Interface application was performed in a randomised order by a nurse, blinded to the measured leakage. MAIN OUTCOME MEASURES: 30 s average leakage, measured in litres per minute (LPM). RESULTS: Analyses showed a significantly lower leakage (mean difference 0.86 LPM, 95% CI 0.07 to 1.65) with prongs (median 2.01 LPM, IQR 1.00-2.80) than nasal mask (median 2.45 LPM, IQR 0.99-5.11). Leak-corrective manoeuvres reduced leakage significantly for both prongs (median 1.22 LPM, IQR 0.54-1.87) and nasal mask (median 2.35 LPM, IQR 0.76-4.75). CONCLUSIONS: Large leakages were common for both interfaces, less with prongs. Simple care manoeuvres reduced leakage for both interfaces. This is the first report of absolute leakage for nasal interfaces and should encourage further studies on leakage during CPAP treatment.

Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study.

BACKGROUND: The thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed. OBJECTIVE: To compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth. STUDY DESIGN AND SETTING: Multicentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals. PARTICIPANTS: Infants with estimated birth weight <1500 g and/or gestational age <30+6 weeks. INTERVENTION: Thermal management with or without a thermal servo-controlled system during stabilisation in the delivery room. PRIMARY OUTCOME: Proportion of normothermia at NICU admission (axillary temperature 36.5°C-37.5°C). RESULTS: At NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36°C-36.4°C) (risk ratio 1.48, 95% CI 1.09 to 2.01). CONCLUSIONS: In very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge. TRIAL REGISTRATION NUMBER: NCT03844204.

Optimizing the sleep position of infants and embroidered "I sleep on my back" sleeping bags in maternity hospitals.

OBJECTIVE: To evaluate the impact in maternity hospitals of using an embroidered "I sleep on my back" sleeping bag on observing the sleeping recommendations at 1 month after birth. METHOD: This was a multicentere prospective study, exposed/unexposed type, in which mothers answered questionnaires (by telephone and online) 1 month after giving birth. The exposed group consisted of mothers who had given birth in a maternity hospital of the ELENA network in which the embroidered sleeping bag was used as a preventive action; the unexposed group of mothers gave birth in a maternity hospital of the RP2S network, without this specific preventive action. RESULTS: A total of 540 mothers participated in the study: 245 in the exposed group and 295 in the unexposed group. In the exposed group, 87.3% of infants slept exclusively on their back versus 75.9% in the unexposed group (P<0.001); 91% of the mothers reported having actually used the sleeping bag. Except for room-sharing, compliance with the other sleeping recommendations was higher in the exposed group. CONCLUSION: Sleeping practices when infants were 1 month old were not optimal in our study population. A simple preventive initiative in maternity hospitals, using the embroidered "I sleep on my back" sleeping bags, is relevant and effective in improving compliance with the sleeping recommendations for infants at home.

Serious Game e-Baby Família: an educational technology for premature infant care.

OBJECTIVES: to develop and assess the serious game e-Baby Família with parents of premature infants. METHODS: a methodological study regarding the development of the serious game, with participatory design in scope definition, starting from parents' learning needs about premature infant care. A qualitative approach was performed in the assessment stage with parents, with content analysis of the speech of the eight participants. RESULTS: the following categories emerged: Realistic appearance of the virtual setting and game content and Gameplay implications for the use of e-Baby Família. The game was satisfactorily assessed regarding content, appearance and dynamics use, motivating participants to learn. FINAL CONSIDERATIONS: in the context of prematurity as a public health problem in Brazil and the need to strengthen family health education for care, the serious game was assessed as motivating and appropriate for health learning.

Pacifiers: A Cause for Confusion.

Pacifier avoidance is recommended in the newborn nursery to optimize exclusive breast-feeding rates according to the Baby-Friendly Hospital Initiative. There are many reasons why parents may choose to provide a pacifier to their infant, particularly due to the association between pacifier use with sleep and risk reduction for sudden infant death syndrome. Early use of a pacifier does not likely cause direct harm to infants or lead to difficulty breast-feeding. Pediatricians should partner with families to share a clear message in support of establishing exclusive breast-feeding, ideally before introduction of a pacifier. [Pediatr Ann. 2020;49(5):e204-206.].

Evaluation of the Reliability and Validity of the Behavioral Indicators of Infant Pain Scale in Chinese Neonates.

BACKGROUND: Behavioral Indicators of Infant Pain scale (BIIP) has been shown to be a good tool to assess pain in infants. AIMS: This paper aimed to translate BIIP into Chinese and evaluate its reliability and validity for neonates in China. DESIGN: A prospective observational study. SETTING AND PARTICIPANTS: A convenience sample of 396 neonates (preterm and term infants) were recruited from neonatal intensive care units in China from July to October 2016. METHODS: The BIIP was translated and adjusted for semantic adaption.396 neonates were assessed during 3 phases of blood collection from an artery/vein. A video camera was positioned for a close-up view of the face and body. The neonates' pain was rated independently by 2 nurses who were trained and familiar with the Chinese version of BIIP (C-BIIP)and FLACC (Facial expression, Legs, Activity, Crying and Consolability). RESULTS: The internal consistency were 0.904 (preterm) and 0.895 (term). The test-retest reliability were 0.947 (preterm) and 0.938 (term) and the interclass correlation coefficients were 0.921 to 0.959 (preterm) and 0.921 to 0.959 (term). The correlations between the C-BIIP and FLACC were high (preterm: r = 0.948, term: r = 0.896). Using the C-BIIP, the 3 phases of blood collection were found to be statistically different (preterm: F = 635.76, term: F = 675.54; P < 0.001), which showed that the construct validity of C-BIIP was good. CONCLUSION: The BIIP is a reliable and valid tool to assess pain in term and preterm neonates in China.

Impact of an integrated nutrition, health, water sanitation and hygiene, psychosocial care and support intervention package delivered during the pre- and peri-conception period and/or during pregnancy and early childhood on linear growth of infants in the first two years of life, birth outcomes and nutritional status of mothers: study protocol of a factorial, individually randomized controlled trial in India.

BACKGROUND: The period from conception to two years of life denotes a critical window of opportunity for promoting optimal growth and development of children. Poor nutrition and health in women of reproductive age and during pregnancy can negatively impact birth outcomes and subsequent infant survival, health and growth. Studies to improve birth outcomes and to achieve optimal growth and development in young children have usually tested the effect of standalone interventions in pregnancy and/or the postnatal period. It is not clearly known whether evidence-based interventions in the different domains such as health, nutrition, water sanitation and hygiene (WASH) and psychosocial care, when delivered together have a synergistic effect. Further, the effect of delivery of an intervention package in the pre and peri-conception period is not fully understood. This study was conceived with an aim to understand the impact of an integrated intervention package, delivered across the pre and peri-conception period, through pregnancy and till 24 months of child age on birth outcomes, growth and development in children. METHODS: An individually randomized controlled trial with factorial design is being conducted in urban and peri-urban low- to mid-socioeconomic neighbourhoods in South Delhi, India. 13,500 married women aged 18 to 30 years will be enrolled and randomized to receive either the pre and peri-conception intervention package or routine care (first randomization). Interventions will be delivered until women are confirmed to be pregnant or complete 18 months of follow up. Once pregnancy is confirmed, women are randomized again (second randomization) to receive either the intervention package for pregnancy and postnatal period or to routine care. Newborns will be followed up till 24 months of age. The interventions are delivered through different study teams. Outcome data are collected by an independent outcome ascertainment team. DISCUSSION: This study will demonstrate the improvement that can be achieved when key factors known to limit child growth and development are addressed together, throughout the continuum from pre and peri-conception until early childhood. The findings will increase our scientific understanding and provide guidance to nutrition programs in low- and middle-income settings. TRIAL REGISTRATION: Clinical Trial Registry - India #CTRI/2017/06/008908; Registered 23 June 2017, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339&EncHid=&userName=society%20for%20applied%20studies.

Serious Game e-Baby Família: an educational technology for premature infant care / Serious Game e-Baby Família: tecnologia educacional para el cuidado del recién nascido premature / Serious Game e-Baby Família: tecnologia educacional para o cuidado do recém-nascido premature

ABSTRACT Objectives: to develop and assess the serious game e-Baby Família with parents of premature infants. Methods: a methodological study regarding the development of the serious game, with participatory design in scope definition, starting from parents' learning needs about premature infant care. A qualitative approach was performed in the assessment stage with parents, with content analysis of the speech of the eight participants. Results: the following categories emerged: Realistic appearance of the virtual setting and game content and Gameplay implications for the use of e-Baby Família. The game was satisfactorily assessed regarding content, appearance and dynamics use, motivating participants to learn. Final Considerations: in the context of prematurity as a public health problem in Brazil and the need to strengthen family health education for care, the serious game was assessed as motivating and appropriate for health learning.

RESUMEN Objetivos: desarrollar y evaluar el serious game e-Baby Família junto a los familiares de los bebés prematuros. Métodos: estudio metodológico en cuanto al desarrollo del juego, con diseño participativo en la definición del tema, partiendo de las necesidades de aprendizaje de los padres sobre los cuidados con el bebé prematuro. Enfoque cualitativo en la etapa de evaluación junto a los familiares, con análisis de contenido de las hablas de los ocho participantes. Resultados: en la evaluación surgieron las categorías: A. Apariencia realista del escenario virtual y contenido del juego, y B. Implicaciones de la jugabilidad para el uso del e-Baby Familia. El juego fue evaluado satisfactoriamente con relación al contenido, apariencia y dinámica de uso, motivando a los participantes al aprendizaje. Consideraciones Finales: en el contexto de la prematuridad como problema de salud pública en Brasil, y de la necesidad de fortalecimiento de la educación en salud de las familias para el cuidado, el serio juego fue evaluado como motivador y adecuado para el aprendizaje en salud.

RESUMO Objetivos: desenvolver e avaliar o Serious Game e-Baby Família junto aos pais de bebês prematuros. Métodos: estudo metodológico quanto ao desenvolvimento do serious game, com design participativo na definição do escopo, partindo-se das necessidades de aprendizagem dos pais sobre os cuidados com o bebê prematuro. Abordagem qualitativa na etapa de avaliação junto aos pais, com análise de conteúdo das falas dos oito participantes. Resultados: na avaliação, emergiram as categorias: Aparência realística do cenário virtual e conteúdo do jogo e Implicações da jogabilidade para o uso do e-Baby Família. O jogo foi avaliado satisfatoriamente com relação ao conteúdo, aparência e dinâmica de uso, motivando os participantes ao aprendizado. Considerações Finais: no contexto da prematuridade enquanto problema de saúde pública no Brasil e da necessidade de fortalecimento da educação em saúde das famílias para o cuidado, o serious game foi avaliado como motivador e adequado para a aprendizagem em saúde.

Review of the Iranian Newborns' Health, Survival, and Care and Future Challenges.

INTRODUCTION: Providing, maintaining, and improving the health of newborns is one of the most important goals of the health care system in the Islamic Republic of Iran. On the eve of the 40th anniversary of the Islamic Revolution of Iran, we will review factors affecting the health of Iranian neonates over the past 40 years. METHODS: We investigated the evolution of neonatal health and contributing factors in all reports, documents, and articles published by the Iranian Ministry of Health and Medical Education and the former Iranian Ministry of Health as well as WHO, and UNICEF databases from 1970 to 2018. The main topics of the present study include recent developments in reduction of maternal and neonatal mortality, major measures taken to decrease risk of neonatal death, and future challenges. RESULTS: We have reviewed more than 3500 pages of documents and articles published by authoritative sources before and after the Islamic Revolution. A neonatal mortality rate (NMR) of 9.6 per 1000 in 2017 was recordred in Iran, demonstrating a reduction of over three-quarters compared with the pre-Revolution period. Improved prenatal care and nutrition, tetanus vaccination of pregnant mothers, performance of 96.4% of deliveries by trained individuals, circulation of clinical protocols for the integration of midwifery and maternity services, provision of neonatal resuscitation equipment in delivery rooms, promotion of breastfeeding from the first hour after birth onward, establishing and equipping NICUs, increased training of specialists and sub-specialists, prevention and treatment of infections, increasing awareness in families and family-centered neonatal care focused on neonatal brain development, the Newborn Indivisualized Developmental Care and Assessment Program (NIDCAP) and Kangaroo-Mother Care (KMC) are examples of progress made in neonate healthcare after the Islamic Revolution. CONCLUSION: Despite 8 years of war and a variety of sanctions being imposed against I.R. of Iran, very substantial improvements have been achieved in neonatal health and relevant underlying factors. However, we are still faced with challenges that require the engagement of experts and researchers in neonatal medicine.

A novel two-body sensor system to study spontaneous movements in infants during caregiver physical contact.

Spontaneous movements, which refer to repetitive limb movements in the absence of any external stimulus, have been found to be reflective of neurodevelopmental status during infancy. These movements are modulated by both individual and environmental factors, including physical contact (holding) with the caregiver. However, it is a challenge to measure spontaneous movements during physical contact because infant-generated movements become coupled with caregiver-generated movements in such contexts. Here, we propose the use of a novel two-body sensor system to distinguish infant-generated movements in the presence of physical contact with the caregiver. Data from seven typically developing infants and their caregivers were recorded during different simulated home activities, which involved different combinations of physical interaction, caregiver's movement and infant positions. The two-body sensor system consisted of two wearable accelerometers - one placed on the infant's arm and one on the caregiver's arm, and we developed a Kalman-filter based algorithm to isolate the infant-generated movements. In addition, video was recorded for qualitative analysis. Results indicated that spontaneous movement activity was higher when there was no physical contact with caregiver. When there was physical contact, spontaneous movements were increased when the caregiver was still and when the infant was held horizontally. These results show that the novel two-body sensor system and the associated algorithms were able to isolate infant-generated movements during physical contact with the caregiver. This approach holds promise for the automated long-term tracking of spontaneous movements in infants, which may provide critical insight into developmental disorders.

Developing safe devices for neonatal care.

Currently, the majority of medical devices are designed for adults; some are then miniaturized for use in neonates. This process neglects population-specific testing that would ensure that the medical devices used for neonates are actually safe and effective for that group. Incorporating human-centered design principles and utilizing methods to evaluate devices that include simulation and clinical testing can improve the safety of devices used in caring for neonates. However, significant regulatory, financial, social and ethical barriers to development remain. In order to overcome these barriers and create a pipeline of safe and effective neonatal medical devices, specific incentives are required.

Quantifying the Impact of Common Feeding Interventions on Nutritive Sucking Performance Using a Commercially Available Smart Bottle.

An estimated 25% to 40% of infants experience difficulties with learning to breast- or bottle-feed. Yet, guidelines and evidence-based support for common feeding practices are limited. The objective of this case report was to quantify the impact of feeding interventions on nutritive sucking performance after discharge in an outpatient setting. This observational case series involved 2 infants. To determine the impact of cumulative interventions, pre- and postintervention effect sizes were calculated. Sucking performance metrics of interest included nipple movement peak sucking amplitude, duration, frequency, and smoothness. Interventions included positional changes and changes in nipple flow rate, among others. For both infants, cumulative interventions had the greatest impact on suck frequency; postintervention, infants were able to increase their rate of nutritive sucking per burst. Other aspects of sucking performance were differentially impacted for each baby. Researchers agree that neonatal and infant feeding has been understudied and that the evidence for common interventions needs to be strengthened. We have demonstrated the implementation of readily available technology that can be used to quantify the direct impact of any intervention on actual sucking performance. In doing so, we can individualize care to support skill development and improve outcomes for infants at risk for ongoing feeding challenges.

Exploración ecográfica de las caderas del bebé en mochilas de porteo / Evaluation by ultrasound of the hips of babies carried in baby carriers

Antecedentes y objetivo: La displasia de cadera se ha asociado con factores de riesgo como la presentación de nalgas, el sexo femenino o los antecedentes familiares. Sin embargo, factores externos, como los sistemas de porteo, parecen influir en el desarrollo de la cadera en los primeros meses de vida. El objetivo del presente trabajo es valorar por imagen ecográfica la posición de las caderas en bebés colocados en diferentes tipos de mochilas portabebés. Método: Se ha realizado un estudio ecográfico de las caderas de bebés sanos entre 1,5 y 3,5meses de edad, cuando el niño es porteado en tres diferentes mochilas portabebés que proporcionan diferentes grados de sujeción de los muslos del bebé. Todas las caderas eran tipoI de Graf. Se han valorado tres parámetros ecográficos: el ángulo alfa de Graf, la cobertura acetabular y la distancia a pubis en situación basal (mesa de exploración) y en las tres diferentes mochilas de porteo. Resultados: En todos los casos los bebés mostraron valores de normalidad en los tres parámetros estudiados, sin diferencias estadísticamente significativas entre ninguna de las situaciones. Tampoco se encontraron diferencias en los parámetros ecográficos relacionadas con el sexo, la edad o el peso del bebé. Conclusiones: La cadera derecha del bebé mantiene unos parámetros ecográficos de normalidad cuando es colocada en cualquiera de los modelos de mochila estudiados

Background and objective: Hip dysplasia has been associated with risk factors such as breech presentation, female gender or family history. However, external factors, such as the use of baby carriers, seem to influence the development of the hip in the first months of life. The aim of this study is to evaluate the position of the hips of babies placed in different types of baby carriers by ultrasound image. Method: An ultrasound study of the hips of healthy babies between 1.5 and 3.5 months of age was carried out, when the children were carried in three different baby backpacks, which provide different degrees of support for the babies' thighs. All hips were typeI according to the Graf classification. Graf's alpha angle, acetabular coverage and distance to the pubis were assessed at baseline (examination table) and when the children were carried in the three different backpacks. Results: In all cases, the babies showed normal values in the three studied parameters, without statistically significant differences between any of the situations. There were also no differences in the ultrasound parameters related to the sex, age or weight of the baby. Conclusions: The right hip of the babies shows normal ultrasound parameters when placed in any of the baby carriers studied

Maternal Factors Associated With the Healthcare Utilization of Technology-Dependent Infants Following NICU Discharge.

This study examined the relationship of mothers' psychological well-being (depressive symptoms, posttraumatic stress symptoms) and resourcefulness with their technology-dependent infants' healthcare utilization (rehospitalization, emergency department [ED] visits) following discharge from the neonatal intensive care unit (NICU). This descriptive, correlational study was conducted at a large Midwest level 4 NICU in the United States. Mothers (n = 19) with a technology-dependent infant (eg, supplemental oxygen, feeding tubes) to be discharged home from the NICU within 2 to 3 weeks were interviewed face-to-face using standardized instruments. Infant rehospitalization and ED visit data were collected from the electronic medical record (EMR) for the first 3 months following the infant's discharge. Analyses included descriptive statistics and negative binomial regression. A majority of infants (72.2%) required at least 1 hospitalization; 33% required at least one ED visit. Mothers' age and resourcefulness were significant predictors of ED visits while only resourcefulness predicted rehospitalizations. Neither depressive symptoms nor posttraumatic stress symptoms significantly predicted healthcare utilization. Maternal resourcefulness was the only main variable that significantly predicted both ED visits and hospitalizations and one of the few modifiable factors that could assist mothers with successfully coping with the complexity of caring for a technology-dependent infant. Future research should focus on interventions to enhance mothers' resourcefulness prior to their technology-dependent infant's NICU discharge.

Evaluation by ultrasound of the hips of babies carried in baby carriers. / Exploración ecográfica de las caderas del bebé en mochilas de porteo.

BACKGROUND AND OBJECTIVE: Hip dysplasia has been associated with risk factors such as breech presentation, female gender or family history. However, external factors, such as the use of baby carriers, seem to influence the development of the hip in the first months of life. The aim of this study is to evaluate the position of the hips of babies placed in different types of baby carriers by ultrasound image. METHOD: An ultrasound study of the hips of healthy babies between 1.5 and 3.5 months of age was carried out, when the children were carried in three different baby backpacks, which provide different degrees of support for the babies' thighs. All hips were typeI according to the Graf classification. Graf's alpha angle, acetabular coverage and distance to the pubis were assessed at baseline (examination table) and when the children were carried in the three different backpacks. RESULTS: In all cases, the babies showed normal values in the three studied parameters, without statistically significant differences between any of the situations. There were also no differences in the ultrasound parameters related to the sex, age or weight of the baby. CONCLUSIONS: The right hip of the babies shows normal ultrasound parameters when placed in any of the baby carriers studied.

Mothers' Perceptions of the Cardboard Box as a Potential Sleep Space.

OBJECTIVE: Due to increasing popularity, our hospital began considering distributing cardboard boxes combined with safe sleep education to new mothers. As a first step in studying the impact of this intervention on bedsharing in our community, we sought to understand mothers' perceptions of the cardboard box. METHODS: We recruited primarily low-income, English- or Spanish-speaking mothers of infants aged 2 to 16 weeks during routine primary care visits. Participants responding to a cross-sectional survey about infant sleep practices were invited to participate in in-depth interviews about the cardboard box. We used a grounded theory approach and the constant comparative method until saturation was reached. RESULTS: Of 120 participants in the survey, 50 (42%) participated in the qualitative study. Participants were mothers of infants aged ≤4 weeks (46%), 4 to 8 weeks (32%), and 16 weeks (22%). Of 50 participants, 52% said they would use the cardboard box for their infant to sleep in, if provided, compared with 42% who said they would not and 6% were unsure. Three themes emerged from the data: (1) safety of the cardboard box; (2) appearance, and (3) variation in planned use. Some participants planned to place the cardboard box in their bed. CONCLUSIONS: Participants in our study were divided about whether they would use the cardboard box for their infant to sleep in. If distributed, hospital staff should advise families to not place the cardboard box in their bed. Next steps include determining bedsharing frequency among parents who choose to use the cardboard box for their infant.

Newborn self-inflating manual resuscitators: precision robotic testing of safety and reliability.

AIM: A controlled bench test was undertaken to determine the performance variability among a range of neonatal self-inflating bags (SIB) compliant with current International Standards Organisation (ISO). INTRODUCTION: Use of SIB to provide positive pressure ventilation during newborn resuscitation is a common emergency procedure. The United Nations programmes advocate increasing availability of SIB in low-income and middle-income nations and recommend devices compliant with ISO. No systematic study has evaluated variance in different models of neonatal SIB. METHODS: 20 models of SIB were incrementally compressed by an automated robotic device simulating the geometry and force of a human hand across a range of precise distances in a newborn lung model. Significance was calculated using analysis of variance repeated measures to determine the relationship between distance of SIB compression and delivered ventilation. A pass/fail was derived from a composite score comprising: minimum tidal volume; coefficient of variation (across all compression distances); peak pressures generated and functional compression distance. RESULTS: Ten out of the 20 models of SIB failed our testing methodology. Two models could not provide safe minimum tidal volumes (2.5-5 mL); six models exceeded safety inflation pressure limit >45 cm H2O, representing 6% of their inflations; five models had excessive coefficient of variation (>30% averaged across compression distances) and three models did not deliver inflation volumes >2.5 mL until approximately 50% of maximum bag compression distance was reached. The study also found significant intrabatch variability and forward leakage. CONCLUSION: Compliance of SIBs with ISO standards may not guarantee acceptable or safe performance to resuscitate newborn infants.

Mapping, Measuring, and Analyzing the Process of Skin-to-Skin Contact and Early Breastfeeding in the First Hour After Birth.

BACKGROUND: Although the benefits of immediate, continuous, uninterrupted skin-to-skin contact (SSC) and early breastfeeding have been widely researched and confirmed, the challenge remains to improve the consistency of this practice. Fewer than half of newborns worldwide are breastfed in the first hour. DESIGN: Cross-sectional descriptive study utilizing iterative review and analysis of video ethnography as well as data extracted from patient records. SAMPLE AND SETTING: Eighty-four medically uncomplicated mothers and full-term newborns were observed during the first hour after birth at a Baby-Friendly designated hospital in the United States. FINDINGS: Process mapping using an algorithm which included Robson criteria indicated that although included mothers were expected to give birth vaginally and had no medical concerns that would preclude eligibility for SSC in the first hour after birth, 31 of 84 newborns (37%) did not receive immediate SSC after vaginal birth as planned and only 23 (27.4%) self-attached and suckled. CONCLUSION: Process mapping of optimal skin-to-skin practice in the first hour after birth using the algorithm, HCP-S2S-IA, produced an accurate and useful measurement, illuminating how work is conducted and providing patterns for analysis and opportunities for improvement with targeted interventions.

Standard care with plastic bag or portable thermal nest to prevent hypothermia at birth: a three-armed randomized controlled trial.

OBJECTIVE: To assess the efficacy of adding plastic bag or portable thermal nest (PTN) to standard care in preventing hypothermia soon after birth in 1500-2499 g infants. METHODS: Infants were randomized into standard thermal care alone, plastic bag with standard care or PTN with standard care. Axillary temperature was measured at admission and every 30 min till euthermia. All babies were followed-up till day 7. RESULTS: We recruited 300 infants: plastic bag (101), PTN (99) and standard care group (100). Admission temperature was 36.4 °C (0.52) in plastic bag group, 36.3 °C (0.50) in PTN and 36.1 °C (0.59) in standard care group (p < 0.001). Incidence of hypothermia was lowest in plastic bag group (44.6%), followed by PTN (60%) and standard care (67%). Secondary outcomes were comparable. CONCLUSION: Addition of plastic bag or PTN to standard care significantly reduces incidence and duration of hypothermia soon after birth. Plastic bag is more effective than PTN.