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2.
J Perinat Neonatal Nurs ; 35(4): 350-361, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34726653

RESUMO

Objectives of this study were to determine whether single-family room (SFR) design enhances parental presence, involvement, and maternal well-being during neonatal intensive care hospitalization. An observational cohort including mothers of infants was randomly assigned to receive care in a tertiary-level open-bay (OB) (n = 35) or SFR (n = 36). Mothers were asked to complete daily diaries documenting parental presence, involvement in care, and questionnaires examining maternal well-being. Mother and father mean presence (standard deviation) was significantly higher in the SFR-17.4 (5.2) and 13.6 (6.8)-compared to OB-11.9 (6.3) and 4.6 (3.7) hours/day. Total time spent in care activities did not differ for mothers, except SFR mothers spent more time expressing breast milk (EBM). SFR fathers had greater involvement with care activities. There were no other significant differences. The SFR was associated with greater maternal presence, but not greater involvement in care activities except for EBM, nor improved maternal well-being. The SFR appears to have greater impact on fathers' involvement in care and comforting activities, although the amount of time involved remained quite low compared with mothers. Further studies examining ways to enhance parental involvement in the neonatal intensive care unit are warranted.


Assuntos
Terapia Intensiva Neonatal , Quartos de Pacientes , Pai , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Mães , Pais
3.
Artigo em Inglês | MEDLINE | ID: mdl-34574759

RESUMO

Maori (Indigenous peoples of Aotearoa New Zealand) bear an unequal burden of poor perinatal health outcomes, including preterm birth. An infant arriving preterm disrupts the birth imaginary of whanau (family collectives) and situates them in a foreign health environment that may not be culturally safe and nurturing. A cross-sectional interpretative phenomenological analysis of first interviews with 19 whanau participating in a Kaupapa Maori (by, with, for Maori) qualitative longitudinal study of preterm birth identified themes from their experiences and the meanings they attributed to them. Preterm birth was an emotional roller coaster, with the birth imaginary and anticipated roles disrupted as health practitioners took over the care of their infants. Whanau expressed the desire to be close to their infants, holding them, loving them, nurturing them, and emplacing them within whakapapa (genealogy, continual layering of foundations) networks. When health practitioners or hospital policies inhibited this intimacy by isolating, excluding, or discriminating, whanau were frustrated. Being familiar with hospital routines, staff, peers, infant cares, and being wrapped in wider whanau support were key for whanau coping. Whakawhanaungatanga (processes of establishing relationships) create safe spaces for whanau to be themselves. This quietens the 'storm' and returns whanau to a sense of calm, through the reclamation of their environment.


Assuntos
Terapia Intensiva Neonatal , Nascimento Prematuro , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Nova Zelândia , Gravidez
4.
J Wound Ostomy Continence Nurs ; 48(5): 394-402, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495929

RESUMO

PURPOSE: The purpose of this study was to explore neonatal nursing practices for neonatal pressure injury (PI) risk assessment, pressure redistribution surface use, and moisture management. DESIGN: A descriptive survey. SUBJECT/SETTINGS: A sample of 252 neonatal nurses mainly from the United States responded to a survey distributed electronically through the National Association of Neonatal Nurses, the Academy of Neonatal Nurses, and on the Wound Source Web site. METHODS: Nurses responded to questions that explored what neonatal nurses used to assess PI risk, types of pressure redistribution surfaces used for neonates, and what moisture management strategies were used to prevent PIs. Descriptive statistics were used to describe nurses' practices. RESULTS: When assessing risk, 78% (n = 197/252) reported using a risk assessment scale: the 2 most common scales were the Neonatal Skin Risk Assessment Scale and the Braden Q Scale. Sixty-nine percent (n = 174/252) reported using a rolled blanket or small soft object as pressure redistribution surfaces. In addition, 15% (n = 39) reported the use of different types of positioners such as a fluidized positioner as pressure redistribution surfaces; however, these are marketed as a positioning devices. It appears that these interventions were considered redistribution surfaces by the nurses. For moisture management, petrolatum-based products (6.7%; n = 17/252) and ostomy powders (6%; n = 16/252) were most frequently used. CONCLUSIONS: Practices for PI prevention are different for neonatal patients due to their gestational age, size, and level of illness. Findings from this study create a beginning knowledge of and an opportunity for further research to determine how these practices affect outcomes such as PI incidence and prevalence.


Assuntos
Enfermagem de Cuidados Críticos , Enfermagem Neonatal , Cuidados de Enfermagem , Lesão por Pressão , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Lesão por Pressão/prevenção & controle , Inquéritos e Questionários , Estados Unidos
5.
Lancet Glob Health ; 9(9): e1273-e1285, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34358491

RESUMO

BACKGROUND: Although therapeutic hypothermia reduces death or disability after neonatal encephalopathy in high-income countries, its safety and efficacy in low-income and middle-income countries is unclear. We aimed to examine whether therapeutic hypothermia alongside optimal supportive intensive care reduces death or moderate or severe disability after neonatal encephalopathy in south Asia. METHODS: We did a multicountry open-label, randomised controlled trial in seven tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh. We enrolled infants born at or after 36 weeks of gestation with moderate or severe neonatal encephalopathy and a need for continued resuscitation at 5 min of age or an Apgar score of less than 6 at 5 min of age (for babies born in a hospital), or both, or an absence of crying by 5 min of age (for babies born at home). Using a web-based randomisation system, we allocated infants into a group receiving whole body hypothermia (33·5°C) for 72 h using a servo-controlled cooling device, or to usual care (control group), within 6 h of birth. All recruiting sites had facilities for invasive ventilation, cardiovascular support, and access to 3 Tesla MRI scanners and spectroscopy. Masking of the intervention was not possible, but those involved in the magnetic resonance biomarker analysis and neurodevelopmental outcome assessments were masked to the allocation. The primary outcome was a combined endpoint of death or moderate or severe disability at 18-22 months, assessed by the Bayley Scales of Infant and Toddler Development (third edition) and a detailed neurological examination. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02387385. FINDINGS: We screened 2296 infants between Aug 15, 2015, and Feb 15, 2019, of whom 576 infants were eligible for inclusion. After exclusions, we recruited 408 eligible infants and we assigned 202 to the hypothermia group and 206 to the control group. Primary outcome data were available for 195 (97%) of the 202 infants in the hypothermia group and 199 (97%) of the 206 control group infants. 98 (50%) infants in the hypothermia group and 94 (47%) infants in the control group died or had a moderate or severe disability (risk ratio 1·06; 95% CI 0·87-1·30; p=0·55). 84 infants (42%) in the hypothermia group and 63 (31%; p=0·022) infants in the control group died, of whom 72 (36%) and 49 (24%; p=0·0087) died during neonatal hospitalisation. Five serious adverse events were reported: three in the hypothermia group (one hospital readmission relating to pneumonia, one septic arthritis, and one suspected venous thrombosis), and two in the control group (one related to desaturations during MRI and other because of endotracheal tube displacement during transport for MRI). No adverse events were considered causally related to the study intervention. INTERPRETATION: Therapeutic hypothermia did not reduce the combined outcome of death or disability at 18 months after neonatal encephalopathy in low-income and middle-income countries, but significantly increased death alone. Therapeutic hypothermia should not be offered as treatment for neonatal encephalopathy in low-income and middle-income countries, even when tertiary neonatal intensive care facilities are available. FUNDING: National Institute for Health Research, Garfield Weston Foundation, and Bill & Melinda Gates Foundation. TRANSLATIONS: For the Hindi, Malayalam, Telugu, Kannada, Singhalese, Tamil, Marathi and Bangla translations of the abstract see Supplementary Materials section.


Assuntos
Encefalopatias/terapia , Hipotermia Induzida , Bangladesh/epidemiologia , Encefalopatias/mortalidade , Países em Desenvolvimento , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Índice de Gravidade de Doença , Sri Lanka/epidemiologia , Resultado do Tratamento
6.
Neonatal Netw ; 40(4): 267-272, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34330877

RESUMO

Chronic pain and agitation can complicate the clinical course of critically ill infants. Randomized controlled trials of analgesia and sedation in neonatal intensive care have focused on relatively short durations of exposure. To date, clinicians have few options to treat chronic visceral pain and hyperalgesia. Gabapentin has emerged as a common therapy for a diverse group of pain syndromes and neurologic conditions in adults. In neonates, case reports and series describe the successful treatment of visceral hyperalgesia arising from gastrointestinal insults with or without concomitant neurologic morbidities. Additionally, a case report and series describe the utility of gabapentin for neonatal abstinence syndrome refractory to standard pharmacotherapy. The adverse effect profile of gabapentin, most notably bradycardia and sedation, compares favorably to alternative analgesics and sedatives. However, the long-term impacts of prolonged gabapentin therapy have not been studied. Therefore, candidates for therapy must be selected carefully, and response must be assessed objectively. Future studies must assess the short-term and long-term benefits and risks of gabapentin compared to standard therapies for chronic pain and agitation in infants and refractory neonatal abstinence syndrome.


Assuntos
Analgésicos , Hipnóticos e Sedativos , Adulto , Analgésicos/efeitos adversos , Gabapentina/uso terapêutico , Humanos , Hipnóticos e Sedativos/efeitos adversos , Lactente , Recém-Nascido , Terapia Intensiva Neonatal , Dor/tratamento farmacológico
7.
Respir Care ; 66(10): 1514-1520, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34230212

RESUMO

BACKGROUND: The RAM cannula (Neotech, Valencia, CA) has become a commonly used interface for CPAP in neonatal intensive care. Performance characteristics of this interface used with a critical care ventilator are not well described. METHODS: This was a bench study utilizing a lung simulator configured as an actively breathing infant (weights of 800 g, 1.5 kg, and 3 kg) with moderate lung disease and a critical care ventilator in CPAP mode with leak compensation on. Three sizes of the RAM cannulae (preemie, newborn, and infant) were compared to 3 BabyFlow nasal prongs (Dräger Medical, Lübeck, Germany) (medium, large, and extra-large). Fabricated nasal models produced a 70% occlusive fit for the RAM cannula and an occlusive fit with the Dräger prongs. Delivered flow and pressure levels were recorded at 9 CPAP levels between 5 and 20 cm H2O. RESULTS: The Dräger prongs produced a mean airway pressure ([Formula: see text]) within 0.20 cm H2O (range -0.10 to 0.35) of the set CPAP across all evaluated prong sizes and CPAP levels. In contrast, the RAM cannula produced [Formula: see text] values that averaged 8.5 cm H2O (range -15 to -3.5) below the set CPAP levels. The deficit in delivered versus target CPAP level for the RAM cannula increased with greater set CPAP. Set CPAP of 5 cm H2O delivered [Formula: see text] values that ranged from 0.6 to 1.5 cm H2O (difference of 3.5-4.4 cm H2O). Set CPAP of 20 cm H2O delivered [Formula: see text] values that ranged from 5.0 to 8.4 cm H2O (difference of 11.7-15 cm H2O). Inspiratory flow required to achieve set CPAP levels did not differ between interfaces, suggesting high resistance in the RAM cannula device masks the delivered CPAP levels. CONCLUSIONS: Use of the RAM cannula with a 30% leak on a critical care ventilator delivered [Formula: see text] values lower than set CPAP. This may be clinically meaningful and should be considered when choosing a nasal interface.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Ventiladores Mecânicos , Cânula , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Nariz
8.
Rev Gaucha Enferm ; 42: e20200261, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34287603

RESUMO

OBJECTIVE: To identify the factors associated with the development of skin allergies in the first year of life in moderate and late preterm infants. METHOD: This is a cross-sectional study with 151 moderate and late preterm infants, born between May 2016 and May 2017. Participants were evaluated in the 3rd, 6th, 9th and 12th months of life, in telephone interviews. Statistical analyzes were performed in the SPSS software with frequency comparison tests and logistic regression. RESULTS: The prevalence of skin allergy, in the perception of caregivers, among late and moderate preterm infants was 16%. Factors such as being admitted to neonatal intensive care (p = 0.006) and not being breastfed (p = 0.041) showed a significant association with the development of skin allergies in the 3rd and 12th months of life, respectively. CONCLUSION: Skin allergy, in the perception of caregivers, is more severe in newborn infants who have clinical respiratory and gastrointestinal manifestations, be it conditioning or cause-effect. Breastfeeding proved to be a protective factor in the first year of life.


Assuntos
Hipersensibilidade , Recém-Nascido Prematuro , Aleitamento Materno , Estudos Transversais , Feminino , Humanos , Hipersensibilidade/epidemiologia , Lactente , Recém-Nascido , Terapia Intensiva Neonatal
9.
Am J Perinatol ; 38(11): 1201-1208, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34225372

RESUMO

OBJECTIVE: Limited data are available regarding family and financial well-being among parents whose infants were hospitalized during the 2019 coronavirus (COVID-19) pandemic. The study objective was to evaluate the family and financial well-being of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) during COVID-19. STUDY DESIGN: Parents were recruited for this online, cross-sectional survey via support groups on social media. Data collection was completed between May 18, 2020 and July 31, 2020. The final sample consisted of 178 parents, who had an infant hospitalized in an NICU between February 1, 2020 and July 31, 2020. The primary outcomes were impact on family life and financial stability, as measured by the Impact on Family scale, an instrument that evaluates changes to family life as a result of infant or childhood illness. RESULTS: Of the 178 parent respondents, 173 (97%) were mothers, 107 (59.4%) were non-Hispanic White, and 127 (69.5%) of the infants were born prematurely. Parents reported significant family impact and greater financial difficulty. Extremely premature infants, lower household income, parent mental health, and lower parental confidence were predictive of greater impacts on family life. CONCLUSION: Parents reported significant family and financial impacts during their infant's hospitalization amid COVID-19. Further studies are needed to guide clinical practice and inform family-supportive resources that can mitigate consequences to family well-being. KEY POINTS: · Impact of infant hospitalization in the context of COVID-19 is largely unknown.. · In a cohort of NICU parents during COVID-19, they reported changes to family life and finances.. · Greater impacts were reported by parents with lower income, confidence, and very premature infants..


Assuntos
COVID-19 , Criança Hospitalizada/psicologia , Saúde da Família , Hospitalização/economia , Saúde Mental , Pais/psicologia , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Saúde da Família/economia , Saúde da Família/estatística & dados numéricos , Feminino , Estresse Financeiro , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/psicologia , Masculino , SARS-CoV-2 , Estados Unidos/epidemiologia
10.
Int Breastfeed J ; 16(1): 46, 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34140025

RESUMO

BACKGROUND: Extremely preterm infants need advanced intensive care for survival and are usually not discharged before they reach the time of expected birth. In a family-centred neonatal intensive care unit both parents are involved at all levels of care including the feeding process. However, studies focusing on fathers in this situation are scarce. The purpose of this study was to explore the experiences of feeding extremely preterm infants in a neonatal intensive care unit from fathers' perspectives. METHODS: The study adopts a qualitative inductive method, reported according to the COREQ checklist. Seven fathers of extremely preterm infants (gestational age 24-27 weeks) in neonatal intensive care in Sweden were interviewed by telephone after discharge in 2013-2014. The interviews were analysed using a qualitative content analysis and confirmed by triangulation in 2021. RESULTS: Six sub-categories and two generic categories formed the main category: "a team striving towards the same goal". The fathers were equally involved and engaged members of the feeding team all hours of the day. The fathers shared responsibility and practical duties with the mothers, and they provided as much support to the mothers as they could. However, the fathers found it difficult to support and encourage the mothers to breastfeed and express breastmilk when the breastmilk production was low. The fathers experienced a loss when breastfeeding was not successful. CONCLUSIONS: The findings indicate that fathers want to be involved with infant care, including night-time feeds, and long and demanding feeding processes. Fathers and staff need to collaborate to provide the best support to mothers during the feeding process. This study may inspire hospital staff to acknowledge and support fathers to become more involved in the oral feeding process when an infant is born extremely preterm.


Assuntos
Lactente Extremamente Prematuro , Terapia Intensiva Neonatal , Aleitamento Materno , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Leite Humano
11.
J Perinatol ; 41(9): 2208-2216, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34091604

RESUMO

OBJECTIVE: Collaborative clinician-family relationships are necessary for the delivery of successful patient- and family-centered care (PFCC) in the NICU. Challenging clinician-family relationships may undermine such collaboration and the potential impacts on patient care are unknown. STUDY DESIGN: Consistent caregivers were surveyed to describe their relationships and collaboration with families of infants hospitalized ≥ 28 days. Medical record review collected infant and family characteristics hypothesized to impact relationships. Mixed methods analysis was performed. RESULTS: Clinicians completed 243 surveys representing 77 families. Clinicians reported low collaboration with families who were not at the bedside and/or did not speak English. Clinicians perceived most clinician-family relationships impact the infant's hospital course. Negative impacts included communication challenges, mistrust or frustration with the team and disruptions to patient care. CONCLUSION: This study identifies features of clinician-family relationships that may negatively impact an infant's NICU stay. Targeting supports for these families is necessary to achieve effective PFCC.


Assuntos
Relações Familiares , Terapia Intensiva Neonatal , Comunicação , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Pais , Assistência Centrada no Paciente
12.
J Perinat Med ; 49(6): 643-649, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34116585

RESUMO

After more than 1 year of the SARS-CoV-2 pandemic, a great deal of knowledge on how this virus affects pregnant women, the fetus and the newborn has accumulated. The gap between different guidelines how to handle newborn infants during this pandemic has been minimized, and the American Academy of Pediatrics (AAP)'s recommendations are now more in accordance with those of the World Health Organization (WHO). In this article we summarize present knowledge regarding transmission from mother to the fetus/newborn. Although both vertical and horizontal transmission are rare, SARS-CoV-2 positivity is associated with an increased risk of premature delivery and higher neonatal mortality and morbidity. Mode of delivery and cord clamping routines should not be affected by the mother's SARS-CoV-2 status. Skin to skin contact, rooming in and breastfeeding are recommended with necessary hygiene precautions. Antibodies of infected or vaccinated women seem to cross both the placenta and into breast milk and likely provide protection for the newborn.


Assuntos
COVID-19/transmissão , Complicações Infecciosas na Gravidez/virologia , Aleitamento Materno , COVID-19/diagnóstico , COVID-19/imunologia , COVID-19/prevenção & controle , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Leite Humano/imunologia , Triagem Neonatal , Alta do Paciente , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Ressuscitação , SARS-CoV-2/imunologia
13.
Orphanet J Rare Dis ; 16(1): 271, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116697

RESUMO

INTRODUCTION: Severe epidermolysis bullosa simplex (EBS sev) is a rare genodermatosis characterized by congenital generalized blistering and mucosal involvement. Increased needs and decreased intake quickly lead to nutritional imbalance. Enteral nutrition support is proposed, but classical nasogastric tubes are not well tolerated in these patients and gastrostomy is preferred. OBJECTIVE AND METHODS: To report the experience with EBS sev in neonatal units of French reference centers for gastrostomy. In this retrospective multicentric study, we included all patients with EBS sev who had gastrostomy placement before age 9 months during neonatal care hospitalization. RESULTS: Nine infants (5 males/4 females) with severe skin and mucosal involvement were included. A gastrostomy was decided, at an early age (mean 3.7 months, range 1.4 to 8 months) in infants with mean weight 4426 g (range 3500 to 6000 g). Techniques used were endoscopy with the pull technique for 5 infants and surgery under general anesthesia for 4. Main complications were local but resolved after treatment. All infants gained weight after gastrostomy. The mean withdrawal time (n = 7) for the gastrostomy was 35.8 months (range 10.5 months to 6.5 years). Seven children had persistent oral disorders. CONCLUSIONS: Gastrostomy in infants with EBS sev can be necessary in neonatal intensive care units. Both surgical and endoscopic pull techniques seem efficient, with good tolerance.


Assuntos
Epidermólise Bolhosa Simples , Epidermólise Bolhosa , Criança , Nutrição Enteral , Feminino , Gastrostomia , Humanos , Lactente , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Estudos Retrospectivos
14.
Cochrane Database Syst Rev ; 6: CD014484, 2021 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-34155622

RESUMO

BACKGROUND: Misoprostol given orally is a commonly used labour induction method. Our Cochrane Review is restricted to studies with low-dose misoprostol (initially ≤ 50 µg), as higher doses pose unacceptably high risks of uterine hyperstimulation. OBJECTIVES: To assess the efficacy and safety of low-dose oral misoprostol for labour induction in women with a viable fetus in the third trimester of pregnancy. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov,  the WHO International Clinical Trials Registry Platform (14 February 2021) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised trials comparing low-dose oral misoprostol (initial dose ≤ 50 µg) versus placebo, vaginal dinoprostone, vaginal misoprostol, oxytocin, or mechanical methods; or comparing oral misoprostol protocols (one- to two-hourly versus four- to six-hourly; 20 µg to 25 µg versus 50 µg; or 20 µg hourly titrated versus 25 µg two-hourly static). DATA COLLECTION AND ANALYSIS: Using Covidence, two review authors independently screened reports, extracted trial data, and performed quality assessments. Our primary outcomes were vaginal birth within 24 hours, caesarean section, and hyperstimulation with foetal heart changes. MAIN RESULTS: We included 61 trials involving 20,026 women. GRADE assessments ranged from moderate- to very low-certainty evidence, with downgrading decisions based on imprecision, inconsistency, and study limitations. Oral misoprostol versus placebo/no treatment (four trials; 594 women) Oral misoprostol may make little to no difference in the rate of caesarean section (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.59 to 1.11; 4 trials; 594 women; moderate-certainty evidence), while its effect on uterine hyperstimulation with foetal heart rate changes is uncertain (RR 5.15, 95% CI 0.25 to 105.31; 3 trials; 495 women; very low-certainty evidence). Vaginal births within 24 hours was not reported. In all trials, oxytocin could be commenced after 12 to 24 hours and all women had pre-labour ruptured membranes. Oral misoprostol versus vaginal dinoprostone (13 trials; 9676 women) Oral misoprostol probably results in fewer caesarean sections (RR 0.84, 95% CI 0.78 to 0.90; 13 trials, 9676 women; moderate-certainty evidence). Subgroup analysis indicated that 10 µg to 25 µg (RR 0.80, 95% CI 0.74 to 0.87; 9 trials; 8652 women) may differ from 50 µg (RR 1.10, 95% CI 0.91 to 1.34; 4 trials; 1024 women) for caesarean section. Oral misoprostol may decrease vaginal births within 24 hours (RR 0.93, 95% CI 0.87 to 1.00; 10 trials; 8983 women; low-certainty evidence) and hyperstimulation with foetal heart rate changes (RR 0.49, 95% CI 0.40 to 0.59; 11 trials; 9084 women; low-certainty evidence). Oral misoprostol versus vaginal misoprostol (33 trials; 6110 women) Oral use may result in fewer vaginal births within 24 hours (average RR 0.81, 95% CI 0.68 to 0.95; 16 trials, 3451 women; low-certainty evidence), and less hyperstimulation with foetal heart rate changes (RR 0.69, 95% CI 0.53 to 0.92, 25 trials, 4857 women, low-certainty evidence), with subgroup analysis suggesting that 10 µg to 25 µg orally (RR 0.28, 95% CI 0.14 to 0.57; 6 trials, 957 women) may be superior to 50 µg orally (RR 0.82, 95% CI 0.61 to 1.11; 19 trials; 3900 women). Oral misoprostol probably does not increase caesarean sections overall (average RR 1.00, 95% CI 0.86 to 1.16; 32 trials; 5914 women; low-certainty evidence) but likely results in fewer caesareans for foetal distress (RR 0.74, 95% CI 0.55 to 0.99; 24 trials, 4775 women). Oral misoprostol versus intravenous oxytocin (6 trials; 737 women, 200 with ruptured membranes) Misoprostol may make little or no difference to vaginal births within 24 hours (RR 1.12, 95% CI 0.95 to 1.33; 3 trials; 466 women; low-certainty evidence), but probably results in fewer caesarean sections (RR 0.67, 95% CI 0.50 to 0.90; 6 trials; 737 women; moderate-certainty evidence). The effect on hyperstimulation with foetal heart rate changes is uncertain (RR 0.66, 95% CI 0.19 to 2.26; 3 trials, 331 women; very low-certainty evidence). Oral misoprostol versus mechanical methods (6 trials; 2993 women) Six trials compared oral misoprostol to transcervical Foley catheter. Misoprostol may increase vaginal birth within 24 hours (RR 1.32, 95% CI 0.98 to 1.79; 4 trials; 1044 women; low-certainty evidence), and probably reduces the risk of caesarean section (RR 0.84, 95% CI 0.75 to 0.95; 6 trials; 2993 women; moderate-certainty evidence). There may be little or no difference in hyperstimulation with foetal heart rate changes (RR 1.31, 95% CI 0.78 to 2.21; 4 trials; 2828 women; low-certainty evidence). Oral misoprostol one- to two-hourly versus four- to six-hourly (1 trial; 64 women) The evidence on hourly titration was very uncertain due to the low numbers reported. Oral misoprostol 20 µg hourly titrated versus 25 µg two-hourly static (2 trials; 296 women) The difference in regimen may have little or no effect on the rate of vaginal births in 24 hours (RR 0.97, 95% CI 0.80 to 1.16; low-certainty evidence). The evidence is of very low certainty for all other reported outcomes. AUTHORS' CONCLUSIONS: Low-dose oral misoprostol is probably associated with fewer caesarean sections (and therefore more vaginal births) than vaginal dinoprostone, and lower rates of hyperstimulation with foetal heart rate changes. However, time to birth may be increased, as seen by a reduced number of vaginal births within 24 hours. Compared to transcervical Foley catheter, low-dose oral misoprostol is associated with fewer caesarean sections, but equivalent rates of hyperstimulation. Low-dose misoprostol given orally rather than vaginally is probably associated with similar rates of vaginal birth, although rates may be lower within the first 24 hours. However, there is likely less hyperstimulation with foetal heart changes, and fewer caesarean sections performed due to foetal distress. The best available evidence suggests that low-dose oral misoprostol probably has many benefits over other methods for labour induction. This review supports the use of low-dose oral misoprostol for induction of labour, and demonstrates the lower risks of hyperstimulation than when misoprostol is given vaginally. More trials are needed to establish the optimum oral misoprostol regimen, but these findings suggest that a starting dose of 25 µg may offer a good balance of efficacy and safety.


Assuntos
Trabalho de Parto Induzido/métodos , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Administração Intravaginal , Administração Oral , Índice de Apgar , Cesárea/estatística & dados numéricos , Dinoprostona/administração & dosagem , Esquema de Medicação , Feminino , Frequência Cardíaca Fetal/efeitos dos fármacos , Humanos , Terapia Intensiva Neonatal/estatística & dados numéricos , Ocitocina/administração & dosagem , Parto , Placebos/administração & dosagem , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Útero/efeitos dos fármacos
15.
Ethiop J Health Sci ; 31(2): 321-328, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34158784

RESUMO

Background: The Ethiopian neonatal mortality has not shown much progress over the years. In light of this, the country has introduced interventions such as the utilization of newborn corners and neonatal intensive care units to avert preventable neonatal deaths. This study was conducted to assess readiness of primary hospitals in providing neonatal intensive care services. Methods: A health facility based cross-sectional study design was employed where data were collected using both prospective and retrospective techniques using a format adapted from national documents. SPSS version 25 was used for data entry and analysis using descriptive statistics. Results: Data were collected from 107 of 113 (94.7%) primary hospitals due to inaccessibility of some primary hospitals. The minimum national standard requirement of a level one neonatal intensive care unit for infrastructure was met by 63% (68/107) and 44% (47/107) had fulfilled the requirements for kangaroo mother care units. The average number of neonatal intensive care unit trained nurses per primary hospital was 2.6, 0.8 for general practitioners and 2.9 support staff; all of which is less than the minimum recommended national standard. The minimum national requirement for medical equipment and renewables for primary hospital level was fulfilled by 24% (26/107) of the hospitals, 65% (70/107) for essential laboratory tests, and 87% (93/107) for clinical services and procedures. The average number of admissions during the six months prior to the data collection was 87.2 sick newborns per facility with a 'discharged improved' rate of 71.5%, referral out rate of 18.4% and level one neonatal intensive care unit death rate of 6.6%. The remaining newborns had either left against medical advice or were still undergoing treatment during data collection. Conclusions: The overall readiness of primary hospitals to deliver neonatal intensive care services in terms of infrastructure, human resource, medical equipment, and laboratory tests was found to be low. There is a need to fill gaps in infrastructure, medical equipment, renewables, human resource, laboratory reagents, drugs and other supplies of neonatal intensive care units of primary hospitals to garner better quality of service delivery.


Assuntos
Método Canguru , Criança , Estudos Transversais , Etiópia , Hospitais , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Estudos Prospectivos , Estudos Retrospectivos
16.
Neonatal Netw ; 40(3): 183-186, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34088864

RESUMO

COVID-19's first wave created chaos for new NICU families as they struggled to cope with the challenge of a fragile infant along with a pandemic. Safety was paramount due to a lack of understanding around how the virus transmits, but much has been learned since then. The next wave of the virus needs to have a rethink around family separation. World leader organization European Foundation for the Care of Newborn Infants (EFCNI) provides insight into the challenges with the first wave and suggests ideas around rethinking how families interact with their baby in the subsequent waves.


Assuntos
COVID-19/psicologia , Unidades de Terapia Intensiva Neonatal/normas , Terapia Intensiva Neonatal/psicologia , Terapia Intensiva Neonatal/normas , Relações Mãe-Filho/psicologia , Guias de Prática Clínica como Assunto , Adulto , Separação da Família , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , SARS-CoV-2
17.
Rev. cuba. pediatr ; 93(2): e1215, fig
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1280372

RESUMO

Introducción: El cierre prematuro del foramen oval o foramen oval restrictivo intraútero es una entidad clínica rara pero seria, de etiología desconocida. Puede ocasionar diversos defectos cardíacos, hipertensión pulmonar, insuficiencia cardiaca congestiva, hidrops fetal y muerte. El diagnóstico puede realizarse mediante ecocardiografía fetal, aunque en la mayoría de los casos sucede en autopsia posmortem. Objetivo: Describir un caso de hidrops fetal secundario al cierre prematuro del foramen oval intraútero. Presentación del caso: Recién nacido pretérmino de 34 semanas en el que, en ecografía y ecocardiografía prenatal se visualizó un aumento de las cavidades cardíacas asociado a cierre intrauterino de foramen oval e hidrops, hallazgos confirmados al nacimiento. Tras una prolongada estancia en unidad de cuidados intensivos neonatal y tratamiento con inotrópicos y diuréticos, se otorgó el alta hospitalaria con diagnóstico de cardiomiopatía dilatada secundaria a foramen oval restrictivo. Conclusiones: La asociación de cierre prematuro de foramen oval con hidrops fetal ha sido descripta en escasas publicaciones y es frecuente en estas la relación con muerte perinatal y con anomalías extracardíacas. En este caso se describe hidrops secundario al cierre temprano del foramen oval intraútero que condicionó a la dilatación global de cavidades cardíacas y a la disfunción ventricular severa persistentes más allá del periodo neonatal sin otras anomalías asociadas. A pesar de la severidad del compromiso cardiovascular, la evolución clínica fue favorable y permitió el egreso hospitalario. Es importante el reconocimiento temprano mediante ecografía y ecocardiografía fetal de estas entidades para guiar un diagnóstico y tratamiento oportunos(AU)


Introduction: Premature closure of the oval foramen or intrauterine restrictive oval foramen is a rare but serious clinical entity of unknown etiology. It can cause various heart defects, pulmonary hypertension, congestive heart failure, fetal hydrops and death. Diagnosis can be made by fetal echocardiography, although in most cases it occurs in postmortem autopsy. Objective: Describe the presentation of a case of fetal hydrops secondary to premature closure of the intrauterine oval foramen. Case presentation: A 34-week preterm newborn in which, in ultrasound and prenatal echocardiography, an increase in the cardiac chambers associated with intrauterine closure of oval foramen and hydrops was visualized; these findings were confirmed at birth. After a prolonged stay in the neonatal intensive care unit and treatment with inotropic and diuretic drugs, hospital discharge was granted with diagnosis of dilated cardiomyopathy secondary to restrictive oval foramen. Conclusions: The association of premature closure of oval foramen with fetal hydrops has been described in few publications and it is common in these the relation with perinatal death and extracardiac abnormalities. In this case, it is described hydrops secondary to the early closure of the intrauterine oval foramen that conditioned the overall dilation of heart chambers, and persistent severe ventricular dysfunction beyond the neonatal period without other associated abnormalities. Despite the severity of cardiovascular compromising, clinical evolution was favorable and allowed hospital discharge. Early recognition using ultrasound and fetal echocardiography of these entities is important to guide timely diagnosis and treatment(AU)


Assuntos
Humanos , Recém-Nascido , Cardiomiopatia Dilatada , Hidropisia Fetal , Terapia Intensiva Neonatal , Disfunção Ventricular , Forame Oval , Coração
18.
J Paediatr Child Health ; 57(9): 1485-1489, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33938084

RESUMO

AIM: Skin breaks (SBs) for procedures and blood sampling are common in neonatal intensive care units (NICU), contributing to pain, infection risk and anaemia. We aimed to document their prevalence, identify areas for improvement and, through staff awareness, reduce their frequency. METHODS: Quality improvement project via prospective audit at a tertiary-level NICU in Australia was conducted. All infants admitted to the NICU for >24 h during two audit periods were included in the study. A specifically designed bedside audit tool was used to prospectively document all SB and blood tests performed on infants during a 4-week audit period (audit 1). Results were reviewed to identify areas for improvement, and disseminated to staff at unit meetings, shift handover and email. Following education and awareness, the audit was repeated (audit 2), and data were compared. Frequency of SB and blood tests performed was measured. Data were tested for normality and analysed using parametric or non-parametric tests where appropriate. RESULTS: There were 52 NICU admissions during each audit period (104 total), with 34 (65%) and 31 (60%) having audit sheets completed, respectively. Median (interquartile range) gestational age and mean (standard deviation) birthweight were 29 (26.3-35) weeks and 1836 (1185) g for audit 1, 30 (28.5-31.5) weeks and 1523 (913) g for audit 2. The reduction in total blood tests (mean) was 36.3%, skin breaks per admitted baby day reduced by 60% and total blood volume sampled (mean) by 37.7%. CONCLUSIONS: A quality improvement project by prospective audit and staff education was associated with reductions in frequency of skin breaks and blood tests in the NICU.


Assuntos
Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Peso ao Nascer , Idade Gestacional , Testes Hematológicos , Humanos , Lactente , Recém-Nascido
19.
J Pediatr ; 236: 62-69.e3, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33940013

RESUMO

OBJECTIVE: To test the hypothesis that newborn infants cared for in hospitals with greater utilization of neonatal intensive care experienced fewer postdischarge adverse events. STUDY DESIGN: We developed 3 retrospective population-based cohorts of Texas Medicaid insured singletons born in 2010-2014 (very low birth weight [VLBW n = 11 139], late preterm [n = 57 509], and non-preterm [n = 664 447]) who received care in higher volume hospitals with level III/IV neonatal intensive care units (NICUs). Measures of NICU care were hospital-level risk adjusted NICU admission rates, special care days (days of nonroutine care) per infant, and the percent of intensive (highest billable care code) special care days. The units of analysis were hospitals (n = 80) and the primary outcome was an adverse event, (defined as admission, emergency department visit, or death) within 30 days postdischarge. RESULTS: Higher use of NICU care at a hospital level was not associated with lower postdischarge 30-day adverse event. Infants cared for in hospitals with above vs below median special care day rates experienced slightly higher postdischarge adverse event per 100 infants (VLBW: 14.01 [95% CI 12.74-15.27] vs 11.84 [10.52-13.16], P < .05; late preterm: 7.33 [6.68-7.97] vs 6.28 [5.87-6.69], P < .01; non-preterm: 4.47 [4.17-4.76] vs 3.97 [3.75-4.18], P < .01). Weak positive associations (Pearson correlations of 0.31-0.37, P < .01) were observed for adverse event with special care days; in no instance was a negative association observed between NICU utilization and adverse event. CONCLUSION: Higher utilization of NICU care was not associated with lower rates of short-term events suggesting that there may be opportunities to safely decrease admission rates and length of NICU stays.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Terapia Intensiva Neonatal/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Masculino , Medicaid , Mortalidade Perinatal , Estudos Retrospectivos , Texas , Estados Unidos
20.
Semin Perinatol ; 45(5): 151424, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33941361

RESUMO

Moderately ill preterm infants residing in medically underserved areas are frequently transferred to tertiary care NICUs that are mostly located in urban areas, resulting in mother-infant separation, high transportation costs, and the emotional costs of limited infant visitation. In 2012, The American Academy of Pediatrics revised neonatal care guidelines, adding in-house neonatal services to the scope of Level II NICUs. Limited availability of neonatologists in medically underserved areas has prompted innovative solutions like telemedicine to meet this requirement. Telemedicine consultations for pediatric transports have demonstrated improved patient outcomes compared with phone consultation, but evidence regarding telemedicine use for neonatal transport is mostly limited to simulation settings. Also, there are limited data on telemedicine use as a primary means to provide intensive care to neonates in Level I/II NICUs. Recently, two groups demonstrated the feasibility and safety of synchronous telemedicine to guide care for premature infants at lower level NICUs. This approach prevented unnecessary transfer and appeared to provide the same quality of care that the baby would have received at the tertiary care facility. As current evidence regarding the use of telemedicine to extend intensive care is based on single-center experiences, additional research and evaluation of the effectiveness of telemedicine for this application is required. This chapter describes the use of telemedicine to support physicians at lower level nurseries and the transport team with management of critical neonates, utility as primary means to provide care at lower level NICUs, barriers for implementation, and future opportunities to enhance telemedicine's impact in NICU settings.


Assuntos
Terapia Intensiva Neonatal , Telemedicina , Criança , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Neonatologistas
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