Effects of parental involvement in infant care in neonatal intensive care units:a meta-analysis

Objective： This meta-analysis aimed to examine the effects of parental involvement in infant care in neonatal intensive care units （NlCUs）. Methods： PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI）, Wanfang database, and VIP database were searched till November 2017. Randomized controlled trials （RCTs） and controlled clinical trials （CCTs） examining the effect of parental involvement in the NICU were considered for inclusion. Resulls： We included 10 studies （three RCTs, seven CCTs） with a total of 1,851 participants. The meta-analysis demonstrated that there were no statistically significant differences on nosocomial infection between two groups （risk ratio [RR] = 0.90, 95% CI 0.63-1.30, P = 0.58）. Compared with no parental involvement groups, parental involvement groups showed more weight gain （mean difference [MD] = 1.47, 95% CI 0.65-2.29, P 〈 0.05）, higher breast-feeding rate （RR = 1.38, 95% CI 1.25-1.53, P 〈 0.05）, lower readmission rate （RR = 0.35, 95% CI 0.15-0.80, P 〈 0.05）, and higher satisfaction rate （RR = 1.09, 95% CI 1.02-1.16, P 〈 0.05）.Conclusions： Parentaiinvolvement in the NICU interventions could not increase the rate of nosocomial infection of neonates, but could improve their weight gain, breast-feeding and parental satisfaction and decrease their readmission. However, since the conclusion of this meta-analysis was drawn based on the limited number of high-quality RCTs, more hioh-quality studies should be conducted in the future to confirm its positive intervention effects.

Mothers’ Knowledge of Health Caring for Premature Infants after Discharge from Neonatal Intensive Care Units in the Gaza Strip, Palestine

Background: Preterm labor is one of the most public health problems related to neonates admitted to Neonatal Intensive Care Unit (NICU). Poor knowledge among mothers about the care requirements of a preterm neonate is immediate cause for post-discharge medical problems in premature and neonates readmission to NICU. Hence, this study aims to evaluate mothers’ knowledge of caring for premature infants post-discharge from Neonatal Intensive Care Units in the Gaza strip. Methods: A Quantitative-based cross-sectional designs study was used to survey 120 mothers of preterm neonates at the time of preterm neonates discharge by face-to-face interview at Al-Shifa medical complex and Nasser hospital between February and June 2018. Results: The results showed that only about 58.4% of mothers of premature babies had good knowledge about health care needed for premature infants after discharge from NICU. Furthermore, there was no statistically significant difference between the level of knowledge and mother’s sociodemographic characteristics (P-values > 0.05). Conclusion: Mothers’ knowledge of premature infants care was not at the optimal level, which might put the newborns at risk. Therefore, the study emphasizes the necessity of thoughtful exchange of health information between team members and mothers and establishing pre- and post-discharge plans with mothers to start their healthy transition of preterm neonate to home and to ameliorate family concerns.

The trajectories of physical growth in 4 months postnatal corrected age among preterm infants discharged from neonatal intensive care units and associated factors: A prospective study

Objectives Growth retardation is a risk for premature infants.In addition to demographic and perinatal factors,preterm infants’physical growth may be affected by neonatal intensive care unit(NICU)stress,maternal postpartum depression,and mother-infant interaction.This study aimed to investigate the trajectories of physical growth in 4 months corrected age among preterm infants discharged from the NICU and the impactors on these trajectories.Methods A prospective study was conducted among 318 preterm infants from September 2019 to April 2021 in Shanghai,China.Latent growth modeling was applied to identify the weight,length,and head circumference growth trajectories in 4 months corrected age and explore the effects of demographic and medical characteristics,infant stress during NICU stay,maternal postpartum depression,and mother-infant interaction on each trajectory.Results Unconditional latent growth models showed curve trajectories with increasingly slower growth in weight,length,and head circumference until 4 months of corrected age.Conditional latent growth models showed that a longer length of stay in the NICU and more skin punctures were negatively associated with weight at 40 weeks corrected gestational age(β=−0.43 and−0.19,respectively,P<0.05).The maternal postpartum depression between 40 weeks corrected gestational age and 1 month corrected postnatal age was associated with a lower growth rate of length(β=−0.17,P=0.040),while between 2 and 3 months corrected postnatal age,there were lower growth rates of weight and head circumference(β=−0.15 and−0.19,respectively,P<0.05).The mother-infant interaction scores between 40 weeks corrected gestational age and 1 month corrected postnatal age negatively predicted the growth rate of weight(β=−0.19,P=0.020).Conclusion The physical growth trajectories of preterm infants discharged from the NICU were influenced by infant stress during the NICU stay,maternal postpartum depression and mother-infant interaction.

Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States

BACKGROUND There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit(NICU)to the pediatric intensive care unit(PICU)without an interim discharge home.These infants are often medically complex and have higher mortality relative to NICU or PICUonly admissions.Given an absence of data surrounding practice patterns for nonemergent NICU to PICU transfers,we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.AIM To characterize non-emergent NICU to PICU transfer practices across the United States and query PICU providers’evaluations of their effectiveness.METHODS A cross-sectional survey was drafted,piloted,and sent to one physician representative from each of 115 PICUs across the United States based on membership in the PARK-PICU research consortium and membership in the Children’s Hospital Association.The survey was administered via internet(REDCap).Analysis was performed using STATA,primarily consisting of descriptive statistics,though logistic regressions were run examining the relationship between specific transfer steps,hospital characteristics,and effectiveness of transfer.RESULTS One PICU attending from each of 81 institutions in the United States completed the survey(overall 70%response rate).Over half(52%)indicated their hospital transfers patients without using set clinical criteria,and only 33%indicated that their hospital has a standardized protocol to facilitate non-emergent transfer.Fewer than half of respondents reported that their institution’s nonemergent NICU to PICU transfer practices were effective for clinicians(47%)or patient families(38%).Respondents evaluated their centers’transfers as less effective when they lacked any transfer criteria(P=0.027)or set transfer protocols(P=0.007).Respondents overwhelmingly agreed that having set clinical criteria and standardized protocols for non-emergent transfer were important to the patient-family experience and patient safety.CONCLUSION Most hospitals lacked any clinical criteria or protocols for non-emergent NICU to PICU transfers.More positive perceptions of transfer effectiveness were found among those with set criteria and/or transfer protocols.

Nurse Stress Associated with Delirium Care in Intensive Care Units: A Cross-Sectional Study

Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patients, limited research exists on ICU nurses’ stress specifically related to delirium care. This study aims to investigate the stress experienced by ICU nurses in China when managing patients with delirium. Methods: This cross-sectional survey was conducted in China from January to February 2023. A total of 243 ICU nurses participated by completing an online survey that included the Personal Information Questionnaire and the Strain of Caring for Delirium Index (SCDI). Although 260 responses were initially collected, 29 invalid questionnaires were excluded, resulting in a final sample size of 243 valid responses. The SCDI scale demonstrated reliable internal consistency, with Cronbach’s α coefficients of 0.744, 0.812, 0.778, and 0.920 across its four subscales. Results: The survey results indicated that hypoactive delirium behaviors were perceived as the most significant stressors when caring for delirious patients. Among the behaviors, “noisy/yelling” was identified as the most challenging, whereas “pulling at tubes, dressings” was rated as the least challenging. No significant associations were found between demographic factors and stress levels. Conclusion: This study sheds light on the stress levels ICU nurses experience when caring for delirious patients, particularly in relation to hypoactive behaviors. Based on these findings, it is recommended that nurse managers implement stress management strategies and provide targeted delirium-related care training to better support ICU nurses and enhance the quality of delirium care.

Improvement of the nutritional support management system for patients in intensive care units

BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.

Risk Factors for Mortality in Acute Kidney Injury in Intensive Care Units in Togo

Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.

Study on the Effect of Early Oral Motor Intervention in Preterm Infants in Neonatal Intensive Care Unit

Objective:To study the effective value of introducing the concept of early oral exercise in the process of nursing intervention for preterm infants in the neonatal intensive care unit(NICU).Methods:96 cases of preterm infants diagnosed from January 2022 to August 2022 were selected and randomly divided into two groups:the general practice group(general nursing intervention),and the early practice group(early oral exercise intervention),and the effect of intervention on preterm infants in the two groups was observed.Results:After nursing care,the mean value of the non-nutritive sucking ability assessment(76.54±5.82),the mean value of the intellectual development degree assessment(104.57±8.45),the mean value of the psychomotor development degree assessment(102.33±6.74),and the mean value of behavioral neural reflexes ability assessment(38.71±2.40)in the early practice group were better than that as compared to the general practice group(P<0.05);the mean value of oral feeding start time of preterm infants in the early practice group(35.42±7.63)weeks,the mean value of all oral feeding time(34.12±5.28)weeks,and the mean time of hospital intervention(15.33±4.25)days were lesser than compared to those of the general practice group at 37.4±5.82 weeks,37.46±3.55 weeks,and 20.46±2.91 days,respectively(P<0.05);the rate of adverse reactions in preterm infants in the early practice group significantly lower than that of the general practice group(P<0.05).Conclusion:The introduction of the concept of early oral exercise intervention among NICU nurses improved the feeding effect,sucking ability of preterm infants,and intellectual development.Hence,early oral motor care should be popularized.

Clinical decision making on the use of physical restraint in intensive care units

Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients'safety and to prevent unexpected accidents.However,existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales,the negative physical and emotional effects on patients,but the lack of perceived alternatives.This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses.By reviewing the literature,intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases.However,it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint.Besides that,such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated.Therefore,despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint,it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

Professional nurses’facilitation of self-care in intensive care units:A concept analysis

Objective:This article aims to provide an in-depth analysis of the concept of self-care in the intensive care unit and outline its defining attributes,antecedents,consequences and empirical referents.Methods:The literature was searched electronically using databases such as CINAHL,Medline,Psych INFO,ERIC,ScienceDirect,Amed,EBSCO(Health Source:Nursing and Academic Edition),Sage,Ujoogle and Google Scholar.Articles from 2013 to 2020 were searched to target recent and up-to-date information about the definitions,attributes,antecedents and consequences of the concept of self-care.Walker and Avant’s framework was utilised to analyse the concept of self-care.Results:The results of the concept analysis identified seven attributes,namely process,activity,capability,autonomous choice,education,self-control and interaction.The seven identified antecedents are self-motivation,participation,commitment,resources,religious and cultural beliefs,social,spiritual and professional support,and the availability of time.The consequences are the maintenance of health and wellbeing,autonomy,increased self-esteem,disease prevention,empowerment,increased social support and the ability to cope with stress.

Mothers’experiences of neonatal intensive care:A systematic review and implications for clinical practice

BACKGROUND Preterm birth is on the rise worldwide.Neonatal intensive care units(NICUs)have enabled many critically ill newborns to survive.When a premature baby is admitted to the NICU,the mother–infant relationship may be interrupted,affecting the mother's mental health.AIM To examine the maternal emotions associated with having a child in the NICU and provide suggestions for clinical practice.METHODS MEDLINE,CINAHL,PsychARTICLES,and PsychINFO were searched for relevant articles between 2005 to 2019,and six qualitative articles were chosen that explored the experiences of mothers who had a preterm infant in the NICU.The thematic analysis method was used to identify the most common themes.RESULTS Four main themes of the experience of mothers who had a preterm infant in the NICU were identified:Negative emotional impacts on the mother,support,barriers to parenting,and establishment of a loving relationship.CONCLUSION NICU environment is not conducive to mother-child bonding,but we stipulate steps that health care professionals can take to reduce the negative emotional toll on mothers of NICU babies.

Indoor Surveillance of Airborne Fungi Contaminating Intensive Care Units and Operation Rooms in Assiut University Hospitals, Egypt

Mycoflora of atmospheric air and dust samples collected from air conditioning systems in 12 of each I.C.U. （intensive care units） and O.R. （operation rooms） were tested using settle and dilution plate methods on four types of agar media and incubated at 25℃. Forty-five fungal species representing 23 genera were isolated and identified. The most prevalent genera recorded were Cladosporium, Aspergillus, Penicillium and Fusarium. The total colony forming units of airborne fungi recovered in I.C.U. and O.R. ranged between 31.13-49.61 colonies/m3 on the four types of media usedl The fungal total catch of the dust samples collected from the air conditioning system filters in I.C.U. and O.R. were ranged from 65.5-170 colonies/mg dust. Since, the interest to replace synthetic xenobiotics by natural compounds with low environmental persistence and biodegradable to control such airborne fungal contaminants is needed. In this respect, essential oils showed to possess a broad spectrum of antifungal activity. Fungal static ability of six oils was tested on 30 different fungal isolates. Vapors of common thyme oil exhibited the strongest inhibitory effects on the tested isolates, whereas the headspace vapors of blue gum and ginger had no inhibitory effects on the tested fungal isolates. These data revealed that the air conditioning systems may be an important source of contamination in I.C.U. and O.R. of Assiut university hospitals. Thus, patients may be in risk of being exposed to contaminated atmospheric air by opportunistic fungi and the use of essential oils as an alternative option to control hospital wards from fungal contaminants needs further studies.

Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings

AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units(ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network(CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection(CLABSI) rate was 6.5 per 1000 central line(CL)-days, the ventilator-associated pneumonia(VAP) rate was 44.3 per 1000 mechanical ventilator(MV)-days, and the catheterassociated urinary tract infection(CAUTI) rate was 5.7 per 1000 urinary catheter(UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9(CLABSI) and 5.3(CAUTI)] and higher than NHSN rates [0.8(CLABSI) and 1.3(CAUTI)]- although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC(16.5) and NHSN's rates(1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates.

Incremental value of thoracic ultrasound in intensive care units:Indications,uses,and applications

Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations. B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago. Its application in the diagnosis of thoracic diseases has always been considered limited, due to the presence of air in the lung and the presence of the bones of the thoracic cage, which prevent the progression of the ultrasound beam. However, the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly "water-rich" or "air-rich". The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.

Liquid Chromatography-tandem Mass Spectrometry for Analysis of Acylcarnitines in Dried Blood Specimens Collected at Autopsy from Neonatal Intensive Care Unit

Objective To investigate the feasibility of analyzing acylcarnitine in dry filter-paper blood spots by liquid chromatography-tandem mass spectrometry(LC-MS/MS) which could be applied to detect inborn errors of metabolism in neonates.Methods We obtained filter-paper blood from 26 dead infants from a neonatal intensive care unit(NICU) between October 1,2008 and September 30,2009.Acylcarnitine and amino acid profiles were obtained with LC-MS/MS.Four infants underwent routine autopsy.The postmortem blood specimens were compared with newborn blood specimens,and with specimens obtained from older infants with metabolic disorders.Results Of all the 26 patients,5(19.2%) were diagnosed as having different kinds of diseases:3 with methylmalonic acidemia(the concentration of C3,and the ratio of C3/C16,C3/C2 increased),1 with maple syrup urine disease(the concentration of leucine and isoleucine increased),and 1 with isovaleric aci-demia(the concentration of C5 increased).Conclusions Postmortem metabolic test can explain infant deaths and provide estimates of deaths attributable to inborn errors of metabolism in NICU.LC-MS/MS is suitable for analysis of postmortem specimens and can be considered for routine application in NICU autopsy.

The Incidence of Respiratory Distress Syndrome among Preterm Infants Admitted to Neonatal Intensive Care Unit: A Retrospective Study

Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) is the most common cause of neonatal morbidity and mortality in preterm infants. We aimed to determine the frequency of RDS among 3 groups of preterm infants and the value of some related factors. Methods: A cross-sectional, descriptive analytical investigation was carried out in the NICU ward of Akbarabadi Hospital (Tehran-Iran) during spring 2011. Newborns’ data were collected and assessed by using their hospital medical records. Seventy-three preterm infants with gestational age < 34 weeks were hospitalized in the NICU. All participants were divided into 3 groups: extremely preterm (<28 weeks), very preterm (28 to <32 weeks) and moderate preterm (32 to 34 weeks). Frequency of RDS and some related factors were compared among 3 groups. Results: RDS was observed in 65.6% of all participants;however frequency of RDS was not different between three groups. An inversely correlation was found between gestational age and mortality rate (p = 0.05). In regard to Betamethasone administration prior to birth, this interval was significantly longer in alive neonates in comparison to infants who died (p < 0.05). Conclusion: RDS was frequent in preterm neonates with gestational age < 32 weeks. Time of Betamethasone administration prior to birth can significantly influence on neonatal mortality rate.

Prevalence and Spectrum of Complex Congenital Heart Disease in the Neonatal Intensive Care Unit at High Altitude in China

Background:Previous studies from high altitudes have reported significantly higher prevalence of congenital heart disease(CHD),consisting almost solely of simple CHD.Little is known about the occurrence of complex CHD.Neonates with complex CHD are likely admitted to NICU.We examined the prevalence and spectrum of complex CHD in NICU in order to depict a truer picture of CHD at high altitude.Methods:We reviewed charts of 4,214 neonates admitted to NICU in Qinghai province(average altitude 3,000 m).Echocardiography was performed in 1,943 babies when CHD was suspected based on clinical examinations.Results:CHD was diagnosed in 1,093(56.3%of echoed babies).Mild CHD in 96.8%(1058 babies).Moderate CHD in 0.8%(9)included 1(0.1%)large secundum atrial septal defect,3(0.3%)moderate pulmonary stenosis,2(0.2%)aortic stenosis and 3(0.3%)partial anomalous pulmonary venous connection.Severe CHD in 2.4%(26)included 6(0.5%)complete atrioventricular septal defect,5(0.5%)complete transposition of the great arteries,5(0.5%)hypoplastic right heart,3(0.3%)hypoplastic left heart,3(0.3%)double outlet right ventricle,3(0.3%)tetralogy of Fallot,2(0.2%)truncus arteriosus,2(0.2%)total anomalous pulmonary venous connection,2(0.2%)severe aortic stenosis,2(0.2%)interrupted aortic arch and 2(0.2%)severe pulmonary stenosis and 1(0.1%)single-ventricle abnormality.At two-years follow-up in 737(67.4%)patients,18(90%)with severe CHD and 38(5.3%)with mild and moderate CHD died,and 15 underwent cardiac surgery with 1 early death.Conclusions:At high altitude,a wide spectrum of CHD exists,with many heretofore unreported complex CHD.There is urgent need for routine echocardiography and early interventions in newborns particularly in NICU.

Healthcare Associated Infection in the Neonatal Intensive Care Unit of King Abdl Aziz Specialist Hospital, Taif, KSA

Healthcare-associated infection is a common problem of newborn in neonatal intensive care units. It results in high mortality rate and serious complications. The Aim: to assess the incidence, etiology and the mortality of healthcareassociated infections of patients in neonatal intensive care unit at King Abdl Aziz Specialist Hospital (KAASH), Taif, Kingdom of Saudi Arabia. Material and Methods: This is a retrospective study including 8033 neonates admitted to neonatal intensive care unit during period between April, 2006 and December, 2012. The health-care associated infection rate, mortality rate, causative organism and risk factors were studied. Results: The prevalence of health-care associated infection was found to be 6.03%;the mortality rate was 27.1%. The highest prevalence was among children with the birth weight below 1000 g. The most frequent causative pathogen was klebseilla spp, followed by other gram negative bacilli. Conclusion: The rate of healthcare-associated infections in neonatal intensive care unit at KAASH was relatively high. In addition, the mortality rate was observed to be high (27.1%) owing to the high virulence of the causative organisms.

Physician staffing pattern in intensive care units:Have we cracked the code?

Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffingmay be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.