Gut microbiota in preterm infants receiving breast milk or mixed feeding

BACKGROUND Preterm birth is the leading cause of mortality in newborns,with very-low-birthweight infants usually experiencing several complications.Breast milk is considered the gold standard of nutrition,especially for preterm infants with delayed gut colonization,because it contains beneficial microorganisms,such as Lactobacilli and Bifidobacteria.AIM To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less.METHODS An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less,born at the University Hospital Dr.JoséEleuterio González at Monterrey,Mexico.A total of 40 preterm neonates were classified into breast milk feeding(BM)and mixed feeding(MF)groups(21 in the BM group and 19 in the MF group),from October 2017 to June 2019.Fecal samples were collected before they were introduced to any feeding type.After full enteral feeding was achieved,the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing.Numerical variables were compared using Student’s t-test or using the Mann–Whitney U test for nonparametric variables.Dominance,evenness,equitability,Margalef’s index,Fisher’s alpha,Chao-1 index,and Shannon’s diversity index were also calculated.RESULTS No significant differences were observed at the genus level between the groups.Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group(P<0.011).In addition,higher counts of Gammaproteobacteria were detected in the final than in the initial sample(P=0.040).According to the Margalef index,Fisher’s alpha,and Chao-1 index,a decrease in species richness from the initial to the final sample,regardless of the feeding type,was observed(P<0.050).The four predominant phyla were Bacteroidetes,Actinobacteria,Firmicutes,and Proteobacteria,with Proteobacteria being the most abundant.However,no significant differences were observed between the initial and final samples at the phylum level.CONCLUSION Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria,contributing to the literature of the gut microbiota structure of very low-birth-weight,preterm.

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.

Pharmacogenomics-based individualized treatment of hypertension in preterm infants: A case report and review of the literature

BACKGROUND Neonatal hypertension is a rare but potentially serious condition that requires careful monitoring and treatment.Pharmacogenomics can help guide individualized drug therapy and improve outcomes.CASE SUMMARY We report a case of a preterm infant with multiple complications,including bronchopulmonary dysplasia(BPD),sepsis,intracranial hemorrhage,and hypertension.The infant was treated with various drugs,including dexamethasone and amlodipine.The infant was diagnosed with neonatal hypertension based on blood pressure measurements exceeding the 95th percentile for his age and sex.The possible causes of hypertension included dexamethasone,hydrochlorothiazide,spironolactone,and BPD.The infant was treated with oral amlodipine to lower his blood pressure.A pharmacogenomic test was performed to evaluate the genetic polymorphisms of ABCB1 and CYP3A5,which are involved in the metabolism and transport of dexamethasone and amlodipine.The infant’s blood pressure was well controlled after the dose of amlodipine was reduced according to the pharmacogenomic results.The infant had a stable general condition and was discharged on the 100th d after birth.CONCLUSION This case illustrates the importance of regular blood pressure monitoring and etiological investigation in preterm infants with hypertension.Pharmacogenomics can provide useful information for individualized drug therapy and safety in this population.

Transcatheter Closure vs.Surgical Ligation in Preterm Infants with Patent Ductus Arteriosus:A Systematic Review and Meta-Analysis

Background:Persistent patent ductus arteriosus(pPDA)is a common condition in preterm infants.This metaanalysis aimed to assess the safety and efficacy of transcatheter closure(TC)when compared to surgical ligation(SL)in preterm infants with pPDA.Methods:A literature search of Ovid Cochrane Library,Medline,Embase,Epub,Scopus,PMC Preprints,and ClinicalTrials.Gov was conducted from inception to May 06,2022.Eligible studies reported infants diagnosed with pPDA born at≤2000 g birth weight or at≤37 weeks’who underwent TC or SL as treatment.This review was registered in PROSPERO(CRD42022325944).Results:From 97 studies screened,8 studies met the eligibility criteria,with a total of 756 preterm infants undergoing either TC(n=366)or SL(n=390).Compared to TC,SL had higher mortality rates(OR=0.32,95%CI:0.16,0.66,I^(2)=0%).No difference was seen in post-procedural complication rate(OR=0.90,95%CI:0.18,4.44,I^(2)=79%),mean duration of post-procedural mechanical ventilation(MD=−2.21 days,95%CI:−4.88,0.47,I^(2)=60%),hospital stay length(MD=−8.30 days,95%CI:−17.03,0.44,I^(2)=0%)or neonatal intensive care unit stay length(MD=−3.50 days,95%CI:−10.27,3.27,I^(2)=0%).Conclusion:Our meta-analysis demonstrated TC as a viable alternative option in managing preterm infants with pPDA in the context of SL.Despite the promising trends demonstrated in this meta-analysis,further studies with larger sample size and controlled baseline characteristics are needed to evaluate the safety and efficacy of TC and SL for preterm infants with pPDA.

Enhancing the role of nurses in breastfeeding preterm infants

The provision of breast milk and breastfeeding is recommended for preterm infants.Multidisciplinary cooperation is required to promote breastfeeding.Nurses play impor tant roles in breastfeeding preterm infants.First,nurses are strong advocates to help families be aware of the significance of breastfeeding.Second,nurses are educators providing technical and emotional support to pregnant and lying-in women.Third,nurses are coordinators in a multidisciplinary team.Nurses’unawareness of the impor tance of breastfeeding,knowledge deficit,and unsupportive lactation policy are barriers to breastfeeding promotion for preterm infants.It is therefore suggested that hospital administrators provide appropriate breastfeeding policies,set up posts,and ensure nurses’responsibilities in breastfeeding.Additionally,tailored training should be strengthened to improve nurses’knowledge and skills and thereby enable them to fully exer t their roles in the breastfeeding promotion of preterm infants.

Effects of Different Surfactant Administrations on Cerebral Autoregulation in Preterm Infants with Respiratory Distress Syndrome

To treat respiratory distress syndrome,surfactant is currently delivered via less invasive surfactant administration（LISA） or INtubation SURfactant Extubation（INSURE）.The aim of this study was to compare the effect of the two delivery methods of surfactant on cerebral autoregulation.Near infrared spectroscopy monitoring was carried out to detect cerebral oxygen saturation（Sc O2）,and the mean arterial blood pressure（MABP） was simultaneously recorded.Of 44 preterm infants included,the surfactant was administrated to 22 via LISA and 22 via INSURE.The clinical characteristics,treatments and outcomes of the infants showed no significant differences between the two groups.The correlation coefficient of Sc O2 and MABP（rSc O2-MABP） 5 min before administration was similar in the two groups.During surfactant administration,rSc O2-MABP increased in both groups（0.44±0.10 to 0.54±0.12 in LISA,0.45±0.11 to 0.69±0.09 in INSURE）.In the first and second 5 min after instillation,rSc O2-MABP was not significantly different from baseline in the LISA group,but increased in the first 5 min after instillation（0.59±0.13,P=0.000 compared with the baseline in the same group） and recovered in the second 5 min after instillation（0.48±0.10,P=0.321） in the INSURE group.There were significant differences in the change rates of rSc O2-MABP between the two groups during and after surfactant administration.Our results suggest that cerebral autoregulation may be affected transiently by surfactant administration.The effect duration of LISA is shorter than that of INSURE（〈5 min in LISA vs.5–10 min in INSURE）.

Early Intratracheal Administration of Corticosteroid and Pulmonary Surfactant for Preventing Bronchopulmonary Dysplasia in Preterm Infants with Neonatal Respiratory Distress Syndrome: A Meta-analysis

There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67;95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56;95% CI: 0.45-0.69, and RR: 0.35;95% CI:0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI:0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.

Reliability and validity of the Chinese version of the Readiness for Hospital Discharge Scale-Parent Form in parents of preterm infants

Background: The Readiness for Hospital Discharge Scale (RHDS)-Parent Form shows satisfactory reli-ability and validity to assess the readiness of parents to take care of their children discharged from hospitals in Western countries. However, the reliability and validity of this instrument has not been evaluated in Chinese populations.Objectives: Evaluate the psychometric features of the RHDS-Parent Form among Chinese parents of preterm infants. Methods: The RHDS-Parent Form was translated into a Chinese version following an international in-strument translation guideline. A total of 168 parents with preterm infants were recruited from the neonatal intensive care units of two tertiary-level hospitals in China. The internal consistency of this measure was assessed using the Cronbach's a coefficient;confirmatory factor analysis was conducted to evaluate the construct validity;and Pearson correlation coefficient was used to report the convergent validity. Results: The Chinese version of RHDS (C-RHDS)-Parent Form included 22 items with 4 subscales, ac-counting for 56.71% of the total variance. The C-RHDS-Parent Form and its subscales showed good reliability (Cronbach's a values 0.78-0.92). This measure and its subscales showed positive correlations with the score of Quality of Discharge Teaching Scale. Conclusion: The factor structure of C-RHDS-Parent Form is partially consistent with the original English version. Future studies are needed to explore the factors within this measure before it is widely used in Chinese clinical care settings.

Multi-center Study of Enteral Feeding Practices in Hospitalized Late Preterm Infants in China

Objective To investigate the current enteral feeding practices in hospitalized late preterm infants in the Beijing area of China. Methods A multi-center, cross-sectional study was conducted. Infants born after 34 weeks and before 37 weeks of gestation were enrolled from 25 hospitals in the Beijing area of China from October 2015 to October 2017. Data on enteral feeding practices were collected and analyzed. Results A total of 1,463 late preterm infants were enrolled, with a mean gestational age（GA） of 35.6（34.9, 36.1） weeks. The percentage of exclusive breastfeeding was 4.5% at the initiation of enteral feeding but increased to 14.4% at discharge. When human milk was not available, most infants（46.1%） were fed with preterm infant formula. The rate of exclusive human milk feeding in infants born at 34 weeks gestation was higher than at discharge（21.1% of infants born at 34 weeks＇ GA versus 12.1% of infants born at 35 weeks＇ GA versus 12.3% of infants born at 36 weeks＇ GA, P 〈 0.001）. Only 28.4% of late preterm infants achieved full enteral feeding at discharge, and only 19.2% achieved 120 kcal/（kg·d） by enteral feeding at discharge. Importantly, 40.5% of infants did not regain the birth weight at discharge. Conclusion Enteral feeding support of late preterm infants has not been standardized to achieve optimal growth. Moreover, the human milk feeding rate was low, and many late preterm infants did not achieve the goal of enteral feeding and failed to regain birth weight at the time of discharge. More aggressive enteral feedings protocols are needed to promote human milk feeding and optimize growth for late preterm infants.

Application of prolonging small feeding volumes early in life to prevent of necrotizing enterocolitis in very low birth weight preterm infants

Objective:To study the effects of prolonging small feeding volumes early in life on the incidence of necrotizing enterocolitis(NEC)in very low birth weight(VLBW)preterm infants.Methods:A total of 128 VLBW infants who could not be breastfed were assigned into the experimental group(63 cases)and the control group(65 cases)using a random number table.The experiment group was fed 12 mL/(kg·d)on day 1 which was increased to 24 mL/(kg·d)for the first 10 study days.The control group was fed 12 mL/(kg·d)for the first 14e48 hours.Then,the feeding volume increased by 24-36 mL/(kg·d)up to 140e160 mL/(kg·d)and maintained until the 10th day after birth.The incidence of feeding intolerance and NEC,duration of hospitalization,time to full enteral feedings,incidence of intrahepatic cholestasis,and the levels of gastrin and motilin in serum were assessed.Results:The incidence of feeding intolerance was significantly lower in the experimental group compared with the control group(15.87% vs.33.84%).There was a significant reduction in the incidence of NEC between the experimental and control groups(7.9% vs.16% in the control group).Conclusion:A protocol that prolongs small feeding volumes early in life can reduce the incidence and severity of NEC,but still warrants further study.

Resuscitation of extremely preterm infants- controversies and current evidence

Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable(gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.

Bedside cardiopulmonary ultrasonography evaluates lung water content in very low-weight preterm neonates with patent ductus arteriosus

BACKGROUND Patent ductus arteriosus(PDA)is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights.When PDA persists,interstitial lung water content increases,which could lead to abnormal circulation hemodynamics and pulmonary edema.It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA.AIM To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA.METHODS From January 2018 to March 2020,69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group.At the same time,89 very low-weight preterm neonates without PDA were randomly selected as the control group.All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth.The clinical characteristics and main ultrasonography results were compared between the two groups.Pearson’s analysis was used to analyze the correlation between lung ultrasonography score(LUS)and other related clinical and ultrasonography results in all neonates.In the PDA group,PDA diameters were recorded,and the correlation with LUS and left atrium to aortic(LA/AO)dimension ratio were also analyzed.LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA.When the ratio is≥1.5,it suggests the possibility of hemodynamic changes in persistent PDA.A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa.RESULTS A total of 158 neonates were enrolled in this study,including 69 in the PDA group and 89 in the control group.There were no statistical differences in sex,gestational age,birth weight,ventilator dependence,hospitalization length and left ventricular ejection fraction between the two groups(P>0.05).The LUS and LA/AO ratio in the PDA group were higher than those in the control group(P<0.05),but there was no difference of LUS in neonates with or without use of the ventilator(t=0.58,P=0.16).In all cases,LUS was negatively correlated with gestational age(r=-0.28,P<0.01)and birth weight(r=-0.36,P<0.01),while positively correlated with the LA/AO ratio(r=0.27,P<0.01).In the PDA group,PDA diameter was positively correlated with the LA/AO ratio(r=0.39,P<0.01)and LUS(r=0.31,P<0.01).Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA(area under the curve=0.741;sensitivity=93.75%;specificity=50.94%).CONCLUSION Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.

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.

Management of Extravasation Injuries in Preterm Infants

Extravasation injuries occur in up to 70% of neonates in intensive care, majority being preterm infants. Their fragile and premature anatomy makes prevention and management of extravasation extra difficult compared to those of full-term. With increasing advances of intensive care for preterm infants, the use of intravenous medication and nutrition will increase, thus lead to further potential risk of extravasation injuries, which has serious complications, such as full-thickness skin loss, tissue necrosis and acute limb compartment syndrome, with long-term functional and cosmetic sequelae. There is a current lack of evidence in the literature on the most appropriate therapeutic strategy for this vulnerable patient group. This review aims to highlight our trust regime on the management of extravasation injuries (non-chemotherapeutic) for preterm infants, including injury classification and assessment, and implementation of initial interventions.

Predictors of readiness for discharge in mothers of preterm infants: The role of stress, self-efficacy and perceived social support

Objective:To determine the predictive role of stress,self-efficacy,and perceived social support on readiness for discharge in mothers of preterm infants.Methods:The present cross-sectional,descriptive-analytical study was conducted on 120 mothers of preterm infants admitted to hospitals affiliated to Lorestan University of Medical Sciences,Iran in 2019.Participants were selected by a convenience sampling method and based on inclusion criteria.Data collection tools included the demographic questionnaire of mothers and infants,parent perceptions of their child's hospital discharge,parental stressor scale:neonatal intensive care unit,perceived maternal parenting,and multidimensional scale of perceived social support.Data were analyzed using Pearson correlation and stepwise regression at the significance level of 0.05.Results:Infant behavior and appearance,situational belief,and family support achieved the highest mean score from parents'stress,self-efficacy,and perceived social support dimensions,respectively.There was a significant relationship between stress,self-efficacy,and perceived social support with readiness for discharge in mothers of preterm infants(P<0.001).The score of mothers'readiness for discharge decreased by 0.07 per 1-point increase in stress score,and the score of readiness for discharge in mothers of preterm infants rose by 0.35 and 0.43,respectively,for a unit increase in the scores of self-efficacy and perceived social support.Conclusions:Stress,self-efficacy,and perceived social support can be considered as predictors of readiness for discharge in mothers of preterm infants.It is suggested that nurses in neonatal intensive care units provide a better platform for the readiness for discharge in mothers of preterm infants by reducing stressors and increasing maternal self-efficacy and social support.

Biological and Nutritional Aspects of Human Milk in Feeding of Preterm Infants

Breastfeeding and human milk are the normative standards for feeding and nutrition of both term and pre-term infants. Fresh mother’s own milk is recognized as the optimal choice for feeding all newborns, including preterm and very low birth weight infants. Evidence documents short and long-term metabolic, immunologic and neurodevelopmental advantages of breastfeeding when compared to formula. Moreover, benefits of breastfeeding on psychological and relational aspects have to be considered. Currently, human milk supplementation is usually performed to meet the specific nutritional requirements of preterm infants. When mother’s milk is unavailable or in short supply, donor milk represents the best alternative, although some nutritional elements are inactivated by the necessary pasteurization process. Aim of this review is to briefly summarize the main biological and nutritional factors that contribute to the beneficial effects of human milk feeding for preterm infants.

“AFGP” bundles for an extremely preterm infant who underwent difficult removal of a peripherally inserted central catheter:A case report

BACKGROUND There have been few reports on level 3 difficult removal of peripherally inserted central catheter(PICC)in neonates.Here,we reported a case of an extremely preterm infant who underwent level 3 difficult removal of a PICC.CASE SUMMARY Female baby A,weighing 1070 g at 27^(+1) wk of gestational age,was diagnosed with extremely preterm infant and neonatal respiratory distress syndrome.She underwent PICC insertion twice.The first PICC insertion went well;the second PICC was inserted in the right lower extremity,however,phlebitis occurred on the second day after the placement.On the third day of catheterization,phlebitis was aggravated,while the right leg circumference increased by 2.5 cm.On the fourth day of catheterization,more red swelling was found in the popliteal part,covering an area of about 1.5 cm×4 cm,which was diagnosed as phlebitis level 3;thus,we decided to remove the PICC.During tube removal,the catheter rebounded and could not be pulled out(several conventional methods were performed).Finally,we successfully removed the PICC using a new approach termed“AFGP”.On the 36th day of admission,the baby fully recovered and was discharged.CONCLUSION The“AFGP”bundle approach was effective for an extremely preterm infant,who underwent level 3 difficult removal of a PICC.

Automatic Abnormal Electroencephalograms Detection of Preterm Infants

Many preterm infants suffer from neural disorders caused by early birth complications. The detection of children with neurological risk is an important challenge. The electroencephalogram is an important technique for establishing long-term neurological prognosis. Within this scope, the goal of this study is to propose an automatic detection of abnormal preterm babies’ electroencephalograms (EEG). A corpus of 316 neonatal EEG recordings of 100 infants born after less than 35 weeks of gestation were preprocessed and a time series of standard deviation was computed. This time series was thresholded to detect Inter Burst Intervals (IBI). Temporal features were extracted from bursts and IBI. Feature selection was carried out with classification in one step so as to select the best combination of features in terms of classification performance. Two classifiers were tested: Multiple Linear Regressions and Support Vector Machines (SVM). Performance was computed using cross validations. Methods were validated on a corpus of 100 infants with no serious brain damage. The Multiple Linear Regression method shows the best results with a sensitivity of 86.11% ± 10.01%, a specificity of 77.44% ± 7.62% and an AUC (Area under the ROC curves) of 0.82 ± 0.04. An accurate detection of abnormal EEG for preterm infants is feasible. This study is a first step towards an automatic analysis of the premature brain, making it possible to lighten the physician’s workload in the future.

PreEMPT (Preterm Infant Early Intervention for Movement and Participation Trial): The Feasibility of a Novel, Participation-Focused Early Physiotherapy Intervention Supported by Telehealth in Regional Australia—A Protocol

Background: Early intervention is beneficial for improving preterm infant motor and cognitive outcomes in early childhood;however, little is known about whether early intervention can influence a preterm infant’s participation. Additionally, many studies investigating the impact of early intervention for preterm infants have been conducted in large metropolitan centres, leaving preterm infants who reside in regional areas underrepresented in the literature to date. Consequentially, it is not yet known whether there are service delivery models, such as using telehealth as an adjunct to face-to-face intervention, that might cater to the needs of preterm infants residing outside metropolitan centres. PreEMPT (Preterm infant Early intervention for Movement and Participation Trial) is a novel early physiotherapy intervention that has been designed to use a participation goal-directed intervention approach via a mixture of face-to-face clinic sessions and telehealth sessions to improve the motor and participation outcomes of preterm born infants. Methods: This study aims to evaluate the feasibility of PreEMPT using an assessor-blinded, randomised controlled trial to compare PreEMPT to Usual Physiotherapy Care (UPC) for preterm infants residing in a regional Australian hospital catchment area. Twenty-six preterm infants (≤34 + 6 weeks gestational age) will be recruited prior to term corrected age from the special care nursery of a regional hospital. Following informed consent and baseline assessments, infants will be randomly allocated to receive either PreEMPT, a novel participation-focused early physiotherapy intervention delivered weekly for 14 forty-five-minute sessions alternating face-to-face sessions with telehealth into the infant’s home, or UPC, two - three physiotherapy sessions in the 4-month intervention period. Outcome measures relating to infant neuromotor development, motor performance, general development, and parental mental health and well-being will be assessed at 4-, 6- and 8-months corrected age. Feasibility will be evaluated by acceptability (parental satisfaction), demand and practicality (recruitment rate and telehealth session implementation), implementation (attendance at assessment and treatment sessions), and limited efficacy testing (comparing outcomes listed above for infants in PreEMPT and UPC). Discussion: This study will be the first of its kind to use the participation of preterm infants in meaningful life situations as the foundation for intervention delivered via alternating face-to-face clinic sessions with telehealth into the home. The feasibility of this approach will be evaluated and used to inform future iterations of research about PreEMPT’s efficacy for improving preterm infant motor and participation outcomes.

Motor Profile of Late Preterm Infants: A Systematic Review of the Last Decade

Motor development at late preterm infants has significant importance as it composes the picture of the severe evidences of motor impairments or other developmental difficulties. Early detection is crucial as early intervention is the unique immediate solution option to catch up the developmental milestones. Method: Α systematic search for scientific articles of the decade 2010-2020 investigating the motor profile of late preterm infants was conducted. Results: The search identified 9 studies, many of which highlighted the risk of motor and developmental delays even at 36 months of age. Conclusions: The stability of motor and developmental delays indicates the need of further investigation at a later age and intervention to avoid possible academic difficulties.