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.

Optic nerve sheath diameters in nontraumatic brain injury:A scoping review and role in the intensive care unit

BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure(ICP)modalities or unstable to transport for imaging.Ultrasonography-based optic nerve sheath diameter(ONSD)is an attractive option as it is reliable,repeatable and easily performed at the bedside.It has been sufficiently validated in traumatic brain injury(TBI)to be incorporated into the guidelines.However,currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made.AIM To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients.METHODS PubMed,Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP.Studies from 2010 to 2024 in English languages were included.RESULTS We found 37 articles relevant to our search.The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm.Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter.ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke,intracerebral bleeding and intracranial infection.However,ONSD is of doubtful utility in septic metabolic encephalopathy,dysnatremias and aneurysmal subarachnoid haemorrhage.CONCLUSION ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.

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.

Application of Flipped Classroom Combined with PBL Teaching Method in the Teaching of Respiratory Intensive Care Unit Nursing

Objective:The aim is to investigate the application effect of flipped classroom combined with problem-based learning(PBL)teaching method in the teaching of respiratory intensive care unit nursing.Methods:100 fresh nursing students who were interned in the respiratory intensive care unit of our hospital from June 2020 to May 2022 were selected and randomly divided into 50 students in the control group and 50 students in the experimental group.The students in the control group were taught by PBL teaching method,and the students in the experimental group were taught by flipped classroom combined with PBL teaching method.After the completion of the teaching,the teachers combined the performance of the two groups of students,and scored them comprehensively in terms of their professional theoretical knowledge,clinical operation skills,independent learning ability,and teamwork ability,and carried out a survey of the experimental group’s students in terms of their satisfaction with the understanding of theoretical knowledge,clinical operation,independent learning ability,teamwork ability,and other dimensions.Results:There was no statistical significance in the specialized theoretical knowledge scores of the two groups of students(P>0.05).The scores of clinical operation,independent learning ability,and teamwork ability of the two groups of students were statistically significant(P<0.05),and all the scores of the students in the experimental group were higher than that of the control group.More than 90%of the students believed that the flipped classroom combined with PBL teaching method could assist in the comprehension of theoretical knowledge,improve the clinical operation skills,enhance the ability of independent learning and teamwork;there were 92%of the students supported the use of flipped classroom combined with PBL teaching in respiratory intensive care unit nursing teaching.Conclusion:In the teaching of respiratory intensive care unit nursing,the use of flipped classroom combined with PBL teaching method can improve the learning effect of students,and has certain value in teaching.

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.

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.

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.

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.

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’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.

Optimization of Exposure Conditions for Computed Radiology Exams in Neonatal Intensive Care

This paper performs a review of existing literature about neonatal imaging in intensive care;we notice that the multiplicity of approaches results in different and sometimes conflicting solutions to optimize acquisition technique of X-ray images. European Guidelines still refer to screen-film combinations used in past decades, current usage of digital technology requires an additional effort to reduce dose to infants and to optimize the sensor’s response exploiting their properties. In this work we investigate response changes of digital medium (computed radiography plates), due to alterations of the beam through incubators components. All combinations in use in our Hospital were tested for evaluating dosimetry and image quality and new exposure solutions were devised to optimize radiology exams, taking into account solutions suggested by the equipments makers. Dose measured was compared with dose levels suggested by European Guidelines, evaluating radiation-induced risk too. Image quality was evaluated in a double-blind comparison by radiologists. An easily repeatable optimization procedure is proposed intended to reduce delivered dose well below European guidelines. The proposed study allowed us to instruct the technologists on the most appropriate methodology for performing the radiology exam, by standardizing the approach to Neonatal Intensive Care Units. We have demonstrated also to radiologic technologists reluctant to use the X-ray tray, as it may optimize imaging in the incubator. We were also able to reduce dose—and radiation-induced risk too—of 37% - 67% depending on the previously used operating mode.

基于Levine守恒理论的家庭参与式护理在支气管肺发育不良患儿出院前的应用观察

目的探讨基于Levine守恒理论的家庭参与式护理(LFIC)在支气管肺发育不良(BPD)患儿出院前照护中的应用效果。方法选取2022年1—12月于上海交通大学医学院附属新华医院新生儿重症监护室住院治疗的BPD患儿66例为研究对象,采用随机数字表法分为观察组(n=35)和对照组(n=31)。两组采用相同的治疗措施,对照组采用早产儿常规护理干预,观察组在对照组早产儿常规护理基础上加用LFIC干预。观察并比较两组患儿的生长速度、母乳喂养率和用氧天数,出院30 d后的体重增加值、再入院率及患儿家长满意度评分。结果观察组患儿生长速度和母乳喂养率均高于对照组(P<0.05);两组用氧天数比较,差异无统计学意义(P>0.05)。出院后30 d,观察组患儿家长满意度评分和体重增加值均高于对照组(P<0.05);两组再入院率比较,差异无统计学意义(P>0.05)。结论基于Levine守恒理论的LFIC方案应用于BPD患儿出院前照护,可有效提高患儿生长速度、母乳喂养率和患儿家长满意度,且出院后患儿体重增加明显。

Can rifaximin for hepatic encephalopathy be discontinued during broad-spectrum antibiotic treatment?

Hepatic encephalopathy(HE)is a formidable complication in patients with decompensated cirrhosis,often necessitating the administration of rifaximin(RFX)for effective management.RFX,is a gut-restricted,poorly-absorbable oral rifamycin derived antibiotic that can be used in addition to lactulose for the secondary prophylaxis of HE.It has shown notable reductions in infection,hospital readmission,duration of hospital stay,and mortality.However,limited data exist about the concurrent use of RFX with broad-spectrum antibiotics,because the patients are typically excluded from studies assessing RFX efficacy in HE.A pharmacist-driven quasi-experimental pilot study was done to address this gap.They argue against the necessity of RFX in HE during broad-spectrum antibiotic treatment,particularly in critically ill patients in intensive care unit(ICU).The potential for safe RFX discontinuation without adverse effects is clearly illuminated and valuable insight into the optimization of therapeutic strategies is offered.The findings also indicate that RFX discontinuation during broadspectrum antibiotic therapy was not associated with higher rates of delirium or coma,and this result remained robust after adjustment in multivariate analysis.Furthermore,rates of other secondary clinical and safety outcomes,including ICU mortality and 48-hour changes in vasopressor requirements,were comparable.However,since the activity of RFX is mainly confined to the modulation of gut microbiota,its potential utility in patients undergoing extensive systemic antibiotic therapy is debatable,given the overlapping antibiotic activity.Further,this suggests that the action of RFX on HE is class-specific(related to its activity on gut microbiota),rather than drug-specific.A recent double-blind randomized controlled(ARiE)trial provided further evidence-based support for RFX withdrawal in critically ill cirrhotic ICU patients receiving broad-spectrum antibiotics.Both studies prompt further discussion about optimal therapeutic strategy for patients facing the dual challenge of HE and systemic infections.Despite these compelling results,both studies have limitations.A prospective,multi-center evaluation of a larger sample,with placebo control,and comprehensive neurologic evaluation of HE is warranted.It should include an exploration of longer-term outcome and the impact of this protocol in non-critically ill liver disease patients.

Use of antenatal corticosteroids among infants with gestational age at 24 to 31 weeks in 57 neonatal intensive care units of China: a cross-sectional study

Background:Antenatal corticosteroids(ACS)can significantly improve the outcomes of preterm infants.This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units(NICU)and to explore perinatal factors associated with ACS use,using the largest contemporary cohort of very preterm infants in China.Methods:This cross-sectional study enrolled all infants born at 24^(+0)to 31^(+6)weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st,2019 to December 30th,2019.The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery.Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.Results:A total of 7828 infants were enrolled,among which 6103(78.0%)infants received ACS.ACS use rates increased with increasing gestational age(GA),from 177/259(68.3%)at 24 to 25 weeks’gestation to 3120/3960(78.8%)at 30 to 31 weeks’gestation.Among infants exposed to ACS,2999 of 6103(49.1%)infants received a single complete course,and 33.4%(2039/6103)infants received a partial course.ACS use rates varied from 30.2%to 100%among different hospitals.Multivariate regression showed that increasing GA,born in hospital(inborn),increasing maternal age,maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.Conclusions:The use rate of ACS remained low for infants at 24 to 31 weeks’gestation admitted to Chinese NICUs,with fewer infants receiving a complete course.The use rates varied significantly among different hospitals.Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.

汉化版Neonatal/Infant Braden Q Scale在NICU新生儿压力性损伤风险评估中的应用

目的:引进翻译美国Neonatal/Infant Braden Q Scale(N/I Braden Q量表)并检验量表信效度。方法:根据Brislin翻译模型对N/I Braden Q量表进行翻译、回译,通过专家咨询对量表进行文化调适。再将量表应用于浙江省某三级甲等医院NICU住院新生儿进行皮肤评估,检验中文版N/I Braden Q量表的信效度。结果:中文版N/I Braden Q量表的评定者间信度系数ICC为0.908(P<0.001);量表的全体一致性S-CVI为0.75,均值S-CVI为0.9583,各条目的内容效度指数为0.83~1;量表的预测临界值为20分,其灵敏度、特异度、阳性预测值、阴性预测值、约登指数分别为75.00%、74.16%、28.13%、95.62%、0.4916,ROC曲线下面积是0.815(95%CI:0.684~0.945)(P<0.001)。结论:中文版N/I Braden Q量表具有良好的信效度,对新生儿压力性损伤发生有早期预警作用,可作为临床护士对患儿进行皮肤评估的结构化指导工具。

Study on the Relationship between Nursing Staffing and Nosocomial Infection in Very Low Birth Weight Infants

Background: At present, there is no domestic research on the relationship between nurse staffing and hospital infection in very low birth weight infants. In this paper, we will explore the relationship between nurses of very low birth weight (VLBW) infants in neonatal intensive care unit (NICU) and nosocomial infections. Methods: The clinical data of 280 very low birth weight infants born in our hospital from January 2010 to January 2020 were collected, and the chi-square test and multiple logistic regression analysis were used to study the nursing staff of each very low birth weight infant who was admitted to the NICU The relationship between the number of infections and hospital infections. Results: On average, each nurse needs to care for 4.3 very low birth weight infants (lowest to highest: 2.50 - 8.42). In the univariate analysis, the higher the incidence of urinary tract infection (P < 0.05), the multivariate logistic regression analysis of neonatal nosocomial infection showed that nurse staffing was significantly related to the incidence of urinary tract infection (OR = 1.78;95% confidence interval, 1.17 - 2.35, P < 0.05). However, there was no significant correlation between nurse staffing and bloodstream infection (OR = 0.91;95% confidence interval, 0.74 - 1.06, P > 0.05) or Ventilator associated pneumonia (VAP) infection (OR = 1.17;95% confidence interval, 0.94 - 1.47, P > 0.05). Conclusion: Our research shows that in the neonatal intensive care unit, the reasonable deployment of nursing staff is an important factor in preventing urinary tract infections in very low birth weight infants. It is important for improving the survival rate of very low birth weight infants and reducing the occurrence of sequelae.

Categorization and Frequency of Indications for Packed Cell Transfusion in the Preterm Newborn during the Initial Hospital Stay at a Tertiary Care Hospital: A Cross-Sectional Study

Introduction: Packed cell transfusion is a lifesaving procedure in premature babies as they have more complications as compared to babies who are born at term. Complications related to prematurity increase as gestational age decreases and anemia is one of the complications of prematurity which needs packed cell transfusions. To date, when to transfuse preterm babies and what would be the threshold for hemoglobin and hematocrit is still a point of argument as well as liberal versus restrictive transfusion protocols have been developed but what should be followed still needs more data. In our study, we have observed frequencies of different indications of packed cell transfusion in the neonatal intensive care unit of a tertiary care hospital. This endeavor will help in the establishment of guidelines regarding transfusion and the threshold on which any intervention should be done also it would be a step towards the identification of preventable causes that lead to transfusion and transfusion-related risks and hazards. Objective: To determine the indication of packed cell transfusion and their frequencies in preterm neonates. Study Design: This was a cross-sectional study. Setting: The study was carried out in the neonatal intensive care unit (NICU). Study Duration: The duration of the study was 1 year. Material and Methods: A total of 246 preterm neonates admitted to Aga Khan University Hospital (AKUH) neonatal intensive care unit in the tenure of 1 year, fulfilling the inclusion criteria and requiring packed cell transfusion were included. After the approval from ethical review committee, charts were reviewed for gestational age, birth weight, mode of delivery (normal vaginal or Cesarean-section) were recorded. Indications of packed cell transfusion (intraventricular hemorrhage, infection or sepsis, anemia of prematurity, phlebotomy losses, increase oxygen requirement, hematological causes, other causes of hemorrhage and other causes) were observed and recorded. Pre-transfusion hemoglobin levels (g/dL) and hematocrit levels were also recorded. Other information like number and volume of transfusion and day of life on which transfusion was administered was also documented. Results: A total of 246 critically ill children were enrolled in this study. Of the total, 52.8% were baby boys and 47.2% were baby girls. 57% of babies were born via cesarean section and 43% were born via vaginal delivery. Out of total preterm newborns admitted in NICU, 22.8% were extremely preterm, 35.4% were very preterm and 41.9% were late preterm. Mean gestational age was observed to be 31 (±4) weeks and the mean birth weight of newborns was 1500 (±600) grams. Indications of packed cell transfusion observed in our study are intraventricular hemorrhage 10%, 26% sepsis/infection, 4% hematological disorders, 12.8% anemia of prematurity, 25.2% was related to increase in oxygen requirement, 13% other hematological causes and 9.3% other causes. Conclusion: An increase in oxygen requirement and anemia of prematurity were the indications that were observed in the extremely preterm and very preterm groups. Sepsis and increase oxygen requirement are some of the major causes of transfusions observed in the late preterm group. Preventable indications can be one of the areas that can be worked on and will reduce the need for transfusion in preterm babies with subsequent prevention of transfusion-associated risks.

Neonatal and Young Infant Sepsis in a Regional Hospital in Ghana

Background: Neonatal sepsis is a global health problem that mainly affects low- and middle-income countries. We have previously shown that early neonatal mortality is high at the Ho Teaching Hospital (HTH) of Ghana. We sought to determine the prevalence of neonatal sepsis, sepsis-related mortality, and bacterial species patterns in neonatal and young infant sepsis in this hospital. Methods: A hospital-based study was conducted in the hospital’s neonatal intensive care unit (NICU) from March to June 2018. Blood samples from 96 babies clinically diagnosed with or at risk of sepsis were cultured using the BACTEC 9050® machine. Clinical data including gravida, parity and antibiotic medication before delivery of mother and delivery type, gestation, birth weight and antibiotic medication status were collected for analysis. MALDI-TOF MS identified bacterial isolates, and their identities were confirmed via tuf gene sequence typing. The data were analyzed using GraphPad Prism 8.0.2. Results: Blood cultures were positive in 28 of the babies, with 14 and 12 representing early-onset and late-onset neonatal sepsis, respectively, and two cases of unknown sepsis type. Of the bacterial species that caused sepsis in the babies, coagulase-negative staphylococcus (CoNS) was the most prevalent isolate in 22 cases, followed by Klebsiella pneumoniae in two and Staphylococcus aureus, Streptococcus agalactiae, the Acinetobacter species, and Escherichia coli in the rest (one each). Of the CoNS, S. haemolyticus and S. epidermidis were the most prevalent species, found in eight and six cases, respectively. Thirteen neonates died, of whom seven had positive blood cultures, and two were referred. A case fatality rate of 7/26 was estimated. Neonatal mortality caused by Gram-negative bacterial infection was higher than that caused by Gram-positive bacteria. Conclusions: These data suggest a significant burden of sepsis among neonates and young infants and are associated with substantial morbidity and mortality at the HTH. There is a need to investigate risk factors associated with the increased sepsis rate in this hospital to inform measures to reduce the neonatal sepsis rate.