scholarly journals P26 Pilot on harmonising dosing recommendation for term and preterm neonates in the Netherlands (Neodose project)

2019 ◽  
Vol 104 (6) ◽  
pp. e27.2-e28
Author(s):  
MA de Hoop-Sommen ◽  
TM van der Zanden ◽  
K Allegaert ◽  
RB Flint ◽  
SHP Simons ◽  
...  
Keyword(s):  
The Netherlands ◽  
Neonatal Intensive Care ◽  
Scientific Evidence ◽  
Local Treatment ◽  
Pilot Project ◽  
Total Daily Dose ◽  
Preterm Neonates ◽  
Treatment Protocols ◽  
Term Neonates ◽  
Dosing Regimens

BackgroundMany drugs are used off-label in term and preterm neonates, and dosing recommendations for many drugs are lacking in the Dutch Paediatric Formulary (DPF). This results in widely varying dosing regimens used across neonatal intensive care units (NICUs) in the Netherlands. The Neodose pilot project aimed to develop best-evidence national dosing recommendations for (pre)term neonates. Because scientific evidence is scarce, a consensus-based approach was used.MethodsA priority drug list, containing the most frequently used drugs for neonates, was drafted. From this list 22 drugs were selected for further research within the Neodose pilot project. The pilot utilized a two-step approach: First, consensus was established with all Dutch NICUs for neonatal dosing recommendations. Local treatment protocols were retrieved, compared and discussed, leading to consensus-based dosing recommendations. Secondly, we aimed to develop best-evidence dosing recommendations for the following five drugs: acyclovir, ganciclovir, ibuprofen, hydrocortisone and dexamethasone.ResultsFor 21 of 22 drugs, local dosing guidelines differed significantly. Mostly concerning total daily dose, dosing frequency and route of administration. Little or no distinction is made between treatment of preterm and term neonates. Approximately half of the consensus-based dosing recommendations (45%) differ in some degree from all local protocols. Comparing the consensus-based dosing recommendations with the available evidence, almost half of the consensus doses were adjusted. The grounds on which dosing recommendations were adjusted differed. Acyclovir-dosing adjustment was based on pharmacokinetics. Hydrocortisone-dosing was adjusted due to new insights after the evidence has been put together. For dexamethasone-dosing, the consensus dose was eventually chosen, because every available trial used a different dosing regimen.ConclusionThis pilot showed that, when evidence is inconclusive, consensus on dosing regimens in neonates can be obtained by comparing local regimens and analysing the available evidence. For more uniform use, these new recommendations will be published in the DPF.Disclosure(s)This project was funded by the federation of medical specialists for qualitative improvement (Stichting Kwaliteitsgelden Medisch Specialisten (SKMS).

Coagulase-Negative Staphylococci in Human Milk From Mothers of Preterm Compared With Term Neonates

2017 ◽  
Vol 33 (2) ◽  
pp. 329-340 ◽  
Author(s):  
Hiie Soeorg ◽  
Tuuli Metsvaht ◽  
Imbi Eelmäe ◽  
Hanna Kadri Metsvaht ◽  
Sirli Treumuth ◽  
...  
Keyword(s):  
Human Milk ◽  
Neonatal Intensive Care ◽  
Tandem Repeats ◽  
Meca Gene ◽  
Variable Number ◽  
Preterm Neonates ◽  
Coagulase Negative Staphylococci ◽  
Term Neonates ◽  
Variable Number Tandem Repeats ◽  
Sequence Types

Background: Human milk is the preferred nutrition for neonates and a source of bacteria. Research aim: The authors aimed to characterize the molecular epidemiology and genetic content of staphylococci in the human milk of mothers of preterm and term neonates. Methods: Staphylococci were isolated once per week in the 1st month postpartum from the human milk of mothers of 20 healthy term and 49 preterm neonates hospitalized in the neonatal intensive care unit. Multilocus variable-number tandem-repeats analysis and multilocus sequence typing were used. The presence of the mecA gene, icaA gene of the ica-operon, IS 256, and ACME genetic elements was determined by PCR. Results: The human milk of mothers of preterm compared with term neonates had higher counts of staphylococci but lower species diversity. The human milk of mothers of preterm compared with term neonates more often contained Staphylococcus epidermidis mecA (32.7% vs. 2.6%), icaA (18.8% vs. 6%), IS 256 (7.9% vs. 0.9%), and ACME (15.4% vs. 5.1%), as well as Staphylococcus haemolyticus mecA (90.5% vs. 10%) and IS 256 (61.9% vs. 10%). The overall distribution of multilocus variable-number tandem-repeats analysis (MLVA) types and sequence types was similar between the human milk of mothers of preterm and term neonates, but a few mecA-IS 256-positive MLVA types colonized only mothers of preterm neonates. Maternal hospitalization within 1 month postpartum and the use of an arterial catheter or antibacterial treatment in the neonate increased the odds of harboring mecA-positive staphylococci in human milk. Conclusion: Limiting exposure of mothers of preterm neonates to the hospital could prevent human milk colonization with more pathogenic staphylococci.

scholarly journals Quantitative Analysis of Gentamicin Exposure in Neonates and Infants Calls into Question Its Current Dosing Recommendations

2018 ◽  
Vol 62 (4) ◽  
Author(s):  
Tamara van Donge ◽  
Marc Pfister ◽  
Julia Bielicki ◽  
Chantal Csajka ◽  
Frederique Rodieux ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Demographic Characteristics ◽  
Total Daily Dose ◽  
Therapeutic Drug ◽  
Dosing Interval ◽  
Model Based ◽  
Optimal Dosing ◽  
Daily Dose ◽  
Dosing Regimens ◽  
Trough Concentrations

ABSTRACTOptimal dosing of gentamicin in neonates is still a matter of debate despite its common use. We identified gentamicin dosing regimens from eight international guidelines and seven Swiss neonatal intensive care units. The dose per administration, the dosing interval, the total daily dose, and the demographic characteristics between guidelines were compared. There was considerable variability with respect to dose (4 to 6 mg/kg), dosing interval (24 h to 48 h), total daily dose (2.5 to 6 mg/kg/day), and patient demographic characteristics that were used to calculate individualized dosing regimens. A model-based simulation study in 1071 neonates was performed to determine the achievement of efficacious peak gentamicin concentrations according to predefined MICs (Cmax/MIC ≥ 10) and safe trough concentrations (Cmin≤ 2 mg/liter) with recommended dosing regimens. MIC targets of 0.5 and 1 mg/liter were used. Dosing optimization was performed giving priority to the first day of treatment and with the goal of simplifying dosing. Current gentamicin neonatal guidelines allow to achieve effective peak concentrations for MICs ≤ 0.5 mg/liter but not higher. Model-based simulations indicate that to attain peak gentamicin concentrations of ≥10 mg/liter, a dose of 7.5 mg/kg should be administered using an extended dosing interval regimen. Trough concentrations of ≤2 mg/liter can be maintained with a dosing interval of 36 to 48 h in neonates according to gestational and postnatal age. For treatment beyond 3 days, therapeutic drug monitoring is advised to maintain adequate serum concentrations.

Electrographic Seizures in Preterm and Full-Term Neonates: Clinical Correlates, Associated Brain Lesions, and Risk for Neurologic Sequelae

PEDIATRICS ◽  
1993 ◽  
Vol 91 (1) ◽  
pp. 128-134 ◽  
Author(s):  
Mark S. Scher ◽  
Kosaburo Aso ◽  
Marquita E. Beggarly ◽  
Marie Y. Hamid ◽  
Doris A. Steppe ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Brain Lesions ◽  
Full Term ◽  
Preterm Neonates ◽  
Term Neonates ◽  
Clinical Correlates ◽  
Neurologic Sequelae ◽  
Electrographic Seizures

Electrographically confirmed seizures in preterm and term neonates were compared with respect to clinical correlates, incidence, associated brain lesions, and risk for neurologic sequelae. Over a 4-year period, 92 neonates from a neonatal intensive care unit population of 4020 admissions at a large obstetric hospital with 40845 livebirths had electrographically confirmed seizures. Sixty-two neonates were preterm and 30 were full-term for gestational age. Chi-square calculations were used to compare the two groups. While the incidence of seizures for all neonates admitted to a neonatal intensive care unit was 2.3%, outborn neonates were more likely to have seizures than inborn neonates. Preterm neonates of ≤30 weeks gestational age had a seizure frequency of 3.9%, which was significantly higher than that of older preterm neonates and full-term neonates. Clinical criteria contemporaneous with electrographic seizures were noted in only 28 (45%) of 62 preterm, and 16 (53%) of 30 full-term neonates. Subtle seizures coincident with electrographically confirmed seizures were the most predominant clinical type for both term and preterm neonates (71% and 68%, respectively). The distribution of clonic, myoclonic, and tonic seizures was also similar for both groups. Autonomic signs coincident with electrographically confirmed seizures (ie, blood pressure, heart rate, oxygenation, respiration changes) were more frequently observed in preterm than full-term neonates with subtle seizures; 7 (37%) of 19 compared with 1 (6%) of 16. Electrical seizures without clinical correlates were noted more frequently than electroclinical seizures for both populations. Fifteen (54%) of 28 of the preterm coincident group and 10 (63%) of 16 of the full-term group had isolated electrographic seizures without clinical seizures on the same or other records, in addition to exhibiting electroclinical seizures. More preterm neonates had a later onset of seizures (>48 hours of life) than term neonates (53% vs 13%, respectively). Ischemic brain lesions were noted in 23 (77%) of 30 of full-term compared with 24 (39%) of 62 preterm neonates. Intraventricular hemorrhange with ventriculomegaly or intraparenchymal involvement was seen in 26 (45%) of 72 preterm neonates compared with 1 (3%) of 30 full-term neonates. Mortality was greater in the preterm than in the term populations, 36 (58%) of 52, compared with 10 (30%) of 30, and a normal outcome was documented in 9 (25%) of 36 preterm neonates compared with 12 (60%) of 30 full-term survivors. However, the incidence of surviving preterm neonates epilepsy developed was the same as the fullterm survivor group at a mean age of 6 ½ years. While the electroclinical expression of neonatal seizures occurs in both preterm and full-term populations, clinical correlates, incidence, etiologic factors, and outcome factors differ between the two populations.

scholarly journals Maternal risk factors and early neonatal outcome among late preterm and term neonates in a neonatal intensive care unit in Punjab, India

2018 ◽  
Vol 5 (2) ◽  
pp. 612
Author(s):  
Kambiakdik T. ◽  
Anish D. Leelalanslat ◽  
Inderpreet Sohi ◽  
Varughese P. Varkey
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Maternal Risk Factors ◽  
Term Neonates ◽  
Maternal Risk

Background: Late preterm neonates (34 to 36 weeks 6/7 days) were considered as ‘near term’ as they appeared apparently mature and comparable to term neonates. Many studies have now reported significantly higher rates of morbidity and mortality among this group of neonates. This study aims to evaluate the maternal risk factors associated with and short-term outcome of late preterm neonates compared to term neonates.Methods: A Retrospective cohort study was conducted in the Neonatal Intensive Care Unit of a tertiary care teaching hospital. All intramural late preterm neonates with gestational age of 34-36 weeks born during the study period were enrolled. The control group included term neonates (37-42 weeks) born during the study period. Data regarding the maternal risk factors and neonatal outcomes for both the late preterm and term neonates were collected from records maintained in the NICU. Results: There were 3275 deliveries during the study period, of which 2447 (74.8%) were term. Among the 828 preterm neonates, 500 (60.4%) were late preterms. The maternal risk factors significantly associated with late preterm neonates were PIH, eclampsia, APH, multiple gestation, PROM, oligohydramnios and abnormal dopplers. Incidence of Respiratory distress syndrome (RDS), sepsis and hypoglycemia were higher among the late preterm group with an odd’s ratio of 56.01, 9.9 and 7.8 respectively. Incidence of hypocalcemia, seizures and Persistent Pulmonary Hypertension (PPHN) were also higher among this group. There was no statistically significant difference in mortality among the two groups.Conclusions: Late preterm neonates have a significantly higher neonatal morbidity compared to term neonates.

scholarly journals Accuracy of Pulse Oximetry in the Presence of Fetal Hemoglobin—A Systematic Review

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 361
Author(s):  
Ena Pritišanac ◽  
Berndt Urlesberger ◽  
Bernhard Schwaberger ◽  
Gerhard Pichler
Keyword(s):  
Pulse Oximetry ◽  
Neonatal Intensive Care ◽  
English Language ◽  
Arterial Oxygen Saturation ◽  
Fetal Hemoglobin ◽  
Arterial Oxygen ◽  
Cochrane Library ◽  
Preterm Neonates ◽  
Neonatal Blood ◽  
The Impact

Continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) is the main method to guide respiratory and oxygen support in neonates during postnatal stabilization and after admission to neonatal intensive care unit. The accuracy of these devices is therefore crucial. The presence of fetal hemoglobin (HbF) in neonatal blood might affect SpO2 readings. We performed a systematic qualitative review to investigate the impact of HbF on SpO2 accuracy in neonates. PubMed/Medline, Embase, Cumulative Index to Nursing & Allied Health database (CINAHL) and Cochrane library databases were searched from inception to January 2021 for human studies in the English language, which compared arterial oxygen saturations (SaO2) from neonatal blood with SpO2 readings and included HbF measurements in their reports. Ten observational studies were included. Eight studies reported SpO2-SaO2 bias that ranged from −3.6%, standard deviation (SD) 2.3%, to +4.2% (SD 2.4). However, it remains unclear to what extent this depends on HbF. Five studies showed that an increase in HbF changes the relation of partial oxygen pressure (paO2) to SpO2, which is physiologically explained by the leftward shift in oxygen dissociation curve. It is important to be aware of this shift when treating a neonate, especially for the lower SpO2 limits in preterm neonates to avoid undetected hypoxia.

Early Arterial Lactate and Prediction of Outcome in Preterm Neonates Admitted to a Neonatal Intensive Care Unit

2003 ◽  
Vol 83 (3) ◽  
pp. 171-176 ◽  
Author(s):  
Floris Groenendaal ◽  
Caroline Lindemans ◽  
Cuno S.P.M. Uiterwaal ◽  
Linda S. de Vries
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Preterm Neonates ◽  
Prediction Of Outcome ◽  
Arterial Lactate

Childbearing culture: a prominent context in the process of maternal role attainment in Iranian mothers with preterm neonates

2021 ◽  
pp. 1-12
Author(s):  
Mona Alinejad-Naeini ◽  
Hamid Peyrovi ◽  
Mahnaz Shoghi
Keyword(s):  
Cultural Context ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Preterm Neonates ◽  
Maternal Role ◽  
Cultural Perceptions ◽  
Factors Affecting ◽  
Purposeful Sampling ◽  
Biological Event ◽  
Maternal Role Attainment

Abstract Transition to the role of mothering is one of the most important events in a woman’s life. While childbirth is a biological event, pregnancy and the experiences around it are more influenced by social structure, which is shaped by cultural perceptions and practices. The aim of this study was to explore cultural context during maternal role attainment in neonatal intensive care units (NICUs) in Iran. The study was part of a grounded theory study on how the mothers of preterm neonates go through maternal role attainment. Data collection was carried out by purposeful sampling from 20 participants (15 mothers of preterm neonates and 5 NICU nurses). Data were analysed according to Corbin and Strauss’s (2015) approach. Four categories of childbearing culture emerged: ‘The necessity of childbearing’, ‘Childbearing rituals’, ‘Maternal persistent presence’ and ‘Attitudes and religious beliefs’. The findings showed that the special beliefs and practices in Iranian culture affected all of the participants’ reactions to mothering process. Culture is one of the most important factors affecting the development of motherhood in Iran. In order to provide sensitive and culturally appropriate care, nurses should be aware of the general impact of cultural norms and values on the process of maternal role attainment and strive to meet the cultural needs of all mothers.

Ethical Decisions in Neonatal Intensive Care Units: The Dutch Experience

PEDIATRICS ◽  
1992 ◽  
Vol 90 (5) ◽  
pp. 729-732
Author(s):  
Pieter J. J. Sauer
Keyword(s):  
Quality Of Life ◽  
Intensive Care ◽  
The Netherlands ◽  
Neonatal Intensive Care ◽  
Fatal Outcome ◽  
Modern Technology ◽  
Withholding Treatment ◽  
Intensive Care Treatment ◽  
Best Interest

Modern technology makes it possible to keep more sick, extremely small, and vulnerable neonates alive. Many neonatologists in the Netherlands believe they should be concerned not only about the rate of survival of their patients, but also about the way the graduates of their care do, in fact, survive beyond the neonatal period. In most cases, we use all available methods to keep newborns alive. However, in some instances there is great concern about the quality of life, if the newborn should survive; here questions do arise about continuing or withholding treatment. In this commentary, I present my impression of the opinions held by a majority of practicing neonatologists in the Netherlands, as well as some personal thoughts and ideas. Recently, a committee convened by the Ministers of Justice and Health in the Netherlands issued an official report regarding the practice of euthanasia and the rules of medical practice when treatment is withheld.1 In this report of more than 250 pages, only 2 pages focus on the newborn. The following conclusions were made in this small section of the report. In almost one half of the instances of a fatal outcome in a neonatal intensive care unit in the Netherlands, discussions about sustaining or withholding treatment did take place at some stage of the hospital stay. A consideration of the future quality of life was always included in the discussion. The committee agreed with doctors interviewed for the report that there are circumstances in which continuation of intensive care treatment is not necessarily in the best interest of a neonate.

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