scholarly journals Implementing a three-hourly feeding schedule in stable preterm infants to decrease maternal fatigue

2021 ◽  
Vol 10 (Suppl 1) ◽  
pp. e001439
Author(s):  
Abhishek S Aradhya ◽  
Inderjot Kaur ◽  
Rima Gupta ◽  
Sonaljot Kaur ◽  
Yamasandi Siddegowda Shrimanth ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Preterm Infants ◽  
Nursing Staff ◽  
Preterm Neonates ◽  
Feeding Schedule ◽  
Nursing Time ◽  
Baseline Phase ◽  
Fatigue Score ◽  
Feed Intolerance ◽  
Maternal Fatigue

BackgroundA three-hourly feeding schedule has been shown to be as safe as a two-hourly schedule in preterm neonates. It saves nursing time and may be less tiring for the mothers. However, tradition and apprehensions have prevented its wider acceptance. We used a quality improvement approach to implement a three-hourly feeding schedule in stable preterm infants >32 weeks postmenstrual age (PMA) in our unit through a series of plan–do–study–act (PDSA) cycles.MethodsAll preterm neonates >32 weeks PMA, who were on full enteral feeds and without any respiratory support were eligible. The key quantitative outcome was maternal fatigue score. Safety was assessed in terms of episodes of hypoglycaemia and feed intolerance. Qualitative experiences from nursing staff were captured. The volume of expressed breastmilk and requirement of formula feeds were also recorded. After recording baseline data on a two-hourly feeding schedule, four PDSA cycles were sequentially completed over 21 weeks. The results of each PDSA cycle informed the change strategy for the next cycle.ResultsIn the baseline phase, five neonates on a two-hourly schedule were studied. In PDSA cycles I, II, III and IV, a cumulative of 122 neonates were studied on a three-hourly schedule. There was a significant decrease in median maternal fatigue score (13 (IQR 8–23) to 3 (IQR 1–6); p=0.01)). Only one neonate had feed intolerance, while two had mild asymptomatic transient hypoglycaemia. Six (5%) neonates were shifted to two-hourly feeds temporarily due to transient reasons. Nursing staff felt mothers could devote more time to Kangaroo mother care. The volume of expressed breastmilk and requirement of formula feeds were not different from the three-hourly schedule.ConclusionsIt was possible to change the traditional two-hourly feeding schedule to three-hourly in stable preterm infants using a quality improvement approach, while objectively documenting its safety and benefits.

scholarly journals A neonatal morbidities and outcomes among late preterm infants

2020 ◽  
Vol 7 (2) ◽  
pp. 248
Author(s):  
Jyoti B. Sarvi ◽  
Sandeep V. H.
Keyword(s):  
Preterm Infants ◽  
Neonatal Morbidity ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Medical Problems ◽  
Term Outcome ◽  
Late Preterm Infants ◽  
Male Preponderance ◽  
Feed Intolerance ◽  
Near Term

Background: Late preterm birth (34-36 weeks) infants are at greater risk of (2-3 fold) compared to near term or term babies. The present study was done with the purpose to examine related morbidities and outcomes among late preterm infants.Methods: The study included all late preterm babies (34 0/7 weeks-36 6/7 weeks) admitted to the Basaveshwar Teaching and General Hospital and Sangameshwar Hospital for a period of one and half year (December 2013-May 2015). Short term outcome was assessed in the form of neonatal morbidities and mortality during the study period.Results: A total of 203 late Preterm neonates comprised the study group. Male preponderance was noticed with a ratio of 1.5:1. This study confirmed that late-preterm infants are a population at risk of increased neonatal morbidity. Neonatal hyperbilirubinemia requiring phototherapy forms the major one followed by sepsis, respiratory distress, and feed intolerance. Majority of late preterm neonates required more than 7 days hospital duration.Conclusions: Late preterm infants suffer a large number of intercurrent medical problems during the neonatal period, especially increased likelihood of resuscitation in the delivery room, hypothermia, hypoglycemia, jaundice requiring phototherapy, respiratory pathologies, sepsis and feeding intolerance. Prolonging pregnancy to the maximum safest gestation will result in decrease in such morbidities.

Ohio Statewide Quality-Improvement Collaborative to Reduce Late-Onset Sepsis in Preterm Infants

PEDIATRICS ◽  
2011 ◽  
Vol 127 (3) ◽  
pp. 427-435 ◽  
Author(s):  
H. C. Kaplan ◽  
C. Lannon ◽  
M. C. Walsh ◽  
E. F. Donovan ◽  
Keyword(s):  
Quality Improvement ◽  
Preterm Infants ◽  
Late Onset ◽  
Quality Improvement Collaborative ◽  
Late Onset Sepsis

A HOSPITAL ROOMING-IN UNIT FOR FOUR NEWBORN INFANTS AND THEIR MOTHERS

PEDIATRICS ◽  
1948 ◽  
Vol 1 (1) ◽  
pp. 28-43 ◽  
Author(s):  
EDITH B. JACKSON ◽  
RICHARD W. OLMSTED ◽  
ALAN FOORD ◽  
HERBERT THOMS ◽  
KATE HYDER
Keyword(s):  
Nursing Staff ◽  
Community Hospital ◽  
Newborn Infants ◽  
Newborn Baby ◽  
New Haven ◽  
Nursing Time ◽  
The Subject ◽  
The University ◽  
First Stage Of Labor ◽  
Paternal Participation

introduction Rooming-in is the term currently in use to designate the hospital arrangement whereby a mother may have her newborn baby in a crib by her bedside whenever she wishes. The term was first used by Gesell and Ilg.1 Such an arrangement was established for study purposes on the University Service of the Grace-New Haven Community Hospital in October 1946. The four-bed ward used for this purpose is known as the Rooming-In Unit. An account of development of this Unit with a few preliminary observations is the subject of this paper. Because of the enthusiastic participation of fathers in the project from the day of its inception, the authors were inclined to entitle the paper,“Rooming-In for Parents and Newborns.” The husband may be with his wife throughout the first stage of labor if mutually agreeable; under normal circumstances he may see his baby shortly after birth—even hold him; he may continue to get closely acquainted with his child day after day in the hospital, and watch his wife and the baby at nursing time if that happens to occur during visiting hours. This paternal participation has afforded obvious satisfaction to both parents which we believe is salutary for the baby. Indeed, the first major assumption in making plans for the Rooming-In Unit has been that a mother's satisfaction with herself and with the attention and care bestowed upon her (by husband, parents, members of medical and nursing staff)is the best guarantee for her inclination and ability to satisfy

scholarly journals ‘CPR for Feet’ care bundle to improve foot assessment in inpatient diabetes

2018 ◽  
Vol 7 (3) ◽  
pp. e000196 ◽  
Author(s):  
Rhea O’Regan ◽  
Ross MacDonald ◽  
James G Boyle ◽  
Katherine A Hughes ◽  
Joyce McKenzie
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Quality Improvement Project ◽  
Care Bundle ◽  
Staff Education ◽  
Pressure Relief ◽  
Improvement Project ◽  
The Third ◽  
Inpatient Diabetes ◽  
Pdsa Cycle

AimsThe Scottish Inpatient Diabetes Foot Audit conducted in 2013 revealed that 57% of inpatients had not had their feet checked on admission, 60% of those at risk did not have pressure relief in place and 2.4% developed a new foot lesion. In response, the Scottish Diabetes Foot Action Group launched the ‘CPR for Feet’ campaign. The aim of this project was to raise awareness of the ‘Check, Protect and Refer’ (CPR) campaign as well as improve the assessment and management of inpatients with diabetes.MethodsA quality improvement project underpinned by Plan-Do-Study-Act (PDSA) methodology was undertaken. The first and second cycles focused on staff education and the implementation of a ‘CPR for Feet’ assessment checklist using campaign guidelines, training manuals and modules. The third and fourth cycles focused on staff feedback and the implementation of a ‘CPR for Feet’ care bundle.ResultsBaseline measurements revealed 28% of patients had evidence of foot assessment. Medical and nursing staff reported to be largely unaware of the ‘CPR for Feet’ campaign (13%). Fifty-two per cent of inpatients with diabetes had their feet assessed and managed correctly following the second PDSA cycle. After completion of the third and fourth PDSA this number improved further to 72% and all staff reported to be aware of the campaign.ConclusionsThe introduction of a ‘CPR for Feet’ care bundle improved the assessment of inpatients with diabetes.

scholarly journals Thyroid dysfunction in preterm neonates exposed to iodine

2017 ◽  
Vol 45 (1) ◽  
Author(s):  
Fiona L.R. Williams ◽  
Jennifer Watson ◽  
Chris Day ◽  
Aung Soe ◽  
Sateesh K. Somisetty ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Contrast Media ◽  
Preterm Infants ◽  
Breast Feeding ◽  
Thyroid Dysfunction ◽  
Exposed Group ◽  
Preterm Neonates ◽  
Iodinated Contrast Media ◽  
Iodinated Contrast ◽  
Blood Spot

AbstractBackground:Infants <32 weeks’ gestation should not be exposed to topical iodine and its avoidance is recommended during pregnancy and breast feeding. Exposure to contrast media and topical iodine is frequently used in many preterm neonates.Aim:To determine whether thyrotropin levels in preterm infants are affected by exposure to intrapartum/neonatal topical iodine and/or the use of iodinated contrast media.Design:Infants <32 weeks’ gestation were recruited. Maternal and neonatal exposures to iodinated contrast media and topical iodine were recorded; levels of thyrotropin and thyroxine were measured from blood-spot cards on postnatal days 7, 14, 28 and the equivalent of 36 weeks’ gestation.Results:One hundred and twenty-five infants were exposed to topical iodine/contrast media and 48 infants were unexposed. No infants were treated for hypothyroidism; three infants (exposed group) had transient hyperthyrotropinaemia. Mean thyrotropin levels were significantly higher on postnatal days 7, 14 and 28 in infants exposed to topical iodine prior to caesarean section compared to unexposed infants, a relationship which persisted after adjustment.Conclusions:In the context of this study, neonatal thyroid dysfunction was seen following exposure to iodine via caesarean section but not via exposure to contrast media.

scholarly journals IV Paracetamol for closure of patent ductus arteriosus in preterm neonates admitted to a tertiary care centre

2018 ◽  
Vol 5 (2) ◽  
pp. 294 ◽  
Author(s):  
Sunil B. ◽  
Shruthi Patel ◽  
Girish N.
Keyword(s):  
Side Effects ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Treatment Options ◽  
Tertiary Care ◽  
Current Treatment ◽  
Preterm Neonates ◽  
Tertiary Care Centre ◽  
Vascular Connection ◽  
Intravenous Paracetamol

Background: Ductus arteriosus is a vascular connection between the pulmonary artery and descending aorta. The incidence is inversely related to birth weight and gestational age (GA). In preterm infants it varies between 40% and 60% on the third day of life. At present, the choice of treatment of clinically significant PDA is with either ibuprofen or indomethacin, but they carry many contraindications and potential side effects. Hence it is important to consider that paracetamol may be used as an alternative to other non steroidal anti-inflammatory drugs and is effective in ductal closure with minimal side effects.Methods:Thirty six preterm infants with hemodynamically significant PDA(hs-PDA) were treated with intravenous paracetamol and subsequent closure was evaluated clinically and by follow-up 2D-Echo.Results: PDA closure following intravenous paracetamol was evident in 27 babies (75%). There were no significant side effects noted with paracetamol therapy.Conclusions: This study shows that paracetamol could offer favourable safety profile in comparison to current treatment options. Therefore, paracetamol may be accepted as a first-line drug treatment for PDA in preterm infants. 

scholarly journals cfDNA and DNases: New Biomarkers of Sepsis in Preterm Neonates—A Pilot Study

Cells ◽  
2022 ◽  
Vol 11 (2) ◽  
pp. 192
Author(s):  
Moritz Lenz ◽  
Thomas Maiberger ◽  
Lina Armbrust ◽  
Antonia Kiwit ◽  
Axel Von der Wense ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Dnase I ◽  
Sepsis Group ◽  
Preterm Neonates ◽  
Control Group ◽  
Suspected Sepsis ◽  
Epidemiological Characteristics

Introduction: An early and accurate diagnosis of early onset neonatal sepsis (EONS) and late onset neonatal sepsis (LONS) is essential to improve the outcome of this devastating conditions. Especially, preterm infants are at risk. Reliable biomarkers are rare, clinical decision-making depends on clinical appearance and multiple laboratory findings. Markers of NET formation and NET turnover might improve diagnostic precision. Aim of this study was to evaluate the diagnostic value of NETs in sepsis diagnosis in neonatal preterm infants. Methods: Plasma samples of neonatal preterm infants with suspected sepsis were collected. Blood samples were assayed for markers of NET formation and NET turnover: cfDNA, DNase1, nucleosome, NE, and H3Cit. All clinical findings, values of laboratory markers, and epidemiological characteristics were collected retrospectively. Two subpopulations were created to divide EONS from LONS. EMA sepsis criteria for neonatal sepsis were used to generate a sepsis group (EMA positive) and a control group (EMA negative). Results: A total of 31 preterm neonates with suspected sepsis were included. Out of these, nine patients met the criteria for sepsis according to EMA. Regarding early onset neonatal sepsis (3 EONS vs. 10 controls), cfDNA, DNase I, nucleosome, and CRP were elevated significantly. H3Cit and NE did not show any significant elevations. In the late onset sepsis collective (6 LONS vs. 12 controls), cfDNA, DNase I, and CRP differed significantly compared to control group.

scholarly journals Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Walufu Ivan Egesa ◽  
Simon Odoch ◽  
Richard Justin Odong ◽  
Gloria Nakalema ◽  
Daniel Asiimwe ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Very Low Birth Weight ◽  
Preterm Neonates ◽  
Low Birth Weight Infants ◽  
Neurodevelopmental Outcomes ◽  
Germinal Matrix ◽  
Posthemorrhagic Hydrocephalus ◽  
Management Interventions ◽  
Incidence Risk

Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.

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