scholarly journals Quality indicators in nutrition therapy and clinical outcomes in a neonatal intensive care unit

2021 ◽  
Vol 34 ◽  
Author(s):  
Luciana Carla HOLZBACH ◽  
Renata Andrade de Medeiros MOREIRA ◽  
Renata Junqueira PEREIRA
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Weight Gain ◽  
Birth Weight ◽  
Enteral Nutrition ◽  
Gestational Age ◽  
Nutrition Therapy ◽  
Energy Deficit ◽  
Cumulative Energy ◽  
Fasting Time

ABSTRACT Objective To associate quality indicators in nutritional therapy and pre-determined clinical outcomes in a neonatal unit. Methods A total of 81 premature newborns were monitored regarding the time to initiate nutrition therapy, time to meet energy needs, energy and protein adequacy, cumulative energy deficit, adequacy of the nutritional formula and fasting periods; weight gain, the occurrence of necrotizing enterocolitis, mortality and length of stay in the intensive care unit. The data were analyzed with the Statistical Package for the Social Sciences at 5% significance level. Results The time to start enteral nutrition and the calories infused/kg/day were predictors of length of hospital stay F(2.46)=6.148; p=0.004; R2=0.211; as well as the cumulative energy deficit+birth weight+infused calories/kg/day (F=3.52; p<0.001; R2=0.422); cumulative energy deficit+calories infused/kg/day+fasting time for Enteral Nutrition (F=15.041; p<0.001; R2=0.474) were predictors of weight gain. The time to start enteral nutrition, gestational age and birth weight were inversely associated with the occurrence of necrotizing enterocolitis (β=-0.38; β=-0.198; β=-0.002). Early enteral nutrition predisposed to mortality (β=0.33). Gestational age, birth weight and calories infused/kg/day were inversely related to mortality (β=-0.442; β=-0.004; β=-0.08). Conclusions Considering the associations between indicators and outcomes, routine monitoring of the time to start enteral nutrition, energy adequacy, energy deficit and fasting time is recommended.

scholarly journals GROWTH ANALYSIS OF PRETERM NEWBORNS WITH GASTROSCHISIS DURING HOSPITALIZATION IN A NEONATAL INTENSIVE CARE UNIT

2021 ◽  
Vol 58 (4) ◽  
pp. 504-508
Author(s):  
Juliana Zoboli Del BIGIO ◽  
Mário Cícero FALCÃO ◽  
Ana Cristina Aoun TANNURI
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Weight Gain ◽  
Birth Weight ◽  
Parenteral Nutrition ◽  
Neonatal Intensive Care Unit ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Growth Analysis ◽  
Preterm Newborns

ABSTRACT BACKGROUND: Gastroschisis, especially complex type, prematurity and low birth weight are associated with a worse clinical outcome with higher mortality, higher incidence of sepsis and catheter-related infection, cholestasis, short bowel syndrome, greater number of days to achieve full diet, longer time of parenteral nutrition and longer hospitalization time. OBJECTIVE: To evaluate the growth of preterm newborns with gastroschisis during their hospitalization in the neonatal intensive care unit. METHODS: Descriptive study, based on a retrospective cohort (January 2012 to December 2018), including preterm newborns (gestational age less than 37 weeks) with simple and complex gastroschisis admitted in a tertiary neonatal intensive care unit. The following parameters were analyzed: maternal age, parity, type of delivery, birth weight, gender, gestational age, nutritional adequacy, type of gastroschisis, fasting time, parenteral nutrition time, time until achieving full enteral nutrition, hospitalization time, weight gain and outcome. The results were expressed in percentage, average, and median. RESULTS: A total of 101 newborns with gastroschisis were admitted, of which 59.4% were premature (80.7% of late preterm infants). From the maternal data, the mean age was 21.2 years and 68.3% were primiparous. Regarding childbirth: 80% were cesarean sections. From newborns: the average birth weight was 2137 g, 56.6% were female, the average gestational age was 34.8 weeks, the average weight gain was 20.8 g/day during hospitalization and 83.3% were discharged from the hospital. CONCLUSION: The growth analysis by weight gain (grams/day) during hospitalization in the intensive care unit showed that more than 90% of the sample presented acceptable or adequate weight gain.

scholarly journals Impact of Propofol Sedation upon Caloric Overfeeding and Protein Inadequacy in Critically Ill Patients Receiving Nutrition Support

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 121
Author(s):  
Roland N. Dickerson ◽  
Christopher T. Buckley
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Lipid Emulsion ◽  
Caloric Intake ◽  
Nutrition Therapy ◽  
Nutrition Support

Propofol, a commonly used sedative in the intensive care unit, is formulated in a 10% lipid emulsion that contributes 1.1 kcals per mL. As a result, propofol can significantly contribute to caloric intake and can potentially result in complications of overfeeding for patients who receive concurrent enteral or parenteral nutrition therapy. In order to avoid potential overfeeding, some clinicians have empirically decreased the infusion rate of the nutrition therapy, which also may have detrimental effects since protein intake may be inadequate. The purpose of this review is to examine the current literature regarding these issues and provide some practical suggestions on how to restrict caloric intake to avoid overfeeding and simultaneously enhance protein intake for patients who receive either parenteral or enteral nutrition for those patients receiving concurrent propofol therapy.

Evaluation of Morbidities and Complications of Neonatal İntensive Care Unit Patients with Respiratory Disorders at Different Gestational Ages

2021 ◽  
Author(s):  
Erbu Yarci ◽  
Fuat E. Canpolat
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Respiratory Distress ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Respiratory Diseases ◽  
Respiratory Disorders ◽  
Live Births

Objective Respiratory distress presented within the first few days of life is life-threatening and common problem in the neonatal period. The aim of this study is to estimate (1) the incidence of respiratory diseases in newborns and related mortality; (2) the relationship between acute neonatal respiratory disorders rates and gestational age, birth weight, and gender; and (3) the incidence of complications associated with respiratory disturbances. Study Design Only inborn patients with gestational age between 230/7 and 416/7 weeks having respiratory distress were included in the study. The data were collected from the medical records and gestational age was based on the menstrual dating. Results There were 8,474 live births between January 1, 2013 and June 30, 2013 in our hospital. A total of 1,367 newborns were hospitalized and oxygen therapy was applied in 903 of them because of respiratory distress. An acute respiratory disorder was found to be in 10.6% (903/8,474) among all live births. Mortality was 0.76% (66/8,474). The incidence of respiratory distress syndrome was 2.8% (n = 242). The occurrence of transient tachypnea of newborn was 3.1% (n = 270). Meconium aspiration syndrome, pneumonia, congenital diaphragmatic hernia, and pulmonary maladaptation and primary persistent pulmonary hypertension rates were 0.1, 0.7, 2.2, and 0%, respectively. Overall, 553 (61%) of the 903 newborns having respiratory diseases had complications. The occurrence of necrotizing enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage and air leak was 6.8, 19.8, 4.7, 24.9, and 5%, respectively. Conclusion This study offers an epidemiological perspective for respiratory disorders from a single-center level-III neonatal intensive care unit. Although number of births, premature newborns, extremely low birth weight/very low birth weight infants, and complicated pregnancies increase in years, decreasing rates of mortality and complications are very promising. As perinatal and neonatal cares are getting better in every day, we think that more promising results can be achieved over the coming years. Key Points

scholarly journals Confounders for Neonatal Intensive Care Unit Admission ın Neonates of Mothers with Preeclampsia

2018 ◽  
Vol 24 (3) ◽  
pp. 162
Author(s):  
Cetin Kilicci ◽  
Cigdem Yayla Abide ◽  
Enis Ozkaya ◽  
Evrim Bostancı Ergen ◽  
İlter Yenidede ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Intensive Care Unit Admission ◽  
Neonatal Intensive Care Unit ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Preterm Neonates ◽  
Apgar Scores ◽  
Gestational Age At Delivery

<p><strong>Objective:</strong> The aim of this study was to investigate the effect of some maternal and neonatal clinical parameters on the neonatal intensive care unit admission rates of neonates born to mothers who had preeclampsia. </p><p><strong>Study Design:</strong> Study included 402 singleton pregnant women with preeclampsia who admitted to Maternal-Fetal Medicine Unit of Zeynep Kamil Children and Women’s Health Training and Research Hospital. Pregnancies with uterine rupture, chorioamnionitis and congenital malformations were excluded. Some maternal and neonatal clinical characteristics were assessed to predict neonatal intensive care unit admission.</p><p><strong>Results:</strong> Among 402 neonates, 140 (35%) of them had an indication for neonatal intensive care unit admission, among 140 neonates, 136 (97%) of them were preterm neonates. Comparison of groups with and without neonatal intensive care unit admission indicated significant differences between groups in terms of gestational age, Apgar scores at 1st and 5th minutes, birth weight, some maternal laboratory parameters (Hemoglobin, hematocrit, alanine aminotransferase, aspartate aminotransferase, albumin). In multivariate analysis, among all study population, gestational age at delivery, birth weight and Apgar scores were found to be significantly associated with neonatal intensive care unit admission. On the other hand, in subgroup of term neonates, none of the variables was shown to be associated with neonatal intensive care unit admission.</p><p><strong>Conclusion:</strong> Gestational age at delivery and the birth weight are the main risk factors for neonatal intensive care unit admission of neonates born to mothers who had preeclampsia.</p>

Are Intensive Care Unit Patients Undergoing Enteral Nutrition Therapy Sufficiently Fed? A Prospective, Descriptive Study

2021 ◽  
Vol 36 (2) ◽  
pp. 119-127
Author(s):  
Volkan Özen ◽  
Aylin Aydin Sayilan ◽  
Miray Turkoglu ◽  
Dilek Mut ◽  
Samet Sayilan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Descriptive Study ◽  
Nutrition Therapy

scholarly journals The value of the middle cerebral to umbilical artery doppler ratio in the prediction of neonatal outcome in patients with high risk pregnancy

2017 ◽  
Vol 6 (9) ◽  
pp. 3965
Author(s):  
Ramkanwar Deora ◽  
Nikhila Gara
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
High Risk ◽  
Cesarean Delivery ◽  
Gestational Age ◽  
Foetal Distress ◽  
Duration Of Treatment ◽  
Risk Pregnancy ◽  
Gestational Age At Delivery

Background: To investigate the diagnostic value of MCA/UA pulsatility index ratio for the prediction of adverse perinatal outcome in patients with high risk pregnancy.Methods: We included in the study 170 patients recovered in our hospital with the diagnosis of preeclampsia and gestational hypertension, twins, postdated, IUGR, BOH from June 2016 to May 2017. All the patients underwent accurate color Doppler velocimetry examination available in our hospital. Outcome variables were intrauterine and early neonatal death, admission to neonatal intensive care unit and the duration of treatment, APGAR score below 7 at 5 minutes, cesarean delivery for foetal distress, gestational age at delivery, neonatal birth weight, IUGR.Results: In 102 patients, we found abnormal values of CPI ratio. Neonates of mothers with abnormal CPI ratio had significantly lower gestational age at delivery, lower birth weight, significantly greater risk for perinatal death, significantly greater risk of admission to intensive care unit, longer duration of treatment in NICU, greater rate of cesarean delivery for foetal distress, increased number of fetuses IUGR.Conclusions: CPI ratio is a very good predictor of adverse outcome in the fetuses of women with pre-eclampsia and other high-risk pregnancy.

scholarly journals Longitudinal Microbiome Composition and Stability Correlate with Increased Weight and Length of Very-Low-Birth-Weight Infants

mSystems ◽  
2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Alyson L. Yee ◽  
Elizabeth Miller ◽  
Larry J. Dishaw ◽  
Jessica M. Gordon ◽  
Ming Ji ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Weight Gain ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Beta Diversity ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Alpha Diversity ◽  
Vlbw Infants

ABSTRACT The microbiomes of 83 preterm very-low-birth-weight (VLBW) infants and clinical covariates were analyzed weekly over the course of their initial neonatal intensive care unit (NICU) stay, with infant growth as the primary clinical outcome. Birth weight significantly correlated with increased rate of weight gain in the first 6 weeks of life, while no significant relationship was observed between rate of weight gain and feeding type. Microbial diversity increased with age and was significantly correlated with weight gain and percentage of the mother’s own milk. As expected, infants who received antibiotics during their NICU stay had significantly lower alpha diversity than those who did not. Of those in the cohort, 25 were followed into childhood. Alpha diversity significantly increased between NICU discharge and age 2 years and between age 2 years and age 4 years, but the microbial alpha diversity of 4-year-old children was not significantly different from that of mothers. Infants who showed improved length over the course of their NICU stay had significantly more volatile microbial beta diversity results than and a significantly decreased microbial maturity index compared with infants who did not; interestingly, all infants who showed improved length during the NICU stay were delivered by Caesarean section. Microbial beta diversity results were significantly different between the time of the NICU stay and all other time points (for children who were 2 or 4 years old and mothers when their children were 2 or 4 years old). IMPORTANCE Preterm infants are at greater risk of microbial insult than full-term infants, including reduced exposure to maternal vaginal and enteric microbes, higher rates of formula feeding, invasive procedures, and administration of antibiotics and medications that alter gastrointestinal pH. This investigation of the VLBW infant microbiome over the course of the neonatal intensive care unit (NICU) stay, and at ages 2 and 4 years, showed that the only clinical variables associated with significant differences in taxon abundance were weight gain during NICU stay (Klebsiella and Staphylococcus) and antibiotic administration (Streptococcus and Bifidobacterium). At 2 and 4 years of age, the microbiota of these VLBW infants became similar to the mothers’ microbiota. The number of microbial taxa shared between the infant or toddler and the mother varied, with least the overlap between infants and mothers. Overall, there was a significant association between the diversity and structure of the microbial community and infant weight and length gain in an at-risk childhood population.

scholarly journals Coagulase-Negative Staphylococcal Infections in the Neonatal Intensive Care Unit

2011 ◽  
Vol 32 (7) ◽  
pp. 679-686 ◽  
Author(s):  
Naomi Jean-Baptiste ◽  
Daniel K. Benjamin ◽  
Michael Cohen-Wolkowiez ◽  
Vance G. Fowler ◽  
Matthew Laughon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Lower Mortality ◽  
Coagulase Negative Staphylococci ◽  
Clinical Sepsis ◽  
Significant Difference

Background.Coagulase-negative staphylococci (CoNS) are the most commonly isolated pathogens in the neonatal intensive care unit (NICU). CoNS infections are associated with increased morbidity, including neurodevelopmental impairment.Objective.To describe the epidemiology of CoNS infections in the NICU. To determine mortality among infants with definite, probable, or possible CoNS infections.Methods.We performed a retrospective cohort study of all blood, urine, and cerebrospinal fluid cultures from samples obtained from infants aged <121 postnatal days.Setting.A total of 248 NICUs managed by the Pediatrix Medical Group from 1997 to 2009.Results.We identified 16,629 infants with 17,624 episodes of CoNS infection: 1,734 (10%) definite, 3,093 (17%) probable, and 12,797 (73%) possible infections. Infants with a lower gestational age and birth weight had a higher incidence of CoNS infection. When controlling for gestational age, birth weight, and 5-minute Apgar score, we found that infants with definite, probable, or possible CoNS infection had lower mortality (odds ratio [OR], 0.74 [95% confidence interval {CI}: 0.61, 0.89], 0.68 [95% CI, 0.59, 0.79], and 0.69 [95% CI, 0.63, 0.76], respectively) compared with infants who had negative culture results (P<.001). No significant difference in overall mortality was found in infants who had definite CoNS infection compared with those who had probable or possible CoNS infection (OR, 0.93 [95% CI, 0.75, 1.16] and 0.85 [95% CI,0.70,1.03], respectively).Conclusions.CoNS infection was strongly related to lower gestational age and birth weight. Infants with clinical sepsis and culture-positive CoNS infection had lower mortality rates than infants with clinical sepsis and negative blood culture results. No difference in mortality between infants with a diagnosis of definite, probable, or possible CoNS infection was observed.

scholarly journals EARLY VS LATE CAFFEINE THERAPY IN PRETERM INFANTS: ANALYSIS OF CLINICAL OUTCOME

2021 ◽  
Vol 71 (2) ◽  
pp. 503-06
Author(s):  
Hafsa Niaz ◽  
Jawad Jalil ◽  
Muhammad Adil ◽  
Faisal Basheer ◽  
Shahzad Akhtar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Clinical Outcome ◽  
Neonatal Intensive Care Unit ◽  
Intensive Care Unit Stay ◽  
Preterm Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Female Ratio

Objective: To study clinical outcome of early versus late caffeine therapy in preterm infants. Study Design: Prospective comparative study. Place and Duration of Study: Neonatal Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi, from Jan to Jul 2018. Methodology: A total of 40 preterm infants with gestational age <32 weeks and birth weight <1500 grams were randomly divided into two groups on the basis of initiation of caffeine therapy i.e. group A (early caffeine group) and group B (late caffeine group). Infant’s demographic data and clinical outcomes were compared between both groups using SPSS IBM software. Results: Mean gestational age was 29.9 ± 1.19 weeks with male to female ratio of 1.5:1 Mean birth weight was 1165.3 ± 316 grams. Half (50%) of the infants were delivered by cesarean section while surfactant was given in 29 (72.5%) infants. While comparing both groups we observed that early caffeine shortens duration of Neonatal Intensive Care Unit stay (p<0.05) whereas caffeine therapy initiation timings didn’t influence the risk of development of Respiratory Distress Syndrome or need of mechanical ventilation. Conclusion: Early caffeine therapy in preterm infants is associated with decrease duration of Neonatal Intensive Care Unit stay. However further work is needed in this regards to establish its efficacy and safety.

scholarly journals Emphasise the role of kangaroo mother care in stabilisation of vitals and weight gain pattern in low birth weight babies inside neonatal intensive care unit

2021 ◽  
Vol 8 (4) ◽  
pp. 721
Author(s):  
Shwetal M. Bhatt ◽  
Khushboo N. Mehta ◽  
Ankita Maheshwari ◽  
Priyanka C. Parmar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Weight Gain ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Kangaroo Mother Care ◽  
P Value

Background: Kangaroo mother care (KMC) is routinely practiced in post-natal wards for care of stable low birth weight (LBW) infants. Objectives of the study were conducted to emphasize on the role of KMC in vitals stabilization and weight gain in LBW babies inside neonatal intensive care unit (NICU).Methods: Cross-sectional analytical quantitative study.Results: A total of 80 babies (48 males and 32 females) were enrolled and given KMC inside NICU. Mean birth weight was 1330 grams. Mean gestational age was 33 weeks (range 30-38 weeks). KMC was initiated within 72 hours of life in majority of babies (71%). Though 65% of them required oxygen support via prongs, KMC was started in them, with monitoring of vitals. No episode of apnea was observed during KMC sessions. Mean duration of KMC was 6 days (3-14 days). Heart rate dropped by 3-4 beats per minute (150+2.12 to 146+1.63, Respiratory rate decreased from 53+3.9 to 49+2.7, Oxygen saturation improved by 2-3% (93+0.42 to 96+0.71). Temperature rose from 36.78+0.01 to 37.07+0.02. P value for all vitals was 0.0001, which is considered significant (<0.05). Average weight gain was 76 grams during the average 6 days of KMC inside NICU, (p value=0.0001).  Conclusions: KMC was found to be effective for stabilization of vitals in NICU, early initiation and upgradation of feeding, early achievement of weight gain pattern, and early shift to postnatal ward by mother’s side. Also, no adverse effects were noted on the babies.

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