scholarly journals Nursing and rehabilitation of very preterm infants: current state of the problem

2017 ◽  
Vol 8 (2) ◽  
pp. 81-88
Author(s):  
Svetlana A Khmilevskaya ◽  
Nikolay I Zryachkin ◽  
Ekaterina S Shcherbatyuk ◽  
Elena I Ermolaeva ◽  
Anastasiya A Rebrova

The article deals with basic ethiopathogenetic factors of birth of extremely premature infants, their malconditions, disease incidence. The authors give live birth criteria adopted in Russia in 2011 according to WHO recommendations. The article presents basic ethiologic factors of prematurely born and the role of intrauterine infection (IUI) in the pathogenesis of this condition, also survival rate, mortality and adverse outcomes. These literatures devoted to the international experience of nursing of such children and forecasting of viability of newborns in the viability limit zone (VLZ) are provided. Reflects the basic malconditions typical of children with very low (VLBW) and extremely low birth weight (ELBW) and leading to disability (damage to the nervous, respiratory system, analysis unit, etc). It is shown significance of IUI in the formation of infectious and inflammatory diseases (IID), the place and especially the innate immune system in the implementation of anti-infectious protection and ways of its correction in severe forms of EWI. Need of development of the differentiated programs of the treatment-and-prophylactic actions directed to correction of critical conditions and simplification of a course of the developed diseases is proved.

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Ola Didrik Saugstad ◽  
Vishal Kapadia ◽  
Ju Lee Oei

Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery room should therefore be optimized, but knowledge gaps, including initial fraction of oxygen (FiO<sub>2</sub>) and how FiO<sub>2</sub> should be changed to reach an optimal oxygen saturation measured by pulse oximetry (SpO<sub>2</sub>) target within the first 5–10 min of life, remain. In order to answer this question, we therefore reviewed relevant literature. For newly born infants with gestational age (GA) &#x3c;32 weeks in need of positive pressure ventilation (PPV) immediately after birth, we identified 2 fundamental issues: (1) the optimal initial FiO<sub>2</sub> and (2) the target SpO<sub>2</sub> within the first 5–10 min of life. For newly born infants between 29 and 31 weeks of GA, an initial FiO<sub>2</sub> of 0.3 hit the target defined by the International Liaison Committee on Resuscitation (ILCOR) best. Newborn infants with GA &#x3c;29 weeks in need of PPV and supplementary oxygen, we suggest starting with FiO<sub>2</sub> 0.3 and adjusting the FiO<sub>2</sub> to reach SpO<sub>2</sub> of 80% within 5 min of life for best outcomes. Prolonged bradycardia (heart rate &#x3c;100 bpm for &#x3e;2 min) is associated with increased risk of adverse outcomes, including death. The combination of strict control of development of SpO<sub>2</sub> in the first 10 min of life and a heart rate &#x3e;100 bpm represents the best tool today to achieve the most optimal outcome in the delivery room of very preterm and immature newborn infants.


2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e9-e9
Author(s):  
Anthony Debay ◽  
Sharina Patel ◽  
Pia Wintermark ◽  
Martine Claveau ◽  
François Olivier ◽  
...  

Abstract Background The physiological stress induced by tracheal intubation (TI) is associated with increased risk of neurological injury among very preterm infants. The location of TI procedure and number of attempts required may contribute to adverse outcomes. Objectives We aimed to assess the association of location where TI is performed and the number of TI attempts with death and/or severe neurological injury (SNI) among very preterm infants born &lt;33 weeks and intubated in the first 7 days of life. Design/Methods Retrospective cohort study of 442 infants born 23-32 weeks gestation, admitted to a Level 3 NICU 2015-2018 within the first 7 days of life. We excluded infants who were moribund and the ones with a major congenital anomaly. Data was collected from the Canadian Neonatal Network database and chart review. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. &gt;1) among infants intubated in the first 7 days of life. Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3-4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders. Results Rate of intubation was 46% (202/442). Rate of death and/or SNI was 2.5% (6/240) among infants never intubated, 12% (13/105) among NICU TI, 32% (31/97) among DR TI, 20% (17/85) among infants with 1 TI attempt and 23% (27/117) among infants with &gt;1 TI attempt. Rate of premedication use for NICU TI was 97% (102/105). Overall, median number of intubation attempts was 1 [IQR 1-2]. Compared to no TI, TI in the NICU (adjusted odds ratio [AOR] 3.39, 95% CI 1.20-10.53) and TI in the DR (AOR 9.28, 95% CI 3.33-29.43) were associated with higher odds of death and/or SNI. DR TI was associated with higher odds of death and/or SNI compared to NICU TI (AOR 2.73, 95% CI 1.23-6.35). Compared to no TI, 1 TI attempt (AOR 5.25, 95% CI 1.93-15.93) and &gt;1 TI attempt (AOR 5.17, 95% CI 1.93-15.69) were associated with higher odds of death and/or SNI. The number of intubation attempts (1 vs. &gt;1) was not associated with death and/or SNI (AOR 0.99, 95% CI 0.47-2.09). Conclusion Intubated infants have higher odds of death and/or SNI. Among intubated infants, DR TI is associated with higher odds of death and/or SNI vs. TI in the NICU with premedication. Optimizing non-invasive ventilation in the DR may help reduce brain injury in preterm infants.


2013 ◽  
Vol 61 (6) ◽  
pp. 495-501 ◽  
Author(s):  
Agata Serwatowska-Bargieł ◽  
Maria Wąsik ◽  
Maria Katarzyna Kornacka ◽  
Elżbieta Górska ◽  
Robert Kozarski

2018 ◽  
Vol 107 (6) ◽  
pp. 981-989 ◽  
Author(s):  
Liset Hoftiezer ◽  
Renske G. Snijders ◽  
Chantal W.P.M. Hukkelhoven ◽  
Richard A. van Lingen ◽  
Marije Hogeveen

2015 ◽  
Vol 9 (2) ◽  
pp. 0-0 ◽  
Author(s):  
Лебедева ◽  
O. Lebedeva

The clinical review of international data about morbidity and mortality of children with very low and extremely low birth weight is presented in this article. The risk factors of unfavorable outcomes and increasing possibilities for survival were analyzed. It was defined that the morbidity and mortality of very preterm infants, especially with the extreme degree of immaturity, vary greatly and depend on the socio-economic background, level of medical care and baseline characteristics of the newborn. However, every newborn, even in relatively equal conditions, has a &#34;degree of stability&#34;, which is determined by biological and genetic factors, the characteristics of the course of the perinatal period and numerous external reasons. The author focuses on the most vulnerable and challenging population of children born in the zone limit of viability earlier than 25 weeks of gestation and weighing less than 700g. She noted that the detailed analysis of the causes of death with the release of the risk factors of adverse outcome is extremely important, especially for relatively promising group of children born with a gestational age of 25 weeks or more. They are the reserve on ways to further reduce neonatal and infant mortality in Russia.


2019 ◽  
Vol 6 (4) ◽  
pp. 226-231
Author(s):  
N. Scherbina ◽  
L. Potapova ◽  
I. Scherbina ◽  
O. Lipko ◽  
O. Mertsalova

THE CURRENT STATE OF THE PROBLEM OF PERINATAL PSYCHOSOMATIC DISORDERS IN PREGNANT WOMEN Scherbina N., Potapova L., Scherbina I., Lipko O., Mertsalova O. Objective: to study the characteristics of the psychosomatic state of women during pregnancy using the Edinburgh Postpartum Depression Scale (EPDS). Materials and Methods: sixty pregnant women in the III trimester of pregnancy were tested using the EPDS questionnaire, a 10-point self-assessment scale that covers the general symptoms of depression. To determine the internal consistency and reliability of this scale, the Cronbach alpha indicator, a statistical indicator that allows evaluation of whether the features included in the questionnaire measure the same thing (high internal agreement), or different things (low internal agreement), was calculated. Results: Subjectively, all pregnant women noted  simplicity, unambiguity and clear wording of the questions, which indicated good acceptability of this questionnaire for the use in the complex of standard monitoring of pregnant women in an antenatal clinic. The Cronbach alpha coefficient was 0.775, which corresponds to a sufficient degree of consistency of the internal elements of the scale. Screening for depressive disorders using EPDS during pregnancy revealed psychosomatic problems of the perinatal period. Data obtained using this scale demonstrate high rates of depressive manifestations in pregnant women. Psychopathological disorders were detected in 40% of women, while in 23% the symptoms of the current "major" depression were identified. The frequency of development of depressive symptoms increases significantly in the presence of a high obstetric risk, characteristic of the current pregnancy (threat of premature birth, hypertensive disorders during pregnancy, intrauterine infection of the fetus, retardation of the fetus development), as well as compromised obstetric and gynecological history. EPDS can be used as a reliable diagnostic tool to prevent pregnancy-related adverse outcomes. Conclusions: identifying the risk factors of pregnancy, screening and examining psychosomatic symptoms with EPDS, and timely referral for psychiatric care are key issues for reducing the risk among women with psychosomatic disorders during pregnancy and the postpartum period. Keywords: pregnancy, psychosomatic disorders, Edinburgh postpartum depression scale.   Абстракт. СУЧАСНИЙ СТАН ПРОБЛЕМИ ПЕРИНАТАЛЬНИХ ПСИХОСОМАТИЧНИХ РОЗЛАДІВ У ВАГІТНИХ. Щербина М., Потапова Л., Щербина I., Ліпко О., Мерцалова О. Мета дослідження: вивчити особливості психосоматичного стану жінок під час вагітності з використанням Единбурзької шкали післяпологової депресії (EPDS). Матеріали і методи: проведено тестування за опитувальником EPDS 60 вагітних жінок в III триместрі вагітності. EPDS є шкалою самооцінки, складається з 10 пунктів охоплює загальну симптоматику депресії. Для визначення внутрішньої узгодженості і надійності зазначеної шкали розраховувався показник альфа Кронбаха, статистичний показник, що дозволяє оцінити вимірюють чи ознаки, що входять в опитувальник одне і те ж (висока внутрішня згода, або різні речі (низький внутрішній згоду). Результати дослідження: суб'єктивно все вагітні відзначали простоту, однозначність і зрозумілу формулювання питань, що свідчило про хорошу прийнятності даного опитувальника для застосування в комплексі стандартного спостереження за вагітними в жіночій консультації. Значення коефіцієнта альфа Кронбаха склало 0,775, що відповідає достатньому ступені узгодженості внутрішніх елементів шкали. Проведений скринінг на наявність депресивних розладів за допомогою EPDS під час вагітності дозволив виявити психосоматичні проблеми перинатального періоду. Дані, отримані на основі застосування цієї шкали демонструють високі показники присутності депресивних проявів у вагітних жінок. Психопатологічні розлади виявлено у 40% жінок, при цьому у 23% визначені симптоми поточної «великої» депресії. Частота розвитку депресивних симптомів значно підвищується при наявності високого акушерського ризику, характерного для поточної вагітності (загроза передчасних пологів, гіпертензивні порушення під час вагітності, внутрішньоутробне інфікування плода, ретардація плода), а також обтяженого акушерського і гінекологічного анамнезів. EPDS може бути використана як надійний діагностичний інструмент для попередження несприятливих наслідків, пов'язаних з вагітністю. Висновок: виявлення факторів ризику  вагітності, скринінг і вивчення психосоматичних симптомів у вагітних із використанням  EPDS, а також своєчасне направлення для надання психіатричної допомоги, є ключовими питаннями зниження ризику серед жінок з психосоматичними розладами під час вагітності та в післяпологовому періоді. Ключові слова: вагітність, психосоматичні розлади, Единбурзька шкала післяродової депресії.    Абстракт СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫ ПЕРИНАТАЛЬНЫХ ПСИХОСОМАТИЧЕСКИХ  РАССТРОЙСТВ У БЕРЕМЕННЫХ. Щербина Н., Потапова Л., Щербина И., Липко О., Мерцалова О. Цель исследования: изучить особенности психосоматического состояния женщин во время беременности с использованием Эдинбургской шкалы послеродовой депрессии (EPDS).Материалы и методы: проведено тестирование по опроснику EPDS 60 беременных женщин в III триместре беременности. EPDS является шкалой самооценки, состоит из 10 пунктов и охватывает общую симптоматику депрессии. Для определения внутренней согласованности и надежности указанной шкалы рассчитывался показатель альфы Кронбаха, статистический показатель, позволяющий оценить измеряют ли признаки, входящие в опросник одно и то же (высокое внутреннее согласие, или разные вещи (низкое внутреннее согласие). Результаты исследования: Субьективно все беременные отмечали простоту, однозначность и понятную формулировку вопросов, что свидетельствовало о хорошей приемлемости данного опросника для применения в комплексе стандартного наблюдения за беременными в женской консультации. Значение коэффициента альфа Кронбаха составило 0,775, что соответствует достаточной степени согласованности внутренних элементов шкалы. Проведенный скрининг на наличие депрессивных расстройств с помощью EPDS во время беременности позволил выявить психосоматические проблемы перинатального периода. Данные, полученныена основе применения этой шкалы демонстрируют высокие показатели присутствия депрессивных проявлений у беременных женщин. Психопатологические расстройства выявлены у 40% женщин, при этом у 23% определены симптомы текущей «большой» депрессии. Частота развитии депрессивных симптомов значительно повышается при наличии высокого акушерского риска, характерного для текущей беременности (угроза преждевременных родов, гипертензивные нарушения во время беременности, внутриутробное инфицирование плода, ретардация плода), а также отягощенного акушерского и гинекологического анамнезов. EPDSможет быть использована как надежный диагностический инструмент для предотвращения неблагоприятных исходов, связанных с беременностью. Заключение: выявление факторов риска беременности и родов, скрининг и изучение психосоматических симптомов cиспользованием EPDS, а также своевременное направление для оказания психиатрической помощи, являются ключевыми вопросами снижения риска среди женщин с психосоматическими расстройствами во время беременности и в послеродовом периоде. Ключевые слова: беременность, психосоматические расстройства, Эдинбургская шкала послеродовой депрессии.


2021 ◽  
Vol 12 ◽  
Author(s):  
Nadia C. Valentini ◽  
Luana S. de Borba ◽  
Carolina Panceri ◽  
Beth A. Smith ◽  
Renato S. Procianoy ◽  
...  

Aim: This study examined the neurodevelopment trajectories, the prevalence of delays, and the risks and protective factors (adverse outcomes, environment, and maternal factors) associated with cognitive, motor, and language development for preterm infants from 4– to 24-months.Method: We assessed 186 preterm infants (24.7% extremely preterm; 54.8% very preterm; 20.4% moderate/late preterm) from 4– to 24-months using the Bayley Scales of Infant Development – III. Maternal practices and knowledge were assessed using the Daily Activities of Infant Scale and the Knowledge of Infant Development Inventory. Birth risks and adverse outcomes were obtained from infant medical profiles.Results: A high prevalence of delays was found; red flags for delays at 24-months were detected at 4– and 8-months of age. The neurodevelopmental trajectories showed steady scores across time for cognitive composite scores for extremely- and very-preterm infants and for language composite scores for the extremely- and moderate/late-preterm; a similar trend was observed for the motor trajectories of moderate/late preterm. Changes over time were restricted to motor composite scores for extremely- and very-preterm infants and for cognitive composite scores for moderate/late preterm; declines, stabilization, and improvements were observed longitudinally. Positive, strong, and significant correlations were for the neurodevelopment scores at the first year of life and later neurodevelopment at 18 and 24 months. The cognitive, language, and motor composite scores of extremely and very preterm groups were associated with more risk factors (adverse outcomes, environment, and maternal factors). However, for moderate/late preterm infants, only APGAR and maternal practices significantly explained the variance in neurodevelopment.Discussion: Although adverse outcomes were strongly associated with infant neurodevelopment, the environment and the parents’ engagement in play and breastfeeding were protective factors for most preterm infants. Intervention strategies for preterm infants should start at 4– to 8-months of age to prevent unwanted outcomes later in life.


2019 ◽  
Vol 2019 ◽  
pp. 1-14 ◽  
Author(s):  
Balaji Govindaswami ◽  
Matthew Nudelman ◽  
Sudha Rani Narasimhan ◽  
Angela Huang ◽  
Sonya Misra ◽  
...  

Introduction. Avoiding intubation and promoting noninvasive modes of ventilator support including continuous positive airway pressure (CPAP) in preterm infants minimizes lung injury and optimizes neonatal outcomes. Discharge home on oxygen is an expensive morbidity in very preterm infants (VPI) with lung disease. In 2007 a standardized bundle was introduced for VPI admitted to the neonatal care unit (NICU) which included delayed cord clamping (DCC) at birth and noninvasive ventilation as first-line cardiorespiratory support in the delivery room (DR), followed by bubble CPAP upon NICU admission. Objective. Our goal was to evaluate the risk of (1) intubation and (2) discharge home on oxygen after adopting this standardized DR bundle in VPI born at a regional perinatal center and treated in the NICU over a ten-year period (2008-2017). Materials and Methods. We compared maternal and neonatal demographics, respiratory care processes and outcomes, as well as neonatal mortality and morbidity in VPI (< 33 weeks gestation) and extremely low birth weight (ELBW, < 1000 g) subgroup for three consecutive epochs: 2008-2010, 2011-2013, and 2014-2017. Results. Of 640 consecutive inborn VPI, 55% were < 1500 g at birth and 23% were ELBW. Constant through all three epochs, DCC occurred in 83% of VPI at birth. There was progressive increase in maternal magnesium during the three epochs and decrease in maternal antibiotics during the last epoch. Over the three epochs, VPI had less risk of DR intubation (23% versus 15% versus 5%), NICU intubation (39% versus 31% versus 18%), and invasive ventilation (37% versus 30% versus 17%), as did ELBW infants. Decrease in postnatal steroid use, antibiotic exposure, and increase in early colostrum exposure occurred over the three epochs both in VPI and in ELBW infants. There was a sustained decrease in surfactant use in the second and third epochs. There was no significant change in mortality or any morbidity in VPI; however, there was a significant decrease in pneumothorax (17% versus 0%) and increase in survival without major morbidity (15% versus 41%) in ELBW infants between 2008-2010 and 2014-2017. Benchmarked risk-adjusted rate for oxygen at discharge in a subgroup of inborn VPI (401-1500 g or 22-31 weeks of gestation) is 2.5% (2013-2017) in our NICU compared with > 8% in all California NICUs and > 10% in all California regional NICUs (2014-2016). Conclusion. Noninvasive strategies in DR and NICU minimize risk of intubation in VPI without adversely affecting other neonatal or respiratory outcomes. Risk-adjusted rates for discharge home on oxygen remained significantly lower for inborn VPI compared with rates at regional NICUs in California. Reducing intubation risk in ELBW infants may confer an advantage for survival without major morbidity. Prenatal magnesium may reduce intubation risk in ELBW infants.


2005 ◽  
Vol 193 (3) ◽  
pp. 928-932 ◽  
Author(s):  
Anna Locatelli ◽  
Patrizia Vergani ◽  
Alessandro Ghidini ◽  
Francesca Assi ◽  
Claudia Bonardi ◽  
...  

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