Evidence Based Skin Care in Preterm Neonates- A Short Review

Preterm neonates are the neonates born alive before completion of 37 weeks of gestation. Prematurity is the real threat for survival of these neonates, especially those who are very-preterm (less than 32 weeks). In developing countries due to lack of basic care such as maintenance of warm chain, breast feeding support, infection control and scarcity of resources to tackle respiratory difficulties; the mortality in preterm infants is very high. Good skin care is a critical component of the basic neonatal care, that can directly reduce complications of prematurity as well address issues arising during the handling of these preterm infants such as injuries due to adhesives or devices, skin dryness, the use of skin emollients and disinfectants etc. In contemporary era, evidence-based practices are the need of hour to guide clinical practice. There are limited research articles dealing with skin care in preterm neonates that offer strong recommendations for skin care modalities. In this short review, the authors have compiled the recent evidences to address various issues related to skin care in very preterm neonates. In this article the evidences related to bathing practices in preterm infants, and the use of disinfectants and emollients for premature skin care has been discussed; besides making general recommendation related to skin care in preterm infants. Keywords: Preterm, skin care, emollients, disinfectant, neonate, prematurity, premature skin.

Download Full-text

Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort

BMJ ◽

10.1136/bmj.i2976 ◽

2016 ◽

pp. i2976 ◽

Cited By ~ 69

Author(s):

Jennifer Zeitlin ◽

Bradley N Manktelow ◽

Aurelie Piedvache ◽

Marina Cuttini ◽

Elaine Boyle ◽

...

Keyword(s):

Preterm Infants ◽

Population Based ◽

Evidence Based ◽

Evidence Based Practices ◽

Very Preterm Infants ◽

Severe Morbidity ◽

Very Preterm

Download Full-text

The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China

Neonatology ◽

10.1159/000519846 ◽

2021 ◽

pp. 1-7

Author(s):

Di Jin ◽

Xinyue Gu ◽

Siyuan Jiang ◽

Yanchen Wang ◽

Tongling Yang ◽

...

Keyword(s):

Brain Injury ◽

Preterm Infants ◽

Gestational Age ◽

Early Death ◽

Evidence Based ◽

Severe Brain Injury ◽

Evidence Based Practices ◽

Very Preterm Infants ◽

Very Preterm ◽

Evidence Based Healthcare

Introduction: Very preterm infants are at high risk of early death or severe brain injury, with potential for impaired long-term neurodevelopmental function and physical health. There are evidence-based healthcare practices that can reduce the incidence. Materials and Methods: Infants born at 24–316 weeks gestational age and admitted within 24 h to NICUs participating in the Chinese Neonatal Network in 2019 were included. We examined the association between 4 evidence-based practices: inborn (born in a tertiary hospital in the Chinese Neonatal Network), ACS (any antenatal corticosteroid), MgSO4 (prenatal magnesium sulfate), and NT (normothermic temperature [36.0–37.5°C] at admission) and early death and/or severe brain injury in the study population. Results: Of 6,035 eligible infants, the incidence of early death and/or severe brain injury was 10.6%. Exposure to ACS only was associated with significant lower incidence of death and/or severe brain injury than none (aOR, 0.71; 95% CI: 0.57–0.88), but not MgSO4 only (aOR, 0.97; 95% CI: 0.81–1.17), NT only (aOR, 0.91; 95% CI: 0.76–1.08), or inborn only (aOR, 0.91; 95% CI: 0.72–1.15). The association between number of practices and incidence of early death and/or severe brain injury is as follows: none = 23% (31/138), any 1 = 14% (84/592), any 2 = 12% (185/1,538), any 3 = 9% (202/2,285), and all 4 = 9% (140/1,482). Discussion/Conclusion: More comprehensive use of evidence-based practices was associated with improved survival without severe brain injury among very preterm infants born at <32 weeks gestational age.

Download Full-text

Faculty Opinions recommendation of Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726487267.793577034 ◽

2020 ◽

Author(s):

Andrew Shennan

Keyword(s):

Preterm Infants ◽

Population Based ◽

Evidence Based ◽

Evidence Based Practices ◽

Very Preterm Infants ◽

Severe Morbidity ◽

Very Preterm

Download Full-text

Long-term effects of pain in infants

Oxford Textbook of Pediatric Pain ◽

10.1093/med/9780198818762.003.0004 ◽

2021 ◽

pp. 38-46

Author(s):

Ruth E. Grunau ◽

Jillian Vinall Miller ◽

Cecil M. Y. Chau

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Pain Treatment ◽

Inflammatory Responses ◽

Imaging Techniques ◽

Preterm Neonates ◽

Long Term Effects ◽

Very Preterm Infants ◽

Very Preterm

The long-term effects of infant pain are complex, and vary depending on how early in life the exposure occurs, due to differences in developmental maturity of specific systems underway. Changes to later pain sensitivity reflect multiple factors such as age at pain stimulation, extent of tissue damage, type of noxious insult, intensity, and duration. In both full-term and preterm infants exposed to hospitalization, sequelae of early pain are confounded by parental separation and quality of pain treatment. Neonates born very preterm are outside the protective uterine environment, with repeated exposure to pain occurring during fetal life. Especially for infants born in the late second trimester, the cascade of autonomic, hormonal, and inflammatory responses to procedures may induce excitotoxicity with widespread effects on the brain. Quantitative advanced imaging techniques have revealed that neonatal pain in very preterm infants is associated with altered brain development during the neonatal period and beyond. Recent studies now provide evidence of pathways reflecting mechanisms that may underlie the emerging association between cumulative procedural pain exposure and neurodevelopment and behavior in children born very preterm. Owing to immaturity of the central nervous system, repetitive pain in very preterm neonates contributes to alterations in multiple aspects of development. Importantly, there is strong evidence that parental caregiving to reduce pain and stress in preterm infants in the Neonatal Intensive Care Unit (NICU) may prevent adverse effects, and sensitive parenting after NICU discharge may help ameliorate potential long-term effects.

Download Full-text

Cumulative effect of evidence-based practices on outcomes of preterm infants born at <29 weeks’ gestational age

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.08.058 ◽

2020 ◽

Vol 222 (2) ◽

pp. 181.e1-181.e10 ◽

Cited By ~ 1

Author(s):

Angelo Rizzolo ◽

Prakesh S. Shah ◽

Isabelle Boucorian ◽

Brigitte Lemyre ◽

Valerie Bertelle ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Cumulative Effect ◽

Evidence Based ◽

Evidence Based Practices

Download Full-text

G209(P) Delivering evidence based practices in preterm infants; a single centre audit of practice

10.1136/archdischild-2018-rcpch.204 ◽

2018 ◽

Author(s):

VJ Monnelly ◽

A Godman ◽

C Kissack ◽

JC Becher

Keyword(s):

Preterm Infants ◽

Evidence Based ◽

Single Centre ◽

Evidence Based Practices

Download Full-text

Prevalence and Risk Factors for Gastroesophageal Reflux in Symptomatic Very Preterm Neonates

10.21203/rs.3.rs-100218/v1 ◽

2020 ◽

Author(s):

Yu Hu ◽

Jian-Hua Fu ◽

Shu-Cheng Zhang

Keyword(s):

Risk Factors ◽

Gastroesophageal Reflux ◽

Confidence Interval ◽

Preterm Infants ◽

Odds Ratio ◽

Preterm Neonates ◽

Very Preterm ◽

Intraluminal Impedance ◽

Immature Development ◽

Impedance Monitoring

Abstract Background Because of immature development, preterm infants are prone to respiratory and digestive symptoms of dyspnea, vomiting, and aspiration pneumonia. These symptoms are often observed in infants with gastroesophageal reflux (GER). However, the relationship between GER and these symptoms remain unclear.Methods A cohort of 61 preterm infants born at 32 weeks of gestation or earlier with respiratory or digestive symptoms were retrospectively reviewed. All the preterm infants underwent 24-hour pH-multichannel intraluminal impedance monitoring. Clinical data were analyzed using logistic regression analyses.Results Among the 61 symptomatic preterm infants, 34 were positive for pathologic GER with a prevalence of 55.7%. The GER associated symptoms included apnea (42.6%), cyanosis (19.7%), vomiting (14.8%), pneumonia (9.8%), and poor weight gain (13.1%). These respiratory and digestive symptoms were more frequent in infants with pathologic GER than in those without. (p<0.05) The risk factors for GER included severe BPD (odds ratio [OR], 6.890; 95% confidence interval [CI], 1.125-42.209). Probiotics and delayed full oral feeds reduced the risk of GER (odds ratio [OR], 0.642; 95% confidence interval [CI], 0.457-0.901, p<0.05; OR, 0.234, 95% CI, 0.069-0.794, p<0.05). Conclusions The prevalence of GER is high in the symptomatic preterm infants. GER aggravates the respiratory and digestive symptoms holding that not all the symptoms are GER associated. Probiotics and delayed full oral feeds can decrease the prevalence of GER.

Download Full-text

The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.201812-2348oc ◽

2019 ◽

Vol 200 (6) ◽

pp. 751-759 ◽

Cited By ~ 60

Author(s):

Erik A. Jensen ◽

Kevin Dysart ◽

Marie G. Gantz ◽

Scott McDonald ◽

Nicolas A. Bamat ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Evidence Based ◽

Very Preterm Infants ◽

Very Preterm

Download Full-text

Prevalence and Risk Factors for Gastroesophageal Reflux in Symptomatic Very Preterm Neonates

10.21203/rs.3.rs-111467/v1 ◽

2020 ◽

Author(s):

Yu Hu ◽

Hua Fu ◽

Cheng Zhang

Keyword(s):

Risk Factors ◽

Gastroesophageal Reflux ◽

Preterm Infants ◽

Preterm Neonates ◽

Very Preterm ◽

Intraluminal Impedance ◽

Immature Development ◽

Impedance Monitoring ◽

The Relationship ◽

Poor Weight Gain

Abstract Objectives Because of immature development, preterm infants are prone to respiratory and digestive symptoms, such as dyspnea, vomiting, and aspiration pneumonia. These symptoms are often observed in infants with gastroesophageal reflux (GER). However, the relationship between GER and these symptoms remains unclear.Methods A cohort of 61 preterm infants born at 32 weeks of gestation or earlier with respiratory or digestive symptoms were retrospectively reviewed. All the preterm infants underwent 24-hour pH-multichannel intraluminal impedance monitoring. Clinical data were analyzed using logistic regression analyses.Results Among the 61 symptomatic preterm infants, 34 were positive for pathologic GER with a prevalence of 55.7%. The GER-associated symptoms included apnea (42.6%), cyanosis (19.7%), vomiting (14.8%), pneumonia (9.8%), and poor weight gain (13.1%). These respiratory and digestive symptoms were more frequent in infants with pathologic GER than in those without (p<0.05). The risk factors for GER included severe bronchopulmonary dysplasia (odds ratio [OR], 6.890; 95% confidence interval [CI], 1.125-42.209). Probiotics and delayed full oral feeds reduced the risk of GER (OR, 0.642; 95% CI, 0.457-0.901, p<0.05; OR, 0.234, 95% CI, 0.069-0.794, p<0.05). Conclusions The prevalence of GER is high in symptomatic preterm infants. GER aggravates the respiratory and digestive symptoms; however, such symptoms are not always GER-associated. Probiotics and delayed full oral feeds can decrease the prevalence of GER.

Download Full-text