The Effects of Training Emotional Intelligence Skills Training on Stress Among the Mothers of Premature Newborns in Neonatal Intensive Care Unit

Background The mothers of premature newborns experience high levels of stress which can affect their relationships with their newborns, cause them ineffective parental role performance, and impair their newborns’ growth and development. Emotional intelligence (EI) has potential positive effects on stress. Objectives This study evaluated the effects of training EI skills on stress among the mothers of premature newborns in neonatal intensive care unit (NICU). Methods This quasi-experimental study was conducted in 2016 with a pretest-posttest design and a control group. Ninety mothers of premature newborns were selected from the NICUs of Zeinabieh and Hafez hospitals, Shiraz, Iran, and randomly allocated to an intervention and a control group. Participants in the control group received EI skills training in six sessions held twice weekly. The Parental Stress Scale was used for stress assessment before and one week after the intervention. The SPSS software (v. 16.0) was used for data analysis. Results Thirty seven participants in each group completed the study. While there was no significant difference between the intervention and the control groups respecting the pretest mean score of stress (48.89±19.02 vs. 44.92±18.55; P = 0.37), the posttest mean score of stress in the intervention group was significantly less than the control group (13.29±13.15 vs. 47.84±22.56; P < 0.001). The mean score of participants’ stress had significant relationship with their income level and their premature newborns’ birth weight. Conclusion Training EI skills is effective in significantly reducing stress among the mothers of premature newborns in NICU.

DO PROBIOTICS HAVE A FUTURE IN NEONATOLOGY? (ANALYSIS OF THE LATEST DATA. PART 3)

The issue of feasibility and effectiveness of probiotics use in newborns is still discussable. A position letter of the Committee on nutrition of the European Society for Pediatric NutritionGastroenterology, Hepatology, and(ESPGHAN) and the Working group of the ESPGHAN on probiotics and prebiotics issues was published in May 2020 in “Pediatric Gastroenterology and Nutrition” magazine as for the use of probiotics in premature newborns. The third part of the literature continues with the position paper and the results of many randomized controlled clinical trials of probiotics. The article considers the answers to 6 clinical questions posed by the working group of the Committee to assess the feasibility of use, routes of administration, dosage and duration of use, as well as the effectiveness and quality of probiotic drugs. It was proved that probiotics, in general, could decrease the level of necrotising enterocolitis, sepsis, and mortality. On the other hand, an increasing number of commercial products containing probiotics of non optimal quality are available. In addition, a large number of departments in the world regularly suggest probiotic supplements as a treatment standard despite the absence of any solid evidence. Moreover, the emphasis was placed on issues of safety of probiotic supplements for premature newborns. Guarantee of quality of probiotic product is deliverance of probiotic strains by transfer genes of resistance to antibiotics, the ability to regularly detect sepsis while using probiotics.

DO PROBIOTICS HAVE A FUTURE IN NEONATOLOGY?

The issue of feasibility and effectiveness of probiotics use in newborns is still discussable. A position letter of the Committee on nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) and the Working group of the ESPGHAN on probiotics and prebiotics issues was published in May 2020 in “Pediatric Gastroenterology and Nutrition” magazine as for the use of probiotics in premature newborns. It stated that over 10,000 premature newborns from all over the world had taken part in random controlled probiotics tests. It was proved that probiotics, in general, could decrease the level of necrotizing enterocolitis, sepsis, and mortality. But the question of choice of microorganism strains, dosing, and duration of medication course remains open. On the other hand, an increasing number of commercial products containing probiotics of non optimal quality are available. In addition, a large number of departments in the world regularly suggest probiotic supplements as a treatment standard despite the absence of any solid evidence. According to the data of the latest meta-analysis, effectiveness in decreasing mortality and incidence was found in the minority of investigated strains or combinations. In the position letter authors wanted to give advice which specific strains can be potentially used and which cannot. Moreover, the emphasis was placed on issues of safety of probiotic supplements for premature newborns. Guarantee of quality of probiotic product is deliverance of probiotic strains by transfer genes of resistance to antibiotics and the possibility of regular identification of probiotic sepsis. There is a conditional recommendation (with a low credibility of evidence) to provide eitherLactobacillus rhamnosus GG ATCC53103, or combination of Bifidobacterium infantis Bb-02, Bifidobacterium lactis Bb-12, and Streptococcus thermophilus TH-4 for decreasing a risk of the necrotizing enterocolitis development subject to all issues of safety.

PECULIARITIES OF EXPANDED NEWBORN SCREENING FOR THE INHERITED METABOLIC DISORDERS IN PREMATURE NEWBORNS

Occurrence of the premature birth in Ukraine is about 6%. Premature newborns are the highest risk group of developing chronic pathology of the nervous system, sensory organs, and respiratory system, causing neonatal mortality and disability; the latter is 22 times higher in premature newborns than in full-term ones. Besides, there is a large group of rare metabolic disorders that significantly disrupt the adaptation and nursing of newborns with signs of morpho-functional and enzymes immaturity. The efficacy of medical care of premature newborns to a great extent relates to prompt diagnosis as common somatic, as rare metabolic disorders.In view of the absence of specific symptoms, it is almost impossible to establish a diagnosis of inherited metabolic disordersduring the clinical examination of a neonate.Expanded newborn screening (ENBS) for inborn errors of metabolism (IEMs) proved to be an effective tool to single out newborns with genetic deficiency of certain metabolic enzymes.The practical experience of performingENBS indicates a problematic issue is the interpretation of results for preterm babies.This article is discussed the key factors affecting the predictive value of ENBS results in premature newborns, like peculiarities of blood sampling based on time intervals from delivery for certain nosologies, repeated sample taking for lab examination considering the basic principles of 2-nd Edition of CLSI "Guideline "Newborn Screening for Preterm, Low Birth Weight, and Sick Newborns, 2019". The CLSI Guideline presents the consensus solutions of a global team of neonatologists, metabolic paediatricians and medical geneticists regarding the accuracy, reliability and timing of laboratory determinations of IEM markers in the blood, as well as a set of factors to consider interpreting ENBS results for premature, low birth weight and newborns with perinatal pathology.The current procedure for neonatal screening for premature babies in Ukraine should be updated to modern requirements of the relevant clinical recommendations of world-recognized medical institutions, including CLSI. The critical issue in improving the quality and reliability of neonatal screening for preterm babies is multiple (repeated) blood sampling for laboratory determination of levels of biochemical IEM markers.A properly established and well- functioning system of expanded neonatal screening proved to be a highly effective tool for reducing early infant mortality and disability associated with inherited metabolic diseases.

Nephrogenesis, Renal Function, and Biomarkers in Preterm Newborns

Background: The survival of premature newborns increased in the last decades due to advances in neonatal care. The physiology of this group is still under investigation, once the incomplete organogenesis entails functional particularities that are not yet clarified by current clinical knowledge. The immature kidneys are especially susceptible to acute injury with potential long-term impacts. Current diagnostic parameters of acute kidney injury are limited among the preterm population. The commonly used serum creatinine protein constitutes a poor biomarker to predict early lesions as it is susceptible to several factors, including muscle mass and gestational age. Objective: The present review explores the evidence on nephrogenesis, renal function, and acute kidney injury in neonatology, as well as studies on renal function biomarkers and their potential application for diagnosis, follow-up, and prognosis in preterm newborns. Results: Premature newborns reach full-term gestational age with reduced number and quality of nephrons. Consequently, the glomerular filtration rate and tubular function become impaired and are proportional to the gestational age. Despite having a high incidence among the pediatric population, acute kidney injury is still underdiagnosed and poorly managed due to the absence of proper, sensible, and non-invasive biomarkers. Although cystatin C, NGAL, and KIM-1, are promising urinary markers, current literature remains inconsistent. Conclusion: Further research is needed to properly identify and standardize sensible and specific urinary biomarkers to better assess kidney function in preterm newborns.

DO PROBIOTICS HAVE ANY FUTURE IN NEONATOLOGY? (ANALYSIS OF THE LATEST DATA. PART I) T. K. Znamenska, O. V. Vorobiova

From year to year prescription of probioticsremains a controversial issue both in medicine for adults andpediatrics. Some doctors make a positive conclusion about theeffectiveness of probiotics, while large individual tests beinga part of meta-analyses show negative results pointing that acertain probiotic strain has no influence on a patient. It’s betterto avoid excessively negative or positive conclusions CRTabout probiotics. The issue of using probiotics in newborns isespecially acute among neonatologists. The aim of this articleis the analysis of the latest data on the possibility of usingprobiotics in newborns.In 2021 the clinical report about the use of probiotics inpremature newborns in the USA was published (ААР committeeon fetus and newborns issue). It pointed out that the numberof premature newborns who get prescriptions for probiotics,namely in the USA, is steadily increasing despite significantdifferences in combinations of probiotic drugs and absenceof pharmaceutical class of probiotic products. Accordingto the latest source of database in the USA, around 10% ofnewborns with extremely low gestational age get a certaintype of probiotics while being in the intensive care unit fornewborns with different variations among the units. Despitethe fact that lots of doctors argue their usual use of probioticsin premature newborns, other groups, including ESPGHANand АРР are more cautious admitting the main restrictions ofmany researches, methodological differences in the design ofa research and guidelines along with the conclusion that theeffectiveness of probiotics may vary widely.Recently the ESPGHAN working group on probiotics andprebiotics has published the document on using an approachof network meta-analysis of finding strains with the largestpotential of effectiveness to prevent major diseases inpremature newborns. Following this the ESPGHAN committeeon feeding issue and the ESPGHAN working group onprobiotics and prebiotics have an aim to develop a documentwhich can serve as a guidance for possible use of probiotics inpremature newborns the positions of which we will consider inthe second part of the article.

COLOSTROTERAPIA E OS SEUS BENEFÍCIOS PARA RECÉM-NASCIDOS PREMATUROS: UMA REVISÃO DE LITERATURA

Breastfeeding is a food of fundamental importance for newborns, especially for those who are born prematurely. In premature babies, due to the interruption in the adequate time for a pregnancy, the incidence of complications in their body is very high. The administration of colostrotherapy, a treatment based on maternal colostrum, has been speculated as a way of promoting immunological factors in premature children. This research aims to investigate from the scientific literature the benefits that the treatment of colostrotherapy can provide to premature newborns. It is a narrative review of literature with a qualitative approach and exploratory character. The study revealed as results that through the oropharyngeal ingestion of colostrum, a potential increase in the level of immunological factors acting in the newborn's body was observed. Thus, strengthening the understanding that the administration of colostrotherapy in newborns can be considered an effective, safe and promising treatment.