Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units

Background This study aimed to describe length of stay (LOS) to discharge and site variations among very preterm infants (VPIs) admitted to 57 Chinese neonatal intensive care units (NICUs) and to investigate factors associated with LOS for VPIs. Methods This retrospective multicenter cohort study enrolled all infants < 32 weeks’ gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network, within 7 days after birth in 2019. Exclusion criteria included major congenital anomalies, NICU deaths, discharge against medical advice, transfer to non-participating hospitals, and missing discharge date. Two multivariable linear models were used to estimate the association of infant characteristics and LOS. Results A total of 6580 infants were included in our study. The overall median LOS was 46 days [interquartile range (IQR): 35–60], and the median corrected gestational age at discharge was 36 weeks (IQR: 35–38). LOS and corrected gestational age at discharge increased with decreasing gestational age. The median corrected gestational age at discharge for infants at 24 weeks, 25 weeks, 26 weeks, 27–28 weeks, and 29–31 weeks were 41 weeks, 39 weeks, 38 weeks, 37 weeks and 36 weeks, respectively. Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals. Conclusions The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents. Large variation of LOS independent of infant characteristics existed, indicating variation of care practices requiring further investigation and quality improvement.

Communication of bad news in the context of neonatal palliative care: experience of intensivist nurses

ABSTRACT Objectives: To know the experiences of nurses in neonatal intensive care units in the face of the process of communicating bad news to the family of newborns in palliative care. Methods: Study with a descriptive qualitative approach, in which 17 professionals participated. Data were collected through a semi-structured interview script, from December/2018 to February/2019, and submitted to content analysis. Results: Four theoretical categories emerged, with 11 subcategories inserted: meanings attributed to bad news; nursing as a support for the family; difficulties in dealing with the process of communicating bad news; nursing and involvement with the family’s suffering. Final considerations: The challenges to deal with the situation are related to lack of preparation, impotence, and subjectivities. The results broaden knowledge on the subject and enable the improvement of nursing care in this context.

Atendimento de Pacientes Neonatais Realizadas pelo Serviço Aeromédico: Uma Revisão Integrativa / Neonatal Patients Carried Out by Aerometric Service: An Integrative Review

Resumo: A remoção rápida e com medidas de segurança de recém-nascidos (RNs) críticos, como por exemplo, os prematuros extremos e os com malformações congênitas complexas, nascidos em centros que apresentam insuficiência de recursos para Unidades de Terapia Intensiva Neonatal (UTIs) por meio de transporte inter-hospitalar é considerada uma das recomendações do Ministério da Saúde devido sua capacidade de diminuição significativa da mortalidade neonatal por causas evitáveis. Objetivo: caracterizar o transporte neonatal através do Serviço Aeromédico Metódos: Trata–se de um estudo de revisão integrativa, com abordagem descritiva e exploratória, sobre o tema: Atendimento de Pacientes Neonatais realizadas pelo Serviço Aeromédico. Para a realização da busca na Biblioteca Virtual da saúde (BVS), foram utilizadas combinações entre as seguintes palavras-chave, consideradas descritores no DeCS: “Neonatologia”, “Resgate aéreo” e “Urgência”. Os termos foram cruzados como descritores e também como palavras do título e do resumo. A busca foi realizada no período de Junho de 2019.Resultados e discussão: A literatura o Serviço Aeromédico é utilizado principalmente entre RNs de alto risco, no qual existem indicações pré-estabelecidas e com isso possibilita a introdução de melhores abordagens. No qual é necessário a utilização de materiais e protocolos pré-estabelcidos, como também uma equipe preparada para realização dos atendimentos nos pacientes neonatais. Conclusão: Diante dessa perspectiva é possível compreender que o avanço tecnológico alinhado ao desenvolvimento de uma medicina de qualidade pode proporcionar melhores abordagens aos pacientes neonatais e com isso estabelecer uma melhor qualidade de vida e diminuição da morbimortalidade destes pacientes.Descritores: Neonatologia, Resgate aéreo, Urgência. Abstract:The rapid and safe removal of critical newborn infants (RNs), such as premature infants and those with complex congenital malformations, born in centers that have insufficient resources for Neonatal Intensive Care Units (ICUs) by means of interhospital transportation is considered one of the recommendations of the Ministry of Health due to its capacity to significantly reduce neonatal mortality from preventable causes. Objective: to characterize neonatal transport through the Aeromedical Service Metódos: This is an integrative review study, with a descriptive and exploratory approach, on the topic: Attendance of Neonatal Patients performed by the Aeromedical Service. In order to perform the search in the Virtual Health Library (VHL), we used combinations of the following keywords, considered descriptors in DeCS: "Neonatology", "Air Rescue" and "Urgency". The terms were cross-referenced as descriptors and also as title and abstract words. The search was performed in June 2019. Results and discussion: The literature the Aeromedical Service is mainly used among high risk NBs, in which there are pre-established indications and with this allows the introduction of better approaches. In which it is necessary to use pre-established materials and protocols, as well as a team prepared to perform care in neonatal patients. Conclusion: In view of this perspective, it is possible to understand that the technological advances aligned to the development of a quality medicine can provide better approaches to neonatal patients and thus establish a better quality of life and decrease of the morbimortality of these patients.Keywords: Neonatology, Air rescue, Urgency

Modern Breastfeeding Options for Preterm Children in Neonatal Hospital

The literature overview on the issue of breastfeeding in neonatal departments, including neonatal intensive care units, is presented. The importance of breastfeeding for newborns with perinatal pathology is justified, as breast milk is vital for these children due to its unique sanogenetic properties. Data on special preventive and therapeutic role of breastfeeding for premature infants is presented. Reasons that complicate the use of breast milk in neonatal hospitals were analyzed (including those related to insufficient bacteriological and virological safety of native breast milk due to methodological errors during its collection and usage). Particular attention was paid to ensuring the breastfeeding safety during new coronavirus infection pandemic. This difficult period has demonstrated and confirmed the expediency of combining two breastfeeding approaches in perinatal centers: use of maternal milk and use of donor breast milk. Another section of review is devoted to modern breast milk processing technologies. Use of electric clinical breast pumps is crucial for promoting and supporting breastfeeding in the perinatal center.

Influence of the Incubator as Direct Patient Environment on Bacterial Colonization of Neonates

Background: Preventing healthcare-associated infections (HAI) in neonatal intensive care units is a challenge of highest priority. For further insight into the incubator as direct patient environment and potential source for contamination, we present data correlating microbiological samples of very low birthweight infants in the form of colonization results of surveillance screenings with samples of their associated incubator in this study. Methods: Samples were taken via rectal and throat swabs of neonates as well as Polywipe® sponges for the incubator. If the same bacterial species was found in corresponding neonate and incubator samples, whole genome sequencing via Illumina technology was performed. Results: 52 microbiological species matches were found, and 30 matches were sequenced where we found 26 clonal pairs (12 E. faecalis, 10 S. aureus, 2 E. coli, 1 E. cloacae, and 1 E. faecium). Conclusion: The combinations of measurements of weekly screenings swabs, probing of surfaces with Polywipes®, and whole genome sequencing showed transmissions of microorganism and risk for potential non-physiological colonization of neonatal infants.