Maintaining Normothermia in Preterm Babies during Stabilisation with an Intact Umbilical Cord

Background: We had experienced an increase in admission hypothermia rates during implementation of deferred cord clamping (DCC) in our unit. Our objective was to reduce the number of babies with a gestation below 32 weeks who are hypothermic on admission, whilst practising DCC and providing delivery room cuddles (DRC). Method: A 12 month quality improvement project set, in a large Neonatal Intensive Care Unit, from January 2020 to December 2020. Monthly rates of admission hypothermia (<36.5 °C) for all eligible babies, were tracked prospectively. Each hypothermic baby was reviewed as part of a series of Plan, Do, Study Act (PDSA) cycles, to understand potential reasons and to develop solutions. Implementation of these solutions included the dissemination of the learning through a variety of methods. The main outcome measure was the proportion of babies who were hypothermic (<36.5 °C) on admission compared to the previous 12 months. Results: 130 babies with a gestation below 32 weeks were admitted during the study period. 90 babies (69.2%) had DCC and 79 babies (60%) received DRC. Compared to the preceding 12 months, the rate of hypothermia decreased from 25/109 (22.3%) to 13/130 (10%) (p = 0.017). Only 1 baby (0.8%) was admitted with a temperature below 36 °C and 12 babies (9.2%) were admitted with a temperature between 36 °C and 36.4 °C. Continued monitoring during the 3 months after the end of the project showed that the improvements were sustained with 0 cases of hypothermia in 33 consecutive admissions. Conclusions: It is possible to achieve low rates of admission hypothermia in preterm babies whilst providing DCC and DRC. Using a quality improvement approach with PDSA cycles is an effective method of changing clinical practice to improve outcomes.

Effects of Late Surfactant Treatment Delivered After a Recruitment Maneuver on Respiratory Outcomes in Extremely Low Gestational Age Newborns: A Randomized Controlled Pilot Trial – LATE-REC-SURF Trial.

Background Mechanical ventilation is still needed in most preterm newborns, even in the non-invasive ventilation era. Ventilator-induced lung injury is one of the known pathogenetic factors of bronchopulmonary dysplasia (BPD) in preterm newborns. Lung injury has several patterns including surfactant dysfunction. Some recent trials have showed that a late surfactant administration can improve respiratory outcome in preterm babies still on invasive ventilation after the first week of life. Unfortunately, these results are still not conclusive. Moreover, giving surfactant after a recruitment manoeuvre in High Frequency Oscillatory Ventilation (HFOV) was shown to be safe and to reduce mortality in extremely preterm infants in a recent RCT. Our aim is to test the hypothesis that endotracheal administration of poractant-alfa preceded by a recruitment manoeuvre in HFOV in preterm infants still requiring mechanical ventilation at 7-10 days of life could facilitate extubation. Methods/Design: This will be an unblinded monocentric pilot trial that will be conducted in a III level Neonatal Intensive Care Unit at Fondazione Policlinico Agostino Gemelli IRCCS in Rome - Italy. Preterm newborns with a gestational age < 28 weeks still requiring invasive mechanical ventilation at 7-10 days of life with a fraction of inspired oxygen (FiO2) of more than 0.30 and/or an oxygenation index of 8 or more for at least 6 hours will be eligible for the study. Patients will be randomly assigned to intervention or to standard care. Intervention group infants will receive up to 4 doses of Poractant-alfa every 12 hours, each dose preceded by a recruitment manoeuvre in HFOV, until extubation. Primary endpoint will be the first successful extubation. Discussion Surfactant therapy is nowadays recommended in case of RDS in the first days of life but little is known about its effects in ventilator-dependant preterm newborns. Late administration of surfactant could help healing the lung of preterm babies in which RDS is evolving in a chronic pulmonary insufficiency of prematurity. The findings of this pilot trial will permit evaluation of the study design for a full-scale RCT. Trial registration: Clinicaltrials.gov – ID NCT04825197. Registered 12 April 2021, https://clinicaltrials.gov/ct2/home

Smart Incubator for Preterm Neonatal Using Kangaroo Mother Care

Kangaroo mother care is an apparatus that provides closed and controlled environmental for the preterm babies. A Preterm birth is commonly defined as any birth base 37 weeks completed weeks of gestation period. This paper deals with cost effective design of incubator that monitors parameters like pulse rate, temperature, humidity, child security and the readings will be continuously displayed In the LED screen and also monitoring the details to the corresponding doctor, nurse and parents by using GSM. The power failure problem is also eliminated by using solar panel. We also intimate the parents about feeding time, dressing time, ear check, eye check. But many of the existing system does not mentioned about above problem and have adopted only with humidity and temperature and also by manual control. So the main objective of this research is to overcome drawbacks and provide eco friendly service to all common people.

Complementary Feeding and Growth in Infants Born Preterm: A 12 Months Follow-Up Study

Evidences demonstrated that timing of weaning influences long-term growth in full term infants. However, studies on preterm infants are still lacking, and the international guidelines are focused only on healthy full-term newborn, without consensus for preterms. We aimed at evaluating, in a cohort study, the consequences of different timing of weaning on auxological outcomes up to 12 months of corrected age in a population of neonates born with gestational age < 32 weeks or birth weight <1500 g. We divided the enrolled neonates in two cohorts according to the timing of weaning: (i) Early Weaning: introduction of complementary food before 6 months of corrected age; (ii) Late Weaning: complementary food introduced after 6 months of corrected age. Growth parameters (weight, length, body mass index, and ponderal index) were measured at 12 months of life. The two groups were statistically comparable for baseline clinical characteristics, and differences on growth parameters were not reported between the two study groups. These results were confirmed in linear and binary logistic regression multivariate models. Timing of weaning is not related to growth of preterm newborns in the first 12 months of corrected age. Studies are needed to reach consensus for the appropriate nutritional approach for preterm babies after discharge.

Foot length as a surrogate maker to identify birth weight

Background: Gestational age and birth weight is an important predicator for morbidity and mortality in neonates. Aim was to determine the correlation of foot length with birth weight and gestational age in neonates.Methods: This was a prospective observational study done in the neonatal unit department of pediatrics in Chirayu medical college and hospital, Bhopal. There were 1739 deliveries included during the study period from January 2016 to December 2020. Study group comprised of all live born babies delivered in within 24 hours of birth who fulfilled the inclusion criteria.Results: The study comprised of 1739 newborn babies, out of which 896 (51.51%) were males and 843 (48.49%) were females. Male:female ratio 1.06:1. In our study group, 337 (15.6%) babies were preterm and 1385 (84.39%) were of term gestation. We found a positive linear correlation of foot length with all birth weight groups in a newborn with a correlation coefficient (r=0.78) and p<0.001 was found. Similarly, a positive correlation of foot length and gestational age of newborn in both term and preterm babies with (r=0.83) with p<0.01. Foot length has 87.4% sensitivity and 91.7% specificity among low-birth-weight babies with respect to cut off foot length of 75.5 mm. Foot length has 78.7% sensitivity and 63.7% specificity among preterm babies.Conclusions: Foot length can be used as a screening tool to identify low birth weight (LBW) and preterm babies as it had a higher sensitivity and specificity.

Nghiên cứu tương quan của chiều dài bàn chân với chỉ số nhân trắc và tuổi thai theo Ballard mới ở trẻ sơ sinh

TÓM TẮT Đặt vấn đề: Thời kỳ sơ sinh là thời kỳ dễ tổn thương nhất trong cuộc đời. Đối với những trẻ sơ sinh sinh ra với một tình trạng bệnh lý nặng hoặc cần chăm sóc đặc biệt ngay thì việc xác định các yếu tố trưởng thành về thể chất và thần kinh để đánh giá tuổi thai hay các chỉ số nhân trắc học là khá khó khăn. Nghiên cứu nhằm mô tả chiều dài bàn chân, các chỉ số nhân trắc học và tìm hiểu mối tương quan giữa chiều dài bàn chân với các chỉ số nhân trắc và tuổi thai theo Ballard mới ở trẻ sơ sinh. Phương pháp: 240 trẻ sơ sinh được nhập viện và sống trong vòng 24 giờ đầu sau sinh tại Trung tâm Nhi khoa Bệnh viện Trung ương Huế và Bệnh viện Trường Đại học Y Dược Huế, thời gian nghiên cứu từ tháng 4/2019 đến tháng 1/2021. Thiết kế nghiên cứu mô tả cắt ngang. Kết quả: Giá trị trung bình và độ lệch chuẩn của chiều dài bàn chân là 76,4 ± 7,7 mm. Có mối tương quan thuận mức độ rất chặt giữa chiều dài bàn chân với tuổi thai (r = 0,927), cân nặng (r = 0,898), chiều dài (r = 0,891), vòng đầu (r = 0,851) và vòng ngực (r = 0,793). Điểm cắt chiều dài bàn chân ≤ 77,2 mm có độ nhạy (88,4%) và độ đặc hiệu (96,1%) để tiên đoán trẻ sơ sinh non tháng. Điểm cắt chiều dài bàn chân ≤ 73,1 mm có độ nhạy (95,4%) và độ đặc hiệu (90,9%) để tiên đoán trẻ sơ sinh cân nặng thấp. Kết luận: Chiều dài bàn chân có tương quan thuận rất chặt với tuổi thai, cân nặng, chiều dài, vòng đầu, vòng ngực. Đồng thời chiều dài bàn chân có độ nhạy và độ đặc hiệu cao trong tiên đoán trẻ sơ sinh non tháng hoặc có cân nặng thấp, đây là một chỉ số đáng tin cậy ở những nơi còn thiếu nhân lực và trang thiết bị như cân nặng, siêu âm. ABSTRACT CORRELATION OF FOOT LENGTH AND ANTHROPOMETRIC PARAMETERS AND GESTATIONAL AGE OF NEWBORN BY NEW BALLARD SCORE Background: Neonatal period is the most vulnerable period of life. For neonates born with a serious medical condition or who need immediate intensive care, determining physical and neurological maturation factors to assess gestational age or anthropometric indices is quite difficult. Therefore, determining the correlation of foot length with anthropometric indices and gestational age according to Ballard score, is a priority in the research. This study describes the foot length, some anthropometric parameters; and study the correlation between foot length and some anthropometric parameters and gestational age of newborn by new Ballard score. Methods: A survey was conducted with 240 neonatal in the first 24 hours at The Pediatric Center in Hue Central Hospital and Hue University Hospital of Medicine and Pharmacy from 4/2019 to 1/2021. Results: The Mean ± SD at birth for Foot Length (FL) was 76.4 ± 7.7 mm. The difference in FL between males and females was not statistically significant. We observed a significant correlation between FL and other anthropometric variables namely GA (r = 0.927), BW (r = 0.898), HC (r = 0.851), CC (r = 0.793) and length (r = 0.891). Using Receiver Operative Characteristic (ROC) curve analysis, we found that FL ≤ 73.1 mm had 95.4% sensitivity and 90.9% specificity in identifying LBW babies. FL ≤ 77.2 mm had 88.4% sensitivity and 96.1% specificity for identifying preterm babies. Conclusions: We observed a significant correlation between foot length and other variables, namely birth weight, gestational age, head circumference, chest circumference, and length. Foot length had a high sensitivity and specificity in identifying LBW and Preterm babies, making it a reliable variable in the rural setup where weighing facilities, ultrasound, and trained personnel are not available.

Effects of Oral Stimulation and Supplemental Nursing System on the Transition Time to Full Breast of Mother and Sucking Success in Preterm Infants: A Randomized Controlled Trial

This study aimed to investigate the effect of oral stimulation and a supplemental nursing system on the time to full maternal breastfeeding and sucking success in preterm infants. The sample consisted of 70 preterm babies. Oral motor stimulation and a supplemental nursing system were applied to the preterm infants in the experimental group, while no intervention was applied to those in the control group. Significant differences were found between the two groups concerning transition time to oral feeding, transition weight, transition time to full maternal breast, discharge age, duration, and weight, LATCH mean scores, continuing to suck in the first month after discharge, and weight averages. Oral stimulation and a supplemental nursing system shortened the transition period to oral feeding and full breastfeeding, increased breastfeeding rates and the sustainability of breastfeeding, and did not affect the period of discharge and vital signs during feeding in preterm babies.

Acute neonatal airway management - The role of laryngeal mask airway

Positive pressure ventilation with Ambu bag and face masks or T-piece resuscitation in preterm babies have proved their worth in acute neonatal airway management. However, failure rates are high and endotracheal intubation is the final life-saving procedure. However, intubation is an invasive procedure and requires good expertise, especially for handling acute emergency situations. Expertise of trainees as well as consultants is coming down rapidly due to various reasons. In these situations, supraglottic airways (laryngeal mask airway or LMA) seem to be ideal. Here, we are reviewing the application and utility of LMA in acute neonatal airway management.