(Lack of) knowledge of mothers about sickle cell trait and disease: a qualitative study

ABSTRACT Objective: to analyze the understanding of mothers about sickle cell disease and/or trait of the family from a diagnosed child. Methods: this is a qualitative study, using a semi-structured interview with 23 mothers, at a sickle cell disease outpatient clinic of a public institution, from October to December 2017. Analysis was thematic. Results: all participants had sickle cell trait as well as the parents of their children. Twenty children were diagnosed with sickle cell disease by Heel Prick Test, and three, after hospitalization due to the disease. Most did not know how to report the presence of the trait or disease in relatives other than nuclear. Final considerations: diagnosis cannot be restricted to the result of neonatal screening, requiring that preventive information on sickle cell crises be reinforced. It is recommended to search for other affected relatives to learn about their genetic condition, reflecting on their reproductive decisions.

Does mother scented simulated hand promote comfort, reduce pain, and distress among mechanically ventilated preterm neonates during invasive procedures?

Introduction: Breakthrough technologies in the neonatal intensive care unit (NICU) revolutionized neonates’ quality of care. Mother scented simulated hand (MSSH) is an ergonomically designed supportive hand that uses the power of touch to simulate the feeling of being held and cuddled. This study aimed to determine the effect of MSSH on promoting comfort among mechanically ventilated preterm neonates during invasive procedures.Methods: A quasi-experimental, pre-posttest two groups study was carried out in NICU in Smouha, Alexandria. A sample of 62 mechanically ventilated neonates was randomly assigned to two equal groups; the study group wrapped with a warm MSSH during the invasive procedures while the control group received standard care of NICU. Two observers independently rated the neonates’ level of comfort, distress, and pain during endotracheal suctioning (ETS) and heel prick using COMFORTneo scale.Results: It is revealed that the mechanically ventilated neonates had a significantly higher comfort level with MSSH than the standard care during and after both ETS and heal break (p < 0.001 for each). The neonates had significantly lower distress and pain scores when encircled by MSSH during invasive procedures than standard care (p < 0.001 for NRS distress and p < 0.001 for NRS distress).Conclusion: Wrapping the preterm neonates with a warm MSSH promotes comfort and reduces their pain and distress during invasive procedures, especially when their mothers are not physically available.

Serological detection of SARS-CoV-2 IgG using a commercially available enzyme immunoassays on dried blood spots collected from patients

Serological testing for SARS-CoV-2 antibodies provides important research and diagnostic information relating to COVID-19 immune response and surveillance. A major challenge when addressing protection post- infection or vaccination is the difficulty of specimen collection from infants and children. Dried blood spots (DBS) collected by finger prick or heel prick are a minimally invasive sample collection alternative previously used to detect antibodies to other viruses. In this study we evaluated DBS for the detection of SARS-CoV-2 antibodies on three commercially available enzyme (EIA) and chemiluminescent (CLIA) immunoassays by analysing paired DBS and serum samples collected from 54 subjects. We demonstrate that testing of DBS samples was highly sensitive and specific, and quantitative results strongly correlated with those of paired serum. These results suggest that DBS derived blood is a viable alternative to plasma or serum for use in EIAs and CLIAs, and has particular utility as a minimally invasive collection tool for COVID-19 serological testing of infants and children.

Neonatal heel prick screening TSH concentration in the Netherlands as indicator of iodine status

Background Neonatal Thyroid Stimulating Hormone (nTSH) is proposed as indicator of iodine deficiency in a population. Population’s iodine sufficiency is indicated by a proportion of the newborns less than 3% having nTSH above 5 mIU/L. The aim of this study was to explore the Dutch neonatal heel prick screening TSH data to assess iodine status in the Netherlands and identify determinants and potential confounders of this assessment. Methods All newborns born in the Netherlands between 2007 and 2015 with a heel prick collection at day 3-7 were included (n = 1,435,600), except preterm neonates and baby’s with a low birth weight. Total T4 was measured for all children, nTSH was measured in the ~ 20% children with lowest total T4. Results The proportion with nTSH > 5mIU/L fluctuated between 0.6-1.3% in 2007-2015. nTSH was significantly associated with laboratory performing the nTSH assay and age of heel prick sampling. The overall increasing trend in proportion nTSH >1mIU/L was confounded by the laboratories with different and changed assays. Conclusions The low proportion neonates with high nTSH suggests a sufficient iodine status in the Netherlands. Whether the increased proportion nTSH>1mIU/L over the years is an early indicator of deterioration of the iodine status remains unclear, due to differences and changes in analytical assays. nTSH might be a valuable and inexpensive way to get crude insight in the (trend in) iodine status, but more research is needed on the validity and potential conditions.

A STUDY TO EVALUATE THE EFFECTIVENESS OF WARM SALINE WATER APPLICATION ON PAIN RESPONSE DURING HEELPRICK AMONG NEWBORN AT NICU, GOVERNMENT RAJAJI HOSPITAL, MADURAI

Objectives:To assess the level of painresponse during heel prick among newborn.To evaluatetheeffectivenessofwarmsalinewaterapplicationonpainresponseduringheelprickamongnewborn.Toassociatethepainresponseduringheelprickamongnewborn at NICU, Government Rajaji Hospital, Madurai with their baseline variables. Hypotheses: There isa statistically significant difference betweenthe post test levelof pain response during heel prick among newborn both in intervention and controlgroup.Thereisastatisticallysignificantassociationbetweenthelevelofpainresponse during heel prick among newborn at NICU with their baseline variables.Conceptual framework: Roys adaptation model. Methodology: True experimentalresearchdesignwasused,60samplesselectedby Simplerandomsamplingandintervention given 2 minutes before heel prick. Post test was assessed by NeonatalInfantPainScale.Results:Thestudyrevealedthattherewasasignificantreductionin level of pain response during heel prick (t=1.25, p=0.21) at 0.05 level. Conclusion:Statistical evidence shows that warm saline during heel prick was effective.

Alternative Cerebral Fuels in the First Five Days in Healthy Term Infants: The Glucose in Well Babies (GLOW) Study

Objectives: To determine plasma lactate and beta-hydroxybutyrate (BHB) concentrations of healthy infants in the first 5 days and their relationships with glucose concentrations. Study design: Prospective masked observational study in Hamilton, New Zealand. Term, appropriately grown singletons had heel-prick blood samples, 4 in the first 24 hours then twice daily. Results: In 67 infants, plasma lactate concentrations were higher in the first 12 hours (median, 20; range, 10-55 mg/dL [median, 2.2 mmol/L; range, 1.1-6.2 mmol/L]), decreasing to 12 mg/dL (range, 7-29 mg/dL [median, 1.4 mmol/L; range, 0.8-3.3 mmol/L]) after 48 hours. Plasma BHB concentrations were low in the first 12 hours (median, 0.9 mg/dL; range, 0.5-5.2 mg/dL [median, 0.1 mmol/L; range, 0.05-0.5 mmol/L]), peaked at 48-72 hours (median, 7.3 mg/dL; range, 1.0-25.0 mg/dL [median, 0.7 mmol/L; range, 0.05-2.4 mmol/L]), and decreased by 96 hours (median, 0.9 mg/dL; range, 0.5-16.7 mg/dL [median, 0.1 mmol/L; range, 0.05-1.6 mmol/L]). Compared with infants with plasma glucose concentrations above the median (median, 67 mg/dL [median, 3.7 mmol/L]), those with lower glucose had lower lactate concentrations in the first 12 hours and higher BHB concentrations between 24 and 96 hours. Lower interstitial glucose concentrations were also associated with higher plasma BHB concentrations, but only if the lower glucose lasted greater than 12 hours. Glucose contributed 72%-84% of the estimated potential adenosine triphosphate throughout the 5 days, with lactate contributing 25% on day 1 and BHB 7% on days 2-3. Conclusions: Lactate on day 1 and BHB on days 2-4 may contribute to cerebral fuels in healthy infants, but are unlikely to provide neuroprotection during early or acute hypoglycemia. Trial registration: The Australian and New Zealand Clinical Trials Registry: ACTRN12615000986572.

Alternative Cerebral Fuels in the First Five Days in Healthy Term Infants: The Glucose in Well Babies (GLOW) Study

Objectives: To determine plasma lactate and beta-hydroxybutyrate (BHB) concentrations of healthy infants in the first 5 days and their relationships with glucose concentrations. Study design: Prospective masked observational study in Hamilton, New Zealand. Term, appropriately grown singletons had heel-prick blood samples, 4 in the first 24 hours then twice daily. Results: In 67 infants, plasma lactate concentrations were higher in the first 12 hours (median, 20; range, 10-55 mg/dL [median, 2.2 mmol/L; range, 1.1-6.2 mmol/L]), decreasing to 12 mg/dL (range, 7-29 mg/dL [median, 1.4 mmol/L; range, 0.8-3.3 mmol/L]) after 48 hours. Plasma BHB concentrations were low in the first 12 hours (median, 0.9 mg/dL; range, 0.5-5.2 mg/dL [median, 0.1 mmol/L; range, 0.05-0.5 mmol/L]), peaked at 48-72 hours (median, 7.3 mg/dL; range, 1.0-25.0 mg/dL [median, 0.7 mmol/L; range, 0.05-2.4 mmol/L]), and decreased by 96 hours (median, 0.9 mg/dL; range, 0.5-16.7 mg/dL [median, 0.1 mmol/L; range, 0.05-1.6 mmol/L]). Compared with infants with plasma glucose concentrations above the median (median, 67 mg/dL [median, 3.7 mmol/L]), those with lower glucose had lower lactate concentrations in the first 12 hours and higher BHB concentrations between 24 and 96 hours. Lower interstitial glucose concentrations were also associated with higher plasma BHB concentrations, but only if the lower glucose lasted greater than 12 hours. Glucose contributed 72%-84% of the estimated potential adenosine triphosphate throughout the 5 days, with lactate contributing 25% on day 1 and BHB 7% on days 2-3. Conclusions: Lactate on day 1 and BHB on days 2-4 may contribute to cerebral fuels in healthy infants, but are unlikely to provide neuroprotection during early or acute hypoglycemia. Trial registration: The Australian and New Zealand Clinical Trials Registry: ACTRN12615000986572.

Efficacy of Heel Warming on Pain Response to Heel Stick in Neonates

Introduction: Heel prick is one of the commonest procedures carried out in the hospitalised newborns. Pain is a subjective experience for which the neonates, infants and children respond with behavioural reactions. Applying hot pack to the skin surface causes proximal blood vessels to dilate due to the raised temperature which may decrease the pain perception in neonates. We intended to study the effect of heel warming during heel prick in perception of pain in neonates. Method: An experimental study was conducted among neonates admitted in paediatric wards of BPKIHS. Total 92 participants undergoing heel prick/stick were selected by consecutive sampling technique and allocated randomly to experimental group and control group. Warmer was applied to the heel of the baby for three to five minutes which provided the baby’s heel with the warmth of 38°C to 40°C prior to heel stick in experimental group only. Newborn’s pain level was assessed in both experimental and control group through The Neonatal Infant Pain Scale (NIPS). Mann Whitney test was used to compare means of pain score between experimental and control groups. Results: The mean pain score among experimental group was 1.39 and in control group was 2.20. Experimental group showed significantly lower pain (p < 0.001) compared to the control group. Application of warmth before heel stick caused reduction in pain. Conclusions: The findings suggest that heat application prior to heel stick is effective in reducing pain in newborns.

STUDY OF HYPOGLYCEMIA IN BREASTFED LATE PRETERM NEONATES

Background: Aim: To evaluate the usefulness of regular monitoring of blood glucose in early diagnosis of hypoglycemia in breastfed late preterm neonate. A total of 100 consecutively born bre Methods: astfed late preterm neonates were studied and assessed for development of hypoglycemia against age of onset, symptomatology, gestational age and sex of the baby, parity and age of mother, and mode of delivery. Serial blood glucose was done at 0, 1, 3, 6, 12, 24, 48 and 72 hours of life to identify hypoglycemia. Blood glucose was estimated from heel prick capillary samples using glucometer. Association of both maternal and neonatal risk factors was studied in relation to hypoglycemia. The overall incidence of hypoglycemia was 15%. O Results: ut of 15 hypoglycemic babies 12(80%) developed symptoms and only 3(20%) were asymptomatic. Most (90%) of the hypoglycemia occurred on the rst day of life. Babies born to primi mothers were more prone for hypoglycemia (25%). Highest incidence was seen in babies weighing less than 2 kg (50%). Symptoms of hypoglycemia included poor feeding (66%), lethargy (58%), jitteriness (41%), and weak cry (25%). Th Conclusion: ere is a signicant incidence of hypoglycemia in late preterm babies in spite of being on breast feeds. Babies born to primiparous mothers are more prone for hypoglycemia. Also hypoglycemia was very high in babies having birth weight below 2 kg. Therefore it is very important to regularly monitor the blood glucose levels in all late preterm babies even if they are on exclusive breast feeding.