Cue-based feeding and short-term health outcomes of premature infants in newborn intensive care units: a non-randomized trial

Background Feedings based on behavioral cues is a method relying on infants’ behavioral expressions of readiness to feed. The objective of this interventional study was to determine the effect of cue-based feeding on the short-term health outcomes of preterm infants. Methods This quasi-experimental study utilized a historical or phase lag design. It involved 60 preterm infants admitted to an Iranian referral hospital’s Level III-Newborn Intensive Care Unit (NICU) from April 2017 until January 2018. The experimental group (n = 30) received a three-step intervention of offering behavioral-cue-based oral (BCBO) feedings: Step 1 – One BCBO feeding every 12 hours for 3 days; Step 2 - Two BCBO feedings every 12 h for 3 days; and Step 3 – All feedings as BCBO feedings for 3 days. The control group received standard care feedings. Group difference data were analyzed with SPSS version 16 using descriptive and inferential statistics. Results The infants’ mean weight at time of discharge for the intervention and control groups were 1492.79 ± 21.65 g and 1395.71 ± 17.61 g (P = .003) respectively. The mean durations of achieving full oral feedings in the intervention and control groups were 17 ± 6 and 20 ± 11 days, respectively (P = .19). The mean frequencies of hypoxia were 1 ± 1.54 and 5 ± 9.31 respectively (P = .03) and of gavage feedings 725 ± 584 and 1846 ± 2097 respectively (P = .009). No apnea events were reported for the intervention group; the frequency of apnea in the control group was 1 ± 2.11 (P = .16). Conclusion The findings indicate that cue-based feeding is beneficial for preterm infants. Therefore, it is recommended that nurses employ cue-based feeding in the NICU. Trial registration IRCTID: IRCT20170828035962N2. Registered 27 may 2018 – Retrospectively registered, https://en.irct.ir/trial/27024.

Clinical, Virologic and Immunologic Correlates of Breast Milk Acquired Infections in Very Low Birth Weight (VLBW) Infants in a Newborn Intensive Care Unit (NICU) Setting

Cytomegalovirus (CMV) infections acquired by very-low-birthweight (VLBW) infants are incompletely characterized. To examine CMV transmission in VLBW infants, we evaluated maternal DNAlactia, infant DNAemia, and presence of clinical disease in a blinded study in VLBW infants in our newborn intensive care unit (NICU). To examine these issues, 200 VLBW infants were enrolled in a surveillance study, with weekly breast milk and infant whole blood samples collected, as available. Virologic (breast milk and infant whole blood real time PCR) and immunologic (IgG, IgM, and IgG avidity) correlates were evaluated. A chart review examined whether infants had symptoms compatible with CMV disease. DNAlactia was identified in 65/150 (43%) of lactating mothers. Nine CMV infections were identified in 9/75 CMV-exposed infants (12% of exposed infants). A higher median breast milk viral load (DNAlactia) correlated with an increased likelihood of DNAemia (p = 0.05). Despite potential symptoms compatible with CMV infection, clinicians had not considered the diagnosis of CMV in 6/9 cases (66%). All of these infants had chronic lung disease at discharge. There was no correlation between IgG antibody titer or IgG avidity index and the likelihood of transmission or CMV disease. In conclusion, in VLBW infants receiving milk from seroposi-tive mothers, CMV infections are commonly acquired, and are frequently unrecognized. Future studies are needed to determine whether routine surveillance for CMV of either breast milk or infant plasma is beneficial in preventing or recognizing infection.

Comparison of Pregnancy Outcomes of Women with and Without Hypertension at the Latent Phase of Labor Who Were Under Medical Care for Preeclampsia

OBJECTIVE: We explored the association between hypertension (>140/90) at the latent phase of labor (resistant hypertension) and the subsequent development of major maternal complications or adverse infant outcomes in women with preeclampsia under medical care. STUDY DESIGN: We drew data from 824 women who were under follow-up at the Department of Perinatology of Health Sciences University Zeynep Kamil Women and Children’s Health Training and Research Hospital with a diagnosis of preeclampsia. Women with and without resistant hypertension were compared in terms of major maternal complications and adverse infant outcomes. RESULTS: Mean age and body mass index were similar between the two groups (p>0.05). The rate of preeclamptic complaints was significantly higher in groups with resistant hypertension (90.1% vs. 67.2%, p<0.05). Proteinuria was more frequent in the resistant hypertension group (78.7% vs. 66.8%, p<0.001). The newborn intensive care unit admission rate was significantly higher in the group with resistant hypertension (65.6% vs. 45.9%, p<0.001). Gestational age at delivery was significantly lower in the group with resistant hypertension compared to the normotensive group (34.6 vs. 32.9 weeks, p<0.001). There was a significant difference between the two groups in terms of the rate of preterm delivery (78.5% vs. 66.7%, p=0.04). CONCLUSION: Resistant hypertension is associated with a higher rate of preeclamptic symptoms during labor and newborn intensive care unit admission.

ANTERIOR TRANSLOCATION OF THE RIGHT PULMONARY ARTERY AS THE INITIAL SURGICAL OPTION FOR A PREMATURE NEWBORN WITH SEVERE BRONCHOPULMONARY DYSPLASIA

We hereby present a case report of an extremely preterm newborn with bronchopulmonary dysplasia (BPD), spending more than 4 months of his early life in the newborn intensive care unit (NICU). The uniqueness of this case report is the difference in the algorithm used for the treatment of BPD with regards to the family’s preference and its successful outcome.

Cue-Based Feeding and Short-Term Health Outcomes of Premature Infants in Newborn Intensive Care Units(NICU) : A None-Randomized Trial

Background: Feedings based on behavioral cues is a method relying on infants’ behavioral expressions of readiness to feed. The objective of this interventional study was to determine the effect of cue-based feeding on the short-term health outcomes of preterm infants.Methods: This quasi-experimental study utilized a historical or phase lag design. It involved 60 preterm infants admitted to an Iranian referral hospital’s Level III-Newborn Intensive Care Unit (NICU) from June 2018 until January 2019. The experimental group (n=30) received a three-step intervention of offering behavioral-cue-based oral (BCBO) feedings: Step 1 – One BCBO feeding every twelve hours for three days; Step 2 - Two BCBO feedings every 12 hours for three days; and Step 3 – All feedings as BCBO feedings for three days. The control group received standard care feedings. Group difference data were analyzed with SPSS version 16 using descriptive and inferential statistics.Results: The infants’ mean weight at time of discharge for the intervention and control groups were 1492.79 ± 21.65 gr and 1395.71 ± 17.61 gr (P = .003) respectively. The mean durations of achieving full oral feedings in the intervention and control groups were 17 ± 6 and 20 ± 11 days, respectively (P = .19). The mean frequencies of hypoxia were 1 ± 1.54 and 5 ± 9.31 respectively (P = .03) and of gavage feedings 725 ± 584 and 1846 ± 2097 respectively (P = .009). No apnea events were reported for the intervention group; the frequency of apnea in the control group was 1 ± 2.11 (P = .16).Conclusion: The findings indicate that cue-based feeding is beneficial for preterm infants. Therefore, it is recommended that nurses employ cue-based feeding in the NICU.Trial Registration: IRCT20170828035962N2. Registered, 27 /05/ 2018- Prospectively registered, https://www.irct.ir/trial/27024.

A cost-analysis study of using adult red cell packs and Pedi-Packs in newborn intensive care units in Southern Iran

Background and objective Saving blood products is an important public health issue especially in developing countries with limited financial resources. We aimed to suggest a new hypothetical model to make a change in the current blood transfusion policy in the newborn intensive care unit (NICU) to reduce wastage of blood supplies as well as the risk of exposure to multiple donors. Methods In this cross-sectional study, all transfused neonates (n = 70) who were admitted to NICU of Nemazee Hospital, a tertiary referral hospital in Southern Iran, were evaluated between March and June 2019. Based on the information of neonates’ transfusion during this study period and determined transfusion indices, a specific pediatric pack was suggested and the related total costs per transfusion, as well as the donor-exposure rate of the hypothetical and the current transfusion method, were compared. Results Considering the mean number of transfusions per neonate: 4 and mean volume of transfused packed red cells: 20 ml per transfusion, the cost-analysis of pediatric and the adult pack was presented. Arithmetically, we proved a higher total cost per transfusion for using adult pack comparing to pediatric pack. Additionally, using a pediatric pack set leads to a 24% reduction in RBCs wastage per transfusion and a 68.13% reduction in donor-exposure rate. Conclusions The assignment of a dedicated pediatric pack for neonates will be able to improve the cost-effectiveness by a substantial reduction in donor-exposure rate and blood wastage. This finding should be taken into consideration to generate economic growth and make improvements in child health status.