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At least 19 recordsLinked to original sources

PubMed1979

Osteomyelitis in a neonatal intensive care unit.

Neonatal osteomyelitis presents with few clinical signs despite multiple sites of involvement. Four cases of osteomyelitis due to Staphylococcus aureus or Candida albicans were encountered in a neonatal intensive care unit. Three were unsuspected clinically and were detected as incidental radiologic findings. The fourth presented with soft-tissue abscesses. Long bone metaphyses were most frequently affected. Other sites included iliac bones, clavicles, and spine. On follow-up the bones healed, but one patient was left with hip deformity secondary to destruction of the cartilaginous femoral heads and another patient developed obstructive hydrocephalus due to Candida ventriculitis. Complete skeletal survey is indicated in any infant with osteomyelitis at one site to seek additional silent areas of involvement.

Abscess↗

PubMed1979

Staff nurse turnover in neonatal intensive care units.

The turnover rate and patterns in Neonatal Intensive Care Units (NICUs) were assessed and compared with adult Intensive Care Units (ICUs) and General Infant Care Units at the same hospitals for the year 1976. Thirty-five hospitals with NICUs participated in the study. The findings of this study disagree with the previous literature in three major ways: 1 The turnover rate of staff nurses was less than half that estimated by The National Commission on Nursing for 1970. 2 The turnover rates in ICUs and NICUs were not significantly higher than that for staff nurses in Non-Intensive Care Units. In addition, the pattern of turnover among leavers is identical for all three major types of unit. The variability pattern for neonatal units, however, is statistically significant; this is not so with the other units studied. 3 There is no evidence for a stabilization of turnover following the usual 'induction crisis period' (the first 3 to 6 months).

Evaluation Studies as Topic↗

PubMed1977

Outcome of infants of very low birthweight treated in neonatal intensive care unit.

The neonatal survival rate of 500 VLBW (less than or equal to 1 500 g) treated in the neonatal unit of the Departement of Paediatrics in Lausanne (C.H.U.V.) was studied according to changing patterns of nursing and medical care occurring in four successive periods (1961 IX-1963, X-1963 - 1965, 1966-1968, IV-1971-1973). The survival rate at 28 days increased from 35.5% to 47.7% between 1961 and 1965. Earlier start of feeding, intravenous fluid therapy, better control of ambient temperature and better oxygenotherapy are the main changes during this period. Further improvement in neonatal care did not affect the 28-day survival rate. 213 VLBW out of 500 (42.6%) survived at 28 days, 13 (6.1%) out of these died within the first two years of life, 36 (16.9%) were lost for the follow-up. The remaining 164 VLBW were followed until ages between 18 months and 8 years. The improvement in neonatal care was associated with a decrease in the incidence of major neurological sequels from 21.1% to 12.2% between 1961 and 1973. Cerebral palsy and epilepsy are responsible for this decrease. The incidence of mental retardation (DQ or IQ less than 80) also decreased from 17.5% to 4.9% during the same period. However, the incidence of retrolental fibroplasia remained stable. The outlook for VLBW infants is now much more encouraging. Further improvement in perinatal care is likely to further reduce the incidence of major handicaps. but it is not clear whether they will affect the incidence of minor problems such as learning difficulties or poor school performances. More prospective studies are necessary to clarify these points and to ensure early detection of these developmental problems.

Central Nervous System Diseases↗

PubMed2025

Implementing customized genomic sequencing reports to empower providers in safety-net neonatal intensive care units.

PURPOSE: Through our implementation study providing rapid genomic sequencing (rGS) in safety-net neonatal intensive care units (NICUs), we investigated the feasibility and perceived usefulness of customized "clinical interpretive reports" (CIRs) to help neonatal providers with interpreting, disclosing, and managing care based on rGS results. METHODS: Enrolled infants received rGS through a clinically accredited vendor. We developed 5 CIR types to provide customized interpretation of rGS results and link results to clinical management considerations, research opportunities, and resources. We developed workflows to triage, create, and deliver CIRs within 3 business days. Providers received the vendor reports and CIRs, disclosed results, and completed post-disclosure surveys. We analyzed summary statistics for the first 100 cases. RESULTS: We delivered 97 of 100 CIRs (97%) within our goal time frame (average 1.3 days) and provided clinical management recommendations in 40 of 100 (40%). Neonatal providers completed the post-disclosure surveys for 86 of 100 disclosures (86%). Most reported using the CIR before disclosure (80/86, 93%) and found it helpful at providing useful information beyond the vendor report (79/80, 99%). CONCLUSION: It is feasible and useful to develop customized rGS reports to assist non-genetics providers in safety-net NICU settings. Similar approaches may hold promise for equitably advancing genomic care in non-NICU settings.

Humans↗

PubMedDate not supplied

The risks of umbilical vessel catheterization in a neonatal intensive care unit.

Five hundred and fourteen high-risk neonates who had indwelling umbilical catheters at the neonatal intensive care unit of the University of Benin Teaching Hospital were studied. of these 514 neonates, 122 (23.8%) had their catheters in-situ for longer than 24 h. Of the 122, fifty-four (44%) had positive bacterial cultures from their catheter tips. Seven (5.7%) and four (3.2%) of the 122 neonates studied developed septicaemia and necrotizing enterocolitis respectively. Catheterization for periods in excess of 48 h significantly increased the risk of bacterial colonization. Malposition of umbilical catheter tips include: insertion into the right portal vein (thirty-six cases); superior mesenteric vein (three cases) and the left atrium (four cases). The complications related specifically to the malposition were: air collection in the hepatic venous system (two cases); cardiac arrest (one case); necrotising enterocolitis (one case) and a case of blanching of the abdominal wall. Because of these complications, the indications for catheterization should be restricted to carefully selected patients and strict aseptic technique be adhered to during the procedure.

Catheterization↗

PubMed1978

Postneonatal infant mortality in infants to a neonatal intensive care unit.

The postneonatal infant mortality (PNIM) of 2,205 infants admitted to a neonatal intensive care unit from January 1971 to December 1974 was 44 in 1,000 infants who survived to age 28 days. This rate is approximately ten times that of the general population. Congenital malformations (59%), infections (12%), sudden infant death syndrome (10%), and asphyxial brain damage (10%) were the most common causes of death. One third (26) of the infants remained in the hospital whereas two thirds (52) had been dismissed prior to death. All who remained in the hospital plus 36 who had been dismissed died of severe illnesses that were incompatible with prolonged survival. The remaining PNIM was 10 in 1,000 neonatal survivors. This rate is still twice that of the general population. These deaths occurred in infants who were apparently well at the time of dismissal and subsequent examinations. Sudden infant death syndrome and infections constituted the largest portion of this mortality. Factors contributing to mortality in this group were poor socioeconomic status and low birth weight. Maternal age, race, marital status, and neonatal illnesses including apnea were not significantly related. Factors that appear to be important in the birth of high-risk infants continued to be operative in the postneonatal period, and contribute to a high mortality in apparently normal infants dismissed from the neonatal intensive care unit.

Abnormalities, Multiple↗

PubMed1978

Otitis media in the neonatal intensive care unit.

Thirty-eight of 125 premature infants who were hospitalized in a neonatal intensive care unit (NICU) had abnormal tympanic membrane mobility compatible with otitis media. Twenty-five of these 38 had received antibiotics within one week of otoscopic examination and were considered to have either serous otitis or partially treated bacterial otitis media; tympanocentesis was not performed in them. Tympanocentesis was performed in the remaining 13 infants who had not received antibiotics. Bacterial otitis media was confirmed in ten of the 13. Either staphylococcal (six cases) or Gram-negative enteric organisms (four cases) were isolated in cultures obtained by tympanocentesis in these cases. The four cases of Gram-negative infections occurred in infants within six weeks of birth. Nasotracheal intubation for more than seven days was significantly correlated with impaired tympanic membrane mobility compatible with otitis media. Otitis media occurs frequently among premature infants who are hospitalized in an NICU, and it should be looked for in any infant in whom sepsis is clinically suspected.

Cross Infection↗

PubMed2026

Advancing the science of Staphylococcus aureus infection prevention in the neonatal intensive care unit.

Despite advances in infection prevention, infections due to Staphylococcus aureus continue to be an important cause of morbidity and mortality in NICUs. Whole genome sequencing (WGS) using advanced analytic approaches for defining transmission have shed new insights into transmission and persistence patterns in the NICU. WGS has also helped uncover important associations between transmission, persistence, and the risk of invasive infections. Current infection prevention strategies rely on hand hygiene compliance and surveillance and decolonization of patients positive for S. aureus. Parent decolonization may also play a role in decreasing parent-child transmission. In the future, precision surveillance of high-risk strains and targeted infection prevention efforts to decrease bacterial burden of those specific strains may provide a more effective and efficient approach to decreasing risk of invasive infections.

Humans↗

PubMed1978

Urinary cyclic AMP in infants admitted to a neonatal intensive care unit.

The urinary excretion of cyclic AMP was studied during the first 3 days of life in 46 randomly selected infants admitted to a neonatal intensive care unit. The data were compared with those of normal newborn infants. Urinary cyclic AMP concentrations were significantly correlated with gestational age (all patients), and with birth weight (all patients except infants of diabetic mothers (IDMs)). The urinary cyclic AMP/creatine ratio increased from day 1 to day 3 in normal newborns and in IDMs, and tended to increase also in small-for-gestational age (SGA), low birth weight (LBW), and sick, term infants, although the changes in the latter groups were not statistically significant. Four infants studied with parallel determinations showed increased cyclic AMP/creatinine ratio from day 1 to day 3 both in plasma and urine. All urinary cyclic AMP/creatine ratios were lower than the corresponding ratios found in plasma. In LBW infants, there was an inverse relationship between urinary cyclic AMP and serum calcium. In IDMs a positive correlation was observed between urinary cyclic AMP and blood glucose concentration. In conclusion, the excretion of cyclic AMP in sick newborn infants is influenced by the following factors: gestational age, postnatal age, birth weight, and derangements of serum calcium and blood glucose concentrations.

Blood Glucose↗

PubMed2026

Acceptability and Feasibility of an Educational Intervention to Improve Researcher-Participant Interactions in a Neonatal Intensive Care Unit Clinical Trial: Research Team Feedback on the BRIEF Intervention.

OBJECTIVE: Interactions with families are essential to successful recruitment conversations that promote informed decision-making about clinical research enrollment. However, there is little evidence about how to implement communication-oriented recruitment training among pediatric clinical research teams. Our objective was to evaluate the feasibility and acceptability of Better Research Interactions for Every Family (BRIEF), a multipart educational intervention to improve relationship-based conversations about clinical trial enrollment with families in the neonatal setting. STUDY DESIGN: We piloted BRIEF in partnership with a neonatal clinical research team. Research team members completed surveys following the BRIEF intervention's online module and the BRIEF group training session. They completed self-assessments after consent discussions before and after the BRIEF intervention, in which they rated their achievement of recruitment skills taught in BRIEF. Research team members also completed a final study interview to provide feedback on the intervention components, training content, and use of skills in practice. RESULTS: All nine research team members completed all components of BRIEF. Survey responses showed moderate to low satisfaction with previous recruitment training before BRIEF and high satisfaction with the BRIEF training. Self-assessments showed significant increases in reported partnership with bedside nursing (p = 0.02) and confirmation of family names (p = 0.05) after BRIEF training. Interviews provided further evidence of overall satisfaction with the BRIEF training, its content, and the skills learned, as well as opportunities for improvement, particularly in supporting challenging conversations. CONCLUSION: This pilot study demonstrated the feasibility and acceptability of the BRIEF intervention, as well as opportunities for improvement in future training. KEY POINTS: · It was feasible to implement the BRIEF researcher training in a single-site NICU trial.. · BRIEF training was acceptable to research team members.. · BRIEF training shows potential to improve relationship-based research communication..

Humans↗

PubMed1979

Intensive care for sick neonates, the earlier the better: improved survival rate of IRDS children, referred by means of a mobile neonatal intensive care unit.

A mobile intensive care unit has been used since september 1976 in the region referring sick neonates to the two University Hospital NICU's of Amsterdam. The present study compares two groups of neonates (suffering from the I.R.D.S.) i.e. a group that had been referred by non specialized transport teams (N S T-group) and a group admitted after institution of the neonatal-transport service (S. T.-group). Significant difference is found in the temperature on admission (S T group greater than N S T group). In the N S T-and the S T-group the need for ventilatory assistance was not significantly different but in the S T-group it was started significantly earlier. Survival after institution of ventilatory assistance and overall-survival are significantly better in the S T-group. These conclusions point to the fact that administering intensive care to sick neonates as early as possible and transportation of this group by means of special "neonatal"-transport services increases their survival rates.

Humans↗

PubMed1978

Present status of the infant of very low birth weight treated in a referral neonatal intensive care unit in 1974.

In 1974, 250 infants with birth weights of 1500 g or less were referred to the Intensive Care Unit at the Hospital for Sick Children, Toronto. Sixty-six per cent survived. Prospective follow-up studies of the survivors have been completed over a minimum of two years. Infants at highest risk for handicapping defects (about 85%) are those who survived intracranial haemorrhage during the neonatal period. Neurological defects encountered in these children were severe--hydrocephalus, spastic quadriplegia, hemiplegia or microcephalus--and were usually associated with low psychometric scoring. The second highest risk group were small for gestational age infants. Of these, 53% were significantly handicapped at two years of age, and 43% had developmental quotients of less than 80. These defects could not be related to postnatal events. The third category at high risk were infants with birth weights of 1000 g or less. Among these, 30% had a significant handicap by two years of age. The outcome in the remainder of the sample was generally good. These results suggest that the decreased mortality of the very premature infant is associated with an increased number of relatively normal survivors and that the infants at highest risk for subsequent defects can be identified at or shortly after birth.

Cerebral Hemorrhage↗

PubMed1978