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ABSTRACT: Objective. Our hypothesis is that specific proinflammatory and anti-inflammatory urinary cytokines are useful in the diagnostic evaluation of risk for sepsis in term neonates. We conducted a pilot, prospective hospital-based longitudinal observational study to test the urine of term neonates with a 13 biomarker panel of cytokines. Methods. Infants were divided into 2 groups: The control group (n = 15) consisted of infants admitted to newborn nursery, and the test group (n = 15) consisted of infants admitted to the neonatal intensive care unit for presumed sepsis. Bagged urine samples were collected from 30 term neonates for testing our hypothesis. Results. Urinary interleukin (IL)-8 (P = .004*), inducible protein (IP)-10 (P = .007*), and monocyte chemoattractant protein (MCP)-1 (P = .02) were significantly increased in the test group compared with the control group. Conclusions. Urinary IL-8, IP-10, and MCP-1 are proinflammatory cytokines that are increased in the neonate during an infectious inflammatory process. These may be useful predictors as an adjunct to the current protocols to recognize neonatal sepsis.
Clinical Pediatrics 03/2013; · 1.15 Impact Factor
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ABSTRACT: PURPOSE: The splanchnic-cerebral oxygenation ratio (SCOR) is a measurement comparing regional tissue oxygen saturation of splanchnic organs and brain tissue. SCOR has been previously proposed as a marker of clinical conditions associated with gut ischemia. Our goal was to determine SCOR values in healthy neonates in their first and second days of life. METHODS: Prospective observational study measuring SCOR in term neonates in the nursery using near-infrared spectroscopy (NIRS). RESULTS: Forty-five subjects with a mean gestational age of 39.4 ± 1.3 weeks were included. Mean SCOR on the first day was 0.90 ± 0.16 and 0.97 ± 0.16 on the second day, p = 0.02 (n = 45). No correlation was found between SCOR and gestational age; however, we did find a positive correlation between hour of life and SCOR values (r = 0.28, r 2 = 0.08, p < 0.01, two tails); SCOR appears to stabilize by 36 h. CONCLUSIONS: Our findings demonstrate SCOR values in healthy neonates consistent with those previously theorized and help to validate it as a diagnostic measure. In addition, we have demonstrated that SCOR values may normally be lower in infants during their first days of life, and this information may be helpful to clinicians using NIRS as a diagnostic tool.
Pediatric Surgery International 02/2013; · 1.25 Impact Factor
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ABSTRACT: Abstract Objective: Family-Centered Care (FCC), which includes involving parents in conversations about medical management, is increasingly employed in the neonatal intensive care unit (NICU). Our aim was to determine which care decisions are discussed by neonatologists with families most frequently and the percentage of clinicians influenced by such conversations. Methods: Anonymous web-based survey provided to 2,137 neonatologists assessing information sharing and parental involvement. Results: 1,002 neonatologists responded; 893 fully completed surveys. 88% practice FCC. Topics most frequently discussed with parents were blood transfusion, steroids for lung disease, and patent ductus arteriosus surgery, each being reported discussed by more than 90% of respondents. Many therapies, including aminoglycoisdes, total parenteral nutrition, and phototherapy, were discussed with parents by far fewer clinicians. Additionally, parents had most influence on clinicians in two categories, blood transfusion and steroids, with more than 70% reporting that their practice was influenced by parental opinion if communicated. For some topics, such as PDA surgery and central line placement, conversations impacted few clinicians. Conclusions: FCC appears to have an impact on NICU clinical decision-making processes, some more than others. Further investigation in this area may provide information on how to best communicate with families and run effective, efficient FCC rounds.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 02/2013; · 1.36 Impact Factor
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ABSTRACT: Objective To determine etiology of neonatal intensive care unit (NICU) admission and acute morbidities in late preterm (LPT) neonates.Methods Neonates admitted at New York University Langone Medical Center's NICU were grouped as follows: period 1: all LPT neonates with gestational age between 340/7 and 366/7 weeks and born between January 2006 and June 2007; period 2: all term neonates born between January 2007 and June 2008. Neonatal and maternal data were collected from both the groups and compared.Results Thirty-three percent of LPT births were admitted to the NICU, compared with 7% of term births (p < 0.05). LPT neonates had an increased incidence of low birth weight, hypoglycemia, hypothermia, and hyperbilirubinemia as an admission diagnosis (p < 0.001). The overall incidence of respiratory distress syndrome (RDS) was 9%, 4%, 3%, 0.7%, 0.2% and 0% in 34-week, 35-week, 36-week, 37-week, 38- to 39-week, and 40-week gestational age neonates (p < 0. 001).There was an increased incidence of RDS and persistent pulmonary hypertension, along with an increased need for surfactant replacement therapy, continuous positive airway pressure, and ventilator support in the LPT group when compared with the term neonates (p < 0.001).Conclusions LPT neonates are at increased risk for hypothermia, hypoglycemia, hyperbilirubinemia, and respiratory morbidity requiring increased respiratory support when compared with term neonates.
American Journal of Perinatology 10/2012; · 1.32 Impact Factor
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ABSTRACT: Premature neonates often receive red blood cell (RBC) transfusions to improve tissue perfusion and oxygen delivery. Clinical and laboratory indicators used to guide transfusion therapy are inadequate to determine physiologic need with high predictability and transfusions frequently do not result in clinical improvement. The splanchnic-cerebral oxygenation ratio (SCOR) provides insight into overall tissue oxygen sufficiency and can be determined using near-infrared spectroscopy (NIRS). Our aim was to assess the usefulness of SCOR as a marker for transfusion need in preterm infants.
This study was a prospective observational pilot study utilizing NIRS to analyze the SCOR in symptomatic anemic premature neonates receiving RBC transfusions and nontransfused asymptomatic premature neonates with similarly low hemoglobin (Hb) levels. Subject clinical status was determined based on frequency of apnea, bradycardia, pulse-oximetry desaturation events, heart rate, respiratory support, and feeding tolerance. We then assessed for any difference between baseline (pretransfusion) SCOR of 1) symptomatic subjects who improved after transfusion, 2) symptomatic subjects who did not improve, and 3) asymptomatic subjects.
The study included 52 subjects (34 transfused, 18 asymptomatic): mean birth weight was 1164 g, mean gestational age was 28.6 weeks, and mean Hb level was 9.0 g/dL. Of 34 transfused subjects, 19 improved (56%). Mean baseline SCOR values were lower in neonates who improved with transfusion, 0.61 ± 0.22, when compared to those without improvement, 0.75 ± 0.17, and asymptomatic neonates, 0.77 ± 0.16 (p = 0.03). Infants with a low baseline SCOR (≤ 0.73) were more likely to improve after transfusion (likelihood ratio, 2.8; 95% confidence interval, 1.1-6.7).
SCOR may help identify premature infants who will benefit from RBC transfusion.
Transfusion 07/2011; 52(2):252-60. · 3.22 Impact Factor
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ABSTRACT: Packed red blood cell (RBC) transfusions are often administered to patients in the neonatal intensive care unit. The purpose of this study was to determine whether current blood transfusion guidelines are as useful as care givers' perception in identifying patients in need of a packed RBC transfusion.
Health care providers were asked to complete a pre- and post-transfusion survey on neonates receiving a packed RBC transfusion. These patients were divided into three groups based on reasons for transfusion: (i) guidelines; (ii) care-givers' perceptions of need for packed RBC transfusion; or (iii) both. These three groups were further subdivided into two cohorts according to whether they had a clinical improvement or not. Demographic data and clinical variables were compared between the groups.
Seventy-eight care-givers were surveyed. Eighteen patients (23%) were transfused based on guidelines, 36 (46%) based on care givers' perception and 24 (31%) based on both. Neonates transfused based on guidelines alone were more likely to have received the transfusion in the first week of life, had a higher pre-transfusion haematocrit, were less symptomatic and had a higher trend to require mechanical ventilation. Neonates transfused based on caregivers' perception were more likely to be on non-invasive ventilatory support and were more symptomatic. Neonates who improved after a transfusion had a lower pre-transfusion haematocrit (p=0.02), were more symptomatic (p=0.01) and were more likely to be on non-invasive ventilatory support (p=0.002) when compared to the group without a clinical improvement. The group without improvement had an increase in oxygen requirement (+2.8±6.4) after the transfusion (p=0.0004). Tachycardia was the most sensitive predictor of a benefit from packed RBC transfusion [OR 6.48: p=0.005].
Guidelines on when to transfuse stable growing neonates with packed RBC should be re-evaluated to include more care giver judgement and perhaps be more restrictive for critically ill neonates.
Blood transfusion = Trasfusione del sangue 01/2011; 9(1):86-94. · 2.10 Impact Factor
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ABSTRACT: Exogenous surfactants commonly used to treat a variety of neonatal respiratory diseases are derived from either bovine or porcine sources. The extent to which parents are aware of this fact is currently unclear, as is the impact that this may have on familial cultural or religious belief systems. Our primary aims were to assess U.S. neonatologists’ utilization of bovine and porcine surfactant preparations, their views on parent disclosure pertaining to the particular animal origins of exogenous surfactant therapy, and their willingness to provide alternative surfactant preparations based on parental religious preferences. An anonymous Web-based survey was provided to 2,137 neonatologists. There was a 46.9% response rate. We found that 63.4% of respondents used only bovine-derived surfactants, 14.9% exclusively used porcine-based surfactants, and 21.7% used combinations. While 74.3% of neonatologists discussed surfactant use with parents, only 2.2% always discussed its animal origins. When asked, 47.9% of neonatologists believed parental preference for religious reasons would not impact their surfactant choice, 19.4% reported it would affect their choice, and 32.7% said it maybe would. Access to only one surfactant was a major barrier to communication. Results showed that many neonatologists may be open to being inclusive of parents regarding surfactant therapy. Carrying different surfactant types on hospital pharmacy formularies and encouraging physician–parent communication may achieve a more family-centered approach to neonatal care.
AJOB Primary Research. 01/2011; 2(1):26-33.
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ABSTRACT: Prematurity is defined as birth before 37 weeks of gestation and is the major determinant of morbidity and mortality in newborns. The gestational ages known as near term or late preterm represent about 75% of preterm births and are the fastest growing subgroups of premature infants. These infants range in gestational age from 34 0/7 to 36 6/7 weeks and are at greater risk of morbidity, such as respiratory complications, temperature instability, hypoglycemia, kernicterus, feeding problems, neonatal intensive care unit admissions, and adverse neurological sequelae when compared with term infants. Long-term neurological and school-age outcomes of late preterm infants are concerns of major public health importance because even a minor increase in the rate of neurological disability and scholastic failure in this group can have a huge impact on the health care and educational systems. There is an urgent need to educate health care providers and parents about the vulnerability of late preterm infants, who are in need of diligent monitoring and care during the initial hospital stay and a comprehensive follow-up plan for post neonatal and long-term evaluations. Clinicians involved in the day-to-day care of late preterm infants, as well as those developing guidelines and recommendations, would benefit from having a clear understanding of the potential differences in risks faced by these infants, compared with their more mature counterparts.
Current problems in pediatric and adolescent health care 10/2010; 40(9):218-33.
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ABSTRACT: Preterm infants often receive multiple packed red blood cell (PRBC) transfusions that are intended to improve tissue oxygen levels. Near-infrared spectroscopy (NIRS) monitors regional cerebral tissue oxygen saturation (CrSO(2)) and splanchnic tissue oxygen saturation (SrSO(2)). Before such technology can be employed in neonatal transfusion management, it must first be established that transfusions result in an increase in tissue oxygen saturation. This prospective, observational study used NIRS to determine if PRBC transfusions increase the CrSO(2) and SrSO(2) of symptomatic anemic premature neonates. CrSO(2) and SrSO(2) values were compared for 20-minute duration immediately before, during, immediately after, and 12 hours after transfusion. As a secondary objective, CrSO(2) and SrSO(2) values were correlated with hemoglobin (Hgb) levels. One-way analysis of variance and Pearson correlation statistical tests were used for analysis. A statistically significant increase in CrSO(2) and SrSO(2) values were observed after transfusion in the 30 subjects included (CrSO(2): 62.8 +/- 1.6, 65.6 +/- 1.7, 68.0 +/- 1.3, 67.6 +/- 1.4, P < 0.001 and SrSO(2): 41.3 +/- 2.2, 46.7 +/- 3.0, 52.1 +/- 2.8, 48.2 +/- 2.5, P < 0.001). No correlation was found between CrSO(2) or SrSO(2) and Hgb values. NIRS identified increases in CrSO(2) and SrSO(2) in preterm neonates after PRBC transfusions and has the potential to become incorporated into neonatal transfusion management paradigms.
American Journal of Perinatology 06/2010; 27(6):445-53. · 1.32 Impact Factor
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ABSTRACT: The role of the neonatal nurse is vital for the successful implementation of developmental care and the provision of an optimal neonatal intensive care unit (NICU) environment. The goal was to identify nurses' perceived barriers to implementation or improving developmental care in their NICUs. Nursing perceptions related to barriers for implementing developmental care were assessed using a 12-point questionnaire during two New York City Neonatal Nursing regional conferences. One hundred forty-six (86%) of 170 nurses representing 24 regional hospitals returned the survey. Developmental care was viewed as essential by 136 nurses (93%), yet 125 nurses (86%) believed that their NICU was not providing optimal developmental care. Light and sound standards were viewed as important to providing care by 71% and 91% of respondents, respectively, yet only four NICUs (3%) had light and sound meters to identify or standardize this environmental source of pain. As a group, the perceived barriers to provision of optimal developmental care in order of decreasing importance were staff nurses and staff physicians (53%) > NICU funds (42%) > physician leadership (37%) > facility limitations (31%) > registered nurse leadership (25%). In contrast, 90% of nurses whose NICU did not use developmental multidisciplinary team meetings or developmental care champions or advocates were significantly more likely to identify nursing or physician colleagues as barriers to implementing or improving developmental care, compared with 38% of nurses whose NICU used such activities ( P < 0.001). Developmental care is perceived by the neonatal nurse as a vital component to the care provided in the NICU. Use of simple light and sound measures may enhance perception of providing an optimal NICU environment. Neonatal nurses perceived barriers to care are often attributed to neonatal staff nursing and physician colleagues. This perception is decreased considerably in those NICUs in which multidisciplinary team meetings or champions are used to address the needs of caregivers by providing developmental care strategies.
American Journal of Perinatology 02/2007; 24(2):71-7. · 1.32 Impact Factor
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ABSTRACT: The purpose of this article is to review the current literature on the association between maternal periodontal disease and poor pregnancy and neonatal outcomes and outline the role nurses can play in improving the oral health of pregnant women. Maternal periodontal disease is linked to preterm birth, low birthweight, and preterm low birthweight, but treatment of periodontal disease during pregnancy has been shown to be safe and effective. Nurses, nurse practitioners, and nurse-midwives are in a position to educate pregnant women on the benefits of good oral health and identify and refer women who are in need of dental care for treatment.
MCN The American Journal of Maternal/Child Nursing 33(1):45-9. · 1.12 Impact Factor
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ABSTRACT: Neonatal encephalopathy after perinatal hypoxic-ischemic insult is a major contributor to global child mortality and morbidity. Brain injury in term infants in response to hypoxic-ischemic insult is a complex process evolving over hours to days, which provides a unique window of opportunity for neuroprotective treatment interventions. Advances in neuroimaging, brain monitoring techniques, and tissue biomarkers have improved the ability to diagnose, monitor, and care for newborn infants with neonatal encephalopathy as well as predict their outcome. However, challenges remain in early identification of infants at risk for neonatal encephalopathy, determination of timing and extent of hypoxic-ischemic brain injury, as well as optimal management and treatment duration. Therapeutic hypothermia is the most promising neuroprotective intervention to date for infants with moderate to severe neonatal encephalopathy after perinatal asphyxia and has currently been incorporated in many neonatal intensive care units in developed countries. However, only 1 in 6 babies with encephalopathy will benefit from hypothermia therapy; many infants still develop significant adverse outcomes. To enhance the outcome, specific diagnostic predictors are needed to identify patients likely to benefit from hypothermia treatment. Studies are needed to determine the efficacy of combined therapeutic strategies with hypothermia therapy to achieve maximal neuroprotective effect. This review focuses on important concepts in the pathophysiology, diagnosis, and management of infants with neonatal encephalopathy due to perinatal asphyxia, including an overview of recently introduced novel therapies.
Current problems in pediatric and adolescent health care 41(5):132-53.
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ABSTRACT: This article explores the effect of a comprehensive developmental care training program on the medical outcome and cost of care for premature infants. Premature infants less than 34 weeks' gestation admitted to 2 regional neonatal intensive care units were prospective studies 6 months before and after implementation of the Wee Care program (Children's Medical Ventures, Norwell, MA). Environment, medical outcome, and hospital charges were recorded. The sample consisted of 242 infants (139 pre- and 103 postintervention). Although the medical outcomes of chronic lung disease, infection rate, mild retinopathy of prematurity, and intraventricular hemorrhage were significantly decreased, there was no change in incidence of severe retinopathy of prematurity. Hospital stay and hospital costs were significantly decreased. The authors conclude that a multidisciplinary, structured program in developmental care can lead to alterations in the neonatal intensive care unit environment associated with improved medical outcome, decreased length of hospitalization, and decreased cost of care. Copyright 2002, Elsevier Science (USA). All rights reserved.
Newborn and Infant Nursing Reviews.
