Topics on Critical Issues in Neonatal Care

Neonatology is one of the areas of greatest development and evolution within pediatrics. Every year there are advances in the management of the different diseases that newborns develop, which makes it necessary to refresh knowledge on traditional and other emerging issues. This book includes six chapters that address critical and relevant issues in neonatal care and seeks to contribute to the clinical work of health teams in neonatal units

Improving Care and Outcomes for the Late Preterm Infant

Abstract The late preterm infant population is the fastest growing and largest segment of preterm infants delivered on a global level. Neonatal Intensive Care Unit transfer and Pediatric unit re-admission rates were examined at a regional medical center in the context of providing an evidence-based practice guideline designed specifically for this cohort of newborns. Prior to instituting the Association of Women\u27s Heath, Obstetric, and Neonatal Nurses Assessment and care of the late preterm infant: Evidence-based clinical practice guideline at a regional medical center, NICU transfer and Pediatric re-admission rates were retrospectively examined. After instituting the guideline for a six-month period, the rates were re-examined for comparison. The results included a significant decrease in Pediatric re-admissions and a slight increase in NICU transfers. These findings suggest a specialized pathway and increased surveillance may reduce costly preventable rehospitalization

Biliary atresia at Red Cross War Memorial Children's Hospital: A retrospective descriptive study reviewing the age of presentation, clinical course and outcome of infants presenting to RCWMCH with biliary atresia

Background: Biliary atresia (BA) is a progressive obstructive cholangiopathy of unknown aetiology, occurring during the perinatal period. If left untreated it rapidly progresses to hepatic fibrosis and cirrhosis, with death occurring within 2 years. It is the leading cause of end-stage liver disease in the paediatric population and remains the most common indication for paediatric liver transplantation in South Africa. Objectives: Despite a wealth of information from developed countries, very little information is available in Africa and other developing nations. This study aimed to describe the age of presentation, clinical course and outcome of infants presenting to Red Cross War Memorial Children's Hospital (RCWMCH) with BA. Methods: A retrospective folder review was conducted on all patients with BA presenting to RCWMCH between January 2003 and December 2013. The main outcomes assessed were median time to presentation to tertiary services, clearance of jaundice post Kasai procedure (bilirubin <20μmol/L) and 2- and 5-year overall survival (OS) and survival with native liver (SNL). Results: The median age at presentation in the 80 cases reviewed was 70 days. Kasai procedure (KP) was performed in 62 (77.5%) patients at a median age of 68 days. 18 patients who presented late did not undergo KP. Clearance of jaundice was achieved in 39% of KPs. 13 patients underwent KP beyond 90 days with a success rate of 38%. 2- and 5-year SNL rates were 41% and 37.5% respectively with OS of 59% at 2-years and 56% at 5-years. Liver transplant was only performed in 12 of the 54 patients who showed progression to require transplantation. Conclusions: Jaundice clearance post KP and SNL compared favourably with international figures, however, lower overall survival rates reflected lack of access to transplantation. Age at KP was not a predictor of poor outcome

The effect of device position and use of transparent covers on the irradiance distribution of LED phototherapy devices

Background Effective phototherapy reduces neonatal jaundice and its complications. Irradiance increases as the distance of the light source decreases from a single phototherapy light. There are limited studies of the effect of distance and positional changes on different LED light designs on achieving effective phototherapy. Objectives To describe and compare the effect of distance, angle and plastic barriers on three different LED lights of different design. Methods Comparisons were made using a Servolite LED light, a General Electric (GE) Lullaby and a Ningbo David LED phototherapy light. Measurements were done according to methods described by the International Electrotechnical Communission (IEC). The effective irradiated area was measured on a grid measuring 60 x 30 cm subdivided into 5 x 5 cm squares. Measurements were done for the following scenarios: light placed at the manufacturers' recommended distance, 20 cm closer, 20 cm further, at an angle, through clear plastic and through scuffed perspex. Results When the lights were placed closer to the irradiated surface than the manufacturers' recommendations, the maximum irradiance increased, but the median irradiance and uniformity ratio decreased. When the lights were angled at 45 the median irradiance was decreased. A decrease in the median irradiance was also seen when phototherapy lights passed through scuffed plastic and food grade plastic. Conclusion Our study demonstrated that placing LED lights closer than the manufacturers recommendations, the use of transparent barriers and the use of lights at an angle, compromised phototherapy irradiance and distribution. Only the GE light met IEC standards

Primiparous women differ from multiparous women after early discharge regarding breastfeeding, anxiety, and insecurity:A prospective cohort study

INTRODUCTION: Breastfeeding and factors influencing breastfeeding are essential when considering the association between parity and neonatal and maternal morbidity risks when mothers are discharged within 24 hours after birth. However, there is a lack of studies examining the effect of parity and breastfeeding in a setting where all healthy mothers are recommended discharge four hours after birth. Therefore, this study examined the association between parity and the time for discharge, breastfeeding, and factors influencing breastfeeding. METHODS: The study was designed as a prospective cohort study. Data were obtained from questionnaires at one and at six weeks after birth, and combined with registered data. All 147 included mothers were healthy, with an uncomplicated birth and a healthy newborn, discharged within 24 hours after birth. RESULTS: This study documented that primiparous women had a higher relative risk (RR=2.62; 95% CI: 1.35–5.10) of having doubts about infant feeding after discharge than multiparous women. Furthermore, 54% of primiparous women contacted the maternity ward after discharge compared to 27% of multiparous women. Twice as many primiparous than multiparous women felt anxious or depressed at one and at six weeks after birth. Finally, the study documented that 13% of primiparous women and 5% of multiparous women discharged within six hours after birth perceived the time before discharge to be too short. CONCLUSIONS: Primiparous women differ from multiparous women regarding breastfeeding, insecurity, and anxiety. Special attention towards primiparous women and a follow-up strategy that allows the mothers to contact the maternity ward after early discharge is recommended

Neonatal skin injuries from mechanical forces: a multicentre, mixed methods study

Deanne August studied neonatal skin injuries through a multicentre, mixed methods research comprised of eight methods, to explore and determine epidemiologic factors of injury. Findings included methods for neonatal injury assessment, multiple forces contributed towards injury; neonates have increased risk compared to older populations; many injuries are currently unpreventable, and identification of new extrinsic and intrinsic risk factors

Deferred cord clamping to improve neonatal blood values. A systematic review and meta-analysis

BackgroundPractices related to umbilical cord clamping at birth should be evidence-based. Deferred cord clamping, compared to immediate cord clamping, shows benefits for preterm neonates but this may also apply to healthy term neonates. Different blood sampling techniques are used to measure effect of deferred and immediate cord clamping.ObjectiveTo assess the statistical and effect size differences between blood biomarkers from umbilical cord and capillary blood samples of healthy term neonates following either immediate or deferred cord clamping.DesignSystematic review and meta-analysis.MethodsThe databases PubMed, Medline, CENTRAL, CINAHL and EMBASE were systematically searched. We included studies with a randomised clinical trial design comparing deferred and immediate cord clamping among healthy term neonates born by a spontaneous vaginal birth, reporting on blood biomarkers. Studies including caesarean births and premature births/neonates were excluded. Study attributes, sampling technique, blood biomarkers, mean differences, and standard deviations were extracted. The standardised mean differences (SMD) and sampling errors were calculated for effect size estimation. Meta-analyses were performed if ≥ 2 studies reported the same outcome using RevMan 5. Subgroup analyses distinguished effects from umbilical cord and capillary blood samples. Moderator tests and publication bias analyses were performed using JASP.ResultsThirteen studies were included for analysis. The biomarkers haematocrit, haemoglobin, and bilirubin were reported in ≥ 2 studies and thus eligible for pooling. No differences were found in haemoglobin (SMD 0.05, 95%CI -0.73 to 0.82) or bilirubin values (SMD 0.03, 95%CI -0.24 to 0.31) between umbilical cord blood samples collected after deferred or immediate cord clamping. Deferred cord clamping led to lower haematocrit values (SMD -0.3, 95%CI -0.53 to − 0.07). Higher haematocrit (SMD 0.67, 95%CI 0.37 to 0.97) and haemoglobin values (SMD 0.75, 95%CI 0.42 to 1.09) from capillary blood samples, collected 2 to 72 h postpartum, showed when cord clamping was deferred. No effect was found on bilirubin values (SMD 0.13, 95%CI -0.09 to 0.36) irrespective of the sampling technique.ConclusionsBlood collected after deferred umbilical cord clamping showed increased haemoglobin and haematocrit values up to 72 h after birth, opposed to bilirubin values. Clinical evaluation of blood biomarkers from the umbilical cord shows different values compared to capillary blood. Sampling time and technique therefore seem essential in estimating the effects of deferred cord clamping