Maternal Psychological Problems Associated with Neonatal Intensive Care Admission

Background. Mothers of infants admitted to a neonatal intensive care unit (NICU) are believed to have heightened distress. The purpose of this paper was to determine depression and anxiety symptoms and attachment style in NICU mothers. Methods. The NICU group consisted of mothers whose infants were admitted to the NICU and the control group consisted of mothers of healthy term infants. The psychosocial assessments were done at the first month. Results. The mean Edinburgh Postpartum Depression (EPDS) score of NICU mothers was significantly higher than that of the control group mothers (9.6 ± 5.6 versus 7.3 ± 4.9, P = .005). NICU mothers who had high EPDS (≥13) scores had significantly higher anxiety scores and insecure attachment style in comparison to the subgroup of NICU mothers who had low EPDS scores. Conclusion. Mothers of NICU babies had higher EPDS scores. Mothers who had higher EPDS scores had higher anxiety scores as well. These NICU mothers should receive appropriate counseling during the hospitalization of their babies

Do We Have to Obtain Rebound Bilirubin Levels and What is the Optimal Time?

Aim:We aimed to determine the frequency of rebound hyperbilirubinemia (RHB) needing treatment and therefrom, to clarify the clinical importance of routinely checking serum total bilirubin (STB) levels after the cessation of phototherapy and to define an optimal time to check STB levels for the detection of RHB.Materials and Methods:Term and late preterm babies who received phototherapy were included in this study. The demographic and clinical features, time of onset of jaundice, phototherapy time and results to determine the etiology of jaundice were recorded for all babies. Serum “rebound” bilirubin measurements were performed two times at 12 and at 24 hours after the cessation of phototherapy. The re-initiation of phototherapy according to the 12th and 24th hour STB levels was accepted as “early rebound” and “late rebound”, respectively. IBM SPSS 22 was used for statistical analyses.Results:Data was available for 110 infants. The rebound rate requiring phototherapy was 9.1% (n=10) and all had a risk factor. Most of the babies (9/10) rebounded at the 12th hour after the termination of phototherapy. Hemolysis and prematurity were found to be statistically significant for RHB (p=0.008; p=0.048).Conclusion:Post-phototherapy bilirubin follow-up may be incorporated using a combined approach of individualization, evaluation of risk factors, and application of common sense before discharge. Our study showed that STB levels could be measured after the cessation of phototherapy, especially in patients with a risk factor, at the 12th hour before discharge. Randomized controlled studies with larger sample sizes are still needed for definitive recommendations

Atomoxetine treatment may decrease striatal dopaminergic transporter availability after 8 weeks: pilot SPECT report of three cases

Attention deficit/hyperactivity disorder is one of the most common neurodevelopmental disorders. The pathophysiology is thought to involve noradrenaline and dopamine. The role of dopamine transporter (DAT) was evaluated in imaging studies using mostly dopamine reuptake inhibitors. Atomoxetine is a selective noradrenaline reuptake inhibitor. Here we report the results of a pilot study conducted to evaluate changes in striatal DAT after 8 weeks of atomoxetine treatment. Our results suggest that 8 weeks of atomoxetine treatment may change striatal DAT bioavailability as measured via SPECT but that change was not correlated with genotype or clinical improvement

Transient Tachypnea of the Newborn: The Treatment Strategies

Transient tachypnea of the newborn results from delayed clearance of lung fluid and is a common cause of admission of full term and late preterm infants to neonatal intensive care units. The condition is particularly common after elective cesarean section. Conventional treatment involves supplemental oxygen, withholding enteral feeds and administration of intravenous fluids and antibiotics. Rarely, infants require CPAP and mechanical ventilation. Occasionally some babies develop severe hypoxemia and may require high concentrations of oxygen. The most effective strategy for accelerating reabsorbtion of fetal lung fluid is exogenous glucocorticoids. Potential therapies for TTN must be based on an understanding of the physiology of normal fetal lung fluid clearence at bith. Furosemide, racemic epinephrine and inhaled - agonists have been studied for possible benefit in TTN. The routine administration of these drugs can not be recommended unless additional data become available

RETRACTED: Comparison of sucrose, expressed breast milk, and breast-feeding on the neonatal response to heel prick (Retracted Article. See vol 4, pg 415, 2003)

Newborns endure many heel pricks and other uncomfortable procedures during their first hospital stay. The aim of this study was to investigate the effectiveness of breast-feeding in reducing pain in newborns undergoing heel prick tests. One hundred thirty healthy term infants requiring a heel prick blood sampling for the Guthrie test were studied. Infants were randomly allocated to 1 of the following treatment groups: group 1, 25% sucrose (n = 35); group 2, breast milk (n = 33); group 3, sterile water (n = 34); and group 4, breast-feeding (n = 28). The median values of crying and recovery time and percent change in heart rate at 1, 2, and 3 minutes were recorded. A behavioral pain scale was applied according to the infant body coding system. The median crying time was 36, 62, 52, and 51 seconds in groups 1, 2, 3, and 4, respectively (P = .002). Similarly, there was a significant overall difference among groups for the duration of recovery time (P = .006) and the percent change in heart rate at 1 (P = .03), 2 (P = .01), and 3 (P = .009) minutes favoring the sucrose group. But when we compared the groups, the significance remained for the sucrose versus breast milk (P = .007) and water (P = .001) groups for the recovery time and sucrose versus all other groups for the percent change in heart rate at 3 minutes. The infant body coding system showed that babies in the sucrose group had significantly lower scores followed by the breast-fed and breast milk groups (P = .0001). Our study revealed that 25% sucrose is superior to breast-feeding in pain relief, which is reflected mainly in crying time and behavioral variables. The behavioral effects of breast-feeding did not provide any additional benefit. (C) 2001 by the American Pain Society

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants-2013 Update

Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report updated recommendations of a European Panel of expert neonatologists who developed consensus guidelines after critical examination of the most up-to-date evidence in 2007 and 2010. This second update of the guidelines is based upon published evidence up to the end of 2012. Strong evidence exists for the role of antenatal steroids in RDS prevention, but it is still not clear if the benefit of repeated courses on respiratory outcomes outweighs the risk of adverse outcomes in the short and long term. Many practices involved in preterm neonatal stabilization at birth are not evidence based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in the management of RDS but the best preparation, optimal dose and timing of administration at different gestations is not completely clear. In addition, use of very early continuous positive airway pressure (CPAP) has altered the indications for prophylactic surfactant administration. Respiratory support in the form of mechanical ventilation may be lifesaving but can cause lung injury, and protocols should be directed at avoiding mechanical ventilation where possible by using non-invasive respiratory support such as CPAP. For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of normal body temperature, proper fluid management, good nutritional support, appropriate management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion. Copyright (c) 2013 S. Karger AG, Base