Oral 24% sucrose associated with nonnutritive sucking for pain control in healthy term newborns receiving venipuncture beyond the first week of life

Objective: To test the hypothesis that oral administration of 24% sucrose associated with nonnutritive sucking in healthy newborns receiving venipuncture beyond the first week of life controls pain and pain-related variation in heart rate (HR) and noninvasive oxygen saturation (SpO2). Methods: A total of 66 term newborns were enrolled between February and September 2017 in the Neonatology Department of AORN Santobono-Pausilipon, Naples. They were randomly assigned to receive oral 1 mL 24% sucrose (treated group [TG], n=33; gestational age 38.53±1.49 weeks; body weight 3,035±55 g; age 22.40±6.82 weeks) or oral 1 mL 10% glucose (control group [CG], n=33; gestational age 38.91±1.45 weeks; body weight 3,203±65 g; age 23.36±7.02 weeks) 1 minute before and during venipuncture. Evaluations were carried out between 8 and 9 am in all newborns. The Neonatal Infant Pain Scale (NIPS) was used to assess pain in newborns. Outcome measurements (HR, SpO2) were obtained before (T0), during (T1), and 1 minute after (T2) venipuncture using a Nellcor bedside SpO2 patient-monitoring system. NIPS scores were recorded throughout the procedure. Statistical analysis was performed using SPSS version 20.0. Changes in HR and SpO2 were assessed by mixed ANOVA for repeated measures. NIPS scores were evaluated by Mann–Whitney U test. Results: There were no statistically significant differences in HR or SpO2 between TG and CG at T0. HR was significantly lower in TG than CG at both T1 and T2 (P<0.05), whereas SpO2 was significantly higher in TG than CG at both T1 and T2 (P<0.05). NIPS scores were significantly lower in TG (median 0) than CG (median 6) during the entire procedure (P<0.05). Conclusion: Oral administration of 24% sucrose associated with nonnutritive sucking prior to and during a painful procedure has a strong impact on pain response in term newborns, reducing NIPS scores and influencing pain-associated variations in HR and SpO2. Complete analgesia during painful procedures in term newborns might prevent pain reactivity and its behavioral and neurodevelopmental consequences. Replication of this study is needed before widespread application of findings

Rooming-in Reduces Salivary Cortisol Level of Newborn

Background. Rooming-in practice improves breastfeeding and reduces newborn stress reactivity. When this modality is not available, partial rooming-in after birth can be considered. Salivary cortisol levels (SCLs) are considered reliable biomarkers to indicate stress. Objective. To test the hypothesis that rooming-in duration impacts neonatal stress response in hospitalized newborns. Design/methods. Forty term newborns, enrolled in the Neonatology and Obstetrics Nursing, C.G. Ruesch, Naples, Italy, were divided, according to the mother's choice, into the study (SG; n = 20) and control (CG; n = 20) groups if they received full (24 hs) or partial (14 hs) rooming-in care, respectively. Saliva samples were collected from all babies between 7: 00 a.m. and 8: 00 a.m. of the 3rd day of life by using oral swab. Salivary cortisol levels were measured using an enzyme immunoassay kit (Salimetrics LLC, PA, USA). Results. A statistically significant difference in the SCLs between SG and CG was found (median: 258 ng/dl versus 488.5 ng/dl; p = 0 048). Conclusions. Data support the practice of full rooming-in care compared with partial rooming-in. The rooming-in duration clearly reduces SCLs and likely neonatal stress. These lower SCLs may have long-term positive effects reducing the risk of metabolic syndrome, high blood pressure, and cognitive and behavioural changes

Supporting parents in taking care of their infants admitted to a neonatal intensive care unit: a prospective cohort pilot study

Abstract Background Family-Centred Care (FCC) is recognized as an important component of all paediatric care, including neonatal care, although practical clinical guidelines to support this care model are still needed in Italy. The characteristics and services for families in Italian NICUs show a lack of organization and participation. Methods The first aim was to compare satisfaction and stress levels in two groups of parents: an FCC group and a non-FCC group (NFCC). The second aim was to evaluate body weight gain in the newborns enrolled. This non-randomized, prospective cohort pilot study was conducted in a single level III NICU at a hospital in Naples, Italy. A cohort of newborns in the NICU, with their parents were enrolled between March 2014 and April 2015 and they were divided into two groups: the FCC group (enrolled between October 2014 and April 2015) remained in the NICU for 8 h a day with FCC model; the NFCC group (enrolled between March 2014 and September 2014) was granted access to the NICU for only 1 hour per day. At discharge, both parent groups completed the Parental Stressor Scale (PSS)-NICU and a questionnaire to assess their satisfaction. In addition, we compared scores from the mothers and fathers within and between groups and the body weights of the newborns in the two groups at 60 days. Results Parents participating in the FCC group were more satisfied and less stressed than those in the NFCC group. Infants in the FCC group also showed increased body weight after 60 days of hospital stay. Conclusions Despite our small population, we confirm that routine adoption of a procedure designed to apply a FCC model can contribute to improving satisfaction and distress among preterm infants’ parents. Future multi-centre, randomized, controlled trials are needed to confirm these findings

Does high fidelity neonatal resuscitation simulation increase salivary cortisol levels of health care providers?

none8noneGiuseppe DE Bernardo, Marina Riccitelli, Maurizio Giordano, Anna L Toni, Desiree Sordino, Daniele Trevisanuto, Giuseppe Buonocore, Serafina PerroneDE Bernardo, Giuseppe; Riccitelli, Marina; Giordano, Maurizio; L Toni, Anna; Sordino, Desiree; Trevisanuto, Daniele; Buonocore, Giuseppe; Perrone, Serafin

Differences between umbilical blood gas in term and preterm newborns

Introduction: Cord blood gas analysis reflects placental respiratory and metabolic function and is commonly used to assess fetal status at birth. Our aim was to identify the differences in blood gas parameters between the umbilical artery (UA) and umbilical vein (UV) in term and preterm infants. Methods: This was a prospective pilot study. Umbilical cord artery and UV samples were consecutively collected from 225 term and 57 preterm infants at the University Hospital of Padua and at the neonatal unit of Ruesch Hospital in Naples, Italy. Blood gas-analysis and glucose measurement were performed in all samples. Term infants were divided into adequate for gestational age (AGA) and small for gestational age (SGA) according to birth weight percentile. Data were analyzed using Pearson Product-Moment Correlation, independent-samples t-test, and paired-samples t-test. A p-value &lt;0.05 was considered statistically significant. Results: The median gestational age of preterm and term newborns were 34 weeks (±2) and 39 weeks (±1) respectively. The pH, pO2, were lower and pCO2, HCO3 − and base excess (BE) were higher in the UA compared with the UV, in both AGA and SGA term infants. In preterm infants, no statistically significant differences were found between the UA and UV regarding pH, while the pO2 was lower and pCO2 was higher in the UA than UV (respectively: 22.5 vs. 32.4 and 53.1 vs. 42.8; p&lt;0.0001). In the UA, pO2, BE and potassium (K+) were lower (respectively: 22.5 vs. 25.1; -2.5 vs. -3.7; 4.8 vs. 5.8; p&lt;0.001) while sodium (Na+) and calcium (Ca++) were higher in preterm than term newborns (respectively: 135.7 vs. 133.6; p&lt;0.001; 1.4 vs. 1.3; p&lt;0.001). Glycaemia was lower in the UA than in the UV in all newborns (respectively: 66 vs. 77 in AGA term newborns; 63 vs. 71 in SGA term newborns; 68 vs. 76 in preterm newborns; p&lt;0.0001) and was related to venous glycaemia measured in the first hour of life (n= 282, r =0.60; p&lt;0.001). Conclusions: Significant differences in blood gas parameters between the UA and UV in term and preterm newborns suggest the importance of the placental barrier and the need for accurate cord blood gas analysis interpretation at birth. UA and UV samples at birth are required to assess with higher accuracy the metabolic status of the newborn in utero. Further studies are needed to evaluat