Nitrogen metabolism in preterm infants

The underlying theme of this work has been to try to understand the protein metabolism in the premature human infant, and its response to perturbations including disease and diet. Since the early work of Schoenheimer et al. it has been recognized that growth takes place as a result of protein synthesis and protein breakdown [16]. With the understanding of protein metabolism itself and the response of protein metabolism to diseases and diet, an improved therapy (treatment as well as nutrition) is possible, leading to an improved growth

Vibration therapy reduces CPAP need in a prospective randomised controlled trial

Background: Increased mucus production is a common phenomena following ventilatory support, which might increase morbidity. In order to reduce airway obstruction we tested the effect of vibration therapy on the duration of ventilatory support. Methodology: We conducted a randomised control study in a level IIIC NICU (28 beds) of a university hospital. Compared were nonactive techniques to vibration therapy in preterm infants with a gestational age of 26 - 33 weeks. All infants were ventilated or receive respiratory support by nasal CPAP. Results: 104 infants were enrolled, 49 in the vibration group and 55 in the control group. Demographic characters were in the vibration group compared to control group mean birth weight 1274 (± 335) gram vs. 1240 (± 351) gram and mean gestational age 29.8 (± 1.3) weeks vs. 29.9 (± 1.4) weeks. Vibration therapy did not reduce ventilation time (100 vs. 80 hours, p = 0.88) however duration of CPAP decreases significant (57 vs 157 hours, p < 0.018). Conclusion: Vibration therapy reduced Mean Airway Pressure, oxygen requirements and CPAP need in preterm infants, but did not reduce the duration of mechanical ventilation

Perceptions of parents, nurses, and physicians on neonatal intensive care practices

OBJECTIVE: To identify satisfaction with neonatal intensive care as viewed by parents and healthcare professionals and to explore similarities and differences between parents and healthcare professionals. STUDY DESIGN: A 3-round Delphi method to identify neonatal care issues (round 1) and to determine the importance of these issues (rounds 2 and 3) was conducted among nurses (n = 84) and physicians (n = 14), followed by an exploratory survey among parents (n = 259). Main outcome measures were 92 neonatal care-related items. RESULTS: Sixty-eight nurses and 13 physicians completed all 3 rounds. The first round yielded 419 neonatal care related statements, which were clustered into 92 items. The survey was completed by 148 (57%) parents. Parents rated 25 of 92 care items significantly higher than did the professionals (effect size of Cohen's d, 0.31 to 1.14, P <or= .02). Two items related to medication administration had the largest effect size. Professionals rated 7 items significantly higher than didparents (Cohen's d, -0.31 to -0.58, P <or= .04). One of these was assigning a physician and a nurse to the parents. Three were related to multicultural care. CONCLUSIONS: This study revealed disparities between parents and neonatal intensive care unit staff on a number of care issues reflecting incongruity in rec

Construction of a parent satisfaction instrument: Perceptions of pediatric intensive care nurses and physicians

Purpose: The aims of the study were (1) to identify parental satisfaction items through the opinions of pediatric intensive care unit (PICU) nurses and physicians, (2) to reach consensus on the identified items, and (3) to apply factor analysis to evaluate the items and domains toward a PICU parental satisfaction instrument. Materials and Methods: Pediatric intensive care unit nurses and physicians working in 8 university hospitals in the Netherlands participated. A 2-round Delphi method was completed. Confirmatory factor analysis was performed on the satisfaction items and domains. Results: Three hundred two nurses and 62 physicians participated in the Delphi study, and 269 (76%) completed 2 questionnaire rounds. In Delphi round 2, 14 of the 78 items had a mean of less than 8.0 (range, 1 [low importance] to 10 [high importance]). The interquartile range of all domains decreased by almost half, and only 10 satisfaction items had a heterogeneity of less than 70%. Structure determination revealed that 4 satisfaction items needed to be excluded. Out of 74 satisfaction items, 72 showed factor loadings greater than 0.50. The reliability estimates, Cronbach α, for the 6 domains varied from 0.74 to 0.92. Conclusions: Priorities in parental satisfaction measures are identified. The findings are fundamental in the development of a PICU parental satisfaction instrument

The Effect of Pasteurization on the Antioxidant Properties of Human Milk:A Literature Review

High rates of oxidative stress are common in preterm born infants and have short- and long-term consequences. The antioxidant properties of human milk limits the consequences of excessive oxidative damage. However, as the mother’s own milk it is not always available, donor milk may be provided as the best alternative. Donor milk needs to be pasteurized before use to ensure safety. Although pasteurization is necessary for safety reasons, it may affect the activity and concentration of several biological factors, including antioxidants. This literature review describes the effect of different pasteurization methods on antioxidant properties of human milk and aims to provide evidence to guide donor milk banks in choosing the best pasteurization method from an antioxidant perspective. The current literature suggests that Holder pasteurization reduces the antioxidant properties of human milk. Alternative pasteurization methods seem promising as less reduction is observed in several studies

Hearing the voices of children: self-reported information on children's experiences during research procedures

__Introduction:__ In paediatric research, there is a tension between what you can ask from a child and what is needed for the development of evidence-based treatments. To find an optimal balance in conducting clinical research and protecting the child, it is necessary to have empirical data on children's experiences. Until now, there are scarce empirical data on the experiences from the perspective of the child. In this manuscript, we describe the protocol of a twophase study measuring children's self-reported experiences during research procedures. __Methods and analysis:__ In the first phase of our study, we aim to interview approximately 40 children (6-18 years) about their self-reported experiences during research procedures. In the second phase, we will develop a questionnaire to measure children's experiences during research procedures in a quantitative way. We will use the interview outcomes for the development of this questionnaire. Next, we will measure the experiences of children during seven research procedures with this questionnaire. A one-month followup is conducted to investigate the emotional impact of the research procedures on the children. Children will be recruited from different research studies in three academic children's hospitals in the Netherlands. __Ethics and dissemination:__ The ethics committee of the VU University medical center evaluated both studies and indicated that there was no risk/discomfort associated, stating that both phases are exempt from getting