Burnout in doctors and nurses working in neonatal and pediatric intensive care units in a General Hospital

Aim: Health professionals working in intensive care units (ICU) are at high risk of developing the syndrome of professional burnout. The aim of the study was to explore the severity of professional burnout in doctors and nurses of neonatal (NICU) and pediatric ICUs (PICU) while identifying the factors associated with it.Study population and methods: Anonymous questionnaires were distributed to the nurses and doctors working in a NICU and PICU of a General Hospital. We utilized a 22-item questionnaire, the Maslach Burnout Inventory that evaluates three domains of burnout; emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA).Results: The response rate was 58% (52/90). The average (SD) scores were 30.71 (11.5) for EE, 10.11 (5.9) for DP, and 33.37 (8.0) for PA. DP scores were significant higher in PICU than NICU (p = 0.032) and EE and DP scores were higher in nurses than doctors (p 0.013 and p 0.0001 for EE and DP, respectively). Employees who reported health issues had a significantly higher degree of EE (p = 0.044) and appeared less satisfied with their PA (p = 0.046). Multiple regression analysis confirmed that ICU type and professional capacity were independent predictors of burnout. The age, marital status and years of ICU work did not significantly affect the burnout severity.Conclusions: There is a significant degree of burnout in the personnel of Greek PICUs and NICUs which is affected by the professional status, type of ICU, and health issues of the employees involved. The state must implement the necessary interventions that will effectively minimize burnout in ICU personnel in order to prevent the unfavorable consequences on both staff members and inpatients

Accuracy of plasma interleukin-6 and C-reactive protein as markers of sepsis in preterm neonates with respiratory distress syndrome

Aim: To evaluate the diagnostic accuracy of plasma interleukin-6 (IL-6) and serum CRP in detecting blood culture proven sepsis in preterm neonates with respiratory distress syndrome (RDS).Patients and Methods: 140 preterm neonates, 62 with RDS and 78 without RDS, who developed clinical signs of sepsis were prospectively studied. Plasma IL-6 and serum CRP levels were measured. The ROC curves, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios (LR) were calculated for IL-6 (> 20 pg/mL and > 80 pg/mL) and CRP (> 10 mg/L).Results: Positive blood cultures were found in 64 neonates (37 with RDS and 27 without RDS). Neonates with RDS had higher IL-6 (p 20 pg/mL was 0,93, 0,65 and 2,68, respectively, in neonates without RDS, and 0,92, 0,16 and 1,09, respectively, in neonates with RDS. The sensitivity, specificity and LR of CRP > 10mg/L were 0,86, 0,71 and 2,97, respectively, in neonates without RDS and 0,73, 0,68 and 2,28, respectively, in neonates with RDS.Conclusions: In neonates without RDS both the IL-6 and CRP are equally accurate markers in diagnosing sepsis, whereas in those with RDS the diagnostic value of IL-6 is limited

The effects of live singing on the biophysiological functions of preterm infants hospitalized in a Neonatal Intensive Care Unit in Greece: A pilot study.

The aim of the study was to investigate the effects of live singing on the biophysiological functions, weight gain, head circumference, body length, and duration of hospitalization of preterm infants hospitalized in a neonatal intensive care unit (NICU) in Greece. Forty-one preterm infants 25-33 + 6 days of PCA took part in the study. 14 infants were assigned to the Mother Singing group (MS) in which mothers sang to their infants for 15 minutes every day during the fourteen-day intervention, 13 to the Music Therapist Singing group (MTS) in which a music therapist sang to the infants for 15 minutes every day during the fourteen-day intervention, and 14 in the control group (CG) which did not receive any additional intervention. Infants of both MS and MTS presented statistically significant improvements in heart rate and blood oxygen saturation, compared to CG. No significant differences between groups were found in weight, head circumference, body length, and duration of hospitalization. The use of live singing by mothers or music therapists appears to elicit positive effects on vital biophysiological functions of premature infants. Further investigation of the role of live singing in NICU is warranted

Modifications of Own Mothers’ Milk Fortification Protocol Affect Early Plasma IGF-I and Ghrelin Levels in Preterm Infants. A Randomized Clinical Trial

The aim was to investigate the effect of two own mother’s milk (OMM) fortification protocols on (a) IGF-I and ghrelin plasma levels at 35 post-conceptional weeks (PCW, T2) and whether this effect is maintained after elimination of the differences in OMM fortification, and (b) growth until 12 months corrected age. Forty-eight OMM-fed preterm infants (GA 24–32 weeks) were randomly allocated to the fixed-fortification (FF) group (n = 23) and the protein-targeting fortification (PTF) group (n = 25) targeting the recommended daily protein intake (PI). Plasma IGF-I and ghrelin were assessed at 35 (T2) and 40 (T3) PCW while growth was longitudinally assessed until 12 months corrected age. PTF group had lower IGF-I and higher ghrelin than FF group at T2, while receiving lower daily protein and energy amounts. PI correlated positively to T2-IGF-I and inversely to T3-ghrelin while energy intake (EI) correlated inversely to T2- and T3-ghrelin. Group and PI were independent predictors of adjusted T2-IGF-I, while group and EI were predictors of adjusted and T2-ghrelin. Growth parameter z-scores were comparable between groups up to 12 months corrected age. Modifications of OMM fortification have a transient effect on early plasma IGF-I and ghrelin levels in preterm infants in a way consistent with the previously recognized protein-energy/endocrine balance, indicating a potential programming effect

Osteomyelitis and Thrombosis in a Newborn with Group A Streptococcus Infection

Neonatal osteomyelitis (OM), although exceptionally rare, has been linked to detrimental sequel, as diagnosis in the early stages is challenging and any delay in treatment can lead to disturbance in skeletal growth. In pediatric OM the most commonly grown bacteria is Staphylococcus aureus followed by group A Streptococcus (GAS). Notwithstanding, sepsis-induced coagulopathy is a well-known entity in children and adults, still sepsis-associated thrombosis is sparsely observed. we present a case of a newborn with GAS associated OM and thrombosis. A term neonate on the 11th day of life was referred to our NICU due to right (R) lower limb edema, cyanosis and core temperature up to 39 °C. Late onset sepsis was suspected and started on vancomycin and amikacin. A colour Doppler scan showed thrombosis of the R common femoral vein. The neonate started on iv unfractionated heparin. Ampicillin was added given positive for GAS blood culture. An MRI on the 5th day of admission, showed evidence of thrombosis resolution. On the 14th day of admission, a bone Tc99 scan showed evidence of OM of R femur. Antibiotic treatment switched to amoxicillin per os. The management was restricted to anticoagulant therapy with low molecular weight heparin for 3 months and antibiotic therapy for 6 months without surgery intervention and the patient recovered and discharged at 42 days of age. Early diagnosis and treatment of neonatal osteomyelitis can prevent bone destruction. Sepsis-associated thrombosis is barely observed during osteomyelitis, yet it should be considered as an emerged case requiring prompt treatment

The Mediterranean diet adherence by pregnant women delivering prematurely: association with size at birth and complications of prematurity

<p><b>Background:</b> The Mediterranean diet (MD) is associated with decreased risk of metabolic syndrome and gestational diabetes due to the anti-inflammatory and antioxidative properties of its components. The aim was to investigate the potential association of MD adherence (MDA) during pregnancy by mothers delivering prematurely, with intrauterine growth as expressed by neonates’ anthropometry at birth and complications of prematurity.</p> <p><b>Participants and methods:</b> This is a single-center, prospective, observational cohort study of 82 women who delivered preterm singletons at post conceptional age (PCA) ≤ 34 weeks and their live-born neonates. Maternal and neonatal demographic and clinical data were recorded. All mothers filled in a food frequency questionnaire, and the MDA score was calculated. Based on 50th centile of MD score, participants were classified into high-MDA and low-MDA groups.</p> <p><b>Results:</b> The low-MDA mothers had significantly higher pregestational BMI and rates of overweight/obesity (odd ratios (OR) 3.5) and gestational hypertension/preeclampsia (OR 3.8). Neonates in the low-MDA group had significantly higher incidence of intrauterine growth restriction (IUGR) (OR 3.3) and lower z-scores of birth weight and BMI. Regarding prematurity-related complications, the low MDA-group was more likely to develop necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity (OR 3.2, 1.3, and 1.6, respectively), while they were less likely to develop respiratory distress syndrome (OR 0.49), although the differences were not statistically significant. However, adjustment for confounders revealed MDA as a significant independent predictor of hypertension/preeclampsia, IUGR, birth weight z-score, necrotizing enterocolitis, and bronchopulmonary dysplasia.</p> <p><b>Conclusions:</b> High MDA during pregnancy may favorably affect intrauterine growth and certain acute and chronic complications of prematurity as well as maternal hypertension/preeclampsia.</p

The Effect of Breastfeeding on Food Allergies in Newborns and Infants

Breastfeeding is the preferred method of infant feeding and its establishment is one of the primary goals for the infant. Allergic diseases are common in childhood, with increased morbidity. Food allergies are also associated with a strong negative impact on health-related quality of life and is a major public health problem. In addition, maternal exclusion of common allergens during pregnancy and/or lactation suggests that supplementation with regular cow’s milk formula during the first week of life should be avoided. Breast milk contains many active immune factors, such as cytokines, inflammatory mediators, signaling molecules and soluble receptors, which may also reduce the risk of allergic disease. The prophylactic effects of breastfeeding have been the subject of many studies, some with weak evidence. In this narrative review, we aim to provide an up-to-date account of the effects of prophylactic breastfeeding on food allergy and other common allergies in infants and children up to 5 years of age. Colostrum in particular has been shown to be prophylactic against food allergy. The American Academy of Pediatrics cautions that the relationship between duration of breastfeeding and incidence of food allergy in early childhood is unclear. The protective role of breastfeeding has a positive effect on allergy prevention, which is opposed by the early introduction of solid foods, but larger studies are needed to confirm the evidence. There is evidence that breastfeeding is effective in providing partial protection to infants