Advances in Neonatal Care最新文献

Background: One of the most important challenges that preterm infants face is nutritional problems. Poor postnatal weight gain can lead to various complications.

Purpose: To determine the effects of listening to the Holy Quran on the feeding status, postnatal weight gain, and length of hospital stay of preterm infants.

Methods: The current randomized clinical trial was conducted in the city of Qazvin in 2024. The samples included 80 preterm infants hospitalized in neonatal intensive care unit, who were randomly assigned to the intervention and control groups (40 in the Holy Quran recitation group and 40 in the control group). In addition to the routine care, the participants in the intervention group listened to the Holy Quran via headphones for 20 minutes 3 times a day, whereas the participants in the control group did not receive any intervention.

Results: The mean days to achieve the first oral feeding ( P < .001), the mean days to achieve full oral feeding ( P < .001), the mean weight gain at the time of achieving the first oral feeding ( P < .046), and the mean length of hospital stay ( P < .001) were significantly lower in the intervention group than in the control group.

Implications for practice and research: In addition to standard treatments, listening to the Holy Quran, as a complementary method, can improve some parameters related to feeding and the quicker discharge of preterm infants.

Background: Neonates admitted to the neonatal intensive care unit (NICU) undergo several painful procedures, causing significant stress. Maternal involvement in neonatal care significantly reduces pain and stress, thereby supporting better neurodevelopment in neonates.

Clinical question: How do maternal involvement strategies reduce neonatal pain and pain-related stress in the NICU?

Data sources: A systematic search was conducted on CENTRAL, PubMed Medline, EMBASE, CINAHL, Scopus, Web of Science, ProQuest databases, and Google Scholar for studies published between January 2007 and March 2024.

Study selection: A search across 7 databases yielded a total of 1360 studies, which were exported to Rayyan software for screening. Two independent authors conducted the screening based on the eligibility criteria.

Data extraction: Cochrane data collection forms were used to extract the data from the included studies.

Results: Out of 1360 titles identified during the initial search, a total of 27 randomized controlled trials were eligible and were included. Although there is a slight inconsistency in results, meta-analysis findings revealed that skin-to-skin care, holding, massage, feeding the baby, and maternal voice stimulation, significantly reduce procedural pain and pain-related stress, in neonates admitted to the NICU.

Implications for practice and research: Given the consistent results, this systematic review strongly supports NICU healthcare professionals in encouraging mothers to engage in neonatal care activities to reduce procedural pain and related stress. More research is needed, including navigating the mothers on the importance of their involvement in neonatal care throughout the NICU admission and after hospital discharge.

Background: Sex-specific differences exist in morbidity and growth yet little is known about other nutritional outcomes in preterm very low birth-weight (VLBW) infants. This is important because providing optimal nutrition is essential to promote growth and reduce neurodevelopmental impairment.

Purpose: To determine the effect of sex on days to full enteral feedings and other nutritional outcomes.

Methods: This was a longitudinal 2-group cohort study using secondary analysis of existing data of 313 infants born ≤32 weeks gestation and weighing ≤1500 g. Information regarding nutritional outcomes was obtained from the infant's electronic medical records.

Results: While not statistically significant, male infants reached full feeds nearly 3 days later (18.1 vs 15.2; P = .89), required parenteral nutrition for nearly an additional 4 days (18.3 vs 14.1; P = .37), and had a central line for 3 days longer (19.6 vs 15.7; P = .65) than female infants. Males had higher direct bilirubin levels ( P = .02), more emesis ( P = .003), and more late-onset sepsis ( P = .03). Birth weight for males was higher at birth but not at 6 weeks and while the slope of weight increase over the 6 weeks was higher in males ( P = .04), growth velocity was similar between sexes yet tended to be higher in females.

Implications for practice and research: Nurses are essential in ensuring preterm infants in the neonatal intensive care unit receive optimal nutrition. This study supports nurses should consider sex-specific differences in nutritional outcomes among VLBW infants in precision based nutritional support.

Background: Little is known about the short- and long-term effects of prenatal opioid exposure on infant neurodevelopment. Infants with neonatal opioid withdrawal syndrome (NOWS) are often admitted to neonatal intensive care units (NICU) where the development of coregulation between mothers and infants is easily disrupted. Understanding early mother-infant coregulation is needed to guide intervention strategies for these high-risk mother-infant dyads.

Purpose: Explore the impact of prenatal opioid exposure on mother-infant coregulation, as an indicator of early infant neurodevelopment, in response to a standardized stress experiment, the Still Face Paradigm (SFP).

Methods: A prospective cohort design was used to enroll opioid-exposed (N = 11) and non-exposed (N = 13) mother-infant dyads, when infants discharged from the NICU were 6 to 9 months. Dyadic heart rate variability (HRV) data were used as a measure of coregulation and were recorded using heart rate monitors during the 3 phases of the SFP: (a) baseline, (b) still-face, or flat affect, and (c) reunion. We conducted analyses to determine differences within the HRV dyad profiles.

Results: HRV profiles differed between the 2 study groups. In the opioid-exposed group: (a) infants exhibited more irregular autonomic processes, (b) mothers had higher HRV baselines, and (c) there was an overall dysregulation between mothers and infants compared to the non-opioid exposed group.

Implications for practice and research: These differences may suggest that prenatal opioid exposure contributes to difficulty with dyadic co-regulation which may negatively impact early infant neurodevelopment. Additional research is needed to better understand the role of prenatal opioid exposure in infant neurodevelopment.

Background: Kangaroo mother care (KMC) is recognized as an effective intervention for promoting growth and neurodevelopment in preterm infants, particularly in resource-limited settings. It addresses critical neonatal care needs by facilitating skin-to-skin contact and breastfeeding.

Purpose: This meta-analysis evaluates the impact of KMC on growth parameters and neurobehavioral development in preterm infants, while considering evidence quality.

Data sources: Six databases were searched for studies published in English, covering studies up to the year 2024. Additionally, citation tracking was used to identify relevant studies.

Study selection: Out of 953 studies initially identified, 17 studies met the inclusion criteria and were reviewed for the meta-analysis.

Data extraction: Data were abstracted and assessed for quality and validity using standardized guidelines, applied independently by multiple observers.

Results: KMC significantly improved the weight, head circumference, and body length of preterm infants. Gestational age was found to influence outcomes: with increasing gestational age, head circumference growth slowed, while body length showed more rapid gains. KMC also demonstrated positive effects on neurodevelopmental and brain growth indicators.

Implications for practice and research: Clinically, nurses can support parents in initiating and maintaining kangaroo care, helping to enhance parental involvement during the NICU stay. While its benefits for health and neurodevelopment are well-established, further research is needed to explore its application at home. Higher-quality evidence is required to validate these findings and support broader clinical adoption in various healthcare settings.

Background: Finding an accurate and simple method of thermometry in the neonatal intensive care unit is important. The temporal artery thermometer (TAT) has been recommended for all ages by the manufacturer; however, there is insufficient evidence for the use of TAT in infants, especially to detect hypothermia.

Purpose: To assess the accuracy of the TAT in hypothermic neonates in comparison to a rectal thermometer.

Methods: This study was a naturalistic, quantitative, and observational study. Temporal artery temperatures (using Exergen TemporalScanner 5000) were compared to rectal temperatures in critically ill infants in the neonatal intensive care unit undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy. Temperatures were taken during a 72-hour cooling period at 33.5 °C and a 6-hour rewarming period to normothermia of 36.5 °C. Nineteen patients and 1280 temperature measurements were included in this study.

Results: During the cooling period, TAT and rectal temperatures had a weak correlation (r = 0.34, P < .001). The correlation during the rewarming period was much stronger (r = 0.70, P < .001), indicating less variability in measures, but not agreement. On average, regardless of period, the TAT temperatures read 0.43 °C (95% confidence interval, 0.37-0.49, P < .001) warmer than the rectal temperatures. The cooling or warming period had no effect on this difference between temperatures.

Implications for practice and research: This study found that temperatures obtained with a TAT are generally warmer than the accepted standard core rectal temperature in hypothermic neonates, and we do not recommend its use in critically ill neonates who require accurate temperature readings.

Background: Early life stress exposure in preterm infants may alter DNA methylation of NR3C1 and HSD11B2 , disrupting neurobehaviors needed for oral feeding (PO) skill development.

Purpose: To (1) examine the feasibility of the study protocol; (2) describe early life stress, DNA methylation of NR3C1 and HSD11B2 , and PO skill development; and (3) explore the association between DNA methylation of NR3C1 and HSD11B2 and infant characteristics, early life stress, and PO skill development.

Method: We employed a longitudinal descriptive pilot study (N = 10). Infant characteristics were collected from the infant's electronic medical record. Early life stress was assessed via the modified Neonatal Infant Stressor Scale. DNA methylation of NR3C1 exon 1F and HSD11B2 promoter regions was analyzed from the infant's buccal samples. PO skill development was evaluated using the Early Feeding Skills Assessment.

Results: Infants who experienced more acute and chronic stress during their neonatal intensive care unit hospitalization demonstrated higher DNA methylation at CpG 17 and 31 of the NR3C1 exon 1F and at CpG 4 and 28 of the HSD11B2 promoter regions. Infants with higher DNA methylation at these CpG sites also exhibited less optimal PO skill development and experienced longer transition from first to full PO.

Implications for practice and research: Our findings revealed relationships among early life stress, DNA methylation of NR3C1 and HSD11B2 , and PO skill development in preterm infants. Future research is warranted to examine the multiomics pathways whereby early life stress influences the phenotypes of infant outcomes.