UNASSIGNED: Mothers with preterm babies at the NICU are at a high risk of acquiring psychological distress as a result of unexpected and upsetting experiences. While there is a strong emphasis on the infant\'s health, the mother\'s well-being, particularly her mental health, is sometimes disregarded. A qualitative exploratory descriptive design was used to explore maternal social support and resilience in caring for preterm newborns at the NICU in Municipal hospital in Ghana from May to July 2022.
UNASSIGNED: A qualitative exploratory method was used, and a purposive sampling technique was used to select 15 postnatal women who had their preterm babies on admission to the NICU until data saturation. Data was analysed using thematic content analysis.
UNASSIGNED: The findings of the study showed that social support for their mothers as they care for their preterm infants contributed to their resilience. Three themes emerged from the analysis of the data: informational support, instrumental support and psychosocial support.
UNASSIGNED: There is a need for training in communication skills and counselling for healthcare professionals working in the NICU to be able to communicate effectively with mothers and also adopt a family-centered approach in the care of preterm infants. This will support mothers to strengthen their resilience when caring for their premature babies in the NICU. The role of instrumental support for mothers specifically financial and physical care support in building maternal resilience cannot be overemphasised.

UNASSIGNED: This study investigated the effects of hospitalization in the neonatal intensive care unit (NICU) due to congenital pneumonia (CP) on maternal stress and attachment, focusing on how the duration of invasive and noninvasive mechanical ventilation, length of NICU stay, and postpartum breastfeeding initiation time influence mother-infant attachment.
UNASSIGNED: Conducted among 30 mothers of 3-month-old infants admitted to the NICU with CP and a control group (n = 30), it analyzed the impact of medical intervention durations and breastfeeding initiation on maternal stress and attachment using statistical methods.
UNASSIGNED: The maternal stress in the NICU group was significantly higher than in the control group (P = .014). However, there was no significant difference between the groups in attachment scores (P = .141). The study revealed that longer invasive mechanical ventilation (P < .001) and NICU stay (P < .001) significantly increased maternal stress. Maternal stress (P < .001) and breastfeeding initiation time(P < .001) exhibit a negative correlation with attachment scores (P < .001).
UNASSIGNED: It is crucial to implement interventions aimed at reducing maternal stress and fostering maternal-infant attachment for mothers of newborns admitted to the NICU. The sustained application of these interventions post discharge holds significance for the mental health of mothers and mother-infant attachment.

OBJECTIVE: Vasopressin has systemic vasoconstrictive yet pulmonary vasodilatory effects, making it an ideal agent for hypotension management in infants with congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension. The side effects of vasopressin in this population, such as hyponatremia, are understudied. This study aims to characterize the effect of vasopressin on sodium concentrations in infants with and without CDH.
METHODS: This was a retrospective review of patients who received vasopressin while admitted to a level IV neonatal intensive care unit. The primary outcome was the incidence of hyponatremia (blood sodium <135 mmol/L) during vasopressin therapy. Secondary outcomes included time to hyponatremia, dose and duration of vasopressin, incidence of severe hyponatremia (blood sodium <125 mmol/L), and hypertonic saline use. Both blood serum and blood gas sample sodium concentrations were used to compare CDH vs non-CDH patients.
RESULTS: The average difference between baseline and lowest blood sodium was significant for both CDH and non-CDH patients for all samples (p < 0.001). There was no significant difference in the primary outcome, nor in the secondary outcomes of time to hyponatremia or duration of vasopressin infusion. The average dose of vasopressin was higher in the CDH vs non-CDH group (p = 0.018). The incidences of severe hyponatremia and hypertonic saline use were greater in the CDH vs non-CDH group for patients who had blood serum sodium samples collected (p = 0.049 and p = 0.033, respectively).
CONCLUSIONS: This study showed that severe hyponatremia occurred more frequently in CDH vs non-CDH patients. Extreme caution is necessary when managing total body sodium in patients with CDH.

OBJECTIVE: To investigate the knowledge level and clinical practice of neonatal intensive care unit nurses on the whole process of hypothermia prevention in preterm infants.
METHODS: A polycentric descriptive cross-sectional study was conducted in 23 hospitals in Shandong province involving 254 neonatal intensive care unit nurses.
METHODS: An evidence-based knowledge and clinical practice questionnaire on hypothermia prevention in preterm infants and a general information questionnaire were used to collect data. SPSS and EXCEL 24.0 database were used for data statistics and analysis.
RESULTS: Nearly one-third of nurses were unclear about the definition of mild hypothermia and heat preservation measures during labour management and resuscitation. Knowledge about the correct rate of amniotic fluid evaporation was low. The higher the hospital level and nurses\' education level, professional title, work experience, and position, the higher the knowledge level. The clinical practice of nurses differed in terms of body temperature assessment tools, measurement sites, and measurement frequency for premature infants.
CONCLUSIONS: Nurses in neonatal intensive care units need to apply evidence-based knowledge and carry out practice interventions to ensure preterm infants\' safe transition from the delivery room to the neonatal intensive care unit.
CONCLUSIONS: There have been few studies evaluating neonatal nurses\' knowledge and practices with regards to the preventing hypothermia of premature infants from delivery room to neonatal intensive care unit. The study identifies the deficiencies and problems in temperature management that can be attributed to the knowledge level of nurses. The findings will help improve the current curriculum, teaching strategies, and the nurses\' knowledge levels, preventing premature hypothermia in infants.
UNASSIGNED: This study adhered to the STROBE statement for observational studies and obtained approval (KYLL-2023LW045) from the ethics committee of The Second Hospital of Shandong University. The other 22 third- and second-level hospitals, as our alliance members, recognized our chairperson status within the alliance and were willing to join our academic activities. Mutual responsibility for ethical filing between alliance units.
UNASSIGNED: 254 nurses were recruited from 23 tertiary and secondary public hospitals in Shandong province. No public or patient involvement. Members of the research group used the Questionnaire Star platform to prepare the electronic questionnaire, including obtaining informed consent, taking precautions for questionnaire completion, and using the aforementioned measurement tools. The project research team contacted the head nurses of 23 neonatal intensive care units in Shandong Province. After obtaining consent from the head nurses, they were asked to send the requirements and link of the electronic questionnaire to their WeChat management group. The nurses go through each question and make a choice which has two options of \'agree\' or \'disagree.\' Based on their answers, nurses were evaluated as having \'mastered\' or \'not mastered\' each item. Each \'mastered\' item (correct answer) was given a score of 4; an item \'not mastered\' (incorrect answer) was given a score of 0. The total score ranged from 0 to 100.

BACKGROUND: Necrotizing enterocolitis is the most severe life-threatening acquired gastrointestinal disorder among preterm neonates. We describe here an outbreak of Clostridium butyricum-related necrotizing enterocolitis in preterm neonates that occurred in three different neonatal centres, in southeast France.
METHODS: We defined a confirmed case of C. butyricum-related necrotizing enterocolitis in preterm neonates by the presence of clinical signs according to modified Bell criteria and C. butyricum identified from stools sample using real-time polymerase chain reaction or culture. A phylogenetic analysis of the isolated strains by whole genome sequencing was also performed.
RESULTS: Between 5 and 27 January 2022, we identified ten confirmed cases of C. butyricum-related necrotizing enterocolitis, including five from neonatal centre 1, four from neonatal centre 2, and one from neonatal centre 3. The attack rate of necrotizing enterocolitis in neonatal centre 1 was 7.1% (5/70). The positivity rate of C. butyricum detected from stool samples was higher during the outbreak period (37/276; 13.4%) than outside this period (7/369; 1.9%), while systematic screening was maintained (P<0.001). Phylogenetic analysis showed a clonality between strains inside four clusters. Two clusters included neonates hospitalised in different neonatal centres, suggesting the transmission of C. butyricum strains during the transfer of neonates between neonatal centres.
CONCLUSIONS: This outbreak of C. butyricum-related necrotizing enterocolitis confirms a cross-transmission between preterm neonates, including twin or triplet siblings, and involving necrotizing enterocolitis cases together with asymptomatic carriers. After three months of follow-up, no further cases were identified following the implementation of contact precautions with sporicidal agents.

Objective: Rates of mother\'s own milk (MOM) provision in the neonatal intensive care unit (NICU) vary widely, despite acceptance as the gold standard for nutrition in preterm infants. Direct breastfeeding (DBF) supports long-term provision of MOM, but factors that support DBF in preterm infants are unknown. The purpose of this study was to identify factors that predict DBF at oral feeding initiation and at NICU discharge. Methods: This was a retrospective cohort study of preterm infants born at ≤ 32 weeks who were receiving MOM at 32 weeks corrected gestational age (cohort 1) and at discharge to home (cohort 2). The primary outcomes were rates of DBF at oral feeding initiation (cohort 1) and at hospital discharge (cohort 2). We examined bivariate associations between infant characteristics, maternal sociodemographic factors, and hospital practices (e.g., lactation visit timing and frequency) with DBF outcomes and then built logistic regression models to determine the adjusted odds ratio and 95% confidence interval ([adjusted odds ratio [aOR] [95%CI]) for independent predictors of the DBF outcomes. Results: Sixty-four percent of eligible infants initiated DBF, and 51% were DBF at discharge. Sociodemographic, NICU, and lactation support factors were associated with both outcomes. Post hoc analysis showed that similar factors also influenced lactation support provision. Conclusions: Lactation support, NICU and sociodemographic variables influence DBF initiation and DBF at discharge. Interventions that optimize efficient use of available lactation support, address bias, and provide ample opportunity for DBF practice could improve rates.

UNASSIGNED: Neonatal acute kidney injury (nAKI) has been reported to be common among neonates admitted to the Neonatal Intensive Care Unit (NICU) and is associated with increased mortality and prolonged duration of hospital stay. However, data on this entity from sub-Saharan Africa are scanty.
UNASSIGNED: This study aimed to assess the burden, risk factors, and short-term outcomes of nAKI in neonates admitted to a low-resource NICU in Zambia.
UNASSIGNED: The design of the study is a prospective cohort study.
UNASSIGNED: The setting of this study was the NICU at the Women and Newborn Hospital of the University Teaching Hospitals (WNBH-UTHs).
UNASSIGNED: In total, 322 neonates who were admitted to the NICU between November 2021 and December 2022.
UNASSIGNED: A serum creatinine was determined on all patients at admission (within 24 hours), at 72 hours and day 7. The modified neonatal Kidney Disease: Improving Global Outcome (KDIGO) Criteria were used to define nAKI. Data were extracted using a predesigned form and analyzed using SPSS. A P-value less than .05 was considered statistically significant.
UNASSIGNED: The prevalence of nAKI was 13.7% (44/322). On multivariable regression analysis, antepartum hemorrhage (adjusted odds ratio [AOR] 5.58; 95% confidence interval [CI]: [1.62-19.13], P = .007), vomiting in the neonate (AOR 5.76; 95% CI: [1.10-30.32], P = .04), history of use of unit second-line antibiotics, meropenem (AOR 4.37; 95% CI: [1.97-9.69], P < .001), and ciprofloxacin (AOR 4.53; 95% CI: [1.22-16.84], P = .02) were associated with increased risk of nAKI. Acute kidney injury (AKI) was significantly associated with longer length of hospital stay and higher mortality (P < .05).
UNASSIGNED: The study did not use the urine output criteria to define nAKI and this may have led to an underestimation of nAKI prevalence. Additionally, kidney, ureter, and bladder ultrasound was not performed on any of the study participants.
UNASSIGNED: AKI is common in neonates admitted to the NICU at WNBH-UTHs, and it is associated with a higher risk of mortality and prolonged length of hospital stay. Further studies among the various NICU sub-populations are needed to better characterize risks and outcomes.
UNASSIGNED: L’insuffisance rénale aiguë néonatale (IRAn) est fréquente chez les nouveau-nés admis aux unités de soins intensifs néonataux (USIN). L’IRAn est associée à une mortalité accrue et à un séjour prolongé à l’hôpital. Cependant, les données sur l’IRAn en Afrique subsaharienne sont rares.
UNASSIGNED: Évaluer les résultats à court terme de l’IRAn, de même que les facteurs de risque et le fardeau posé par la maladie, chez les nouveau-nés admis dans une unité de soins intensifs néonataux à faibles ressources de la Zambie.
UNASSIGNED: Étude de cohorte prospective.
UNASSIGNED: L\'unité de soins intensifs néonataux du Women and Newborn Hospital of the University Teaching Hospitals (WNBH-UTHs).
UNASSIGNED: Trois cent vingt-deux (322) nouveau-nés admis à l’USIN entre novembre 2021 et décembre 2022.
UNASSIGNED: Une mesure de la créatinine sérique a été réalisée chez tous les patients à leur admission (dans les 24 heures), à 72 heures et au septième jour. Les critères d’une version modifiée pour l’insuffisance rénale néonatale du KDIGO (modified neonatal kidney Disease: Improving Global Outcome) ont été utilisés pour définir l’IRAn. Les données ont été extraites à l’aide d’un formulaire préconçu et analysées à l’aide du SPSS. Une valeur P < 0,05 a été considérée comme statistiquement significative.
UNASSIGNED: La prévalence de l’IRAn était de 13,7 % (44/322). Selon l’analyze de régression multivariée, l’hémorragie antepartum (rapport de cote corrigé [RCC]: 5,58; IC 95 % [intervalle de confiance]: [1,62–19,13]; P = 0,007), les vomissements chez le nouveau-né [RCC: 5,76; IC 95 %: [1,10 – 30,32]; P = 0,04) et les antécédents d\'utilization de méropénème, un antibiotique de deuxième ligne, (RCC: 4,37; IC à 95 %: [1,97 – 9,69]; P < 0,001) et de ciprofloxacine (RCC: 4,53; IC 95 %: [1,22 – 16,84]; P = 0,02) étaient associées à un risque accru d’IRAn; laquelle a été associée de façon significative à un séjour prolongé à l’hôpital et à une mortalité plus élevée (P < 0,05).
UNASSIGNED: L’étude n’a pas utilisé la diurèse comme critère pour définir l’IRAn et cela pourrait avoir conduit à une sous-estimation de la prévalence. Aucun participant à l’étude n’avait subi d’échographie des reins, des uretères et de la vessie.
UNASSIGNED: L’IRA est fréquente chez les nouveau-nés admis à l’USIN du WNBH-UTHs et elle a été associée à un séjour prolongé à l’hôpital ainsi qu’à un risque accru de mortalité. D’autres études avec différentes sous-populations de patients des USIN sont nécessaires afin de mieux caractériser les facteurs de risque et les résultats.

Background and Objective: The benefits of physical rehabilitation for very-low-birth-weight infants (VLBWI) have been reported in previous studies; however, the implementation rate of physical rehabilitation in this population remains to be clarified. This study aimed to examine the implementation rate of physical rehabilitation among VLBWI admitted to the neonatal intensive care unit (NICU) using real-world data. Material and Methods: This observational study obtained data from a nationwide administrative database associated with the diagnostic procedure combination (DPC) system in Japan (2014-2019). The participants were 30,464 infants admitted to the NICU between 2014 and 2019. The overall NICU physical rehabilitation rates and background factors of the participants were examined. Results: The overall physical rehabilitation rate in NICUs was 18%. Infants born at <28 weeks of age and extremely low birth weight infants (ELBWI) were more likely to receive physical rehabilitation interventions. The length of stay at the NICU and hospital, as well as the rate of discharge, were higher in patients who received physical rehabilitation than those in infants who did not. Conclusions: One-fifth of all patients admitted to the NICU received physical rehabilitation interventions. Extremely preterm infants and ELBWI were more likely to receive physical rehabilitation interventions. We need to consider ways to increase physical rehabilitation intervention rates in the NICU.

BACKGROUND: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs).
OBJECTIVE: We aimed to identify the usage extent and clinical application of nHFOV in Romania.
METHODS: A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU\'s size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0.
RESULTS: A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10-17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%); heated, humidified high-flow nasal cannula (HHHFNC) (61.9%); and nHFOV (11/21 units; 52.4%). A total of 5/11 units reported frequent nHFOV use (in two or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). Face/nasal masks and short binasal prongs are the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV. Only three of the NICUs had a written protocol for nHFOV use. Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode.
CONCLUSIONS: Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV.

Central nervous system infections are among the most severe infectious conditions in the neonatal period and are still burdened by significant mortality, especially in preterm infants and those with a low birth weight or other comorbidities. In this study, we examined the role of fosfomycin-containing antibiotic regimens in neonates with central nervous system infections. We included six neonates over a period of five years: four with meningitis and two with cerebral abscesses. All patients underwent fosfomycin therapy after failing first-line antibiotic regimens. Of the six neonates, two died; two developed neurological and psychomotor deficits and two recovered uneventfully. None of the neonates experienced adverse reactions to fosfomycin, confirming the safety of the molecule in this population. In conclusion, the deep penetration in the central nervous system, the unique mechanism of action, the synergy with other antibiotic therapies, and the excellent safety profile all make fosfomycin an attractive drug for the treatment of neonatal central nervous system infections.