Placental Transfusion, Timing of Plastic Wrap or Bag Placement, and Preterm Neonates.

OBJECTIVE: Compare delivery room practices and outcomes of infants born at less than 32 weeks' gestation or less than 1,500 g who have plastic wrap/bag placement simultaneously during placental transfusion to those receiving plastic wrap/bag placement sequentially following placental transfusion. STUDY DESIGN: Retrospective analysis of data from a multisite quality improvement initiative to refine stabilization procedures pertaining to placental transfusion and thermoregulation using a plastic wrap/bag. Delivery room practices and outcome data in 590 total cases receiving placental transfusion were controlled for propensity score matching and hospital of birth. RESULTS: The simultaneous and sequential groups were similar in demographic and most outcome metrics. The simultaneous group had longer duration of delayed cord clamping compared with the sequential group (42.3 ± 14.8 vs. 34.1 ± 10.3 seconds, p < 0.001), and fewer number of times cord milking was performed (0.41 ± 1.26 vs. 0.86 ± 1.92 seconds, p < 0.001). The time to initiate respiratory support was also significantly shorter in the simultaneous group (97.2 ± 100.6 vs. 125.2 ± 177.6 seconds, p = 0.02). The combined outcome of death or necrotizing enterocolitis in the simultaneous group was more frequent than in the sequential group (15.3 vs. 9.3%, p = 0.038); all other outcomes measured were similar. CONCLUSION: Timing of plastic wrap/bag placement during placental transfusion did affect duration of delayed cord clamping, number of times cord milking was performed, and time to initiate respiratory support in the delivery room but did not alter birth hospital outcomes or respiratory care practices other than the combined outcome of death or necrotizing enterocolitis. KEY POINTS: · Plastic bag placement during placental transfusion is effective in stabilization of preterms.. · Plastic bag placement after placental transfusion is effective in stabilization of preterms.. · Plastic bag placement during placental transfusion and risk of death or necrotizing enterocolitis needs additional study..

Factors Associated With the Need for Pharmacological Management of Neonatal Opioid Withdrawal Syndrome.

BACKGROUND: Neonatal opioid withdrawal syndrome (NOWS) is a significant and growing health problem that affects more than 23,000 infants annually, with an estimated hospital cost of more than $720 million. PURPOSE: The purpose of this study was to examine factors associated with the need to initiate medication for the treatment of NOWS. METHODS: A retrospective review of medical records was conducted of 204 infants born to mothers who used opioids during pregnancy from April 2011 to September 2017. Associations between maternal, infant, and environmental factors and the need for neonatal pharmacological management were examined using χ, t tests, and regression analysis. RESULTS: Of 204 neonates exposed to opioids prenatally, 121 (59%) developed symptoms of NOWS, requiring treatment with morphine. Neonates requiring morphine had significantly higher gestational ages (37.7 weeks vs 36.4 weeks; P < .001), and mothers were present at the neonate's bedside for a lower proportion of their total hospital stay (57% vs 74% of days; P < .001). Maternal factors associated with the need for neonatal medication treatment included the mother's reason for opioid use (P = .014), primary type of opioid used (P < .001), tobacco use (P = .023), and use of benzodiazepines (P = .003). IMPLICATIONS FOR PRACTICE: This research provides information regarding the proportion of infants exposed to opioids prenatally who develop NOWS that requires treatment, as well as maternal, infant, and environmental factors associated with the need for neonatal medication use. IMPLICATIONS FOR RESEARCH: Future research is needed to examine these relationships prospectively in a larger and more diverse sample.

Energy expenditure in extremely low birth weight infants near time of hospital discharge.

OBJECTIVE: To test the hypothesis that total energy expenditure is significantly higher in extremely low birth weight (ELBW) infants compared with healthy term infants near the time of discharge. STUDY DESIGN: This study was designed to determine total energy expenditure and body composition in a group of ELBW infants nearing discharge receiving full-volume enteral feedings of fortified breast milk or postdischarge formula (Neosure) (n = 10; mean birth weight, 0.8 +/- 0.1 kg; mean gestational age, 26 +/- 0.8 weeks; mean age at study, 68 +/- 9 days; mean postconceptional age, 36 +/- 1 weeks) and compare them with healthy term newborns all receiving breast milk (n = 14; mean birth weight, 3.5 +/- 0.5 kg; mean gestational age, 39.0 +/- 1.4 weeks; mean age at study, 2.3 +/- 1 days). Body composition and total energy expenditure were measured using the doubly labeled water method over a 7-day period. RESULTS: Mean total energy expenditure was significantly higher in the ELBW infants compared with the term infants (89 +/- 22 kcal/kg/day vs 58 +/- 19 kcal/kg/day; P