Caregiver Presence and Involvement in a Canadian Neonatal Intensive Care Unit: An Observational Cohort Study.

BACKGROUND: Presence in the neonatal intensive care unit (NICU) is a vital step for caregivers initiating involvement, such as skin-to-skin contact, holding or singing/reading to their newborn. Little is known about caregiver presence and involvement in Canadian NICU's context by caregiver type (mother, father, other), and the association between maternal presence and key maternal and newborn characteristics. PURPOSE: The primary objective was to examine the presence and involvement of family caregivers in the NICU. The secondary objective was to examine the relationship between maternal presence and maternal and newborn characteristics. DESIGN AND METHODS: A prospective observational cohort study in an open bay setting of an Eastern Canadian NICU. Presence (physically present at the newborn's bedside) and involvement (e.g., skin-to-skin, singing/reading) were tracked daily by families in the NICU until discharge. Demographic information was also collected. RESULTS: Participants included 142 mothers and their newborns. Mothers were present 8.7 h/day, fathers were present 4.1 h/day, and other caregivers were present 1.8 h/day in the NICU in the first 34 days. Mothers were involved in care activities 50% of the time they were present in the NICU, whereas fathers and other caregivers were spending 20% and 6% of their time respectively. Regression identified maternal age, distance to home, parity, birthweight, and length of stay to be statistically significant variables related to maternal presence. CONCLUSIONS: There is variation in presence and involvement by caregiver type. Targeted interventions to maintain and increase mothers, fathers and other caregivers' presence and involvement in care throughout their stay in the NICU are recommended.

Surfactant use outside the tertiary care centre.

Early administration of surfactant to preterm babies with respiratory distress syndrome saves lives and decreases morbidity such as pneumothorax. Surfactant administration shortly after birth to intubated babies less than 30 weeks gestation decreases pulmonary air leak, chronic lung disease and mortality. Some preterm babies may be born in hospitals with a transport team hours away. Surfactant administration may cause transient bradycardia or hypoxemia and may rapidly improve lung function. As preterm babies born outside of tertiary care centres will benefit from early administration of surfactant, every peripheral hospital performing deliveries should develop a plan in association with physicians in referral hospitals to provide this potentially life saving therapy.

Severe congenital chylothorax treated with octreotide.

We report a neonate with severe congenital chylothorax. Subcutaneous octreotide was added to the standard treatment regime. The chylothorax resolved with no observed side effects.