Experience in endoscope choice for neuroendoscopic lavage for intraventricular hemorrhage of prematurity: a systematic review.

OBJECTIVE: Intraventricular hemorrhage (IVH) of prematurity occurs in 20-38% of infants born < 28 weeks gestational age and 15% of infants born in 28-32 weeks gestational age. Treatment has evolved from conservative management and CSF diversion of temporizing and shunting procedures to include strategies aimed at primarily clearing intraventricular blood products. Neuroendoscopic lavage (NEL) aims to decrease the intraventricular blood burden under the same anesthetic as temporizing CSF diversion measures in cases of hydrocephalus from IVH of prematurity. Given the variety of neuroendoscopes, we sought to review the literature and practical considerations to help guide neuroendoscope selection when planning NEL. METHODS: We conducted a systematic review of the literature on neuroendoscopic lavage in IVH of prematurity to examine data on the choice of neuroendoscope and outcomes regarding shunt rate. We then collected manufacturer data on neuroendoscopic devices, including inflow and outflow mechanisms, working channel specifications, and tools compatible with the working channel. We paired this information with the advantages and disadvantages reported in the literature and observations from the experiences of pediatric neurosurgeons from several institutions to provide a pragmatic evaluation of international clinical experience with each neuroendoscope in NEL. RESULTS: Eight studies were identified; four neuroendoscopes have been used for NEL as reported in the literature. These include the Karl Storz Flexible Neuroendoscope, LOTTA® system, GAAB system, and Aesculap MINOP® system. The LOTTA® and MINOP® systems were similar in setup and instrument options. Positive neuroendoscope features for NEL include increased degrees of visualization, better visualization with the evolution of light and camera sources, the ability to sterilize with autoclave processes, balanced inflow and outflow mechanisms via separate channels, and a working channel. Neuroendoscope disadvantages for NEL may include special sterilization requirements, large outer diameter, and limitations in working channels. CONCLUSIONS: A neuroendoscope integrating continuous irrigation, characterized by measured inflow and outflow via separate channels and multiple associated instruments, appears to be the most commonly used technology in the literature. As neuroendoscopes evolve, maximizing clear visualization, adequate inflow, measured outflow, and large enough working channels for paired instrumentation while minimizing the footprint of the outer diameter will be most advantageous when applied for NEL in premature infants.

Updates in Neonatal Extracorporeal Membrane Oxygenation and the Artificial Placenta.

Extracorporeal life support, initially performed in neonates, is now commonly used for both pediatric and adult patients requiring pulmonary and/or cardiac support. Data suggests the clinical feasibility of Extracorporeal Membrane Oxygenation for premature infants (29-33 weeks estimated gestational age [EGA]). For extremely premature infants less than 28 weeks EGA, an artificial placenta has been developed to recreate the fetal environment. This approach is investigational but clinical translation is promising. In this article, we discuss the current state and advances in neonatal and "preemie Extracorporeal Membrane Oxygenation" and the development of an artificial placenta and its potential use in extremely premature infants.

An economic analysis of the cost of survival of micro preemies: A systematic review.

OBJECTIVE: This study aimed to systematically review the current literature on the economic costs of micro preemie as well as evidence on the cost-effectiveness of interventions to improve outcomes for micro preemie babies with a birth weight of ≤500 g. METHOD: We searched MEDLINE, CINAHL, Scopus, ECONLIT, Business Source Premier and Cochrane Library for studies reporting costs of micro preemie from January 2000. Costs were inflated to 2019 United States dollars (US$). All full-text articles were assessed for eligibility and a quality assessment of included articles was conducted using the Drummond and the Larg and Moss checklists. RESULTS: The search identified three studies that met the inclusion criteria; two cost-of-illness studies and one cost-effectiveness study. Across studies, the mean healthcare spending per micro preemie survivor (in 2019 US$) ranged from US$61,310 (birth admission) to US$263,958 (inpatient and outpatient for the first six months of life). One modelling study reported exclusive human milk diet for micro preemies at birth was more cost-effective compared to the standard approach with cow milk diet from the third-party payer and societal perspectives. CONCLUSION: Despite significant advances in perinatal care and expanded access to life-saving equipment to improve survival outcomes of micro preemie, there remains a paucity of research on economic costs associated with these babies. No study has utilised quality-adjusted life-years as an outcome measure. Given the chronic conditions and long-term neurologic disability associated with micro preemie survivors, an estimate of the lifetime cost to the individual, healthcare providers and society would provide a benchmark of the potential cost-savings that could accrue from cost-effective interventions to improve the survival rate of micro preemies.

Racism in the NICU: It Exists and It Needs to Stop.

NICUs around the United States seem like cloistered environments where only the best of professional intentions are exhibited. Yet implicit bias is real and it does exist in NICUs. In interviewing 3-time preemie mom Ashley Randolph, we dive in with great honesty about the fact that racism is lurking in ways that are not always as overt. We need to do better.

A NICU's Best Friend for the Holidays: Silvie Bells.

Families in the NICU during the holiday season are confronted with an even tougher isolation than normal. The group Silvie Bells has set out to provide much-needed smiles during that time in the form of very generous care packages and support.

The Other Side of the Incubator: A Preemie Turns 40 Years Old.

Deb Discenza interviews Geoff, a preemie born almost 40 years ago, and gets unique insight into his birth, his NICU stay, and life afterward.

The Top Ten Things Parents Want to Hear From You in the NICU.

Connecting with a family is a huge challenge for nurses as they are more focused on the technical aspects of caring for the premature infant in the NICU. In this column, the top ten things parents want to hear from nurses in a variety of scenarios help to provide insight into the patient family mind-set and how to best work with them.

Real Awareness in the NICU and Through the Lifespan.

Awareness of prematurity goes well beyond the birth and the NICU stay. It is a life span matter, one that the neonatal field needs to re-think in terms of helping better the outcomes in babies. Deb Discenza tells the all-too-real scenario of her daughter's fate and how that is driving her passion of advocating for preemies and their families to a whole new level.

Vínculo afectivo materno-infantil: método canguro / Maternal-infant affective bond: kangaroo method

El Método Canguro se define como la atención a los bebés prematuros, manteniéndolos en contacto piel a piel con su madre/padre. El contacto estrecho entre la madre y su bebé recién nacido (RN) es la norma biológica de la especie humana. El objetivo de este trabajo es reflejar el conocimiento científico sobre la práctica del Método Canguro y a partir de este conocimiento elaborar un plan de cuidados enfocado en ello; para ello, se ha realizado una revisión bibliográfica de documentos del estado actual de la producción científica enfermera en la práctica del Método Canguro. Dicha revisión, se ha basado en la búsqueda en las siguientes bases de datos: Cuiden, Pubmed, Cochrane Plus, Liliacs y Medline. Más de dos décadas de aplicación e investigación han dejado claro que el método madre canguro constituye algo más que una alternativa a los cuidados en incubadora. Los claros beneficios para los bebés del método canguro, dieron paso a los beneficios para cualquier bebé. Es importante aportar toda la información sanitaria sobre el método canguro, dar a conocer a los padres todos los beneficios que aporta a su hijo, para ello la educación sanitaria en este campo es fundamental. Las conclusiones a las que se llega tras la lectura de todos los artículos es que el método canguro, se trata de un método eficaz y fácil de aplicar que fomenta la salud y el bienestar tanto, de los recién nacidos prematuros como de los nacidos a término; además, el personal de enfermería desempeña un papel importante en su educación sanitaria para implicar a los padres, eliminando las barreras y fomentando la aplicación de esta técnica.

Kangaroo care is defined as care for premature babies, keeping skin to skin contact with their mother / father. The close contact between the mother and her newborn baby (RN) is the biological norm of the human species. The aim of this work is to reflect scientific knowledge on the practice of Kangaroo Method and from this knowledge develop a plan of care focused on it; for this, there has been a literature review documents the current state of nursing scientific production in practice the Kangaroo Method. Such review was based on the search in the following databases: Cuiden, Pubmed, Cochrane, and Medline Liliacs. More than two decades of implementation and research have made it clear that KMC is more than an alternative to incubator care. The clear benefits for babies Kangaroo method, gave way to the benefits for any baby. It is important to provide all health information on KMC, give all the benefits your child to the parents, for this health educcaión in this field is essential. The conclusions that can be reached after reading all the articles is that the kangaroo method is an effective and easy method of applying that promotes health and well-being both of preterm infants as those born at term; Additional nursing staff plays an important role in their health education to involve parents by removing barriers and encouraging the use of this technique.

Why NICU nurses mean so much to parents.

Parents of premature infants are grateful for their child's NICU nurse. Take a step onto the parent's side and see the top ten reasons parents are grateful for the nurses, and you might see some surprises.