The Stockholm Neonatal Family Centered Care Study: effects on length of stay and infant morbidity.

OBJECTIVE: Parental involvement in the care of preterm infants in NICUs is becoming increasingly common, but little is known about its effect on infants' length of hospital stay and infant morbidity. Our goal was to evaluate the effect of a new model of family care (FC) in a level 2 NICU, where parents could stay 24 hours/day from admission to discharge. METHODS: A randomized, controlled trial was conducted in 2 NICUs (both level 2), including a standard care (SC) ward and an FC ward, where parents could stay from infant admission to discharge. In total, 366 infants born before 37$$\raisebox{1ex}{$0$}\!\left/ \!\raisebox{-1ex}{$7$}\right.$$ weeks of gestation were randomly assigned to FC or SC on admission. The primary outcome was total length of hospital stay, and the secondary outcome was short-term infant morbidity. The analyses were adjusted for maternal ethnic background, gestational age, and hospital site. RESULTS: Total length of hospital stay was reduced by 5.3 days: from a mean of 32.8 days (95% confidence interval [CI]: 29.6-35.9) in SC to 27.4 days (95% CI: 23.2-31.7) in FC (P = .05). This difference was mainly related to the period of intensive care. No statistical differences were observed in infant morbidity, except for a reduced risk of moderate-to-severe bronchopulmonary dysplasia: 1.6% in the FC group compared with 6.0% in the SC group (adjusted odds ratio: 0.18 [95% CI: 0.04-0.8]). CONCLUSIONS: Providing facilities for parents to stay in the neonatal unit from admission to discharge may reduce the total length of stay for infants born prematurely. The reduced risk of moderate-to-severe bronchopulmonary dysplasia needs additional investigation.

Blood glucose testing at alternate sites in newborn infants.

AIM: To compare a method of testing at alternate skin sites (AST) with that of the usual heel-stick approach (SM) for determining blood glucose levels in newborn infants. Our other aims were to compare these methods as regards their accuracy, the pain caused by the procedures, the times taken to obtain a result and the possible delay in accurate test results using AST during rapid changes in blood glucose. METHODS: One hundred and eighty-six preterm and term infants were enrolled. The blood glucose levels were determined by a standard bedside method (SM, HemoCue) and AST (Freestyle), which permitted blood samples to be taken from the arm or leg. RESULTS: The levels of blood glucose ranged between 0.6 and 8.6 mmol/l. We found a significant correlation between SM and AST (r = 0.90, p < 0.001). The coefficient of variation was similar, pain was significantly less (median pain score 3.5 vs 7.5, p < 0.01) and the time taken to obtain a result significantly shorter (mean 35 vs 111 s, p < 0.01) with AST than with SM. No significant differences were found between these methods during rapid changes in the blood glucose levels. CONCLUSION: AST, a relatively simple and painless method of determining blood glucose levels in newborn infants, is acceptably accurate and causes minimal blood loss.

[Successful breast feeding after neonatal intensive care]. / Goda möjligheter till amning efter neonatalvård.

We have performed a follow-up study of breastfeeding in 1,696 infants (734 preterm) admitted for neonatal intensive care. Six months after discharge from hospital, 80% of term infants were breastfeeding, exclusively or in part. This does not differ from national statistics for all babies born in Sweden. The corresponding breastfeeding frequency among very preterm infants (gestational age < 30 w) was 47%. As maturity evolves and morbidity becomes subsidiary, breastfeeding can be successfully established in most preterm and previously sick neonates. This information provide reassuring support for their mothers.