Increase in Oxytocin From Skin-to-Skin Contact Enhances Development of Parent-Infant Relationship.

OBJECTIVE: To examine changes that occur in infant and parent salivary oxytocin (OT) and salivary cortisol (SC) levels during skin-to-skin contact (SSC) and whether SSC alleviates parental stress and anxiety while also supporting mother-father-infant relationships. METHODS: This randomized crossover study was conducted in the neonatal intensive care unit (NICU) with a sample of 28 stable preterm infants and their parents. Saliva samples were collected from infants, mothers, and fathers on Days 1 and 2 (1/parent) for OT and cortisol measurement pre-SSC, during a 60-min SSC session, and a 45-min post-SSC. Parental anxiety was measured at the same time points. Parent-infant interaction was examined prior to discharge on Day 3 via video for synchrony and responsiveness using Dyadic Mutuality Coding. RESULTS: Salivary OT levels increased significantly during SSC for mothers ( p < .001), fathers ( p < .002), and infants ( p < .002). Infant SC levels decreased significantly ( p < .001) during SSC as compared to before and after SSC. Parent anxiety scores were significantly related to parent OT and SC levels. Parents with higher OT levels exhibited more synchrony and responsiveness ( p < .001) in their infant interactions. CONCLUSION: This study addresses a gap in understanding the mechanisms linking parent-infant contact to biobehavioral responses. SSC activated OT release and decreased infant SC levels. Facilitation of SSC may be an effective intervention to reduce parent and infant stress in the NICU. Findings advance the exploration of OT as a potential moderator for improving responsiveness and synchrony in parent-infant interactions.

Case Report of Haemophilus parainfluenzae Sepsis in a Newborn Infant Following Water Birth and a Review of Literature.

Water birth has grown in popularity over the recent years. Although beneficial for mothers, there are concerns for the infants. There are previous reports of infection following water birth. The information regarding infection with Haemophilus parainfluenzae is limited. We report a case of a neonate with H. parainfluenzae bacteremia following water birth. The child was successfully treated with both antibiotic and supportive care. Previous reports of neonatal H. parainfluenzae infection are reviewed.

Neonatal/infant validation study of the CAS model 740 noninvasive blood pressure monitor with the Orion/MaxIQ NIBP module.

OBJECTIVE: Blood pressure monitoring is an essential vital sign when caring for critically ill children. Invasive monitoring is considered the gold standard, but is not always feasible. The following study compared the CAS model 740 noninvasive blood pressure monitor with the Orion/MaxIQ NIBP module with the reference (invasive arterial measurement). We evaluated the validity of the system using the criteria provided by the Association for the Advancement of Medical Instrumentation. RESULTS: We performed paired measurements of 29 critically ill neonates and children. For individual paired comparisons, the mean difference in the systolic blood pressure was 2.42 mmHg (SD ± 6.3). The mean difference in the diastolic blood pressure was -1.29 mmHg (SD ± 5.45). The percentage of readings within 5, 10, and 15 mmHg for systolic blood pressure was 65.6, 86.0, and 96.8%, respectively. The percentage of readings within 5, 10, and 15 mmHg for diastolic blood pressure was 77.7, 93, and 95.5%, respectively. CONCLUSION: The CAS model 740 noninvasive blood pressure monitor with the Orion/MaxIQ NIBP module fulfills the accuracy performance criteria of the Association for the Advancement of Medical Instrumentation. This model may allow for rapid and accurate noninvasive blood pressure monitoring in neonates and children.

A computerized system to diagnose and treat neonatal apnea using vibrotactile stimulation.

AIM: To develop an appropriate apparatus for monitoring physiological signals and offering noninvasive automated mechanical stimulations for interrupting apneic events in neonates. RATIONALE: Vibrotactile stimulation (VTS) maybe an effective, safer alternative to nursing hand stimulation in treating neonatal apnea. We therefore developed a new diagnostic and therapeutic instrument. METHODS: The main components of the system are a computer running Windows XP using an AMD Athlon TM 64 processor, a neonatal physiological monitor (Model 511; CAS Medical Inc. in Branford, CT), a connector board, cable and data acquisition card (DAQ6602E), an amplifier, external lights, a tacaid vibrotactile stimulator (Audiological Engineering, Somerville, MA and a software application Labview 7.1, National Semiconductor Corporation). The device is a proof of concept at this point and has not undergone testing on neonatal patients. We have tested its ability to identify apneic events and appropriately administering vibrotactile stimulation on a 12-year-old boy with 10 simulated apnea events. RESULTS: Our device functioned 100% in (1) identification of "true apnea," (2) immediate VTS function, (3) accurate monitoring, and (4) safety. CONCLUSIONS: Our evaluation of this system demonstrates that under simulated conditions, pauses in breathing with associated decreased oxygen levels and heart rate are identified. This new medical device has potential to diagnose and treat neonatal apnea effectively and improve the quality of care.

Feasibility of an electronic stethoscope system for monitoring neonatal bowel sounds.

OBJECTIVE: Bowel dysfunction remains a major problem in neonates. Traditional auscultation of bowel sounds as a diagnostic aid in neonatal gastrointestinal complications is limited by skill and inability to document and reassess. Consequently, we built a unique prototype to investigate the feasibility of an electronic monitoring system for continuous assessment of bowel sounds. METHOD: We attained approval by the Institutional Review Boards for the investigational study to test our system. The system incorporated a prototype stethoscope head with a built-in microphone connected to a digital recorder. Recordings made over extended periods were evaluated for quality. We also considered the acoustic environment of the hospital, where the stethoscope was used. The stethoscope head was attached to the abdomen with a hydrogel patch designed especially for this purpose. We used the system to obtain recordings from eight healthy, full-term babies. A scoring system was used to determine loudness, clarity, and ease of recognition comparing it to the traditional stethoscope. The recording duration was initially two hours and was increased to a maximum of eight hours. RESULTS: Median duration of attachment was three hours (3.75, 2.68). Based on the scoring, the bowel sound recording was perceived to be as loud and clear in sound reproduction as a traditional stethoscope. We determined that room noise and other noises were significant forms of interference in the recordings, which at times prevented analysis. However, no sound quality drift was noted in the recordings and no patient discomfort was noted. Minimal erythema was observed over the fixation site which subsided within one hour. CONCLUSION: We demonstrated the long-term recording of infant bowel sounds. Our contributions included a prototype stethoscope head, which was affixed using a specially designed hydrogel adhesive patch. Such a recording can be reviewed and reassessed, which is new technology and an improvement over current practice. The use of this system should also, theoretically, reduce risk of infection. Based on our research we concluded that while automatic assessment of bowel sounds is feasible over an extended period, there will be times when analysis is not possible. One limitation is noise interference. Our larger goals include producing a meaningful vital sign to characterize bowel sounds that can be produced in real-time, as well as providing automatic control for patient feeding pumps.

Informed consent for procedures in the Neonatal Intensive Care Unit.

Establishing those procedures that require documentation of specific informed consent in a Neonatal Intensive Care Unit (NICU) setting remains controversial. Although documentation of specific informed consent for blood transfusions is universally mandated, consent for other procedures such as umbilical catheterizations may or may not be obtained and/or documented. In a retrospective study, medical charts of 116 neonates were reviewed to determine if consent for umbilicalvein and arterial catheterizations, blood transfusions, and procedures that require documentation of consent at Connecticut Children's Medical Center (CCMC), had been obtained. Consent for blood transfusions was obtained 98% (87/89) of the time compared with 34% (64/191) for umbilical vein and arterial catheterizations combined. Variables contributing to decreased consent rates for catheterizations were explored as were alternatives that would increase the consent rate. National Neonatal Intensive Care Unit consent policies from eight children's hospitals were reviewed to further evaluate current practice. Future research investigating expectations of families would be useful to create policy revisions.

Does a mother singing to her premature baby affect feeding in the neonatal intensive care unit?

Recent studies suggest that premature neonates exposed to music have reduced symptoms of stress, faster weight gain, and shorter neonatal intensive care unit (NICU) stays. This pilot study attempted to measure contingent effects of mothers' singing during feedings. Mothers sang to their babies during 2 of 4 feedings on 2 consecutive days, logging songs they sang, and subjectively evaluating each feeding. Infants' heart and respiration rates were recorded as well as duration of feeding and volume of fluid taken orally; feeding velocity and percent of feeding goal were calculated. In paired t tests, no significant benefits or deterrents assignable to the singing were observed.

Vibrotactile stimulation system to treat apnea of prematurity.

We modified a system that uses vibrotactile stimulation (VTS) to treat apnea (a cessation of respiration) in neonates in order to make the system more portable and easier to use by clinicians and nurses. The biomedical engineering department at Hartford Hospital (Hartford, CT) together with the Neonatology Division at the Connecticut Children's Medical Center (CCMC) (Hartford, CT) has been involved in developing the VTS system. Clinical trails were conducted in the neonatal intensive care unit of CCMC, and further preliminary data were collected. The main components of the system are a Tacaid vibrotactile stimulator (Audiological Engineering, Somerville, MA), a neonatal physiological monitor (Model 511; CAS Medical Inc, Branford, CT), a laptop computer running Windows 95 by Microsoft, National Instruments' data acquisition cards DAQCard-1200 and DAQCard-5102, and a software application developed by Premise Development Corporation, Hartford, CT. Heart rate, oxygen saturation, pulse, thoracic impedance, nasal airflow, and electrocardiogram are recorded from the monitor to the laptop. Whenever an apneic spell is detected, the nurse has the option of triggering a 3-second, 10-V, 250-Hz square-wave pulse to the transducer. The vibrotactile transducer is placed noninvasively with tape on the infant's thorax. This stimulus should arouse the infant and end the apneic event. To facilitate clinical study, the system provides voice and visual prompts for the clinician and nurses. Preliminary data continue to support both the safety and efficacy of the VTS.

Do newborn intensive care unit staff know the gender and first names of their patients?

We studied whether or not our personnel knew the gender and first names of their neonatal patients. A volunteer high-school student interviewed 18 NICU nurses without their awareness as to the true nature of the study. While asking open-ended questions, the interviewer would listen for the newborn to be correctly or incorrectly identified by gender and first name. Of the 42 newborns, incorrect gender identification was observed for six (14%) of them. The first name was unknown for 12 (29%) of the 42 infants. When combining both gender and name recognition 11 (61%) of the 18 nurses had an incorrect response for at least one of their patients. Initial day contact and infrequent parental visitations were identified as possible reasons for lack of gender and/or name awareness. Referring to neonatal patients by both their first and last names may be helpful in improving gender and name acknowledgement.

Prediction of outcome based on clinical seizure type in newborn infants.

OBJECTIVE: To determine whether the clinical features of neonatal seizures are of value in predicting outcome. STUDY DESIGN: Demographic features, clinical seizure types, etiologic factors, and laboratory findings of all 77 patients with seizures admitted to our neonatal intensive care unit over a consecutive 7-year period were extracted from the medical records. RESULTS: Twenty-three (30%) died; 59% of the survivors had abnormal neurologic examinations, 40% were mentally retarded, 43% had cerebral palsy, and 21% were epileptic at mean follow-up of 3.5 years. Compared with patients with other seizure types, those with subtle and generalized tonic seizures had a significantly higher prevalence of epilepsy (P =.04 and P =.01 respectively); mental retardation (P =.02; P =.007), and cerebral palsy (P =.03; P =.002). Subtle seizures were, in addition, more likely to be associated with abnormalities on the neurologic examination at follow-up (P =.03). Similar outcome comparisons for those with focal and multifocal clonic, focal tonic, and multifocal myoclonic seizures revealed no significant differences. However, patients with >or=2 seizure types were significantly more likely to have epilepsy (P =.02), mental retardation (P =.001), cerebral palsy (P =.001), and abnormal examinations (P =.05). CONCLUSIONS: Clinical semiology is predictive of outcome in neonates with seizures and suggests the presence of unique pathophysiologic processes for different seizure types.