A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions.

OBJECTIVE: Expectant parents who live through perinatal loss experience intense grief, which is not always acknowledged or accepted. A screening tool to detect bereaved parents' grief reactions can guide professionals, including perinatal palliative care teams, to provide follow-up for those in need. This review's goal is to identify and synthesize the international published literature on existent instruments specifically measuring the grieving process after any perinatal loss and to identify factors that could moderate grief reactions. METHOD: Systematic review (PROSPERO # CRD42018092555) with critical synthesis. PUBMED, Cochrane, and PsycINFO databases were searched in English language articles using the keywords "perinatal" AND ("grief" OR "bereavement" OR mourning) AND ("scale" OR "questionnaire" OR "measure" OR "assessment") up to May 2018. Eligibility criteria included every study using a measure to assess perinatal grief after all kinds of perinatal losses, including validations and translations to other languages and interventions designed to alleviate grief symptoms. RESULTS: A total of 67 papers met inclusion criteria. Seven instruments measuring perinatal grief published between 1984 and 2002 are described. The Perinatal Grief Scale (PGS) was used in 53 of the selected studies. Of those, 39 analyzed factors associated with grief reactions. Six articles used PGS scores to evaluate pre- and post-bereavement interventions. Studies in English language only might have limited the number of articles. SIGNIFICANCE OF RESULTS: The PGS is the most used standardized measures to assess grief after perinatal loss. All parents living through any kind of perinatal loss should be screened.

Investigation of an outbreak of Enterobacter cloacae in a neonatal unit and review of the literature.

Enterobacter cloacae has emerged as an important pathogen in neonatal units, with several outbreaks of infection being reported. The aim of this study was to investigate an outbreak of sepsis due to E. cloacae in a neonatal unit and to review the literature. A retrospective cohort study was conducted in which cases were compared with all newborns hospitalised for more than 48h in the neonatal intensive care unit (NICU). Cohorting of infected patients and work reorganisation were implemented. Pulsed-field gel electrophoresis was performed. The retrospective cohort included the six cases and 13 control patients that had been in the NICU during April 2006. Univariate analysis showed that the use of dobutamine was significantly associated with infection (P=0.036) and that enteral feeding was a protective factor (P=0.02). Multivariate analysis did not find any independent risk factor. Bed occupancy rate in March 2006 was 109.6%, indicating overcrowding. PFGE identified indistinguishable patterns among isolates from all six newborns. PubMed and OVID was search from 1 January 1983 to 15 January 2008 for papers including the terms 'E. cloacae', 'outbreaks', 'clusters' in combination with 'neonate', 'newborn', and 'infant'. We found 26 reports of outbreaks due to E. cloacae in neonate patients: sixteen (52%) were bloodstream infection outbreaks, of which two (12.5%) were related to multiple-dose medications. The source for our outbreak was not identified. Reinforcement of hygiene practices, restrictions on new admissions and the establishment of single-dose medications helped to control the outbreak.

Use of corticosteroids and the outcome of infants with bronchopulmonary dysplasia.

UNLABELLED: Ventilator-dependent premature infants are often treated with dexamethasone. Several trials showed that steroids while improve pulmonary compliance and facilitate extubation, some treated infants may have adverse effects, such as alterations of growth curves. We conducted this retrospective study to evaluate the effects of steroids on mechanical ventilation, oxygen therapy, hospital length stay and mortality, in ventilator-dependent infants with bronchopulmonary dysplasia (BPD) (defined as the need of oxygen supplementation at 28 days of life). Twenty-six newborns with BPD were evaluated during 9 - 42 days postpartum (mean = 31 days) and were divided into two groups: Group I - 14 newborns that did not receive dexamethasone, and Group II - 12 newborns that received dexamethasone at 14 - 21 days of life. Dexamethasone was given at a dose of 0.25 mg per kilogram of body weight twice daily intravenously for 3 days, after which the dose was tapered. RESULTS: There were no statistically significant differences in the mean length of mechanical ventilation (Group I - 37 days, Group II - 35 days); oxygen supplementation (Group I - 16 days, Group II - 29 days); hospital stay (Group I - 72 days, Group II - 113 days); mortality (Group I - 35.7%, Group II - 41.6%). At birth, Group II was lighter (BW: Group I - 1154 grams +/- 302, Group II - 791 grams +/- 165; p < 0.05) and smaller (height: Group I - 37.22 cm +/- 3.3, Group II - 33.5 +/- 2.4; p< 0.05) than Group I. At 40 weeks, there were no statistically significant differences between groups in relation to anthropometric measurements. CONCLUSIONS: The use of corticosteroids in bronchopulmonary dysplasic infants may influence the somatic growth during its use. However, after its suspension, a recovery seems to occur, suggesting that its influence could be transitory.