Knowledge, Attitudes, and Practices Toward Retinopathy of Prematurity Among Neonatal Intensive Care Nurses: A Cross-sectional Study.

It is important to study the awareness of retinopathy of prematurity (ROP) among neonatal care nurses in hospitals. Unfortunately, there is a lack of studies conducted among nurses on this subject in Palestine. Thus, this study purposed to assess the knowledge, attitudes, and practices toward ROP among neonatal intensive care nurses in Palestine. A cross-sectional was used to conduct this study. A convenience sampling method was utilized to recruit 289 neonate intensive care nurses working in private and governmental hospitals. The findings showed that around 48.0% of the nurses had low knowledge about preventing ROP. Most of the nurses (78%) reported a neutral attitude toward preventing ROP. Moreover, overall nurses' practices regarding ROP were fair (57.1%). There was a difference in practices regarding ROP according to the health sector (P < .05), in which the private sector had better practices compared to the governmental sector. Additionally, there was a significant difference in knowledge regarding ROP according to educational level (P < .05). Also, a significant difference was found in knowledge and practices regarding ROP according to nurses' experience. Attitudes and practices were the main significant predictors of knowledge (B = 0.153, P < .05; B = 0.172, P < .05, respectively). Knowledge and practices were the main predictors of attitudes (B = 0.126, P < .05; B = 469, P < .001), respectively. Knowledge, attitudes, and experience in neonate intensive care nurses were the main significant predictors of practices (B = 0.135, P < .05; B = 0.449, P < .001; B = 0.224, P < .05, respectively). It is necessary to develop an educational program and competency-based training programs for neonate intensive care nurses about ROP and implement preventive strategies.

Impact of intermittent kangaroo mother care on weight gain of neonate in nicu: Randomized control trial.

OBJECTIVE: To measure the impact of intermittent kangaroo mother care on weight-gain of neonates in a neonatal intensive care unit. METHODS: The randomised controlled trial was conducted at the Department of Neonatology, the Children Hospital and the Institute of Child Health, Lahore, Pakistan, from March to October, 2018, and recruited newborns admitted to the neonatal intensive care unit. The subjects were randomised into case and control groups. Intermittent kangaroo mother care was given in the case group for seven days. Data was collected and analysed using SPSS 23. RESULTS: Of the 153 neonates, 140(91.5%) were included; 70(50%) in each group. The most common reason for admission was bronchopneumonia 49(35%). In the case group, average weight gain was 10.22±1.65 grams/kg/day compared to 7.87±1.71 in the control group (p=0.0001). The average length of stay in the case group was significantly low compared to the control group (p=0.003). Multivariate analysis determined the effect of kangaroo mother care therapy as effective (p<0.0001). CONCLUSIONS: Intermittent kangaroo mother care was found to be effective for improving weight-gain in neonates in addition to the conventional treatment.

Clinical Risk Index for Babies (CRIB II) Scoring System in Prediction of Mortality in Premature Babies.

BACKGROUND: Clinical Risk Index for Babies scoring system (CRIB II) score is a recently developed tool to predict initial risk of mortality amongst low birth weight babies, the utility of which is scarce in many developing countries. OBJECTIVE: To assess the efficiency of CRIB II score as a tool to predict the risk for neonatal mortality among the LBW babies admitted to neonatal intensive care unit (NICU) at a tertiary care facility Kasr El-Aini paediatric hospital, Cairo, Egypt. MATERIALS AND METHODS: Prospective cohort study design where 113 neonates, admitted during the first 24 hours to the NICU of Kasr El-Aini Hospital, from November 2013 till May 2014 were included. On admission, history taking, neonatal examination, arterial blood gas analysis and variables of CRIB II score were done. Subjects were followed up from admission till discharge or death. RESULTS: Male to female ratio was 1.1:1. Gestational age ranged from 25-32 weeks, the birth weight ranged from 700-1500 gm with mean of 1134.5 (± 202). CRIB II score ranged from 1-19 with a mean of 9.9 (± 4.0). The total mortality in the included cohort was 34.5% (31/113). Significant positive correlations were found between gestational age, birth weight, temperature, excess base, CRIB II score and the occurrence of mortality and with progressive increase in mortality with increasing CRIB II score (p=0.001). CRIB II score ≥ 11, gestational age ≤ 28 and birth weight ≤ 1100 were all found to be significantly associated with neonatal mortality. Area under ROC curve for CRIB II, gestational age and birth weight were found to be (0.968, 0.900 and 0.834) respectively. CRIB II score with cutoff point of ≥ 11 was the most sensitive (94.9%) with the predictive value (74.0%) and specificity (82.4%) compared to birth weight and gestational age. CRIB II score showed good calibration to predict neonatal mortality as demonstrated with Hosmer-lemeshow goodness of fit test (p= 0.952). CONCLUSION: CRIB II score is a valid tool of initial risk assessment in LBW, predicting outcome more accurately than birth weight or gestational age alone. It is easily applicable and should replace the traditional models as predictor of neonatal outcome.

Targeted monitoring of nosocomial infections in a neonatal intensive care unit / 现代临床护理

Objective To explore the incidence of nosocomial infection in a neonatal intensive care unit(NICU) so as to come out with scientific and effective measures for infection control. Method Real-time monitoring system was used for investigating nosocomial infection of ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central-line associated bloodstream infection (CLABSI) in NICU. Results Among 2 836 patients, 28 patients were infected, with the rate of 0.99%and the case-time infection rate of 1.09%. The nosocomial infection manifested to be blood infection with the rate of 35.48%, and 10%of main pathogens were gram-negative bacteria. Conclusions Targeted monitoring in NICU can make the nosocomial infection information acquired timely, objectively and accurately. The strict and intensified prevention and control program should be adopted to reduce the neonatal nosocomial infection.

[Chest ultrasonography in pediatric critical care practice]. / Apport de l'échographie pleuropulmonaire en pédiatrie.

An increasingly amount of evidence suggests that lung ultrasonography constitutes a relevant complementary diagnostic tool for adults patient in acute respiratory failure. A comprehensive and standardized ultrasonographic semiology has been described, relying on accurate and reproducible data directly obtained at patient's bedside. Therefore, pleural effusion, pneumothorax, pulmonary consolidation and interstitial lung disease can be diagnosed in a critical care environment with a similar level of performance than when reference diagnosis methods such as thoracic CT-scan are employed. Furthermore, lung ultrasonography seems to be able to contribute to an early therapeutic decision based on such online physiopathological data. Pioneers works in this field have suggested an attractive similarity between the ultrasonographic patterns described in adults and children. Nevertheless, the clinical usefulness of lung ultrasonographic approach in the pediatric critical care medicine still needs to be confirmed by specifically designed studies.

The prevalence and pathogenic bacteria and their antibiotic susceptibility of urinary tract infections in NICU / 中国小儿急救医学

Objective To study the constituent ratio and antimicrobial susceptibility patterns of pathogenic bacteria in patients with urinary tract infection (UTI) in NICU. Methods Data were collected retrospectively of neonates who admitted to NICU in St. Louis Children' s Hospital in Washington University School of Medicine between Jan 1 ,2005 and Dec 31,2006. Results The prevalence of UTI in NICU was 6. 5%. Gram-negative organisms were the most common agents of UTI in NICU,of which Ecoli ranked highest ,followed by Klebiella and Enterobacter cloacae. Of gram-positive organisms Enterococcus species and Coagulase-negative Staphylococci were the most common agents. Cefepime and gentamycin showed high activity against gram-negative organisms. Overall, non-E. coli microorganisms showed more resistances compared with Escherichia coli. The best susceptible antibiotics for gram-positive organisms were vancomycin and rifampin. Almost all gram-negative bacteria showed resistant to ampicillin and all of gram-positive bacteria resistant to penicillin and oxacillin. Conclusion Gram-negative organisms were the most common agents of UTI in NICU in this study. The drug resistance of bacteria is severe,especially to ampicillin and penicillin,which will be no longer the first choice clinically. So urine culture should be examined when initiating antibiotics treatment for UTI.

Pregnancy outcome of gestational diabetic mothers: experience in a tertiary center.

BACKGROUND: Carbohydrate intolerance is the most common metabolic complication of pregnancy. Gestational Diabetes Mellitus (GDM) poses numerous problems for both mother and fetus. The objectives of this study are to find out the incidence of gestational diabetes mellitus in pregnant women and their pregnancy outcomes. It was also to discover the risk factors for the admission of neonates to the Neonatal Intensive Care Unit (NICU). DESIGN AND PATIENTS: A hospital-based prospective study performed at King Khalid University hospital (KKUH), where 685 pregnant women who were diagnosed with gestational diabetes mellitus, out of 8000 pregnant women registered between January 2000 - December 2001, were followed and their outcomes studied. RESULTS: The incidence of gestational diabetes mellitus was found to be 8.6% (95% C.I: 8.1, 9.3). There were 511 (74.6%) spontaneous vertex deliveries, and 148 (21.6%) were delivered by lower segment cesarean section. Maternal morbidity in these women was 1.2%. A total of 697 babies were delivered by these 685 women, out of whom 675 were singleton pregnancies, 9 sets of twins and one set of quadruplets. Six-hundred-eighty-seven babies were born alive, 7 babies died in utero and 3 died in the neonatal period. The incidence of neonatal intensive care admission was 4.9%. The mean length of stay in the NICU was 16 days. The commonest cause of neonatal NICU admission was hyperbilirubinemia (41.2%). The risk factors for NICU admission were delivery by non SVD procedure (RR: 4.6, 95% C.I:2.8, 7.7), preterm deliveries, (RR: 4.6, 95% C.I.:2.7, 7.7), and induction of labor (RR: 2.5, 95% C.I: 1.4, 4.5). CONCLUSION: The observation and quantification of maternal outcomes with gestational diabetes mellitus are necessary, so that proper measures could be taken to reduce complications during delivery and the neonatal period and thereby, minimize particularly NICU admission rate.

Scores of SNAP and SNAP Variants Indices for Evaluation of Acute Severity in Newborn Infants

PURPOSE: The score for neonatal acute physiology (SNAP) based on physiologic derangements, is applied to variable fields including morbidity as well as mortality estimate. We evaluate the clinical usefulness of SNAP and SNAP variants for neonatal acute severity and mortality. METHODS: Twenty-one neonates were evaluated the SNAP, SNAP-PE, SNAP-II, and SNAPPE-II, who survived more than 24 hours in Neonatal Intensive Care Unit in Department of Pediatrics, Kyunghee University from July 2003 to December 2004. A study group included 21 neonates as death group and a control group matched for gestational age and birth weight. We analyzed the differences of clinical usefulness of SNAP and SNAP variants indices between the two groups. RESULTS: 1) SNAP:The scores were ranged 2-18 (median 6.5) in survival group and 9-31 (median 13.0) in death group. 2) SNAP-PE:The scores were ranged 2-48 (median 16.5) in survival group and 23-75 (median 32.0) in death group. 3) SNAP-II:The scores were ranged 0-16 (median 10.5) in survival group and 10-62 (median 21.0) in death group. 4) SNAPPE-II:The scores were ranged 0-45 (median 24.5) in survival group and 35-109 (median 44.0) in death group. The median values were higher in those who were died:SNAP<0.05 (P-value), SNAP-PE<0.01, SNAP-II<0.01, SNAPPE-II<0.01 showing the significant differences. CONCLUSION: The study shows that SNAP and SNAP variables are useful for the evaluation of acute severity and excellent predictors of neonatal survival. They would help the management of neonatal intensive care unit.