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Advances in Neonatal Care
Journal Prestige (SJR): 0.438  Citation Impact (citeScore): 1 Number of Followers: 46  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1536-0903 - ISSN (Online) 1536-0911 Published by LWW Wolters Kluwer  [330 journals]
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- Optimizing Pain Relief for Neonates Through Evidence-Based Strategies
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Abstract:
No abstract available
PubDate: Wed, 26 Mar 2025 00:00:00 GMT-
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- Advances in Neonatal Care’s 25th Anniversary Celebration
Continues—A Look Back-
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No abstract available
PubDate: Wed, 26 Mar 2025 00:00:00 GMT-
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- Evidenced-Based Recommendation for Involving Mothers to Reduce the
Procedural Pain and Stress in High-Risk Neonates: A Systematic Review and
Meta-Analysis of Randomized Controlled Trials-
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Authors: Siva; N.; Praharaj, Manisha; Tanay, Kshirabdhi; Das, Sasmita; Nayak, Baby S.; Lewis, Leslie Edward S.; Noronha, Judith A.
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Background: Neonates admitted to the neonatal intensive care unit (NICU) undergo several painful procedures, causing significant stress. Maternal involvement in neonatal care significantly reduces pain and stress, thereby supporting better neurodevelopment in neonates.Clinical Question: How do maternal involvement strategies reduce neonatal pain and pain-related stress in the NICU'Data Sources: A systematic search was conducted on CENTRAL, PubMed Medline, EMBASE, CINAHL, Scopus, Web of Science, ProQuest databases, and Google Scholar for studies published between January 2007 and March 2024.Study Selection: A search across 7 databases yielded a total of 1360 studies, which were exported to Rayyan software for screening. Two independent authors conducted the screening based on the eligibility criteria.Data Extraction: Cochrane data collection forms were used to extract the data from the included studies.Results: Out of 1360 titles identified during the initial search, a total of 27 randomized controlled trials were eligible and were included. Although there is a slight inconsistency in results, meta-analysis findings revealed that skin-to-skin care, holding, massage, feeding the baby, and maternal voice stimulation, significantly reduce procedural pain and pain-related stress, in neonates admitted to the NICU.Implications for Practice and Research: Given the consistent results, this systematic review strongly supports NICU healthcare professionals in encouraging mothers to engage in neonatal care activities to reduce procedural pain and related stress. More research is needed, including navigating the mothers on the importance of their involvement in neonatal care throughout the NICU admission and after hospital discharge.
PubDate: Wed, 26 Mar 2025 00:00:00 GMT-
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- Evidenced-Based Recommendation for Involving Mothers to Reduce the
Procedural Pain and Stress in High-Risk Neonates-
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Abstract: No abstract available
PubDate: Wed, 26 Mar 2025 00:00:00 GMT-
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- Impact of a Sedation Reduction Protocol in Infants Undergoing MRI Scanning
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Authors: Bruckman; Heather; Blazier, Laura A.; Wing, Sarah E.; Boyle, Frances A.; Radhakrishnan, Rupa; Stefanescu, Beatrice M.
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Background: Brain magnetic resonance imaging (MRI) is an important diagnostic tool for infants with possible brain abnormalities. While sedation may be necessary for high quality images, it carries risks of complications. The sedation rate for MRI procedure varies widely, ranging from 0% to 100%, influenced by infant characteristics and institutional practices, with an increasing focus on non-sedated or minimally sedated approaches to reduce risks.Purpose: We studied sedation utilization in infants undergoing MRI scanning before and after implementing an MRI bundle.Methods: This cohort study utilized a pre- post-intervention design. An MRI bundle, including a process map, a safety checklist and a questionnaire collecting detailed information on sedation, were developed for our off-unit MRI suite. Pre-intervention group included infants scanned March 2018 to February 2019, and Post-intervention group March 2019 to February 2022. We hypothesized that sedation rates would significantly decrease following the intervention.Results: In the study, 229 infants in the Pre-Intervention group and 764 infants in the Post-Intervention group underwent MRI scanning. Sedation use decreased by 62%, from 29% pre-intervention to 18% post-intervention (P = 0.0003). Post-intervention infants were 47.6% less likely to be sedated, adjusting for gestation-corrected age (OR 0.524 [0.369, 0.745]; P
PubDate: Fri, 21 Mar 2025 00:00:00 GMT-
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- Meta-analysis of the Impact of Kangaroo Care on Physical Growth and
Neurobehavioral Development in Premature Infants-
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Authors: Han; Zimin; Li, Xiaoxiao; Hu, Fangfang; Yang, Jifeng
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Background: Kangaroo mother care (KMC) is recognized as an effective intervention for promoting growth and neurodevelopment in preterm infants, particularly in resource-limited settings. It addresses critical neonatal care needs by facilitating skin-to-skin contact and breastfeeding.Purpose: This meta-analysis evaluates the impact of KMC on growth parameters and neurobehavioral development in preterm infants, while considering evidence quality.Data Sources: Six databases were searched for studies published in English, covering studies up to the year 2024. Additionally, citation tracking was used to identify relevant studies.Study Selection: Out of 953 studies initially identified, 17 studies met the inclusion criteria and were reviewed for the meta-analysis.Data Extraction: Data were abstracted and assessed for quality and validity using standardized guidelines, applied independently by multiple observers.Results: KMC significantly improved the weight, head circumference, and body length of preterm infants. Gestational age was found to influence outcomes: with increasing gestational age, head circumference growth slowed, while body length showed more rapid gains. KMC also demonstrated positive effects on neurodevelopmental and brain growth indicators.Implications for Practice and Research: Clinically, nurses can support parents in initiating and maintaining kangaroo care, helping to enhance parental involvement during the NICU stay. While its benefits for health and neurodevelopment are well-established, further research is needed to explore its application at home. Higher-quality evidence is required to validate these findings and support broader clinical adoption in various healthcare settings.
PubDate: Mon, 17 Mar 2025 00:00:00 GMT-
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- Relationships Between NICU Infant Stressors and Childhood Behavior and
Development-
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Authors: D’Agata; Amy L.; Miller, Jennifer S.; Yoo, Ji Youn; Springer, Cary M.; Groer, Maureen W.
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Background: Preterm infants face many stressful experiences in the neonatal intensive care unit (NICU). Critical aspects of brain growth and development may be affected by stressor exposure. Longer term neurodevelopmental effects may result.Purpose: The aims were to examine relationships between NICU stressor scores and childhood behavior and neurodevelopment at 4 years of age in a cohort of preterm infants.Methods: We measured daily stress events with the Neonatal Infant Stress Scale (NISS) in 83 preterm infants over the first 6 weeks of life. Twenty-five of these children were followed up at 4 years of age the Child Behavior Checklist (CBCL) and the Battelle Developmental Index-Screening Test (BDI-2 ST).Results: The cumulative NISS score was significantly correlated with both childhood scales in unadjusted models, but the CBCL and BDI-2 ST were not correlated with each other, suggesting they measured different constructs. Gestational age (GA) and time until full enteral feeding were the only consistent infant variables significantly associated with the CBCL scales and were selected as covariates in the regression models. Only the Score for Neonatal Physiology with Perinatal Extension (SNAPPE-II) was significantly associated with the BDI-2 ST personal-social, motor, communication, and total scales and was selected as the covariate in the regression models. Hierarchical regressions on CBCL internalizing, externalizing, and total behavior scores and BDI-2 ST scales showed relationships between the NISS and both scales, but other factors influenced these relationships, including GA, SNAPPE-II, and length of time to enteral feeding.Implications for Practice and Research: The amount and nature of neonatal stress may have impacts on neurodevelopment at 4 years of age. Limitations were the small sample size. Further larger studies of neonatal stress and neurodevelopment are warranted. Practice implications would be to ensure efforts to reduce unnecessary stress during the NICU stay and to provide developmental support as these children grow.
PubDate: Fri, 14 Mar 2025 00:00:00 GMT-
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- Kangaroo Care in the Neonatal Intensive Care Unit—A Practice Change
Initiative-
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Authors: Beaumont; Lane; Mullaney, Dorothy; Eklund, Wakako; DeGrazia, Michele
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Background: Kangaroo care (KC) is essential for both the infant’s health and the mother’s well-being.Purpose: The purpose of this quality improvement (QI) project is to implement a practice change that aligns the neonatal intensive care unit’s (NICU) KC policy with the most recent World Health Organization guidelines, potentially improving the outcomes of preterm and very low birth-weight infants. The aims were to revise the unit’s current KC policy, create a pamphlet for parent distribution regarding KC awareness, and increase the number of KC sessions by 20% and the duration in minutes of KC sessions by 50% for eligible infant–mother dyads following implementation of the updated policy.Methods: A framework developed and published by Guenther et al guided intervention readiness and delivery action sequence in this project. The assessment was made through successful workgroup participation consisting of 5 direct care registered nurses and the project leader. Pre-/post-practice change improvement interventions were assessed by comparing KC-eligible daily census, if KC was performed, and the average duration of individual KC sessions in minutes.Results: After the implementation of an updated policy and distribution of a newly created KC parent pamphlet, there was a 58.1% increase in the number of KC sessions offered and a 140% increase in duration.Implications for Practice & Research: Expanding the role of KC in the NICU may decrease an infant’s NICU-associated morbidities, thereby decreasing healthcare costs. This project’s findings may serve as a model for other units to expand their KC practices.
PubDate: Fri, 14 Mar 2025 00:00:00 GMT-
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- Healthcare Utilization and Costs Among Commercially Insured Infants With
and Without Medically Complex Conditions-
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Authors: Vance; Ashlee J.; Henderson, James; Yin, Zhe; Costa, Deena K.; Meghea, Cristian
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Background: Little is known about healthcare use and costs for commercially insured infants in the first year of life following a Neonatal Intensive Care Unit (NICU) hospitalization.Purpose: To evaluate healthcare utilization and costs in the 12-months after a neonatal hospitalization among commercially insured infants, comparing infants with and without medically complex conditions.Methods: This retrospective, cross-sectional, cohort study uses data from the IBM MarketScan Commercial database (2015–2019). The cohort included infants with and without medically complex conditions, hospitalized at birth in the NICU, discharged alive, and had 12-months continuous coverage. The primary outcomes are healthcare utilization (i.e., hospital readmissions, emergency department (ED) visits, and primary care and specialty outpatient visits) and out-of-pocket (OOP) costs.Results: The analysis included 23,940 infants, of which 84% resided in urban areas, 48% were born term (>37 weeks) and 43% had a medically complex diagnosis. Medically complex infants exhibited higher rates of readmissions, ED visits, specialist utilization, and specialty services. Average OOP costs for medically complex infants was $1893, compared to $873 for noncomplex infants. Almost half (48%) of the cohort had costs that exceeded $500 in the first year of life.Implications for practice and research: This study provides insights into the financial implications of post-NICU care for infants. Findings underscore the importance of considering medical complexity over gestational age when understanding healthcare use and spending patterns. Policymakers, healthcare providers, and families can use these insights to address the financial challenges associated with caring for infants with complex medical conditions beyond the NICU.
PubDate: Fri, 14 Mar 2025 00:00:00 GMT-
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- Sex-Related Nutritional Outcomes Among Preterm Very Low Birth-Weight
Infants-
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Authors: Parker; Leslie A.; Weaver, Michael; de la Cruz, Diomel; Neu, Josef
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Background: Sex-specific differences exist in morbidity and growth yet little is known about other nutritional outcomes in preterm very low birth-weight (VLBW) infants. This is important because providing optimal nutrition is essential to promote growth and reduce neurodevelopmental impairment.Purpose: To determine the effect of sex on days to full enteral feedings and other nutritional outcomes.Methods: This was a longitudinal 2-group cohort study using secondary analysis of existing data of 313 infants born ≤32 weeks gestation and weighing ≤1500 g. Information regarding nutritional outcomes was obtained from the infant’s electronic medical records.Results: While not statistically significant, male infants reached full feeds nearly 3 days later (18.1 vs 15.2; P = .89), required parenteral nutrition for nearly an additional 4 days (18.3 vs 14.1; P = .37), and had a central line for 3 days longer (19.6 vs 15.7; P = .65) than female infants. Males had higher direct bilirubin levels (P = .02), more emesis (P = .003), and more late-onset sepsis (P = .03). Birth weight for males was higher at birth but not at 6 weeks and while the slope of weight increase over the 6 weeks was higher in males (P = .04), growth velocity was similar between sexes yet tended to be higher in females.Implications for practice and research: Nurses are essential in ensuring preterm infants in the neonatal intensive care unit receive optimal nutrition. This study supports nurses should consider sex-specific differences in nutritional outcomes among VLBW infants in precision based nutritional support.
PubDate: Fri, 07 Mar 2025 00:00:00 GMT-
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- Music Therapy Intervention Using a Holy Quran Recitation Improves Feeding
Status, Weight Gain and Length of Stay Among Preterm Infants in the
Neonatal Intensive Care Unit: A Randomized Clinical Trial-
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Authors: Rashvand; Farnoosh; Qolizadeh, Arina; Momeni, Maryam
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Background: One of the most important challenges that preterm infants face is nutritional problems. Poor postnatal weight gain can lead to various complications.Purpose: To determine the effects of listening to the Holy Quran on the feeding status, postnatal weight gain, and length of hospital stay of preterm infants.Methods: The current randomized clinical trial was conducted in the city of Qazvin in 2024. The samples included 80 preterm infants hospitalized in neonatal intensive care unit, who were randomly assigned to the intervention and control groups (40 in the Holy Quran recitation group and 40 in the control group). In addition to the routine care, the participants in the intervention group listened to the Holy Quran via headphones for 20 minutes 3 times a day, whereas the participants in the control group did not receive any intervention.Results: The mean days to achieve the first oral feeding (P
PubDate: Fri, 07 Mar 2025 00:00:00 GMT-
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- Prenatal Opioid Exposure and Maternal-Infant Coregulation as Indicators of
Early Infant Neurodevelopment-
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Authors: Cleveland; Lisa M.; McGlothen-Bell, Kelly; Scott, Leticia; Choi, Byeong Yeob; Gelfond, Jonathon; Bibriescas, Natashia; McGrath, Jacqueline M.
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Background: Little is known about the short- and long-term effects of prenatal opioid exposure on infant neurodevelopment. Infants with neonatal opioid withdrawal syndrome (NOWS) are often admitted to neonatal intensive care units (NICU) where the development of coregulation between mothers and infants is easily disrupted. Understanding early mother-infant coregulation is needed to guide intervention strategies for these high-risk mother-infant dyads.Purpose: Explore the impact of prenatal opioid exposure on mother-infant coregulation, as an indicator of early infant neurodevelopment, in response to a standardized stress experiment, the Still Face Paradigm (SFP).Methods: A prospective cohort design was used to enroll opioid-exposed (N = 11) and non-exposed (N = 13) mother-infant dyads, when infants discharged from the NICU were 6 to 9 months. Dyadic heart rate variability (HRV) data were used as a measure of coregulation and were recorded using heart rate monitors during the 3 phases of the SFP: (a) baseline, (b) still-face, or flat affect, and (c) reunion. We conducted analyses to determine differences within the HRV dyad profiles.Results: HRV profiles differed between the 2 study groups. In the opioid-exposed group: (a) infants exhibited more irregular autonomic processes, (b) mothers had higher HRV baselines, and (c) there was an overall dysregulation between mothers and infants compared to the non-opioid exposed group.Implications for Practice and Research: These differences may suggest that prenatal opioid exposure contributes to difficulty with dyadic co-regulation which may negatively impact early infant neurodevelopment. Additional research is needed to better understand the role of prenatal opioid exposure in infant neurodevelopment.
PubDate: Thu, 06 Mar 2025 00:00:00 GMT-
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- A Pilot Randomized Control Trial of Holding During Hypothermia and Effects
on Maternal and Infant Salivary Cortisol Levels-
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Authors: Fox; Leah; Cutler, Anya; Kaneko-Tarui, Tomeko; Deerwester, Kyle; Evans, Scott; Maron, Jill; Craig, Alexa
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Background: The lack of physical contact during therapeutic hypothermia (TH) is challenging for parents of newborns with hypoxic ischemic encephalopathy. Holding is often avoided due to concerns for effects on infant temperature and for dislodging equipment.Purpose: We assessed the effect of holding during TH on maternal and infant salivary cortisol levels and on infant vital signs.Methods: Prospective crossover study with infants randomized to a 30-minute session of holding on day-2 versus day-3 of TH. “No-holding” occurred on the alternate day at the same time. Pre- and post-holding salivary cortisol levels were compared between holding and no-holding conditions. Vital signs were collected at 2-minute intervals. Data was analyzed using mixed-effects models.Result: Thirty-four mothers and infants were recruited. The median gestational age was 39 weeks, 16 (94%) had moderate encephalopathy and all were on morphine during TH. Salivary cortisol levels decreased after holding for infants on day-2 (P = .02) and mothers on day-2 and day-3 (P = .01). Infants held on day-2, but not on day-3, had lower heart rates, respiratory rates, and mean arterial pressures. Temperature and oxygen saturations were stable on both days.Implications for Practice and Research: We demonstrate positive effects of holding during TH as evidenced by lower salivary cortisol for both mother and infant and decreased heart rate, respiratory rate, and blood pressure for the infant on day-2. Further research is needed to replicate these results, to understand the lack of infant response on day-3 and to assess correlation with cumulative morphine exposure.
PubDate: Thu, 06 Mar 2025 00:00:00 GMT-
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- Infant-Led Incubator Weaning: A Promising Paradigm Shift in Preterm
Neonatal Care-
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Authors: Rath; Jennifer; Stracuzzi, Lauren A.; Wawrzynski, Sarah E.; Haut, Catherine
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Background: Thermoregulation is paramount in preterm infant care, traditionally addressed through nurse-led incubator weaning protocols. Recent research has introduced infant-driven incubator protocols that are demonstrating promise.Purpose: This study, conducted at a freestanding academic pediatric hospital in the mid-Atlantic, examined the impact of infant-led incubator weaning on a specific neonatal cohort. The primary hypothesis posited that infants in the infant-led weaning group would wean out of the incubator at earlier gestational ages and lower weights, while maintaining comparable or greater weight gain during the transition to open cribs.Methods: A retrospective chart review compared 40 infants weighing less than 1500 g before and after a weaning protocol change.Results: Infant-led weaning demonstrated lower weights at weaning to crib (M = 1836.80 g) compared with nurse-led weaning (M = 1975.9 g), with statistical significance (t [36] = 2.27, P = .02, Cohen’s d = 0.74). Infants in the infant-led group had a lower weight change 5 days prior to weaning (M = 141 g) compared with the nurse-led group (M = 185 g), which is also statistically significant (t [36] = 1.93, P = .03, Cohen’s d = 0.63). T-tests revealed no significant differences in gestational age at wean to crib, change in weight post-weaning, gestational age, or days to discharge.Implications for Practice and Research: Infant-led weaning emerges as a safe alternative with potential benefits for preterm neonates and their families. While initial positive outcomes are evident, further research with a larger neonatal cohort is imperative to validate the efficacy of infant-led weaning as a successful alternative to traditional methods.
PubDate: Tue, 04 Feb 2025 00:00:00 GMT-
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