Children

Editorial

Jump to: Research, Review, Other

4 pages, 195 KiB

Open AccessEditorial

Special Issue: Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment

by Stefan Grosek

Children 2023, 10(7), 1203; https://0-doi-org.brum.beds.ac.uk/10.3390/children10071203 - 11 Jul 2023

Viewed by 691

Abstract

Many physicians and researchers in the recent past have recognized the need to provide care and to study term and preterm infants when sufficient knowledge had not yet been attained, and to research how to approach and care for the most vulnerable children, [...] Read more.

Many physicians and researchers in the recent past have recognized the need to provide care and to study term and preterm infants when sufficient knowledge had not yet been attained, and to research how to approach and care for the most vulnerable children, i [...] Full article

(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

Research

Jump to: Editorial, Review, Other

12 pages, 883 KiB

Open AccessArticle

Ultrasound-Guided Centrally Inserted Central Catheter (CICC) Placement in Newborns: A Safe Clinical Training Program in a Neonatal Intensive Care Unit

by Tommaso Zini, Lucia Corso, Cinzia Mazzi, Cecilia Baraldi, Elisa Nieddu, Laura Rinaldi, Francesca Miselli, Luca Bedetti, Eugenio Spaggiari, Katia Rossi, Alberto Berardi, Licia Lugli and on behalf of the CVC Study Group

Children 2024, 11(4), 395; https://0-doi-org.brum.beds.ac.uk/10.3390/children11040395 - 26 Mar 2024

Viewed by 697

Abstract

Background: Centrally inserted central catheters (CICCs) are increasingly used in neonatal care. CICCs have garnered attention and adoption owing to their advantageous features. Therefore, achieving clinical competence in ultrasound-guided CICC insertion in term and preterm infants is of paramount importance for neonatologists. A [...] Read more.

Background: Centrally inserted central catheters (CICCs) are increasingly used in neonatal care. CICCs have garnered attention and adoption owing to their advantageous features. Therefore, achieving clinical competence in ultrasound-guided CICC insertion in term and preterm infants is of paramount importance for neonatologists. A safe clinical training program should include theoretical teaching and clinical practice, simulation and supervised CICC insertions. Methods: We planned a training program for neonatologists for ultrasound-guided CICCs placement at our level III neonatal intensive care unit (NICU) in Modena, Italy. In this single-centre prospective observational study, we present the preliminary results of a 12-month training period. Two paediatric anaesthesiologists participated as trainers, and a multidisciplinary team was established for continuing education, consisting of neonatologists, nurses, and anaesthesiologists. We detail the features of our training program and present the modalities of CICC placement in newborns. Results: The success rate of procedures was 100%. In 80.5% of cases, the insertion was obtained at the first ultrasound-guided venipuncture. No procedure-related complications occurred in neonates (median gestational age 36 weeks, IQR 26–40; median birth weight 1200 g, IQR 622–2930). Three of the six neonatologists (50%) who participated in the clinical training program have achieved good clinical competence. One of them has acquired the necessary skills to in turn supervise other colleagues. Conclusions: Our ongoing clinical training program was safe and effective. Conducting the program within the NICU contributes to the implementation of medical and nursing skills of the entire staff. Full article

(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

► Show Figures

Figure 1

17 pages, 1793 KiB

Open AccessArticle

Investigating the Association between Serum and Hematological Biomarkers and Neonatal Sepsis in Newborns with Premature Rupture of Membranes: A Retrospective Study

by Maura-Adelina Hincu, Gabriela-Ildiko Zonda, Petronela Vicoveanu, Valeriu Harabor, Anamaria Harabor, Alexandru Carauleanu, Alina-Sînziana Melinte-Popescu, Marian Melinte-Popescu, Elena Mihalceanu, Mariana Stuparu-Cretu, Ingrid-Andrada Vasilache, Dragos Nemescu and Luminita Paduraru

Children 2024, 11(1), 124; https://0-doi-org.brum.beds.ac.uk/10.3390/children11010124 - 18 Jan 2024

Viewed by 979

Abstract

(1) Background: Neonatal early-onset sepsis (EOS) is associated with important mortality and morbidity. The aims of this study were to evaluate the association between serum and hematological biomarkers with early onset neonatal sepsis in a cohort of patients with prolonged rupture of membranes [...] Read more.

(1) Background: Neonatal early-onset sepsis (EOS) is associated with important mortality and morbidity. The aims of this study were to evaluate the association between serum and hematological biomarkers with early onset neonatal sepsis in a cohort of patients with prolonged rupture of membranes (PROM) and to calculate their diagnostic accuracy. (2) Methods: A retrospective cohort study was conducted on 1355 newborns with PROM admitted between January 2017 and March 2020, who were divided into two groups: group A, with PROM ≥ 18 h, and group B, with ROM < 18 h. Both groups were further split into subgroups: proven sepsis, presumed sepsis, and no sepsis. Descriptive statistics, analysis of variance (ANOVA) and a Random Effects Generalized Least Squares (GLS) regression were used to evaluate the data. (3) Results: The statistically significant predictors of neonatal sepsis were the high white blood cell count from the first (p = 0.005) and third day (p = 0.028), and high C-reactive protein (CRP) values from the first day (p = 0.004). Procalcitonin (area under the curve—AUC = 0.78) and CRP (AUC = 0.76) measured on the first day had the best predictive performance for early-onset neonatal sepsis. (4) Conclusions: Our results outline the feasibility of using procalcitonin and CRP measured on the first day taken individually in order to increase the detection rate of early-onset neonatal sepsis, in the absence of positive blood culture. Full article

(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

► Show Figures

Figure 1

12 pages, 265 KiB

Open AccessArticle

Diagnostic Accuracy of Multiplex Polymerase Chain Reaction in Early Onset Neonatal Sepsis

by Anja Stein, Daniel Soukup, Peter-Michael Rath and Ursula Felderhoff-Müser

Children 2023, 10(11), 1809; https://0-doi-org.brum.beds.ac.uk/10.3390/children10111809 - 14 Nov 2023

Cited by 1 | Viewed by 925

Abstract

Early onset neonatal sepsis is a significant contributor to neonatal morbidity and mortality. Although blood cultures remain the diagnostic gold standard, they detect pathogens in only a minority of suspected cases. This study compared the accuracy of blood cultures with a rapid multiplex [...] Read more.

Early onset neonatal sepsis is a significant contributor to neonatal morbidity and mortality. Although blood cultures remain the diagnostic gold standard, they detect pathogens in only a minority of suspected cases. This study compared the accuracy of blood cultures with a rapid multiplex PCR test. Newborns at risk of neonatal sepsis were prospectively screened as recommended per national guidelines. Evaluations included laboratory parameters (CrP, IL6, differential blood count), blood culture, and a molecular multiplex PCR test (ROCHE LightCycler SeptiFast^®) identifying 20 common microbial agents. Blood samples were taken simultaneously from umbilical cord or venous sources on the first day of life. Of 229 infants included, 69% were born preterm. Blood culture and multiplex PCR sensitivity were 7.4% and 14.8%, respectively. Specificity, negative and positive predictive values between methods showed no significant variance, although multiplex PCR had more false positives due to contamination. The limited sensitivity of blood cultures for early onset neonatal sepsis is concerning. Despite quicker results, multiplex PCR does not enhance diagnostic accuracy or antibiotic therapy guidance, thus it cannot be recommended for this indication. Full article

(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

► Show Figures

Graphical abstract

9 pages, 254 KiB

Open AccessArticle

A Higher Amount of Nutritional Intake as a Possible Cause of Hyperglycemia in Extremely Premature Infants in Parenteral and Enteral Nutrition at the Tertiary Neonatal Intensive Care Unit

by Iza Predanič Drobne, Lilijana Kornhauser Cerar, Vanja Erčulj and Štefan Grosek

Children 2023, 10(10), 1651; https://0-doi-org.brum.beds.ac.uk/10.3390/children10101651 - 04 Oct 2023

Viewed by 866

Abstract

Background: This study aimed to find an association between infants who had hyperglycemia and those who did not, those treated with insulin or not and several prenatal and postnatal variables or the suboptimal prescription of parenteral nutrition. Methods: We conducted a retrospective study, [...] Read more.

Background: This study aimed to find an association between infants who had hyperglycemia and those who did not, those treated with insulin or not and several prenatal and postnatal variables or the suboptimal prescription of parenteral nutrition. Methods: We conducted a retrospective study, which included extremely premature infants (<28 weeks of gestation) admitted to the tertiary NICU, University Medical Centre Ljubljana, between 1 January 2021 and 31 December 2021. Blood glucose measurements, insulin treatment, general characteristics, nutritional data and complications of prematurity were obtained retrospectively from hospital data. RESULTS: There were 21 infants included in the study who did not receive insulin and 17 who were treated with insulin. Infants receiving insulin were younger and lighter compared to the non-insulin treatment group (mean gestational age 178 vs. 188 days; median birth weight 680 g vs. 990 g). The younger insulin group of infants received the same daily number of total macronutrients per kg per day compared to the older non-insulin group, i.e., glucose, lipids and amino acids, as recommended for the gestational age and birth weight. After adjusting for gestational age, no significant association with complications of prematurity was found. Conclusions: The postulated explanation (with the prescription of a higher amount of macronutrients during the first seven days) for hyperglycemia and treatment with insulin in the less mature and lighter infants cannot be supported by the data given. Full article

(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

11 pages, 560 KiB

Open AccessArticle

Contingent Mother’s Voice Intervention Targeting Feeding in Hospitalized Infants with Critical Congenital Heart Defects

by Caitlin P. Kjeldsen, Lelia Emery, Janet Simsic, Zhulin He, Ann R. Stark, Mary Lauren Neel and Nathalie L. Maitre

Children 2023, 10(10), 1642; https://0-doi-org.brum.beds.ac.uk/10.3390/children10101642 - 30 Sep 2023

Viewed by 927

Abstract

Infants with critical congenital heart defects (CCHD) are at high risk for feeding challenges and neurodevelopmental delays; however, few interventions promoting the neurodevelopmental progression of feeding have been studied with this population. Contingent mother’s voice has been successfully used as positive reinforcement for [...] Read more.

Infants with critical congenital heart defects (CCHD) are at high risk for feeding challenges and neurodevelopmental delays; however, few interventions promoting the neurodevelopmental progression of feeding have been studied with this population. Contingent mother’s voice has been successfully used as positive reinforcement for non-nutritive suck (NNS) in studies with preterm infants, leading to improved weight gain and more rapid cessation of tube feedings; however, this type of intervention has not been studied in infants with CCHD. This study aimed to determine whether an NNS-training protocol using the mother’s voice as positive reinforcement and validated in preterm infants could improve oral feeding outcomes in hospitalized infants with CCHD undergoing cardiac surgical procedures. Infants were randomized to receive the contingent mother’s voice intervention before or after cardiac surgery, with a control comparison group receiving passive exposure to the mother’s voice after surgery. There were no significant differences in discharge weight, PO intake, length of stay, time to full feeds, or feeding status at 1-month post-discharge between infants who received contingent mother’s voice compared to those who did not. There were significant differences in PO intake and time to full feeds following surgery based on infants’ pre-enrollment PO status and severity of illness. At 1-month post-discharge, parents of infants in the intervention group expressed a higher rate of positive feelings and fewer concerns regarding their infant’s feeding compared to parents of infants in the control group. While the current protocol of 5 sessions was not associated with improved feeding outcomes in infants with CCHD, it empowered parents to contribute to their infant’s care and demonstrated the feasibility of using the mother’s voice as positive reinforcement for infants with CCHD. Further study of timing, intensity, and duration of interventions leveraging the mother’s voice in this population is needed. ClinicalTrials.gov Identifier: NCT03035552. Full article

(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

10 pages, 236 KiB

Open AccessReview

Central Lines and Their Complications in Neonates: A Case Report and Literature Review

by Tina Perme

Children 2024, 11(1), 26; https://0-doi-org.brum.beds.ac.uk/10.3390/children11010026 - 25 Dec 2023

Viewed by 1546

Abstract

Central lines are essential devices in NICUs, used primarily in preterm neonates and critically ill term neonates. They are typically divided into non-tunnelled, tunnelled and totally implanted. In light of the increasing use of central lines in the NICU setting, monitoring of the [...] Read more.

Central lines are essential devices in NICUs, used primarily in preterm neonates and critically ill term neonates. They are typically divided into non-tunnelled, tunnelled and totally implanted. In light of the increasing use of central lines in the NICU setting, monitoring of the risk factors associated with complications has to be an important part of neonatal care quality management. Presented here is a case of a preterm neonate with cardiac tamponade caused by UVC tip migration. Among complications of central lines are CLABSI, with an incidence of 3 to 21 per 1000 catheter days, and portal vein thrombosis, which is common but probably under-recognised, whereas other mechanical complications such as pericardial and pleural effusions are rare, with an incidence of less than 1%. Complications can cause injury to the neonates, as well as increase the costs of health services because of increases in the length of stay in the NICU. It is recommended that the catheter tip location is confirmed either by X-ray or ultrasonography. In order to minimise the risk of CLABSI, the use of bundles is recommended. Certain recommendations need to be followed when using different types of catheters. Future research is aimed at novel ways of central line securement to minimise mechanical complications and the use of antimicrobial catheters to reduce the rate of CLABSI. Full article

(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

12 pages, 791 KiB

Open AccessReview

Noninvasive Monitoring Strategies for Bronchopulmonary Dysplasia or Post-Prematurity Respiratory Disease: Current Challenges and Future Prospects

by Tommaso Zini, Francesca Miselli and Alberto Berardi

Children 2023, 10(11), 1753; https://0-doi-org.brum.beds.ac.uk/10.3390/children10111753 - 29 Oct 2023

Viewed by 861

Abstract

Definitions of bronchopulmonary dysplasia (BPD) or post-prematurity respiratory disease (PPRD) aim to stratify the risk of mortality and morbidity, with an emphasis on long-term respiratory outcomes. There is no univocal classification of BPD due to its complex multifactorial nature and the substantial heterogeneity [...] Read more.

Definitions of bronchopulmonary dysplasia (BPD) or post-prematurity respiratory disease (PPRD) aim to stratify the risk of mortality and morbidity, with an emphasis on long-term respiratory outcomes. There is no univocal classification of BPD due to its complex multifactorial nature and the substantial heterogeneity of clinical presentation. Currently, there is no definitive treatment available for extremely premature very-low-birth-weight infants with BPD, and challenges in finding targeted preventive therapies persist. However, innovative stem cell-based postnatal therapies targeting BPD-free survival are emerging, which are likely to be offered in the first few days of life to high-risk premature infants. Hence, we need easy-to-use noninvasive tools for a standardized, precise, and reliable BPD assessment at a very early stage, to support clinical decision-making and to predict the response to treatment. In this non-systematic review, we present an overview of strategies for monitoring preterm infants with early and evolving BPD-PPRD, and we make some remarks on future prospects, with a focus on near-infrared spectroscopy (NIRS). Full article

(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

► Show Figures

Figure 1

Other

Jump to: Editorial, Research, Review

14 pages, 2076 KiB

Open AccessSystematic Review

Platelet Counts and Risk of Severe Retinopathy of Prematurity: A Bayesian Model-Averaged Meta-Analysis

by Mohamad F. Almutairi, Silvia Gulden, Tamara M. Hundscheid, František Bartoš, Giacomo Cavallaro and Eduardo Villamor

Children 2023, 10(12), 1903; https://0-doi-org.brum.beds.ac.uk/10.3390/children10121903 - 08 Dec 2023

Viewed by 831

Abstract

Background: We aimed to conduct a systematic review and Bayesian model-averaged meta-analysis (BMA) on the association between platelet counts and severe retinopathy of prematurity (ROP). Methods: We searched for studies reporting on platelet counts (continuous variable) or thrombocytopenia (categorical variable) and severe ROP [...] Read more.

Background: We aimed to conduct a systematic review and Bayesian model-averaged meta-analysis (BMA) on the association between platelet counts and severe retinopathy of prematurity (ROP). Methods: We searched for studies reporting on platelet counts (continuous variable) or thrombocytopenia (categorical variable) and severe ROP or aggressive posterior ROP (APROP). The timing of platelet counts was divided into Phase 1 (<2 weeks) and Phase 2 (around ROP treatment). BMA was used to calculate Bayes factors (BFs). The BF₁₀ is the ratio of the probability of the data under the alternative hypothesis (H₁) over the probability of the data under the null hypothesis (H₀). Results: We included 21 studies. BMA showed an association between low platelet counts and severe ROP. The evidence was strong (BF₁₀ = 13.5, 7 studies) for phase 1 and very strong (BF₁₀ = 51.0, 9 studies) for phase 2. Thrombocytopenia (<100 × 10⁹/L) in phase 2 was associated with severe ROP (BF₁₀ = 28.2, 4 studies). Following adjustment for publication bias, only the association of severe ROP with thrombocytopenia remained with moderate evidence in favor of H₁ (BF₁₀ = 4.30). Conclusions: Thrombocytopenia is associated with severe ROP. However, the evidence for this association was tempered when results were adjusted for publication bias. Full article

(This article belongs to the Special Issue Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Published Papers (9 papers)

Editorial

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI