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Ambia AM, Duryea EL, Wyckoff MH, Tao W, McIntire DD, Seasely AR, Moussa M, Leveno KJ. A Randomized Trial of the Effects of Ambient Operating Room Temperature on Neonatal Morbidity. Am J Perinatol 2024; 41:e1553-e1559. [PMID: 36918157 DOI: 10.1055/a-2053-7242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Newborn hypothermia has been implicated in neonatal morbidity without randomized evidence that it compromises the infant. Our objective was to determine if a difference in operating room temperature at cesarean birth impacts neonatal morbidity. STUDY DESIGN Women undergoing cesarean delivery of a liveborn infant without major malformations were included. The institutional preexisting operating room temperature of 20°C (67°F) was compared with an experimental group of 24°C (75°F) by cluster randomization assigned on a weekly basis. Newborn hypothermia was defined as axillary temperature on arrival to the nursery of less than 36.5°C (<97.7°F). The primary outcome was a composite of neonatal morbidity including respiratory support, sepsis, hypoglycemia, and neonatal death. RESULTS Between November 2016 and May 2018, 5,221 women had cesarean deliveries at Parkland Hospital with 2,817 randomized to the standard care group and 2,404 to the experimental group. The rate of neonatal composite morbidity did not differ between the groups: standard care 398 (14%) versus experimental 378 (16%), p = 0.11. This was despite a significant decrease in the rate of neonatal hypothermia: standard care 1,195 (43%) versus experimental 414 (18%), p < 0.001. There was no difference in the composite outcome for preterm infants (<37 wk) between the groups: standard care 194 (49%) versus experimental 185 (54%), p = 0.25. CONCLUSION An 8°F increase in operating room temperature was significantly associated with a reduced rate of neonatal hypothermia, although this decrease was not associated with a significant improvement in neonatal morbidity. However, the increase in operating room temperature was met with resistance from obstetricians and operating room personnel. This trial is registered (registration no.: NCT03008577).
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Affiliation(s)
- Anne M Ambia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elaine L Duryea
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Weike Tao
- Division of Obstetric Anesthesia, Department of Anesthesia, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Donald D McIntire
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Angela R Seasely
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Moussa Moussa
- Parkland Health and Hospital System, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kenneth J Leveno
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
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Ludington-Hoe SM, Addison C. Sudden Unexpected Postnatal Collapse: Review and Management. Neonatal Netw 2024; 43:76-91. [PMID: 38599773 DOI: 10.1891/nn-2023-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.
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3
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Mendu SB, Neela AR, Tammali S, Kotha R. Impact of Early Bonding During the Maternal Sensitive Period on Long-Term Effects: A Systematic Review. Cureus 2024; 16:e53318. [PMID: 38435959 PMCID: PMC10905202 DOI: 10.7759/cureus.53318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
This research project examines the long-term effects of maternal-neonatal bonding during a mother's "sensitive period." The review explores how early contact between a mother and her newborn can affect their psychosocial and emotional well-being in the future. Within an hour after birth, oxytocin levels increase for mothers, while catecholamine surges enhance neonates' memory retention to encourage immediate skin-to-skin contact (SSC), which promotes breastfeeding with benefits, such as quicker placenta expulsion, less bleeding, and lower stress. As per sources to date, there is no systematic review on this subject; however, numerous studies exist regarding short-term outcomes, exclusive breastfeeding, and childhood problems. The exploration involves rigorous searches of academic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for transparency and reproducibility by using the Population, Intervention, Comparison, and Outcome (PICO) framework. Of the 516 initially identified articles, only five were relevant based on refined selection criteria, making it clear from the analysis that sensitive-period bonding produces long-term impacts in infants. Few studies are available, particularly in recent years; thus, more research is required in this area.
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Affiliation(s)
| | - Aruna Rekha Neela
- Obstetrics and Gynecology, Government Medical College, Siddipet, Siddipet, IND
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4
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Ardern J, Hayward B, Vandal AC, Martin-Babin M, Coomarasamy C, McKinlay C. Improving Golden Hour Care Coordination: Using Defined Roles to Improve Nurse Confidence and Care Coordination of Neonates Following Admission. J Perinat Neonatal Nurs 2023; 37:232-241. [PMID: 37310073 PMCID: PMC10445624 DOI: 10.1097/jpn.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/16/2023] [Indexed: 06/14/2023]
Abstract
STUDY AIM To investigate whether use of admission lanyards improves nurse confidence, care coordination, and infant health outcomes during neonatal emergency admissions. METHODS Admission lanyards that defined team roles, tasks, and responsibilities were evaluated in a mixed-methods, historically controlled, and nonrandomized intervention study. Methods included (i) 81 pre- and postintervention surveys to explore nurse confidence, (ii) 8 postintervention semistructured interviews to elicit nurse perceptions of care coordination and nurse confidence, and (iii) a quantitative comparison of infant care coordination and health outcomes for 71 infant admissions before and 72 during the intervention. RESULTS Nurse participants reported that using lanyards during neonatal admissions improved clarity of roles and responsibilities, communication, and task delegation, contributing to better admission flow, team leadership, accountability, and improved nurse confidence. Care coordination outcomes showed significantly improved time to stabilization for intervention infants. Radiographies for line placement were performed 14.4 minutes faster, and infants commenced intravenous nutrition 27.7 minutes faster from time of admission. Infant health outcomes remained similar between groups. CONCLUSION Admission lanyards were associated with improved nurse confidence and care coordination during neonatal emergency admissions, significantly reducing time to stabilization for infants, shifting outcomes closer to the Golden Hour.
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Affiliation(s)
- Julena Ardern
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Brooke Hayward
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Alain C. Vandal
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Margot Martin-Babin
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Christin Coomarasamy
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Chris McKinlay
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
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5
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Pfurtscheller D, Wolfsberger CH, Höller N, Schwaberger B, Mileder LP, Baik-Schneditz N, Urlesberger B, Schmölzer GM, Pichler G. Cardiac output and regional-cerebral-oxygen-saturation in preterm neonates during immediate postnatal transition: An observational study. Acta Paediatr 2023. [PMID: 36880893 DOI: 10.1111/apa.16745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
AIM To examine potential correlations between cardiac output (CO) with cerebral-regional-oxygen-saturation (crSO2 ) and cerebral-fractional-tissue-oxygen-extraction (cFTOE) during immediate foetal-to-neonatal transition in term and preterm neonates with and without respiratory support. METHODS Post hoc analyses of secondary outcome parameters of prospective observational studies were performed. We included neonates with cerebral near-infrared-spectroscopy (NIRS) monitoring and an oscillometric blood pressure measurement at minute 15 after birth. Heart rate (HR) and arterial oxygen saturation (SpO2 ) were monitored. CO was calculated with Liljestrand and Zander formula and correlated with crSO2 and cFTOE. RESULTS Seventy-nine preterm neonates and 207 term neonates with NIRS measurements and calculated CO were included. In 59 preterm neonates (mean gestational age (GA): 29.4 ± 3.7 weeks) with respiratory support, CO correlated significantly positively with crSO2 and significantly negatively with cFTOE. In 20 preterm neonates (GA 34.9 ± 1.3 weeks) without respiratory support and in 207 term neonates with and without respiratory support, CO correlated neither with crSO2 nor with cFTOE. CONCLUSION In compromised preterm neonates with lower gestational age and in need of respiratory support, CO was associated with crSO2 and cFTOE, whereas in stable preterm neonates with higher gestational age as well as in term neonates with and without respiratory support, no associations were observed.
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Affiliation(s)
- Daniel Pfurtscheller
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Christina H Wolfsberger
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Nina Höller
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Schwaberger
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Lukas P Mileder
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Nariae Baik-Schneditz
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, Division of Neonatology Department of Pediatrics and Adolescent Medicine Medical, University of Alberta, Edmonton, Alberta, Canada
| | - Gerhard Pichler
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Shimizu Y, Kanda T, Kutara K, Ohnishi A, Saeki K, Miyabe M, Asanuma T, Ishioka K. Effect of Hot Water Bottles on Body Temperature during Magnetic Resonance Imaging in Dogs under General Anesthesia: A Retrospective Study. Vet Sci 2022; 9:vetsci9120660. [PMID: 36548821 PMCID: PMC9785548 DOI: 10.3390/vetsci9120660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Prevention of hypothermia induced by anesthesia and enhanced by low environmental temperatures is difficult in magnetic resonance imaging (MRI) examinations in dogs as forced warming devices, including magnetic materials, are not acceptable for use in the MRI room. A hot water bottle (HWB) can be carried into an MRI examination room and can contribute to the prevention or attenuation of hypothermia. Here, we retrospectively investigated the effects of HWB on body temperature during MRI examinations in dogs under general anesthesia (GA). From anesthesia records of the Veterinary Medical Teaching Hospital, Okayama University of Science, validated data of 100 dogs that underwent an MRI examination under GA were obtained and divided into the following two groups: one group received HWB, while the other did not. Decrease in rectal temperature 15 min after intubation was significantly smaller in the group using HWB than in the group without HWB. In conclusion, the use of hot water bottles might be one of the methods to attenuate hypothermia in the early period but should not be expected for complete prevention of hypothermia, and it was not recommendable necessarily for body temperature management during MRI examinations in dogs under general anesthesia.
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Affiliation(s)
- Yuki Shimizu
- Veterinary Medical Teaching Hospital, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
- Graduate School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
| | - Teppei Kanda
- Veterinary Medical Teaching Hospital, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
- Faculty of Veterinary Medicine, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
- Correspondence:
| | - Kenji Kutara
- Veterinary Medical Teaching Hospital, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
- Faculty of Veterinary Medicine, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
| | - Akihiro Ohnishi
- Veterinary Medical Teaching Hospital, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
- Faculty of Veterinary Medicine, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
| | - Kaori Saeki
- Veterinary Medical Teaching Hospital, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
- Faculty of Veterinary Medicine, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
| | - Masahiro Miyabe
- Veterinary Medical Teaching Hospital, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
- Faculty of Veterinary Medicine, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
| | - Taketoshi Asanuma
- Veterinary Medical Teaching Hospital, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
- Faculty of Veterinary Medicine, Okayama University of Science, Ikoino-oka 1-3, Imabari, Ehime 794-8555, Japan
| | - Katsumi Ishioka
- Graduate School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
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Jeong SH, Jeong MH, Park SJ, Lee N, Bae MH, Han YM, Park KH, Byun SY. Implementing the Golden Hour Protocol to Improve the Clinical Outcomes in Preterm Infants. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: Since premature infants are sensitive to the changes in blood glucose levels and body temperature, maintaining these parameters is important to avoid the risk of infections. The authors implemented the Golden Hour protocol (GHP) that aims to close the final incubator within one hour of birth by implementing early treatment steps for premature infants after birth, such as maintaining body temperature, securing airway, and rapidly administering glucose fluid and prophylactic antibiotics by securing breathing and rapid blood vessels. This study investigated the effect of GHP application on the short- and long-term clinical outcomes.Methods: We retrospectively analyzed the medical records between 2017 and 2018 before GHP application and between 2019 and 2020 after GHP application in preterm infants aged 24 weeks or older and those aged less than 33 weeks who were admitted to the neonatal intensive care unit.Results: Overall, 117 GHP patients and 81 patients without GHP were compared and analyzed. Peripheral vascularization time and prophylactic antibiotic administration time were shortened in the GHP-treated group (P=0.007 and P=0.008). In the short-term results, the GHP-treated group showed reduced hypothermia upon arrival at the neonatal intensive care unit (P=0.002), and the blood glucose level at 1 hour of hospitalization was higher (P=0.012). Furthermore, the incidence of neonatal necrotizing enteritis decreased (P=0.043). As a long-term result, the incidence of BPD was reduced (P=0.004).Conclusion: We confirmed that applying GHP improved short- and long-term clinical outcomes in premature infants aged <33 weeks age of gestation, and we expect to improve the treatment quality by actively using it for postnatal treatment.
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Araújo KEDAS, Santos CCD, Caminha MDFC, Silva SLD, Pereira JDCN, Batista Filho M. SKIN TO SKIN CONTACT AND THE EARLY INITIATION OF BREASTFEEDING: A CROSS-SECTIONAL STUDY. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to identify the prevalence and factors associated with the occurrence of skin-to-skin contact and the early initiation of breastfeeding in a Baby-friendly hospital in northeastern Brazil. Method: cross-sectional study, composed of pregnant women, in which delivery occurred at the Baby-friendly Hospital. Data were collected between April 2017 and May 2019 through forms containing sociodemographic variables, obstetric history and data on the delivery and birth of the newborn. The possible associated factors were analyzed through the chi-square test, adopting the significance level of 0.05. Result: among the 727 pregnant women, skin-to-skin contact occurred in 83.6% and breastfeeding in 58.3%. Full-term birth, birth weight ≥ 2500g, Apgar index >7 in the first minute, vaginal delivery, 6 or more prenatal consultations and years of study >9 were the factors associated with the practice of skin-to-skin contact. Regarding breastfeeding, in addition to the first five factors related to skin-to-skin contact, a statistical relationship with the beginning of prenatal care in the first trimester, skin-to-skin contact and multiparity was also evidenced. Conclusions: this study found a prevalence rate of skin-to-skin contact appropriate to a Baby-friendly Hospital and a direct association of this practice with breastfeeding.
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Affiliation(s)
| | | | | | - Suzana Lins da Silva
- Instituto de Medicina Integral Prof. Fernando Figueira, Brasil; Faculdade Pernambucana de Saúde, Brasil
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9
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Hitchings L, Rodriguez M, Persaud R, Gomez L. The effect of delayed cord clamping on blood sugar levels on 34-36 week neonates exposed to late preterm antenatal steroids. J Matern Fetal Neonatal Med 2020; 35:3587-3594. [PMID: 33043779 DOI: 10.1080/14767058.2020.1832074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neonatal hypoglycemia is a known side effect of antenatal betamethasone (BMZ) given for fetal maturation. We sought to investigate if delayed cord clamping (DCC) has an impact on neonatal hypoglycemia induced by antenatal late preterm BMZ administration. MATERIAL AND METHODS Retrospective cohort study (January 2019-May 2019) of pregnancies undergoing delivery at 34-0/7 to 36-6/7 weeks at a single center included in two groups: DCC + BMZ and BMZ-only (no DCC). The primary outcome was the occurrence of neonatal hypoglycemia at the first hour after delivery. RESULTS A total of 62/188, 32.98% (DCC + BMZ group) and 45/100, 45% (DCC-only group) infants presented with hypoglycemia at 1-h after birth (adjusted p = .06; OR 0.73, 95% CI 0.54-1.01). When stratified according to gestational age at delivery, DCC was associated with a 46% reduction in the occurrence of neonatal hypoglycemia among those born at 35-0/7 to 35-6/7 weeks (adjusted p = .033; OR 0.54, 95% CI 0.33-0.88) and 35% reduction among those born at 36-0/7 to 36-67 weeks (adjusted p = .046; OR 0.65, 95% CI 0.43-0.97). CONCLUSION In our cohort, delayed cord clamping in infants receiving late preterm BMZ born between 35-0/7 and 36-6/7 weeks' gestation protects from early neonatal hypoglycemia.
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Affiliation(s)
- Laura Hitchings
- Children's National Health System, Prenatal Pediatric Institute, Washington, DC, USA
| | - Marcella Rodriguez
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Inova Health Systems, Falls Church, VA, USA.,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Reva Persaud
- Children's National Health System, Prenatal Pediatric Institute, Washington, DC, USA
| | - Luis Gomez
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Inova Health Systems, Falls Church, VA, USA.,Division of Maternal Fetal Medicine, Perinatal associates of Northern Virginia, Fairfax, VA, USA
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10
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The golden hour in Finnish birthing units - An ethnographic study. Midwifery 2020; 89:102793. [DOI: 10.1016/j.midw.2020.102793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
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11
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Sharma D, Padmavathi IV, Tabatabaii SA, Farahbakhsh N. Late preterm: a new high risk group in neonatology. J Matern Fetal Neonatal Med 2019; 34:2717-2730. [PMID: 31575303 DOI: 10.1080/14767058.2019.1670796] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Late preterm infants are those infants born between 34 0/7 weeks through 36 6/7 week of gestation. These are physiologically less mature and have limited compensatory responses to the extrauterine environment compared with term infants. Despite their increased risk for morbidity and mortality, late preterm newborns are often cared in the well-baby nurseries of hospital after birth and are discharged from the hospital by 2-3 days of postnatal age. They are usually treated like developmentally mature term infants because many of them are of same birth weight and same size as term infants. There is a steady increase in the late preterm birth rate in last decade because of either maternal, fetal, or placental/uterine causes. There has been shift in the distribution of births from term and post-term toward earlier gestations. Although late preterm infants are the largest subgroup of preterm infants, there has been little research on this group until recently. This is mainly because of labeling them as "near-term". Such infants were being looked upon as "almost mature", and were thought as neonate requiring either no or minimal concern. In the obstetric and pediatric practice, late preterm infants are often considered functionally and developmentally mature and often managed by protocols developed for full-term infants. Thus, limited efforts are taken to prolong pregnancy in cases of preterm labor beyond 34 weeks, moreover after 34 weeks most centers do not administer antenatal prophylactic steroids. These practices are based on previous studies reporting neonatal mortality and morbidity in the late preterm period to be only slightly higher in comparison with term infants and whereas in the current scenario the difference is significant. Late preterm infants have 2-3-fold increased risk of morbidities such as hypothermia, hypoglycemia, delayed lung fluid clearance, respiratory distress, poor feeding, jaundice, sepsis, and readmission rates after initial hospital discharge. This leads to huge impact on the overall health care resources. In this review, we cover various aspects of these late preterm infants like etiology, immediate and long-term outcome.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Sciences, Jaipur, India
| | | | | | - Nazanin Farahbakhsh
- Department of Pulmonology, Pediatric Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Neczypor JL, Holley SL. Providing Evidence-Based Care During the Golden Hour. Nurs Womens Health 2018; 21:462-472. [PMID: 29223210 DOI: 10.1016/j.nwh.2017.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/01/2017] [Indexed: 11/26/2022]
Abstract
The Golden Hour encompasses a set of evidence-based practices that contribute to the physiologic stabilization of the mother-newborn dyad after birth. Important elements of the Golden Hour include delayed cord clamping, skin-to-skin contact for at least an hour, the performance of newborn assessments on the maternal abdomen, delaying non-urgent tasks (e.g., bathing the newborn) for 60 minutes, and the early initiation of breastfeeding. The Golden Hour contributes to neonatal thermoregulation, decreased stress levels in a woman and her newborn, and improved mother-newborn bonding. Implementation of these actions is further associated with increased rates and duration of breastfeeding. This article explores the evidence supporting the Golden Hour and provides strategies for successfully implementing a Golden Hour protocol on a hospital-based labor and delivery unit.
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