Improving Neonatal Care with Technology

Ethics Considerations Regarding Artificial Womb Technology for the Fetonate

Since the early 1980's, with the clinical advent of in vitro fertilization resulting in so-called "test tube babies," a wide array of ethical considerations and concerns regarding artificial womb technology (AWT) have been described. Recent breakthroughs in the development of extracorporeal neonatal life support by means of AWT have reinitiated ethical interest about this topic with a sense of urgency. Most of the recent ethical literature on the topic, however, pertains not to the more imminent scenario of a physiologically improved method of neonatal care through AWT, but instead to the remote scenario of "complete ectogenesis" that imagines human gestation occurring entirely outside of the womb. This scoping review of the ethical literature on AWT spans from more abstract concerns about complete ectogenesis to more immediate concerns about the soon-to-be-expected clinical life support of what we term the fetal neonate or fetonate. Within an organizing framework of different stages of human gestational development, from conception to the viable premature infant, we discuss both already identified and newly emerging ethical considerations and concerns regarding AWT and the care of the fetonate.

Association of sex with the global burden of vision impairment caused by neonatal preterm birth: An analysis from the global burden of disease study 2019

Aims

To investigate the sex-specific global burden of neonatal preterm birth (NPB) vision impairment by year, age, and socioeconomic status using years lived with disability (YLDs).

Methods

The global, regional, and national sex-specific YLD numbers, crude YLD rates, and age-standardized YLD rates of NPB-related moderate and severe vision loss and blindness were obtained from the Global Burden of Disease Study 2019. The Wilcoxon test and linear regression were used to investigate the relationship between sex difference in age-standardized YLD rates and the Human Development Index (HDI).

Results

Between 1990 and 2019, the gender disparity in age-standardized YLD rates for NPB-related vision impairment remained stable, increasing from 10.2 [95% uncertainty interval (UI) 6.7–14.6] to 10.4 (95% UI 6.9–15.0) for men and 10.3 (95% UI 6.8–14.7) to 10.7 (95% UI 7.2–15.1) for women, with women consistently having higher age-standardized YLD rates. Between the ages of 25 and 75, women had higher YLD rates than males, with the biggest disparity in the 60–64 age group. In 2019, sex difference in age-standardized YLD rates across 195 nations was statistically significant. Women had higher age-standardized YLD rates than men in both low (Z = −3.53, p < 0.001) and very high HDI countries (Z = −4.75, p < 0.001). Additionally, age-standardized YLD rates were found to be adversely associated with HDI (male: Standardized β = −0.435, female: Standardized β = −0.440; p < 0.001).

Conclusion

Despite advancements in worldwide NPB health care, sexual differences in NPB-related vision impairment burden showed little change. Female had higher burden than male, particularly in low and very high socioeconomic status countries.

The Development and Validation of a Perceived Nursing Support Scale for Mothers of Preterm Infants

PURPOSE

Many studies have maintained that nursing support is necessary and essential for mothers of preterm infants; however, the perceived nursing support for mothers of preterm infants has not been sufficiently measured. This study aimed to develop a perceived nursing support scale for mothers of preterm infants (PNSS-MP).

METHODS

The preliminary items of the PNSS-MP were developed through a literature review and in-depth interviews with mothers of preterm infants. Content validity and face validity were assessed by experts and mothers of preterm infants. A pilot study was conducted to confirm the feasibility and comprehension of the scale. To validate the PNSS-MP, 223 mothers of preterm infants were surveyed. Exploratory factor analyses were performed to confirm construct validity. Convergent and discriminant validity were analyzed using a multitrait-multimethod (MTMM) matrix. Reliability was tested by calculating Cronbach's alpha and performing split-half testing.

RESULTS

The PNSS-MP consisted of 27 items and was categorized into five factors, explaining 65.27% of the total variance. The factors were named: "baby care support" (7 items), "mental care support" (6 items), "maternal role support" (6 items), "introducing resources support" (4 items), and "information delivery support" (4 items). The overall reliability of the scale was .95.

CONCLUSION

The PNSS-MP adequately reflected the neonatal intensive care unit (NICU) in South Korea. Additionally, the PNSS-MP proved relatively valid and reliable; therefore, it can be used to measure nursing support in the NICU.

Signal Processing of Heart Rate for Predicting Sepsis in Premature Neonates

The heart rate characteristic (HeRO score) is a figure derived from the analysis of premature neonate's electrocardiogram signals, and can be used to detect infection before the onset of clinical symptoms. The United States and Europe accept this diagnostic technique, but we require more tests to prove its efficacy. This method is not accepted in other developed countries so far. The present study aimed to investigate changes in the heart characteristics of two neonates in Akbar Abadi Hospital in Tehran. Experts chose one newborn as a sepsis case, and the other neonate was healthy. The results were analyzed and compared with previous studies. In this research, a group of five neonates was selected randomly from the neonatal intensive care unit, and cardiac leads were attached to them for recording heart rates. We selected two neonates from the five cases, as a case (proven sepsis) and control, to analyze heart rate variability (HRV). Then, we compared the differences in the heart rate of both neonates. Analysis of HRV of these two neonates showed that the pattern of HRV is compatible with reports from US studies. Considering the results of this study, heart rates and their analysis can provide useful indicators for mathematical modeling before the onset of clinical symptoms in newborns.

Implementing Family-Centered Care in the Neonatal Intensive Care Unit - A Quality Improvement Initiative

OBJECTIVE

The present study aims to implement family-centered care (FCC) in neonatal intensive care unit (NICU). FCC facilitates mother-infant bonding with benefits for both families and health system. The authors used quality-improvement (QI) methods to implement FCC in level-2 NICU from an existing baseline of 30% to 80% over a period of 6 mo.

METHODS

Using the Institute of Healthcare model for improvement, the authors implemented strategies for family participation in caregiving activities, oral feeding and kangaroo care for neonates admitted in level-2 NICU. Eligibility criteria included the availability of at least one family member, preferably the mother for at least 6 h/d and a stable neonate based on physiological criteria irrespective of gestational age. The key interventions were: (1) adoption of a unit protocol for FCC with expanded visitation hours; (2) parental education through audio-visual aids, and (3) capacity building through training and peer support.

RESULT

Between August 2019 and January 2020, 1587 neonates were admitted to the NICU and 505 admitted in level-2 were enrolled. The proportion of eligible mother-infant dyads participating in FCC increased from a baseline of 32% to 44% during intervention and to 66% in the postintervention phase. The number of days per month FCC was tracked increased from 67% in the baseline to 82% in postintervention phase. There was no increase in the incidence of sepsis after implementation of FCC.

CONCLUSION

Orientation of parents to FCC using audio-visual aids, provision of hands-on training and peer-support facilitated them to become active participants in their neonates' care.

Why are pollution damages lower in developed countries? Insights from high-Income, high-particulate matter Hong Kong

Conventional wisdom suggests that marginal damages from particulate matter pollution are high in less-developed countries because they are highly polluted. Using administrative data on the universe of births and deaths, we explore birthweight and mortality effects of gestational particulate matter exposure in high-pollution yet high-income Hong Kong. The marginal effects of particulates on birthweight are large but we fail to detect an effect on neonatal mortality. We interpret our stark mortality results in a comparative analysis of pollution-mortality relationships across studies. We provide early evidence that marginal mortality damages from pollution are high in less-developed countries because they are less developed, not because they are more polluted.

What is stopping us? An implementation science study of kangaroo care in British Columbia's neonatal intensive care units

BACKGROUND

The goal of the Neonatal Intensive Care Unit (NICU) is to provide optimal care for preterm and sick infants while supporting their growth and development. The NICU environment can be stressful for preterm infants and often cannot adequately support their neurodevelopmental needs. Kangaroo Care (KC) is an evidence-based developmental care strategy that has been shown to be associated with improved short and long term neurodevelopmental outcomes for preterm infants. Despite evidence for best practice, uptake of the practice of KC in resource supported settings remains low. The aim of this study was to identify and describe healthcare providers' perspectives on the barriers and enablers of implementing KC.

METHODS

This qualitative study was set in 11 NICUs in British Columbia, Canada, ranging in size from 6 to 70 beds, with mixed levels of care from the less acute up to the most complex acute neonatal care. A total of 35 semi-structured healthcare provider interviews were conducted to understand their experiences providing KC in the NICU. Data were coded and emerging themes were identified. The Consolidated Framework for Implementation Research (CFIR) guided our research methods.

RESULTS

Four overarching themes were identified as barriers and enablers to KC by healthcare providers in their particular setting: 1) the NICU physical environment; 2) healthcare provider beliefs about KC; 3) clinical practice variation; and 4) parent presence. Depending on the specific features of a given site these factors functioned as an enabler or barrier to practicing KC.

CONCLUSIONS

A 'one size fits all' approach cannot be identified to guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers to its uptake. Support for improving parental presence, shifting healthcare provider beliefs, identifying creative solutions to NICU design and space constraints, and the development of a provincial guideline for KC in NICUs may together provide the impetus to change practice and reduce barriers to KC for healthcare providers, families, and administrators at local and system levels.

Adaptation of the parent readiness for hospital discharge scale with mothers of preterm infants discharged from the neonatal intensive care unit

AIMS AND OBJECTIVES

To evaluate the psychometric properties of a new Persian translation of the Readiness for Hospital Discharge Scale.

BACKGROUND

Globally, one in 10 newborns are born preterm and many require care in a neonatal intensive care unit (NICU). A primary role of NICU nurses is to assure parents are well prepared to take their newborns home from the hospital. Assessment of parent perception of discharge readiness provides important input into discharge decisions. The availability of reliable and valid instruments tested within the geographical and cultural context is needed for a comprehensive assessment of predischarge readiness, so that parent needs can be identified and the necessary interventions designed and implemented.

DESIGN

This psychometrics study included a convenience sample of 200 mothers with preterm infants being discharged from the NICU of Shahid Sadoughi Hospital in Yazd, Iran. The original 29-item version of the Readiness for Hospital Discharge Scale-Parent questionnaire was translated into Persian using the standard forward-backward method. Face, content and construct validity (principal components analysis), and reliability (internal consistency-Cronbach's alpha) were assessed. Methods followed STROBE criteria as applicable (see Appendix S1).

RESULTS

The content validity index and content validity ratio were both 0.93. Construct validity testing identified 6 factors (mother and infant physical-psychological readiness, expected support, knowledge of future events and care, knowledge of infant personal care, pain and therapeutic interventions). Using Cronbach's alpha coefficient, the reliability of the whole instrument was estimated to be 0.87.

CONCLUSION

The Persian Readiness for Hospital Discharge-Parental Form for use with mothers of preterm infants being discharged from an Iranian NICU has acceptable validity and reliability.

RELEVANCE TO PRACTICE

This tool can be used before discharge to determine the needs of mothers and design the necessary measures to improve quality of discharge care.

Fecal Volatile Organic Compound Profiles are Not Influenced by Gestational Age and Mode of Delivery: A Longitudinal Multicenter Cohort Study

Fecal volatile organic compounds (VOC) reflect human and gut microbiota metabolic pathways and their interaction. VOC behold potential as non-invasive preclinical diagnostic biomarkers in various diseases, e.g., necrotizing enterocolitis and late onset sepsis. There is a need for standardization and assessment of the influence of clinical and environmental factors on the VOC outcome before this technique can be applied in clinical practice. The aim of this study was to investigate the influence of gestational age (GA) and mode of delivery on the fecal VOC pattern in preterm infants born below 30 weeks of gestation. Longitudinal fecal samples, collected on days 7, 14, and 21 postnatally, were analyzed by an electronic nose device (Cyranose 320^®). In total, 58 preterm infants were included (29 infants born at GA 24–26 weeks vs. 29 at 27–29 completed weeks, 24 vaginally born vs. 34 via C-section). No differences were identified at any predefined time point in terms of GA and delivery mode (p > 0.05). We, therefore, concluded that correction for these factors in this population is not warranted when performing fecal VOC analysis in the first three weeks of life.

Assessment of educational performance of nurses in neonatal intensive care unit from parents' perspective

INTRODUCTION

One of the key elements in family-centered care is educating parents with hospitalized infant at intensive care unit. Education is a fundamental role of nursing at intensive care units to satisfy parents and accelerate disease progression that eventually reduces hospital re-admission.

MATERIALS AND METHODS

This was a cross-sectional study conducted in 2018, and the study population was admitted infants (n = 90) in the neonatal intensive care unit (NICU) of Shahid Beheshti University of Medical Sciences hospitals. We used a questionnaire including sociodemographic characteristics and performance of nurses in educating parents. Nurses' performance was assessed in five major areas composed of family-centered care, delivering cares according to individualized needs, education on equipment, basic needs of infants, and finally, nutritional education. All statistical analyses were conducted using SPSS version 22. The data were analyzed using t-test, ANOVA, and nonparametric tests.

RESULTS

Findings from the current study indicated that nurses performed their educational role weakly (37% of standard level). We also found that nurses who participated in neonatal educational courses had better performance compared to their counterparts. The results showed that year of experiences working as a clinical nurse was significantly associated (P < 0.05) with performing standard education.

CONCLUSION

Our findings indicated that nurses performed their educational role weakly which might be due to staff shortage, heavy workload, and lack of time for educating parents. Therefore, it is necessary to improve the quality of education among nurses working at the NICUs and provide the necessary standards and indicators to evaluate this important task.