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Haddad RN, Bonnet D, Malekzadeh-Milani S. Early spontaneous closure of large arterial ducts in two term neonates with Ebstein anomaly after failed attempts of transcatheter closure. Cardiol Young 2023; 33:1726-1729. [PMID: 36918290 DOI: 10.1017/s1047951123000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
In neonatal Ebstein's anomaly of the tricuspid valve, prolonged ductal patency in patients without anatomic pulmonary valve atresia can be deleterious. Circular shunts may develop in patients with different degrees of pulmonary and tricuspid insufficiency. Closure of the arterial duct may result in haemodynamic improvement in particular scenarios. The transcatheter approach is a valuable closure alternative despite some technical difficulties in large-sized arterial ducts and low birth weight neonates. Herein, we report on two consecutive term newborns with Ebstein's anomaly and large arterial ducts in whom mechanical stimulus of the arterial duct during failed attempts of transcatheter closure led after two days to definitive closure followed by good clinical outcomes.
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Affiliation(s)
- Raymond N Haddad
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Küçüktepe A, Canbulat Şahiner N. The effect of regional massage performed before blood collection on pain and vital signs in newborns. J Paediatr Child Health 2023; 59:660-666. [PMID: 36755524 DOI: 10.1111/jpc.16368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/12/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023]
Abstract
AIM This randomised-controlled trial aims to examine the effect of regional massage performed before blood collection on pain and vital signs in term newborns. METHODS The study sample consisted of a total of 96 term newborns, 49 in the experimental group and 47 in the control group, in the neonatal intensive care unit (NICU). Before the blood collection process, those in the experimental group received two (2) minutes of massage on their blood collection region, and their pain levels and vital signs were observed. Data were collected using a newborn information form, an intervention follow-up form, and the Neonatal Infant Pain Scale (NIPS). Statistical analyses of the collected data included descriptive statistics, Chi-squared test, independent-samples t test, paired-samples t test and Cohen's kappa statistic. A value of P < 0.05 was considered statistically significant. RESULTS While 51% (n = 49) of the newborns were included in the experimental group, 38.5% (n = 37) were born at the 38th gestational week. Their mean post-natal age was 4.82 ± 4.04 days. The newborns in the experimental and control groups had similar demographic characteristics and blood collection experiences, and there was no statistically significant difference between them (P > 0.05). The mean crying time in the control group (56.9 ± 25.4 s) was significantly longer than that in the experimental group (30.6 ± 29.3 s) (P < 0.05). The newborns in the experimental group had shorter crying times, lower pain levels and heart rate, and higher oxygen saturation than those in the control group. CONCLUSION The regional massage intervention reduced pain in term newborns. Therefore, neonatal nurses can be trained to use massage as an alternative infant care practice.
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Affiliation(s)
- Ayşe Küçüktepe
- Neonatal Intensive Care Unit, Karaman Training and Research Hospital, Karaman, Turkey
| | - Nejla Canbulat Şahiner
- Nursing Department, Karamanoglu Mehmetbey University Health Science Faculty, Karaman, Turkey
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Shen J, Shen M, Jin A. Application of breast milk smears in umbilical care of full- term newborn. Biotechnol Genet Eng Rev 2023:1-11. [PMID: 36600526 DOI: 10.1080/02648725.2022.2163816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023]
Abstract
With the continuous innovation of digital technology in my country at this stage and the design of medical imaging technology systems, the depth and breadth of the development of digital medical imaging technology have been greatly expanded. This paper focus on application of medical images in breast milk smearing of the umbilical nursing for full-term newborns. OBJECTIVE To explore the effect of breast milk application in umbilical nursing of full-term newborns. METHODS 596 full-term newborns were divided into three groups: Experimental Group, Control Group A and Control Group B, Experimental Group A treated with breast milk, control group a treated with 75% alcohol, and control group B treated with 37 ~ 42°C warm boiled water, the time of umbilical cord abscission, infection and other complications were compared among the three groups. The process was recorded by images. RESULTS According to the images, compared with the Control Group A and B, the experimental group significantly shortened the time of umbilical cord shedding, the difference was statistically significant (p < 0.001). CONCLUSION The application of breast milk in umbilical region of full-term neonates can reduce the time of umbilical cord abscission without increasing the incidence of Omphalitis.
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Affiliation(s)
- Jie Shen
- Department of Delivery Room, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Minhong Shen
- Department of Delivery Room, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Aiying Jin
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
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Ohns MJ. Necrotizing Enterocolitis in a Term Newborn: A Case Report. J Pediatr Health Care 2022; 36:598-602. [PMID: 36058818 DOI: 10.1016/j.pedhc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
This case report describes a 5-day-old term infant with necrotizing enterocolitis (NEC). The clinical presentation, diagnostic reasoning, current literature, hospital course, and follow-up are discussed. Necrotizing enterocolitis is a gastrointestinal emergency characterized by severe inflammation and ischemic necrosis of the intestinal mucosa. Usually a condition of prematurity, NEC primarily occurs in very low birth weight premature infants. Necrotizing enterocolitis can be managed medically or surgically, depending on the severity. Although the etiology of NEC is unknown, the clinical presentation includes abdominal distention and tenderness, feeding intolerance, grossly bloody stools, and severe hypotension and acidosis.
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Ristovska S, Stomnaroska O, Danilovski D. Hypoxic Ischemic Encephalopathy (HIE) in Term and Preterm Infants. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:77-84. [PMID: 35451288 DOI: 10.2478/prilozi-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hypoxic-ischemic syndrome (HIS) and Hypoxic-ischemic encephalopathy (HIE) are conditions that affect term and premature babies, with different pathophysiology and different brain disorders. HIE appears in 1-6 / 1000 live births and 26/1000 live births in developing countries. 15-20% die in the early neonatal period, while surviving babies have severe neurological impairment, including cerebral palsy, epilepsy, visual and hearing impairment, cognitive impairment, intellectual, behavioural, and social disorders. The hypoxic-ischemic event occurs before, during or after birth. The reasons may be related to the mother, the way of birth, the placenta, and the newborn. The criteria for diagnosis of HIE include a combination of perinatal factors, the need for resuscitation, standard neurological examinations, neurophysiological monitoring, neuroimaging methods and biochemical markers. The most effective treatment for HIE is hypothermia in combination with pharmacological therapy. HIE and HIS are problem that still persist in developing countries due to inadequate obstetric care, neonatal resuscitation, and hypothermia. Current and emerging research for HIE examines new markers for early recognition, treatment, and appropriate neuroprotection of high-risk term and premature infants.
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Mohy Eldeen S, Ali S, Salama H. Clinical characteristics, diagnosis, and management outcome of surfactant deficiency respiratory distress syndrome in term and near-term neonates. A retrospective observational study. Acta Biomed 2022; 93:e2022337. [PMID: 36533740 PMCID: PMC9828914 DOI: 10.23750/abm.v93i6.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 01/21/2023]
Abstract
AIM This study aims to describe the clinical characteristics of SRDS in term and late preterm neonates. METHODS This is an observation retrospective chart review of full-term and late preterm neonates born older than 35 to 41 weeks gestation age diagnosed with SRDS. The diagnosis was based on clinical & radiological manifestations of SRDS. RESULTS 1547 neonates were admitted during this period to NICU with a diagnosis of increased work of breathing for further management. 117 cases of term and near-term neonates (mean GA = 36.8 wks) had a confirmed diagnosis of Surfactant deficiency SRDS. Who compared 60 preterm neonates with SRDS less than 35 weeks gestation (mean GA 27.5 wks) as a control. The mean birth weight was 2.8 kg vs 1.1 kg in the preterm group. SRDS occurs more among the male gender (58%), with CS in 78.6 % of all diagnosed cases. No apparent cause was found in 28.2 %, while 37.6% of all cases were born to mothers with diabetes mellitus, and 27% were born to mothers with either GBs infection, maternal chorioamnionitis, or prolonged rupture of the membrane. CONCLUSION SRDS is not uncommon among full-term and near-term neonates (10/1000 live birth). By far, the most common associated risk factors are maternal diabetes mellitus and cesarean section. It affects males more than females. Most cases will run a mild-to-moderate course that responds to non-invasive ventilation.
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Oumer M, Tazebew A, Alemayehu M. Anterior Fontanel Size Among Term Newborns: A Systematic Review and Meta-Analysis. Public Health Rev 2021; 42:1604044. [PMID: 34692179 PMCID: PMC8386755 DOI: 10.3389/phrs.2021.1604044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Anterior fontanel is an integral element of an infant craniofacial system. There are six fontanels in the newborn skull, namely anterior, posterior, two mastoid, and two sphenoid fontanels. The anterior fontanel is the largest, prominent, and most important for clinical evaluation. Sex, race, genetics, gestational age, and region are the principal factors that influence anterior fontanel size. There exist inconclusive findings on the size of anterior fontanel in newborns. Therefore, this systematic review and meta-analysis aimed to determine the pooled mean size of anterior fontanel among term newborns and to identify the pooled mean difference of anterior fontanel size between males and females. Methods: PubMed/Medline, Google Scholar, Science Direct, JBI Library, embase, and Cochrane Library databases were systematically searched. All essential data were extracted using a standardized data extraction format. The heterogeneity across studies was assessed using the Cochrane Q test statistic, I2 test statistic, and p-values. A fixed-effect model and random effect model were used to estimate the pooled mean size of anterior fontanel and the pooled mean difference between male newborns and female newborns, respectively. To deal with heterogeneity, sub-group analysis, meta-regression analysis, and sensitivity analysis were considered. JBI quality appraisal checklist was used to evaluate the quality of studies. Results: In this meta-analysis, 8, 661 newborns were involved in twenty-six studies. Among studies, 13 conducted in Asia, 7 in Africa, 5 in America, and 1 in Europe. The pooled mean size of anterior fontanel was 2.58 cm (95% CI: 2.31, 2.85 cm). The pooled mean size of anterior fontanel for Asia, Africa, America, and Europe region was 2.49, 3.15, 2.35, and 2.01 cm, respectively. A statistically significant mean difference was detected between male and female newborns (D + L pooled MD = 0.15 cm, 95% CI: 0.02, 0.29 cm). Conclusion: The pooled estimate of this review does provide the mean value of the anterior fontanel size in the newborns. There was a statistically significant mean fontanel size difference between male and female newborns. Therefore, male newborns had a significantly larger mean size than female newborns.
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Affiliation(s)
- Mohammed Oumer
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Department of Epidemiology, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Tazebew
- Departments of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekuriaw Alemayehu
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sardar S, Pal S, Mishra R. A randomized controlled trial of restricted versus standard fluid management in late preterm and term infants with transient tachypnea of the newborn. J Neonatal Perinatal Med 2021; 13:477-487. [PMID: 32444567 DOI: 10.3233/npm-190400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transient tachypnea of the newborn(TTNB) is the most common respiratory morbidity in late preterm and term babies and is pathophysiologically related to delayed lung fluid clearance after birth. Mimicking low physiological fluid intake in the initial period of life may accelerate the recovery from TTNB. In a randomized controlled trial, we compared the roles of restricted versus standard fluid management in babies with TTNB requiring respiratory support. METHODS This parallel group,non-blinded, stratified randomized controlled trial was conducted in a level III neonatal unit of eastern India. Late preterm and term babies with TTNB requiring continuous positive airway pressure (CPAP) were randomly allocated to standard and restricted fluid arms for the first 72 hours (hrs). Primary outcome was CPAP duration. RESULTS In total, 100 babies were enrolled in this study with 50 babies in each arm. CPAP duration was significantly less in the restricted arm (48[42, 54] hrs vs 54[48,72] hrs, p = 0.002). However, no difference was observed in the incidence of CPAP failure between the two arms. In the subgroup analysis, the benefit of reduced CPAP duration persisted in late preterm but not in term infants. However, the effect was not significant in the late preterm babies exposed to antenatal steroid. CONCLUSION This trial demonstrated the safety and effectiveness of restrictive fluid strategy in reducing CPAP duration in late preterm and term babies with TTNB. Late preterm babies, especially those not exposed to antenatal steroid were the most benefitted by this strategy.
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Affiliation(s)
- S Sardar
- Department of Neonatology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - S Pal
- Department of Neonatology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - R Mishra
- Department of Physiology, Ananda Mohan College, University of Calcutta, Kolkata, India
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Tran HT, Nguyen TT, Giang HTN, Huynh LT, Barnett D, Mathisen R, Murray JCS. Factors Associated with the Use of Pasteurized Donor Milk for Healthy Newborns: Experience from the First Human Milk Bank in Vietnam. Nutrients 2021; 13:nu13041151. [PMID: 33807207 PMCID: PMC8066195 DOI: 10.3390/nu13041151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Pasteurized donor milk (PDM) is typically prescribed to preterm or low birthweight newborns when their mother’s own milk is unavailable. In surplus, PDM is prescribed to meet the nutritional needs of healthy newborns in the first few days of life. However, its overuse can undermine efforts to promote and support breastfeeding, waste resources, and reduce the availability of PDM for at-risk newborns. We conducted this study to examine factors associated with the prescription and prolonged use (>48 h) of privately purchased PDM to healthy newborns. Methods: Prospective observational study of 2440 mothers of healthy, term, and normal birthweight newborns born at Da Nang Hospital for Women and Children between April and August 2019. In addition to the descriptive analysis, we performed multiple logistic regressions to examine factors associated with the prescription of PDM (n = 2440) and prolonged PDM use among those who used PDM (n = 566). Results: Twenty-three percent (566/2440) of healthy, term, and birthweight ≥2500 g newborns received PDM and were included in the study. The prevalence of PDM use was higher for cesarean births (OR: 2.05; 95% CI: 1.66, 2.55) and among male newborns (OR: 1.33; 95% CI: 1.09, 1.62), but lower for farmers or workers (vs. other jobs; OR: 0.71; 95% CI: 0.54, 0.93), family income <10 million VND (vs. ≥10 million VND; OR: 0.67; 95% CI: 0.55, 0.82), and duration of skin-to-skin ≥90 min (vs. <90 min; OR: 0.54; 95% CI: 0.39, 0.76). Prolonged PDM use (12.4% of 566 newborns who used PDM) was associated with the mother having a higher socioeconomic status job (professional, small trader or homemaker; OR: 4.00; 95% CI: 1.39, 12.5), being a first-time mother (OR: 3.39; 95% CI: 1.92, 6.01) or having a cesarean birth (OR: 2.09; 95% CI: 1.02, 4.28). Conclusions: The prescription and prolonged use of privately purchased PDM was associated with non-medical factors unrelated to the ability to breastfeed effectively. The findings suggest the need for improved breastfeeding communication, counseling and support skills for health staff, development, and application of strict criteria on PDM use for healthy newborns and better routine monitoring of PDM use over time.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang 50506, Vietnam;
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam
- Correspondence: ; Tel.: +84-903-543-115
| | - Tuan T Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (T.T.N.); (R.M.)
| | - Hoang Thi Nam Giang
- International Cooperation and Scientific Research Office, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam;
| | - Le Thi Huynh
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang 50506, Vietnam;
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam
| | - Debbie Barnett
- Milk Bank Scotland, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK;
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (T.T.N.); (R.M.)
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Sarici SU, Ozcan M, Akpinar M, Altun D, Yasartekin Y, Koklu E, Serdar MA, Sarici D. Transcutaneous Bilirubin Levels and Risk of Significant Hyperbilirubinemia in Early-Term and Term Newborns. J Obstet Gynecol Neonatal Nurs 2021; 50:307-315. [PMID: 33684342 DOI: 10.1016/j.jogn.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare the course of the transcutaneous bilirubin (TcB) values of early-term newborns with those of term newborns in the first month of life and to investigate whether early-term newborns have an increased risk of significant hyperbilirubinemia requiring treatment. DESIGN A prospective, controlled cohort analysis. SETTING A tertiary level mother-child birth and health care center. PARTICIPANTS Four hundred early-term (37 0/7 to 38 6/7 weeks) and 320 term (39 0/7 to 41 6/7 weeks) newborns born during a 27-month period. METHODS A total of six TcB measurements in a longitudinal manner were made in early-term and term newborns: the first two at 6 and 48 hours after birth and the next four on routine examination days (Days 4, 7, 15, and 30). Demographic characteristics, values of daily TcB measurements, number of newborns with significant hyperbilirubinemia, and risk of jaundice requiring treatment were compared between the two groups. RESULTS All six TcB values were significantly greater in the early-term group than in the term group (p < .001 for each). Early-term newborns had a statistically significant increased risk of jaundice requiring treatment compared to term newborns (risk ratio = 1.91; 95% confidence interval [1.23-2.96]; p = .0046). Results of the repeated-measures analysis of variance and post hoc adjusted multiple comparison analysis showed that TcB levels increased to and peaked at 96 hours after birth and then gradually decreased to baseline (first measurement) levels at 30 days after birth in each group. CONCLUSIONS Early-term newborns should not be treated as full-term newborns because they have significantly higher TcB levels. These newborns should be closely monitored for pathologic jaundice because they have increased risk for significant hyperbilirubinemia requiring phototherapy.
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Abstract
Purpose: This study was carried out to assess the effect of the odor of breast milk and formula milk on reducing the acute pain of newborn infants during the heel-prick blood sampling. Methods: Eighty-four newborn were randomly assigned into two groups (formula milk group and breast milk group) with 42 infant searches. The pain that the newborn felt before, during, and after heel-prick blood sampling was assessed using Neonatal Infant Pain Scale; their heart rate and blood oxygen saturation were measured with a pulse oximeter. Saliva samples were taken from newborns before and after sampling, and their salivary cortisol level was measured. During sampling, the crying duration of newborn was recorded with a chronometer. Results: The pain threshold and heart rates of the newborn in the breast milk group were significantly lower than those in the formula milk group (p < 0.001). Salivary cortisol in the formula milk group increased and oxygen saturation levels in these infants decreased significantly more as compared to the breast milk group (p < 0.05). Conclusions: The odor of breast milk may be helpful in reducing the pain of newborn during heel-prick blood sampling.
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Affiliation(s)
- Bircan Tasci
- Department of Paediatric Nursing, Institute of Health Sciences, Bülent Ecevit University, Zonguldak, Turkey
| | - Tülay Kuzlu Ayyildiz
- Department of Paediatric Nursing, Institute of Health Sciences, Bülent Ecevit University, Zonguldak, Turkey
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Burgmann DM, Foerster K, Klemme M, Delius M, Hübener C, Wisskott R, Boulesteix AL, Flemmer AW. Delivery room desaturations and bradycardia in the early postnatal period of healthy term neonates - a prospective observational study. J Matern Fetal Neonatal Med 2020; 35:1457-1461. [PMID: 32375581 DOI: 10.1080/14767058.2020.1757064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE It has been suggested that desaturations and bradycardia precede acute life-threatening events (ALTE) and that ALTE is more common in the delivery room than later in life. However, frequency, duration and severity of desaturations in the first hours of life and additional risk factors have not readily been studied. METHODS Term neonates (n = 100) were monitored for the first two hours after birth by pulse oximetry. The impact of maternal and perinatal factors on the frequency and severity of desaturations (<85%) and bradycardia (<80/min) was evaluated. RESULTS Desaturations were detected in 30%, prolonged desaturations in 25% of infants. Desaturations were observed significantly more often in infants born by planned Cesarean section (pCs) compared to other modes of delivery (pCs 20/49; others 10/51; p = .029). Desaturations were also more frequent in infants diagnosed with neonatal infection (NI) or infants born to a mother with gestational diabetes (GDM), although not significantly. No bradycardia <80/min was detected. CONCLUSIONS In our collective 4% of healthy term neonates had prolonged, clinically relevant desaturations in the first hours after birth. The mode of delivery and maternal risk factors may increase the risk for these events. However, our cohort was too small to detect any ALTE or SIDS and determine potential risk factors for these events. Our data lay ground for a large-scale prospective trial to investigate whether the mode of delivery could be an indication for general pulse oximetry monitoring of newborn in the delivery room.
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Affiliation(s)
- D-M Burgmann
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - K Foerster
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - M Klemme
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - M Delius
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - C Hübener
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - R Wisskott
- Department of Medical Information Processing, Biometry and Epidemiology, University Hospital, LMU Munich, Munich, Germany
| | - A L Boulesteix
- Department of Medical Information Processing, Biometry and Epidemiology, University Hospital, LMU Munich, Munich, Germany
| | - A W Flemmer
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
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Havranek T, Shatzkin E, Chuang M, Xie X, Kim M, Rosen O. Respiratory outcomes after neonatal prone versus supine positioning following scheduled cesarean delivery: a randomized trial. J Matern Fetal Neonatal Med 2019; 34:2938-2944. [PMID: 31564177 DOI: 10.1080/14767058.2019.1674805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prone positioning is a common practice after vaginal birth promoting skin to skin contact and has been associated with improved oxygenation in mechanically ventilated neonates in the recent analysis. Neonates of women not in labor delivered via C-section are at increased risk of respiratory distress; it is unclear whether vigorous neonates without a need of resuscitation would benefit from prone positioning immediately after birth. OBJECTIVE To determine whether prone positioning of vigorous term neonates for the first 5 min after scheduled cesarean delivery will decrease the incidence of respiratory distress and therapeutic interventions, characterized by the frequency and duration of respiratory support (RS). DESIGN/METHODS In a single center, randomized parallel clinical trial, vigorous term neonates delivered via scheduled cesarean delivery were positioned prone or supine and their heart rate, oxygen saturation and signs of respiratory distress were recorded at 1-min intervals for the first 5 min. Infants not reaching target oxygen saturations suggested by the neonatal resuscitation guidelines received RS via Neopuff in supine position; respiratory support was discontinued once oxygen saturation targets were met and infant was free of respiratory symptoms. Primary outcomes measured were frequency and duration of RS, secondary outcomes were admission to the NICU for respiratory distress, length of stay, heart rate and oxygen saturation during the initial 5 min of life. RESULTS Two hundred twenty-five neonates in prone and 231 in supine position completed the study out of 500 randomized subjects. Frequency of RS (31 versus 30%, p = .93), mean RS duration (4.08 versus 4.39 min; p = .71), frequency of admission to the NICU (5% in both groups; p = .95) and mean length of stay (0.14 versus 0.28 days; p = .42) were similar between the prone and supine groups. The supine cohort had higher initial oxygen saturation (p = .02) as well as heart rate (p = .004). CONCLUSIONS Prone or supine positioning of term neonates after scheduled cesarean delivery resulted in comparable respiratory outcomes including the need for resuscitation in the first minutes of life.
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Affiliation(s)
- Tomas Havranek
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Ellen Shatzkin
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Meleen Chuang
- Department of OB/GYN Women's Health/Montefiore, Bronx, NY, USA
| | - Xianhong Xie
- Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mimi Kim
- Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Orna Rosen
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
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DiCioccio HC, Ady C, Bena JF, Albert NM. Initiative to Improve Exclusive Breastfeeding by Delaying the Newborn Bath. J Obstet Gynecol Neonatal Nurs 2019; 48:189-96. [PMID: 30677407 DOI: 10.1016/j.jogn.2018.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To examine whether delayed newborn bathing would increase rates of in-hospital exclusive breastfeeding and plans to use human milk at discharge. DESIGN A retrospective, two-group, pre- and postintervention design. SETTING/LOCAL PROBLEM At our facility, the initial bath was completed within 2 hours of birth, and the rate of in-hospital exclusive breastfeeding was low. PARTICIPANTS Couplets of mothers and healthy newborns (N = 996). INTERVENTION/MEASUREMENTS Newborn baths were delayed at least 12 hours after birth. Pre- and postintervention data were retrieved from the hospital's electronic medical record and administrative database. Univariate and multivariate analyses were completed. RESULTS Of 996 mother-newborn couplets, 448 were preintervention couplets and 548 were postintervention couplets. Of all mothers, 63.3% were White, 67.8% were married, and 67.1% gave birth vaginally. Of all newborns, 49.6% were female, and the mean (standard deviation) birth weight was 3.3 kg (0.50). We found no differences in maternal or newborn characteristics by group. Median (25th percentile, 75th percentile) times from birth to first bath before and after the intervention were 1.9 (1.6, 2.3) and 17.9 (11.9, 25.0) hours, respectively (p < .001). In-hospital exclusive breastfeeding increased from 59.8% before the intervention to 68.2% after the intervention (p = .006). In multivariate modeling, in-hospital exclusive breastfeeding increased for all couplets after the intervention (odds ratio = 1.49, 95% confidence interval [1.14, 1.96]; p = .004) and with vaginal versus cesarean birth (odds ratio = 1.60, 95% confidence interval [1.14, 2.25]; p = .006). In addition, the postintervention discharge feeding plan reflected an increase in use of human milk. CONCLUSION Delaying the newborn bath was associated with increased in-hospital exclusive breastfeeding rates and use of human milk as a part of the discharge feeding plan.
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Jefferson UT, Bibb D. A Breastfeeding Algorithm to Guide Bedside Health Care Practice for Term Newborns. Nurs Womens Health 2019; 23:49-58. [PMID: 30562477 DOI: 10.1016/j.nwh.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/16/2018] [Accepted: 11/01/2018] [Indexed: 11/20/2022]
Abstract
Many women experience challenges with breastfeeding. The early postpartum period is a critical time to set a foundation for successful initiation of breastfeeding and to promote continued breastfeeding. Nurses need a quick reference guide for implementation of evidence-based strategies to promote breastfeeding for all mother-newborn dyads. This article describes the development and implementation of a breastfeeding algorithm based on clinical practices outlined in the revised 2018 Ten Steps to Successful Breastfeeding to guide bedside care for term newborns.
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López Gómez L, Marín Gabriel MA, Encinas B, de la Cruz Troca JJ, Rodríguez Marrodán B. Oxytocin Receptor Antagonist (Atosiban) in the Threat of Preterm Birth: Does It Have Any Effect on Breastfeeding in the Term Newborn? Breastfeed Med 2018; 13:123-128. [PMID: 29356563 DOI: 10.1089/bfm.2017.0206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Oxytocin is a hormone involved in the mechanism of breastfeeding, uterine contractions, and social relationships. Atosiban (competitive oxytocin antagonist) is one of the most commonly used tocolytics for the threat of preterm labor in Europe. The aim of this study is to determinate if the administration of atosiban has any influence in the type of feeding in the term newborn at discharge. The secondary objective is to verify its effectiveness for the prevention of preterm delivery and in the possibility of applying treatment to complete lung maturation. MATERIALS AND METHODS Retrospective cohort study carried out in a tertiary University Hospital distinguished by WHO-UNICEF as a Baby-Friendly Hospital Initiative. The analysis included 264 women exposed to atosiban during a period of 4 years. One hundred met inclusion criteria. Unexposed infants born right after and before the exposed ones were selected as the not exposed subgroup (n = 200). RESULTS Among women treated with atosiban, 82% maintained exclusively breastfed (EBF), 8% had mixed breastfeeding, and 10% had formula feeding at discharge. In the nonexposed group, 82% maintained EBF, 9.5% had mixed breastfeeding, and 8.5% had formula feeding at discharge (p = 0.84). 97.5% of pregnant women treated with atosiban received corticosteroid for lung maturation, and 49.5% completed gestation with term newborns. CONCLUSION There were no significant differences in the type of feeding at discharge between the atosiban group and the nonexposed group. In most cases, the administration of tocolytic therapy allowed to complete lung maturation.
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Affiliation(s)
| | - Miguel A Marín Gabriel
- 2 Department of Neonatology, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain .,3 Department of Pediatrics, Autónoma University , Madrid, Spain
| | - Begoña Encinas
- 4 Department of Obstetrics, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain
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Hishikawa K, Fujinaga H, Ito Y. Increased dead space in face mask continuous positive airway pressure in neonates. Pediatr Pulmonol 2017; 52:107-111. [PMID: 27333152 DOI: 10.1002/ppul.23506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 05/12/2016] [Accepted: 06/07/2016] [Indexed: 11/09/2022]
Abstract
THE OBJECTIVES Continuous positive airway pressure (CPAP) by face mask is commonly performed in newborn resuscitation. We evaluated the effect of face mask CPAP on system dead space. WORKING HYPOTHESIS Face mask CPAP increases dead space. STUDY DESIGN A CPAP model study. METHODOLOGY We estimated the volume of the inner space of the mask. We devised a face mask CPAP model, in which the outlet of the mask was covered with plastic; and three modified face mask CPAP models, in which holes were drilled near to the cushion of the covered face mask to alter the air exit. We passed a continuous flow of 21% oxygen through each model and we controlled the inner pressure to 5 cmH2 O by adjusting the flow-relief valve. To evaluate the ventilation in the inner space of each model, we measured the oxygen concentration rise time, that is, the time needed for the oxygen concentration of each model to reach 35% after the oxygen concentration of the continuous flow was raised from 21% to 40%. RESULTS The volume of inner space of the face mask was 38.3 ml. Oxygen concentration rise time in the face mask CPAP model was significantly longer at various continuous flow rates and points of the inner space of the face mask compared with that of the modified face mask CPAP model. CONCLUSIONS Our study indicates that face mask CPAP leads to an increase in dead space and a decrease in ventilation efficiency under certain circumstances. Pediatr Pulmonol. 2017;52:107-111. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kenji Hishikawa
- Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hideshi Fujinaga
- Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yushi Ito
- Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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18
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Treviño-Garza C, Villarreal-Martínez L, Estrada-Zúñiga CM, Leal-Treviño M, Rodríguez-Balderrama I, Nieto-Sanjuanero A, Cárdenas-Del Castillo B, Montes-Tapia FF, de la O-Cavazos M. Leptin, IL-6 and TNF-α levels in umbilical cord blood of healthy term newborns in relation to mode of delivery. J OBSTET GYNAECOL 2016; 36:719-721. [PMID: 27012976 DOI: 10.3109/01443615.2016.1148128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the development of the foetal immune system, cytokines play an important role in its function. Therefore, we sought to determine whether the mode of delivery affects the expression of leptin, IL-6 and TNF-α in umbilical cord blood in healthy term newborns. We collected 125 samples of umbilical cord blood to analyse leptin, IL-6 y TNF-α levels with multiplex immunoassay (MIA). The samples were classified according to mode of delivery: vaginal delivery (VD) and caesarean section (CS). Leptin and IL-6 had higher concentrations in umbilical cord blood in VD than in CS: 42.55 ng/ml (11.92-104.28) versus 35.20 ng/ml (3.26-9326.76), p = 0.039; 9.32 pg/ml (1.13-2020.31) versus 3.81 pg/ml (0.52-834.69) p < 0.001, respectively. Also, a weak correlation between TNF-α and IL-6 was found (r = 0.238, p = 0.007). The most important finding in our study was the differential concentrations of leptin and IL-6 according to mode of delivery.
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Affiliation(s)
| | | | | | - Mariana Leal-Treviño
- b Department of Gynaecology and Obstetrics , Dr. José E. González University Hospital, Universidad Autónoma De Nuevo León , Monterrey , Nuevo León , México
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Hishikawa K, Goishi K, Fujiwara T, Kaneshige M, Ito Y, Sago H. Pulmonary air leak associated with CPAP at term birth resuscitation. Arch Dis Child Fetal Neonatal Ed 2015; 100:F382-7. [PMID: 25854822 DOI: 10.1136/archdischild-2014-307891] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/12/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The Japan Resuscitation Council (JRC) Guidelines 2010 for neonatal resuscitation introduced continuous positive airway pressure (CPAP) in delivery room. The present study evaluated the effect of CPAP for pulmonary air leak at term birth. DESIGN, SETTING AND PATIENTS This retrospective single-centre study used the data of term neonates who were born without major congenital anomalies at our centre between 2008 and 2009, and between 2011 and 2012. INTERVENTIONS Resuscitation according to the JRC Guidelines 2010. MAIN OUTCOME MEASURES We examined the association between the JRC Guidelines 2010, CPAP by face mask and pulmonary air leak. RESULTS A total of 5038 infants were analysed. The frequency of CPAP by face mask increased after the update of the JRC Guidelines in 2010 (1.7% vs 11.1%; p<0.001). Pulmonary air leak increased at early term (37 weeks: 1.0% vs 3.5%, p=0.02; 38 weeks: 0.7% vs 2.2%, p=0.02). While adjusting for confounders, the JRC Guidelines 2010 was associated with pulmonary air leak in early-term neonates (37 weeks: adjusted OR (aOR) 4.37; 95% CI 1.40 to 17.45; 38 weeks: aOR 2.80; 95% CI 1.04 to 8.91), but this association disappeared while adjusting for face mask CPAP additionally (37 weeks: aOR 1.90; 95% CI 0.47 to 8.71; 38 weeks: aOR 1.66; 95% CI 0.54 to 5.77). CONCLUSIONS Following the update of the JRC guidelines on neonatal resuscitation, we observed an increased use of CPAP via face mask, which was associated with a higher prevalence of pulmonary air leak in early-term neonates in our centre.
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Affiliation(s)
- Kenji Hishikawa
- Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Keiji Goishi
- Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Developmental Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Masao Kaneshige
- Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yushi Ito
- Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, Newman TB, Zupancic J, Lieberman E, Draper D. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation. Pediatrics 2014; 133:30-6. [PMID: 24366992 PMCID: PMC4079292 DOI: 10.1542/peds.2013-1689] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To define a quantitative stratification algorithm for the risk of early-onset sepsis (EOS) in newborns ≥ 34 weeks' gestation. METHODS We conducted a retrospective nested case-control study that used split validation. Data collected on each infant included sepsis risk at birth based on objective maternal factors, demographics, specific clinical milestones, and vital signs during the first 24 hours after birth. Using a combination of recursive partitioning and logistic regression, we developed a risk classification scheme for EOS on the derivation dataset. This scheme was then applied to the validation dataset. RESULTS Using a base population of 608,014 live births ≥ 34 weeks' gestation at 14 hospitals between 1993 and 2007, we identified all 350 EOS cases <72 hours of age and frequency matched them by hospital and year of birth to 1063 controls. Using maternal and neonatal data, we defined a risk stratification scheme that divided the neonatal population into 3 groups: treat empirically (4.1% of all live births, 60.8% of all EOS cases, sepsis incidence of 8.4/1000 live births), observe and evaluate (11.1% of births, 23.4% of cases, 1.2/1000), and continued observation (84.8% of births, 15.7% of cases, incidence 0.11/1000). CONCLUSIONS It is possible to combine objective maternal data with evolving objective neonatal clinical findings to define more efficient strategies for the evaluation and treatment of EOS in term and late preterm infants. Judicious application of our scheme could result in decreased antibiotic treatment in 80,000 to 240,000 US newborns each year.
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Affiliation(s)
- Gabriel J. Escobar
- Kaiser Permanente Division of Research, and,Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California;,Department of Inpatient Pediatrics, Kaiser Permanente Medical Center, Walnut Creek, California
| | - Karen M. Puopolo
- Division of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Soora Wi
- Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California
| | - Benjamin J. Turk
- Kaiser Permanente Division of Research, and,Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California
| | - Michael W. Kuzniewicz
- Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California
| | - Eileen M. Walsh
- Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California
| | - Thomas B. Newman
- Division of Clinical Epidemiology, University of California, San Francisco, San Francisco, California
| | - John Zupancic
- Harvard Medical School, Boston, Massachusetts;,Beth Israel-Deaconess Medical Center, Boston, Massachusetts; and
| | - Ellice Lieberman
- Division of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
| | - David Draper
- Baskin School of Engineering, University of California, Santa Cruz, Santa Cruz, California
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