Journal of Neonatology

To develop and implement a discharge preparedness scale and protocol for preterm neonates in order to improve discharge preparedness by 25% from the pre-assessment, as measured by scores on the neonatal intensive care unit parent discharge preparedness scale (NICU-PDPS).

A quality improvement (QI) study using the plan, do, study, act (PDSA) model was conducted in the neonatal units of a tertiary care center in North India from July to October 2024. A total of 50 healthcare professionals (HCPs) and 80 parents of preterm neonates were enrolled. The study was conducted in three phases: pre-assessment, development of the protocol, and the implementation phase. Pre-assessment was done using the NICU-PDPS and the observation checklist. Focus group discussions (FGDs) were conducted with HCPs. Based on the pre-assessment and FGDs with HCPs and parents, root-cause analysis, the identified problems were placed in Eisenhower’s matrix, and discharge preparedness protocol development and implementation were chosen as a change. Three PDSA cycles were conducted. Adherence to the discharge preparedness protocol was measured by assessing scores on the NICU-PDPS and the observation checklist.

Discharge preparedness information provided to parents increased substantially, from 37.75% at baseline to 64.42% after the third PDSA cycle, reflecting a 26.6% improvement in the communication of essential information and skills by HCPs. The mean NICU-PDPS score also improved, rising from 80.6 at baseline to 128.2 after the third PDSA cycle.

The QI study has successfully improved the discharge preparedness for preterm neonates by enhancing the level of communication of essential information and skills to parents.

Metabolic bone disease (MBD) is an important cause of morbidity in preterms. Approximately 16%-40% of very low birth weight babies develop MBD. In low-income countries, its incidence may be higher.

To estimate the incidence of MBD in our population and to describe the clinical profile and the factors associated with it.

Study design: A prospective observational study. Study participants: All preterm babies born <32 weeks and admitted in the neonatal intensive care unit of a tertiary care center with parental consent for the study.

Incidence of MBD, clinical profile and factors associated with it.

The incidence of MBD was found to be 40%. 88.8% cases of MBD were detected at 2 weeks of postnatal age but as gestational age decreased, there was a trend for late presentation. 22.38% of babies did not respond in the initial 2 weeks of treatment. ≤28 weekers required more time for resolution. Multivariable analysis of the risk factors identified on univariate analysis showed delayed attainment of full feeds and delayed starting of mineral supplementation (>14 days) as the independent risk factors. Alkaline phosphatase was elevated only in 2.9% of cases. All anthropometric parameters showed a significant decrease in the MBD group at 40 weeks.

The incidence of MBD in ≤32 weekers in this study is similar to other studies from developed countries. In the majority, it will get manifested from 2 weeks of age. Progression to full feeds and starting of mineral supplementation should be addressed well.

Changes to parental presence and engagement in neonatal intensive care units (NICUs) during the COVID-19 pandemic were associated with marked reductions in direct breastfeeding among premature infants. Whether these rates have recovered following the removal of pandemic-related restrictions remains unclear. This study examined direct breastfeeding rates 1 year after the pandemic among premature infants admitted to a NICU.

A retrospective cohort study was conducted in a level II-III NICU. Sixty-four infants born at ≤34 weeks’ gestation whose mothers intended to breastfeed were included. Infants were grouped as pre-pandemic (n = 28), in-pandemic (n = 12), or post-pandemic (n = 24). The occurrence of direct breastfeeding at the first oral feeding attempt and at hospital discharge was evaluated.

There was a statistically significant difference in the proportion of infants receiving direct breastfeeds at hospital discharge across the three groups: 20/28 (71%) pre-pandemic, 1/14 (8%) in-pandemic, and 2/24 (8%) post-pandemic (p = .001).

Direct breastfeeding rates among premature infants have not returned to pre-pandemic levels despite the removal of visitation restrictions. These findings underscore the continued need for targeted parental engagement and lactation support strategies within NICUs.

Preterm neonates admitted to neonatal intensive care units (NICUs) frequently encounter challenges with breast milk feeding, which compromises their nutrition and immunity. This study aimed to improve colostrum availability for administration from a baseline of 10%-50% among preterm infants using some low-cost, quality improvement (QI) interventions.

A quasi-experimental pre- and post-test QI study was conducted between June 2023 and May 2024 in a Level III NICU in Northern India. After the initial baseline assessment, interventions including lactation counseling, posters, breast pumps, wrist tags, and tailored educational materials were cyclically implemented in four phases after an initial baseline phase. The study followed four Plan-Do-Study-Act (PDSA) cycles, including a sustenance phase involving a total of 432 participants. Key outcomes were colostrum expression within 6 h and exclusive breastfeeding rates at discharge.

The overall frequency of colostrum expression within the first 6 h increased significantly from 15.57% to 56.63% (P < .001) post-intervention, was further sustained at 75.67% during the sustainability phase, and the exclusive breastfeeding rates at discharge improved from 49.63% to 85.68% (P < .001). Subgroup analyzes further showed the absence of any disparities in outcomes based on either mode of delivery or maternal background, being rural or urban, highlighting the interventions’ adaptability and effectiveness.

Structured, low-cost QI strategies for proper implementation can significantly enhance early colostrum expression and exclusive breastfeeding rates in NICU settings. These findings highlight the need for such cost-effective interventions to improve neonatal outcomes in diverse healthcare setups, thereby providing a practical framework for improving neonatal outcomes in resource-limited environments.

Preterm neonates requiring noninvasive respiratory support are exposed to prolonged noxious stimuli, predisposing them to stress and adverse neurodevelopmental outcomes. Pharmacological interventions are limited by safety concerns, while nonpharmacological strategies, such as immediate Kangaroo Mother Care (iKMC), provide a promising alternative. However, evidence on iKMC’s effect on acute prolonged pain in ventilated preterm neonates is limited.

To assess acute prolonged pain in preterm neonates admitted to the neonatal intensive care unit using the Premature Infant Pain Profile (PIPP) scale at 12 and 72 h of noninvasive respiratory support, and to evaluate the role of iKMC in pain mitigation.

A prospective cohort study was conducted in preterm neonates (<37 weeks) requiring more than 72 h of noninvasive respiratory support. iKMC was initiated within 2 h of life as per protocol. Pain was assessed by the original PIPP scale at 12 and 72 h after initiating respiratory support, and cumulative iKMC hours were recorded. The exact timing of iKMC initiation (birth to skin-to-skin placement) was prospectively documented.

Of 276 neonates enrolled, 26 were excluded (16 required invasive ventilation; 10 became unstable, needing inotropes). Of the remaining cohort, 72% received continuous positive airway pressure, 18% heated humidified high flow nasal cannula, and 10% oxygen via nasal cannula. The mean PIPP score was 15.94 ± 1.719 at 12 h, significantly reducing to 5.70 ± 1.843 at 72 h with iKMC. The mean daily iKMC duration was 5.70 ± 1.843 h, and the mean initiation age was 1.75 ± 0.17 h (median 1.7 h). No neonate discontinued iKMC due to intolerance.

Preterm neonates on noninvasive respiratory support who received iKMC had significantly lower PIPP scores. iKMC appears to be a safe, feasible, and effective nonpharmacological intervention for reducing acute prolonged pain in this vulnerable population.

Elizabethkingia meningoseptica is an aerobic, Gram-negative bacterium commonly found in the environment and has emerged as a significant nosocomial pathogen, particularly in neonatal intensive care units (NICUs). It predominantly affects premature and immunocompromised neonates, causing meningitis, bacteremia, and pneumonia. The organism’s resistance to common antibiotics poses a challenge for effective treatment, with high mortality and long-term morbidity rates, including hydrocephalus and developmental delays.

This case series aims to highlight the clinical-laboratory profile, antibiotic resistance patterns, complications, and outcomes of neonatal meningitis caused by E. meningoseptica in a NICU setting, with a review of the literature. The case series includes six neonates with suspected or confirmed E. meningoseptica meningitis, spanning gestational ages from 29+1 weeks to 39 weeks. Clinical presentations varied, including poor feeding, lethargy, apnea, seizures, and fever.

All neonates were identified with E. meningoseptica infection either through blood or cerebrospinal fluid (CSF) analysis. Blood and CSF culture antibiotic susceptibility showed sensitivity/intermediate sensitivity to levofloxacin, minocycline, ciprofloxacin, and cefoperazone-sulbactam. Complications included hydrocephalus and seizures.

E. meningoseptica represents a significant neonatal pathogen with a high risk of neurological complications and mortality, especially in preterm neonates. The pathogen’s resistance to common antibiotics complicates treatment, emphasizing the need for timely diagnosis and tailored antibiotic therapy. This case series provides critical insights into the management of a sustained outbreak despite rigorous infection control measures and underscores the persistent challenges in environmental source identification. Therefore, early identification, appropriate treatment, and effective infection control are essential for improving neonatal outcomes in affected NICUs. Further research is also needed to refine treatment protocols and reduce long-term complications in affected neonates.