Ranibizumab for treatment of retinopathy of prematurity

Laser therapy has been a standard therapy for retinopathy of prematurity (ROP), but prior studies suggest that intravitreal injection of an anti-vascular endothelial growth factor (VEGF) agent may also be effective. In a trial of 225 infants with type I ROP, either intravitreal ranibizumab (IVR) or laser therapy achieved similarly high rates of ROP regression (>95 percent); infants receiving laser therapy had more unfavorable structural eye findings [13]. These results further support anti-VEGF therapy as an effective treatment for ROP that may be associated with a lower risk of ocular morbidity, although long-term safety and vision outcomes are needed. Based on current data, either modality is acceptable for treatment of ROP, and the choice depends on the medical stability of the infant, the ophthalmologist’s capability, and caregiver preferences. (See “Retinopathy of prematurity: Treatment and prognosis”, section on ‘Anti-vascular endothelial growth factor therapy’.)

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Targeted Staphylococcus aureus decolonization of parents of NICU infants

Staphylococcus aureus is an important cause of infection in the neonatal intensive care unit (NICU), and parents are a frequent source of exposure. In a randomized trial in two NICUs, S. aureus-colonized parents of over 200 NICU infants were assigned to five days of decolonization (intranasal mupirocin and chlorhexidine bathing) or placebo [12]. By the 90-day follow-up, infants with parents in the decolonization group had lower rates of concordant S. aureus colonization (15 versus 29 percent) or colonization with any strain of S. aureus (31 versus 46 percent) compared with placebo. Although targeted decolonization of parents is a promising strategy for prevention of S. aureus infection in NICU infants, additional studies are necessary before it can be routinely recommended. (See “Methicillin-resistant Staphylococcus aureus (MRSA) in children: Prevention and control”, section on ‘Neonatal intensive care unit’.)

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Development of the NEC-Zero Toolkit: Supporting Reliable Implementation of Necrotizing Enterocolitis Prevention and Recognition

The goal of the NEC-Zero project is to reduce the burden of necrotizing enterocolitis (NEC) by increasing access to evidence-based tools to help clinicians and parents integrate evidence into daily care. It involves (a) human milk feeding with prioritized mother’s own milk; (b) use of a unit-adopted standardized feeding protocol; (c) a unit-adopted strategy for timely recognition that integrates risk awareness and a structured communication tool when symptoms develop; and (d) stewardship of empiric antibiotics and avoidance of antacids. A toolkit for caregivers and parents was developed to make implementation consistent. For clinicians the toolkit includes: the GutCheckNEC risk score, a structured communication tool, the “Avoiding NEC” checklist, and the NEC-Zero website. For parents, NEC-Zero tools include the website, three educational brochures in English and Spanish, and a collaborative care video produced with the NEC Society. This article describes the toolkit and how it has been accessed and used.

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Walk with Me: A Bridge Program for Assisting Families Expecting Babies with Fetal Anomalies and/or a Terminal Diagnosis

When an expectant mother hears the news that her infant has a fetal anomaly, she may feel unsure of the future. A RN recognized the needs of women (and their families) expecting infants with critical fetal diagnoses and reached out to help them through their journey—through the pregnancy, delivery, and beyond. The act of walking alongside the mothers through their experience has grown into a formal program at a specialized children’s and womens’ hospital in the southeastern United States. This article describes the purpose of the program, how the program came into existence, and what services the program provides to this special population. The program continues to evolve, and the team members have worked with over 169 mothers to date.

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Oral Feeding in Preterm Infants: A Conceptual Model for Health Care Practitioners

Oral feeding competence is a critical milestone needed for proper growth and development in preterm infants. Commonly, the oral feeding process is conceptualized as an infant’s ability to coordinate suck–swallow–breathe. However, oral feeding is a highly complex multisystem process. In this article, an oral feeding model is presented that takes into consideration the intrinsic and extrinsic factors that influence oral feeding performances. The intrinsic neurophysiologic factors include the musculoskeletal, gastrointestinal, respiratory, cardiovascular, behavioral, and neurologic systems. The extrinsic environmental factors include the physical surroundings, NICU policies, parental attributes, health care practitioners, and feeding equipment. The objectives of this article are to (1) describe the intrinsic and extrinsic factors affecting oral feeding performance of preterm infants in the NICU, (2) introduce a conceptual model of oral feeding that displays the relationship between these factors, and (3) provide a reference guide for health care practitioners to refer to when evaluating an infant’s oral feeding performance.

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Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study

Perinatal decision-making affects outcomes for extremely preterm babies (22–26 weeks’ gestational age (GA)): more active units have improved survival without increased morbidity. The authors hypothesised such units may gain skills and expertise meaning babies at higher gestational ages have better outcomes than if they were born elsewhere. They examined mortality and morbidity outcomes at age two for babies born at 27–28 weeks’ GA in relation to the intensity of perinatal care provided to extremely preterm babies.

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Men’s grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model

Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men’s grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men’s grief, this systematic review sought to summarise and appraise the literature focusing on men’s grief following pregnancy loss and neonatal loss. The authors concluded that there is a need to increase the accessibility of support services for men following pregnancy/neonatal loss, and to provide recognition and validation of their experiences of grief. Cohort studies are required among varied groups of bereaved men to confirm grief-predictor relationships, and to refine an emerging socio-ecological model of men’s grief.

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