Circumcision bleeding complications: neonatal intensive care infants compared to those in the normal newborn nursery

Purpose: To determine if a significant difference exists in the bleeding complications following circumcision in neonates admitted to neonatal intensive care unit (NICU) versus the normal newborn nursery (NNN).

Materials and methods: Observational cohort study of 260 infants undergoing circumcision with Gomco clamp. Vitamin K was given to neonates at delivery. Demographic data, procedural characteristics, bleeding complications, and interventions were recorded. The bleeding rates of the two groups were compared using chi square.

Results: NICU neonates experienced increased bleeding complications versus NNN neonates (22% vs. 9.6%, p?=?.029). No differences were found regarding gestational age at delivery, age at circumcision, and birth weight. Neonates with circumcision performed at =5?days of life experienced increased rates of bleeding complications versus those performed at =4?days (28% vs. 10.3%, p?=?.023). All neonates with circumcision performed =5?days of life were initially admitted to the NICU.

Conclusion: NICU neonates had increased rate of bleeding complications following circumcision when compared to the NNN neonates. There was an increased rate of bleeding complications in neonates who undergo circumcision at =5?days of life. Further research may help to determine if redosing of vitamin K or variations in the circumcision procedure are necessary for circumcision at >4?days of life.

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Neonatal uterine bleeding as a biomarker for reproductive disorders during adolescence: a worldwide call for systematic registration by nurse midwife

Neonatal uterine bleeding (NUB) occurs in approximately 5% of newborns and is generally considered to be of little clinical significance. However, the real clinical importance of this condition and its long-term implications remain to be determined. The reason why NUB is rare despite high circulating levels of progesterone can be attributed to a progesterone resistance present in a majority of neonates. Recent work indicates that NUB represents a significant biomarker for events that can occur later-on during adolescence. Indeed, clinical studies have shown that “neonatal menstruation” constitutes a sign of fetal distress during late pregnancy, reflecting a stage of endometrium development that may subsequently have an impact on the reproductive life of the adolescent and the young adult. Via retrograde flow, NUB can cause endometrial stem/progenitor cells to arrive into the pelvic cavity and survive there, dormant underneath the peritoneal surface, until menarche activates them. Indeed, there is both clinical and epidemiological evidence of a link between NUB and adolescent endometriosis. In addition, if progesterone resistance persists till the onset of menarche, in case of an early teen pregnancy, it can result in a disorder of deep placentation. Therefore, we propose that NUB should be carefully recorded so that prospective studies can examine its links with reproductive disorders in adolescence and beyond.

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The use of neonatal extracorporeal life support in pediatric cardiac intensive care unit

Aim: The aim of the study is to evaluate extracorporeal life support system (ECLS) employed in neonates in pediatric cardiac intensive care unit.

Material and methods: Twenty-five neonates that required ECLS in between November 2010 and November 2015 were evaluated.

Results: The median age was 12 days (range 3–28 days) and the median body weight was 3?kg (range 2.5–5?kg). Venoarterial ECLS was performed in all of the cases. Ascendan aorta-right atrial cannulation in 22 patients and neck cannulation in three patients were performed. The reason for ECLS was E-CPR in two patients, inability to wean from cardiopulmonary bypass (CPB) in seven patients, respiratory insufficiency and hypoxia in nine patients, low cardiac output (LCOS) in seven patients. Median duration of ECLS was four days (range 1–15). Hemorrhagic complications developed in 15, renal complications in 13, pulmonary complications in 12, infectious complications in 11, neurologic complications in three and mechanical complications in two of the patients. Weaning was successful in 15 of the patients. Eleven patients were successfully discharged.

Conclusion: ECLS is an important treatment option that is performed successfully in many centers around the world to maintain life support in patients unresponsive to medical treatment. The utilization of this modality especially in newborns with congenital heart disease should be taken into consideration.

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Fathers’ Needs and Masculinity Dilemmas in a Neonatal Intensive Care Unit in Denmark

Most healthcare professionals in neonatal intensive care units typically focus on the infants and mothers; fathers often feel powerless and find it difficult to establish a father-child relationship. In family-centered healthcare settings, exploring fathers’ experiences and needs is important because men’s roles in society, especially as fathers, are changing.

The purpose of this study was to describe fathers’ needs when their infants are admitted to a neonatal intensive care unit and to discuss these needs within a theoretical framework of masculinity to advance understanding and generate meaningful knowledge for clinical practices.

Health professionals in neonatal intensive care units must be aware of fathers’ need and desire to be equal coparents. Nurses should play a key role by, for example, showing that fathers are as important to their infants as are the mothers, helping them become involved in childcare, and ensuring that they are directly informed about their children’s progress.

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Mother’s Lived Experience During Repair of Long-Gap Esophageal Atresia: A Phenomenological Inquiry

Infants born with long-gap esophageal atresia (LGEA) pose unique physiologic risks in the newborn period. Anatomic and physiologic anomalies require an extended hospitalization with procedural analgesia and sedation that impact the mother’s experience of birth, maternal response, and nurturing of her infant.

The aim of this study was to understand the meaning of experiences that mothers of infants born with LGEA encounter in the neonatal intensive care unit while their infant undergoes esophageal repair.

 Nurses’ knowledge and understanding of maternal experiences of having an infant with LGEA will enable for increased physical closeness, optimizing time spent together to learn their infant’s unique personality. Creating partnerships with mothers can enhance our understanding of their perspectives, concerns, needs, and guide interventions.

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A Fortified Donor Milk Policy is Associated With Improved In-Hospital Head Growth and Weight Gain in Very Low-Birth-Weight Infants


The purpose of this study was to evaluate the impact of early human milk feeding (donor milk and/or mother’s own milk) with standard fortification on in-hospital growth of very low-birth-weight infants.

This pre-/postretrospective study included selected newborn infants less than 1500 g admitted to a level IV neonatal intensive care unit before and after the introduction of a policy providing donor milk when mother’s own milk was not available in sufficient quantity to meet her infant’s need. When enteral feeds reached 80 mL/kg per day, all human milk was fortified.

Seventy-two “before” (any formula-fed) and 114 “after” (human milk-fed) infants were enrolled in this study. Infant characteristics and neonatal morbidity were similar in both groups. Outcomes revealed that an initial human milk diet with standard fortification was associated with significantly higher early extrauterine weight gain and head growth in very low-birth-weight infants than a formula-fed diet.

Very early initiation of fortified breast and/or donor milk feeding can help promote in-hospital head growth and weight gain of preterm infants. Formula may not be appropriate for early use among preterm infants.

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Quality Improvement Project to Reduce Delayed Vaccinations in Preterm Infants

The goal of this quality improvement project was to improve on time vaccinations of preterm infants hospitalized in the neonatal intensive care unit.

 The Plan-Do-Study-Act model of quality improvement was adopted to develop, test, and implement interventions aimed at improving timely vaccination of preterm infants. The primary outcome measure of interest was the rate of on time vaccination, which was defined as the proportion of medically eligible preterm infants who received vaccinations within 2 weeks of the recommended schedule.

 Baseline on time vaccination rate was only 36%. Following several Plan-Do-Study-Act cycles, a steady increase in on time vaccinations of eligible infants was observed, and a new baseline on time vaccination rate of 82% was achieved.

Simple interventions implemented within the context of Plan-Do-Study-Act cycles are effective in improving timely vaccinations among preterm infants.

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