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TECHNOLOGY AND INNOVATIONS TO SUPPORT CARE DELIVERY DURING COVID 19 - BENEFITS AND CHALLENGES
SLEEP-WAKE CYCLE DEVELOPMENT IN PRETERM NEWBORNS UNDER 34 WEEKS OF GESTATIONAL AGE MONITORED WITH AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY
Abstract
Background and Aims
The incidence of impaired outcomes related to brain injury in preterm newborns is high. Amplitude-integrated electroencephalography (aEEG) is a non-invasive, bedside and simplified method to access brain function, presence of seizures and sleep-wake cycle (SWC). The presence of SWC involves endogenous brain activity and has impact on cognitive, psychomotor, and behavioral development. We aimed to describe SWC with aEEG background activity and presence of seizures in newborns.
Methods
Retrospective and descriptive analysis of the database of a private company that works with brain monitoring of newborns with aEEG at 26 hospitals in Brazil. All preterm newborns under 34 weeks of gestational age monitored with aEEG from July 2017 up to December 2020 were included in this study. SWC and seizure were categorized as present or absent, and aEEG background activity as pathological and non-pathological. The data was presented according to absolute and relative frequency.
Results
1070 newborns were included in this study. SWC was absent in 649 (61%) newborns, with pathological aEEG background activity in 369(57%), and 247(38%) had seizures, mainly subclinical (199;81%). When SWC was absent, aEEG pathological background activity was shown in 316(49%) and 176(27%) had seizures.
Conclusions
More than half of preterm newborns had absence of SWC. Preterm newborns with brain dysfunction had alteration in SWC. The importance of brain monitoring was pointed when more than 81% of diagnosed seizures were subclinical and detected only because of aEEG monitoring, this helped to guide the treatment and, possibly, improved the prognosis.
LIGHTING LEVEL IN NEONATAL INTENSIVE CARE UNITS: REPERCUSSIONS FOR NEONATE HEALTH
Abstract
Background and Aims
Continuous exposure to light is harmful to hospitalized newborns, as it influences sleep patterns and clinical conditions. To reduce these effects, some units carry out environmental management, with reduced noise, light and handling of newborns. We aimed to identify the light levels in neonatal intensive care units (NICUs) that perform environmental management or not, and indicate the condition that promotes a better environment for the newborn, according to the type of furniture and proximity to natural light.
Methods
Descriptive study developed in two NICUs in Brazil, one that does not perform environmental management and another that performs it for 1 hour, four times a day. The sample consisted of measuring the light level inside an incubator, an incubator with photoprotection and an acrylic cradle, positioned according to the proximity of the natural light source. The luximeter measurements took place in each proposed condition, every 60 seconds for 24 hours uninterrupted. The Mann-Whitney test was used, with a significance level of 5%.
Results
The 1441 light levels varied (min=0; max=889) according to the presence of environmental management and type of furniture. The distance from the source of natural light did not influence the light levels. The use of protection over incubators provided less exposure to light, as well as the management of the environment in the NICU (p<0.001).
Conclusions
Environmental management and the use of an incubator with photoprotection, regardless of the distance from the source of natural light, provide the best light condition for newborns.
PARENTAL PERCEPTIONS OF THE IMPACT OF COVID-19 RESTRICTIONS ON FAMILY CENTRED CARE ON A PAEDIATRIC INTENSIVE CARE UNIT
Abstract
Background and Aims
The Covid-19 pandemic forced us to implement stringent measures on PICU. These included requiring parents to leave during ward rounds, single-carer visiting from a maximum of 2 identified visitors, closure of shared facilities, and parental PPE. We hypothesise that these had a profoundly negative impact on the delivery of Family Centred Care (FCC) and adversely affected parental well-being on PICU.
Methods
Contemporaneous experience questionnaires were issued to parent(s) of patients admitted to a 22-bedded PICU during the most limiting restrictions of the UK’s “first wave” of COVID-19 infections in April 2020. Comments were collated and thematically analysed.
Results
13 questionnaires (65%) were returned. Regarding visiting restrictions, key themes of parental understanding but also of isolation and distress were identified. Logistical challenges and psychological impacts on families were described. Ward round changes led to disappointment, exclusion and difficulty processing piecemeal information. Paents understood why facilities were closed but multiple comments highlighted their value. Parents complied with PPE unreservedly, demonstrating understanding and emphasising their focus on safety. There was anxiety on account of impaired communication and contact due to PPE.
Conclusions
PICU restrictions merit a risk:benefit re-evaluation. Limited parental visiting was particularly challenging. In response to parental absence from rounds we implemented a bedside communication sheet, and strived to offer daily medical updates. The importance of local facilities for families was clear and must be addressed. PPE was seen as a major barrier to parent-child physical contact and therefore the emotional contact essential for FCC. Parents demonstrated considerable understanding, resilience and compliance to changes in practice.