Attentional Generative Multimodal Network for Neonatal Postoperative Pain Estimation.

Artificial Intelligence (AI)-based methods allow for automatic assessment of pain intensity based on continuous monitoring and processing of subtle changes in sensory signals, including facial expression, body movements, and crying frequency. Currently, there is a large and growing need for expanding current AI-based approaches to the assessment of postoperative pain in the neonatal intensive care unit (NICU). In contrast to acute procedural pain in the clinic, the NICU has neonates emerging from postoperative sedation, usually intubated, and with variable energy reserves for manifesting forceful pain responses.

Multimodal neonatal procedural and postoperative pain assessment dataset.

This paper presents the first multimodal neonatal pain dataset that contains visual, vocal, and physiological responses following clinically required procedural and postoperative painful procedures. It was collected from 58 neonates (27-41 gestational age) during their hospitalization in the neonatal intensive care unit. The visual and vocal data were recorded using an inexpensive RGB camera while the physiological responses (vital signs and cortical activity) were recorded using portable bedside monitors.

Novel method of measuring chronic stress for preterm infants: Skin cortisol.

Background And Objectives: Infants who begin life in the medicalized environment of the neonatal intensive care unit (NICU) do so under stressful conditions. Environmental exposures are often abrasive to vulnerable infants, while invasive and noninvasive lifesaving interventions provide additional pain and/or stress. The most commonly selected biomarker to measure stress is cortisol.

Survival and healthcare utilization of infants diagnosed with lethal congenital malformations.

Objective: We assessed survival, hospital length of stay (LOS), and costs of medical care for infants with lethal congenital malformations, and also examined the relationship between medical and surgical therapies and survival.

Study Design: Retrospective cohort study including infants born 1998-2009 with lethal congenital malformations, identified using a longitudinally linked maternal/infant database.

Results: The cohort included 786 infants: trisomy 18 (T18, n = 350), trisomy 13 (T13, n = 206), anencephaly (n = 125), bilateral renal agenesis (n = 53), thanatophoric dysplasia/achondrogenesis/lethal osteogenesis imperfecta (n = 38), and infants > 1 of the birth defects (n = 14).

Automatic Infants' Pain Assessment by Dynamic Facial Representation: Effects of Profile View, Gestational Age, Gender, and Race.

Infants' early exposure to painful procedures can have negative short and long-term effects on cognitive, neurological, and brain development. However, infants cannot express their subjective pain experience, as they do not communicate in any language. Facial expression is the most specific pain indicator, which has been effectively employed for automatic pain recognition.

A Review of Automated Pain Assessment in Infants: Features, Classification Tasks, and Databases.

Bedside caregivers assess infants' pain at constant intervals by observing specific behavioral and physiological signs of pain. This standard has two main limitations. The first limitation is the intermittent assessment of pain, which might lead to missing pain when the infants are left unattended.

Outpatient Management of Neonatal Abstinence Syndrome: A Quality Improvement Project.

Background: An increasing number of infants are diagnosed with neonatal abstinence syndrome (NAS). The study's primary objectives were to describe an academic medical center's level IV neonatal ICU's (NICU's) comprehensive outpatient NAS management effort, measure guideline compliance, and assess its safety. Secondary objectives were to describe the duration and cumulative methadone exposure, and to improve parent and provider knowledge of NAS.

Changes in the Immune Components of Preterm Human Milk and Associations With Maternal and Infant Characteristics.

Objective: To describe difference in cytokines, chemokines, and growth factors (CCGFs) and secretory immunoglobulin A (sIgA) in the breast milk of mothers who gave birth preterm and maternal or infant characteristics related to these immune components.

Design: A prospective, repeated-measures, one-group design.

Setting: Data were collected at an 82-bed NICU in West Central Florida.

Relationships of Feeding and Mother's Own Milk with Fecal Calprotectin Levels in Preterm Infants.

Objective: To describe longitudinal effects of feeding volume and type of milk on fecal calprotectin (f-CP) in very low-birth weight (VLBW) infants.

Study Design: Prospective data were collected across Neonatal Intensive Care Unit (NICU) admission for 6 weeks or until discharge in 75 VLBW neonates. The mean gestational age on entry into the study was 29 weeks.

A Systematic Review: The Utility of the Revised Version of the Score for Neonatal Acute Physiology Among Critically Ill Neonates.

The revised version of the Score for Neonatal Acute Physiology (SNAP-II) has been used across all birth weights and gestational ages to measure the concept of severity of illness in critically ill neonates. The SNAP-II has been operationalized in various ways across research studies. This systematic review seeks to synthesize the available research regarding the utility of this instrument, specifically on the utility of measuring severity of illness sequentially and at later time points.

Improving Human Milk and Breastfeeding Practices in the NICU.

Objective: To determine if systematic implementation of the Spatz Ten Steps for Promoting and Protecting Breastfeeding for Vulnerable Infants (Ten Steps) would result in an improvement in the percentage of infants receiving mother's own milk (MOM) at initiation of feedings and at hospital discharge.

Design: Continuous quality improvement (QI) process.

Setting: Urban, 82-bed, Level-III NICU.

Development of the preterm infant gut microbiome: a research priority.

The very low birth weight (VLBW) infant is at great risk for marked dysbiosis of the gut microbiome due to multiple factors, including physiological immaturity and prenatal/postnatal influences that disrupt the development of a normal gut flora. However, little is known about the developmental succession of the microbiota in preterm infants as they grow and mature. This review provides a synthesis of our understanding of the normal development of the infant gut microbiome and contrasts this with dysbiotic development in the VLBW infant.

Outcomes of a Neonatal Golden Hour Implementation Project.

The objective of this study was to implement and evaluate a quality improvement project (the golden hour pathway [GHP]) aimed at improving the quality and efficiency of care delivered to extremely low birth weight (ELBW) infants <28 weeks gestation and/or <1000 g birth weight during the first hour of life. Process improvement and patient data collected during the quality improvement cycles were compared with retrospective data for ELBW infants admitted to the study neonatal intensive care unit during the 2 years prior to GHP implementation. GHP implementation resulted in improvements compared with past internal performance in time to surfactant administration, time to administration of dextrose and amino acids, body temperature at admission, odds of developing chronic lung disease, and odds of developing retinopathy of prematurity.

Cytokines, Chemokines, and Growth Factors in Banked Human Donor Milk for Preterm Infants.

Background: There has been a recent increase in availability of banked donor milk for feeding of preterm infants. This milk is pooled from donations to milk banks from carefully screened lactating women. The milk is then pasteurized by the Holder method to remove all microbes.

Effects of maternal magnesium sulfate administration on intestinal blood flow velocity in preterm neonates.

Background: Antenatal MgSO4 administration is used extensively as a tocolytic agent and to treat preeclampsia. Various effects on the fetus and newborn have been reported, and MgSO4 has well-documented vasoactive effects.

Objective: To determine if antenatal MgSO4 administration affects intestinal blood flow velocity in newborn preterm infants.

Right tracheal bronchus in an infant with congenital diaphragmatic hernia.

Neonates with congenital diaphragmatic hernia (CDH) often have other major malformations. Anatomic airway anomalies associated with CDH include congenital stenosis, pulmonary hypoplasia, and abnormal bronchial branching. We describe an infant with CDH who, after developing recurrent upper-lobe atelectasis, was found to have a right tracheal bronchus.

The effects of maternal dietary docosahexaenoic acid intake on rat pup myelin and the auditory startle response.

Unlabelled: We investigated the effects of maternal docosahexanoic acid (DHA) supplementation on pups' auditory startle responses and the composition of brain myelin.

Methods: Timed-pregnant rats were fed throughout pregnancy and lactation diets that contained 0, 0.3, 0.

Longitudinal measurements of bone status in preterm infants.

Background: Quantitative ultrasound measurement of the speed of sound (SOS) through bone has been investigated as a means of assessing bone status in preterm infants. Few studies report longitudinal measurements.

Objective: To assess longitudinal changes in bone SOS in preterm infants.

Quantitative ultrasound in the evaluation of bone status in premature and full-term infants.

Metabolic bone disease of prematurity (MBDP) is a common and significant problem that often gives rise to osteopenia, fractures, osteomalacia, and osteoporosis. The purpose of our study is to establish normative data on bone status in premature and full-term infants to help future studies on MBDP. Bone status was prospectively determined as part of a multicenter study among newborns within 96 hours of life.

The use of quantitative ultrasound in assessing bone status in newborn preterm infants.

Objective: Quantitative ultrasound is increasingly used to assess bone status in adults and children; however, few studies have been carried out in neonates. Our objective was to determine if tibial bone speed of sound (SOS) correlates with gestational age and birth anthropometrics, and if bone SOS is related to maternal factors.

Study Design: We prospectively studied 95 preterm infants to assess factors related to bone status as measured by quantitative ultrasound.

Tolerance of simulated amniotic fluid in premature neonates.

Objective: To assess the tolerance of simulated amniotic fluid enterally administered in premature neonates.

Design: A multicentered, Phase I, dose-escalation trial was accomplished among 30 preterm neonates. Groups of 10 patients received 5, 10, or 20 mL/kg/d enterally of the amniotic fluid solution, divided into every-3-hour dosing, for 3 days.