Neonatal Intensive Care

EPIPAGE 2 is a population-based prospective study scheduled to follow children up to the age of 12 years. Eligible participants include all infants live born or stillborn and all terminations of pregnancy between 22 and 31 completed weeks of gestation in all the maternity units in 25 French regions (21 of the 22 metropolitan regions and 4 overseas regions) during the inclusion period. The only region that did not participate accounted for 18 415 births in 2011, i.e., 2.2% of all births in France. In addition, a sample of moderate preterm births, i.e., births and late terminations at 32–34 weeks, was included in the same regions. The study began on March 28, 2011, and ended on December 31, 2011. The population eligible for follow-up includes all children alive at discharge from neonatal intensive care or special units or maternity wards whose parents have not declined to participate. This study will also use a sample of children born at term for control purposes. This group will be extracted from the population of the Elfe study, a contemporary cohort with a 20-year planned follow-up of 18 500 children born at or near term in 2011, in 344 randomly selected public and private maternity units in metropolitan France (
http://www.elfe-france.fr). Information on the Elfe study is described elsewhere
[21 (link)].

We searched for articles describing burden on informal caregivers of adult ICU survivors, using PubMed and CINAHL from database inception to June 2014. The search strategy is presented in Table 1. Only English and Dutch articles were included.Table 1

Search strategy

Database		Search terms
PubMed	Participant	Mesh	Caregivers; family; spouses; family health; proxy
	ICU	Mesh	Critical care; critical illness; intensive care units; intensive care
	Exclusion	Mesh	Intensive care, neonatal; intensive care units, pediatric; intensive care units, neonatal; child; infant; infant, newborn; child, preschool
CINAHL	Participant	Mesh	Family; caregiver burden; caregivers; spouses; family health
	ICU	Mesh	Critical care; critical illness; intensive care units
	Exclusion	Mesh	Intensive care, neonatal; intensive care units, pediatric; intensive care units, neonatal; neonatal intensive care nursing; pediatric critical care nursing; child; infant; infant, newborn; child, preschool

Two authors (IvB and FBR) independently assessed the titles and abstracts of 50 randomly selected articles to ensure that the inclusion criteria were not ambiguous. For 47 (94 %) of these articles the inclusion criteria were applied identically. After discussing the differences, consensus was reached. We considered the consistency between the two authors sufficient and made no alterations to the inclusion criteria. We included original studies if: the subject of the study was an informal caregiver of an adult ICU patient; the ICU patient was discharged from hospital alive; at least one of the measurements of the burden took place after hospital discharge; and the burden on the informal caregiver was a main outcome of the study. We excluded studies on deceased ICU patients, studies on the needs or satisfaction of the informal caregiver, presence during cardiopulmonary resuscitation, and involvement in end-of-life decisions, because we hypothesized that informal caregivers of these groups would suffer different burdens.
One author (IvB) evaluated the titles and abstracts of all articles. The abstracts were either included, excluded or marked as doubtful. Another author (FBR) read the title and abstract of articles marked as doubtful and both authors discussed these articles to reach consensus on inclusion. We supplemented our searches by scanning the reference lists of previously included articles. The full text of all eligible articles was read by two authors (IvB and one of FBR, NdK, MvdS, or DAD). Both authors extracted data on the study type, characteristics of the informal caregivers, hospital and setting, type of burden and instruments used to assess the burden. If information could not be extracted from the article or online appendices, we e-mailed the corresponding author for additional information. We assessed the quality of the quantitative articles, using the Newcastle-Ottawa scale (NOS) [15 ] for observational studies and the PEDro scale [16 (link)] for randomized trials.

A protocol was developed and registered with the University of York Centre for Reviews and Dissemination (PROSPERO) on 6/11/2012 and updated on the 13/02/2014, registration number CRD42012003215(http://www.crd.york.ac.uk/PROSPERO/index.asp).
A systematic search of the literature was undertaken using the following inclusion criteria: primary observational studies (cohort study, cross-sectional studies) in geographically defined population or a community sample (including samples from primary health care services) of children aged under 8 years using the PEDS[15 ] with available prevalence data (Additional file 1). Studies using the modified “Survey PEDS” were also included in this review [14 ]. Electronic databases searched were Web of Science and Google Scholar, PubMed (Nov 2012), EMBASE (Nov 2012), Medline (Nov 2012), Psychinfo (Nov 2012), Global Health (Nov2012) CINAHL (Nov 2012), the Cochrane Library (Nov 2012), LILACS (Nov 2012), ERIC (Nov 2012), and Proquest (Nov 2012). Secondary searches of citations in review articles, requests to experts in the field and additional searches of the USA based PEDStest and RCH PEDS website for key studies were undertaken. Advice from the Cochrane Child Development, Psychosocial and Learning Groups was sought regarding search terms which were specific for early child development, developmental risk and the PEDS. There were no language limitations. Studies using specific clinical samples, for example, neonatal intensive care graduates or with participants who had a known developmental disorder were excluded.
The study titles, abstracts and full papers of “potentially relevant articles” were reviewed independently by two authors (SW&VE). Disagreements about inclusion were resolved through consensus and discussion with a third author (KW). Study characteristics, prevalence, and risk factors, were extracted independently by SW and VE on a data extraction form that was piloted and modified prior to use. Where insufficient data were reported, study authors were contacted. If no reply was forthcoming or full data not made available, data were included in analysis where possible. Methodological quality was assessed independently by SW and VE based on a validity of the study methods (design, sampling frame, sample size, outcome measures, measurement and response rate), interpretation of the results and applicability of the findings [19 (link)], a score of 6 or greater was rated by the reviewers as high quality.

Finnish and Icelandic Medical Birth Registers include data on all hospital births, planned home births (<0.2% of births in Finland [26 (link)] and 2% of births in Iceland [27 ]), planned births at midwives’ clinics in Iceland (2% of Icelandic births), and unplanned births outside of the hospital. The high quality of the registers and their virtually complete coverage of all births has been described previously [28 (link), 29 ]. The data in these registers are typically provided by midwives or physicians attending out-of-hospital births, or by the hospitals where women have given birth or where women been treated after the birth. In Finland, neonatal care for babies born before 32 weeks is centralised to five university hospitals. In Iceland, a neonatal intensive care unit at the university hospital in Reykjavík provides care for babies born after 22 weeks, and a special care unit in Akureyri also provides care for babies born after 34 weeks.
The Nova Scotia Atlee Perinatal Database contains data from all births in Nova Scotia and includes out-of-hospital births (1% of births in Nova Scotia), both planned and unplanned. Validation studies have demonstrated its high data quality [30 (link)]. The type of neonatal care provided for babies in Nova Scotia is region-dependent.
In Scotland, the Maternity Inpatient and Day Case Scottish Morbidity Records (SMR02) include data from inpatient and outpatient hospital-based “episodes” (any interaction with the health care system, irrespective of duration), which are submitted to Public Health Scotland (PHS) when a woman is discharged from that episode of care. Delivery data accounts for approximately half of all SMR02 discharges [31 ]. Until 2019, SMR02 did not include data on homebirths (1% of births in Scotland [27 ]) or births at non-NHS hospitals, unless data were subsequently recorded by an NHS hospital. However, SMR02 delivery records are consistently reported to be 99% complete for all known births registered by the statutory National Records of Scotland (NRS) per year [31 ]. The type of neonatal care provided in Scotland is location-dependent.
The Rabin Medical Center Database contains data from all births within this tertiary hospital alone, which accounts for 5% of births in Israel, and provides neonatal intensive care for babies from 23 weeks onwards.

An institution-based prospective cohort study was conducted from the first of November 2018, to the first of November 2019 in selected hospitals in Northwest Ethiopia. The study was conducted at Debre Markos Comprehensive Specialized Hospital, Shegaw Motta District Hospital, and Injibara General Hospital. They are 300 kilometers, 371 kilometers, and 445 kilometers apart from Addis Ababa, Ethiopia’s capital, respectively. The three hospitals serve for more than 6.5 million people in the Amhara regional state and neighboring regions. Apart from other services, all three hospitals offer neonatal intensive care for seriously ill newborns, including those who suffered from asphyxia.

Following the KRINKO guideline of 2013, our clinic decided to introduce a colonization screening which includes every neonatal intensive care patient on all of our three neonatal wards. We test all neonates with an estimated stay of at least 12 h upon admission and then weekly by anal and pharyngeal swabs irrespective of their gestational age and birth weight. In addition, all neonates are tested on inpatient admission. In suspicion of an infection or nosocomial transmissions, shortened screening intervals apply. Additionally, a bacteriological screening is taken from tracheal aspirate from all neonatal patients on ventilation after intubation or admission and continued twice weekly. A parents’ questionnaire supports the identification of high-risk patients for MRSA colonization. Whenever there is a positive medical history indicating a high prevalence background such as contact to farm animals, necessity of dialysis, chronic skin lesions, or hospitalization in the past 12 months, we perform a pharyngeal swab test for MRSA. VRE screening is solely performed for neonates with VRE history and for all neonates in case of an infection on the ward. A colour coded alert system assures sufficient hygienic management on the ward: At the time of admission, neonates remain isolated by bed location and are treated as potentially colonized. After receipt of the microbiological screening results (up to 48 h), patients are either isolated in a single room (red category) in case of 3- or 4MRGN or MRSA, remain isolated by bedside in case of 2MRGN NeoPaed (yellow category) or isolation is set aside (green category, negative test results).