A Risk of Sensory Deprivation in the Neonatal Intensive Care Unit

http://www.jpeds.com/article/S0022-3476(14)00112-7/fulltext
Alan. H. Jobe.

Sound Exposures in NICU:
...........The appropriate emphasis on sound abatement in the new or renovated NICU should be on background noise, alarm noise, and other non-human noises that can startle and disrupt sleep of the preterm.¹³ However, the focus on noise abatement has morphed into a goal of silence in the NICU with exclusion of staff talk and lively discussions on work rounds. The result may be a severe limitation of the exposure of the vulnerable developing auditory cortex to human voices and sounds that are necessary for language development. This delay in language development for infants in single rooms is just what was observed by the Pineda article.³ In contrast, the open ward better reflects the fetal environment with human sounds and activities.

Light Exposures in NICU:
......... Circadian rhythms regulate more than sleep cycles, and there is minimal research to explore other potential effects of light on the preterm infant. Accepting that the fetus has a circadian rhythm and the dark-exposed preterm infant does not, the conservative approach to exposure of the preterm infant to light would be cycling of dim light sufficient for care at night to brighter light during the day. The covering of the isolettes with blankets continuously seems to be questionable because visual development requires light exposure. The biology suggests that judicious light exposure is appropriate until more is known about the effects of light on the preterm infant.

Tracheostomies in preterm infants associated with higher morbidities?

http://www.jpeds.com/article/S0022-3476(13)01560-6/abstract

Objectives

To evaluate the neurodevelopmental outcomes of very preterm (<30 infants="" p="" tracheostomy.="" underwent="" weeks="" who="">

Study design

Retrospective cohort study from 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N = 8683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI; a composite of ≥1 of developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed the impact of timing by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life.

Results

Tracheostomies were associated with all neonatal morbidities examined and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83% of infants with tracheostomies and 40% of those without (OR adjusted for center 7.0, 95% CI 5.2-9.5). After adjustment for potential confounders, odds of death or NDI remained higher (OR 3.3, 95% CI 2.4-4.6), but odds of death alone were lower (OR 0.4, 95% CI 0.3-0.7) among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life (aOR 0.5, 95% CI 0.3-0.9).

Conclusions

Tracheostomy in preterm infants is associated with adverse developmental outcomes and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population.

Musings of A MedMan: Oh Mother! What is Thy Nature?

Musings of A MedMan: Oh Mother! What is Thy Nature?:   Oh our dear Mother You are the Nature’s Best For He created you, so He could Rest. By nature, you shower endless kindness T...

Oh Mother! What is Thy Nature?

 

Oh our dear Mother

You are the Nature’s Best

For He created you, so He could Rest.

By nature, you shower endless kindness

Through nurture, we taste your tenderness.

Drowned in the flood of your love, we are reminded of Nature’s force

Oh Mother!

Respecting you is respecting our Mother Nature

 For the Mother Nature, you are her human form.

Like trees with delicious peach,

You provide us delicious food moment we reach

Like the sun, and soft breeze

You are the light of our lives

 Gently caressing our painful Hives.

Our jabs and jeers, you take with a cheer.

To give love is thy nature-A Mother(’s) Nature.

 

Pradeep Alur.