Despite the recent improvements in perinatal medical care leading to an increase in survival rates, adverse neurodevelopmental outcomes occur more frequently in preterm and/or high-risk infants. Medical risk factors for neurodevelopmental delays like male gender or intrauterine growth restriction and family sociocultural characteristics have been identified. Significant data have provided evidence of the detrimental impact of overhelming environmental sensory inputs, such as pain and stress, on the developing human brain and strategies aimed at preventing this impact. These strategies, such as free parental access or sleep protection, could be considered 'principles of care'. Implementation of these principles do not require additional research due to the body of evidence. We review the scientific evidence for these principles here.

Objective To evaluate COVID-19 pandemic preparedness, available resources, and guidelines for neonatal care delivery among neonatal health care providers in low- and middle-income countries (LMICs) across all continents. Study design Cross-sectional, web-based survey administered between May and June, 2020. Results Of 189 invited participants in 69 LMICs, we received 145 (77%) responses from 58 (84%) countries. The pandemic provides significant challenges to neonatal care, particularly in low-income countries. Respondents noted exacerbations of preexisting shortages in staffing, equipment, and isolation capabilities. In Sub-Saharan Africa, 9/35 (26%) respondents noted increased mortality in non-COVID-19-infected infants. Clinical practices on cord clamping, isolation, and breastfeeding varied widely, often not in line with World Health Organization guidelines. Most respondents noted family access restrictions, and limited shared decision-making. Conclusions Many LMICs face an exacerbation of preexisting resource challenges for neonatal care during the pandemic. Variable approaches to care delivery and deviations from guidelines provide opportunities for international collaborative improvement.

ObjectiveTo assess the perceptions of healthcare professionals (HCPs) regarding parental presence at medical rounds in French neonatal intensive care units (NICUs). We hypothesised that HCPs would perceive barriers against allowing parental participation in round discussions.MethodsThis cross-sectional study approached 304 HCPs from three groups; group 1: French professionals that attended an annual French-speaking meeting of the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP); group 2: NICU professionals from a tertiary care academic hospital in western France; and group 3: paediatric residents from six French universities. We invited all HCPs to complete a questionnaire about medical round practices and their perceptions towards parent participation in family-centred rounds (FCRs).ResultsOf the 176 (58%) questionnaires returned, 159 were included in the analysis. The majority of medical rounds took place at the bedside for groups 1 and 3 (68%, 95% CI 54 to 80 and 71%, 95% CI 56 to 84, respectively) and in a conference room for group 2 (65%, 95% CI 51 to 78). Overall, respondents positively perceived FCR for themselves, parents and students. However, most respondents agreed with the following claims: ‘Parental attendance at medical rounds prevents some discussions between health professionals’ (66%, 95% CI 57 to 73), ‘FCR increases round durations’ (63%,95% CI 55 to 71) and ‘Some decisions made during medical rounds may be stressful for parents’ (51%, 95% CI 42 to 59). Nevertheless, responses varied significantly according to NIDCAP training and NICU experience and consequently group 1 displayed a significantly more positive attitude than other groups (p<0.001); they expressed less concern about potentially inhibiting discussions between HCPs (p<0.001), the feasibility (p=0.02) and prolonged round durations (p<0.001). Several difficulties and facilitators of FCR implementation were variously reported, but all groups agreed that routine workload was an important difficulty and that medical leadership would be an important facilitator.ConclusionFrench HCPs expressed rather positive perceptions towards parental presence in NICU rounds. However, some concerns need to be addressed.

BackgroundImproving pain and stress assessments in neonates remains important in preventing the short- and long-term consequences. We aimed to identify the relationships between different pain assessment parameters by simultaneously measuring changes in cortical, autonomic, hormonal, physiological, and behavioral evoked responses to venepuncture in healthy, full-term neonates.MethodsThis observational, prospective study (ancillary to the ACTISUCROSE trial) included 113 healthy, 3-day old, full-term neonates who underwent venepuncture for systematic neonatal screening, from July to October 2013, in a tertiary-level maternity ward of a university hospital. During venepuncture, we simultaneously measured the cortical single-channel near-infrared spectroscopy (NIRS) signals, foot skin conductance, salivary cortisol, physiological responses, and behavioral (Neonatal Facial Coding System [NFCS]) evoked responses.ResultsRegarding the NIRS analysis, the highest correlation was between the NFCS at venepuncture and the change in NIRS integrated values of total hemoglobin (r=0.41, P<0.001) or oxygenated hemoglobin (r=0.27, P<0.001). The NFCS at venepuncture was moderately positively correlated with changes in salivary cortisol (r=0.42, P<0.001) and skin conductance (r=0.29, P<0.001). Salivary cortisol and skin conductance changes were not correlated; the latter parameters were not correlated with heart rate, respiratory rate, or SpO2.ConclusionDuring venepuncture, NFCS was mildly or moderately correlated with salivary cortisol, skin conductance, and cortical NIRS changes.

Cefotaxime is one of the most frequently prescribed antibiotics for the treatment of Gram-negative bacterial sepsis in neonates. However, the dosing regimens routinely used in clinical practice vary considerably. The objective of the present study was to conduct a population pharmacokinetic study of cefotaxime in neonates and young infants in order to evaluate and optimize the dosing regimen. An opportunistic sampling strategy combined with population pharmacokinetic analysis using NONMEM software was performed. Cefotaxime concentrations were measured by high-performance liquid chromatography-tandem mass spectrometry. Developmental pharmacokinetics-pharmacodynamics, the microbiological pathogens, and safety aspects were taken into account to optimize the dose. The pharmacokinetic data from 100 neonates (gestational age [GA] range, 23 to 42 weeks) were modeled with an allometric two-compartment model with first-order elimination. The median values for clearance and the volume of distribution at steady state were 0.12 liter/h/kg of body weight and 0.64 liter/kg, respectively. The covariate analysis showed that current weight, GA, and postnatal age (PNA) had significant impacts on cefotaxime pharmacokinetics. Monte Carlo simulations demonstrated that the current dose recommendations underdosed older newborns. A model-based dosing regimen of 50 mg/kg twice a day to four times a day, according to GA and PNA, was established. The associated risk of overdose for the proposed dosing regimen was 0.01%. We determined the population pharmacokinetics of cefotaxime and established a model-based dosing regimen to optimize treatment for neonates and young infants. C efotaxime is one of the most frequently prescribed antibiotics in neonates (1). This third-generation cephalosporin is mainly used in the treatment of neonatal sepsis (2) and meningitis caused by Gram-negative bacteria. Because of the high rates of morbidity and mortality (3), the optimal use of cefotaxime is essential in neonatal infection management. However, the dosing regimens routinely used in clinical care vary considerably. As reported in our previous study, 25 different dosage regimens of cefotaxime were identified in the French neonatal intensive care unit (NICU) network, with median daily doses varying from 75 mg/kg of body weight/day to 180 mg/kg/day among NICUs (4). This huge variation can be partly explained by the different dosage recommendations available in reference textbooks and published guidelines (1). It also highlights the need for powerful pharmacokinetic (PK) data for neonates. As recently reviewed by Pacifici et al. (5), the pharmacokinetics of cefotaxime in neonates were mainly studied in the 1980s with a limited number of patients. The study design and analysis method limited the power to determine a precise dose of cefotaxime derived from pharmacokinetic data, as the quantitative impacts of covariates (i.e., maturation, organ function) on dose were not fully assessed. The simplification of the impacts of covariates could lead to signific...

Actigraphy using the Actiwatch Mini was not a reliable method for measuring sleep patterns in healthy late preterm and term neonates a few days after birth.

Background Facilitating factors and barriers to breast milk feeding (BMF) very preterm (VP) infants have been widely studied at the individual level. We aimed to describe and analyse factors associated with BMF at discharge for VP infants, with a special focus on unit policies aiming to support BMF. Methods We described BMF at discharge in 3108 VP infants enrolled in EPIPAGE‐2, a French national cohort. Variables of interest were kangaroo care during the 1st week of life (KC); unit's policies supporting BMF initiation (BMF information systematically given to mothers hospitalised for threatened preterm delivery and breast milk expression proposed within 6 hours after birth) and BMF maintenance (availability of protocols for BMF and a special room for mothers to pump milk); the presence in units of a professional trained in human lactation and regional BMF initiation rates in the general population. Associations were investigated by multilevel logistic regression analysis, with adjustment on individual factors. Results In total, 47.2% of VP infants received BMF at discharge (range among units 21.1%‐84.0%). Unit policies partly explained this variation, regardless of individual factors. BMF at discharge was associated with KC (adjusted odds ratio (aOR) 2.26 (95% confidence interval (CI) 1.40, 3.65)), with policies supporting BMF initiation (aOR 2.19 (95% CI 1.27, 3.77)) and maintenance (aOR 2.03 (95% CI 1.17, 3.55)), but not with BMF initiation rates in the general population. Conclusion Adopting policies of higher performing units could be an effective strategy for increasing BMF rates at discharge among VP infants.

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