Background and Objectives: Hammersmith Neonatal Neurologic Examination (HNNE) is used to identify term and preterm infants at risk of neurodevelopmental disability. The test is recommended at corrected term age in preterm; and around 2 weeks postnatal age in term neonates. As the current trend is to discharge based on physiological stability, it may not be feasible to perform HNNE at recommended age. The authors investigated whether predictive ability of the test for neurodevelopmental disability remained unchanged if performed early (before discharge). Methods: The authors enrolled preterm and at-risk term neonates. HNNE PE was performed before discharge in all infants. The test was repeated in preterm infants at 40 weeks postmenstrual age and in term neonates at 2 weeks of age (HNNE RA). Neurodevelopmental disability was assessed at 1 year of age. Results: HNNE PE was done in 125 neonates (103 preterm, 22 term neonates). HNNE RA was done in 58% infants. Neurodevelopmental disability was assessed in 84 (67%) of infants. Neurodevelopmental disability was noted in 14/84 (16.6%) babies. The receiver operating characteristic curve of raw scores showed that area under the curve for HNNE PE (0.71) and HNNE RA (0.66) were similar. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for both the tests were similar for a cutoff optimality score of 32.5. HNNE PE could be performed up to 4 weeks earlier than HNNE RA with the same predictive ability for neurodevelopmental disability. Conclusions: HNNE PE was as reliable as HNNE RA in predicting neurodevelopmental disability at 1 year of age. Completion of the test is assured and provides several weeks lead time for early intervention.

Objectives Use of continuous positive airway pressure (CPAP) in neonates is associated with nasal injury (NI) for which various risk factors related to the neonatal characteristics and properties of interfaces used have been reported. BPrivileging^of nursing staff may influence safety and incidence of adverse events. In this prospective cohort study, authors studied the incidence of NI and risk factors for NI in babies requiring CPAP after privileging staff for CPAP care bundles. Methods All neonates on CPAP over a 6-mo period were included. Standard operating procedures were formulated and staff of NICU (nurses and doctors) were educated at the start of the study and periodically in 6 comprehensive areas of careencompassing position of head, prongs and cap; nasal suctioning and interruptions in pressure on the nose. The staff who completed the training and evaluation were declared as Bprivileged^. NI (measured by a standard staging) and risk factors were predefined and studied. Results Of the 51 babies who required respiratory supports, 35 required CPAP care. Nine babies (25%) out of 35 who required CPAP had NI (2, 4, 3 babies had stages 1, II and III of NI respectively). Seventy seven percent of babies were cared for by privileged nurses. NI was significantly higher when cared for by non-privileged staff (66% vs. 11%, unadjusted RR = 6.75, 95%CI 2.16-21.09). All other risk factors were not significant. Conclusions NI was noted in 25% neonates on CPAP, and those cared for by non-privileged staff had higher chances of NI. Quality processes and emphasis on continued monitoring and evaluation of nursing skills may help prevent these untoward complications.

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Objective This research aimed to study the impact of early parent participation program (EPPP) for preterm infants in neonatal intensive care unit (NICU) on physiological instability, breastmilk feeding rates, and discharge timing. Materials and Methods Families of 147 infants born between 28 and 33 weeks' gestation were randomized at birth to EPPP group or conventional care (CC). Families in the EPPP group were trained soon after admission by using a structured education program and encouraged to spend more time with their baby. Soon after enrolment (day of life 1 to 2), they would sequentially participate in daily NICU care processes such as orogastric tube feeding, nesting, oil massages, diaper changes, and daily weight checks. Families in the CC group would undergo the same after their infant was off parenteral nutrition and respiratory support. Proportion of infants having physiological instability (significant apnea, feeding intolerance, or needing investigation for sepsis) in two groups was compared. Results There was a significant reduction in the proportion of infants with physiological instability (feeding intolerance) in the EPPP group (relative risk = 0.70 [0.52–0.94], p = 0.016). Infants in EPPP group had a trend toward higher breastmilk feeding rates at discharge (66 vs. 51%, p = 0.076). Conclusion Very early parent participation was feasible in the NICU and led to decrease in physiological instability in preterm infants. Key Points

Background Aggressive nutrition may benefit early growth; nevertheless, effects on neurodevelopmental outcomes are unclear. We planned a descriptive analytical study to compare survival without neurodevelopment disability (NDD) at 1 year in 2 groups during 2 time epochs—before and after implementation of early optimal nutrition strategies. NDD was defined as any one of the following: mental and/or motor development quotient < 85 at 12 months of age, corrected for prematurity; Denver Developmental Screening Test abnormal/suspect in even 1 domain out of the 4 domains; seizures; requirement of hearing aid; or blindness in 1 or both eyes. We also compared mortality, survival without bronchopulmonary dysplasia, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage, periventricular leukomalacia, sepsis, metabolic bone disease (MBD), and extrauterine growth restriction (EUGR). Methods Preterm neonates born between 27 and 32 weeks’ gestation were included. The prospective study group (AO) was recruited after implementation of early optimal nutrition policy. The comparative retrospective cohort (BO) received nutrition based on clinicians’ decisions. Both groups were followed up using a structured plan till 1 year corrected age. Results 137 neonates were enrolled in AO and 151 in the BO cohort. There was no statistically significant difference in survival without NDD at 1 year—75.5% in AO vs 72.1% in BO, odds ratio 0.84 (95% CI 0.5–1.6). Babies who received early optimal nutrition had less NEC, EUGR, and ROP requiring laser therapy but more MBD. Conclusion There was no difference in survival without NDD in early optimal nutrition cohort compared to the cohort before implementation of the nutrition strategy. Short‐term benefits themselves may justify the need for early optimal nutrition.