CoNP Evidence Corner
What is the evidence corner? Evidence Corner on the Community of Neonatal Nursing Practice website serves as a beacon of knowledge and expertise for neonatal nurses. It is a dedicated space where evidence-based practices, research findings, and clinical insights converge to empower neonatal healthcare professionals. Here, nurses can delve into the latest research studies, clinical guidelines, and best practices in the field, ensuring that their care is informed by the most up-to-date evidence. From critical assessments of interventions to discussions on emerging trends, the Evidence Corner equips neonatal nurses with the tools they need to deliver the highest standard of care to their tiny patients and their families.
Topic: Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants
Author: Askie, L. Ml, Darlow, B A., Davis, P. G., Finer, N., Stenson, B., Vento, M., Whyte, R.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011190.pub2/full
Author conclusion:
This study examined a meta-analysis of five randomized trials that demonstrated no significant difference in the primary composite outcome of death or major disability in extremely preterm infants when targeting a lower (SpO₂ 85% to 89%) versus higher (SpO₂ 91% to 95%) oxygen saturation range. In comparison when they compared the higher target to lower target, there was a significant increase in the incidence of death at discharge and at 18-24 correct gestational age, and necrotizing enterocolitis. It was demonstrated that the lower range significantly decreases the incidence of retinopathy of prematurity. There were no significant differences between the two treatment groups for major disability, including blindness, severe hearing loss, cerebral palsy, or other significant neonatal morbidities.
Plain Language:
What is known is noise in neonatal intensive care units are louder than what is experienced in homes and most work environments. The noise is most likely very harmful for premature babies, disturbing their development and often leading to hearing impairment. The American Academy of Pediatrics recommends decreasing noise levels to below 45 decibels (dB) the WHO recommends less than 30 dB. Both are very difficult to achieve. What is known is that 2% to 10% of preterm infants are diagnosed with hearing loss compared to 0.1% of the general child population.
Citation:
Askie LM, Darlow BA, Davis PG, Finer N, Stenson B, Vento M, Whyte R. Effects of targeting
lower versus higher arterial oxygen saturations on death or disability in preterm infants. Cochrane
Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011190. DOI:
10.1002/14651858.CD011190.pub2. Accessed 08 September 2024.
Topic: Noise or sound management in the neonatal intensive care unit for preterm or very low birth weight infants
Author: Sibrecht, G., Wroblewska-Seniuk, K., Bruschettini, M. (2024)
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010333.pub4/full?highlightAbstract=
noise%7Cnois%7Clevel
Author conclusion:
Via this Cochrane Review it was demonstrated that no studies were able to reduce the sound levels below 45 dB across the neonatal unit. The author found one study that demonstrated the use of silicone earplugs versus no earplugs in newborns less than 1500 grams. The evidence presented was uncertain and could not demonstrate that the earplugs were effective at reducing noise and preventing consequences such as cerebral palsy.
Plain Language:
What is known is noise in neonatal intensive care units are louder than what is experienced in homes and most work environments. The noise is most likely very harmful for premature babies, disturbing their development and often leading to hearing impairment. The American Academy of Pediatrics recommends decreasing noise levels to below 45 decibels (dB) the WHO recommends less than 30 dB. Both are very difficult to achieve. What is known is that 2% to 10% of preterm infants are diagnosed with hearing loss compared to 0.1% of the general child population.
Citation:
ID: CD010333
AU: Sibrecht G
AU: Wróblewska-Seniuk K
AU: Bruschettini M
TI: Noise or sound management in the neonatal intensive care unit for preterm or very low birth weight infants
SO: Cochrane Database of Systematic Reviews YR: 2024 NO: 5 PB: John Wiley & Sons, Ltd SN: 1465-1858 KY: *Infant, Premature [growth & development]; *Infant, Very Low Birth Weight [growth & development]; *Intensive Care Units, Neonatal; *Noise [adverse effects]; *Randomized Controlled Trials as Topic; Bias; Ear Protective Devices; Hearing Loss, Noise-Induced [prevention & control]; Humans; Infant, Newborn; Sound DOI: 10.1002/14651858.CD010333.pub4 US: https://doi.org//10.1002/14651858.CD010333.pub4
Topic: Prophylactic barbiturate use for presentation of morbidity and mortality following perinatal asphyxia
Author: Leslie Young, Marie Berg, Roger Soli
Author conclusion:
The evidence for the practice of administering prophylactic barbiturates for babies with birth asphyxia was low quality. The studies did demonstrate that the risk of seizures was reduced for infants who received prophylactic barbiturates. Still, the mortality and long-term outcomes did not change compared to infants who did not receive prophylactic barbiturates. It is not recommended to become a routine clinical practice, and barbiturates should be given only to infants with seizures. e.
Citation:
Citation: ID: CD001240
AU: Young L
AU: Berg M
AU: Soll R
TI: Prophylactic barbiturate use for the prevention of morbidity and mortality following perinatal asphyxia
SO: Cochrane Database of Systematic Reviews
YR: 2016
NO: 5
PB: John Wiley & Sons, Ltd
SN: 1465-1858
KY: Anticonvulsants [*therapeutic use]; Asphyxia Neonatorum [complications, *drug therapy, mortality]; Barbiturates [*therapeutic use]; Humans; Infant; Infant, Newborn; Infant, Premature; Neurodevelopmental Disorders [etiology, prevention & control]; Phenobarbital [therapeutic use]; Phenytoin [therapeutic use]; Randomized Controlled Trials as Topic; Seizures [mortality, *prevention & control]; Thiopental [therapeutic use]
CC: [Neonatal]
DOI: 10.1002/14651858.CD001240.pub3
Topic: Fibreoptic phototherapy for neonatal jaundice
Mills, J. F., Tudehope, D. i (2021)
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002060/full?highlightAbstract=phototherapy%7Cphototherapi
Author conclusion:
When available, fibreoptic phototherapy is a good alternative to conventional phototherapy for term infants with physiologic jaundice.
Citation: Cochrane Review ID,Author(s),Title,Source,Year,Abstract,Issue,Publisher,ISSN,Keywords,DOI,URL,Cochrane Review Group Code
"CD002060","Mills, JF; Tudehope, D","Fibreoptic phototherapy for neonatal jaundice","Cochrane Database of Systematic Reviews","2001",,"1","John Wiley & Sons, Ltd","1465-1858","Fiber Optic Technology [*methods]; Humans; Hyperbilirubinemia [therapy]; Infant, Newborn; Jaundice, Neonatal [*therapy]; Phototherapy [*methods]; Randomized Controlled Trials as Topic","10.1002/14651858.CD002060","https://doi.org//10.1002/14651858.CD002060","Neonatal
Topic: Hand hygiene for the prevention of infections in neonates
Kuti BP, Ogunlesi TA, Oduwole O, Oringanje CCMO, Udoh EE, Bello S, Horn D,
Meremikwu MM.
Hand hygiene for the prevention of infections in neonates. Cochrane Database of Systematic Reviews 2023, Issue 6. Art. No.: CD013326. DOI:10.1002/14651858.CD013326.pub4. Accessed 04 April 2024.
Author conclusion: It is important to note that there is insufficient data from RCT to definitively determine the most effective agent for hand washing to prevent neonatal infections. While there is a substantial amount of data from moderate to very low evidence research that suggests the superiority of one form of antiseptic hand hygiene agent over others to prevent neonatal infection this research is not as rigorous as a RCT’s. Consideration should be given to the fact that actual hand-washing techniques, particularly the seven-step and five-moment washing methods, were not measured in RCT research. The author concluded that the available RCT research did not provide sufficient data to make a statement about the best hand hygiene agent or method. The researchers concluded that more well-designed randomized controlled trials are needed to assess how hand hygiene and agent used can prevent noninvasive and invasive infections.
Topic: Caffeine versus other methylxanthines for the prevention and treatment of apnea in preterm infants.
Moresco, Sjogren, Marques, Soll, Bruschettini (2023)
Author conclusion: Caffeine does improve clinical outcomes but there are few studies that compare caffeine to other methylxanthines such as aminophylline. This Cochrane review showed little to no difference in overall mortality, development of bronchopulmonary dysplasia or length of stay. Overall, the comparison between Caffeine and other methylxanthines have an uncertain effect on long-term development. Based on this Cochrane study there is little evidence to support Caffeine over other methylxanthines and they recommended more research especially for the preterm less than 28 weeks.