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Background: Meconium intestinal obstructions in newborns can be caused by various pathologies such as meconium ileus, meconium obstruction of prematurity, meconium disease, and meconium plug syndrome. These are often mistaken as the same clinical entities; however, meconium ileus stands out through its association with the genetic disorder known as cystic fibrosis. In case of delayed diagnosis, the complete obstruction can progress to a complex form of meconium ileus, with numerous complications. The primary focus of the search was to emphasize on the necessity of a prompt diagnosis using diagnostic tools, and to react accordingly with an adequate therapeutic approach. Methods: PubMed database were searched for relevant articles. Results: Meconium ileus is a multifactorial pathology combining genetical, physiological and clinical elements. This includes a mutation of the cystic fibrosis transmembrane receptor gene, immaturity of a synchronized neuromuscular coordination to reach functional peristalsis, and the influence of maternal and infant-related risk factors. Meconium ileus initially presents with abdominal distention and emesis but can however rapidly progress to a complex form. This is best prevented integrating the following diagnostic tools: 1) clinical evaluation, 2) abdominal radiographs and/or 3) diatrizoate (Gastrografin®) enema. Following diagnosis, different therapeutical approaches, such as saline and N-acetylcysteine irrigation, glycerin suppositories, Gastrografin® enema and surgery, can be established depending on the clinical condition. Conclusion: By reaching a prompt diagnosis of meconium ileus, therapeutic measures can be taken which helps infants reach a more stable hemodynamic condition quickly with less invasive methods. Furthermore, immediate diagnose also contributes to prevent infant morbidity and mortality.

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Neonatal care has dramatically improved over the past decades. This has led to an increased survival of preterm infants. Common co-morbidities associated with prematurity are bronchopulmonary dysplasia, intraventricular hemorrhage and periventricular leukomalacia. Preterm infants with these co-morbidities often have disturbed oral feeding skills. Our aim is to review the prevalence, risk factors and pathogenesis of these feeding problems in preterm infants with these co-morbidities. We will also explore the relation between bronchopulmonary dysplasia and gastro-esophageal reflux. PubMed was searched for articles. Afterwards the chain sampling technique was used for more articles. To attain safe oral feeding, the coordination of sucking, swallowing and breathing is essential. This coordination is immature in all preterm infants and is even more disturbed in infants with bronchopulmonary dysplasia or brain injuries. The prevalence of the feeding problems in infants with these co-morbidities is unknown. In infants with bronchopulmonary dysplasia the coordination of sucking, swallowing and breathing is disturbed. This is due to an irregular breathing pattern, weak sucking pressure and less frequent swallowing. Moreover, oral hypersensitivity and aversion arise caused by multiple negative facial manipulations. The correlation between gastro-esophageal reflux and bronchopulmonary dysplasia is still uncertain. In preterm infants with an intraventricular hemorrhage or periventricular leukomalacia, the sucking and swallowing are impeded. This is probably due to dysfunction of the central pattern generators in the brainstem that regulate the complex sucking-swallowing-breathing processes. Also, the risk for oral aversion is higher in these infants with a complicated neonatal period. This results in a delayed achievement of full oral feeding in infants with bronchopulmonary dysplasia or intraventricular hemorrhage, usually around 38 weeks postmenstrual age. This is respectively 11 and 9 days later compared to healthy preterm infants. We conclude that medical follow-up and nutritional support are important to maintain adequate intake in preterm infants with associated co-morbidities. This is necessary to ensure normal growth and to support neurodevelopment in these patients at risk.

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Congenital heart disease (CHD) is a common birth defect with an increasing survival rate due to improved neonatal care. However, neonatal care is still challenged because of the higher prevalence of associated comorbidities in infants with CHD including feeding difficulties and impaired nutritional intake. Feeding difficulties are associated with a variety of problems such as impaired safety and efficiency of swallowing, behavioral troubles, and cardiorespiratory deficits. A large proportion of the infants with CHD is capable of exclusive oral feeding. However, oral feeding difficulties may lead to unsafe and inadequate oral intake, requiring implementation of tube feeding for some infants. Tube feeding can control the nutritional intake, but is associated with risks and complications that need to be taken in account. Furthermore, feeding is related to other factors such as surgical interventions. Surgery can enhance or deteriorate the feeding of the infant with CHD depending on factors such as the type of surgery and gestational age. Surgery can also cause vocal cord dysfunction which in turn leads to additional feeding difficulties. Hence, feeding is multifactorial influenced which complicates a simple conclusion. This narrative review provides an overview of the current evidence of feeding in infants with CHD.

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Objective : This scoping review aims to identify the available scientific evidence for infantile swallowing disorders in neurological diseases such as Intracranial Haemorrhage (ICH), Arterial Ischemic Stroke (AIS) and Hypoxic Ischemic Encephalopathy (HIE). The following aspects of swallowing disorders will be investigated: the (a) prevalence, (b) types of swallowing/feeding issues, (c) diagnostic tools, (d) available treatment options and (e) the involvement of the multidisciplinary healthcare team. Methods: The study design presumed upon the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A structured search strategy was conducted in five databases and one register system, pertaining to three concepts: swallowing/feeding disorders, infants and neurological disorders. Results: The search strategy yield an aggregate of 5,110 articles and 25 out of them met the inclusion criteria. The available evidence about swallowing disorders was analysed in three main categories according to the occurring disease in infants: 1. Intracranial Haemorrhage (ICH), 2. Arterial Ischemic Stroke (AIS) and 3. Hypoxic Ischemic Encephalopathy (HIE). The prevalence of swallowing disorders in ICH and AIS is documented in the majority of the relevant articles included but it is rarely discussed in HIE. The most common clinical presentations in neonates or infants are vomiting and poor sucking in ICH, aspiration/high risk for aspiration and gastroesophageal reflux in AIS. Aspiration, sucking/breastfeeding difficulties and persistent feeding impairment are mostly presented in HIE. Limited data are found for ICH and the diagnostic evaluation of swallowing problems. However, instrumental evaluation is often utilized. The literature does not identify any available means of assessment in AIS. When investigating deglutitive impairment in HIE population, both clinical and instrumental means are indicated; VFSS, pharyngo-esophageal and/or esophageal manometry and the Penetration Aspiration Scale (PAS) are most often employed. Alternative feeding methods such as nasogastric/gastrostomy tube are the predominant means of dysphagia management. Diet modification is also reported in AIS intervention plans. Oral stimulation is frequently mentioned in HIE treatment options. Overall, paediatric neurologists and Speech and Language Pathologists (SLPs) are reported to be the prevailing healthcare professionals in the multidisciplinary team recruitment. The complicity of the multidisciplinary healthcare team is not extensively identified in the literature. Conclusion : This scoping review indicates that deglutitive issues are present in the neonatal neurological diseases. There is only limited data available on swallowing issues in ICH and AIS population. In the case of HIE, there is limited evidence for the manifestations, the assessment and the intervention methods. The contribution of the multidisciplinary healthcare team to dysphagia management is lacking in literature. These research findings underline the importance of further investigation to analyse the nature of feeding problems, enrich dysphagia toolkit and identify the best ways for dysphagia management in infants with neurological impairment.

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Nora Haesevoets; Amber Jacobs, Umbilical cord care in hospitalized preterm and term infants born in developed countries: a scoping review. Master thesis presented to obtain the degree of Master Nursing and Midwifery, June 2023. Promotor: prof. dr. Maissa Rayyan Background: Dry cord care is recommended by the World Health Organisation, but many other products are used for umbilical cord care. Aim: This scoping review aims to provide an overview of different products used for umbilical cord care and to define the most effective method to prevent infection and neonatal mortality in hospitalized neonates, both term and preterm born in developed countries. Methods: A search strategy for PubMed and Embase was established focusing on three main concepts: neonates, umbilical cord, and infant care/umbilical cord care. A blind selection was performed in two steps (title/abstract and full text) by two independent evaluators. Conflict resolution was executed by a third independent evaluator. The selection criteria included the study outcome, population, language, type of literature, and publication date. Additionally, the references of included articles and secondary literature were also evaluated. Results: After the selection of the 4703 extracted articles, 40 articles were included. Dry cord care and additional 11 different products were identified. Conclusion: Dry cord care and different types of products are used for umbilical cord care. Some caution for the choice of product is advised in premature infants. Dry umbilical cord care is preferred. Human milk is also strongly recommended. The use of antiseptics prolongs the umbilical cord separation process but stays important in case of infection prevention. National uniform guidelines for umbilical cord care are necessary to ensure that there is uniformity in care about the best method of umbilical care in the context of the shortest separation time and least risk of infection. Practice relevance: Even in Belgium, hospitals do not always have uniformity about the best umbilical care. This scoping review can help guide how best to perform umbilical care and which products to use or not.