Introduction: Kangaroo care (KC) is defined by the World Health Organization as a method of care consisting in putting premature infants or newborns in skin-to-skin contact with their parents. KC is an effective method of promoting health and well-being of infants and their families. Physiological stability during KC has been widely analyzed, however with controversial results. Methods: A systematic review was conducted. Electronic databases searched included MEDLINE, Embase, CINAHL, and Scopus. Two authors independently reviewed and extracted information using a data extraction form. The methodological quality of the observational studies was assessed using “STROBE” and the “Cochrane Collaboration tool” for randomized controlled trials. The physiological monitoring parameters included were heart rate (HR), arterial oxygen saturation (SpO₂), regional cerebral oxygen saturation (rScO₂), and fractional oxygen extraction (FtOE). Results: A total of 345 articles were identified. First, 302 articles were excluded by title and then 34 articles after full-text analysis. Finally, a total of 25 studies were included. Physiological parameters monitored (HR, SpO₂, rScO₂, and FtOE) showed no significant changes at different study periods: pre-KC, during KC, and post-KC. Conclusions: We conclude that stable preterm infants receiving or not respiratory support show no significant differences in HR, SpO₂, FtOE during KC compared to routine incubator care. rScO₂ remains stable during KC with slight upward trend. Further studies with a higher level of methodological quality are needed to confirm these findings.

(1) Objective. We aimed to demonstrate that the use of the ultrasound-guided technique facilitates peripheral venous cannulation as compared to the standard technique in patients with difficult access at emergency services. (2) Method. A case–control study, randomized research. Variables were collected from a population with non-palpable or not visible veins, classified into size risk groups for 6 months. In the comparative analysis, the patients were divided into two groups: the cases group was composed of patients to whom the peripheral venous cannulation was performed with the ultrasound-guided technique (UST), while the control was composed of patients with whom the standard technique (ST) was performed. The ultrasound LOGIQ P5 750VA from General Electric Healthcare, with an 11 mHz linear probe, was utilized, along with peripheral venous catheters model Insyte^TM Autoguard^TM with gauges of 14G to 26G. (3) Results. Seventy-two cases. The use of the ultrasound decreased the time (618.34s ST, 126s UST) and the number of punctures (2.92 ST, 1.23 UST); about 25% of the patients did not have complications with the UST, as compared to 8% with the ST. The use of the ultrasound decreased the pain experienced by 1.44 points in the visual analog scale, as compared to 0.11 points with the ST. The rate of success of the first try with the UST was 76%, as compared to 16% of the ST. The gauge of the catheter increased with the UST, with successful cannulations obtained with 20G (56%) and 18G (41%) gauges. (4) Conclusions. The use of ultrasound facilitates venous cannulation according to the variables of the study. The ultrasound visualization of the vessels is associated with the selection of the catheter gauge. There was no relation between the complications and the depth of the blood vessels.

The glutathione (GSH)-to-glutathione disulfide (GSSG) ratio is an essential node contributing to intracellular redox status. GSH/GSSG determination in whole blood can be accomplished by liquid chromatography–mass spectrometry (LC-MS) after the derivatization of GSH with N-ethylmaleimide (NEM). While this is feasible in a laboratory environment, its application in the clinical scenario is cumbersome and therefore ranges reported in similar populations differ noticeably. In this work, an LC-MS procedure for the determination of GSH and GSSG in dried blood spot (DBS) samples based on direct in situ GSH derivatization with NEM of only 10 µL of blood was developed. This novel method was applied to 73 cord blood samples and 88 residual blood volumes from routine newborn screening performed at discharge from healthy term infants. Two clinical scenarios simulating conditions of sampling and storage relevant for routine clinical analysis and clinical trials were assessed. Levels of GSH-NEM and GSSG measured in DBS samples were comparable to those obtained by liquid blood samples. GSH-NEM and GSSG median values for cord blood samples were significantly lower than those for samples at discharge. However, the GSH-NEM-to-GSSG ratios were not statistically different between both groups. With DBS testing, the immediate manipulation of samples by clinical staff is reduced. We therefore expect that this method will pave the way in providing an accurate and more robust determination of the GSH/GSSG values and trends reported in clinical trials.

Introduction: We aimed to investigate the cerebral fractional tissue oxygen extraction (FtOE) during kangaroo care (KC) in premature infants and compare cardiorespiratory stability and hypoxic or bradycardic events between KC and incubator care. Methods: A single-center prospective observational study was carried out at the NICU of a level 3 perinatal center. Preterm infants <32 weeks gestational age were subjected to KC. Patients were subjected to continuous monitoring of regional cerebral oxygen saturation (rScO2), peripheral oxygen saturation (SpO2), and heart rate (HR) during KC, before KC (pre-KC), and after KC (post-KC). The monitoring data were stored and exported to MATLAB for synchronization and signal analysis including the calculation of the FtOE and events analysis (i.e., desaturations and bradycardias counts and anormal values). Furthermore, the event counts and the mean SpO2, HR, rScO2, and FtOE were compared between studied periods employing the Wilcoxon rank-sum test and the Friedman test, respectively. Results: A total of forty-three KC sessions with their corresponding pre-KC and post-KC segments were analyzed. The distributions of the SpO2, HR, rScO2, and FtOE showed different patterns according to the respiratory support, but not differences between the studied periods were detected. Accordingly, no significant differences in monitoring events were evidenced. However, cerebral metabolic demand (FtOE) was significantly lower during KC compared with post-KC (p = 0.019). Conclusion: Premature infants remain clinically stable during KC. Moreover, cerebral oxygenation is significantly higher and cerebral tissular oxygen extraction is significantly lower during KC compared with incubator care in post-KC. No differences in HR and SpO2 were shown. This novel data analysis methodology could be expanded to other clinical situations.

Introduction: Moderate and late preterm (MLPT) infants represent a substantial percentage of all preterm infants and frequently need support in the delivery room. Deferred cord clamping (DCC) improves SpO2 and heart rate (HR) stabilization in term infants. However, data on MLPT infants are limited. Methods: We performed a prospective observational study collecting SpO2 and HR by pulse oximetry in healthy MLPT infants with DDC to construct percentile graphs for the first 10 min after birth. Results: A total of 96 MLPT infants were monitored for preductal SpO2 and HR, and percentiles were calculated. SpO2 mean was significantly lower for MLPT than for term infants during the first 6 min after birth, and 15% did not achieve SpO2 ≥85% in the first 5 min after birth. HR was significantly lower in MLPT infants in the first 4 min after birth; however, HR consistently remained above bradycardic values (>100 bpm). NICU admission and postnatal complications were not different between MLPT achieving SpO2 ≥85% or not. Conclusion: MLPT infants with DCC achieved stable SpO2 and HR significantly later, 6 min and 4 min, respectively, than term infants. In addition, 15% of MLPT infants did not achieve SpO2 ≥85% at 5 min after birth. However, admission to the NICU and clinical evolution did not differ from newborns with SpO2 ≥85% at 5 min. Larger studies including long-term follow-up are needed to assess if lower SpO2 in the first 5 min has clinical consequences in non-resuscitated MLPT.