Exposure and reactivity of the preterm infant to noise in the incubator

Thermoregulation, incubator humidity, and skincare practices in appropriate for gestational age ultra-low birth weight infants: need for more evidence

BACKGROUND

Although not universal, active care is being offered to infants weighing < 500 g at birth, referred to as ultra-low birth weight (ULBW) infants appropriate for gestational age. These infants have the greatest risk of dying or developing major morbidities. ULBW infants face challenges related to fluid and heat loss as well as skin injury in the initial days of life from extreme anatomical and physiological immaturity of the skin. Although there is an emerging literature on the outcomes of ULBW infants, there is a paucity of evidence to inform practice guidelines for delivering optimal care to this cohort of infants.

DATA SOURCES

A comprehensive review of the literature was performed using the PubMed and Embase databases. Searched keywords included "thermoregulation or body temperature regulation", "incubator humidity", "skin care", "infant, extremely low birth weight" and "ultra-low birth weight infants".

RESULTS

Evidences for thermoregulation, incubator humidity, and skincare practices are available for preterm infants weighing < 1500 g at birth but not specifically for ULBW infants. Studies on thermoregulation, incubator humidity, or skincare practices had a small sample size and did not include a sub-group analysis for ULBW infants. Current practice recommendations in ULBW infants are adopted from research in very and/or extremely low birth weight infants.

CONCLUSIONS

This narrative review focuses on challenges in thermoregulation, incubator humidity, and skincare practices in ULBW infants, highlights current research gaps and suggests potential developments for informing practices for improving health outcomes in ULBW infants. Video abstract (MP4 1,49,115 kb).

Noise in a Neonatal Intensive Care Unit: Exploring Its State and Solutions

BACKGROUND

Concerns regarding the environmental noise issue in neonatal units and an interest in developing strategies to reduce this noise have motivated researchers to conduct comprehensive qualitative research to elucidate the current situation and help improve it.

PURPOSE

This study aims to explore the current state of noise and possible solutions in a neonatal intensive care unit (NICU) in Konya, Turkey.

METHODS

In 2021, a descriptive exploratory study was conducted with a qualitative content analysis approach. Eighteen nurses, three physicians, seven staff members, and four mothers were selected to participate in the study via purposeful sampling. The data were collected from two semi-structured interviews, six focus groups, six observations, and sound source level measurements using a sound decibel meter. Qualitative content analysis was used to analyze the data.

RESULTS

Three main themes and seven major categories emerged from the data analysis. The themes were overt and covert sources, pan-negative effects, and holistic modification. All recorded sound levels exceeded the recommended noise level of 45 dB. Fifty-seven percent of sound sources were in the range of 45-65 dB, and 43% were higher than 65 dB.

IMPLICATIONS FOR PRACTICE AND RESEARCH

This study showed that NICU has a noisy environment with hidden sound sources that can negatively affect all people. This situation must be approached seriously by holistic modification involving environmental modification, behavioral modification, and resource management. It highlighted that each environment is unique and needs to be carefully evaluated to find a suitable and cost-effective solution.

Medical staff's sentiments on the establishment of quiet time in the NICU

AIM

To explore the sentiments of medical staff in setting quiet time in a tertiary neonatal intensive care unit.

BACKGROUND

Quiet time, which can help create a healing neonatal intensive care unit environment, is increasingly being valued by hospital administrators.

METHODS

Semi-structured interviews were used to interview twelve neonatal intensive care unit staff members, with data analyzed using the content analysis method.

RESULTS

This study extracted four themes: support, concern, education, and teamwork.

CONCLUSIONS

If quiet time needs to be set up, implemented, and maintained in the neonatal intensive care unit, it is necessary to establish a quiet time culture throughout the whole ward, to carry out detailed management of quiet time, and to cooperate and communicate with multidisciplinary departments.

IMPLICATIONS FOR NURSING MANAGEMENT

To keep the ward quiet and minimize handling during quiet time, it is necessary to take adequate steps from a management level. Targeted staff training and education allow staff to appreciate the necessity and urgency of setting quiet time for themselves and babies. It is also necessary to refine the educational content of noise reduction and minimal handling, and provide clear guidance on the best means to carry out clinical work during quiet time. Nursing managers need to establish a monitoring system for NICU noise and manage various noise sources made from equipment and people.