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Minotti C, Aghlmandi S, Bielicki JA. Electronic hand hygiene monitoring tools for implementation of optimal hand sanitizing adherence in neonatal intensive care. J Hosp Infect 2024; 147:213-215. [PMID: 38447807 DOI: 10.1016/j.jhin.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Affiliation(s)
- C Minotti
- Paediatric Research Centre, University Children's Hospital Basel, Basel, Switzerland; Infectious Disease and Vaccinology, University Children's Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - S Aghlmandi
- Paediatric Research Centre, University Children's Hospital Basel, Basel, Switzerland
| | - J A Bielicki
- Paediatric Research Centre, University Children's Hospital Basel, Basel, Switzerland; Infectious Disease and Vaccinology, University Children's Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St George's, University of London, London, UK
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2
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Moore CM, O'Sullivan S, Curley AE. Parents' understanding and experiences of blood component transfusion in the neonatal intensive care unit: A qualitative study. Acta Paediatr 2023; 112:2493-2502. [PMID: 37615240 DOI: 10.1111/apa.16952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
AIM Blood component transfusion is a common intervention in the neonatal intensive care unit (NICU). Parents consent on their babies' behalf. This study aimed to explore parents' understandings and experiences of consenting and the subsequent blood transfusion. METHODS A "low inference" qualitative descriptive semi-structured interview approach was utilised. Grounded theory was employed. Parents described their memories of babies' transfusions, their responses to the consent process and assessed the written information they were given. RESULTS A purposive sample of 17 parents whose babies required blood transfusion in the NICU participated. Parents talked about their initial fears of transfusion, later replaced by confidence in the process and results of transfusion and trust in the healthcare professional team. The main themes elicited by the interviews were parents' expectations and outcomes of transfusion, parents' prior and current opinions of transfusion, parents trust in healthcare professionals and how parents would like to receive information about transfusions in the NICU. CONCLUSION Parents in our study trust information from the healthcare professionals caring for their baby and would like more specific information about how blood transfusion will impact their baby, in a variety of means. Parents felt that blood transfusions were beneficial for their babies.
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Affiliation(s)
- Carmel Maria Moore
- School of Medicine, University College Dublin, Dublin 4, Ireland
- Neonatology, National Maternity Hospital, Dublin 2, Ireland
| | - Sara O'Sullivan
- School of Sociology, University College Dublin, Dublin 4, Ireland
| | - Anna E Curley
- School of Medicine, University College Dublin, Dublin 4, Ireland
- Neonatology, National Maternity Hospital, Dublin 2, Ireland
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3
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Ding L, Chen Y, Zhang W, Song J, Yao X, Wan Y, Huang R. Effect of family integrated care on breastfeeding of preterm infants: A scoping review. Nurs Open 2023; 10:5950-5960. [PMID: 37306324 PMCID: PMC10416000 DOI: 10.1002/nop2.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
AIMS The aims are to describe the key components of family integrated care intervention for preterm infants in the neonatal intensive care unit (NICU) and assess the impact on breastfeeding outcomes for those infants. DESIGN A scoping review. METHODS We conducted a systematic study search based on the databases, including PubMed, Scopus, Cochrane, Web of Science, MEDLINE, CINAHL, CNKI and Wanfang Database in December 2022. The search time ranged from database establishment to 31 December 2022. Papers by manual searching were also listed on the references. We adopted Joanna Briggs Institute Reviewer's Manual methodology and followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) to conduct the review. Two independent reviewers filtered the papers, extracted data and synthesized the findings. A table was used to extract data and synthesize results. RESULTS After systematic searching, 11 articles that implemented family integrated care (FIcare) were finally included in this scoping review. By analysing the implementation of this nursing model, we identified seven main components: NICU staff training, parent education, parent participation in infants' care, parent involvement in medical plans, peer support, NICU environmental support and mobile app for parents. Based on the extracted breastfeeding data, this scoping review concludes that family integrated care shows a positive effect on increasing breastfeeding rates at discharge. Through this scoping review, we find that family integrated care is feasible and it can support breastfeeding of preterm infants. Further studies will be needed to provide more evidence that family integrated care could facilitate breastfeeding of preterm infants. IMPACT This scoping review provides evidence for the positive role of family integrated care on breastfeeding outcomes. The analysis may contribute to the implementation of family integrated care. NO PATIENT OR PUBLIC CONTRIBUTION No further public or patient contribution was made in view of the review-based nature of the research.
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Affiliation(s)
- Lijing Ding
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yanli Chen
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Wenyan Zhang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Jianqi Song
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiao Yao
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yue Wan
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Rong Huang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
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4
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Romeo R, Pezanowski R, Merrill K, Hargrave S, Hansen A. Parent and staff perspectives on the benefits and barriers to communication with infants in the neonatal intensive care unit. J Child Health Care 2023; 27:410-423. [PMID: 35232268 PMCID: PMC9433464 DOI: 10.1177/13674935221076216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exposure to high quantity and quality of language in the neonatal period is critical to neurocognitive development; however, Neonatal Intensive Care Unit (NICU) environments may contribute to language deprivation. Using qualitative thematic content analysis, this study aimed to characterize the knowledge and attitudes of NICU staff and patient families toward the importance of early language experience, the current NICU language environment, and the benefits and barriers of communication in the NICU. Results revealed that all respondents recognized the importance of communication for optimal cognitive development, though few understood why. Staff and family members alike recognized the role of nurses as coaches and role models in promoting communication at the bedside. Nurses generally felt that family members communicate less with their babies than family members themselves perceived, and that cell phone use has fewer communicative advantages than parents perceive. Respondents reported that patient illness, lack of time, and intimidating equipment all raise barriers to communication. These findings yield important considerations for developing educational interventions to improve NICU language environments, including a synergistic, dual focus on both staff and families. Communication in the NICU is a low cost, feasible, and accessible target with aims of ensuring optimal neurocognitive development for at-risk children.
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Affiliation(s)
- Rachel Romeo
- Boston Children’s Hospital, Boston MA USA
- Harvard Medical School, Boston MA USA
- Massachusetts Institute of Technology, Cambridge MA USA
| | | | | | | | - Anne Hansen
- Boston Children’s Hospital, Boston MA USA
- Harvard Medical School, Boston MA USA
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5
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Arriaga-Redondo M, Sanz-Lopez E, Rodríguez-Sánchez de la Blanca A, Marsinyach-Ros I, Lambea-Rueda L, Díaz-Redondo A, Sanchez-Luna M. Parent Perception of Child Safety following Admission to a Neonatal Unit. Am J Perinatol 2023; 40:424-431. [PMID: 33971671 DOI: 10.1055/s-0041-1729554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Parent partnership is a key aspect of neonatal hospital care. However, there is a lack of information regarding parents' perception of neonatal safety. This study explores parents' opinions on safety during their child's hospitalization to identify points for improvement. STUDY DESIGN We used a questionnaire, validated by the Spanish National Healthcare Authorities, on perception of safety with respect to hospital health care. RESULTS Thirty-seven parents of 20 newborns treated in the neonatal intensive care unit (NICU) and 139 parents of newborns in intermediate care (IC) participated in this study. With regard to overall perception of safety, more than 96% of parents felt "very safe" or "fairly safe." In the NICU, an area for improvement detected was to ask parents more often their opinion about the care or treatment provided to their child. In IC, three points for improvement were identified from the group of parents whose child was admitted directly to IC: the consistency of the information received, the request for consent for procedures, and the request for an opinion on their child's care and treatment. Only four parents reported that their child suffered an incident. Regarding incident management, parents were not completely satisfied with the information they received. CONCLUSION To the best of our knowledge, this is the first study of parent perception of patient safety in a neonatal unit using a validated questionnaire. Our findings suggest that parents can provide valuable information on neonatal safety, which can then be used to identify areas for improvement. KEY POINTS · There is a lack of information regarding parents' perception of neonatal safety.. · This study explores parent's opinion about safety of their child during the hospitalization.. · Our findings suggest that parents can provide valuable information to identify improvement areas..
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Affiliation(s)
| | - Ester Sanz-Lopez
- Preventive Medicine Service, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | | | - Alicia Díaz-Redondo
- Preventive Medicine Service, Gregorio Marañón University Hospital, Madrid, Spain
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6
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Petersson MÅ, Benzein E, Massoudi P, Wåhlin I, Persson C. Parents' experiences of the significance of interpersonal interactions for becoming parents and a family during neonatal intensive care. J Pediatr Nurs 2022; 69:e1-e6. [PMID: 36481222 DOI: 10.1016/j.pedn.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To describe parents' experiences of the significance of interpersonal interactions for becoming parents and a family during neonatal intensive care. DESIGN AND METHODS We employed a qualitative descriptive design with semi-structured family interviews. Ten families were included from four neonatal intensive care units (NICU) in Sweden. Results were evaluated using thematic analysis. RESULTS The results were presented as two themes: 1) Interactions within the family, and 2) Interactions between parents and staff. Analyses revealed that interpersonal interactions could both facilitate and hinder development in becoming a parent and a family. CONCLUSION Interactions within the family and with the staff have an important function in the process of becoming a parent and a family. This process would benefit from a systemic approach, focusing on the family as a unit, as unique individuals, and as parents with unique needs and experiences. PRACTICE IMPLICATIONS Our findings can facilitate changes to reduce the separation between family members (mother-father-newborn-siblings) during their stay in NICU; guiding parents to take care of their child, while being sensitive and balancing their situation as to where they are in their process; supporting the family through joint conversations by listening to the parents and their expectations and experiences both in the NICU and at home; and encouraging parents to do everyday things together outside NICU like an ordinary family.
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Affiliation(s)
- Marie Åberg Petersson
- Clinical Training Center, Region Kalmar County, Kalmar, Sweden; School of Health and Caring Sciences, Linnaeus University, Växjö, Kalmar, Sweden.
| | - Eva Benzein
- School of Health and Caring Sciences, Linnaeus University, Växjö, Kalmar, Sweden
| | - Pamela Massoudi
- Department of Research and Development, Region Kronoberg, Sweden; Department of Psychology, University of Gothenburg, Sweden
| | - Ingrid Wåhlin
- School of Health and Caring Sciences, Linnaeus University, Växjö, Kalmar, Sweden; Research section, Region Kalmar County, Kalmar, Sweden
| | - Carina Persson
- School of Health and Caring Sciences, Linnaeus University, Växjö, Kalmar, Sweden
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Venkatesh KK, Lynch CD, Costantine MM, Backes CH, Slaughter JL, Frey HA, Huang X, Landon MB, Klebanoff MA, Khan SS, Grobman WA. Trends in Active Treatment of Live-born Neonates Between 22 Weeks 0 Days and 25 Weeks 6 Days by Gestational Age and Maternal Race and Ethnicity in the US, 2014 to 2020. JAMA 2022; 328:652-662. [PMID: 35972487 PMCID: PMC9382444 DOI: 10.1001/jama.2022.12841] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Birth in the periviable period between 22 weeks 0 days and 25 weeks 6 days' gestation is a major source of neonatal morbidity and mortality, and the decision to initiate active life-saving treatment is challenging. OBJECTIVE To assess whether the frequency of active treatment among live-born neonates in the periviable period has changed over time and whether active treatment differed by gestational age at birth and race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional descriptive study using National Center for Health Statistics natality data from 2014 to 2020 for 61 908 singleton live births without clinical anomalies between 22 weeks 0 days and 25 weeks 6 days in the US. EXPOSURES Year of delivery, gestational age at birth, and race and ethnicity of the pregnant individual, stratified as non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White. MAIN OUTCOMES AND MEASURES Active treatment, determined by whether there was an attempt to treat the neonate and defined as a composite of surfactant therapy, immediate assisted ventilation at birth, assisted ventilation more than 6 hours in duration, and/or antibiotic therapy. Frequencies, mean annual percent change (APC), and adjusted risk ratios (aRRs) were estimated. RESULTS Of 26 986 716 live births, 61 908 (0.2%) were periviable live births included in this study: 5% were Asian/Pacific Islander, 37% Black, 24% Hispanic, and 34% White; and 14% were born at 22 weeks, 21% at 23 weeks, 30% at 24 weeks, and 34% at 25 weeks. Fifty-two percent of neonates received active treatment. From 2014 to 2020, the overall frequency (mean APC per year) of active treatment increased significantly (3.9% [95% CI, 3.0% to 4.9%]), as well as among all racial and ethnic subgroups (Asian/Pacific Islander: 3.4% [95% CI, 0.8% to 6.0%]); Black: 4.7% [95% CI, 3.4% to 5.9%]; Hispanic: 4.7% [95% CI, 3.4% to 5.9%]; and White: 3.1% [95% CI, 1.1% to 4.4%]) and among each gestational age range (22 weeks: 14.4% [95% CI, 11.1% to 17.7%] and 25 weeks: 2.9% [95% CI, 1.5% to 4.2%]). Compared with neonates born to White individuals (57.0%), neonates born to Asian/Pacific Islander (46.2%; risk difference [RD], -10.81 [95% CI, -12.75 to -8.88]; aRR, 0.82 [95% CI, [0.79-0.86]), Black (51.6%; RD, -5.42 [95% CI, -6.36 to -4.50]; aRR, 0.90 [95% CI, 0.89 to 0.92]), and Hispanic (48.0%; RD, -9.03 [95% CI, -10.07 to -7.99]; aRR, 0.83 [95% CI, 0.81 to 0.85]) individuals were significantly less likely to receive active treatment. CONCLUSIONS AND RELEVANCE From 2014 to 2020 in the US, the frequency of active treatment among neonates born alive between 22 weeks 0 days and 25 weeks 6 days significantly increased, and there were differences in rates of active treatment by race and ethnicity.
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MESH Headings
- Clinical Decision-Making
- Cross-Sectional Studies
- Ethnicity/statistics & numerical data
- Female
- Fetal Viability
- Gestational Age
- Humans
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/ethnology
- Infant, Premature, Diseases/therapy
- Intensive Care, Neonatal/methods
- Intensive Care, Neonatal/statistics & numerical data
- Intensive Care, Neonatal/trends
- Live Birth/epidemiology
- Live Birth/ethnology
- Patient Care/methods
- Patient Care/statistics & numerical data
- Patient Care/trends
- Pregnancy
- Retrospective Studies
- United States/epidemiology
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Affiliation(s)
- Kartik K. Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Courtney D. Lynch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Maged M. Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Carl H. Backes
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Jonathan L. Slaughter
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Heather A. Frey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Xiaoning Huang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark B. Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Mark A. Klebanoff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
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8
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Lee HC, Lyell DJ. Active Treatment and Shared Decision-making for Infants Born Extremely Preterm at 22 to 25 Weeks. JAMA 2022; 328:624-626. [PMID: 35972504 DOI: 10.1001/jama.2022.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Henry C Lee
- Division of Neonatology, Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - Deirdre J Lyell
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford, California
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9
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Affiliation(s)
- Andrei S Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM U1153 EPOPé, INRA, Paris, France
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- Department of Neonatal Medicine, Maternité Port-Royal, Association Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Marina Mendonça
- Department of Psychology, University of Warwick, Coventry, UK
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nicole Thiele
- European Foundation for Care of the Newborn Infant, Munich, Germany
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- National Institute for Health Research, University College London Hospital Biomedical Research Centre, London, UK
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10
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de Sousa JCS, de Carvalho AVD, Monte de Prada LDC, Marinho AP, de Lima KF, Macedo SKDO, Santos CDP, da Câmara SMA, Barreto ACDNG, Pereira SA. Nutritional Factors Associated with Late-Onset Sepsis in Very Low Birth Weight Newborns. Nutrients 2021; 14:196. [PMID: 35011069 PMCID: PMC8747100 DOI: 10.3390/nu14010196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Delayed onset of minimal enteral nutrition compromises the immune response of preterm infants, increasing the risk of colonization and clinical complications (e.g., late-onset sepsis). This study aimed to analyze associations between late-onset sepsis in very low birth weight infants (<1500 g) and days of parenteral nutrition, days to reach full enteral nutrition, and maternal and nutritional factors. METHODS A cross-sectional study was carried out with very low birth weight infants admitted to a neonatal intensive care unit (NICU) of a reference maternity hospital of high-risk deliveries. Data regarding days of parenteral nutrition, days to reach full enteral nutrition, fasting days, extrauterine growth restriction, and NICU length of stay were extracted from online medical records. Late-onset sepsis was diagnosed (clinical or laboratory) after 48 h of life. Chi-squared, Mann-Whitney tests, and binary logistic regression were applied. RESULTS A total of 97 preterm infants were included. Of those, 75 presented late-onset sepsis with clinical (n = 40) or laboratory (n = 35) diagnosis. Maternal urinary tract infection, prolonged parenteral nutrition (>14 days), and extrauterine growth restriction presented 4.24-fold, 4.86-fold, and 4.90-fold higher chance of late-onset sepsis, respectively. CONCLUSION Very low birth weight infants with late-onset sepsis had prolonged parenteral nutrition and took longer to reach full enteral nutrition. They also presented a higher prevalence of extrauterine growth restriction than infants without late-onset sepsis.
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Affiliation(s)
- Juliany Caroline Silva de Sousa
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Ana Verônica Dantas de Carvalho
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Lorena de Carvalho Monte de Prada
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Arthur Pedro Marinho
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Kerolaynne Fonseca de Lima
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Suianny Karla de Oliveira Macedo
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Camila Dayze Pereira Santos
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | | | - Anna Christina do Nascimento Granjeiro Barreto
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Silvana Alves Pereira
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal 59075-000, Brazil;
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11
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Scala M, Marchman VA, Brignoni-Pérez E, Morales MC, Dubner SE, Travis KE. Impact of the COVID-19 pandemic on developmental care practices for infants born preterm. Early Hum Dev 2021; 163:105483. [PMID: 34649193 PMCID: PMC8489845 DOI: 10.1016/j.earlhumdev.2021.105483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/09/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm. METHODS We analyzed electronic medical record data from 129 infants born at less than 32 weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to Nov 30, 2020, n = 67) and the analogous period in 2019 (n = 62). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for covariates. RESULTS Families of infants visited the hospital at nearly half of the rate during 2020 as during 2019 (p = 0.001). Infants experienced developmental care less frequently in 2020 vs. 2019 (3.0 vs. 4.3 activities per day; p = 0.001), resulting in fewer minutes per day (77.5 vs. 130.0; p = 0.001). In 2020, developmental care activities were 5 min shorter, on average, than in 2019, p = 0.001. Similar reductions occurred in both family- and staff-delivered developmental care. Follow-up analyses indicated that effects persisted and even worsened as the pandemic continued through fall 2020, despite relaxation of hospital visitation policies. CONCLUSIONS The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.
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Affiliation(s)
- Melissa Scala
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA.
| | - Virginia A Marchman
- Department of Psychology, Stanford University, Stanford, CA, USA; Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
| | - Edith Brignoni-Pérez
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Maya Chan Morales
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
| | - Sarah E Dubner
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
| | - Katherine E Travis
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
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12
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Pineda R, Smith J, Roussin J, Wallendorf M, Kellner P, Colditz G. Randomized clinical trial investigating the effect of consistent, developmentally-appropriate, and evidence-based multisensory exposures in the NICU. J Perinatol 2021; 41:2449-2462. [PMID: 34012055 PMCID: PMC8516670 DOI: 10.1038/s41372-021-01078-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Evaluate the effect of a manualized multisensory program, applied across NICU hospitalization, on infant and parent outcomes. STUDY DESIGN Seventy parent-infant dyads (born ≤32 weeks gestation) in a Level IV NICU were randomized at birth to the multisensory program or standard-of-care. Parents in the multisensory group administered prespecified amounts of age-appropriate, evidence-based sensory interventions to their infants each day during NICU hospitalization according to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. RESULTS Infants who received the SENSE program had more lethargy on the NICU Network Neurobehavioral Scale (NNNS) (p = 0.05), even after controlling for medical and social risk (p = 0.043), and had higher Communication scores on the Ages and Stages Questionnaire (p = 0.04) at 1-year corrected age, but this relationship failed to reach significance after controlling for medical and social risk (p = 0.12). CONCLUSION The SENSE program shows promise for improving outcomes, but more research with larger sample sizes is needed.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, USA.
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.
- Program in Occupational Therapy, Washington University, St. Louis, MO, USA.
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jessica Roussin
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | | | - Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Graham Colditz
- Department of Surgery, Washington University, St. Louis, MO, USA
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13
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Williams EE, Lee R, Williams N, Deep A, Subramaniam N, Dwarakanathan B, Dassios T, Greenough A. The impact of transfers from neonatal intensive care to paediatric intensive care. J Perinat Med 2021; 49:630-631. [PMID: 33544995 DOI: 10.1515/jpm-2021-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Infants receiving care from neonatal intensive care unit (NICU) can develop chronic problems and be transferred to a paediatric intensive care unit (PICU) for on-going care. There is concern that such infants may take up a large amount of PICU resource, but this is not evidence based. We determined the impact of such transfers. METHODS We reviewed 10 years of NICU admissions to two tertiary PICUs, which had approximately 12,000 admissions during that period. RESULTS Sixty-seven infants, gestational age at birth 34.7 (IQR 27.1-38.8) weeks and postnatal age on transfer 81 (IQR 9-144) days were admitted from NICUs. The median (IQR) length of stay was 12 (4-41) days. The 19 infants born <28 weeks of gestation had a greater median length of stay (32, range IQR 10-93 days) than more mature born infants (7.5, IQR 4-26 days) (p=0.003). The median cost of PICU stay for NICU transfers was £23,800 (range 1,205-1,034,000) per baby. The total cost of care for infants transferred from NICUs was £6,457,955. CONCLUSIONS Infants transferred from NICUs were a small proportion of PICU admissions but, particularly those born <28 weeks of gestation, had prolonged stays which needs to be considered when determining bed capacity.
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Affiliation(s)
- Emma E Williams
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rebecca Lee
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nia Williams
- Paediatric Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Akash Deep
- Paediatric Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
- The Asthma UK Centre for Allergic Mechanisms in Asthma, London, UK
- NIHR Biomedical Research Centre based at Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
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14
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Yu M, Yang M, Ku B, Mann JS. Effects of Virtual Reality Simulation Program Regarding High-risk Neonatal Infection Control on Nursing Students. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:189-196. [PMID: 33894407 DOI: 10.1016/j.anr.2021.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Virtual reality simulation can give nursing students a safe clinical experience involving high-risk infants where access to neonatal intensive care units is limited. This study aimed to examine the effects of a virtual reality simulation program on Korean nursing students' knowledge, performance self-efficacy and learner satisfaction. METHODS A nonequivalent control group design was applied. Senior nursing students were divided into an experimental group (n = 25) experiencing virtual reality simulation and routine neonatal intensive care unit practice and a control group (n = 25) having routine neonatal intensive care unit practice. The program consisted of three scenarios: basic care, feeding management and skin care and environmental management for prevention of neonatal infection. The total execution time for the three scenarios was 40 minutes. The simulation created immersive virtual reality experiences using a head-mounted display with hand-tracking technology. Data were collected from December 9, 2019, to January 17, 2020, and were analyzed using descriptive statistics and the t-test, paired t-tests, Mann-Whitney test and Wilcoxon signed-ranks test. RESULTS Compared to the control group, the experimental group showed significantly greater improvements in high-risk neonatal infection control performance self-efficacy (t = -2.16, p = .018) and learner satisfaction (t = -5.59, p < .001). CONCLUSION The virtual reality simulation program can expand the nursing students' practice experience in safe virtual spaces and enhance their performance self-efficacy and learning satisfaction.
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Affiliation(s)
- Mi Yu
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.
| | - Miran Yang
- Graduate School of Nursing, Gyeongsang National University, Jinju, Republic of Korea
| | - Boram Ku
- Neonatal Intensive Care Unit, Samsung Changwon Hospital, Graduate School of Nursing, Gyeongsang National University, Jinju, Republic of Korea
| | - Jon S Mann
- Academic Specialist and Instructor, Office of Academic Affairs, University of Illinois at Chicago, Illinois, USA
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15
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Thom CS, Deshmukh H, Soorikian L, Jacobs I, Fiadjoe JE, Lioy J. Airway emergency management in a pediatric hospital before and during the COVID-19 pandemic. Int J Pediatr Otorhinolaryngol 2020; 139:110458. [PMID: 33130467 PMCID: PMC7568466 DOI: 10.1016/j.ijporl.2020.110458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Children's hospitals frequently care for infants with various life-threatening airway anomalies. Management of these infants can be challenging given unique airway anatomy and potential malformations. Airway emergency management must be immediate and precise, often demanding specialized equipment and/or expertise. We developed a Neonatal-Infant Emergency Airway Program to improve medical responses, communication, equipment usage and outcomes for all infants requiring emergent airway interventions in our neonatal and infant intensive care unit (NICU). PATIENTS AND METHODS All patients admitted to our quaternary NICU from 2008 to 2019 were included in this study. Our program consisted of a multidisciplinary airway response team, pager system, and emergency equipment cart. Respiratory therapists present at each emergency event recorded specialist response times, equipment utilization, and outcomes. A multidisciplinary oversite committee reviewed each incident. RESULTS Since 2008, there were 159 airway emergency events in our NICU (~12 per year). Mean specialist response times decreased from 5.9 ± 4.9 min (2008-2012, mean ± SD) to 4.3 ± 2.2 min (2016-2019, p = 0.12), and the number of incidents with response times >5 min decreased from 28.8 ± 17.8% (2008-2012) to 9.3 ± 11.4% (2016-2019, p = 0.04 by linear regression). As our program became more standardized, we noted better equipment availability and subspecialist communication. Few emergency situations (n = 9, 6%) required operating room management. There were 3 patient deaths (2%). CONCLUSIONS Our airway safety program, including readily available specialists and equipment, facilitated effective resolution of airway emergencies in our NICU and multidisciplinary involvement enabled rapid and effective changes in response to COVID-19 regulations. A similar program could be implemented in other centers.
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Affiliation(s)
- Christopher S Thom
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neonatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Hitesh Deshmukh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leane Soorikian
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ian Jacobs
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John E Fiadjoe
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Lioy
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neonatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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16
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Affiliation(s)
- Virginie Rigourd
- 37072 Neonatal Department, APHP Necker Enfants Malades Hospital, Paris, France
- 37072 Human Milk Bank Ile de France, APHP Necker Enfants Malades Hospital, Paris, France
| | - Alexandre Lapillonne
- 37072 Neonatal Department, APHP Necker Enfants Malades Hospital, Paris, France
- EHU 7328 PACT, Paris Descartes University, Paris, France
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17
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Abstract
BACKGROUND/SIGNIFICANCE Infants born extremely premature (<1500 g) often experience lengthy stays in the challenging environment of the neonatal intensive care unit (NICU) separated from their parents. PURPOSE The purpose of this study was to explore nurses' knowledge, attitude, and use of maternal voice as a therapeutic intervention for preterm infants in the NICU. METHODS Neonatal nurses (n = 117) completed an online survey about the use of maternal voice in their individual units. Questions included: (1) previous knowledge surrounding use of maternal voice in the NICU; (2) their attitudes about using maternal voice recordings and/or live maternal speech as an intervention; (3) whether their unit had the necessary equipment and environment conducive to using the therapy; (4) average amount of time parents were in the NICU with their neonate; and (5) in what situations they would personally encourage the use of maternal recordings (during procedures, rounds, etc). RESULTS Of those responding, 73.3% of nurse (n = 117) respondents agreed they were willing to incorporate maternal recordings into caregiving, with 80.8% indicating they were open to learning and employing different therapies to improve parental involvement in infant care. IMPLICATIONS FOR PRACTICE When the appropriate equipment is available, neonatal nurses are interested and willing to use alternative therapies that incorporate parental participation into direct caregiving as well as utilizing maternal voice recordings. IMPLICATIONS FOR RESEARCH Further research with larger, more diverse samples is needed to determine the current knowledge, attitudes, and practices of maternal voice recordings by NICU nurses. Future research can also focus on barriers to utilization of the therapy during daily care.
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Affiliation(s)
- Selena Williamson
- School of Nursing, University of Connecticut, Storrs, and Hartford Hospital, Connecticut (Ms Williamson); and School of Nursing, University of Texas Health Science Center at San Antonio (Dr McGrath)
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18
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Hernández-Salazar AD, Gallegos-Martínez J, Reyes-Hernández J. Level and Noise Sources in the Neonatal Intensive Care Unit of a Reference Hospital. Invest Educ Enferm 2020; 38:e13. [PMID: 33306903 PMCID: PMC7885542 DOI: 10.17533/udea.iee.v38n3e13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/05/2020] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Determine the level of environmental and periauricular noise in preterm babies and identify the sources generating noise in the Neonatal Intensive Care Unit -NICU- of a reference hospital in San Luis Potosí, Mexico. METHODS Cross-sectional and analytic study of the measurement of the level of environmental noise in five critical areas of the NICU, according with the method of measurement of noise from fixed sources by the Mexican Official Norm and periauricular at 20 cm from the preterm patient's pinna. The measurements were carried out during three representative days of a week, morning, evening and nocturnal shifts. A STEREN 400 sound level meter was used with 30 to 130 dB range of measurement and a rate of 0.5 s. RESULTS The average level of periauricular noise (64.5±1.91dB) was higher than the environmental noise (63.3±1.74 dB) during the days and shifts evaluated. The principal noise sources were activities carried out by the staff, like the nursing change of shift and conversations by the staff, which raised the level continuously or intermittently, operation of vital support equipment (alarms) and incidences (clashing of baby bottles and moving furnishings) produced sudden rises of noise. CONCLUSIONS Environmental and periauricular noise in NICU exceeds by two and almost three times the 45 dB during the day and 35 dB at night from the norm in hospitals. It is necessary to implement permanent noise reduction programs to prevent sequelae in the preterm infant and professional burnout in the nursing staff.
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MESH Headings
- Burnout, Professional/etiology
- Burnout, Professional/prevention & control
- Child Development
- Cross-Sectional Studies
- Environment Design
- Environmental Exposure/adverse effects
- Environmental Exposure/analysis
- Environmental Exposure/prevention & control
- Environmental Exposure/statistics & numerical data
- Hospitals
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/prevention & control
- Intensive Care Units, Neonatal
- Intensive Care, Neonatal/methods
- Intensive Care, Neonatal/statistics & numerical data
- Noise/adverse effects
- Noise/prevention & control
- Nurses, Neonatal/psychology
- Stress, Physiological
- Stress, Psychological/etiology
- Stress, Psychological/prevention & control
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19
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Ponthier L, Ensuque P, Guigonis V, Bedu A, Bahans C, Teynie F, Medrel-Lacorre S. Parental presence during painful or invasive procedures in neonatology: A survey of healthcare professionals. Arch Pediatr 2020; 27:362-367. [PMID: 32891481 DOI: 10.1016/j.arcped.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/25/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Newborns in neonatology are exposed to invasive and painful procedures. The absence of parents during procedures revealed significantly high pain scores. OBJECTIVE The aim of this study was to assess practices regarding the role of parents during painful and invasive procedures. METHODS This was a prospective, observational, multicenter study in France in which 471 caregivers participated. Professional practices regarding the role of parents during painful procedures on their child were assessed. Univariate and multivariate analyses were performed to identify factors associated with parental presence during painful procedures. RESULTS Parental presence was most often allowed during capillary blood sampling, nasogastric tube insertions, and vein punctures, whereas it was mostly restricted during central line insertions, extubations, lumbar punctures, and intubations. However, we found discrepancies depending on the type of facility and caregiver seniority. CONCLUSION An important variability in practices concerning the role of parents during painful and invasive procedures on their child was reported.
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Affiliation(s)
- L Ponthier
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France.
| | - P Ensuque
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - V Guigonis
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - A Bedu
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - C Bahans
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - F Teynie
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - S Medrel-Lacorre
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
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20
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Bale G, Mitra S, Tachtsidis I. Metabolic brain measurements in the newborn: Advances in optical technologies. Physiol Rep 2020; 8:e14548. [PMID: 32889790 PMCID: PMC7507543 DOI: 10.14814/phy2.14548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023] Open
Abstract
Neonatal monitoring in neonatal intensive care is pushing the technological boundaries of newborn brain monitoring in order to improve patient outcome. There is an urgent need of a cot side, real time monitoring for assessment of brain injury severity and neurodevelopmental outcome, in particular for term newborn infants with hypoxic-ischemic brain injury. This topical review discusses why brain tissue metabolic monitoring is important in this group of infants and introduces the currently used neuromonitoring techniques for metabolic monitoring in the neonatal intensive care unit (NICU). New optical techniques that can monitor changes in brain metabolism together with brain hemodynamics at the cot side are presented. Early studies from these emerging technologies have demonstrated their potential to deliver continuous information regarding cerebral physiological changes in sick newborn infants in real time. The promises of these new tools as well as their potential limitations are discussed.
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Affiliation(s)
- Gemma Bale
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Subhabrata Mitra
- Neonatology, EGA Institute for Women's HealthUniversity College LondonLondonUK
| | - Ilias Tachtsidis
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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21
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Mazmanyan P, Kerobyan V, Shankar-Aguilera S, Yousef N, De Luca D. Introduction of point-of-care neonatal lung ultrasound in a developing country. Eur J Pediatr 2020; 179:1131-1137. [PMID: 32060800 DOI: 10.1007/s00431-020-03603-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
Despite neonatal lung ultrasound (LU) being diffused worldwide, its introduction in limited-resource areas has not been formally investigated. We conceived a project to introduce it in a level 3 NICU of a developing country and verify if, after a short protocolized training, clinicians may efficaciously use LU. Inter-rater agreement between ultrasound trainees and trainers was analyzed within both the local test and the diffusion phases of the project. High inter-rater agreements were found between expert trainers and the two neonatologists who were trained in a skilled European center (Cohen's Kappa, 0.951; 95%CI, 0.882-0.999), as well as between the two and the second round of locally trained colleagues (Cohen's Kappa, 0.896; 95%CI, 0.797-0.996). Moreover, a high agreement was found between the clinical respiratory diagnosis (used as the "gold standard") and the LU diagnosis given by the first two trainees (intraclass correlation, 0.992; 95%CI, 0.987-0.996) and the locally trained physicians (intraclass correlation, 0.97; 95%CI, 0.95-0.98). A final survey demonstrated that the project was perceived as efficacious and that LU was going to be integrated into routine clinical practice.Conclusions: А short LU training provided sufficient proficiency and allowed the LU introduction in clinical practice in the neonatal intensive care unit in a developing country.What is Known:• Lung ultrasound is a promising technique for evaluating neonatal respiratory distress at least in high-income countries. Previous studies revealed high specificity and sensitivity in diagnosing specific neonatal disorders.• An important barrier to the more extensive use of lung ultrasound in neonatal critical care is a lack of efficient and suitable training solutions.What is New:• Descriptive LU performed by neonatologist in a developing country after a short formal training is feasible with good quality.• A short formal LU training program provided good proficiency and allowed a correct descriptive diagnosis in a neonatal unit in a developing country.
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Affiliation(s)
- P Mazmanyan
- Department of Neonatology, Yerevan State Medical University, 2 Koryun St, 0025, Yerevan, Armenia.
| | - V Kerobyan
- Department of Neonatology, Yerevan State Medical University, 2 Koryun St, 0025, Yerevan, Armenia
| | - S Shankar-Aguilera
- Division of Pediatrics, Transportation and Neonatal Critical Care, "A. Béclère" Medical Center, South Paris, University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
| | - N Yousef
- Division of Pediatrics, Transportation and Neonatal Critical Care, "A. Béclère" Medical Center, South Paris, University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
| | - D De Luca
- Division of Pediatrics, Transportation and Neonatal Critical Care, "A. Béclère" Medical Center, South Paris, University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
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22
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Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, Sanchez-de-Toledo J, Brierley J, Colunga JM, Raffaj D, Da Cruz E, Durand P, Kenderessy P, Lang HJ, Nishisaki A, Kneyber MC, Tissieres P, Conlon TW, De Luca D. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24:65. [PMID: 32093763 PMCID: PMC7041196 DOI: 10.1186/s13054-020-2787-9] [Citation(s) in RCA: 267] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. METHODS Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. RESULTS Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). CONCLUSIONS Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.
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Affiliation(s)
- Yogen Singh
- Department of Paediatrics - Neonatology and Paediatric Cardiology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine, Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
- Addenbrooke's Hospital, Box 402, Cambridge, UK.
| | - Cecile Tissot
- Paediatric Cardiology, Centre de Pédiatrie, Clinique des Grangettes, Geneva, Switzerland
| | - María V Fraga
- Department of Paediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Nadya Yousef
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
| | - Rafael Gonzalez Cortes
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Jorge Lopez
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - Joe Brierley
- Department of Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Juan Mayordomo Colunga
- Department of Paediatric Intensive Care, Hospital Universitario Central de Asturias, Oviedo. CIBER-Enfermedades Respiratorias. Instituto de Salud Carlos III, Madrid. Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Dusan Raffaj
- Department of Paediatric Intensive Care, Nottingham University Hospitals, Nottingham, UK
| | - Eduardo Da Cruz
- Department of Paediatric and Cardiac Intensive Care, Children's Hospital Colorado, Aurora, USA
| | - Philippe Durand
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Peter Kenderessy
- Department of Paediatric Anaesthesia and Intensive Care, Children's Hospital Banska Bystrica, Banska Bystrica, Slovakia
| | - Hans-Joerg Lang
- Department of Paediatrics, Medicins Sans Frontieres (Suisse), Geneva, Switzerland
| | - Akira Nishisaki
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Martin C Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pierre Tissieres
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Thomas W Conlon
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM Unit U999, South Paris Medical School, Paris Saclay University, Paris, France
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Ostojic D, Guglielmini S, Moser V, Fauchère JC, Bucher HU, Bassler D, Wolf M, Kleiser S, Scholkmann F, Karen T. Reducing False Alarm Rates in Neonatal Intensive Care: A New Machine Learning Approach. Adv Exp Med Biol 2020; 1232:285-290. [PMID: 31893422 DOI: 10.1007/978-3-030-34461-0_36] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED In neonatal intensive care units (NICUs), 87.5% of alarms by the monitoring system are false alarms, often caused by the movements of the neonates. Such false alarms are not only stressful for the neonates as well as for their parents and caregivers, but may also lead to longer response times in real critical situations. The aim of this project was to reduce the rates of false alarms by employing machine learning algorithms (MLA), which intelligently analyze data stemming from standard physiological monitoring in combination with cerebral oximetry data (in-house built, OxyPrem). MATERIALS & METHODS Four popular MLAs were selected to categorize the alarms as false or real: (i) decision tree (DT), (ii) 5-nearest neighbors (5-NN), (iii) naïve Bayes (NB) and (iv) support vector machine (SVM). We acquired and processed monitoring data (median duration (SD): 54.6 (± 6.9) min) of 14 preterm infants (gestational age: 26 6/7 (± 2 5/7) weeks). A hybrid method of filter and wrapper feature selection generated the candidate subset for training these four MLAs. RESULTS A high specificity of >99% was achieved by all four approaches. DT showed the highest sensitivity (87%). The cerebral oximetry data improved the classification accuracy. DISCUSSION & CONCLUSION Despite a (as yet) low amount of data for training, the four MLAs achieved an excellent specificity and a promising sensitivity. Presently, the current sensitivity is insufficient since, in the NICU, it is crucial that no real alarms are missed. This will most likely be improved by including more subjects and data in the training of the MLAs, which makes pursuing this approach worthwhile.
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Affiliation(s)
- D Ostojic
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland.
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - S Guglielmini
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - V Moser
- CSEM, Neuchâtel, Switzerland
| | - J C Fauchère
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - H U Bucher
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Wolf
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - S Kleiser
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - F Scholkmann
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - T Karen
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Ghetti C, Bieleninik Ł, Hysing M, Kvestad I, Assmus J, Romeo R, Ettenberger M, Arnon S, Vederhus BJ, Söderström Gaden T, Gold C. Longitudinal Study of music Therapy's Effectiveness for Premature infants and their caregivers (LongSTEP): protocol for an international randomised trial. BMJ Open 2019; 9:e025062. [PMID: 31481362 PMCID: PMC6731830 DOI: 10.1136/bmjopen-2018-025062] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Preterm birth has major medical, psychological and socioeconomic consequences worldwide. Music therapy (MT) has positive effects on physiological measures of preterm infants and maternal anxiety, but rigorous studies including long-term follow-up are missing. Drawing on caregivers' inherent resources, this study emphasises caregiver involvement in MT to promote attuned, developmentally appropriate musical interactions that may be of mutual benefit to infant and parent. This study will determine whether MT, as delivered by a qualified music therapist during neonatal intensive care unit (NICU) hospitalisation and/or in home/municipal settings following discharge, is superior to standard care in improving bonding between primary caregivers and preterm infants, parent well-being and infant development. METHODS AND ANALYSIS: Design: international multicentre, assessor-blind, 2×2 factorial, pragmatic randomised controlled trial; informed by a completed feasibility study. Participants: 250 preterm infants and their parents. Intervention: MT focusing on parental singing specifically tailored to infant responses, will be delivered during NICU and/or during a postdischarge 6-month period. Primary outcome: changes in mother-infant bonding at 6-month corrected age (CA), as measured by the Postpartum Bonding Questionnaire. Secondary outcomes: mother-infant bonding at discharge and at 12-month CA; child development over 24 months; and parental depression, anxiety and stress, and infant rehospitalisation, all over 12 months. ETHICS AND DISSEMINATION The Regional Committees for Medical and Health Research Ethics approved the study (2018/994/REK Nord, 03 July 2018). Service users were involved in development of the study and will be involved in implementation and dissemination. Dissemination of findings will apply to local, national and international levels. TRIAL REGISTRATION NUMBER NCT03564184.
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Affiliation(s)
- Claire Ghetti
- GAMUT - The Grieg Academy Music Therapy Research Centre, The Grieg Academy - Department of Music, University of Bergen, Bergen, Norway
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Łucja Bieleninik
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
- Institute of Psychology, Uniwersytet Gdanski, Gdansk, Poland
| | - Mari Hysing
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Regional Center for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Ingrid Kvestad
- Regional Center for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Jörg Assmus
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Renee Romeo
- King's Health Economics, King's College London, London, UK
| | - Mark Ettenberger
- Department of Patient and Family Care, Hospital Universitario Fundacion Santa Fe de Bogotá, Bogotá, Colombia
- SONO - Centro de Musicoterapia, Bogota, Colombia
| | - Shmuel Arnon
- Neonatal Department, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tora Söderström Gaden
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
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Huang J, Tang Y, Tang J, Shi J, Wang H, Xiong T, Xia B, Zhang L, Qu Y, Mu D. Educational efficacy of high-fidelity simulation in neonatal resuscitation training: a systematic review and meta-analysis. BMC Med Educ 2019; 19:323. [PMID: 31464614 PMCID: PMC6716944 DOI: 10.1186/s12909-019-1763-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/20/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND The training of neonatal resuscitation is an important part in the clinical teaching of neonatology. This study aimed to identify the educational efficacy of high-fidelity simulation compared with no simulation or low-fidelity simulation in neonatal resuscitation training. METHODS The PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, Chinese databases (CBM, CNKI, WanFang, and Weipu), ScopeMed and Google Scholar were searched. The last search was updated on April 13, 2019. Studies that reported the role of high-fidelity simulation in neonatal resuscitation training were eligible for inclusion. For the quality evaluation, we used the Cochrane Risk of Bias tool for RCTs and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for non-RCTs. A standardized mean difference (SMD) with a 95% confidence interval (CI) was applied for the estimation of the pooled effects of RCTs. RESULTS Fifteen studies (10 RCTs and 5 single arm pre-post studies) were ultimately included. Performance bias existed in all RCTs because participant blinding to the simulator is impossible. The assessment of the risk of bias of single arm pre-post studies showed only one study was of high quality with a low risk of bias whereas four were of low quality with a serious risk of bias. The pooled results of single arm pre-post studies by meta-analysis showed a large benefit with high-fidelity simulation in skill performance (SMD 1.34; 95% CI 0.50-2.18). The meta-analysis of RCTs showed a large benefit in skill performance (SMD 1.63; 95% CI 0.49-2.77) and a moderate benefit in neonatal resuscitation knowledge (SMD 0.69; 95% CI 0.42-0.96) with high-fidelity simulation when compared with traditional training. Additionally, a moderate benefit in skill performance (SMD 0.64; 95% CI 0.06-1.21) and a small benefit was shown in knowledge (SMD 0.39; 95% CI 0.08-0.71) with high-fidelity simulation when compared with low-fidelity simulation. CONCLUSIONS Improvements of efficacy were shown both in resuscitation knowledge and skill performance immediately after training. However, in current studies, the long-time retention of benefits is controversial, and these benefits may not transfer to the real-life situations.
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Affiliation(s)
- Jichong Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Ying Tang
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Jing Shi
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Hua Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Bin Xia
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Li Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China.
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Adler A, Worley S, Radhakrishnan K. Increased Needs for Copper in Parenteral Nutrition for Children in the Neonatal Intensive Care Unit With an Ostomy. Nutr Clin Pract 2019; 35:724-728. [PMID: 31270844 DOI: 10.1002/ncp.10365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Copper (Cu) is an essential trace element, with deficiency causing anemia, neutropenia, and other abnormalities. Cu is mainly absorbed in the small intestine. Patients with intestinal failure or jejunostomy have increased Cu losses and require additional Cu supplementation in parenteral nutrition (PN). The American Society for Clinical Nutrition standards for trace element recommendations in PN, including Cu, were created in 1988, and the American Society for Parenteral and Enteral Nutrition currently follows the same recommendations. METHODS Patients admitted to the neonatal intensive care unit for surgical intervention resulting in an ostomy (ileal or jejunal) were included in this retrospective study. Patients received PN support with Cu dosed individually, rather than in a multi-trace element package. Cu and ostomy output were analyzed daily. Serum Cu was obtained 2 months postsurgical intervention. RESULTS Out of the 7 patients enrolled, 71% had low serum Cu. Weekly mean Cu intake for all 7 patients ranged from 5.3 to 154.8 μg/kg/day from enteral and parenteral sources, with individual mean weekly Cu intake ranging from 18.9 to 74.4 μg/kg/day from surgical intervention to 2 months post-surgery. Patients' weekly ostomy outputs ranged from 0 mL/kg/day to 77.2 mL/kg/day, with individual mean weekly output ranging from 3.7 to 41.6 mL/kg/day. CONCLUSION Providing 20 μg/kg/day of Cu in PN to neonates with ostomies is insufficient to prevent Cu deficiency. Further studies are warranted to determine an optimal dosage of parenteral Cu to prevent Cu deficiency.
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Affiliation(s)
- Andrea Adler
- Pediatric Nutrition Support, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Sarah Worley
- Quantitative Health Sciences, Learner Research Institute, Cleveland, Ohio, USA
| | - Kadakkal Radhakrishnan
- Department of Pediatric Gastroenterology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
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Sethi A, Sankar MJ, Thukral A, Saxena R, Chaurasia S, Agarwal R. Prophylactic Vitamin K Administration in Neonates on Prolonged Antibiotic Therapy: A Randomized Controlled Trial. Indian Pediatr 2019; 56:463-467. [PMID: 31278224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare the prevalence of vitamin K deficiency after intramuscular vitamin K or no treatment in neonates with sepsis on prolonged (>7 days) antibiotic therapy. STUDY DESIGN Open label randomized controlled trial. SETTING Level 3 Neonatal Intensive Care Unit (NICU). PARTICIPANTS Neonates with first episode of sepsis on antibiotics for ≥7 days were included. Neonates with clinical bleeding, vitamin K prior to start of antibiotic therapy (except the birth dose), cholestasis or prenatally diagnosed bleeding disorder were excluded. INTERVENTIONS Randomized to receive 1 mg vitamin K (n=41) or no vitamin K (n=39) on the 7th day of antibiotic therapy. MAIN OUTCOME MEASURES Vitamin K deficiency defined as Protein Induced by Vitamin K Absence (PIVKA-II) >>2 ng/mL after 7 ± 2 days of enrolment. RESULTS The prevalence of vitamin K deficiency was 100% (n=80) at enrolment and it remained 100% even after 7 ± 2 days of enrolment in both the groups. CONCLUSIONS Neonates receiving prolonged antibiotics have universal biochemical vitamin K deficiency despite vitamin K administration on 7th day of antibiotic therapy.
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Affiliation(s)
- Amanpreet Sethi
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Chaurasia
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Ramesh Agarwal, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India.
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Thakre R. The Oxygen Blender 'Blunder'. Indian Pediatr 2019; 56:332-333. [PMID: 31064909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Jorge J, Villarroel M, Chaichulee S, Green G, McCormick K, Tarassenko L. Assessment of Signal Processing Methods for Measuring the Respiratory Rate in the Neonatal Intensive Care Unit. IEEE J Biomed Health Inform 2019; 23:2335-2346. [PMID: 30951480 DOI: 10.1109/jbhi.2019.2898273] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Knowledge of the pathological instabilities in the breathing pattern can provide valuable insights into the cardiorespiratory status of the critically-ill infant as well as their maturation level. This paper is concerned with the measurement of respiratory rate in premature infants. We compare the rates estimated from the chest impedance pneumogram, the ECG-derived respiratory rhythms, and the PPG-derived respiratory rhythms against those measured in the reference standard of breath detection provided by attending clinical staff during 165 manual breath counts. We demonstrate that accurate RR estimates can be produced from all sources for RR in the 40-80 bpm (breaths per min) range. We also conclude that the use of indirect methods based on the ECG or the PPG poses a fundamental challenge in this population due to their poor behavior at fast breathing rates (upward of 80 bpm).
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Chu E, Freck S, Zhang L, Bhakta KY, Mikhael M. Three-hourly feeding intervals are associated with faster advancement in very preterm infants. Early Hum Dev 2019; 131:1-5. [PMID: 30721843 PMCID: PMC6435383 DOI: 10.1016/j.earlhumdev.2019.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the effect of two-hourly (Q2H) vs. three-hourly (Q3H) feeding on time to achieve full enteral feeding, growth metrics and respiratory tolerance in very preterm infants with birth weight ≤ 1250 g. STUDY DESIGN Retrospective study review of 18 months before and after a change in our feeding guideline from Q3H to Q2H feedings. RESULTS 113 infants were included, 59 in Q3H and 54 in Q2H groups. Q2H infants required 10% more days to achieve full enteral feeding, however it was not statistically significant (P = 0.054). Q2H feeding was associated with 16% more central catheter days (P = 0.02) and 17% more parenteral nutrition days (P = 0.019). There were no differences in respiratory outcomes or growth metrics between the groups. CONCLUSION Very preterm infants fed Q3H had less central catheter and parenteral nutrition days when compared to those fed Q2H, without significant differences in growth or respiratory outcomes.
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Affiliation(s)
- Elaine Chu
- Neonatology Division, Harbor-UCLA Medical Center, Torrance, CA, USA; Neonatal-Perinatal Medicine Division, CHOC Children's, Orange, CA, USA
| | - Sue Freck
- Clinical Nutrition and Lactation Services, Children's Hospital of Orange County, Orange, CA, USA
| | - Lishi Zhang
- Institute for Clinical and Translational Science, University of California, Irvine, CA, USA
| | - Kushal Y Bhakta
- Neonatal-Perinatal Medicine Division, CHOC Children's, Orange, CA, USA
| | - Michel Mikhael
- Neonatal-Perinatal Medicine Division, CHOC Children's, Orange, CA, USA.
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Abstract
The LOVE MOM cohort (Longitudinal Outcomes of VLBW Infants Exposed to Mothers' Own Milk; NIH: R010009; Meier PI) enrolled 430 infants with very low birth weight (VLBW) between 2008 and 2012 to study the impact of the dose and exposure period of MOM during hospitalization in the neonatal intensive care unit (NICU) on potentially preventable complications of prematurity and their associated costs. In this prospective study, MOM and formula feedings were calculated daily (mL), medical diagnoses for NICU morbidities (necrotizing enterocolitis [NEC], late-onset sepsis [sepsis], and bronchopulmonary dysplasia [BPD]) were confirmed independently by 2 neonatologists, and propensity scoring was used to analyze covariates. Neurodevelopmental outcome was measured for a subset of 251 LOVE MOM infants at 20 months of age, corrected for prematurity (CA). Data revealed a dose-response relationship between higher amounts of MOM received during critical NICU exposure periods and a reduction in the risk of NEC, sepsis, BPD, and their costs, as well as higher cognitive index scores at 20 months CA. MOM appears to function via different mechanisms during NICU exposure periods to reduce the risk of potentially preventable complications and their costs in VLBW infants. Institutions should prioritize the economic investments needed to acquire, store, and feed high-dose MOM in this population.
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Manja V, Guyatt G, Lakshminrusimha S, Jack S, Kirpalani H, Zupancic JAF, Dukhovny D, You JJ, Monteiro S. Factors influencing decision making in neonatology: inhaled nitric oxide in preterm infants. J Perinatol 2019; 39:86-94. [PMID: 30353082 PMCID: PMC6298829 DOI: 10.1038/s41372-018-0258-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/27/2018] [Accepted: 08/20/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We studied decision making regarding inhaled nitric oxide (iNO) in preterm infants with Pulmonary Hypertension (PH). STUDY DESIGN We asked members of the AAP-Society of Neonatal-Perinatal Medicine and Division-Chiefs to select from three management options- initiate iNO, engage parents in shared decision making or not consider iNO in an extremely preterm with PH followed by rating of factors influencing their decision. RESULTS Three hundred and four respondents (9%) completed the survey; 36.5% chose to initiate iNO, 42% to engage parents, and 21.5% did not consider iNO. Provider's prior experience, safety, and patient-centered care were rated higher by those who initiated or offered iNO; lack of effectiveness and cost considerations by participants who did not chose iNO. CONCLUSIONS Most neonatologists offer or initiate iNO therapy based on their individual experience. The minority who chose not to consider iNO placed higher value on lack of effectiveness and cost. These results demonstrate a tension between evidence and pathophysiology-based-therapy/personal experience.
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Affiliation(s)
- Veena Manja
- Departments of Surgery and Pediatrics, University of California at Davis, Sacramento, CA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Satyan Lakshminrusimha
- Departments of Surgery and Pediatrics, University of California at Davis, Sacramento, CA, USA.
- Department of Pediatrics, UC Davis Medical Center, 2516 Stockton Blvd, Sacramento, CA, USA.
| | - Susan Jack
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Haresh Kirpalani
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine,, Philadelphia, PA, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - John J You
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sandra Monteiro
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Chellani H, Mittal P, Arya S. Mother-Neonatal Intensive Care Unit (M-NICU): A Novel Concept in Newborn Care. Indian Pediatr 2018; 55:1035-1036. [PMID: 30745471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Health facilities in India are faced with the challenge of providing quality newborn care in the face of major skilled human resource shortage. A possible solution is the concept of Mother-Neonatal ICU (M-NICU), where the mother has her bed inside the neonatal intensive care unit (NICU) by the side of baby's warmer. Our observations in M-NICU of a public sector hospital in New Delhi, India, indicate that mothers can be easily trained to follow asepsis routines and monitor the neonates, and are better prepared for their post-discharge care. Incorporating space for both mothers and their newborns in level-II NICUs may provide quality and developmentally supportive newborn care in coming years.
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Affiliation(s)
- Harish Chellani
- Department of Pediatrics, VMMC and Safdarjung Hospital, New Delhi, India. Correspondence to: Dr Harish Chellani, Professor and Head, Neonatal Division, Department of Pediatrics, Vardhman Mahavir Medical College Safdarjang Hospital, New Delhi, India.
| | - Pratima Mittal
- Department of Obstetrics, VMMC and Safdarjung Hospital, New Delhi, India
| | - Sugandha Arya
- Department of Pediatrics, VMMC and Safdarjung Hospital, New Delhi, India
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Romanis EC. Artificial womb technology and the frontiers of human reproduction: conceptual differences and potential implications. J Med Ethics 2018; 44:751-755. [PMID: 30097459 PMCID: PMC6252373 DOI: 10.1136/medethics-2018-104910] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/04/2018] [Accepted: 07/06/2018] [Indexed: 05/20/2023]
Abstract
In 2017, a Philadelphia research team revealed the closest thing to an artificial womb (AW) the world had ever seen. The 'biobag', if as successful as early animal testing suggests, will change the face of neonatal intensive care. At present, premature neonates born earlier than 22 weeks have no hope of survival. For some time, there have been no significant improvements in mortality rates or incidences of long-term complications for preterms at the viability threshold. Artificial womb technology (AWT), that might change these odds, is eagerly anticipated for clinical application. We need to understand whether AWT is an extension of current intensive care or something entirely new. This question is central to determining when and how the biobag should be used on human subjects. This paper examines the science behind AWT and advances two principal claims. First, AWT is conceptually different from conventional intensive care. Identifying why AWT should be understood as distinct demonstrates how it raises different ethico-legal questions. Second, these questions should be formulated without the 'human being growing in the AW' being described with inherently value laden terminology. The 'human being in an AW' is neither a fetus nor a baby, and the ethical tethers associated with these terms could perpetuate misunderstanding and confusion. Thus, the term 'gestateling' should be adopted to refer to this new product of human reproduction: a developing human being gestating ex utero. While this paper does not attempt to solve all the ethical problems associated with AWT, it makes important clarifications that will enable better formulation of relevant ethical questions for future exploration.
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Affiliation(s)
- Elizabeth Chloe Romanis
- Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK
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Muirhead R, Kynoch K. Safety and effectiveness of parent/nurse controlled analgesia on patient outcomes in the neonatal intensive care unit: a systematic review protocol. JBI Database System Rev Implement Rep 2018; 16:1959-1964. [PMID: 29912720 DOI: 10.11124/jbisrir-2017-003711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The review question is: How safe is parent/nurse controlled analgesia and what is its effectiveness on patient outcomes in the neonatal intensive care unit?
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Affiliation(s)
- Renee Muirhead
- The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
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Haase B, Johnson TS, Wagner CL. Facilitating Colostrum Collection by Hospitalized Women in the Early Postpartum Period for Infant Trophic Feeding and Oral Immune Therapy. J Obstet Gynecol Neonatal Nurs 2018; 47:654-660. [PMID: 30196807 DOI: 10.1016/j.jogn.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 11/15/2022] Open
Abstract
Administration of colostrum for early trophic feedings and colostrum oral immune therapy for neonates in the NICU is essential to enhance gut maturation and lower risk of infections. However, it is often difficult for women to collect early colostrum because of its thick viscosity and low volume. Women may be unable to sit upright during pumping sessions because of postsurgical pain, acute or chronic illness, or birth complications and may need assistance. In this article, we describe specific techniques that providers can use to help women to collect colostrum when they are unable to accomplish collection on their own. Helping women collect and administer colostrum to their neonates in the NICU may engage and motivate them to continue to pump and provide breast milk for their hospitalized neonates.
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Sigurdson K, Morton C, Mitchell B, Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. J Perinatol 2018; 38:600-607. [PMID: 29622778 PMCID: PMC5998372 DOI: 10.1038/s41372-018-0057-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify how family advocates and clinicians describe disparities in NICU quality of care in narrative accounts. STUDY DESIGN Qualitative analysis of a survey requesting disparity stories at the 2016 VON Quality Congress. Accounts (324) were from a sample of RNs (n = 114, 35%), MDs (n = 109, 34%), NNPs (n = 55, 17%), RN other (n = 4, 1%), clinical other (n = 25, 7%), family advocates (n = 16, 5%), and unspecified (n = 1, <1%). RESULTS Accounts (324) addressed non-exclusive disparities: 151 (47%) language; 97 (30%) culture or ethnicity; 72 (22%) race; 41 (13%) SES; 28 (8%) drug use; 18 (5%) immigration status or nationality; 16 (4%) sexual orientation or family status; 14 (4%) gender; 10 (3%) disability. We identified three types of disparate care: neglectful care 85 (26%), judgmental care 85 (26%), or systemic barriers to care 139 (44%). CONCLUSIONS Nearly all accounts described differential care toward families, suggesting the lack of equitable family-centered care.
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Affiliation(s)
- Krista Sigurdson
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
- Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Christine Morton
- California Maternal Quality Care Collaborative, Palo Alto, CA, USA
| | - Briana Mitchell
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
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Weiss EM, Xie D, Cook N, Coughlin K, Joffe S. Characteristics Associated With Preferences for Parent-Centered Decision Making in Neonatal Intensive Care. JAMA Pediatr 2018; 172:461-468. [PMID: 29554176 PMCID: PMC5875325 DOI: 10.1001/jamapediatrics.2017.5776] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/21/2017] [Indexed: 11/14/2022]
Abstract
Importance Little is known about how characteristics of particular clinical decisions influence decision-making preferences by patients or their surrogates. A better understanding of the factors underlying preferences is essential to improve the quality of shared decision making. Objective To identify the characteristics of particular decisions that are associated with parents' preferences for family- vs medical team-centered decision making across the spectrum of clinical decisions that arise in the neonatal intensive care unit (NICU). Design, Setting, and Participants This cross-sectional survey assessed parents' preferences for parent- vs medical team-centered decision making across 16 clinical decisions, along with parents' assessments of 7 characteristics of those decisions. Respondents included 136 parents of infants in 1 of 3 academically affiliated hospital NICUs in Philadelphia, Pennsylvania, from January 7 to July 8, 2016. Respondents represented a wide range of educational levels, employment status, and household income but were predominantly female (109 [80.1%]), white (68 [50.0%]) or African American (53 [39.0%]), and married (81 of 132 responding [61.4%]). Main Outcomes and Measures Preferences for parent-centered decision making. For each decision characteristic (eg, urgency), multivariable analyses tested whether middle and high levels of that characteristic (compared with low levels) were associated with a preference for parent-centered decision making, resulting in 2 odds ratios (ORs) per decision characteristic. Results Among the 136 respondents (109 women [80.1%] and 27 men [19.9%]; median age, 30 years [range, 18-43 years]), preferences for parent-centered decision making were positively associated with decisions that involved big-picture goals (middle OR, 2.01 [99% CI, 0.83-4.86]; high OR, 3.38 [99% CI, 1.48-7.75]) and that had the potential to harm the infant (middle OR, 1.32 [99% CI, 0.84-2.08]; high OR, 2.62 [99% CI, 1.67-4.11]). In contrast, preferences for parent-centered decision making were inversely associated with the following 4 decision characteristics: technical decisions (middle OR, 0.82 [99% CI, 0.45-1.52]; high OR, 0.48 [99% CI, 0.25-0.93]), the potential to benefit the infant (middle OR, 0.42 [99% CI, 0.16-1.05]; high OR, 0.21 [99% CI, 0.08-0.52]), requires medical expertise (middle OR, 0.48 [99% CI, 0.22-1.05]; high OR, 0.21 [99% CI, 0.10-0.48]), and a high level of urgency (middle OR, 0.47 [99% CI, 0.24-0.92]; high OR, 0.42 [99% CI, 0.22-0.83]). Conclusions and Relevance Preferences for parent-centered vs medical team-centered decision making among parents of infants in the NICU may vary systematically by the characteristics of particular clinical decisions. Incorporating this variation into shared decision making and endorsing models that allow parents to cede control to physicians in appropriate clinical circumstances might improve the quality and outcomes of medical decisions.
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Affiliation(s)
- Elliott Mark Weiss
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, Washington
| | - Dawei Xie
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Noah Cook
- Division of Neonatology, Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia
| | - Katherine Coughlin
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Hawes JA, Lee KS. Reduction in Central Line-Associated Bloodstream Infections in a NICU: Practical Lessons for Its Achievement and Sustainability. Neonatal Netw 2018; 37:105-115. [PMID: 29615158 DOI: 10.1891/0730-0832.37.2.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Central venous catheters are commonly used for the provision of parenteral nutrition and medications for critically ill neonates in the NICU. However, central line-associated bloodstream infections (CLABSIs) are a major complication associated with their use and remain an important cause of nosocomial sepsis in NICUs. Central line-associated bloodstream infection has shifted from being an expected routine complication of central line use to an adverse event now evaluated as a critical event with the goal of identifying root causes so future CLABSI events are prevented. Success has been achieved through multiple strategies including implementation and maintenance of care bundles, education strategies to promote consistent adherence to bundle components, and institutional and unit support. Although low CLABSI rates can be achieved, sustaining low CLABSI rates and achieving zero CLABSI remain an ongoing challenge. We describe our experience with lessons learned, with an emphasis on the areas of difficulty during implementation of the bundle elements and the strategies and tools we utilized to overcome them.
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Ho LY. Follow-up Care and Outcome Evaluation of High-Risk Preterm Infants: A Life-Course Commitment. Ann Acad Med Singap 2018; 47:51-55. [PMID: 29549370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Lai Yun Ho
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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Sanders MR, Hall SL. Trauma-informed care in the newborn intensive care unit: promoting safety, security and connectedness. J Perinatol 2018; 38:3-10. [PMID: 28817114 PMCID: PMC5776216 DOI: 10.1038/jp.2017.124] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/30/2017] [Accepted: 06/26/2017] [Indexed: 12/19/2022]
Abstract
Both babies and their parents may experience a stay in the newborn intensive care unit (NICU) as a traumatic or a 'toxic stress,' which can lead to dysregulation of the hypothalamic-pituitary-adrenal axis and ultimately to poorly controlled cortisol secretion. Toxic stresses in childhood or adverse childhood experiences (ACEs) are strongly linked to poor health outcomes across the lifespan and trauma-informed care is an approach to caregiving based on the recognition of this relationship. Practitioners of trauma-informed care seek to understand clients' or patients' behaviors in light of previous traumas they have experienced, including ACEs. Practitioners also provide supportive care that enhances the client's or patient's feelings of safety and security, to prevent their re-traumatization in a current situation that may potentially overwhelm their coping skills. This review will apply the principles of trauma-informed care, within the framework of the Polyvagal Theory as described by Porges, to care for the NICU baby, the baby's family and their professional caregivers, emphasizing the importance of social connectedness among all. The Polyvagal Theory explains how one's unconscious awareness of safety, danger or life threat (neuroception) is linked through the autonomic nervous system to their behavioral responses. A phylogenetic hierarchy of behaviors evolved over time, leveraging the mammalian ventral or 'smart' vagal nucleus into a repertoire of responses promoting mother-baby co-regulation and the sense of safety and security that supports health and well-being for both members of the dyad. Fostering social connectedness that is mutual and reciprocal among parents, their baby and the NICU staff creates a critical buffer to mitigate stress and improve outcomes of both baby and parents. Using techniques of trauma-informed care, as explained by the Polyvagal Theory, with both babies and their parents in the NICU setting will help to cement a secure relationship between the parent-infant dyad, redirecting the developmental trajectory toward long-term health and well-being of the baby and all family members.
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Affiliation(s)
- M R Sanders
- Division of Neonatology, Department of Pediatrics/Neonatology, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, The University of Connecticut School of Medicine, Farmington, CT, USA
| | - S L Hall
- St. John’s Regional Medical Center, Oxnard, CA, USA
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Abstract
Stabilisation and resuscitation of babies at birth is one of the most frequently performed procedures and requires considerable skill. If it is not done well, the baby may suffer prolonged hypoxia and bradycardia. Over the last few years there has been a growing interest in carefully evaluating an infant's condition at birth and the details of what is happening during resuscitation. Clinical assessment of an infant at this time is difficult and often inaccurate. Assessments of heart rate, colour, chest excursions, mask leak, tidal volume, inflation and expiration times, endotracheal intubation, and spontaneous breathing are imprecise. Detailed monitoring of gas flow in and out of the baby, integrated to tidal volume and used to calculate the leak around the face mask or endotracheal tube, together with ventilation pressures, pulse oximetry, ECG, and capnography add objectivity to the clinical assessments. These physiological parameters can be used directly to guide care but are also very useful for debriefing, feedback, audit, teaching, and research. With simultaneous video recording of the resuscitation it is possible to see exactly what is happening during the procedure. Endotracheal intubation is a difficult skill to learn and teach. However, this is now much easier with video laryngoscopy showing the intubator and supervisors exactly what is happening at the larynx.
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Johnson MJ, Leaf AA, Pearson F, Clark HW, Dimitrov BD, Pope C, May CR. Successfully implementing and embedding guidelines to improve the nutrition and growth of preterm infants in neonatal intensive care: a prospective interventional study. BMJ Open 2017; 7:e017727. [PMID: 29217722 PMCID: PMC5728292 DOI: 10.1136/bmjopen-2017-017727] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES We aimed to improve the nutritional care of preterm infants by developing a complex (multifaceted) intervention intended to translate current evidence into practice. We used the sociological framework of Normalization Process Theory (NPT), to guide implementation in order to embed the new practices into routine care. DESIGN A prospective interventional study with a before and after methodology. PARTICIPANTS Infants <30 weeks gestation or <1500 g at birth. SETTING Tertiary neonatal intensive care unit. INTERVENTIONS The intervention was introduced in phases: phase A (control period, January-August 2011); phase B (partial implementation; improved parenteral and enteral nutrition solutions, nutrition team, education, August-December 2011); phase C (full implementation; guidelines, screening tool, 'nurse champions', January-December 2012); phase D (postimplementation; January-June 2013). Bimonthly audits and staff NPT questionnaires were used to measure guideline compliance and 'normalisation', respectively. NPT Scores were used to guide implementation in real time. Data on nutrient intakes and growth were collected continuously. RESULTS There were 52, 36, 75 and 35 infants in phases A, B, C and D, respectively. Mean guideline compliance exceeded 75% throughout the intervention period, peaking at 85%. Guideline compliance and NPT scores both increased over time, (r=0.92 and 0.15, p<0.03 for both), with a significant linear association between the two (r=0.21, p<0.01). There were significant improvements in daily protein intake and weight gain between birth and discharge in phases B and Ccompared with phase A (p<0.01 for all), which were sustained into phase D. CONCLUSIONS NPT and audit results suggest that the intervention was rapidly incorporated into practice, with high guideline compliance and accompanying improvements in protein intake and weight gain. NPT appears to offer an effective way of implementing new practices such that they lead to sustained changes in care. Complex interventions based on current evidence can improve both practice and clinical outcomes.
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Affiliation(s)
- Mark J Johnson
- National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison A Leaf
- National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Freya Pearson
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Howard W Clark
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University Child Health, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Borislav D Dimitrov
- Department of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Carl R May
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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Abstract
PURPOSE To develop and content validate the Neonatal Eating Assessment Tool (NeoEAT), a parent-report measure of infant feeding. DESIGN The NeoEAT was developed in three phases. Phase 1: Items were generated from a literature review, available assessment tools, and parents' descriptions of problematic feeding in infants.Phase 2: Professionals rated items for relevance and clarity. Content validity indices were calculated. Phase 3: Parent understanding was explored through cognitive interviews. SAMPLE Phase 1: Descriptions of infant feeding were obtained from 12 parents of children with diagnosed feeding problems and 29 parents of infants younger than seven months. Phase 2: Nine professionals rated items. Phase 3: Sixteen parents of infants younger than seven months completed the cognitive interview. MAIN OUTCOME VARIABLE Content validity of the NeoEAT. RESULTS Three versions were developed: NeoEAT Breastfeeding (72 items), NeoEAT Bottle Feeding (74 items), and NeoEAT Breastfeeding and Bottle Feeding (89 items).
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Walker S, Datta A, Massoumi RL, Gross ER, Uhing M, Arca MJ. Antibiotic stewardship in the newborn surgical patient: A quality improvement project in the neonatal intensive care unit. Surgery 2017; 162:1295-1303. [PMID: 29050887 DOI: 10.1016/j.surg.2017.07.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/29/2017] [Accepted: 07/29/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is significant diversity in the utilization of antibiotics for neonates undergoing surgical procedures. Our institution standardized antibiotic administration for surgical neonates, in which no empiric antibiotics were given to infants with surgical conditions postnatally, and antibiotics are given no more than 72 hours perioperatively. METHODS We compared the time periods before and after implementation of antibiotic protocol in an institution review board-approved, retrospective review of neonates with congenital surgical conditions who underwent surgical correction within 30 days after birth. Surgical site infection at 30 days was the primary outcome, and development of hospital-acquired infections or multidrug-resistant organism were secondary outcomes. RESULTS One hundred forty-eight infants underwent surgical procedures pre-protocol, and 127 underwent procedures post-protocol implementation. Surgical site infection rates were similar pre- and post-protocol, 14% and 9% respectively, (P = .21.) The incidence of hospital-acquired infections (13.7% vs 8.7%, P = .205) and multidrug-resistant organism (4.7% vs 1.6%, P = .143) was similar between the 2 periods. CONCLUSION Elimination of empiric postnatal antibiotics did not statistically change rates of surgical site infection, hospital-acquired infections, or multidrug-resistant organisms. Limiting the duration of perioperative antibiotic prophylaxis to no more than 72 hours after surgery did not increase the rate of surgical site infection, hospital-acquired infections, or multidrug-resistant organism. Median antibiotic days were decreased with antibiotic standardization for surgical neonates.
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Affiliation(s)
- Sarah Walker
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Ankur Datta
- Division of Neonatology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Roxanne L Massoumi
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Erica R Gross
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado, Stony Brook, NY
| | - Michael Uhing
- Division of Neonatology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Marjorie J Arca
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
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Duffin C. Five-year plan will revamp neonatal services in Scotland. Nurs Child Young People 2017; 29:10. [PMID: 28262053 DOI: 10.7748/ncyp.29.2.10.s9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Scottish Government is considering recommendations for a revamp of neonatal services - including creating three specialist neonatal intensive care units in the next five years.
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Roué JM, Kuhn P, Lopez Maestro M, Maastrup RA, Mitanchez D, Westrup B, Sizun J. Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2017; 102:F364-F368. [PMID: 28420745 DOI: 10.1136/archdischild-2016-312180] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 12/30/2022]
Abstract
Despite the recent improvements in perinatal medical care leading to an increase in survival rates, adverse neurodevelopmental outcomes occur more frequently in preterm and/or high-risk infants. Medical risk factors for neurodevelopmental delays like male gender or intrauterine growth restriction and family sociocultural characteristics have been identified. Significant data have provided evidence of the detrimental impact of overhelming environmental sensory inputs, such as pain and stress, on the developing human brain and strategies aimed at preventing this impact. These strategies, such as free parental access or sleep protection, could be considered 'principles of care'. Implementation of these principles do not require additional research due to the body of evidence. We review the scientific evidence for these principles here.
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Affiliation(s)
| | - Pierre Kuhn
- Department of Neonatal Medicine, University Hospital of Strasbourg, Strasbourg, France
| | | | | | - Delphine Mitanchez
- Division of Neonatology, Department of Perinatology, Hopital Armand-Trousseau, Paris, France
| | - Björn Westrup
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jacques Sizun
- Department of Neonatal Medicine, CHRU de Brest, Brest, France
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Cole JCM, Olkkola M, Zarrin HE, Berger K, Moldenhauer JS. Universal Postpartum Mental Health Screening for Parents of Newborns With Prenatally Diagnosed Birth Defects. J Obstet Gynecol Neonatal Nurs 2017. [PMID: 28646642 DOI: 10.1016/j.jogn.2017.04.131] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the implementation of a nurse-led project to screen parents for depression and traumatic stress in the postpartum period after visiting their newborns in the NICU. DESIGN A standardized universal mental health postpartum screening and referral protocol was developed for parents of high-risk neonates. SETTING/LOCAL PROBLEM The project occurred at the Garbose Family Special Delivery Unit, the world's first obstetrics unit housed within a pediatric hospital serving healthy women who give birth to newborns with prenatally diagnosed fetal anomalies. Parents of neonates admitted to the NICU are at greater risk to develop postpartum psychological distress; therefore, early identification is critical. PATIENTS A total of 1,327 participants were screened, including 725 women who gave birth to live newborns at the Garbose Family Special Delivery Unit and 602 fathers. INTERVENTION/MEASUREMENTS Obstetric nurses asked parents to complete a screening tool that assessed their psychological risk in the postpartum period. A system for mental health triage and referral was available for parents with elevated scores. RESULTS Overall monthly screening procedure compliance rates were high (96.5% mothers and 79.6% fathers). Women (5.5%, n = 40) and men (5.5%, n = 33) showed high risk for traumatic stress, and 35.9% (n = 260) of women and 9.5% (n = 57) of men showed elevated risk for major depression in the imediate postpartum period. CONCLUSION Incorporating the screening process into routine nursing practice with immediate mental health triage and referral made the program feasible. The risk factors identified add to the growing knowledge about parents of newborns in the NICU.
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Ibrahim NR, Kheng TH, Nasir A, Ramli N, Foo JLK, Syed Alwi SH, Van Rostenberghe H. Two-hourly versus 3-hourly feeding for very low birthweight infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2017; 102:F225-F229. [PMID: 27671836 DOI: 10.1136/archdischild-2015-310246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 08/21/2016] [Accepted: 09/05/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achieve full enteral feeding and to compare their outcome in very low birthweight preterm infants. DESIGN Parallel-group randomised controlled trial with a 1:1 allocation ratio. SETTING Two regional tertiary neonatal intensive care units. PATIENTS 150 preterm infants less than 35 weeks gestation with birth weight between 1.0 and 1.5 kg were recruited. INTERVENTIONS Infants were enrolled to either 2-hourly or 3-hourly interval feeding after randomisation. Blinding was not possible due to the nature of the intervention. MAIN OUTCOME MEASURES The primary outcome was time to achieve full enteral feeding (≥100 mL/kg/day). Secondary outcomes include time to regain birth weight, episode of feeding intolerance, peak serum bilirubin levels, duration of phototherapy, episode of necrotising enterocolitis, nosocomial sepsis and gastro-oesophageal reflux. RESULTS 72 infants were available for primary outcome analysis in each group as three were excluded due to death-three deaths in each group. The mean time to full enteral feeding was 11.3 days in the 3-hourly group and 10.2 days in the 2-hourly group (mean difference 1.1 days; 95% CI -0.4 to 2.5; p=0.14). The mean time to regain birth weight was shorter in 3-hourly group (12.9 vs 14.8 days, p=0.04). Other subgroup analyses did not reveal additional significant results. No difference in adverse events was found between the groups. CONCLUSION 3-hourly feeding was comparable with 2-hourly feeding to achieve full enteral feeding without any evidence of increased adverse events. TRIAL REGISTRATION NUMBER ACTRN12611000676910, pre-result.
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Affiliation(s)
- Nor Rosidah Ibrahim
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Tan Hooi Kheng
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ariffin Nasir
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Noraida Ramli
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Jimmy Lee Kok Foo
- Department of Paediatrics, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Sharifah Huda Syed Alwi
- Department of Paediatrics, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Hans Van Rostenberghe
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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