Neonatal Network最新文献

Extremely preterm infants (EPIs) require complex management because of structural and functional organ immaturity leading to unique medical needs and evolving approaches throughout their NICU course because of changes in physiology. A comprehensive approach to care for these small babies is essential, as changes in management of one organ system can have downstream effects on others. This care plan ideally begins before delivery and involves a multidisciplinary team developing the initial plan of care based on individual patient factors and continues to evolve. Because of the complexity of these fragile patients, multidisciplinary guidelines developed by a team with expertise in caring for EPIs can lead to improved care and outcomes. Additionally, multicenter collaboration to share knowledge and experience, work together on research and quality improvement initiatives, and discuss complicated cases is essential because of the relatively small numbers of these tiniest patients at each individual site.

The use of a humidified environment has long been established as a method of maintaining a thermoneutral environment and minimizing evaporative insensible water losses in the extremely low birth weight (ELBW) population. The ELBW infant is at high risk for insensible water losses leading to dehydration, excessive weight loss, temperature instability, and electrolyte abnormalities, thereby increasing the ELBW infant's risks of morbidity and mortality. Literature supports the use of a humidified environment; however, a lack of consensus has led to widespread variation in the implementation of humidity protocols. Utilizing the Iowa Model for Evidence-Based Practice, this project sought to explore whether an individualized humidification algorithm would affect the incidence of transepidermal water loss (TEWL). Results demonstrated statistical significance in sodium levels, improved median sodium levels, and improved fluid balance after implementation. Results suggested that an individualized humidity weaning algorithm may improve the incidence of hypernatremia in the ELBW infant. Further research studies are needed to describe the causal relationship between humidification and the ELBW infant's TEWL.

Danielle Vassell is a wonder. Born at 1 pound, she is now an adult and a living proof that prematurity is not a bad thing. In fact, it is a superpower. She defied the odds, and she challenges others to do the same. This interview provides positive insight into prematurity and one that will help professionals insert that positivity into their families at bedside.

Education access and quality are the second of five domains of determinants of health influencing the well-being of families and communities. In this column, the impacts of educational attainment and health literacy on health and well-being will be described. There is an increased need for adequate health literacy during pregnancy and parenting, including when infants require NICU care and following their discharge into the early years and beyond. Creating environments where universal precautions for health literacy and plain language communication are used will improve health outcomes for infants and parenting confidence. NICU nurses hold an essential role in creating these environments and tailoring education to parent needs.

Advancements in the fields of obstetrics and neonatal medicine, notably the use of antenatal corticosteroids and exogenous surfactant, have significantly improved the chances of survival for babies born prematurely. Extremely premature infants, born before 28 weeks of gestation, have underdeveloped lungs and pulmonary vasculature, necessitating a carefully tailored respiratory management strategy that incorporates both noninvasive and invasive methods throughout their NICU stay. The primary goal of respiratory management in this cohort is to provide the least amount of support necessary while oxygenating and ventilating the lungs. Noninvasive ventilation (NIV) methods are preferred to invasive methods to minimize the risk of damaging the lungs from mechanical ventilation. Nasal continuous positive airway pressure, high-flow nasal cannula, noninvasive positive pressure ventilation, noninvasive neurally adjusted ventilatory assist, and noninvasive high-frequency oscillatory ventilation are the types of NIV most readily available for use in extremely premature infants. Invasive methods such as conventional mechanical ventilation, high-frequency oscillatory ventilation, high-frequency jet ventilation, and neurally adjusted ventilatory assist are used to manage these fragile infants when intubation is required. Despite attempts to use noninvasive methods, many extremely premature infants may still require intubation. The main goal remains to improve outcomes while minimizing risks, although bronchopulmonary dysplasia still remains a challenge. Ongoing research and a consistent approach are essential for enhancing outcomes for these babies.

Recent advancements in medicine have improved the survival of extremely low gestational age neonates, or small babies (22-27 weeks' gestation). Once inconceivable that an infant born as early as 22 weeks' gestation could survive, infants born at periviable gestational ages are now increasingly surviving to discharge from the NICU. Subsequently, clinical focus is pivoting toward practices that decrease morbidity in this extremely vulnerable population. This article aims to discuss obstetrical and neonatal practices during delivery to improve outcomes of the small baby and emphasize the importance of collaboration among all disciplines involved in the pregnancy, delivery, and postnatal care of the small baby. Effective communication and teamwork are cornerstones to improving outcomes in this patient population.

This article aims to provide a comprehensive description of the postnatal effects of drug exposure on neonates, including neonatal abstinence syndrome (NAS), and the neonatal advanced practice registered nurse (APRN)'s role in working with this vulnerable and marginalized population. Maternal substance use disorders (SUDs) are a significant epidemic in the United States and are a leading cause of infant admission to the NICU. Substance use disorders carry stigmas for individuals experiencing them. The opioid crisis has played a pivotal role, with opioids being the most used substance during pregnancy. Neonatal abstinence syndrome manifests as a multisystem disorder resulting from chronic exposure to illicit or prescribed substances in utero that are abruptly halted at delivery. Symptoms of NAS vary in severity depending on the substance type and duration of exposure. The neonatal APRN is in a unique position to have a positive impact on the care provided to neonates experiencing NAS and their mothers experiencing SUD.