Neonatal Network最新文献

Death and grieving are regular events in the human lifecycle, and the rituals associated with the loss bring closure to dear ones. Ambiguous loss, a term coined by Pauline Boss, is a state in which there is no actual "death" and, therefore, no "grieving" or closure associated with it. Pregnancy is a happy event most of the time; however, the loss of pregnancy can be distressing to the parents. Additionally, a prenatal diagnosis can be an emotional burden to the family where the fetus is there, but an unknown loss is anticipated. While the birth of a child is expected to be a joyful event, premature birth and subsequent admission to the NICU for prolonged periods with fluctuating conditions force the parent to be in a constant crisis mode where the outcome is unknown. This can mentally, physically, and emotionally drain the parents and may cause depression or other mental health challenges. Perinatal and neonatal nurses are uniquely positioned to recognize the warning signs of emerging grief crises in the parents and support them appropriately. Such support can equip the parents for a healthy transition of care to home and help parents learn to live a healthy life despite the challenges.

In the field of neonatal care, the integrity of an infant's skin is paramount yet often underestimated. This article provides a comprehensive review of neonatal skin, illuminating the critical necessity for tailored care practices. The authors explore the developmental variances, highlighting the premature skin's vulnerability to external insults and its role in physiological processes, such as thermoregulation and barrier function. This review synthesizes current best practices in neonatal skin care, including hygiene, protection, and treatment protocols. Furthermore, it addresses common dermatological conditions in infants, providing insights into their identification, implications, and management strategies.

Neonatal jaundice is a common condition affecting four out of five healthy newborns, characterized by the yellowing of the skin due to elevated bilirubin levels. This condition, known as hyperbilirubinemia, is typically benign and transient when properly managed but may progress to severe complications such as kernicterus-a permanent neurologic condition-if untreated. Newborns are particularly susceptible to jaundice due to increased red blood cell turnover, immature liver enzymes, and delayed stooling patterns. Preventive measures during pregnancy, such as maternal blood typing and Rh immunoglobulin administration, can mitigate the risk of hemolytic conditions leading to jaundice. Early detection through bilirubin screening and prompt treatment, including phototherapy, are critical to preventing neurotoxicity. Recent updates to the American Academy of Pediatrics guidelines emphasize higher thresholds for intervention, stratified by gestational age and risk factors. Effective management relies on thorough assessment, parental education, and close postdischarge follow-up. Understanding the pathophysiology, risk factors, and treatment protocols enables health care providers to optimize outcomes and prevent long-term sequelae in affected infants. This article will provide an overview of neonatal jaundice and neonatal hyperbilirubinemia, focusing on its pathophysiology, diagnostic methods, and the most recent treatment guidelines. The aim is to provide this guidance to support the bedside NICU nursing practice.

The purpose of this study is to describe the prevalence of problematic feeding in the first 6 months of life in infants born preterm, the impact of feeding problems on the family and parent, and explore which factors known at the time of neonatal discharge predict later symptoms of problematic feeding. The study design is a longitudinal, observational study. The sample included 43 infants born at 28.3 (23.57-33.86) weeks postmenstrual age at 1, 3, and 6 months corrected gestational age. The Infant Eating Assessment Tool and Feeding Impact Scales provided the main outcome variables. Prevalence of problematic feeding was 64% at 1 month, 66% at 3 months, and 29% at 6 months. Diagnosis of gastroesophageal reflux disease while in the NICU was the greatest predictor of problematic feeding in the first 6 months. Families and parents were more negatively impacted when their infant had problematic feeding.

Meconium ileus (MI) is the result of the accumulation of thick, dry, inspissated meconium that creates a bowel blockage, most commonly in the terminal ileum. These pockets of meconium prevent passage of stool beyond the point of obstruction, which leads to distention of the proximal bowel, bowel wall thickening, and distal microcolon. Occurring most commonly (90%) in conjunction with cystic fibrosis (CF), the occurrence of MI without CF is rare. The literature describes the incidence of MI associated with CF occurring in as many as 24.9% of those who have a pair (homozygous) of the most common CF gene mutation, Delta F508. The incidence of MI decreases with other CF mutations, of which there are over 2,000. The morbidity and mortality risks are related to whether the MI is simple or complex. Simple MI can be managed clinically with contrast enemas to relieve the obstruction and restore bowel function, while complex MI requires surgical intervention for possible bowel necrosis, perforation, peritonitis, strictures, and/or volvulus that can occur in utero or after birth. This article presents a case report of a 32-week-gestation female infant with gross abdominal distention beginning on day of life 1. The differential diagnosis, necessary testing, and required treatment that led to the final diagnosis will be presented. Additionally, radiographic modalities used to confirm the diagnosis are discussed. Finally, nursing management of the infant with simple or complex MI and short- and long-term challenges for infants and their families will be addressed.

As a NICU parent, I was always wondering how my daughter could sleep through all of the noise in the NICU what with her very early birth. I was already concerned about her developmental outcomes due to the birth itself, but the alarms and noise in the NICU gave me incredible pause. So when I found about DREAMIES, a product that helps muffle the noise not only in the NICU but during transport and during an MRI, I was amazed.

Advanced practice providers (APPs) experience limited clinical opportunities to perform neonatal procedures to maintain competency and hospital credentialing, especially high-acuity procedures that are extremely rare but crucial during patient emergencies. Incorporating simulation as part of continuing professional education can help APPs maintain clinical procedural competency and learn new procedural techniques to improve the quality and safety of procedures performed in the clinical setting. In 2013, we successfully developed and implemented an annual didactic and simulation-based neonatal procedural skills program. Since then, our APP group has experienced significant growth, which introduced challenges to sustain a high-quality program that would be valued by participants. These challenges presented the opportunity for a major program redesign addressing education, competency, credentialing, safety, and quality improvement. In this article, we describe the challenges that we uncovered from a comprehensive needs assessment that informed program redesign. We also present evaluation of the redesigned program, which includes learner, patient care, and systems-based outcomes.