Neonatal Network最新文献

Respectful maternity care (RMC) is a topic that has received increasing focus among clinicians, researchers, and the public in recent years. While clinicians recognize the importance of respectful care, patients report that they are not consistently receiving it. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) created the RMC Framework, Evidence-Based Guidelines and Implementation Toolkit to provide nursing teams with the knowledge, tools, and structures they need to promote RMC. For true change to happen, the implementation of respectful care must be translated across the maternity care continuum, including in the NICU. This article shares a health care organization's journey toward respectful, equitable maternity care for women, neonates, and their families. This article outlines the AWHONN RMC Framework and the leverage of its components to promote RMC for neonates and their families in the NICU. The outcomes of these efforts are also highlighted.

This piece was written as a letter of admiration for NICU parents from a NICU nurse. A NICU parent is a special person tasked with one of the most terrifying and burdensome paths possible. Allowing strangers to care for your vulnerable and miraculous child is asking a lot of a person. NICU nurses and staff know this and feel this. Parents should know that they are rock stars. They deserve so much credit. This letter is a small way to give that credit.

There is ample research discussing the benefits of a pacifier-activated music system with preterm and high-risk infants. Benefits include improving the quality of nonnutritive sucking (NNS) and increased feeding volume/attempts/endurance, which lead to decreased time to full oral feedings and shortened hospital stays. The use of pacifier-activated music systems supports a faster transition to oral feeding in preterm infants while learning to breastfeed or bottle feed in the NICU. When coupling pacifier-activated music systems with the NNS of a pacifier, the preterm infant gains efficacy in feeding strength and endurance. Benefits also include faster nipple feeding success, mother/infant stress reduction, fewer rehospitalizations, diminished length of stay, and other long-term benefits. This article will discuss how the benefits of using music in the NICU are widespread and should be implemented as a multidisciplinary approach in a variety of NICU settings. Several NICU patient populations can benefit from music using a music pacifier system dependent on the modes used.

This program evaluation aimed to assess the impact of a streamlined and less expensive version of Goslings-I (a NICU parent education program) on parents' early language and literacy practices and their confidence in interacting with their infants. This evaluation used a single-group, pre- and posttest, mixed-methods design. Sixty-three parents completed pre- and postprogram questionnaires on the frequency of language and literacy activities, confidence in understanding infant signals, and program satisfaction. Seven parents participated in follow-up interviews. Interview participants reported on interaction with their infants 1-2 weeks after attending the program. Goslings-II resulted in self-reported positive behavioral changes in parent-infant interactions, increased early language and literacy activities, and enhanced confidence. Parents also reported they could apply Goslings-II skills to other parent-infant interactions, like diapering. Positive results from this evaluation are similar to the original program, Goslings-I, demonstrating program effectiveness at a more affordable price.

Early exposure to human milk and time to first trophic feed in low birth weight (LBW) infants (<2 kg) is associated with a decreased risk of mortality, sepsis, and length of hospital stay. This project, focused on infants born at less than 2 kg, aimed to identify the mean time to first feed after birth, identify barriers to initiation of the first feed, and meet the target of having 90% of infants receive their first feed within the first 6 hours of life. This quality improvement (QI) project occurred in a thirty-bed level III NICU over 29 months using two Plan-Do-Study-Act (PDSA) cycles. A first-feed audit tool and a multifaceted educational plan were at the forefront of this initiative. Interventions were multidisciplinary, targeted, and extended to all healthcare team members caring for LBW infants, including staff of Labor and Delivery, the NICU, and the Child Health Transport Team. At the end of the QI project, 91.3% of inborn infants and 27.5% of outborn infants were being fed by 6 hours of age, compared with 78.8% and 12.5%, respectively, prior to the project. The mean time to first feed for inborn infants after the PDSA cycles was reduced to 4.4 hours, having a decrease of 80 minutes. A multidisciplinary approach was a key factor in the success of this QI initiative. Increasing staff education and improving clinical practice guidelines regarding the importance of early exposure to human milk are associated with reducing first feed times after birth.

Premature infants admitted to the NICU often require intravenous (IV) therapy. Peripheral intravenous catheter (PIVC) insertion is a common painful/stressful/invasive procedure. Repeated exposure to stressors produces toxic stress: a prolonged, frequent activation of the body's stress response that occurs when buffering relationships, that is, mother/supportive adult, are absent. This article presents an exemplar case study of a PIVC insertion to describe toxic stress responses a premature infant experienced during the procedure. The infant was admitted for extreme prematurity and respiratory failure. Twenty-nine days later, the infant developed possible necrotizing enterocolitis that necessitated cessation of enteral feedings, gastric decompression, IV administration of fluids, parenteral nutrients, and antibiotics. The PIVC insertion procedure was monitored and observed. The infant showed physiologic dysregulation, including bradycardia, tachycardia, oxygen desaturation, and high skin conductance responses, resulting from the stress exposure and insufficient nonpharmacologic/pharmacologic stress interventions. Education and practice change are needed to promote pain/stress management.