Advances in Neonatal Care最新文献

Background: Pain assessment by the healthcare professional is essential in caring for newborns. However, it is unclear whether there is a difference in the assessment or pain management between different healthcare provider groups.

Purpose: In this study, we determined whether there is a difference in perceived neonatal procedural pain between physicians and nurses working at the same facility who care for the same patients. Furthermore, we assessed perceived compliance of healthcare providers with the Japanese guidelines for neonatal pain management.

Methods: We performed a cross-sectional survey using a questionnaire sent to hospitals in Japan with neonatal intensive care units. The questionnaire included responses from both physicians and nurses.

Results: For most procedures, nurses' perceptions of the degree of pain in newborns were higher than that of physicians. Thus, nurses were more likely to believe that newborns perceived more pain. For 5 of the 19 guideline recommendations, more than 80% of the hospitals reported that both physicians and nurses implement pain management, although there were some items on which physicians and nurses had divergent opinions.

Implications for practice and research: Our findings suggest that current pain management differs among healthcare professionals, including pain assessment and the actual pain management provided in the hospital wards. Establishing cooperation and having sufficient communication among the different healthcare professionals are required to improve care for newborn patients.

Background: Neonates are at high risk of intravenous extravasation, which can cause severe tissue necrosis. However, few studies have combined silver sulfadiazine (SSD) with recombinant human epidermal growth factor (rh-EGF), which has limited application in neonatal patients, to treat extravasation. This report describes the case of a female neonate treated with SSD and rh-EGF for a skin injury caused by epinephrine extravasation.

Clinical findings: The patient (gestational age: 33 + 5 weeks) experienced extravasation during epinephrine hydrochloride infusion on the first day of hospitalization in the neonatal intensive care unit (NICU).

Primary diagnosis: Extravasation was diagnosed 6 hours following initiation of epinephrine hydrochloride infusion, which led to specific signs, including erythema, swelling, and pain.

Interventions: The patient suffered an extravasation injury in her right lower limb. Sterile puncture points were made from the edge of the leak toward the puncture center. Phentolamine was administered at the puncture site. SSD and rh-EGF were applied to the injured area and covered with Vaseline gauze.

Outcomes: After treatment, the extravasation injury in the right lower limb resolved without any debridement or noticeable signs of infection. The black and purple skin discoloration decreased gradually, achieving normalization 13 days post-injury. The patient recovered completely with no scarring and was subsequently discharged.

Practice recommendations: Patients receiving infusions with high extravasation risk should be continuously and carefully evaluated for signs of dislocation, leakage swelling, or extravasation to quickly identify and prevent further injury. Combining SSD and rh-EGF may be an alternative treatment for advanced extravasation lesions in the NICU.

Background: Mothers of infants with congenital anomalies may experience challenges with milk production. Antenatal milk expression (AME) is thought to support milk production, as past research suggests it facilitates secretory activation. However, past research relied on self-reported data.

Purpose: This study examined secretory activation and coming to volume, 2 critical stages of postpartum milk production, by measurement of human milk biomarkers from days 1 to 7 and 24-hour milk volume from birth until day 14 in mothers of infants with congenital anomalies who practiced AME.

Methods: Women carrying infants with congenital anomalies received AME education, did AME, gave birth, and recorded their 24-hour pumping frequency and milk volume. An ion selective electrode (ISE) and laboratory analysis were used to measure human milk biomarkers.

Results: Sixteen mothers completed AME, and all infants were born at term. Most mothers (87.5%) had normal biomarkers at least once, but biomarkers did not stay in normal range. Four mothers (25%) experienced secretory activation within 72 hours after birth. The pumping frequency and 24-hour milk volume varied. Only 9 (56.25%) mothers secreted ≥500 mL of milk by day 14.

Implications for practice: AME may offer benefits, but secretory activation does not appear to be impacted. The ISE shows promise as a nursing-driven intervention to screen for potential milk volume concerns.

Implications for research: Further research is needed on AME and human milk biomarkers in this at-risk population.

Background: Couplet Care, which allows mothers and newborns to receive treatment together, has gained prominence in neonatal and maternity care settings. This model supports early bonding, skin-to-skin contact, and breastfeeding, benefiting both preterm and sick newborns.

Purpose: The study aims to explore parents' experiences with Couplet Care after a caesarean section in an integrated neonatal and maternity unit, where both mother and newborn required treatment.

Methods: A qualitative, semi-structured interview approach was employed. Eight mothers and 6 fathers participated, sharing their perspectives on Couplet Care through interviews conducted at a Danish hospital setting providing Couplet Care in 6 family rooms in a level II neonatal intensive care unit. Data were analyzed using content analysis inspired by Graneheim and Lundman.

Results: Parents initially relied heavily on nurses, gradually gaining autonomy as their hospital stay progressed. Fathers played an essential role in caregiving, especially when mothers were immobile post-surgery. The study highlighted the importance of clear communication from nurses, which fostered parental confidence.

Implications for practice and research: Couplet Care offers a supportive environment that promotes parental autonomy and emphasizes the critical role fathers play in caregiving. Future research should investigate the long-term effects on family dynamics and the mental health of both mothers and fathers following caesarean sections in similar settings.

Background: Infants who require a stay in the Neonatal Intensive Care Unit (NICU) may require significantly higher levels of care once they are ready for discharge. Although providers try to ensure a smooth transition to home, caregivers may not be fully prepared for home life and may need questions or concerns addressed before their follow-up appointments. Providing telemedicine (TM) visits shortly after NICU discharge may ease these issues and improve care.

Purpose: The primary aim of this quality improvement project was to obtain family feedback on potential benefits of post-NICU discharge TM visits conducted by a neonatal nurse practitioner. A secondary aim was to determine if a recent change in the nutrition discharge process was beneficial to caregivers.

Methods: All infants discharged from the NICU who had a TM appointment (N = 35) from April to December 2022 were eligible for the telephone interview. Semi-structured caregiver interviews were conducted with the team dietitian by telephone within 2 weeks of the TM FU.

Results: Of those who had TM appointments, 30 families participated in the interviews (85.7%), and 28 (93.3%) reported finding the visits beneficial.

Implications: Families found TM visits after NICU discharge to be beneficial. TM visits may serve as a safety net for families who at the time of NICU discharge do not yet realize the types of challenges that they will face once home.

Background: Family centered-care (FCC) has documented benefits for infants, parents, and staff, but is variably practiced.

Purpose: To describe parental and staff perspectives on the quality of FCC culture in a neonatal intensive care unit (NICU).

Methods: Parents of hospitalized infants and staff at a referral NICU completed validated survey instruments to measure NICU FCC quality on topics including trust, communication, and shared decision-making at multiple time points. We compared parent and staff responses using a cumulative log-odds model with a single predictor to model the odds of a score lower than a prespecified value.

Results: A total of 92 parents of 80 NICU infants and 96 NICU providers participated. Most rated items highly, indicating a positive experience with FCC. The items with the highest scores for parents were receiving guidance and being trusted in their infant's care (both 97.1% positive); for staff, listening to parents (95%). Receiving/providing emotional support received the lowest scores from parents (19.1% negative or neutral) and staff (24.5%). Parent and staff answers differed significantly for 6 of 8 questions, with lower scores reported by staff relative to parents.

Implications for practice and research: Parents and staff have variable perspectives on different aspects of FCC. Understanding these nuances of centers' FCC culture can help target interventions and may strengthen FCC delivery for NICU infants and families and career satisfaction for staff. Future directions include assessing FCC quality over time and among specific infant, family, and staff cohorts, especially diverse populations to determine if FCC is equitably delivered.

Background: The COVID-19 pandemic disrupted our practice of outpatient methadone weaning for pharmacologic management of infants with neonatal abstinence syndrome (NAS), resulting in increased average length of stay (ALOS). In response, we integrated a responsive Bassinet (SNOO), into our Eat, Sleep, Console (ESC) care model.

Purpose: Our primary aim through this quality improvement work was to explore whether integration of SNOO within our ESC care model had an impact.

Methods: Using quality improvement methodologies, a retrospective chart review was conducted for neonates admitted to the NICU for NAS from December 2020 to September 2022 ( N = 109). Study inclusion criteria were primary diagnosis of NAS, birth gestational age ≥35 weeks, and absence of other co-morbid diagnoses. Neonates were organized into two groups based on date of bassinet implementation. An online survey was sent to 76 NICU nurses 6 months post-implementation. Outcome measures included ALOS, number of sleep-related "yes" scores (indicating poor sleep), and nurse experience.

Results: Of 109 infants, 13 met inclusion criteria ALOS declined by 17.38% ( P= .57), and "yes" scores decreased by 41.72% ( P =.52). Nurses reported an average of 2.43 hours saved per 12-hour shift.

Implications for practice and research: The addition of SNOO as a non-pharmacologic intervention within ESC care models for infants with NAS may lead to a decreased average length of stay, improved infant sleep, and improved nursing experience (such as time savings).

Background: Understanding parent satisfaction with care is an integral part of ensuring care delivery is family-focused and responsive to family needs, preferences, and values.

Purpose: The purposes of the study were to describe parental satisfaction with neonatal care, assess differences between satisfaction scores and identify areas for care improvement.

Methods: A secondary analysis of data collected from an online survey of the neonatal intensive care unit (NICU) parent experiences during the early months of the COVID-19 Pandemic in the United States was used. Parent satisfaction with NICU care was measured using the EMpowerment of PArents in THe Intensive Care (EMPATHIC) scale. Descriptive statistics described individual items, domain scores, and total score. Independent t-tests with Bonferroni correction compared this study to previously published results.

Results: 159 mothers and 5 fathers responded to the EMPATHIC scale. The overall mean and all domain scores were significantly different from a pre-pandemic sample where scores were consistently higher. Parents indicated their desire for more cultural competence, emotional support, acknowledgement, and space to discuss their experience, guidance for discharge, better medication information and quicker response to an infant's condition.

Implications for practice and research: Our study identified statistically significant differences between our sample and a pre-pandemic sample and found the absolute mean difference in 3 domain scores to be > 1, suggesting clinical significance. We were able to offer more clarity about what factors were contributing to higher or lower satisfaction scores.

Background: There is sufficient evidence to support safe discharge from the neonatal intensive care unit (NICU) with nasogastric tube (NGT) feedings when appropriate caregiver education, outpatient support, and feeding therapy are available.

Purpose: We sought to identify infants eligible for safe discharge with NGT feedings to reduce NICU length of stay and avert unnecessary surgical gastrostomy tube (GT) placement.

Method: A protocol with infant eligibility criteria for NICU discharge with NGT feedings was developed and implemented. A focus group was conducted to identify perceived successes, barriers and lessons learned.

Results: There was low uptake of the new protocol. Barriers to implementation included inconsistent protocol adoption by NICU providers, concerns about lack of outpatient support, and significant language barriers for non-English speaking families.

Implications: Outpatient multidisciplinary support is crucial to successfully implement home NGT feedings upon NICU discharge. A well-developed protocol provides eligibility standards and decision support.