Advances in Neonatal Care最新文献

Background: In 2020, the rate of newborns diagnosed with neonatal abstinence syndrome (NAS) in the United States was 6.3 for every 1000 newborn hospitalizations. Resources used to care for this population, particularly NICU beds, are being overwhelmed. In 2020, the state of Ohio saw a rate of 9.5 newborns with NAS for every 1000 newborn hospitalizations.

Purpose: To determine if using the Eat, Sleep, Console (ESC) model of care to guide management of neonates with NAS instead of the Finnegan Scale would reduce the number of admissions of neonates diagnosed with NAS to the neonatal intensive care unit (NICU).

Methods: The PDSA (Plan, Do, Study, Act) method was used in the planning and implementation of this pilot quality improvement project. Education regarding the ESC model of care was provided to the Mother/Infant Unit (MIU), with ongoing education and resources provided and readily available on the unit.

Results: Fifteen neonates were managed with ESC. Of the 5 who would have been admitted to the NICU for pharmacological treatment if Finnegan Scores were the determining factor for admission, 2 were discharged home from the MIU having been managed with ESC.

Implications for practice and research: The use of the ESC model of care can be a useful tool in the management and assessment of neonates with NAS. Resource allocation for care of this population must be assessed to provide optimal non-pharmacological interventions.

Background: Due to the geographical distance, work obligations, and parenting responsibilities, it is often difficult for parents to visit the neonatal intensive care unit (NICU). Limited parent presence might also constrain updates about infant status thus increasing anxiety, which potentially leads to a stronger necessity for visitation.

Purpose: Examine the evidence for use of electronic visit (eVisit) technology for parents of newborns in NICU, for example, do eVisits decrease anxiety and are there other factors that demonstrate effectiveness.

Data sources: Seven databases were used to search for evidence from 1 January 2000 to 13 November 2023.

Study selection: Studies were included with terms related to eHealth, NICU, infant, parent and 41 eligible studies were assessed.

Data extraction: Data were extracted by 2 reviewers with a systematic-staged review approach.

Results: Eight studies with a total of 1450 cases were included. Results of meta-analysis showed that eVisit technology improved anxiety compared with conventional visitation (MD = - 5.04, 95% CI [-5.92, - 4.17], P < .01) and hospitalization satisfaction (RR = 1.09, 95% CI [1.05, 1.13], P < .01), but the effect was not significant with regard to reduction in infant length of stay (MD = - 1.07, 95% CI [-5.39, 3.25], P = .63).

Implications for practice and research: A large sample, high-quality, multi-centered randomized controlled study needs to be conducted to validate the effect of eVisit technology on the psychological state of parents, implications for nursing practice as well as potential newborn affects to improve future ease of use.

Video abstract: Available for more insights from the authors. This video shows the concept, current status, significance, and implications for practice and research of eVisit technology.

Background and significance: In neonatal intensive care, the communication of difficult news can have lingering repercussions throughout the lives of those receiving such information. Uncertainty and stress associated with the COVID-19 pandemic may negatively influence this sensitive yet essential communication process.

Purpose: To analyze the communication of difficult news during the COVID-19 pandemic from the perspective of parents of newborns admitted to a neonatal intensive care unit.

Methods: A qualitative, descriptive research study was completed in a hospital in Brazil. Individual and semistructured interviews were conducted with 21 parents of newborns hospitalized in an intensive care unit and submitted to thematic analysis.

Results: Three themes were built: "Tools and strategies to manage difficult news," "What makes difficult news hard to listen," and "The importance of being prepared to receive difficult news." When comparing these findings with prepandemic literature, the COVID-19 period changed communication dynamics, including coping tools and altered family dynamics. Additionally, assessing healthcare providers' positive and negative behaviors by parents could clarify essential skills to support the family's hospitalization process during a crisis.

Implications for practice and research: Applying and investing in skills training such as spirituality assessment, providing clear and straightforward information, and empathy can reduce the impact of difficult news and, thus, requires both recognition and action from healthcare professionals. Knowing some of the effects COVID-19 had on the communication process for parents with critically ill infants, healthcare providers can better prepare themselves for communication in several scenarios and establish successful interactions.

Background: Using Artificial Intelligence (AI) for neonatal pain assessment has great potential, but its effectiveness depends on accurate data labeling. Therefore, precise and reliable neonatal pain datasets are essential for managing neonatal pain.

Purpose: To develop and validate a comprehensive multimodal dataset with accurately labeled clinical data, enhancing AI algorithms for neonatal pain assessment.

Methods: An assessment team randomly selected healthy neonates for assessment using the Neonatal Pain, Agitation, and Sedation Scale. During painful procedures, 2 cameras recorded neonates' pain reactions on site. After 2 weeks, assessors labeled the processed pain data on the EasyDL platform in a single-anonymized setting. The pain scores from the 4 single-modal data types were compared to the total pain scores derived from multimodal data. The On-Site Neonatal Pain Assessment completed using paper quality scales is referred to as OS-NPA, while the modality-data neonatal pain labeling performed using labeling software is MD-NPL.

Results: The intraclass correlation coefficient among the 4 single-modal groups ranged from 0.938 to 0.969. The overall pain intraclass correlation coefficient score was 0.99, with a Kappa statistic for pain grade agreement of 0.899. The goodness-of-fit for the linear regression models comparing the OS-NPA and MD-NPL for each assessor was greater than 0.96.

Implications for practice and research: MD-NPL represents a productive alternative to OS-NPA for neonatal pain assessment, and the validity of the data labels within the Multimodality Dataset for Neonatal Acute Pain has been validating. These findings offer reliable validation for algorithms designed to assess neonatal pain.

Background: Rates of severe retinopathy of prematurity (ROP) continue to rise globally despite advances in healthcare. Differences in practices related to optimizing oxygenation is among key factors that increase the risk of severe ROP. A recent increase in severe ROP rates at 2 local neonatal intensive care units (NICUs) prompted further investigation into potential preventative practices.

Purpose: The project team's goal was to reduce rates of severe ROP by 20% in the 2 participating units.

Methods: A level IV and level III NICU were targeted, including 255 infants at risk for ROP. Interventions included staff education, implementation of new established oxygen guidelines, as well as use of order sets, and alarm limits. Compliance rates and severe ROP rates before and after new guideline implementation were assessed.

Results: After implementing the new guidelines, average alarm limit compliance met project goals of 90% at both sites. Severe ROP rates declined from 10% to 7% in the level IV NICU site and from 6% to 0% in the level III NICU site during the 24-month study period from 2022 to 2023.

Implications for practice and research: Education and increased understanding regarding risk factors for ROP patients are crucial to successfully implementing and sustaining standardized oxygenation guidelines. Including the entire healthcare team and patient families is key to successful QI initiatives and improving patient outcomes. Further research is needed for optimal standardized oxygen alarm limits for this patient population.

Video abstract: One of the leading causes of childhood blindness is retinopathy of prematurity (ROP).1 ROP is a disease of the retina that affects premature infants, with the highest risk to very low birthweight (VLBW) infants born with a gestational age of less than 30 to 32 weeks or infants weighing less than 1500 grams.2 There are 5 stages of ROP. Stages 1 and 2 are considered mild and resolve on their own. Stage 3 is considered moderate-severe and sometimes resolves independently, with many cases requiring treatment. Stages 4 and 5 ROP are deemed severe and require treatment.

Background: The COVID-19 pandemic affected the maternal-infant dyad, especially due to visitation restrictions in neonatal units. These changes may impact the psychological, physical, and developmental health of mothers and newborns.

Purpose: This systematic review evaluates the impact of enforced separation and restrictive visitation policies in neonatal units during the pandemic, focusing on the maternal-infant dyad.

Data sources: Data sources include CINAHL, MEDLINE, Web of Science, APA PsycINFO, Academic Search Ultimate, and Embase, covering studies published between 2020 and 2024.

Study selection: A detailed search was conducted using terms related to COVID-19, maternal and neonatal health, and visitation restrictions in neonatal units. Articles were included if they were peer-reviewed, written in English, and focused on the impact of visitation restrictions on maternal and neonatal health.

Data extraction: The data extraction process began with 789 references. After removing duplicates, we screened titles and abstracts. We then conducted a full-text assessment of the remaining studies, selecting 14 that met the inclusion criteria.

Results: The analysis showed significant emotional, psychological, and developmental impacts on mothers and newborns due to pandemic-induced separation and inconsistent policies. It highlighted depressive symptoms, stress, bonding disruptions, and the effectiveness of virtual bonding.

Implications for practice and research: The review emphasizes the need for family-centered care, coping strategies, and virtual bonding in neonatal units. It calls for culturally sensitive policies to support mothers and infants during crises. The review also highlights the importance of studying the long-term effects of pandemic-induced separations and improving support for future health emergencies.

Background: Thermoregulation interventions in the delivery room have historically focused on preterm infants and studies often exclude term infants or those infants with known congenital anomalies.

Purpose: The purpose of this quality improvement project was to reduce the rate of admission hypothermia in neonates of all gestational ages born with congenital anomalies and admitted to the intensive care unit (ICU).

Methods: Utilizing the Institute for Healthcare Improvement model for improvement, implementation of plan, do study, act cycles focused on standardizing temperatures of the delivery room and resuscitation bed, recommendations for temperature monitoring, trialing polyethylene lined hats, and implementing a delivery room thermoregulation checklist.

Results: Overall, the mean rate of neonates admitted to the ICU hypothermic (<36.5°C) decreased from 27% to 9% over an 8-month period.

Implications for practice and research: The interventions significantly reduced the number of neonates admitted to the ICU with hypothermia. Implementation of thermoregulation bundles should apply to all neonates with congenital anomalies to decrease risks associated with hypothermia.

Background: Necrotizing enterocolitis (NEC) is common in preterm infants, especially infants less than 32 weeks gestation. Mortality from NEC is 7% and occurs in 1 out of 1000 preterm infants. Studies have shown the efficacy of an exclusive milk from mother diet in decreasing rates of NEC and associated mortality.

Purpose: To evaluate the effectiveness of an existing exclusive human milk diet (EHMD) protocol on the incidence of NEC in extremely premature infants. EHMD, for the purposes of this project is defined as breast milk of mother, with or without human milk-based fortifier.

Methods: A single-center retrospective quasi-experimental study. The sample included 201 infants born less than 32 weeks gestation, weighing less than 1250 grams, small for gestational age (SGA) and with low Apgar scores. Outcomes measured included incidences of NEC, mortality, and co-morbidities in infants pre- and postinitiation of an EHMD protocol.

Results: Just 4.8% of the EHMD group had a NEC diagnosis compared to 10.5% of the bovine-based (BOV) group. There was a 1% mortality rate of the EHMD group as compared to 6% in the BOV group. The EHMD group had a statistically significant greater weight gain during hospitalization as compared to infants fed BOV ( P = < .05).

Implications for practice and research: Neonatal intensive care units should consider EHMDs for use in this infant population. Future research is needed to support dissemination of the use of EHMD as standard of practice.