Advances in Neonatal Care最新文献

Background: Skin-to-skin care (SSC) is an evidence-based care method for preterm-born infants. Staff may hesitate to initiate early SSC, the first or second week of life, for the most extremely preterm infants; 1 reason could be nurses' attitudes.

Purpose: The aim was to investigate the attitudes and experiences of neonatal nurses regarding early SSC for the most extremely preterm infants, born at gestational week (GW) 22-23, using an exploratory and descriptive approach.

Methods: A web-based survey was sent to all nurses across the 6 Swedish units routinely caring for the most extremely preterm infants. Descriptive statistics and qualitative content analysis were used to analyze the data.

Results: The response rate was 258 out of 547 (47%). This study reveals a spectrum of attitudes and experiences among nurses, ranging from viewing early SSC as an integral aspect of infant care to deeming it very challenging or simply not feasible. The outcomes are presented in 2 categories, describing both facilitators and challenges associated with early SSC. Noteworthy, facilitators include well-implemented guidelines that support early SSC. Conversely, challenges encompass knowledge gaps and the scarcity of scientific evidence demonstrating the safety of all SSC, including early, for the most extremely preterm infants.

Implications for practice and research: This study underscores the importance of spreading knowledge, and has clinical adapted guidelines about the practical aspects of SSC for infants born at 22-23 GW. Future research is required to clarify safety aspects pertaining to SSC for the most extremely preterm infants.

Background: More than 350,000 U.S. infants are admitted to the neonatal intensive care unit (NICU) annually and likely experience discomfort. Although nurse perceptions of infant symptoms, suffering, and quality of life (QOL) are valuable, the availability of standardized assessment tools to measure these concepts are limited.

Purpose: To provide preliminary evidence of the internal structure, reliability, and validity of the Nurse Perception of Infant Condition (NPIC) scale.

Methods: Infants were enrolled from a Level IV NICU in the U.S. Midwest. Nurses reported on their perceptions of the infant symptom experience and their expectations for infant survival. Weekly behavioral observations of infants were obtained before and after standard delivery of care to obtain a comfort score.

Results: 237 nurses who cared for 73 infants completed 569 surveys over 28 months. All NPIC items were significantly correlated with each other ( P < .001). Factor analysis revealed strong evidence of a 2-factor structure (survival and suffering subscales). Both subscales demonstrated good to excellent internal consistency. Together the 2 factors explained 82% of the variability in the scale responses. Limited validity evidence was found.

Implications for practice and research: Evidence was found to support the internal structure and reliability of the NPIC scale. However, further item development and refinement is needed to increase the utility NPIC scale in clinical and research settings. The development of improved assessments of the infant NICU experience is warranted. Nurse perceptions of infant suffering or poor QOL may have implications for their expectations for infant survival and possibly care delivery.

Background: Unplanned extubations (UEs) continue to be one of the most common adverse events in the neonatal intensive care unit (NICU). Management of endotracheal tubes (ETTs) can be particularly challenging in neonates due to the unique needs and physical characteristics of this patient population.

Purpose: The purpose of this quality improvement project was to decrease the rate of UEs from 0.76 to less than 0.5 per 100 ventilator days in an urban level III NICU in the Midwest, United States.

Methods: A newly formed interprofessional team created an evidence-based, standardized, bedside nurse-led care bundle for intubations and ETT care in the NICU. This project also created standardized, clear, closed-loop communication for the transition of bedside staff at shift change.

Results: The UE rate decreased from 0.76 to 0 per 100 ventilator days, reaching the goal of less than 0.5 per 100 ventilator days, during the 10-week project implementation period from December 2021 to February 2022.

Implications for practice and research: Many NICUs focus on reducing UEs due to the impact on healthcare resource utilization, acute complications, and long-term outcomes for infants. The development of a standardized, nurse-led care bundle for ETTs decreased the rate of UEs. Future research is needed to study the potential for generalization to different units and beyond the scope of the neonatal population.

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: 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 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: 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.