Advances in Neonatal Care最新文献

Background: Acquired human cytomegalovirus (CMV) is a noteworthy disease in infants. This case study will highlight the influence of early diagnosis of CMV retinitis (CMVR) on avoid visual impairment.

Clinical findings: We describe a preterm female infant with a birth weight of 2060 gr that was admitted for tracheostomy placement due to hypoxic-ischemic encephalopathy. There were no signs of CMV infection or sepsis in laboratory results upon admission such as serology (IgG, IgM antibodies), Toxoplasma gondii , Rubella virus, Herpes simplex virus, CMVR and urine polymerase chain reaction (PCR).

Primary diagnosis: Incidentally, upon screening for retinopathy of prematurity, diffuse occlusive vasculitis was detected in the retinal image on the 112th day of life.

Intervention: Intravenous and intraocular ganciclovir were administered for 4 weeks.

Outcomes: In the follow-up visit 6 weeks after discharge from the hospital, visual impairment was detected on both sides.

Practice recommendations: This is a report of a case of acquired CMVR, a silent finding, as an uncommon complication in preterm neonates during the hospital stay. This diagnosis should be taken into consideration in preterm infants, since early diagnosis and treatment are crucial to avoid visual impairment.

Background: Though prior literature has demonstrated that communication in the Neonatal Intensive Care Unit (NICU) needs to be improved, in-depth descriptions of parents' views of NICU communication are lacking.

Purpose: We sought (1) to explore parent perceptions of communication in the NICU and (2) to understand parents' communication needs and preferences.

Methods: We conducted in-depth semi-structured cognitive interviews utilizing concurrent probes with parents of 10 patients in our urban level IV Neonatal Intensive Care Unit over a period of 4 months (July 2021-October 2021). Interview questions were derived from the Quality of Communication scale. We conducted thematic analysis of interview transcripts modeled after work by Braun and Clarke.

Results: Four overarching themes were identified: Strengths, Challenges, People, and Coping Strategies. Parents reported a range of communication quality in the NICU. Results revealed that the first 48 hours of NICU hospitalization represent a period of vulnerability and uncertainty for parents. Parents value clear yet hopeful communication about a baby's clinical status and expected course.

Implications for practice and research: We hope that the concrete findings from this study can both inform practice in the NICU now and influence practice guidelines to include such components as emphasis on the first 48 hours, desire for proactive information sharing, and the importance of including hope.

Background: Enhancing the current breast pump sanitization method may improve maternal satisfaction and increase a mother's likelihood of providing human milk for their hospitalized infants in the Neonatal Intensive Care Unit (NICU). Other than Centers for Disease Control (CDC) data, there is lack of studies on sanitization practices. Currently, the only option in the hospital setting for breast pump equipment cleaning is a steam sanitization plastic bag.

Purpose: Using the Q. Basin will increase participant satisfaction compared to the steam sanitization bag.

Methods: A multi-phased pilot study was conducted in our quaternary care NICU to test the Q. Basin, a novel design developed to wash, dry, and safely steam sanitize breast pump equipment compared to the standard steam bag. A bacterial study was conducted on breast pump equipment from 10 mothers by swabbing the equipment immediately at hour zero and 24 hours. Twenty NICU mothers concurrently evaluated their satisfaction via a 3-question survey comparing the Q. Basin and the steam sanitization plastic bag method.

Results: The results showed a 20% increase in satisfaction with Q. Basin compared to the steam bag method.

Implications for practice and research: Data analysis from the satisfaction survey concludes that mothers pumping preferred the Q. Basin as a quicker, faster, and more environmentally friendly method for breast pump part sanitization. Additional safety and materials studies are required before using the Q. Basin in the clinical environment.

Background: Preterm infants require the use of nasogastric and orogastric enteral access devices (EADs) to provide nutrition and medications. Confirmation of the location of the tip of the EAD is essential to minimize complications. At the study site, EAD location was limited to verifying the centimeter marking at the lip/nares and nonevidence-based methods of visual observation of aspirate and auscultation.

Purpose: Implement an evidenced-based EAD placement confirmation protocol, and by 90 days post-education and implementation, achieve adherence of 90%.

Methods: This quality improvement project implemented a nurse-driven evidence-based protocol for EAD verification. The intervention was based on the New Opportunities for Verification of Enteral Tube Location best practice recommendations. Prior to implementation, education sessions focused on insertion measurement technique and gastric pH measurement. Radiographs, insertion measurement technique, centimeter marking, and gastric pH measurement were used for EAD location confirmation. To determine compliance with the protocol, audits were conducted and questionnaires assessing current practice regarding EAD confirmation were administered pre- and postimplementation.

Results: The protocol increased nursing knowledge regarding evidence-based EAD insertion and verification procedures, incorporated pH measurement into practice, and reduced use of auscultation for confirmation. Nursing adherence to the protocol was 92%.

Implications for practice and research: This provides a model for how to successfully implement and achieve adherence to an evidence-based EAD placement confirmation nurse-driven protocol. Further research is needed to verify the effectiveness of the protocol and establish consensus on approaches specifically for the neonatal population.

Background: In the neonatal intensive care unit (NICU), elevated noise negatively impacts the neurodevelopmental environment, interrupts sleep, and can affect brain development in neonates. The American Academy of Pediatrics recommends that noise levels in the NICU should not exceed 45 dB.

Purpose: The project aims were to: (1) decrease average noise level by 10% from baseline and (2) decrease exposure to severe noise (>65 dB) to <5% of the time.

Methods: This quality improvement project was conducted during 2021-2022 as a pre/post observational design in a Level IV NICU in New York City. We monitored sound levels for 20-24 h, 5 d/wk. Quality improvement interventions included: novel approaches to staff education, visual cues for when noise thresholds were exceeded, parent education, including access to personal decibel meters, technical improvements to vital sign monitors and entry doors, and defined quiet times (HUSH) for 2 h each 12-hour shift.

Results: Education efforts and technical improvements successfully reduced median noise levels within the stepdown unit ( P < .001), though not in the acute care NICU. In contrast, the implementation of 2-hour periods of enforced "quiet time" every 12 h effectively reduced both median noise levels and the incidence of severe noise (>65 dB) in both locations.

Implications for practice and research: The HUSH strategy may be a sustainable way to decrease noise in the NICU. Future projects should prioritize education and dedicated quiet times to align with recommended standards, while research should explore the long-term developmental impacts of excessive noise levels on neonatal growth.

Background: It has long been understood and acknowledged that the Neonatal Intensive Care Unit (NICU) environment and the transport environments are extremely loud, with both long- and short-term sequelae to the neonate, being well over the recommended amount of noise by the American Academy of Pediatrics (AAP). This problem has yet to be properly addressed. The purpose of this manuscript is to define and explain the concept of acoustic neuroprotection. While we cannot change the internal structures of the neonates' auditory system, we could change the acoustics of the environment to be support neuroprotection of these sensitive patients.

Evidence acquisition: Walker and Avant's concept analysis steps were followed to create and define the idea of acoustic neuroprotection, as it has not had a definition before. A total of 45 articles from multiple search engines were chosen. A combination of 2 concepts were used: acoustic protection and neurodevelopmental protection/support. The search was expanded past 20 years for lack of research and importance of seminal works.

Results: To achieve acoustic neuroprotection, a neonate should not be exposed to sound greater than 45 decibels (dBa) for longer than 10 s, and exposure to sound above 80 dBa should never occur. Appropriate interventions need to include supporting the neurodevelopment of the neonate through therapeutic sound, while decreasing the amount of toxic noise exposure to safe levels.

Implications for practice and research: By further understanding and having a quantifiable goal of acoustic neuroprotection for neonates, neonatal clinicians can work together to create new interventions for how to better protect and support the care of our tiniest patients.

Background: Small infants experience a myriad of stimuli while in the Neonatal Intensive Care Unit (NICU), with many being painful or stressful experiences, although medically necessary.

Purpose: To determine what is known about nonpharmacological developmental care interventions used in the NICU to mitigate procedural pain of infants born under 32 weeks gestation.

Search/strategy: Five electronic databases were searched: Medline, CINAHL, Scopus, Embase and the Cochrane Library. The inclusion criteria were as follows: experimental and nonexperimental studies from all publication years with infants born at less than 32 weeks gestational age; peer-reviewed research articles studying nonpharmacological interventions such as skin-to-skin care, facilitated tucking, nonnutritive sucking, hand hugs, and swaddling; and English language articles. Our search yielded 1435 articles. After the elimination of 736 duplicates, a further 570 were deemed irrelevant based on their abstract/titles. Then, 124 full-text articles were analyzed with our inclusion and exclusion criteria.

Findings: Twenty-seven studies were reviewed. Sucrose, facilitated tucking, pacifier, skin-to-skin care, and human milk appeared to lessen pain experienced during heel sticks, suctioning, nasogastric tube insertions, and echocardiograms. All nonpharmacological interventions failed to prove efficacious to adequately manage pain during retinopathy of prematurity (ROP) examinations.

Implications for practice: Evidence review demonstrates that healthcare practitioners should use nonpharmacological measures to help prevent pain from day-to-day procedures in the NICU including heel sticks, nasogastric tube insertions, suctioning, echocardiograms, and subcutaneous injections.

Implications for research: Future research is necessary to better understand and measure how pain is manifested by very small premature infants. Specific research on mitigating the pain of examinations for retinopathy of prematurity is also needed.

Background: Enteral feeding by a transpyloric tube in critically ill infants is indicated when there is a failure in gastric feeding. However, there is a wide variability regarding the insertion technique.

Purpose: To perform a systematic review of the methods for inserting a transpyloric feeding tube in newborns and infants.

Data sources: Nine databases, without date or language restrictions, accessed in September 2021.

Study selection: A systematic review of experimental and nonexperimental studies, according to the "Patient/problem; Intervention; Comparison; Outcome" strategy and the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The clinical question was about the measurement and insertion techniques, as well as the success rates of properly placing a transpyloric tube in newborns and infants.

Data extraction: Two authors (N.M.Q. and J.F.S.) analyzed 6 observational descriptive prospective studies, all of them published in peer-reviewed indexed medical journals and one in the official journal of the National Association of Neonatal Nurses.

Results: The success rate varied between 70% and 100%. There was an important variability in the type of tube, measurement method, and insertion techniques. It was found that the most common strategies to achieve proper positioning were glabella-calcaneal measurements, gastric air insufflation, and right lateral decubitus.

Implications for practice: A transpyloric catheter insertion protocol needs to be established in each neonatal unit, according to the literature findings.

Implications for research: Randomized controlled studies that evaluate the gastric air insufflation technique and other adjuvant measures could elucidate the knowledge gap concerning the correct positioning of transpyloric tubing in newborns and infants.

Background: Skin-to-skin contact (SSC) is widely implemented in the neonatal intensive care unit (NICU) due to its established role in reducing mortality and morbidity. However, the impact of SSC on diaphragmatic electrical activity (Edi) in premature infants undergoing noninvasive pressure control (NIV-PC) for respiratory management remains insufficiently explored.

Purpose: To assess the effects of SSC on Edi and vital signs in preterm infants managed with NIV-PC.

Methods: A prospective, observational, crossover study was conducted, involving preterm infants admitted to a level III NICU between May 2020 and August 2021, who were receiving respiratory support with NIV-PC. Data were collected at 3 distinct time points: before SSC (pre-SSC period), during SSC (SSC period), and after SSC (post-SSC period). Thirty-minute periods of stable data were extracted for analysis.

Results: A total of 21 SSC sessions were performed on 14 preterm infants, with a median age at the initiation of SSC of 62 days. The median (interquartile range) Edi peak (in microvolts) before, during, and after SSC was 7.1 (5.8-10.8), 6.8 (4.3-8.8), and 7.1 (5.5-8.8), respectively. No statistically significant differences were observed in Edi peak or minimum values during SSC, when compared with the periods before and after the SSC procedure. Likewise, no significant changes were noted in respiratory rate, oxygen saturation, heart rate, or the incidence of apnea.

Implications for practice and research: SSC in preterm infants undergoing NIV-PC does not exacerbate their clinical condition. Further investigations involving diverse patient cohorts are warranted.