Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing最新文献

Objective: To determine if performing heel stick procedures for capillary blood sampling without prior heel warming is noninferior to the standard practice of warming the heel in very-low-birth-weight newborns.

Design: Noninferiority randomized control trial.

Setting: The study took place in two Level 3 NICUs in The Netherlands.

Participants: Newborns born at less than 32 weeks gestation in their second or third week of life without an arterial line in situ or known coagulopathy (N = 100).

Methods: We randomized participants to undergo a heel stick procedure in one of two groups: without heel warming (n = 50) and heel warming with a washcloth warmed with 37 °C tap water (n = 25) or with a microwaved hot pack (n = 25). The primary outcome was length of time for obtaining the required blood sample. The secondary outcomes were number of attempts, reliability of the blood sample, newborn comfort, and adverse events.

Results: We observed no differences in background characteristics between groups and found no statistically significant or clinically relevant differences in primary or secondary outcomes.

Conclusion: Among participants, not warming the heel before a heel stick was noninferior to warming the heel. Therefore, preheating the heel as a standard of care may be an unnecessary nursing intervention.

The author describes and compares current education offerings to improve the quality of maternity care.

Labor induction increased in the United States after the publication of A Randomized Trial of Induction Versus Expectant Management (ARRIVE) in 2018. During this trial, investigators found that elective induction at 39 weeks in low-risk nulliparous women led to similar perinatal outcomes when compared to expectant management. However, other researchers have since linked rising labor induction rates to worse hospital- and population-level outcomes. It is possible that elective induction of labor has a neutral effect on patients who are induced while at the same time lessening hospital capacity to care for other maternity patients, which leads to a negative effect on patient outcomes overall. During a trial, this represents a form of negative spillover, in which an intervention indirectly harms the comparison group and leads to overestimation of intervention benefit. Although further research is needed, evidence from ARRIVE and subsequent studies provides preliminary support for this possibility.

Skin-to-skin care (SSC) is essential, can help to prevent separation of parents and the neonate in the NICU, and should be a standard practice. It can safely be integrated into the routine care of preterm neonates, those who require surgery, and those who require all levels of intensive care. Years of experience with the provision of SSC in our NICU influenced our approach to care and resulted in practice guidelines for the safe provision of SSC. In this article, we present our clinical practical guidelines that support SSC and closeness between parents and the neonate to ensure the use of these practices for all neonates in the NICU.

Objective: To identify barriers or facilitators that influenced mothers to provide mother's own milk (MOM) for 6 months to their infants who were hospitalized in the NICU after major surgery.

Design: Descriptive qualitative.

Setting: An 80-bed, Level 4 NICU of a regional pediatric hospital in the western United States.

Participants: Fourteen mothers who provided MOM for their infants who required surgery within 1 week of age.

Methods: We conducted in-person interviews upon admission and discharge of the infant, phone interviews 1 and 2 weeks after discharge, and phone interviews monthly for 6 months or until discontinuance of the provision of MOM. We analyzed interviews using the Brooks thematic template analysis method.

Results: Eleven infants received exclusive MOM at discharge, and nine infants remained on exclusive MOM at 6 months. We generated four principal themes from the participants' comments: Value of Breast Milk, Challenges of Providing MOM, Emotional Fluctuation, and Coping With Reality of Circumstances.

Conclusion: Internalizing the value of MOM, family support, and coping with barriers were key factors that influenced participants to provide MOM for at least 4 months. Findings of this study suggest that prenatal education with anticipatory guidance and lactation support in the NICU can help mothers achieve the goal of extended provision of MOM to infants with serious conditions that require surgery. Education and support may be especially helpful for young, first-time mothers.