Advances in Neonatal Care最新文献

{"title":"Is Early and Recurrent Anemia in a Preterm Infant a Risk Factor for Neonatal Appendicitis?","authors":"Jorge L Alvarado Socarras, Delia E Theurel Martín, Beatriz H Franco Mateus, Edwin A Medina Medina, Adriana P Orejarena, Hernando Parra Reyes","doi":"10.1097/ANC.0000000000001229","DOIUrl":"https://doi.org/10.1097/ANC.0000000000001229","url":null,"abstract":"<p><strong>Background: </strong>Neonatal appendicitis (NA) is a rare condition with an estimated incidence of 0.04% to 0.2%. It is more prevalent in male preterm infants, with a mortality rate of 20% to 25%. It is usually misdiagnosed as neonatal necrotizing enterocolitis (NEC) owing to its diverse diagnostic challenges. Poor perfusion, hypoxia, anemia, or any other condition that impairs intestinal blood supply is a risk factor for bowel injury, which could explain the physiopathology of NA.</p><p><strong>Clinical findings: </strong>We describe an interesting case of a preterm infant with recurrent episodes of abdominal distension and persistent anemia who was finally diagnosed with NA.</p><p><strong>Primary diagnosis: </strong>The patient was treated with exploratory laparotomy and appendicectomy, with further symptom resolution. The diagnosis was confirmed by pathological examination.</p><p><strong>Interventions: </strong>Surgery for acute abdomen secondary to perforated appendicitis.</p><p><strong>Outcomes: </strong>Improved recurrent abdominal distension and persistent anemia and achieved full enteral nutrition. Patients with other diseases such as Hirschsprung's disease were ruled out.</p><p><strong>Practice recommendations: </strong>This case demonstrates that identifying the early signs and symptoms of NA requires a high index of suspicion. Anemia may play a significant role in the etiology of intestinal injury, increasing the risk of NA and NEC. Further studies are needed to explore the association between anemia and intestinal injury and its implications for neurodevelopment.</p>","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":"25 1","pages":"55-60"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Associated With Care Models for Neonates With Complex Medical Needs: A Scoping Review to Support Program Evaluation.","authors":"Nicole Loewen, Manon Ranger, Emily Kieran","doi":"10.1097/ANC.0000000000001225","DOIUrl":"10.1097/ANC.0000000000001225","url":null,"abstract":"<p><strong>Background: </strong>Neonates with complex medical needs (NCMNs) are a small proportion of neonatal intensive care unit admissions but are high healthcare utilizers. Since 2018, NCMNs at our hospital have been cared for by the Neonatal Complex Care Team. This model has yet to be evaluated.</p><p><strong>Purpose: </strong>To inform the evaluation of our care model, we examined literature on care practices for the management of NCMNs and utilized that to define outcome measures.</p><p><strong>Data sources: </strong>MEDLINE and Cumulated Index to Nursing and Allied Health Literature were searched. Inclusion dates: January 1, 1993, until July 15, 2023.</p><p><strong>Study selection: </strong>The PRISMA extension for scoping reviews was used. The population was neonates in the neonatal intensive care unit, the concept was models of care, and the context was medical complexity. Two reviewers performed the title/abstract screening and full-text review. A total of 148 articles were screened, 17 fully reviewed, and 5 articles included.</p><p><strong>Data extraction: </strong>Data extraction was completed by one reviewer utilizing resources from the Joanna Briggs Institute.</p><p><strong>Results: </strong>Care practices ranged from structured discharge meetings with families to an inpatient care model. Few reported new clinical models, and long-term health outcome data were limited. Multidisciplinary care teams emerged as crucial to in-hospital care and smooth discharge. Length of stay and readmission were identified as key outcomes for clinical program evaluation.</p><p><strong>Implications for practice and research: </strong>There is limited literature on this topic; however, we identified themes and outcomes that are useful for clinical program evaluation. Long-term evaluation of novel models of care is needed.</p>","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":" ","pages":"77-83"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Pandemic-Induced Separation and Visitation Restrictions on the Maternal-Infant Dyad in Neonatal Units: A Systematic Review.","authors":"Victoria J Kain, Sasitorn Phumdoung, Siriporn Vetcho, Piyada Chaisri","doi":"10.1097/ANC.0000000000001213","DOIUrl":"10.1097/ANC.0000000000001213","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Purpose: </strong>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.</p><p><strong>Data sources: </strong>Data sources include CINAHL, MEDLINE, Web of Science, APA PsycINFO, Academic Search Ultimate, and Embase, covering studies published between 2020 and 2024.</p><p><strong>Study selection: </strong>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.</p><p><strong>Data extraction: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Implications for practice and research: </strong>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.</p>","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":" ","pages":"84-91"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A NICU Postoperative Pain Management Improvement Project to Reduce Uncontrolled Pain and Improve Staff Satisfaction.","authors":"Alicia Sprecher, Kimberly Roeloffs, Michelle L Czarnecki, Kristen Labovsky, Anna Kissell, Genesee Hornung, Michael Uhing","doi":"10.1097/ANC.0000000000001234","DOIUrl":"10.1097/ANC.0000000000001234","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain management in the neonatal period is an area of high variability and a source of staff dissatisfaction. Pain management is a key component of high-quality care; however, pain assessment in infants is difficult and analgesics can negatively impact the developing brain.</p><p><strong>Purpose: </strong>We aimed to improve postoperative pain control for infants in our neonatal intensive care unit (NICU), limit variability in the approach to pain management, and increase staff satisfaction.</p><p><strong>Methods: </strong>This project was completed between April 2019 and March 2022 with sustainment tracked through December 2023. Interventions took place in a 70-bed level IV NICU using quality improvement methodology. Interventions included efforts aimed at improving pain assessment as well as development and implementation of a pain management guideline. Outcome measures included frequency of uncontrolled postoperative pain and measures of staff satisfaction. Process measures included compliance with pain assessment cadence and guideline recommendations. Opioid exposure within 24 hours of surgery was included as a balancing measure.</p><p><strong>Results: </strong>Pain management was assessed in 811 infants: 392 prior to guideline implementation, 273 during implementation, and 146 during sustainment period. Uncontrolled postoperative pain decreased from 26% pre-implementation to 18% post implementation and into the sustainment period. Staff satisfaction improved from 67% to 83%. These improvements were associated with decreased variability in postoperative pain management and a decrease in postoperative opioid exposure.</p><p><strong>Implications for practice and research: </strong>The use of a postoperative pain management guideline can improve pain control, decrease drug regimen variability, decrease opioid exposure, and increase staff satisfaction.</p>","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":" ","pages":"18-27"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treprostinil Use in the NICU.","authors":"Diana Lee","doi":"10.1097/ANC.0000000000001218","DOIUrl":"https://doi.org/10.1097/ANC.0000000000001218","url":null,"abstract":"<p><strong>Background: </strong>Treprostinil is a prostacyclin analogue that is frequently used in the pediatric and adult population to treat pulmonary hypertension; however, it is not often a drug of choice for patients in the neonatal intensive care unit (NICU).</p><p><strong>Purpose: </strong>To evaluate the efficacy of treprostinil as a treatment for pulmonary hypertension of the neonate.</p><p><strong>Data sources: </strong>Electronic databases such as PubMed, CINAHL, and Embase were used for this literature review. Twelve articles within the last 10 years (2014-2024) were included in this review.</p><p><strong>Study selection: </strong>136 articles were identified and primary research studies published in English and with patients younger than one year of age were included. Duplicates were removed and studies discussing genetics and congenital heart disease were excluded.</p><p><strong>Data extraction: </strong>Abstracts were reviewed and articles referencing treprostinil use in the NICU were included for review. Independent extraction was completed by author.</p><p><strong>Results: </strong>Findings showed treprostinil to have a therapeutic benefit in infants with congenital diaphragmatic hernias and possibly with premature infants. Some adverse effects were noted, one of which included hypotension; however, management strategies exist to mitigate this effect.</p><p><strong>Implications for practice and research: </strong>Initiating treprostinil in the NICU may help decrease the severity of persistent pulmonary hypertension of the newborn (PPHN) which can help reduce neonatal morbidity and mortality. Future research is needed to determine the optimal timeframe to initiate treprostinil in the NICU; the duration of treatment; use in other conditions that can cause PPHN (i.e. meconium aspiration syndrome); and the other potential effects it may have for the preterm infant.</p>","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":"24 6","pages":"554-560"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why it is Important to Develop Your Personal and Professional Identity.","authors":"Jacqueline M McGrath, Debra Brandon","doi":"10.1097/ANC.0000000000001219","DOIUrl":"https://doi.org/10.1097/ANC.0000000000001219","url":null,"abstract":"","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":"24 6","pages":"495-496"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Novel Feeding Algorithm for Oral Feeding Transition of Infants Born Prematurely.","authors":"Kelly Laborde, Nanette Gremillion, Jeannie Harper, Andrew G Chapple, Ashley Deaton, Allison Yates, Steven Spedale, Elizabeth Sutton","doi":"10.1097/ANC.0000000000001203","DOIUrl":"10.1097/ANC.0000000000001203","url":null,"abstract":"<p><strong>Background: </strong>Feeding skill acquisition is commonly a limiting factor determining when an infant born prematurely can be discharged.</p><p><strong>Purpose: </strong>This study aimed to determine if the addition of a novel feeding progression algorithm (combination of objective data from a suck measurement device and slow flow/low variability nipples) to current neonatal intensive care unit (NICU) standards could decrease feeding-related length of stay (primary outcome). We hypothesized that by timing the initiation of oral feedings to coincide with adequate sensory-motor skill development, feeding-related length of stay may be decreased.</p><p><strong>Methods: </strong>This was a prospective intervention study, with a historical control cohort, of infants born less than 30 weeks' gestational age without comorbidities affecting feeding skill acquisition at a Regional Level III-S NICU at a women and infant's hospital in Louisiana. A novel feeding progression algorithm utilized objective assessment of sucking to determine progression in nipple flow rates with slow flow/low variability nipples (flow rates from 0 to 9 mL/min) for infants receiving intervention (n = 18). Thirty-six controls who did not receive the feeding progression algorithm were identified via electronic medical record retrospective chart review.</p><p><strong>Results: </strong>Eighteen completed the study. Compared to the control group, infants receiving feeding interventions had delayed sequencing initiation, extended time between initially off positive pressure ventilation and initiation of sequencing, and decreased feeding-related length of stay, with similar total length of stay.</p><p><strong>Implications for practice and research: </strong>This study adds to existing research supporting the effectiveness of novel feeding progression algorithms and interventions to support the health and outcomes of infants born prematurely. Future research should focus on implementation studies for feeding progression algorithm integration into standard NICU care.</p>","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":" ","pages":"594-603"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Announcing NANN and NANN-AP'S 2024-2025 Leadership.","authors":"","doi":"10.1097/ANC.0000000000001232","DOIUrl":"https://doi.org/10.1097/ANC.0000000000001232","url":null,"abstract":"","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":"24 6","pages":"497-499"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of White Noise and Therapeutic Touch on Pain and Comfort in Newborns during Heel Lance: A Randomized Controlled Study.","authors":"Duygu Deniz Erol, Gülçin Özalp Gerçeker","doi":"10.1097/ANC.0000000000001200","DOIUrl":"10.1097/ANC.0000000000001200","url":null,"abstract":"<p><strong>Background: </strong>Nonpharmacological methods such as white noise and therapeutic touch can be used in pain management in neonates.</p><p><strong>Purpose: </strong>This randomized controlled study evaluated the effects of white noise and therapeutic touch during heel lance procedures on pain, comfort levels, and physiological parameters in healthy neonates.</p><p><strong>Methods: </strong>This parallel, randomized controlled study was conducted in the Obstetrics and Gynecology Service of a regional hospital. The sample comprised 160 neonates with gestational ages of >35 weeks randomly assigned to 4 groups (white noise [WN], therapeutic touch [TT], white noise + therapeutic touch [WT], and control [CG] group). Pain and comfort levels were evaluated according to the Neonatal Infant Pain Scale, and the COMFORTneo Scale. The primary outcomes were pain and comfort levels, and the secondary outcomes were heart rate and SpO2 levels. The Kruskal-Wallis test was used to compare the scale scores among groups.</p><p><strong>Results: </strong>There were significant differences among groups in terms of Neonatal Infant Pain Scale and COMFORTneo scores (P < .05). The pain scores for the white noise, therapeutic touch, and white noise + therapeutic touch groups were 4.2 ± 2.0, 5.2 ± 1.6, and 3.3 ± 1.7, respectively. There was a significant difference in average heart rate during the heel lance procedure among the groups (P < .05). Pain scores of the intervention groups were lower compared to the control group.</p><p><strong>Implications for practice and research: </strong>The combination of white noise and therapeutic touch was more effective in reducing pain and increasing comfort levels. Nurses could reduce procedural pain by applying these pain relief methods.</p>","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":"24 6","pages":"E79-E87"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Neonatal Nurse Practitioners in the Implementation of a Bedside Point-of-Care Ultrasound Program.","authors":"Jacklin H Tong, Christine Manipon, Shelby Vallandingham-Lee, Reedhi Dasani, Alexis S Davis, Shazia Bhombal","doi":"10.1097/ANC.0000000000001217","DOIUrl":"10.1097/ANC.0000000000001217","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) is becoming increasingly utilized, with the focus of training aimed at physicians. However, the role of neonatal nurse practitioners (NNPs) in the development of POCUS programs is not well described.</p><p><strong>Purpose: </strong>To describe the NNP role in the implementation of a NICU POCUS program and exemplify the potential to expand the professional scope and educational advancement of NNPs.</p><p><strong>Methods: </strong>In 2018, a multidisciplinary team assembled to develop a POCUS program in the NICU at Lucile Packard Children's Hospital (LPCH). Three NNPs received formal POCUS training in order to provide onsite training, perform and supervise POCUS imaging, and participate in quality assurance sessions. NNPs also assisted with the development of a REDCap database and imaging protocols.</p><p><strong>Results: </strong>The LPCH POCUS NNP providers contributed to the advancement of the profession by practicing to the full scope of their role, providing leadership in program development, research, and education. Incorporating NNPs into the programmatic structure of a POCUS program can be a model for others. With advancing skill set, NNPs can be positioned to be national leaders and educators.</p><p><strong>Implications for practice and research: </strong>NICUs developing POCUS programs can benefit from the integration of NNPs to serve as consistent content experts to expand the number of trained providers while assuring the quality of image capture. POCUS is becoming increasingly essential to the care of newborns. NNPs can play a central role in performing POCUS, participating in quality improvement and research, and educating other NICU providers.</p>","PeriodicalId":48862,"journal":{"name":"Advances in Neonatal Care","volume":" ","pages":"536-543"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}