Advances in neonatal care : official journal of the National Association of Neonatal Nurses最新文献

{"title":"Iron-Clad Care for Neonates: Precision Iron Supplementation Using Reticulocyte Hemoglobin Values, a Quality Improvement Project.","authors":"Erica Prado Del Rey, Vicki Johnston, Penni Huffman","doi":"10.1097/ANC.0000000000001420","DOIUrl":"https://doi.org/10.1097/ANC.0000000000001420","url":null,"abstract":"<p><strong>Background: </strong>Iron is the most common nutrient deficiency globally, affecting nearly 2 billion people. It may cause long-term neurocognitive impairments and behavioral deficits in premature and low-birthweight neonates. Reticulocyte hemoglobin (Ret-He) is a reliable, valid, low-cost, and minimally invasive phlebotomy laboratory test for assessing iron status and guiding iron dosing.</p><p><strong>Purpose: </strong>The overarching aim is to standardize Ret-He use as a guide for precision iron supplementation that may increase the rate of iron sufficiency among infants born at less than 32 weeks of gestational age or 1500 grams within the neonatal intensive care unit.</p><p><strong>Methods: </strong>The quality improvement project included the creation of an evidence-based algorithm, provider education, and an electronic medical record order set for individualized iron supplementation using Ret-He. The preimplementation data were retrospectively collected through an electronic medical record review. The postimplementation data were prospectively gathered, and all data were analyzed using IBM SPSS Statistics Software.</p><p><strong>Results: </strong>There was a substantial increase in the number of Ret-He levels drawn from 77% to 100%. In the preimplementation group, 81.3% of patients with Ret-He levels at 37 weeks or discharge were iron-sufficient. However, 48.4% of patients did not have Ret-He levels measured. The postimplementation group had an 82.1% rate of iron sufficiency.</p><p><strong>Implication for practice and research: </strong>Ret-He can be used to guide iron dosing. Further research is needed to determine whether Ret-He values should differ for specific gestational ages or high-risk populations, such as small-for-gestational-age infants. Additional knowledge is needed on maximum iron doses and duration of intake.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Kangaroo Care on the Attainment of Full Enteral Feeding in Neonatal Intensive Care Unit Infants: A Systematic Review and Meta-analysis.","authors":"Hyesoo Woo, Subin Park, Hyejung Lee","doi":"10.1097/ANC.0000000000001384","DOIUrl":"https://doi.org/10.1097/ANC.0000000000001384","url":null,"abstract":"<p><strong>Background: </strong>Delayed attainment of full enteral feeding (FEF) remains a challenge in preterm infants and is associated with gastrointestinal maturation and readiness for hospital discharge. Although kangaroo care (KC) is widely implemented in neonatal intensive care units (NICUs), its effect on time to FEF is unclear.</p><p><strong>Purpose: </strong>To synthesize evidence from randomized controlled trials (RCTs) examining the effect of KC on time to FEF in preterm infants.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with Joanna Briggs Institute methodology and PRISMA 2020 guidelines. RCTs comparing KC with standard NICU care and reporting time to FEF were identified by searching 5 databases from inception to October 17, 2025. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool.</p><p><strong>Results: </strong>Five RCTs involving 624 preterm infants were included. Meta-analysis showed that KC significantly shortened time to FEF compared with standard care (mean difference = -3.32 days, 95% CI [-5.88, -0.76], P = .01; I2 = 91%). Infants receiving KC also demonstrated greater weight gain than controls (mean difference = 5.68 g, P = .0002). No significant difference was observed between groups in length of hospital stay (P = .62).</p><p><strong>Implications for practice and research: </strong>KC may serve as an effective, nursing-led intervention to support feeding progression and early growth in preterm infants while reinforcing family-centered care in the NICU. Given variability in protocols and outcome definitions, further multicenter RCTs are needed to confirm these findings and clarify implications for hospital resource utilization.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Implementing an Infant Positioning Tool on Patient Positioning in a Neonatal Intensive Care Unit.","authors":"Barbara A Smith, Jill Kellis, Jolene Kramer, Hayden L Smith","doi":"10.1097/ANC.0000000000001386","DOIUrl":"https://doi.org/10.1097/ANC.0000000000001386","url":null,"abstract":"<p><strong>Background: </strong>Neonate patients receiving care may benefit from postural alignment support in improving neurodevelopment, physiologic functioning, and stability.</p><p><strong>Purpose: </strong>To assess the effectiveness of an infant positioning tool on patient positioning in a neonatal intensive care unit (NICU).</p><p><strong>Methods: </strong>A pre-post study design was used at a NICU within a free-standing children's hospital located in the Midwestern United States. The study was based on the implementation of an infant positioning tool by nursing. Study personnel collected neonate positioning scores before and after the tool's implementation. The instrument includes score values from 0 to 12, with higher scores representing better positioning. An intent-to-treat design was used to evaluate change. The primary study outcome was the observed median improvement in positioning scores.</p><p><strong>Results: </strong>Study sample included 168 (51%) observations collected from 89 unique neonates during the preintervention period and 159 (49%) observations collected from 69 unique neonates during the postintervention period. The sample had a median gestational age of 36 weeks, and most patients were direct NICU admissions. Primary admitting diagnoses were related to respiratory distress or failure. Median neonate positioning scores were 8 (interquartile range: 6, 9) in the preintervention and 10 (interquartile range: 9, 11) in the postintervention period represented by an estimated 2.1 (95% CI: 1.6, 2.8) median point increase.</p><p><strong>Implications for practice: </strong>Study revealed an observed improvement in NICU infant positioning scores after the implemented change. Literature indicates that long-term impacts could include multisystemic improvements including orthopedic alignment, neurologic development, sensory/vestibular development, respiratory status, and potential decreased length of stay.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Content Validity of the Spanish Version of the Parental Stressor Scale: Neonatal Intensive Care Unit.","authors":"Natalia Cuadrado Obregón, Raquel Navarro Miguel, Juan José Fernández Muñoz, María Gema Cid Expósito","doi":"10.1097/ANC.0000000000001407","DOIUrl":"https://doi.org/10.1097/ANC.0000000000001407","url":null,"abstract":"<p><strong>Background: </strong>There are few validated instruments that specifically measure the stress experienced by parents of babies admitted to neonatal intensive care units. The Parental Stress Scale: Neonatal Intensive Care Unit, developed by M. Miles et al in 1987, translated and validated in several languages, is a questionnaire that comprehensively measures parental stress in these units. The objective was to perform the translation, cross-cultural adaptation, and content validation of the Parental Stress Scale: Neonatal Intensive Care Unit to assess the stress experienced by parents of babies admitted to Spanish neonatal intensive care units.</p><p><strong>Methods: </strong>Four translators produced the final version. A panel of 13 experts validated the content based on criteria of relevance, clarity, simplicity, and appropriateness using the Delphi method, calculating validity indices for each item and for the scale as a whole.</p><p><strong>Results: </strong>The content validity index for the instructions was 0.98. After 2 rounds of expert review, nearly all items scored above 0.75; 3 did not, with 1 being modified and 2 retained after analysis by the research team.</p><p><strong>Implications for practice and research: </strong>The Spanish version of the Parental Stress Scale: Neonatal Intensive Care Unit is a relevant, clear, simple, and appropriate tool for assessing the stress experienced by parents of babies admitted to neonatal intensive care units in Spain, as well as in other Spanish-speaking countries. Its psychometric properties should be evaluated in future studies.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Kangaroo Mother Care Duration and Clinical Outcomes in Preterm and Low Birth-Weight Infants: A Dose-Response Meta-Analysis.","authors":"Yan Xiang, Lu Qin, Yefang Zhu, Mingyi Xu, Yanjun Mu","doi":"10.1097/ANC.0000000000001416","DOIUrl":"https://doi.org/10.1097/ANC.0000000000001416","url":null,"abstract":"<p><strong>Background: </strong>Determining the optimal daily Kangaroo Mother Care (KMC) duration is important for improving outcomes in preterm and low birth-weight (LBW) infants, but existing evidence is mostly as broad categories rather than a continuous dose-response relationship.</p><p><strong>Purpose: </strong>To examine the dose-response association between daily KMC duration and 4 outcomes in preterm/LBW infants: weight gain and hospital stay (primary), breastfeeding (including direct feeding and receipt of expressed human milk) and hypothermia (secondary).</p><p><strong>Data sources: </strong>PubMed, Web of Science, Cochrane Library, China Biology Medicine, Wanfang, China National Knowledge Infrastructure, and CQVIP Chinese Journals Platform were searched from inception to May 31, 2025.</p><p><strong>Study selection: </strong>Randomized controlled trials comparing Kangaroo Mother Care to conventional care in preterm or low birth-weight infants were eligible. Thirty-six trials meeting PICOS criteria with extractable daily KMC duration and at least 1 outcome were included.</p><p><strong>Data extraction: </strong>Two reviewers independently screened records, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Disagreements were resolved by discussion or consultation with a third reviewer.</p><p><strong>Results: </strong>Across 36 RCTs (N = 4210), daily KMC duration had a nonlinear association with weight gain, with benefits increasing beyond approximately 11.8 hours per day. Hospital stay also showed a nonlinear association, with the greatest reduction at approximately 6 hours per day. Breastfeeding rates increased linearly with longer KMC duration, and each additional KMC hour lowered hypothermia odds. Because outcome trajectories differed, 6 hours per day best reduced hospital stay, while longer exposure may add growth benefit when feasible.</p><p><strong>Implications for practice and research: </strong>For preterm and LBW infants, use KMC when feasible. Approximately 6 hours per day reduces hospital stay; longer exposure may further benefit growth. Future trials should report daily and cumulative KMC exposure, initiation timing, daily continuation, and long-term outcomes.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surface Electromyography Assessment of Muscle Activity in Preterm Infants With Feeding Disorders Following Premature Infant Oral Motor Intervention: A Prospective Pilot Study.","authors":"Shamim Ghazi, Zahra Sadeghi, Farin Soleimani, Brenda Lessen Knoll, Akbar Darouie, Iraj Abdollahi, Enayatollah Bakhshi","doi":"10.1097/ANC.0000000000001370","DOIUrl":"10.1097/ANC.0000000000001370","url":null,"abstract":"<p><strong>Background: </strong>Premature infants frequently experience feeding difficulties because of immature oral-motor coordination. The Premature Infant Oral Motor Intervention (PIOMI) has been shown to improve feeding skills, but objective evidence regarding its effects on orofacial muscle activity remains limited.</p><p><strong>Purpose: </strong>To evaluate the effects of PIOMI on orofacial muscle activity and feeding outcomes in premature infants with feeding disorders.</p><p><strong>Methods: </strong>This pilot study was conducted in Neonatal Intensive Care Units in Mazandaran, Iran. Ten premature infants (gestational age 29-36 weeks; mean 32.4 ± 2.1; birth weight 1706 ± 476 g) received daily PIOMI sessions for 7 days by a trained speech therapist. Orofacial muscle activity (masseter, zygomatic, and orbicularis oris) was measured using surface electromyography (sEMG) at rest and during non-nutritive sucking. Oral-motor skills were assessed with the Preterm Infant Oral Feeding Readiness Assessment Scale (POFRAS), and milk intake volume was recorded.</p><p><strong>Results: </strong>All infants completed the intervention in March 2025 without adverse events. The sEMG amplitudes increased significantly for the masseter (20.96-52.79 μV, P < .001), zygomatic (29.07-69.56 μV, P < .001), and orbicularis oris (20.97-73.36 μV, P < .001). POFRAS scores improved from 12.10 ± 3.38 to 20.70 ± 5.60 (P < .001), and milk intake from 40.00 ± 6.66 mL to 45.00 ± 18.40 mL (P < .001).</p><p><strong>Implications for practice and research: </strong>PIOMI enhances orofacial muscle activity and feeding skills in premature infants. These findings support sEMG as an objective evaluation tool and provide preliminary evidence for larger clinical trials.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foundations in Neonatal Care are Important to Guide Practice.","authors":"Tracey Bell, Jacquline McGrath","doi":"10.1097/ANC.0000000000001410","DOIUrl":"10.1097/ANC.0000000000001410","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":"26 4","pages":"329-332"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Concept Analysis of NICU-Based Toxic Stress.","authors":"","doi":"10.1097/ANC.0000000000001414","DOIUrl":"10.1097/ANC.0000000000001414","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":"26 4","pages":"e22"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Concept Analysis of NICU-Based Toxic Stress.","authors":"Hind B Alsabti, Susan M Ludington-Hoe","doi":"10.1097/ANC.0000000000001358","DOIUrl":"10.1097/ANC.0000000000001358","url":null,"abstract":"<p><strong>Background: </strong>Preterm infants (PTIs) are exposed to tremendous stressors within the neonatal intensive care unit (NICU), an environment that is supposed to be nurturing rather than disruptive. Toxic stress has yet to be defined as a concept relevant to premature and older infants. The lack of buffering support (a mother or another meaningful adult who provides physical/emotional support to minimize stressful events and promote resilience) triggers adverse childhood experiences leading to unfavorable-neurodevelopmental consequences.</p><p><strong>Purpose: </strong>This article aims to clarify the concept of toxic stress in premature infants and infants younger than 2 years old.</p><p><strong>Method/search strategy: </strong>Walker and Avant's approach is the Wilsonian method, which is a systematic approach for clarifying and presenting a concept. The analysis focuses on infants aged 0 to 24 months in the NICU setting. Using the keywords related to toxic stress' physiologic and behavioral responses, databases including PubMed, CINAHL, and Google Scholar were searched to explore the toxic stress concept.</p><p><strong>Result: </strong>Analysis of 33 English articles published in the last 20 years yielded an enhanced definition and empirical referents of toxic stress. The defining attributes, antecedents, consequences, and exemplar cases of the proposed concept were discussed.</p><p><strong>Implications for practice and research: </strong>Clinical concerns are the uncommon use of the toxic stress concept in the NICU and the lack of physiologic and behavioral toxic stress assessment during routine care. Interventional studies are needed to test strategies to minimize/eliminate toxic stress and modify NICU practices. Mitigating the negative impacts of toxic stress often relies on high-quality nursing assessment and family-integrated care models incorporation.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"362-377"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Melatonin as a Supportive Biomarker in Early-Onset Neonatal Sepsis: A Prospective Study.","authors":"Burçin Kaya, Emrah Can, Yakup Karakurt, Çağrı Cumhur Gök, Nehir Ulu Öğüt","doi":"10.1097/ANC.0000000000001354","DOIUrl":"10.1097/ANC.0000000000001354","url":null,"abstract":"<p><strong>Background: </strong>Early-onset neonatal sepsis (EOS) remains a diagnostic challenge because clinical signs are nonspecific and blood cultures, although the diagnostic gold standard may yield false-negative results due to low blood volumes or maternal antibiotic exposure.</p><p><strong>Purpose: </strong>To determine whether serum melatonin levels differ between term neonates with clinically suspected EOS and healthy controls, and to evaluate the diagnostic performance of melatonin relative to standard inflammatory markers.</p><p><strong>Methods: </strong>This prospective case-control study included 84 term infants: 42 with clinically suspected EOS, defined according to the Centers for Disease Control and Prevention and National Institute for Health and Care Excellence criteria, and 42 controls. Blood cultures, complete blood count, C-reactive protein, and serum melatonin levels measured by enzyme-linked immunosorbent assay were obtained within 24 hours of life before antibiotic initiation. Receiver operating characteristic (ROC) analyses were performed for all suspected EOS cases and separately for culture-confirmed EOS.</p><p><strong>Results: </strong>Eleven infants (26.2%) in the suspected EOS group had positive blood cultures. Mean melatonin levels were significantly lower in suspected EOS than in controls (193.5 ± 61.8 vs 231.6 ± 71.1 pg/mL; P = .010). However, melatonin levels did not differ significantly between culture-positive and culture-negative suspected EOS cases. ROC analysis for suspected EOS yielded an area under the curve of 0.628; a melatonin cutoff of 242 pg/mL provided 81% sensitivity but limited specificity (45.2%). ROC performance for culture-confirmed EOS was modest.</p><p><strong>Implications for practice and research: </strong>Melatonin demonstrates limited diagnostic specificity and should be interpreted only as a supportive marker within a multimodal evaluation strategy.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"e15-e21"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146129088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}