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

{"title":"Examining Use of Dual Point Temperature Display in Servo-Control With Early Preterm Infants.","authors":"Robin B Dail,&nbsp;Abbas S Tavakoli,&nbsp;Sherry L Moseley,&nbsp;Victoria B Bergstedt,&nbsp;Devon Kuehn,&nbsp;Weili Chang","doi":"10.1097/ANC.0000000000000827","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000827","url":null,"abstract":"<p><strong>Background: </strong>Previously, we recorded periods of time with foot higher than abdominal temperatures in association with infection in preterm infants. Monitoring dual temperatures may be an important tool to assess infant instability. Currently, incubators cannot measure and display dual temperatures in servo-control mode.</p><p><strong>Purpose: </strong>To examine the usability of GE Healthcare's Giraffe OmniBed with research software to measure, display, and record dual temperatures, and their differences while in servo-control. In addition, nurses' perceptions of the use and display of dual temperatures and differences were evaluated.</p><p><strong>Methods: </strong>A multiple-case, mixed-methods design. Abdominal and foot temperatures were measured, displayed, and stored for 28 days for 14 preterm infants. Nurses were surveyed for satisfaction and preferences with the dual temperature display. Nurses noted abnormal temperature differences and infant condition in bedside journals.</p><p><strong>Results: </strong>Study infants were 26 to 31 weeks of gestational age and 670 to 1410 g. Abdominal, foot, and the abdominal-foot temperature difference was measured, recorded, and downloaded successfully in all infants over all days. Nurses liked using dual temperature display with the abdominal-foot temperature difference. Surveys indicated preferences for larger displays and alarms for abnormal values. Thermal instability, stimulation, and thermistor detachment were associated with abnormal thermal gradients. Two exemplar cases are presented.</p><p><strong>Implications for practice: </strong>Monitoring dual temperatures adds information to the clinical assessment.</p><p><strong>Implications for research: </strong>Studies are needed to examine relationships between abnormal thermal gradients and infections, infant stability, and nursing care along with the underlying physiologic mechanisms. Studies are needed for wireless dual temperature monitoring.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E180-E190"},"PeriodicalIF":1.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25530405","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":"An Interdisciplinary Approach to Reducing NEC While Optimizing Growth: A 20-Year Journey.","authors":"Jane M Noonan","doi":"10.1097/ANC.0000000000000929","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000929","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing enterocolitis (NEC) and postnatal growth restriction are significant clinical dilemmas that contribute to short- and long-term morbidities for the most premature infants.</p><p><strong>Purpose: </strong>After a rise in NEC rates in a regional neonatal intensive care unit (NICU), improvement practices were implemented by an interdisciplinary quality improvement (QI) work group whose focus was initially on nutrition and growth. QI work was refocused to address both NEC and growth concurrently.</p><p><strong>Methods: </strong>Through various QI initiatives and with evolving understanding of NEC and nutrition, the work group identified and implemented multiple practices changes over 2-decade time span. A standardized tool was used to review each case of NEC and outcomes were continually tracked to guide QI initiatives.</p><p><strong>Local findings: </strong>Focused QI work contributed to a significant reduction in NEC rates from 16.2% in 2007 to 0% in 2018 for inborn infants. Exclusive human milk diet was a critical part of the success. Postnatal growth outcomes initially declined after initial NEC improvement work. Improvement work that focused jointly on NEC and nutrition resulted in improved growth outcomes without impacting NEC.</p><p><strong>Implications for practice: </strong>Use of historical perspective along with evolving scientific understanding can guide local improvement initiatives. Work must continue to optimize lactation during NICU hospitalization. More research is needed to determine impact of care practices on gastrointestinal inflammation including medication osmolality, probiotics, and noninvasive respiratory support.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"433-442"},"PeriodicalIF":1.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39409177","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":"Racial Disparity in the NICU: Position Statement #3070.","authors":"Julie Sundermeier","doi":"10.1097/ANC.0000000000000955","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000955","url":null,"abstract":"Preterm birth continues to be a significant public health problem in the United States. In 2018, one out of every 10 infants in the United States was born prior to 37 weeks gestation (Centers for Disease Control and Prevention, 2019). The U.S. preterm birth rate increased to 10.02% in 2018, representing a 1% increase from 2017 and the fourth straight year of increases in this rate. The increase in the preterm birth rate among non-Hispanic White mothers between 2017 and 2018 was not statistically significant (~9%), but preterm delivery rates among non-Hispanic Black mothers increased to 14.13% and among Hispanic mothers to 9.73%. (Martin, Hamilton, Osterman, & Driscoll, 2019). These statistics are even more concerning given the racial health disparities for premature infants that have been well documented in the literature.","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"431"},"PeriodicalIF":1.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39946363","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":"Decreasing Complete Blood Count Clotting Rates: An Improvement Project in an Academic Neonatal Intensive Care Unit.","authors":"Emily Giddens","doi":"10.1097/ANC.0000000000000853","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000853","url":null,"abstract":"<p><strong>Background: </strong>In premature and critically ill infants, a complete blood count (CBC) is commonly collected via the heel-stick method, which is preferred because of the ongoing requirements to preserve intravenous sites. However, because of sample clotting, these specimens are often rejected, leading to unnecessary repeat heel sticks, painful stimuli, and increased costs.</p><p><strong>Purpose: </strong>The purpose of this quality improvement project was to decrease the rate of clotted CBC samples obtained from neonates admitted in the neonatal intensive care unit.</p><p><strong>Methods: </strong>The RE-AIM translation model, which stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance, was adopted to decrease the rate of clotted CBC samples through staff education, randomized audits of the staff's heel-stick technique, and the development and implementation of a standardized capillary blood sampling protocol. The primary outcome measure was the rate of clotted CBC samples, which was defined as the proportion of clotted CBC samples.</p><p><strong>Results: </strong>CBC clotted sample rates decreased by 27%, resulting in a cost saving of $1136, and overall CBC rejection rates decreased by 23%.</p><p><strong>Implications for practice: </strong>All hospital units should provide staff with an evidence-based resource, recurrent education, and evaluation of skills to avoid unnecessary repeat heel sticks and prevent increased pain sensitivity, social hypervigilance, and avoidance behavior in early infancy.</p><p><strong>Implications for research: </strong>Future efforts should focus on the long-term benefits of routine education and its effects on clotted sample rates and whether samples drawn by laboratory phlebotomy staff versus registered nurses/patient care technicians result in disproportionate rejection rates.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E171-E179"},"PeriodicalIF":1.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25544491","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":"Relationship Between Moral Distress and Intent to Leave a Position Among Neonatal Intensive Care Nurses.","authors":"Suzanne M Hally,&nbsp;Margaret Settle,&nbsp;Brett D Nelson","doi":"10.1097/ANC.0000000000000891","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000891","url":null,"abstract":"<p><strong>Background: </strong>The phenomenon of moral distress is prevalent in the literature, but little is known about the experiences of nurses working in the neonatal intensive care unit (NICU). In addition, a paucity of literature exists exploring the relationship between moral distress and intent to leave a position in NICU nurses.</p><p><strong>Purpose: </strong>To explore the phenomenon of moral distress in NICU nurses using the Measure of Moral Distress for Health Care Professionals (MMD-HP) survey.</p><p><strong>Methods: </strong>A cross-sectional, descriptive, correlational study was conducted nationally via an electronic survey distributed to NICU nurses who are members of National Association of Neonatal Nurses (NANN). Participants were asked to electronically complete the MMD-HP survey between March 27 and April 8, 2020.</p><p><strong>Findings: </strong>A total of 75 NICU nurses completed the survey, and 65 surveys were included for data analysis. Five situations from the survey had a composite MMD-HP score of more than 400. Results indicated that 41.5% of the NICU nurses surveyed considered leaving a clinical position due to moral distress, and 23.1% of the nurses surveyed left a position due to moral distress.</p><p><strong>Implications: </strong>for Practice: NICU nurses experiencing high MMD-HP scores are more likely to leave a position. Further research is needed to develop strategies useful in mitigating moral distress in and prevent attrition of NICU nurses.</p><p><strong>Implications for research: </strong>Many NICU nurses experiencing high levels of moral distress have left positions or are considering leaving a clinical position. Longitudinal interventional studies are vital to understand, prevent, and address the root causes of moral distress experienced by NICU nurses.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E191-E198"},"PeriodicalIF":1.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38952690","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":"Parental Experiences of Infant Car Bed Use After Failure of Car Seat Tolerance Screen.","authors":"Christina M O'Connor,&nbsp;Jacqueline McGrath,&nbsp;Michele DeGrazia","doi":"10.1097/ANC.0000000000000844","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000844","url":null,"abstract":"<p><strong>Background: </strong>Failure of the car seat tolerance screen (CSTS) during hospitalization often leads to a recommendation for automobile travel within a car bed at discharge.</p><p><strong>Purpose: </strong>To describe the parental experience utilizing a car bed for infant automobile transportation.</p><p><strong>Methods: </strong>A descriptive, qualitative study design was undertaken with a purposive sample of parents recruited for a single interview in the pulmonary clinic at the time of the follow-up CSTS, approximately 1 month after hospital discharge. Interviews, guided by a semistructured interview tool, provided a holistic understanding of the parental experience utilizing car bed travel.</p><p><strong>Findings/results: </strong>Data from 15 parental interviews revealed an overarching emotional journey consisting of 5 themes: (1) an adjustment period; (2) decision-making related to the car bed purchase; (3) encounters with varied provider education and knowledge; (4) safety and security of the car bed during transit; and (5) space and mobility restrictions imposed by the car bed.</p><p><strong>Implications for practice: </strong>While recommendations exist for infant travel in a car seat, supportive recommendations for parents with an infant who needs to travel in a car bed do not exist. Based on study findings, providing parents supportive guidelines, education, and recommendations for their infant requiring travel in a car bed may be a strategy to ease the stress experienced in this situation.</p><p><strong>Implications for research: </strong>Findings indicated a need to develop policies and standards, as well as comprehensive education, for providers and parents related to car bed travel. Further research is needed to identify strategies to best support parents and infants.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"503-512"},"PeriodicalIF":1.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25530406","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":"Availability of Donor Human Milk Decreases the Incidence of Necrotizing Enterocolitis in VLBW Infants.","authors":"","doi":"10.1097/ANC.0000000000000916","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000916","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E110"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39375066","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":"Clinical Presentation and Multifactorial Pathogenesis of Necrotizing Enterocolitis in the Preterm Infant.","authors":"Rachael E Andrews,&nbsp;Kristi L Coe","doi":"10.1097/ANC.0000000000000880","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000880","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing enterocolitis (NEC) is a serious infection of the bowel wall induced by multiple pathological factors, which include inflammation and tissue invasion with bacteria known to cause severe infections. NEC is now understood to be several disease processes under one umbrella. The most common form occurs in premature infants and can exert significant impacts to preterm morbidity and mortality.</p><p><strong>Purpose: </strong>This narrative review describes current knowledge of the clinical presentation and pathophysiology of NEC in premature infants.</p><p><strong>Methods/search strategy: </strong>A review of literature was conducted using key words in PubMed and CINAHL with preference for years 2015 to 2020.</p><p><strong>Findings/results: </strong>Several converging and interrelated factors including characteristics of the premature intestinal mucosa, gut ischemia, dysregulation of the microbiome, enteral feeding, and genetics create an environment where NEC is more likely to occur.</p><p><strong>Implications for practice: </strong>To recognize and diagnose NEC in preterm infants, an understanding of underlying factors that create an optimal environment for disease acquisition in premature infants is essential.</p><p><strong>Implications for research: </strong>Prevention of NEC remains the most important strategy for decreasing morbidity and mortality. Multiple areas of potential study exist for NEC pathophysiology including those that consider how the factors discussed in this review are interrelated and how each particular pathway can be optimized to prevent the onset of NEC.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"349-355"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38967093","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":"NANN's Thermoregulation in the Care of Infants Guideline for Practice Executive Summary.","authors":"Valerie K Moniaci,&nbsp;Bobby Bellflower","doi":"10.1097/ANC.0000000000000945","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000945","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"340"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39375063","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":"Changes in Assessment of and Satisfaction With Discharge Preparation From the Neonatal Intensive Care Unit.","authors":"Vincent C Smith,&nbsp;Wenyang Mao,&nbsp;Marie C McCormick","doi":"10.1097/ANC.0000000000000862","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000862","url":null,"abstract":"<p><strong>Background: </strong>A successful transition from the neonatal intensive care unit (NICU) to home is aided by a comprehensive discharge planning program that keeps families involved and engaged with the discharge preparation process.</p><p><strong>Purpose: </strong>To compare the assessment of parental NICU discharge preparedness with parental satisfaction with the NICU discharge preparation.</p><p><strong>Methods: </strong>Families were surveyed 4 to 6 weeks after NICU discharge, and those selecting \"very prepared\" were considered \"satisfied\" with their discharge preparation. On discharge day, families were considered \"prepared\" for discharge based on their overall level of preparedness and their nurse's rating of them on a discharge readiness assessment tool.</p><p><strong>Results: </strong>In total, 1104 families (60%) reported being both \"satisfied\" and \"prepared\"; 293 families (16%) were \"satisfied\" but not \"prepared\"; 297 families (16%) were not \"satisfied\" but were \"prepared\"; and 134 families (7%) were neither \"satisfied\" nor \"prepared.\" Compared with families that were both \"satisfied\" and \"prepared,\" families that were neither \"satisfied\" nor \"prepared\" were more likely to be raising the infant alone, of Black race, and to have sicker infants.</p><p><strong>Implications for practice: </strong>Some families are at a higher risk and merit more consideration during NICU discharge planning. Assess the discharge readiness of all families prior to discharge. Those at an increased risk may benefit from more discharge education and training, specifically for single mothers, those with limited resources, or others considered at high risk.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E144-E151"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25587974","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}