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

{"title":"Neonatal Intensive Care Unit Admission Temperatures of Infants 1500 g or More: The Cold Truth.","authors":"Audrey R Apanovitch,&nbsp;Jacqueline M McGrath,&nbsp;Kelly McGlothen-Bell,&nbsp;Carrie-Ellen Briere","doi":"10.1097/ANC.0000000000000787","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000787","url":null,"abstract":"<p><strong>Background: </strong>Smaller preterm infants often receive extra attention with implementation of additional thermoregulation interventions in the delivery room. Yet, these bundles of interventions have largely remained understudied in larger infants.</p><p><strong>Purpose: </strong>The purpose of this study was to evaluate initial (or admission) temperatures of infants born weighing 1500 g or more with diagnoses requiring admission to the neonatal intensive care unit (NICU).</p><p><strong>Methods: </strong>Retrospective medical record review of 388 infants weighing 1500 g or more admitted to the NICU between January 2016 and June 2017.</p><p><strong>Result: </strong>In total, 42.5% of infants weighing 1500 g or more were admitted hypothermic (<36.5°C), 54.4% with a normothermic temperature, and 2.8% were hyperthermic. Of those infants admitted hypothermic, 30.4% had an admission temperature ranging from 36°C to 36.4°C and 12.1% had an admission temperature of less than 36°C. When compared with infants weighing less than 1500 g, who were born at the same institution and received extra thermal support interventions, there was a statistically significant difference (P < .001) between admission temperatures where infants less than 1500 g were slightly warmer (36.8°C vs 36.5°C).</p><p><strong>Implications for practice: </strong>Ongoing admission temperature monitoring of all infants requiring NICU admission regardless of birth weight or admission diagnosis is important if we are going to provide the best support to decrease mortality and morbidity for this high-risk population.</p><p><strong>Implications for research: </strong>While this study examined short-term outcomes, effects on long-term outcomes were not addressed. Findings could be used to design targeted interventions to support thermal regulation for all high-risk infants.</p><p><strong>Conclusion: </strong>Neonates admitted to the NICU weighing 1500 g or more are at high risk for developing hypothermia, similar to smaller preterm infants.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"214-221"},"PeriodicalIF":1.7,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38298800","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 Feasibility of Kangaroo Care and the Effect on Maternal Attachment for Neonates in a Pediatric Cardiac Intensive Care Unit.","authors":"Mary Jane Broge,&nbsp;Lisa M Steurer,&nbsp;Patrick M Ercole","doi":"10.1097/ANC.0000000000000800","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000800","url":null,"abstract":"<p><strong>Background: </strong>As survival rates in neonates with congenital heart disease have improved, research has shown they are at an increased risk for brain injury and neurodevelopmental delay. One intervention shown to have a positive impact on the development in premature and full-term newborns, as well as a positive impact on mother-infant relationship, is kangaroo care (KC). There is limited evidence to support the use of KC in infants with congenital heart disease, some of who may also be premature.</p><p><strong>Purpose: </strong>The purpose of this study was to examine the safety and feasibility of introducing KC for neonates with congenital heart disease in the pediatric cardiac intensive care unit.</p><p><strong>Methods: </strong>A descriptive observational feasibility study was employed to evaluate the safety and efficacy of KC for this population.</p><p><strong>Results: </strong>There were 25 neonates included with 60 sessions of KC. There were no adverse events including line and tube dislodgments and physiological instability related to the use of KC.</p><p><strong>Implications for practice: </strong>This study found KC to be safe and feasible for neonates with KC.</p><p><strong>Implications for research: </strong>This is the first study examining the feasibility and safety of KC in this vulnerable population of neonates. Further research should be conducted using a quasi-experimental design to investigate neurodevelopmental outcomes with a larger sample of patients.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E52-E59"},"PeriodicalIF":1.7,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38450962","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 Research Summit 2021.","authors":"","doi":"10.1097/ANC.0000000000000876","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000876","url":null,"abstract":"Background: Neonatal intensive care unit (NICU) nurses need a better understanding of fathers' needs and perceptions in order to provide more family holistic care. Previous research aimed at exploring fathers' experiences in the NICU resulted in identifying some needs; however, these studies mostly occurred outside the United States where practices may differ. Therefore, research is needed to explore NICU fathers' needs within the United States. Purpose: The purpose of this study was to explore the needs of fathers who previously had a premature infant in the NICU. Methods: This qualitative descriptive study used semistructured interviews collected to obtain in-depth knowl-edge of fathers' needs in the NICU. Twenty-eight fathers were recruited through 3 parent support organizations: Hand to Hold, NICU Parent Support Network, and March of Dimes. Results: Results revealed 3 themes: need for support, clarity and to be recognized. Implications for Practice: Fathers have specific needs in the NICU that need to be addressed and that may differ from mothers. Awareness of addressing fathers' needs promotes more holistic care to fathers, supports coping within the NICU environment and the multifaceted impact of the experience, and helps them engage in the care of their infant. Implications for Research: Further research is needed to explore the needs of fathers from diverse backgrounds and those who perceive to be or are less involved in their infant's care as well as their experiences and needs related to the recent COVID-19 pandemic. Comparative research is also needed to identify differences between mothers' and fathers' needs in order to determine interventions that promoting more holistic, family-centered care.","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E44-E51"},"PeriodicalIF":1.7,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38916594","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":"Medical-Grade Honey for the Treatment of Extravasation-Induced Injuries in Preterm Neonates: A Case Series.","authors":"Eleftherios Smaropoulos,&nbsp;Niels A J Cremers","doi":"10.1097/ANC.0000000000000781","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000781","url":null,"abstract":"<p><strong>Introduction: </strong>Preterm neonates often depend on peripheral intravenous administration of nutrition and medication. Since their skin is not fully developed and very vulnerable, extravasation injury is a risk. Medical-grade honey (MGH) possesses antimicrobial activity and stimulates wound healing; although its use in neonatal patients is limited.</p><p><strong>Clinical findings: </strong>We present a case series of 7 preterm neonates (28-36 weeks of gestation) with extravasation injuries secondary to peripheral intravenous administration of total parental nutrition and medication.</p><p><strong>Primary diagnosis: </strong>Extravasation injury following the unintentional leakage of total parenteral nutrition, and medication into the surrounding tissue. Signs of extravasation include local pain, erythema, burning, pruritus, and/or swelling.</p><p><strong>Interventions: </strong>All extravasation injuries were treated with daily cleaning and application of MGH. Some of the cases needed additional surgical intervention or assisted debridement.</p><p><strong>Outcomes: </strong>After treatment, all extravasation injury wounds presented with granulation tissue formation progressed to normal epithelialization and closed in 7 to 67 days (median: 32 days). Upon initial application, peripheral edema and inflammation decreased. When present, necrotic tissue was effectively debrided, slough was removed, and no signs of infection were detected, irrespective of initial wound presentations. Cicatrization was minimal, and the full range of motion was preserved in all cases.</p><p><strong>Practice recommendations: </strong>Continuous and thorough assessment of peripheral intravenous line placement for malposition, leaking, and signs of extravasation is needed for fast discovery and prevention of further damage.</p><p><strong>Conclusion: </strong>Medical-grade honey possesses antimicrobial, anti-inflammatory, and antioxidative activity, enhancing wound healing. Medical-grade honey was safe and effective for treating extravasation-induced injuries, independent of location and severity. We recommend MGH for treating extravasation wounds and consideration for other types of wounds.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"122-132"},"PeriodicalIF":1.7,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38164006","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 New Strategic Pillar: Health and Racial Equity.","authors":"","doi":"10.1097/ANC.0000000000000874","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000874","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"97-98"},"PeriodicalIF":1.7,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25530292","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":"Neonatal Abstinence Syndrome and Preterm Infants: A Look at Current Practice.","authors":"Debra Armbruster,&nbsp;Caitlyn Schwirian,&nbsp;Ashley Mosier,&nbsp;Wai-Yin Mandy Tam,&nbsp;Pavel Prusakov","doi":"10.1097/ANC.0000000000000858","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000858","url":null,"abstract":"<p><strong>Background/significance: </strong>Intrauterine opioid drug exposure is associated with an increased risk of preterm birth. Preterm infants may not exhibit the same withdrawal symptoms as term infants diagnosed with neonatal abstinence syndrome (NAS). There are no current standards for how to screen, assess, or treat NAS in preterm infants.</p><p><strong>Purpose: </strong>This study explored the current state of practice for preterm infants born at less than 34 weeks of gestational age exposed to intrauterine opioids.</p><p><strong>Methods: </strong>This was a descriptive cross-sectional study of NAS practice in preterm infants born at less than 34 weeks of gestational age in neonatal intensive care units (NICUs) in the United States and Canada. The study was conducted May through September 2018. All respondents cared for preterm infants born at less than 34 weeks of gestational age exposed to intrauterine drugs.</p><p><strong>Results: </strong>There were 70 respondents representing 67 hospitals in the United States and 1 in Canada. Level III NICUs represented 69% of respondents. Ninety-three percent reported neonatal triggers for further evaluation. Review of maternal history and maternal urine testing was the most consistent practice across NICUs. A modified Finnegan scoring tool was used for both preterm and term infants. Morphine was reported as the most common first-line drug used for treatment.</p><p><strong>Implications for practice: </strong>Great variability in NAS practice for preterm infants born at less than 34 weeks of gestational age across the multiple NICUs supports the need for a validated preterm infant assessment tool and development of appropriate treatment strategies.</p><p><strong>Implications for research: </strong>Future research describing the NAS symptomatology of preterm infants born at less than 34 weeks of gestational age exposed to intrauterine opioids is warranted.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"107-114"},"PeriodicalIF":1.7,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25508740","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":"Neonatal Alloimmune Thrombocytopenia: A Concise Review.","authors":"Tonya Norton,&nbsp;Desi Newberry,&nbsp;Amy Jnah","doi":"10.1097/ANC.0000000000000775","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000775","url":null,"abstract":"<p><strong>Background: </strong>Neonatal alloimmune thrombocytopenia (NAIT) is defined as an uncommon platelet disorder caused by maternal alloimmunization to human-specific antigens (HPAs) that are paternally inherited, resulting in low fetal/neonatal platelet levels and debilitating effects on the newborn. The incidence of NAIT is 1 in every 1000 live births within the United States; it is the most common cause of severe thrombocytopenia (<30 × 109/L) and intracranial hemorrhage in term newborns.</p><p><strong>Purpose: </strong>The purpose of this article is to discuss the pathophysiology, clinical manifestations, diagnosis, and treatment of NAIT and its implications upon the lifespan of the neonate.</p><p><strong>Methods: </strong>A literature review was conducted using PubMed, CINAHL, and Google Scholar (2014-2019). Search terms included NAIT, neonatal/fetal alloimmune thrombocytopenia, newborn platelets, and intracranial bleeding and NAIT.</p><p><strong>Results: </strong>NAIT can affect first pregnancies and often goes undiagnosed until delivery. Universal screening tools with a focus on HPA-1a typing via noninvasive testing have been successfully trialed and have yielded promising results indicating a 75% reduction in risks associated with NAIT; however, none have been incorporated into practice and prophylactic treatment remains unavailable.</p><p><strong>Implications for research: </strong>Adopting a universal screening tool and prophylaxis for NAIT would allow for early diagnosis and treatment in utero.</p><p><strong>Implications for practice: </strong>Many healthcare providers are not familiar with NAIT often focusing on other causes of thrombocytopenia as a potential diagnosis.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"115-121"},"PeriodicalIF":1.7,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38148535","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":"INSTRUCTIONS: CE Test for Neonatal Alloimmune Thrombocytopenia: A Concise Review.","authors":"","doi":"10.1097/ANC.0000000000000868","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000868","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E23"},"PeriodicalIF":1.7,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25530295","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":"Parents Are \"Essential\" Caregivers.","authors":"Jodi Herron Behr,&nbsp;Debra Brandon,&nbsp;Jacqueline M McGrath","doi":"10.1097/ANC.0000000000000861","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000861","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"93-94"},"PeriodicalIF":1.7,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25530293","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":"Baby STRENGTH: Eat, Sleep, Console for Infants With Neonatal Abstinence Syndrome.","authors":"Patricia A Miller,&nbsp;Tina Willier","doi":"10.1097/ANC.0000000000000840","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000840","url":null,"abstract":"<p><strong>Background: </strong>Traditional medication-based management of neonatal abstinence syndrome (NAS) results in long hospitalizations. Nonpharmacologic treatment and using the Eat, Sleep, Console (ESC) model of care have been shown to decrease lengths of stay (LOSs).</p><p><strong>Purpose: </strong>To determine whether using the ESC model of care to treat infants with opioid withdrawal resulted in decreased LOSs and number of infants receiving morphine when compared with traditional medication management.</p><p><strong>Methods: </strong>Retrospective medical review for all patients admitted for NAS 12 months before and 12 months after implementing the ESC model of care. Data collected from electronic health records included demographic data, maternal history, infant LOS, infants receiving morphine, and birth weight/weight on day of life (DOL) 5. Univariate analysis was used to control for demographic data/risk factors. A 2-samples t test was used to compare average LOSs. Chi-square test was used to detect differences in the number of infants receiving morphine. Data were analyzed using SAS 9.4 software.</p><p><strong>Results: </strong>LOS decreased from mean of 17.7 days to a mean of 5.9 days (P < .0001). The number of infants receiving morphine decreased from 20 (58.9%) to 1 (2.7%) (P < .0001). No statistically significant difference was noted in the percentage of weight loss on DOL 5. Data showed an increase in breastfeeding rates from 41.18% to 64.86% (P = .0456).</p><p><strong>Implications for practice: </strong>The ESC model of care decreased infant LOS and the number of morphine doses administered for opioid withdrawal symptoms. Maternal breastfeeding rates increased.</p><p><strong>Implications for research: </strong>More research is needed to determine long-term neurodevelopmental outcomes of infants managed using ESC principles.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"99-106"},"PeriodicalIF":1.7,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25331329","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}