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

{"title":"Speaking Up to Address Racism and Health Inequity.","authors":"Debra Brandon, Jacqueline M McGrath","doi":"10.1097/ANC.0000000000000831","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000831","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"1-2"},"PeriodicalIF":1.7,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38795514","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":"Recovering Together: Mothers' Experiences Providing Skin-to-Skin Care for Their Infants With NAS.","authors":"Kelly McGlothen-Bell,&nbsp;Pamela Recto,&nbsp;Jacqueline M McGrath,&nbsp;Elizabeth Brownell,&nbsp;Lisa M Cleveland","doi":"10.1097/ANC.0000000000000819","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000819","url":null,"abstract":"<p><strong>Background: </strong>Over the past 2 decades, the prevalence of neonatal abstinence syndrome (NAS) has increased almost 5-fold. Skin-to-skin care (SSC), a method of parent-infant holding, is a recommended nonpharmacologic intervention for managing NAS symptoms. SSC has the potential to reduce withdrawal symptoms while positively influencing parent-infant attachment. Yet, little is known about the SSC experiences of mothers of infants with NAS.</p><p><strong>Purpose: </strong>The purpose of this study was to explore the SSC experiences of mothers of infants with NAS, including perceived barriers to SSC in the hospital and following discharge home.</p><p><strong>Methods: </strong>A qualitative descriptive design was used to obtain new knowledge regarding the experience of SSC of mothers of infants with NAS. Purposive sampling was used to recruit participants eligible for the study. We conducted semistructured individual interviews with postpartum mothers of infants with NAS. Data were analyzed using thematic analysis.</p><p><strong>Findings/results: </strong>Thirteen mothers participated in the study. Four themes emerged from the data analysis: \"a little nerve racking\"; \"she needed me, and I needed her\"; dealing with the \"hard times\"; and \"a piece of my puzzle is missing.\" SSC was described as a conduit for healing and bonding; in addition, several barriers to SSC were reported.</p><p><strong>Implications for practice and research: </strong>These findings highlight the inherent benefits of SSC for infants with NAS and demonstrate the unique challenges of these mother-infant dyads. Critical changes in hospital practices are needed to create an environment supportive of SSC for this patient population. In addition, research regarding implementation of interventions to increase SSC usage in this population is warranted.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"16-22"},"PeriodicalIF":1.7,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38740819","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 Evolution of an Interdisciplinary Developmental Round in a Surgical Neonatal Intensive Care Unit.","authors":"Nadine Griffiths,&nbsp;Kristen James-Nunez,&nbsp;Kaye Spence,&nbsp;Cathryn Crowle,&nbsp;Jane Pettigrew,&nbsp;Alison Loughran-Fowlds","doi":"10.1097/ANC.0000000000000741","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000741","url":null,"abstract":"<p><strong>Background: </strong>Developmentally supportive environments are known to improve medical outcomes for hospitalized neonates and are considered the overarching philosophy for practice in the neonatal setting. Developmental rounds are a strategy incorporated by multidisciplinary teams to support development within and beyond the neonatal unit. Typically, they consist of bedside consultations and individualized developmentally supportive recommendations for families and clinicians. Globally, the use of developmental rounds has been described since the early 1990s. They are viewed as a measure to counter some of the barriers to developmental care implementation while buffering against the effect of an intensive care admission. To date, their use in the surgical neonatal intensive care unit (sNICU) has been minimally reported in literature.</p><p><strong>Purpose: </strong>This article describes the focus and work of a developmental round team and strategy in the sNICU.</p><p><strong>Method: </strong>A retrospective audit of developmental round key performance criteria undertaken over a 4-year period (2015-2018).</p><p><strong>Findings/results: </strong>More than 300 developmental consults and 2000 individualized developmental recommendations occurred annually. Parental presence during the developmental round increased by 10%, from 48% to 58%, during the audit period.</p><p><strong>Implications for practice/implications for research: </strong>Literature has supported the use of developmental round interventions; however, minimal data have been reported to date. This article provides retrospective audit data of a developmental round intervention in the sNICU with a focus on data over 4 years to highlight key areas, including the structure and process, recommended educational standards for team members, and parental engagement, as key markers for developmental round efficacy. Future research should focus on the link between the developmental round intervention and long-term neonatal outcomes.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E2-E10"},"PeriodicalIF":1.7,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37914460","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":"Needs of Socioeconomically Diverse Fathers of Premature Hospitalized Infants: A Multicenter Study.","authors":"Linda Merritt,&nbsp;Becky Spencer","doi":"10.1097/ANC.0000000000000767","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000767","url":null,"abstract":"<p><strong>Background: </strong>To effectively practice true family-centered care (FCC) in the neonatal intensive care unit (NICU) setting, a nurse needs to understand the perceptions and concerns of all fathers. Although research is emerging on fathers' perceptions and experiences, the samples of fathers represented are not from diverse socioeconomic, racial, and ethnic populations, which limit the findings' generalizability.</p><p><strong>Purpose: </strong>The purpose of this study was to determine the needs of NICU fathers and whether these needs differed based on sociodemographic factors.</p><p><strong>Methods: </strong>A quantitative, comparative, descriptive design was used to determine the needs of NICU fathers. Additional analysis was conducted to determine whether the needs differed based on education, income, and gestational age, whether the father preferred speaking English or Spanish, and whether these sociodemographic factors could predict needs. To determine sociodemographic factors and needs, a demographic questionnaire and the NICU Family Needs Inventory were administered to 99 fathers in 6 level III NICUs.</p><p><strong>Results: </strong>Data were analyzed using independent sample t test, 1-way analysis of variance, and multiple linear regression. The results showed that fathers reported a broad span of needs and fathers from disadvantaged populations may have greater needs in certain areas.</p><p><strong>Implications for practice: </strong>These results emphasize the importance of the nurses' role in assessing the needs of NICU fathers. By understanding fathers' needs, nurses can provide individualized FCC to fathers to help them be more involved in the care and support of their infant.</p><p><strong>Implications for research: </strong>Further research is needed to support these findings and test interventions that promote communication between providers and fathers.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E11-E22"},"PeriodicalIF":1.7,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40544953","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 Sepsis: A Review of Pathophysiology and Current Management Strategies.","authors":"Margaret A Glaser,&nbsp;Lauren M Hughes,&nbsp;Amy Jnah,&nbsp;Desi Newberry","doi":"10.1097/ANC.0000000000000769","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000769","url":null,"abstract":"<p><strong>Background: </strong>Early-onset sepsis, occurring within 72 hours of birth, and late-onset sepsis, occurring after this time period, present serious risks for neonates. While culture-based screening and intrapartum antibiotics have decreased the number of early-onset cases, sepsis remains a top cause of neonatal morbidity and mortality in the United States.</p><p><strong>Purpose: </strong>To provide a review of neonatal sepsis by identifying its associated risk factors and most common causative pathogens, reviewing features of the term and preterm neonatal immune systems that increase vulnerability to infection, describing previous and the most current management recommendations, and discussing relevant implications for the neonatal nurse and novice neonatal nurse practitioner.</p><p><strong>Methods/search strategy: </strong>An integrative review of literature was conducted using key words in CINAHL, Google Scholar, and PubMed.</p><p><strong>Findings/results: </strong>Group B streptococcus and Escherichia coli are the most common pathogens in early-onset sepsis, while Coagulase-negative staphylococci comprise the majority of cases in late-onset. The neonatal immune system is vulnerable due to characteristics including decreased cellular activity, underdeveloped complement systems, preferential anti-inflammatory responses, and insufficient pathogenic memory. Blood cultures remain the criterion standard of diagnosis, with several other adjunct tests under investigation for clinical use. The recent development of the sepsis calculator has been a useful tool in the management of early-onset cases.</p><p><strong>Implications for practice: </strong>It is vital to understand the mechanisms behind the neonate's elevated risk for infection and to implement evidence-based management.</p><p><strong>Implications for research: </strong>Research needs exist for diagnostic methods that deliver timely and sensitive results. A tool similar to the sepsis calculator does not exist for preterm infants or late-onset sepsis, groups for which antibiotic stewardship is not as well practiced.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=40.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"49-60"},"PeriodicalIF":1.7,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ANC.0000000000000769","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38402921","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":"Use of a Smart Pump and Dedicated Medication Line to Reduce Peripherally Inserted Central Catheter Damage.","authors":"Deborah Pritchett,&nbsp;Tige Bjornson,&nbsp;Kristine Randall,&nbsp;Anita Walsh-Sunde,&nbsp;Carol Nygaard,&nbsp;Ashley Jarman,&nbsp;Bette Schumacher","doi":"10.1097/ANC.0000000000000798","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000798","url":null,"abstract":"<p><strong>Background: </strong>Neonatal intensive care unit (NICU) infants frequently require peripherally inserted central catheter (PICC) placement for medication and nutrition. The occurrence of leaking catheters led to practice evaluation of manual intravenous (IV) flush and medication push technique in an upper Midwest NICU. A variation in unit practice was revealed.</p><p><strong>Purpose: </strong>To describe an evidence-based practice change that standardized medication administration, eliminating routine manual IV push medication and flush administration and reducing catheter malfunction. Emergency \"code\" medication administration was not addressed.</p><p><strong>Methods: </strong>A systematic review of the literature was performed. A unit practice investigation ensued to study medication administration techniques and syringe size utilization, understand syringe pressure generated by various sizes of syringes, select optimal IV tubing supplies, review the smart pump library, electronic order sets/documentation, and address staff knowledge and skills. Practice change eliminating IV push and recommendations incorporating best evidence occurred.</p><p><strong>Results: </strong>Moving from a traditional method of manual pushing/flushing medication to use of medication delivery via smart pump can decrease or eliminate PICC damage and potential harm to neonatal patients.</p><p><strong>Implications for practice: </strong>Examination of IV push technique may identify opportunities for safer medication administration. Use of an infusion pump and a dedicated medication line can be a feasible option to deliver most IV medication doses in the NICU.</p><p><strong>Implications for research: </strong>Safe medication administration practices for the neonatal population and barriers to that practice.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=41.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"61-67"},"PeriodicalIF":1.7,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38486938","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":"Delayed Diagnosis in Esophageal Atresia and Tracheoesophageal Fistula: Case Study.","authors":"Joanne E Scott,&nbsp;Alisa Hawley,&nbsp;Jo-Anne Brooks","doi":"10.1097/ANC.0000000000000763","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000763","url":null,"abstract":"<p><strong>Background: </strong>Timely identification of esophageal atresia is challenging. Diagnosis may be suspected antenatally with a combination of polyhydramnios, associated with a small or absent stomach bubble or other anomalies. Esophageal atresia can be suspected postnatally in the presence of tachypnea, increased oral secretions, and an inability to advance an orogastric tube. Failure to recognize an esophageal atresia can have life-threatening implications.</p><p><strong>Clinical findings: </strong>A 5-day-old infant with a history of failure to thrive and respiratory distress presented in a community emergency department following a prolonged apnea associated with a breastfeed.</p><p><strong>Primary diagnosis: </strong>Delayed postnatal diagnosis of esophageal atresia and tracheoesophageal fistula.</p><p><strong>Interventions: </strong>During stabilization in the emergency department, a nasogastric tube was placed to decompress the stomach. A subsequent chest and abdominal radiograph identified the nasogastric tube curled in the upper esophagus, confirming an esophageal atresia. The abdominal radiograph demonstrated gaseous distension, suggesting the presence of a distal tracheoesophageal fistula.</p><p><strong>Outcomes: </strong>The neonate had a primary esophageal anastomosis and fistula ligation in a surgical neonatal unit. He was discharged home at 29 days of life.</p><p><strong>Practice recommendations: </strong>Understanding the challenges of an antenatal diagnosis and awareness of postnatal presentation with a view to improving postnatal recognition and better-quality outcomes for infants with an esophageal atresia and tracheoesophageal fistula.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"68-76"},"PeriodicalIF":1.7,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37914382","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":"Systematic Review of the Effects of Skin-to-Skin Care on Short-Term Physiologic Stress Outcomes in Preterm Infants in the Neonatal Intensive Care Unit.","authors":"Britt Frisk Pados,&nbsp;Francis Hess","doi":"10.1097/ANC.0000000000000596","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000596","url":null,"abstract":"<p><strong>Background: </strong>Infants in the neonatal intensive care unit (NICU) are exposed to many stressors. There is growing evidence that chronic stress early in life has long-term neurodevelopmental implications. Skin-to-skin care (SSC) is an intervention used to reduce stress in the NICU.</p><p><strong>Clinical question: </strong>In premature infants in the NICU, what is the available evidence that SSC improves short-term physiologic stress outcomes compared with incubator care?</p><p><strong>Search strategy: </strong>PubMed and CINAHL were searched for terms related to SSC, stress, physiology, and premature infants. Of 1280 unique articles, 19 were identified that reported on research studies comparing SSC with incubator care in the NICU and reported stress-related physiologic outcome measures.</p><p><strong>Results: </strong>Although there have been some mixed findings, the research supports that SSC improves short-term cardiorespiratory stress outcomes compared with incubator care. The evidence is clearer for studies reporting stress hormone outcomes, with strong evidence that SSC reduces cortisol and increases oxytocin levels in preterm infants.</p><p><strong>Implications for practice and research: </strong>SSC is safe and has stress-reducing benefits. SSC should be considered an essential component to providing optimal care in the NICU. More research is needed to determine the timing of initiation, duration, and frequency of SSC to optimize the stress-reducing benefits. Future research should include the most fragile infants, who are most likely to benefit from SSC, utilize power analyses to ensure adequate sample sizes, and use sophisticated data collection and analysis techniques to more accurately evaluate the effect of SSC on infants in the NICU.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"48-58"},"PeriodicalIF":1.7,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ANC.0000000000000596","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37236470","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":"Malassezia furfur Emergence and Candidemia Trends in a Neonatal Intensive Care Unit During 10 Years: The Experience of Fluconazole Prophylaxis in a Single Hospital.","authors":"I-Ting Chen,&nbsp;Chih-Cheng Chen,&nbsp;Hsin-Chun Huang,&nbsp;Kuang-Che Kuo","doi":"10.1097/ANC.0000000000000640","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000640","url":null,"abstract":"<p><strong>Background: </strong>Because Candida spp is a major cause of mortality and morbidity in preterm infants, fluconazole prophylaxis has been suggested by some experts and hospital policy. In our hospital, fluconazole prophylaxis was used in eligible preterm infants and set as the neonatal intensive care unit (NICU) practice in 2014.</p><p><strong>Purpose: </strong>This study focused on fungal bloodstream infections and aimed to evaluate the benefit and harm of fluconazole prophylaxis.</p><p><strong>Methods/search strategy: </strong>This retrospective, descriptive study involved medical record reviews in our hospital from April 2005 to October 2016. NICU patients were included if Candida species, yeast-like organisms, or Malassezia species were cultured from their venous catheter tips or blood cultures.</p><p><strong>Findings/results: </strong>After fluconazole prophylaxis, cases of Candida spp decreased and those of Malassezia furfur emerged. We reviewed 19 cases of catheter-related M furfur colonization and 1 case of M furfur fungemia. The gestational age was 27.3 ± 2.0 weeks and birth weight was 959.2 ± 229.8 g. Hyperalimentation with lipid infusion was used in all cases. All of the neonates survived with antifungal agent use.</p><p><strong>Implications for practice: </strong>This study highlights that prophylactic fluconazole may be an associated factor of Malassezia colonization; M furfur remains a potential concern for fungemia in the care of premature infants and thus requires our attention.</p><p><strong>Implications for research: </strong>Future studies should further investigate the incidence and impact of noncandidal fungal infections with fluconazole prophylaxis use in premature infants.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E3-E8"},"PeriodicalIF":1.7,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ANC.0000000000000640","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37160046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of the NICU in Father Involvement, Beliefs, and Confidence: A Follow-up Qualitative Study.","authors":"","doi":"10.1097/ANC.0000000000000709","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000709","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E1-E2"},"PeriodicalIF":1.7,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ANC.0000000000000709","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37581258","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}