Subgaleal or subaponeurotic hemorrhage is the most serious form of extracranial hemorrhage in newborns. Although rare, subgaleal hemorrhage is associated with a mortality rate of with a mortality rate of 17%–25%. This disorder is a clinical emergency occurring at birth or within a few hours of life. The risk of death increases with delay in identifying the condition and initiating aggressive treatment. Understanding the risks and underlying pathophysiology and recognizing the clinical manifestations of SGH are imperative to promptly provide necessary life-saving intervention.
Today, neonatal and maternal health and mortality rates, and the effects on neonates, families, and societies have risen to the world’s policy stage. The recognition that most of neonatal and maternal deaths are preventable creates the “perfect storm or conditions” for professional organizations, private and public corporations, non-governmental organizations, and governmental groups to collaborate to improve health outcomes for these most vulnerable populations. The Council of International Neonatal Nurses, Inc. (COINN) unites neonatal nursing globally to bring the nursing perspective to this work. This column features an update from the jENS (Joint European Neonatal Societies) meeting in Budapest, Hungary, in September, 2015.
The objective of the study is to determine whether infant caregivers are complying with current safe sleep recommendations based on the American Academy of Pediatrics guidelines. This is a literature review utilizing four databases: PubMed, CINAHL, Scopus, and Embase. Numerous barriers prevent some infant caregivers from complying with current safe sleep recommendations. Formal intervention and education programs are effective in increasing safe sleep compliance. Not all caregivers are following back to sleep guidelines. Gaps in caregiver knowledge regarding safe sleep need to be addressed and further research should be conducted with emphasis on education.
Neonatal care is a highly complex specialized area in medicine and nursing. While evidence is growing to support our interventions, many “gray” areas still exist. This column on “Point-Counter Point” is meant to evoke more questions than answers, to debate the pros and cons on topics – not suggesting one is right, the other wrong. We invite your thoughts.
In the United States, the majority of babies are born at community hospitals that have a limited ability to care for premature or ill neonates. Regionalization was developed in the early 1970’s in an effort to improve the outcomes of these neonates and pregnant women. Hospitals were designated a level of care based on their resources and capability to care for the premature or ill neonates and pregnant women. The highest level of care is the regional center. A requirement of these centers is to provide outreach education and initiatives to the referral hospitals in their referral area. The perinatal/neonatal clinical nurse specialist working in regional centers is an ideal position to lead the hospital outreach initiative to improve the care of neonates and pregnant women in the referral area.
The transition from fetus to neonate is a period marked by intense changes – physiologic, anatomic, and biochemical. Some of these changes must occur immediately while others can evolve over a more protracted time span. However, failure of some vital changes to ensue has resulted in negative, sometimes fatal consequences. Of all the facets of transition to extrauterine life the most immediately vital changes occur in the cardiorespiratory system. This article presents a review of information necessary to understand the transition from fetal to neonatal life: fetal circulation, the pulmonary vascular bed, transition from fetal to neonatal circulation, stages of transition, and the cycle of events that occur when transition is disrupted.
Professional staff members in a neonatal intensive care unit (NICU) implementing the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) expressed the need for enhancement of their well-being. The Neurorelational Framework (Lillas and Turnbull, 2009) served as a guide for supporting staff education about the science of brain development and function and the provision of trauma-informed care. This paper describes an innovative pilot project implementing a reflective peer consultation group (RPC) facilitated by an infant psychiatrist. The RPC group provided opportunities for education about stress and triggers to stressful responses, and promoted staff reflection as well as strategies to promote stress recovery. Staff reported improved physical and emotional well-being after participating in RPC groups. Additionally, group members implemented changes to their clinical practices with infants and their parents in the NICU to facilitate recovery from stress in intensive care units.
Lighting technologies are rapidly evolving, creating many opportunities for good lighting within the NICU. With the widespread adoption of advanced solid-state lighting technologies, lighting no longer needs to be static. Rather, lighting systems can be more easily adjusted to the different and changing visual and non-visual needs of the professional staff, infants and family members throughout the 24-hour day. This paper provides a conceptual framework for defining good lighting in the NICU, recognizing the needs of various constituent groups, each with very different needs from the lighting. Several other papers on the topic of lighting for various constituent groups at different times of the day in the NICU are summarized. Attention is given specifically to the Recommended Standards for Newborn ICU Design, a consensus standard developed by a wide range of experts, to help the reader translate this conceptual framework to practice.
Early preterm infants (EPT) (<33 6/7 weeks) are at increased risk for autism spectrum disorders (ASDs) but prevalence estimates vary widely across studies. Furthermore, there are very few studies addressing the association between late preterm (LPT) births (34-36 6/7 weeks) and ASDs. To address the question of whether LPT infants carry the same risk for ASDs as full-term infants, this study aimed to estimate the relative probability of an ASD diagnosis using Bayes rule. A retrospective cohort analysis of 406 children was undertaken to look at gestational age, ASDs, and birth history. The application of Bayes rule was used, given that there is not sufficient information about the joint probabilities related to prematurity and autism. Using the estimated gestational age proportions within ASD diagnosis, plus national estimates of ASDs, probabilities for ASDs within a given gestational age were calculated. Among these 406 children with ASDs, 6.7% were EPT and 10.6% were LPT. In comparison to full term, EPT children are at 1.9 multiplicative increase in risk (95% CI [1.3, 2.5]). While the probability of ASDs for LPT children was higher than that for term, the estimated relative risk of the LPT infants was not statistically significant (95% CI [0.9, 1.5]). EPT infants were significantly more likely to be diagnosed with ASDs compared to their term peers. While the relative probability of ASD diagnosis among children born LPT was not statistically significant in this limited sample, the results indicate a possible elevated risk. A larger cohort is needed to adequately estimate this risk.
Early diagnosis of autism spectrum disorders (ASD) enables early intervention that improves long term functioning of children with ASD but is often delayed until age of school entry. Few studies have identified factors that affect timely diagnosis. This study addressed how maternal education, race, age, marital status as well as neonatal birth factors affect the age at which a child is diagnosed with ASD. This study involved a retrospective analysis of 664 records of children treated at one of the largest autism treatment centers in the United States from March 1, 2009 to December 30, 2010. Logistic regression and Cox proportional hazards regression were used to identify maternal and neonatal factors associated with age of diagnosis. Infant gender, maternal race, marital status, and maternal age were identified as significant factors for predicting the age of ASD diagnosis. In the Cox proportional hazards regression model, only maternal race and marital status were included. Median survival age till diagnosis of children born to married mothers was 53.4 months compared to 57.8 months and 63.7 months of children born to single and divorced or widowed mothers respectively. Median survival age till diagnosis for children of African American mothers was 53.8 months compared to 57.2 months for children of Caucasian mothers. No statistically significant difference of timing of ASD diagnosis was found for children of varying gestational age. Children born to older or married mothers and mothers of minority races were more likely to have an earlier ASD diagnosis. No statistically significant differences in timing of ASD diagnosis were found for children born at varying gestational ages. Identification of these factors has the potential to inform public health outreach aimed at promoting timely ASD diagnosis. This work could enhance clinical practice for timelier diagnoses of ASD by supporting parents and clinicians around the world in identifying risk factors beyond gender and SES and developing strategies to recognize earlier signs of ASD and contribute to improved development outcomes in children with ASD.
The number of neonatal intensive care units (NICUs) designed to meet basic criteria for green design is increasing. Some organizations, however, are reluctant to embark on a program of sustainability. The resistance is typically due to cost concerns and lack of knowledge about how to accomplish goals of sustainability. This paper evaluates the availability and quality of information with regard to sustainable NICU design. Sources of information are provided including LEED (Leadership in Energy and Environmental Design), a system authored by the U.S. Green Building Council, and the recommended standards for newborn ICU design. Among the topics explored via this literature review on green NICUs are sustainable materials and equipment, energy and water conservation, and recycling and waste disposal. Nature and access to daylight are also identified as contributors to sustainability. As such, the role of biophilia (the innate affiliation of humans with nature) in NICU settings is also discussed.
The study evaluated the effectiveness of a neonatal nurse-training program in improving knowledge, patient care practices and processes of nurses in a neonatal intensive care unit in a resource-limited setting. The study was a pre-post intervention design assessing a nurse-training program in Kenya. We found a significant improvement in the primary outcome of nursing competency assessed on measures of knowledge and patient care practices post-intervention (p<0.0001). There was a decrease in the median length of stay post-intervention (p=0.03). After controlling for birth weight, mortality rate was significantly reduced post-intervention, OR 0.63 (95% CI: 0.42–0.99). In conclusion, a nurse training program, using a modified S.T.A.B.L.E. Program, among nurses in a resource-limited setting can significantly improve nurse competency and the quality of patient care as measured by improvement in knowledge, processes and crucial patient outcomes such as mortality.
Neonatal intensive care unit (NICU) design has been evolving in significant ways in response to changes in neonatal care, based on continuing research. The single family room concept has gained broad acceptance for improving the physical environment for the preterm baby and its family while in the NICU. While there are many benefits associated with the single family room, there are some scenarios in the NICU that could benefit from the development of larger, multi-purpose patient rooms. The extended family room is a design concept for a new patient room prototype; one that has the flexibility to accommodate some of these additional care scenarios, such as couplet care for mothers immediately after birth, the birth of multiples, group care, hospice care, and super-critical babies.
A cross-sectional study was conducted to examine fathers' perceptions of their parental role among men with babies aged 4 to 12months. Data were collected on Personal Information Forms alongside scores from the Father Role Perception Scale between January and June 2015. Data were analyzed using percentage distributions, independent samples t test, and one-way ANOVA for comparison of more than two groups. Statistically significant differences were found in the scores of fathers for the fathers' role perception scale and their educational background, their profession, their level of income, their wives' educational background and their health insurance (p<.05). The fathers had high positive parental perception level scores.
The statistics regarding the aging American workforce, including the nursing workforce, are quite daunting. The aging workforce coupled with nursing's inability to recruit nurses to replace those leaving the field, creates a sense of urgency to develop strategies to retain the nurses actively engaged in the profession. There is also a sense of urgency to work to develop a subset of nurses to successfully assume leadership positions that will be vacated in the next five to ten years. Succession planning, management, and implementation are activities that are urgently needed in the nursing workforce today.Give light and the people will find their way Ella Baker (C) 2016 Elsevier Inc. All rights reserved.
Hypoxic ischemic encephalopathy (HIE) of the neonate is a devastating consequence of a spectrum of perinatal complications. The etiology of HIE is multifactorial with the level of neurological injury influenced by both the degree of ischemic insult and the infant’s gestational age. Early diagnostic imaging provides healthcare providers with objective data following ischemic brain injury, however it is unclear which modality or combination of modalities may provide the best prognostic information. Diffusion-weighted MRI has become the diagnostic tool of choice in moderate to severe neonatal HIE with a high predictive value; however the utility of MRI alone in mild HIE remains unclear. This case review presents an infant with HIE with abnormalities in both early cranial ultrasound and EEG, yet with a post-cooling MRI without significant abnormality. This case suggests that in mild HIE, multiple imaging modalities may be a more accurate predictor for neurological outcomes than MRI alone.
Modern neonatal intensive care arose from, and will forever depend upon, technology. There are increasing pressures to leverage new technologies to make care safer, more efficient and cost-effective. Changes in the delivery room will bring better monitoring and data display for the resuscitation team. Sensing and monitoring advances will be used in the NICU, measuring a wider range of physiologic parameters. Better integration of technologies with the EMR will be the basis for decision support and predictive analytics. Communication will be improved between the EMR, NICU staff and parents of newborns. Advances in conventional, CT, MRI and ultrasound imaging of neonates will aid in our diagnostic efforts. Ventilators are getting smarter, with wider ranges of support options and monitoring, in parallel with improvements in non-invasive respiratory support. New technologies can be used to evaluate and support neurodevelopment and to optimize nutrition. Laboratory testing can be done more rapidly, with smaller sample size and reduced costs, bringing more testing to the bedside. All these new technologies should optimize the NICU physical environment, improving the experience for patients, their families and hospital staff.
This Research Methodology Column will address issues and topics pertinent to conducting neonatal and infant research. Some of the columns will address current issues and topics while others will address longstanding or classic issues and topics. The goal of these columns is to inform novice and expert nurse researchers about the research process with neonates and infants, and help troubleshoot issues that might prevent, impede, or suspend research. This column is devoted consideration of timing of specific tests and measures with neonate/infant research participants.
This study explored factors influencing the implementation of environmental design guidelines to facilitate neurodevelopmental supportive care in neonatal intensive care units in a South African public hospital and recommended implementation strategies. A qualitative design, explorative, descriptive and contextual in nature was used, utilizing the Model of Synactive Organization of Behavioral Development as a guiding framework. Data collection was conducted during four focus group interviews with 20 professional nurses working in a neonatal intensive care unit (NICU). Thematic analyses were done using Tesch's eight-step approach. Three themes emerged: current practices regarding the best practice guidelines, reasons for not implementing best practice guidelines and recommendations to implement best practice guidelines. Available best practice guidelines were not implemented due to shortages of staff, poor maintenance plans, financial constraints and lack of resources. These aspects need to be addressed for best practice guidelines to be implemented and sustained to enhance preterm infants' neurodevelopmental outcomes.
