BACKGROUND Early skin-to-skin contact (SSC) is an evidence-based care practice with well-documented benefits for preterm infants and their parents. Among extremely preterm infants, implementation of early SSC remains variable across neonatal intensive care units (NICUs), despite growing evidence supporting its safety. Nurses play a central role in facilitating SSC, and their perceptions and perceived barriers may influence its implementation. PURPOSE To describe NICU nurses' perceptions of early SSC for extremely preterm infants and to identify perceived barriers to its implementation in neonatal intensive care settings. METHODS A descriptive cross-sectional study using a web-based survey was conducted among NICU nurses in Finnish university hospitals. A total of 148 nurses responded, and the data were analyzed using descriptive statistics and one-way analysis of variance. RESULTS Most nurses held positive perceptions toward early SSC, whereas most considered it not feasible for all extremely preterm infants, and many reported safety-related and family-related concerns. Perceived barriers varied significantly between NICUs (P < .001) and by NICU experience (P = .018), with higher barriers among nurses with 2-5 years of experience. Early SSC was not perceived by most nurses to increase workload. IMPLICATIONS FOR PRACTICE AND RESEARCH Consistent implementation of early SSC appears to depend on unit-level practices and nurses' experience. Clear clinical guidance, staff education, and parental support may facilitate its integration into routine neonatal care, whereas further research is needed to identify effective implementation strategies.
ABSTRACT Background: Accurate assessment of neonatal jaundice requires competent healthcare providers. Evidence suggests that educational and competency-building interventions improve provider performance and adherence to evidence-based practices, highlighting the importance of strengthening provider competency to support early detection and neonatal outcomes. Purpose: Improving Healthcare Provider Competency in Neonatal Jaundice Screening Using a Transcutaneous Bilirubinometer in Rwanda. Methods: A pre–post educational evaluation was conducted among 47 healthcare providers, including nurses, midwives, and doctors, at a large tertiary hospital in Kigali, Rwanda. Competency-based education, hands-on training in TcB use, supervised clinical practice, and monthly performance feedback were provided. Paired t-tests were used to compare baseline and postintervention scores; a run chart was used for monitoring monthly trends, and Cohen d was calculated to assess effect sizes. Results: Statistically significant improvements were observed in provider knowledge, practical skills, and documentation accuracy after implementation of the competency-building intervention ( P < 0.001 for all comparisons). Knowledge scores increased from 80.3% to 91.8%, practical skills from 40.8% to 97.1%, and documentation accuracy from 85.6% to 91.3%. Monthly assessments demonstrated progressive improvement across the implementation period. Implications for Practice and Research: Strengthening and sustaining healthcare provider competency should be prioritized to ensure consistent and accurate neonatal jaundice assessment, and future research should evaluate strategies that support long-term adherence to screening practices.
BACKGROUND Necrotizing enterocolitis (NEC) is a multifactorial disorder of the gastrointestinal tract of very low birth-weight (VLBW) infants. Blood transfusions are suspected to be associated with NEC in this population. PURPOSE To examine the association between packed red blood cells (PRBCs) transfusion and NEC in VLBW neonates (less than 1500 gm) or less than 32 weeks. METHODS A retrospective cohort study of all VLBW neonates admitted to the neonatal intensive care unit (NICU) at King Abdulaziz University Hospital (KAUH) from January 1, 2014, to December 31, 2020. RESULTS Of 3018 newborns admitted to the NICU, 441 were VLBW neonates born at less than 32 weeks of gestational age (mean: 29 weeks ± 2.3; male: 220, 49.9%). The sample was divided into 2 groups: those who developed NEC 49 (11.1%) and those who did not develop NEC 392 (88.9%). Infants who developed NEC had significantly lower birth weight, gestational age (GA), and initial hematocrit (P < 0.05). Although blood transfusions were more often noted in those who developed NEC 7.4% versus 32.1% (P < 0.01), only sepsis showed significant associations with NEC, OR 8.2 (3.893-17.259) after adjusting for other studied risk factors. IMPLICATION FOR PRACTICE AND RESEARCH PRBC transfusion was not associated with an increased risk of NEC in VLBW neonates. Sepsis was the only variable found to be significantly associated with NEC. Future prospective cohort studies to assess the role of anemia, the timing of PRBC transfusion, and the number of transfusions on incidence of NEC are needed.
BACKGROUND Peripherally inserted central catheters (PICCs) are commonly used in neonatal intensive care units (NICUs) to provide prolonged intravenous access for preterm and critically ill infants. They are generally preferred over surgically placed central venous catheters because of easier insertion and, in some settings, lower infection rates. However, rare but life-threatening complications may occur. Cardiac tamponade, resulting from catheter malposition or delayed migration with perforation of the superior vena cava (SVC) or cardiac wall, is one such complication. This case highlights the need for vigilant monitoring even when initial catheter placement is confirmed as correct. CLINICAL FINDINGS A male infant born at 32 weeks' gestation with intrauterine growth restriction (IUGR) required mechanical ventilation and surfactant therapy. A PICC was inserted through the right radial vein, and radiographic assessment confirmed appropriate positioning in the SVC. The infant initially improved. On day 10 of NICU admission, he developed sudden respiratory distress, hypotonia, bradycardia, and cardiovascular collapse. DIAGNOSIS Echocardiography demonstrated severe pericardial effusion and cardiac tamponade due to SVC perforation by the PICC tip. INTERVENTION AND OUTCOME The catheter was immediately removed, and emergency pericardiocentesis was performed. Despite aggressive resuscitation, the infant died on day 11 of life. PRACTICE RECOMMENDATIONS Delayed perforation can occur days after apparently correct placement. Preventive strategies should include risk-stratified catheter positioning, preference for lower SVC tip placement, routine echocardiographic surveillance especially after the first week and enhanced staff training for early recognition of warning signs. Continuous quality improvement and readiness for emergency intervention are essential to improve neonatal outcomes.
BACKGROUND Black preterm infants cared for in the neonatal intensive care unit (NICU) are less likely to receive mothers' own milk (MOM) at NICU discharge than non-Black preterm infants. This disparity increases the risk of health and neurodevelopmental problems and their associated costs throughout the lifespan. One modifiable barrier to receipt of MOM at NICU discharge may lie within the role of Black maternal matriarchs; however, this role is not well characterized. PURPOSE To describe and synthesize evidence related to the Black matriarch's influence on a mother's decision to provide MOM for a preterm infant hospitalized in a NICU. DATA SOURCES We searched the Cochrane Database of Systematic Reviews, CENTRAL, PubMed, CINAHL, and Web of Science databases and reviewed reference lists of included articles. STUDY SELECTION A total of 139 articles were retrieved (n = 99 after deduplication), of which 2 met a priori criteria for inclusion. DATA EXTRACTION We conducted an integrative review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. RESULTS One key theme emerged: the Black matriarch serves as a barrier to continued MOM provision among mothers of preterm infants in the NICU, despite mothers perceiving the Black matriarch as supportive or helpful. IMPLICATIONS FOR PRACTICE AND RESEARCH Matriarchal influence over Black women's decision to provide MOM to their preterm infant hospitalized in the NICU likely serves as a barrier to continued MOM provision. Research priorities include developing culturally sensitive instruments to measure Black matriarchal support for MOM provision and conducting intergenerational studies.
