The analgesic effects of breastfeeding (BF), skin-to-skin care (SSC), and oral sucrose/glucose for neonates during painful procedures are well-established. Although parents report wanting to comfort their babies during painful procedures, use of these strategies is inconsistent. This study investigated clinicians' support/use of BF, SSC and sucrose during newborn heel lance in Australia and perceptions of a clinician-targeted video demonstrating how to perform heel lance while newborns were BF/SSC. A cross-sectional online survey was conducted. Snowball sampling and distribution via partner organizations were used. Descriptive statistics and content analysis were used for quantitative and qualitative data, respectively. Respondents included 729 nurses, midwives, and phlebotomists, caring for healthy newborns (39%, n = 283); sick newborns (41% n = 300) and both sick and healthy newborns (20%, n = 146). Most respondents caring for healthy newborns were "very likely" to support BF (80%, n = 199) and SSC (65%, n = 162). Most (89%, n = 237) caring for sick newborns were "very likely" to use sucrose; one third "very likely" to support mothers to BF (29%, n = 78) and 32% (n = 85) to use SSC. Barriers to BF and SSC included parents being absent and critically ill newborns. Most considered the video applicable (81%, n = 488) and likely to increase BF or SSC (84%, n = 502). Analysis from comment data identified two categories: "healthcare context and practice" and "parent and baby." The key findings that clinicians reported the video to be highly useful and that BF and SSC during heel lance for healthy newborns was high confirm that further research is needed to examine parents' use of BF and SSC during painful procedures.

Developmental care (DC) mitigates the impact of neonatal intensive care unit (NICU) stressors on infants and their families. However, the effect of variable exposure to DC-educated nurses on infant and parent outcomes remains unclear. Social network analysis (SNA), which maps relationships and interaction patterns, was used to evaluate the influence of nurse DC education in a surgical NICU (sNICU). In this prospective observational study, 45 infants >34 weeks' gestation, their parents, and sNICU nurses participated. We examined associations between nurse DC education levels and infants' behavioural and physiological responses during caregiving, nurses' perceptions of infant behaviour, and parents' perceptions of nurse support. Nearly one-third of infants received care from DC-educated nurses for less than half of their hospital admission. Exposure to nurses without DC education was associated with higher odds of infant inconsolability [OR: 11.30 (1.32; 96.56), p = .027], increased requirement for support during caregiving (p = .032) and reduced parental perception of emotional support from nurses [Mean Difference - 0.16 (-0.31; -0.01), p = .043]. Decreased continuity of care (repeat nurse allocation) significantly increased the likelihood of parental depression at 4 months corrected gestational age [OR: 1.93 (1.02; 3.66), p = .044]. These findings highlight the immediate and longer-term effects of DC education and consistent caregiving exposure on parent and infant outcomes. Based on these findings integrating evidence-based DC education and promoting continuity of care in sNICUs should be prioritised to optimise developmental outcomes and support emotional wellbeing during a critical period of infant and family adaptation within and beyond the NICU.

OBJECTIVE:To investigate infants' physiological and behavioral responses during routine nurse-delivered care following surgery. DESIGN:Cross-sectional observational study. SETTING:Surgical NICU. PARTICIPANTS:Infants (N = 45) who underwent major neonatal surgery after 34 weeks gestation for congenital anomalies. METHODS:We used bedside monitoring sources to capture continuous heart rate (HR) data and video-recorded nurse-delivered care episodes. We defined physiological stress as a change in mean HR of 10 bpm or more across pre-, during, and post-nurse-delivered care. Two independent reviewers evaluated infant state, stress, and self-regulation behaviors. We analyzed 99,840 HR data points and 1608 min of infant behavior video data. We used correlation to explore relationships among variables and used analysis of variance (ANOVA) methods and t tests to explore effects of care on infant responses within and between groups. RESULTS:In total, 24 participants (53.3%) had gastrointestinal surgery, 11 (24.4%) had cardiac surgery, and 10 (22.2%) had respiratory/esophageal surgery. Nurse-delivered care significantly affected HR. Changes in mean HR (bpm) varied across groups, with a mean change of 15.3 (SD = 12.88) for gastrointestinal surgery, a mean change of 11.8 (SD = 10.94) for cardiac surgery, and a mean change of 11.3 (SD = 8.19) for respiratory/esophageal surgery (ps' < .018). All groups exhibited behavioral stress indicators, including squirm, splay, and limb extension. Infants who had cardiac surgery exhibited vocal sounds more frequently than twitching of extremities (p = .019). CONCLUSION:Infants demonstrated physiological and behavioral stress during post-surgical nurse-delivered care. We observed variation between surgical groups that may represent the differing effects of congenital anomalies. Education about expected responses of infants with specific surgical conditions would equip nurses to better mitigate infant stress post-surgical responses.

ABSTRACTRepetitive and prolonged experience of pain by infants in neonatal intensive care units (NICUs) may adversely affect growth and alter pain responses. The degree of infant prematurity and/or presence of neurological impairment (NI) may impact an infant's ability to behaviorally respond to pain. This study aimed to determine whether the scores on the mPAT, a widely used pain assessment tool, is impacted by postmenstrual age (PMA) at assessment, irrespective of neurological impairment. Data from medical records were collected on infants admitted to the NICU who underwent a pain assessment with the modified Pain Assessment Tool (mPAT) between March 2019 and September 2021. Total mPAT, behavioral, and physiological pain scores were independently analyzed using logistic regression to detect differences based on PMA categories (< 33 weeks, 33–36 weeks, ≥ 37 weeks) and presence of NI. Significant differences were indicated when p < 0.05. Of 204 infants sampled, 62% were male, and 71% were born at term‐age (i.e., ≥ 37 wks). Thirty‐six (18%) infants had a queried or confirmed NI and 28 (14%) infants were postsurgical. Logistic regression analysis showed that neither PMA nor presence of NI predicted pain for total mPAT scores (χ2 (3) = 3.9, p > 0.05) or physiological scores (χ2 (3) = 2.7, p > 0.05). Higher behavioral scores were 3.7 times (OR 0.27, 95% CI 0.10–0.77, p = 0.01) more likely in extremely‐to‐very preterm (< 33 weeks) infants when compared to term (≥ 37 weeks) infants. The mPAT may be suitable for clinicians to utilize when assessing infants in NICUs regardless of PMA or NI status. The higher behavioral responses in younger infants require further investigation in a future prospective study.

Aim(s)To identify, synthesise and map systematic reviews of the effectiveness of nursing interventions undertaken in a neonatal intensive care unit or special care nursery.DesignThis scoping review was conducted according to the JBI scoping review framework.MethodsReview included systematic reviews that evaluated any nurse-initiated interventions that were undertaken in an NICU or SCN setting. Studies that reported one or more positive outcomes related to the nursing interventions were only considered for this review. Each outcome for nursing interventions was rated a 'certainty (quality) of evidence' according to the Grading of Recommendations, Assessment, Development and Evaluations criteria.Data SourcesSystematic reviews were sourced from the Cochrane Database of Systematic Reviews and Joanna Briggs Institute Evidence Synthesis for reviews published until February 2023.ResultsA total of 428 articles were identified; following screening, 81 reviews underwent full-text screening, and 34 articles met the inclusion criteria and were included in this review. Multiple nursing interventions reporting positive outcomes were identified and were grouped into seven categories. Respiratory 7/34 (20%) and Nutrition 8/34 (23%) outcomes were the most reported categories. Developmental care was the next most reported category 5/34 (15%) followed by Thermoregulation, 5/34 (15%) Jaundice 4/34 (12%), Pain 4/34 (12%) and Infection 1/34 (3%).ConclusionsThis review has identified nursing interventions that have a direct positive impact on neonatal outcomes. However, further applied research is needed to transfer this empirical knowledge into clinical practice.Implications for the profession and/or patient careImplementing up-to-date evidence on effective nursing interventions has the potential to significantly improving neonatal outcomes.Patient or public contributionNo patient or public involvement in this scoping review.

Background: Nurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses' perceptions of developmental care. Objective: To determine perceptions and attitudes towards developmental care in a specialty neonatal setting. Design: Cross-sectional study. Settings: Two surgical neonatal intensive care units in Australia. Participants: Registered nurses permanently employed at the study sites between May 2021 to April 2022. Methods: A modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses' perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)]. Results: Of 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement ( >90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3-8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1-6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1-6.2]. Conclusions: The results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.

Purpose Identifying interventions that significantly impact on neonatal outcomes and mapping them to practice standards distinguishes neonatal nurses' unique contribution to quality health care. This article describes the implementation science model utilised by a group of senior neonatal nurses to develop an evidence-based audit tool and neonatal care bundle. Methods We utilised a four-step implementation science mapping process: 1) Establishment of a stakeholder group; 2) Identification of 20 nursing interventions with high to moderate evidence (certainty); 3) Mapping the interventions across National and International Neonatal Care Standards, and; 4) Development of seven Intervention/Standard Models. Results The project team identified 20 nursing interventions with high to moderate evidence (certainty) that positively impact neonatal morbidity and mortality. The interventions were then categorised into seven models and mapped against national and international neonatal nursing care standards to provide a comprehensive reference framework for defining best-practice neonatal care. The models included infant and family development, neonatal pain, nutrition and feeding, infant thermoregulation, respiratory support and care, prevention of neonatal jaundice, and the prevention of neonatal sepsis. Conclusion and practice implications The seven models provide a foundation for high-quality neonatal care that can be used to measure and ensure adequate neonatal staffing and skill mix.

AIM:The primary objective of this study is to determine the impact of a standardised feeding protocol for infants with gastroschisis on early enteral feeds, suck feeds, management of gastric residuals and breastfeeding at discharge. Secondary objectives were evaluation of growth, length of stay in neonatal intensive care unit (NICU), the duration of total parental nutrition (TPN), blood-culture confirmed sepsis and serum bilirubin level (SBR). METHODS:This single-centre retrospective quality improvement project included infants admitted to a quaternary care NICU for management of gastroschisis from 2010 to 2021. The Gastroschisis feeding protocol, a standardised pathway for managing the feeding of infants with gastroschisis, was implemented in this NICU in 2016. The outcomes of infants in the pre-feeding protocol and post-feeding protocol groups were compared. RESULTS:Of the 100 infants included in the study, 49 were in the post-feeding protocol group. The baseline characteristics of the study population did not differ statistically in both groups. In post-feeding protocol group, there was significant reduction in the time to the first enteral feed (P value <0.0001) and first suck feed (P value = 0.002). The median length of stay in the post-feeding protocol group was significantly lower by 11 days (P value = 0.001). Duration of TPN was 241 h higher in the pre-feeding protocol group (P value 0.0007). CONCLUSIONS:Implementation of a feeding protocol in infants with gastroschisis led to earlier initiation of enteral feeds and suck feeds. There is a likelihood of reduction in the use of TPN and duration of admission in NICU.

Objective To determine whether continuous local anaesthetic wound infusion (CLAWI) provides more effective pain relief and decrease the need for systemic opioids compared to other analgesic agents in term or preterm newborn infants undergoing thoracic or abdominal surgery. Methods Cochrane Central Register of Controlled Trials, Medline, Embase and CINAHL were searched from database inception to August 2022. Publications were screened and their references were hand-searched to identify additional studies. This review included randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. Two reviewers independently extracted data and examined the methodological quality of the eligible studies. A meta-analysis was performed for available outcomes. Results After screening 1202 articles, two RCTs with 98 patients were included. Meta-analysis for combined data was possible for only two outcomes: pain scores post-surgery and length of hospital stay. The random effects model for the pooled standardised mean difference of pain scores between treatment groups post-surgery was -2.54 (95 % CI:7.53, 2.46, p = 0.3196) and for length of stay in the NICU was -0.19 (95 % CI:0.58, 0.21, p = 0.3574), suggesting that CLAWI was not more effective in either providing pain relief or reducing length of stay. However, the small number of studies included, the considerable heterogeneity between the studies, and the small sample sizes of the individual studies limit the generalizability of the findings. Conclusion This review highlights the need for further, adequately powered well-designed, multicentre trials to examine the effectiveness of CLAWI in reducing postoperative pain in newborns undergoing abdominal and thoracic surgery. Level of evidence Level I - Evidence from a systematic review of all relevant randomized controlled trials

Admission to the surgical neonatal intensive care unit (sNICU) is a stressful experience. Care is often complex, with inherent risks and potential complications. This study describes the implementation of an outpatient mental health screening process for parents of infants admitted to a sNICU. Parents of infants aged >34 weeks gestation with a congenital anomaly requiring neonatal surgery participated in this prospective observational study. Standardised measures to screen for parenting stress (Parenting Stress Index™ Fourth Edition Short Form) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) were administered at the first outpatient visit scheduled when the infant's corrected gestational age was 4 months. A triage algorithm was developed, to review the initial screening results prompting appropriate action and intervention. Positive screens were triaged as evaluate (assess within 48 h), targeted information (email contact), or escalate response (same day risk assessment). Demographic factors associated with parental stress and depressive symptoms were explored. Forty parents (response rate: 88 %) participated in screening. A high portion of parents (52.5 %) required secondary screening, for parenting stress (n = 10), depressive symptoms (n = 5) or both stress and depressive symptoms (n = 6). Socioeconomic disadvantage was positively associated with parenting stress (p = 0.02) and greater depressive symptoms with parent education levels (p = 0.01). Results indicate screening of parent mental health in the outpatient setting is feasible. Use of a triage algorithm helped prioritise parent follow-up and facilitate workflows. Parent mental health screening should be prioritised within and beyond the sNICU to support family and infant outcomes during this critical period of development.

Parents' whose babies underwent surgery, completed five days of stay in the surgical neonatal intensive care unit (NICU) and were literate in English, participated in this exploratory cohort study. Parents provided written responses to two open-ended questions relating to their baby's pain management. Thematic analysis of data from 52 parents revealed four major themes: Information Resources; Communication Practices; Barriers to Parental Role; and Staff Appreciation. The majority of parents wanted information provided in different formats about how to recognise their babies' pain and how to comfort their babies in addition to discussions with clinicians. They also wanted the choice to stay with their baby during painful procedures. A barrier to this was COVID-19 restrictions. Twenty-nine percent of parents responded that no additional resources were required. The findings highlight the need to improve parent-focussed resources and clinician education to better inform and support parents' involvement in managing their babies' pain in the surgical NICU.

To explore neonatal nurses' and parents’ perceptions of parental needs and stressors in a surgical neonatal intensive care unit (NICU) using the Neonatal Family Needs Inventory and Parental Stressor Scale:NICU. Matched data for 99 nurse-parent dyads showed only limited agreement (Gwet's agreement coefficients 0.23 - 0.26). Nurses recognised Assurance as parents' priority need and Parental Role Alteration as parents' greatest stressor. They identified 8 of parents' 10 most important needs and recognised parents' highest stressors. Nurses under-estimated the importance of mothers' (p's < 0.01, large effect sizes [ES]) but not fathers' needs. They under-rated parents' stress at feeling helpless to protect their baby and overrated stress around NICU sights and sounds (medium ES's). Nurses' years of NICU experience showed no significant effects. Greater awareness is needed of the importance and uniqueness of parents’ needs and stressors. Education to enhance attunement would better support individualized family-centred care.

Parents whose babies had undergone major surgery and were admitted to the surgical neonatal intensive care unit for more than five days, and who could communicate in English were surveyed to explore their use of nonpharmacological methods to manage their baby's procedural pain in the post-operative period. Eighty-one parents, including 48 mothers, completed a 4-part questionnaire. Parents most frequently used physical and comforting touch methods to comfort their babies. Skin-to-skin care, sucrose, breastmilk-scented pads, and breastfeeding were least frequently used. While the majority of parents were aware of most unit practices regarding their baby's pain management, some practices needing greater awareness were identified. These findings highlight the need to promote a range of parent-led nonpharmacological pain management methods. This could be achieved by educating clinicians to collaboratively support and encourage parents' involvement in managing their baby's pain.

BACKGROUND:Evidence for analgesic effects of parent-led pain management strategies during painful procedures in newborn infants exists; however, such strategies are inconsistently used in practice. A publicly available parent-targeted video demonstrates breastfeeding, skin-to-skin care, and sucrose during painful procedures. Australian parents' use and knowledge of this video and these strategies was unknown.PURPOSE:To determine parents' use of pain management strategies, and perceived acceptability and usefulness of the parent-targeted video.METHODS:A cross-sectional, online, anonymous survey with embedded video. Participants were recruited via social media channels of the Miracle Babies Foundation, an Australian parent support network. Target participants were parents or family members of infants currently or previously hospitalized in neonatal special and/or intensive care nurseries, or high dependency units.RESULTS:A total of 162 of 189 respondents provided sufficient data for analysis; all identified as mothers. Only 6 (4%) had previously seen the video; however, nearly all rated it as potentially useful and helpful (n = 124, 82%). Although most reported that sucrose had been used (n = 112, 84%), fewer reported having used skin-to-skin care (n = 50, 37%), or breastfeeding (n = 33, 25%). Most intended to advocate for skin-to-skin care (n = 108, 88%) or breastfeeding (n = 100, 81%) in future procedures. Perceived barriers to utilizing strategies included lack of information-sharing and organizational practices that excluded parent involvement.IMPLICATIONS FOR PRACTICE AND RESEARCH:The video may be valuable in supporting mothers to advocate for their involvement during painful procedures in preterm and sick hospitalized infants. Further research is recommended to explore coordinated strategies targeting parents and healthcare professionals to overcome barriers to implementing parent-led infant pain management strategies.

Objective To determine the effect of continuous wound infusion of local anaesthetic drug (bupivacaine) on total amount of systemic opioid use in the first 72 hours in newborn infants undergoing laparotomy.Design A two-arm parallel, open-label randomised controlled trial.Setting A quaternary newborn intensive care unit.Patients Infants>37 weeks of gestation undergoing laparotomy for congenital or acquired abdominal conditions.Interventions Continuous wound infusion of local anaesthetic (bupivacaine) for the first 72 hours along with systemic opioid analgesia (catheter group) or only systemic opioid analgesia (opioid group).Main outcome Total amount of systemic opioid used within the first 72 hours post laparotomy.Results The study was underpowered as only 30 of the expected sample size of 70 infants were enrolled. 16 were randomised to catheter group and 14 to opioid group. The two groups were similar at baseline. There was no significant difference between the groups for the primary outcome of median total systemic opioid use in the first 72 hours post laparotomy (catheter 431.5 µg/kg vs opioid 771 µg/kg, difference −339.5 µg/kg, 90% CIhigh 109, p value 0.28). There was no significant difference between the groups for any of the secondary outcomes including pain scores, duration of mechanical ventilation, time to reach full feeds and duration of hospital stay. There were no adverse events noted.Conclusion Continuous wound infusion of local anaesthetic along with systemic opioid analgesia is feasible. The lack of a difference in total systemic opioid use in the first 72 hours cannot be reliably interpreted as the study was underpowered.Trial registration number ACTRN12610000633088.