Neonatal Intensive Care Unit Care Research Articles

Updated management protocols of common situations in neonatal intensive care units

Objective To review the updated management protocols of common situations in the neonatal intensive care unit (NICU). Data sources A systematic search of MEDLINE (PubMed, Medscape, ScienceDirect, EMF-Portal) and Internet was conducted on all articles published from 2000 to 2018. Study selection English-language reports of the updated management protocols of common situations in the NICU. The initial search presented 160 articles where 23 had inclusion criteria. Data extraction Articles not reporting on updated management protocols of common situations in the NICU in the title or abstract were not included. Fifteen independent investigators extracted data on the methods. Data synthesis Comparisons were made by a structured review with the results tabulated. Seven authors emphasized on the new approaches for managing neonatal hypoglycemia, 16 about the management of neonatal hyperthermia, seizures, and transport. Findings Dextrose gel is safe and has the potential to decrease health-care costs and other risks related to the treatment of hypoglycemia. Antiepileptic drugs are then administered according to clinical preference, independent of the seizure cause. It should only be initiated once seizure activity is confirmed, due to a lack of evidence for any positive outcomes if they are administered in the absence of seizures. As a mobile ICU, transport vehicles, equipment, and supplies must reflect the needs of the patient population. Conclusion Further phrasing of guidelines to cover all aspects of neonatal care in the NICU, following the application of the set protocols in the practical field. Detecting improvement or deterioration of the outcome after applying these protocols to have an 'evidence-based' judgment over these selected guidelines.

Maternal Bacteremia Caused by Staphylococcus Aureus With a Focus on Infective Endocarditis.

BackgroundSepsis is an important cause of morbidity and mortality in the pregnant patient. Injection drug use in pregnant populations has led to increased cases of bacteremia and infective endocarditis (IE) due to Staphylococcus aureus. We describe all cases of S. aureus bacteremia and IE among admitted pregnant patients at our hospital over a 6-year period.MethodsThis was a retrospective review of pregnant patients hospitalized with S. aureus bacteremia between April 2013 and November 2019. Maternal in-hospital mortality and fetal in-hospital mortality were the primary outcomes measured; the secondary outcome was the rate of 6-month maternal readmission.ResultsTwenty-seven patients were included; 15 (56%) had IE. The median (interquartile range [IQR]) age was 29 (25–33) years; 22 (82%) patients had methicillin-resistant S. aureus. Infection onset occurred at a median (IQR) of 29 (23–34) weeks’ gestation. Twenty-three (85%) mothers reported active injection drug use, and 21 (78%) were hepatitis C seropositive. Fifteen (56%) mothers required intensive care unit (ICU) care. Twenty-two (81%) patients delivered 23 babies; of the remaining 5 mothers, 3 (11%) were lost to follow-up and 2 (7%) terminated pregnancy. Sixteen (73%) babies required neonatal ICU care, and 4/25 (16%) infants/fetuses died during hospitalization. One (4%) mother died during hospitalization, and 7/26 (27%) mothers were readmitted to the hospital within 6 months for infectious complications.ConclusionsInjection drug use is a modifiable risk factor for S. aureus bacteremia in pregnancy. Fetal outcomes were poor, and mothers were frequently readmitted secondary to infection. Future targeted interventions are needed to curtail injection drug use in this population.

Risk factors for postpartum depression in mothers of newborns admitted to neonatal intensive care unit

ABSTRACT Background There is a lack of information on how maternal stress coping styles during admission of the newborn to the neonatal intensive care unit (NICU) influences the onset of the postpartum depression (PPD). We examined potential risk factors for the emergence of the PPD in mothers whose infants were admitted to the NICU. Methods A cross-sectional study was conducted on 401 mothers, 125 were mothers whose infants were admitted to the NICU and 276 mothers without NICU care. Newborn illness severity information score was taken throughout NICU admission via the Clinical Risk Index for Babies (CRIB). Six weeks after giving birth, participants from both groups individually completed the Edinburg Postnatal Depression Scale (EPDS), the Postpartum Bonding Questionnaire (PBQ) and the Coping Strategies Inventory (CSI) using an online platform. Results No differences were found regarding PPD and bonding in either groups. Multivariate analysis provided a final model in which cognitive restructuring, problem avoidance, severity of neonatal health problems during the first 12 hours of life, and problem solving were the best predictors of postpartum depression explaining, 43.7% of the variance in the NICU group. Conclusion It is necessary to obtain early detailed information on coping styles in the NICU environment to prevent the possible onset of PPD.

Human Milk Fat Loss Is Strongly Affected by Syringe Position During Tube Feeding in the NICU Population

Abstract Objectives Human milk is the recommended feeding for preterm infants. It is a dynamic, non-homogenized fluid. The most variable component is the fat content, which rapidly separates out when milk is allowed to sit. Fat from human milk is thought to adhere to the plastic syringe and tubing products used to administer tube feedings. The objective of this study was to identify best practices for tube feeding preterm infants to minimize nutrient loss from human milk during administration in the Neonatal Intensive Care Unit (NICU). Methods A study was conducted to investigate the effect of different tube feeding methods on the macronutrient content of donated unpasteurized (raw) frozen human milk samples. Tube feeding scenarios tested were: (1) 30 min pump syringe tip horizontal; (2) 30 min pump syringe tip up; (3) 4 hr pump syringe tip horizontal; (4) 4 hr pump syringe tip up; (5) 15 min gravity syringe tip down; (6) 30 min gravity syringe tip down; and (7) controls. Fat loss was calculated using paired “pre” and “post” samples (n = 51 pairs). Percent fat loss was compared for each scenario versus control. Results More fat was lost with syringe tip horizontal or down than with tip pointed up. Another contributing factor was the pump infusion time. Greatest fat loss occurred with the 4 hr pump syringe tip horizontal (average fat loss 13.1%), followed by: 4 hr tip up (8.3%); 30 min tip horizontal (6.7%); and 30 min tip up (3.4%). Fat loss via gravity drip was similar for 15 min (6.6%) and 30 min (5.7%), so the two gravity scenarios were combined into one. Fat loss for controls was small (1.5%). Except for the 30 min pump tip up scenario (P = 0.16), all the other scenarios had higher fat loss when compared to control (P-values <0.001). Conclusions These findings suggest that, for best delivery of fat, tube feedings of raw human milk given by pump should be run with the syringe tip pointed directly up and with the shortest infusion time that the infant will tolerate. In contrast to previous published studies, both 15 and 30 min gravity drip delivery resulted in more fat loss than 30 min pump infusion with syringe tip up. This difference may be due to the short gravity delivery times (<5 min) reported in prior studies. In our study, 15 and 30 min times were tested for gravity delivery to more realistically mimic those observed in routine NICU care. Funding Sources N/A.

Immunization practices and adverse events following vaccination in infants admitted to the Neonatal Intensive Care Unit

Objective: To determine if vaccinations administered in the neonatal intensive care unit (NICU) were administered following Centers for Disease Control and Prevention guidelines while assessing for adverse reactions in the 48 hours post-vaccination. Study Design: Retrospective cohort study of infants who received Diphtheria-Tetanus-Pertussis, inactivated Polio, Hepatitis B vaccines during NICU admission from February 2016 to January 2017 with a total of 337 immunization events reviewed. Data were assessed to determine vaccination delay according to recommended schedules as well as rate of adverse events. Knowledge base and attitudes were evaluated through a questionnaire administered over a three-week period to NICU care providers. Results: Of the 337 immunization events reviewed, 256 vaccines were administered within 7 days of the recommended vaccination schedule, leaving 24% (n=81) administered outside of this schedule. Taking into account weaning of respiratory support and deterioration of respiratory status in the 48 hours prior to vaccination, total adverse event rates for the remaining 312 immunization events were 2% (n=7). Questionnaire showed many providers felt adverse events are commonplace following vaccination and highlighted a possible gap in knowledge of recommended vaccination guidelines. Conclusions: This study suggests neonates admitted to the NICU are at risk for vaccination delay. Immunizations have a low rate of adverse events, thus confirming safety. Factors that may increase adverse events post-immunization include coincidental worsening of overall status and recent wean in respiratory support. Further studies are needed to examine best practices to promote improved vaccination in the NICU.

Single-centre prospective observational study on postdelivery room care

ObjectivesAs quality of care in the delivery room has major impact on outcome of preterm infants, multiple guidelines have been established in recent years. There is, however, little evidence on...

The effects of latency period in PPROM cases managed expectantly

Objective: Preterm premature rupture of membranes (PPROM), associated with prematurity, is an important obstetric complication that may cause neonatal mortality and morbidity. The optimal delivery time is controversial in cases with the expectant approach. The fetal effects of long-term exposure to PPROM are unknown. This study aimed to evaluate the maternal and fetal outcomes of expectantly-managed PPROM cases with different latency periods at 240/7–346/7 weeks of gestation.Material and method: The study group consisted of 206 patients at 240/7–346/7 weeks of gestation who met the inclusion criteria. Patients were divided into three groups according to their weeks of PPROM diagnosis as 240/7−286/7, 290/7−316/7, and 320/7−346/7. The period from membrane rupture to delivery was defined as the latency period and divided into three subgroups as 3–7 days, 8–13 days and ≥14 days. In addition to the demographic characteristics of the patients, maternal and obstetric complications, primary and secondary neonatal outcomes were compared between the groups. Primary neonatal outcomes were determined in terms of pathological Apgar scores (<5 at minute 1, <7 at minute 5), requiring resuscitation, admission to Neonatal Intensive Care Unit (NICU) and NICU length of stay. Secondary neonatal outcomes were determined in terms of respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, periventricular leukomalacia, and neonatal sepsis. In addition, for the prediction of morbidity and mortality, newborns were evaluated by SNAPPE II (Score for Neonatal Acute Physiology with Perinatal extension-II) consisting of the combination of biochemical and physiological parameters, using the parameters including mean blood pressure (mm/Hg), corporal temperature (°C), PO2/FiO2 ratio, lowest serum pH, multiple seizures, urine output (ml/kg/hr), Apgar score, birth weight, and small for gestational age. The higher the score of SNAPPE II, the higher the morbidity and mortality risk of neonates. For the statistical analysis, the Kruskal Wallis and one-way ANOVA tests were utilized for the numerical data. Categorical data were compared using the chi-square test. The receiver operating characteristic (ROC) test was used to determine the threshold value of the data affecting neonatal morbidity.Results: The mean PPROM week was found to be 29.7 ± 3.0 weeks and the mean delivery week was 31.8 ± 2.5 weeks. The mean latency period for all the patients was 15.1 ± 13.8 days. Clinic chorioamnionitis was observed in 17% of the cases. The lowest chorioamnionitis rate (8.6%) was in the 3–7-day latency period group. Total complications were significantly lower in the 290/7–316/7 week PPROM group in which the latency period was ≥14 days, compared to those in 3–7 days and 8–13 days (p = .001). Total complications were lower in the < 32 weeks PPROM groups in which the latency period was ≥14 days compared to those obtained in 3–7 days and 8–13 days. There was no significant difference between the latency period and total complications after 32 weeks (p = .422). The best discriminative cutoff value of SNAPPE-II for neonatal morbidity was 11.0 (sensitivity 82%, specificity 80%). In the present study, the optimal latency period for the best neonatal outcomes was found to be 34.5 days (sensitivity 70% and specificity 84%) between weeks 240/7–286/7, and 11.0 days between weeks 290/7–316/7 (sensitivity 68% and specificity 85%).Conclusions: Our findings indicated that a long latency period did not increase neonatal morbidity and there was no increase in neonatal complications after 32 weeks of the gestational period compared to those obtained before 32 weeks.

Do NICU developmental care improve cognitive and motor outcomes for preterm infants? A systematic review and meta-analysis

BackgroundThe aim of this study was to review the effects of developmental care in neonatal intensive care unit (NICU) setting on mental and motor development of preterm infants.MethodWe searched PubMed, EMBASE, CINAHL, Scopus, Web of Science and Cochrane library until October 8th 2017, and included randomized controlled trials that assessed effects of developmental care in NICU on mental and motor development of preterm infants at 12 and 24 months of age, using the Bayley scale of infant development in this systematic review. In addition, data were pooled by random effects model and Standardized Mean Difference (SMD) with 95% confidence intervals (CI), calculated for meta-analysis.ResultsTwenty one studies were eligible to be included in this systematic review; however, only thirteen studies had data suitable for meta-analysis. According to statistical analysis, developmental care in NICU improved mental developmental index (MDI) (standardized mean difference [SMD] 0.55, 95% confidence interval [CI] 0.23–0.87; p < 0.05), and psychomotor developmental index (PDI) (SMD 0.33, [CI] 95% CI 0.08–0.57; p < 0.05) of BSID at 12 months of age and PDI at 24 months of age (SMD 0.15, 95% CI -0.02–0.32; p < 0.1) of preterm infants. However, the benefit was not detected at 24 months of age on MDI (SMD 0.15, 95% CI -0.05–0.35; p = 0.15).ConclusionCurrent evidence suggests that developmental care in only NICU setting could have significant effect on mental and motor development of preterm infants, especially at 12 months of age. However, because of clinical heterogeneity, more studies are needed to evaluate the effects of developmental NICU care in the development of preterm infants.

Single-family room neonatal intensive care unit design: do patient outcomes actually change?

This study examined outcomes in a single-family room neonatal intensive care unit (NICU) compared to an open bay within a public safety net hospital. We included 9995 NICU encounters over 5 years pre and post move for a predominantly low SES population. Outcomes were length of stay (LOS), growth, time to first oral feeding, and incidence of sepsis. Analysis included regression models, interrupted time series, and growth models. LOS decreased over time in preterm infants both pre and post move, but increased post move for term/post-term infants (p < 0.001). First oral feeding decreased over time in both periods. A higher incidence of sepsis was found in the post period for term/post-term infants (p = 0.01). Our analysis appropriately accounted for time trends. Few differences were observed. Changes in LOS for term/post-term infants should be further explored as well as the impact of NICU care patterns.

Necrosis of Anterior Wall of Stomach Presenting as Pneumoperitoneum in Neonates- Report of Two Cases with Review of Literature

Necrotising enterocolitis is a common disease that leads to low birth weight and preterm babies. Mostly small intestine and large intestine develop necrosis sparing stomach and duodenum. Necrosis involving the anterior wall of stomach and sparing other parts of Gastrointestinal (GI) tract is a rare entity, but can present in neonates with massive pneumoperitoneum. Though the exact aetiology is not known, it may be related to perinatal hypoxia. Case report of two preterm low birth weight babies who presented with pneumoperitoneum on day three of life had an area of anterior gastric wall necrosis with perforation peritonitis. The rest of GI tract was healthy. After excision of necrotic tissue, suture repair of viable stomach and feeding jejunostomy was done in both cases. These two neonates survived with intensive neonatal ICU care and gradual jejunostomy feeding. Gastric wall necrosis with perforation peritonitis is a rare entity in neonates with high mortality. Tip of nasogastric tube lying outside stomach shadow can give clue to the diagnosis. Survival can be improved by early surgery, good neonatal Intensive Care Unit (ICU) care and gradual jejunostomy feeding.

Quality of nursing services provided at neonatal intensive care units (NICUs) at governmental hospitals in the Gaza Strip, Palestine

Objective: The overall aim of this study is to assess the quality of nursing care provided to neonate infants in neonatal intensive care units (NICUs) in governmental hospitals in the Gaza Strip. Method: We followed a quantitative, descriptive cross-sectional design. This study was carried out in NICU units at Shifa Medical Complex (SMC), Nasr Pediatric Hospital (NPH), Al-Aqsa Hospital (AH), Nasser Medical Complex (NMC), El-Emaraty Hospital (EH) and the European Gaza Hospital (EGH). Data were collected from a sample of nurses (N=110) using a self-administered questionnaire that includes 8 domains that assess the quality of nursing care. A questionnaire was constructed and data was collected by the researchers through a face to face interview with nurses. Findings: The results showed that the total quality of nursing care in NICUs was 75.8%. The highest concepts associated with quality of nursing care on infection and inflammation 78.6% and the lowest on professional issues in NICU nursing 73.6%. Furthermore, there was statistically significant difference between in the average of ethics and quality of nursing care. According to educational level, where the quality of nursing care of participants with a diploma is lower than those with bachelors and master's degrees. In contrast, there wasn’t statistically significant difference according to nurse’s age in NICUs. Conclusion and recommendations: This study revealed the presence of gap in the quality of nursing care. There was existing knowledge gap in key areas of professional issues in NICU and pain and stress. The main recommendations were suggested that there need more focus on educational and training programs about main issues such as: pain management, and improve practices in neonates' care. documented policy and procedure manuals were also recommended for assuring maintained quality care at the NICU.

Acceptance of Traditional Chinese Medicine in the Neonatal Intensive Care Unit: A Launching Point.

BackgroundBecause neonatology is a relatively new medical specialty, it is host to on-going, rapid adaptation and evolution of medical treatments and practices. This process has almost exclusively focused on Western, biomedical treatment modalities, without inclusion of potentially beneficial Traditional Chinese Medicine practices. It is unclear how receptive health-care providers in the neonatal intensive care unit (NICU) and families of NICU patients would be to the introduction of adapted Traditional Chinese Medicine treatments into the NICU environment.ObjectiveTo assess the potential for engagement of patients, families, and staff in the NICU with Traditional Chinese Medicine therapies and to provide targeted education and low-risk Traditional Chinese Medicine treatments to support the health and well-being of those 3 groups.MethodsA feasibility pilot study including weekly walk-in Traditional Chinese Medicine sessions within the NICU for parents and staff, and neonatal patient consultations, both of which included hands-on therapies and education tailored to each participant's unique needs. Pre- and postsurveys were administered over 3 phases.ResultsWalk-in sessions were attended by 83 adults and participants reported benefits, with no ill effects. There were 5 neonatal consultations with staff expressing an interest in more. Several obstacles to accessing Traditional Chinese Medicine modalities were identified in pre-surveys and were addressed with education and preemptive modifications to the therapies offered.ConclusionAcceptance of Traditional Chinese Medicine modalities in the NICU opens the door to future studies implementing integrative health services into the NICU care model.

Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi-site quasi-experimental clinical trial protocol

BackgroundFamily Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes.MethodsThis exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2).DiscussionThis study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings.Trial registrationClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017.

Hygiene practices of mothers of hospitalized neonates at a tertiary care neonatal intensive care unit in Zambia

AbstractRisk of neonatal mortality secondary to infections such as pneumonia and diarrhoeal diseases can be influenced by maternal hygiene, but little information is known about current maternal hygiene practices in low- and middle-income countries. This study aimed to assess the hygiene practices of mothers of neonatal intensive care unit (NICU) patients in Lusaka, Zambia and associated epidemiological factors. A cross-sectional survey of the mothers of hospitalized neonates at the University Teaching Hospital (UTH) in Lusaka was conducted. Study nurses orally administered questionnaires to mothers in their local languages about their hygiene practices related to newborn care. Of the 201 mothers surveyed, self-reported hygiene practice was associated with literacy (p = 0.013) and income (p &amp;lt; 0.0001). In contrast, adherence to recommended hygienic newborn care was less common, with only 36% of mothers practising recommended cord care practices. Forgetfulness (32%) and lack of hygiene resources (13%) were the major barriers to hygienic behaviours. Surveyed Zambian women who delivered babies requiring NICU care self-reported adequate hygienic practices and apparently faced difficulty practising them due to forgetfulness and a lack of hygiene resources. Future efforts should focus on improving cord care education, reinforcement of the importance of hygienic behaviours, and the supply of affordable antiseptic tools.

Pharmaceutical Care in NICUs in Australia and Poland: Attitudes and Perspectives of Doctors and Nurses.

A multidisciplinary and collaborative team network is essential in ensuring positive health outcomes for critically ill neonatal patients. The objective of this study was to investigate the perceptions of neonatal intensive care unit (NICU) doctors and nurses in Australia and Poland toward pharmaceutical care services in the NICU. A cross-sectional, anonymous, electronic-based survey was distributed between January and April 2017 among a sample of NICU doctors, nurses, and midwives. A total of 77 participants from Australia and 93 from Poland completed the survey. Overall, from the perspectives of medical and nursing staff, it is apparent that clinical pharmacy practice on the NICU is more established in Australia than in Poland. Only 8.6% of Polish participants reported that a pharmacist worked directly on the NICU in comparison with 87% of Australian participants (P < .001). The main roles performed by pharmacists in Polish NICUs related to the provision of medicines, whereas Australian pharmacists were highly involved in all aspects of pharmacotherapy, particularly in the clinical and education domains. Future efforts should focus on how practice is structured in each country and what support can be implemented from educational, cultural, and legislative levels to enable better pharmacist integration into the NICU therapeutic team.

Quality improvement can reduce unintended extubations

Studies spanning the last thirty years have examined contributors to unintended extubation (UE) in neonatal intensive care units (NICUs).1 Common themes emerge: low staff-to-patient ratios, less stable securement methods, procedures which cause patient movement and insufficient patient sedation.1 Implementation of comprehensive and multifaceted quality improvement (QI) initiatives to reduce UE has more recently been demonstrated effective in multiple NICUs.2, 3 Galiote et al report a single-centre QI project designed to reduce UE in a Level IV NICU in the USA through which a reduction in UE rate to the recommended benchmark of <1 per 100 ventilation days was achieved.1 The QI methodology used is appropriate, and the manuscript follows the reporting guidelines for QI in health care (http://www.equator-network.org/reporting-guidelines/squire/). Overall, the implementation project is well structured and designed. For QI efforts to be effective in a healthcare service, it is vital to have clear leadership combined with an environment where frontline staff are empowered to actively engage in the process.4, 5 There is evidence of positive cultural change in this project's NICU, with one intervention point focused on enabling nurses and respiratory therapists to speak up with their concerns. It appears that the project was appropriately multidisciplinary, with dedicated QI teams for UE prevention assembled in Epochs 1 and 2 of the intervention. It is assumed the overall QI team for UE was made up of neonatologists, nursing staff, respiratory therapists and administrators. However, given the composition of NICU clinical teams varies between units and neonatal networks, it would have been useful for the background and roles of each team member in this project to be described in more detail. It does not appear that there was formal parent or caregiver involvement in the study: while not commonly reported at present, collaboration with families for QI in NICUs can add great value to these endeavours.6 This implementation project was first prompted by an observation that UE had increased to an unacceptable level in this NICU. The process of intervention planning was well structured, and spanned across several elements of NICU care including bolstering staff presence at high UE risk timepoints, procedure standardization for endotracheal tube securement, guidance for managing patient position and episodes of high-risk movement, real-time reporting and analysis of adverse events, optimising communication and the use of visual aids for clear identification of at-risk infants. Further information on why each particular intervention was selected over other potential interventions would be informative for NICUs planning similar projects. It is also not clear in the paper whether the team appraised reasons for the initial rise in UE in their unit that prompted the project in the first place: this may have provided valuable insight to the key UE drivers identified. It is clear from this study and others that UE can be successfully reduced through the use of multiple, well-selected interventions that are driven by a dedicated QI team.2, 3, 7 Future QI endeavours for UE in NICUs should focus on the sustainability of these initiatives, with a view to ensuring longevity of a safety culture in NICUs. https://ebneo.org/2019/09/unintended-extubations/ None.

Validation of a surgical neonatal nursing workload tool

ObjectiveTo describe the development and validation of the Winnipeg Assessment of Neonatal Nursing Needs Tool-Surgical Complex (WANNNT-SC), a nursing workload tool for use in a surgical neonatal intensive care unit (NICU). MethodsThe Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT) was modified to create the WANNNT-SC. Nursing staff utilized the tool over 60 consecutive shifts to determine the number of nurses needed to appropriately staff the unit. The charge nurse, based on professional judgement, also determined how many nurses were required to staff the unit on each shift. ResultsThe WANNNT-SC determined that 1.76 fewer nurses were needed for direct patient care. The tool was reliable across multiple users (mean difference 0.003, SD 0.32). ConclusionThe WANNNT-SC is valid, reliable, and can be used to determine the number of nursing staff required to provide direct patient care in a surgical NICU.

VLBW Protocol for Transport: Step#1 Thermoregulation

Background: The first hours of life can be critical to a very low birthweight (VLBW) infant. For many, that timeframe occurs outside the neonatal intensive care unit (NICU). Steps employed to ensure best practices to deliver the same quality of NICU care throughout transport can have life long effects. SMART Aim: By May, 2016, a protocol to guide care of the VLBW infant will be written, initiated and monitored during the transport of infants < or = to 1500 grams (birth weight (BW)) with the goal of providing optimal thermoregulation …

Modelling potential cost savings from use of real-time continuous glucose monitoring in pregnant women with Type 1 diabetes.

AimTo investigate potential cost savings associated with the use of real‐time continuous glucose monitoring (RT‐CGM) throughout pregnancy in women with Type 1 diabetes.MethodsA budget impact model was developed to estimate, from the perspective of National Health Service England, the total costs of managing pregnancy and delivery in women with Type 1 diabetes using self‐monitoring of blood glucose (SMBG) with and without RT‐CGM. It was assumed that the entire modelled cohort (n = 1441) would use RT‐CGM from 10 to 38 weeks’ gestation (7 months). Data on pregnancy and neonatal complication rates and related costs were derived from published literature, national tariffs, and device manufacturers.ResultsThe cost of glucose monitoring was £588 with SMBG alone and £1820 with RT‐CGM. The total annual costs of managing pregnancy and delivery in women with Type 1 diabetes were £23 725 648 with SMBG alone, and £14 165 187 with SMBG and RT‐CGM; indicating potential cost savings of approximately £9 560 461 from using RT‐CGM. The principal drivers of cost savings were the daily cost of neonatal intensive care unit (NICU) admissions (£3743) and the shorter duration of NICU stay (mean 6.6 vs. 9.1 days respectively). Sensitivity analyses showed that RT‐CGM remained cost saving, albeit to lesser extents, across a range of NICU costs and durations of hospital stay, and with varying numbers of daily SMBG measurements.ConclusionsRoutine use of RT‐CGM by pregnant women with Type 1 diabetes, would result in substantial cost savings, mainly through reductions in NICU admissions and shorter duration of NICU care.

Economic assessment of neonatal intensive care.

Most of the studies on the costing of neonatal intensive care has concentrated on the costs associated with preterm infants which takes up more than half of neonatal intensive care unit (NICU) costs. The focus has been on determining the cost-effectiveness of extreme preterm infants and those at threshold of viability. While the costs of care have an inverse relationship with gestational age (GA) and the lifetime medical costs of the extreme preterm can be as high as $450,000, the total NICU expenditure are skewed towards the care of moderate and late preterm infants who form the main bulk of patients. Neonatal intensive care, has been found to be very cost-effective at $1,000 per term infant per QALY and $9,100 for extreme preterm survivor per QALY. For low and LMIC, where NICU resources are limited, the costs of NICU care is lower largely due to a patient profile of more term and preterm of greater GAs and correspondingly less intensity of care. Public health measures, neonatal resuscitation training, empowerment of nurses to do resuscitation, increasing the accessibility to essential newborn care are recommended cheaper cost-effective measures to reduce neonatal mortality in countries with high neonatal mortality rate, whilst upgraded neonatal intensive care services are needed to further reduce neonatal mortality rate once below 15 per 1,000 livebirths. Economic evaluation of neonatal intensive care should also include post discharge costs which mainly fall on the health, social and educational sectors. Strategies to reduce neonatal intensive care costs could include more widespread implementation of cost-effective methods of improving neonatal outcome and reducing neonatal morbidities, including access to antenatal care, perinatal interventions to delay preterm delivery wherever feasible, improving maternal health status and practising cost saving and effective neonatal intensive care treatment.