Care Of High-risk Infants Research Articles

Follow-up of Very Low Birth Weight Infants (VLBW) 1247

Follow-up (FU) programs in Argentina and in the University Hospital were established in the mid 80's. However the present FU clinic was set up in September 1996 after an interruption of some years. The clinic provides care for high risk infants discharged from the NICU, specially VLBW infants. The present paper reports 1 year FU of VLBW graduates from the NICU at the University Hospital. Twenty four patients were discharged from the NICU and attended FU clinic for at least 3 months. Mean birth weight was 1140 and mean GA, 31 weeks. Ten infants are 9- 12 months old; 8 are 6 - 9 months, and 6 are≤ 6 months. Growth during study period was appropriate for head and weight; length growth was below the 3rd centile in 5 infants. All infants received EPO. None required transfusions during FU. Only one patient (> 9 months) has BPD; 4 patients had mild bronchiolitis during the first year. Six patients had some degree of ROP: 3 patients had ROP grade I; 2 grade II and 1, grade III that required cryotherapy once on both eyes. Two patients exhibited anomalies on auditory evoked responses initially, not requiring devices. Three infants had mild ventriculomegaly; none developed hydrocephalus.No patient has cerebral palsy. Neurological evaluation revealed soft signs in 13 patients: Mild hypertonia (Amiel Tyson) 10 patients, developmental delay (Rodriguez- Arancibia), 3 pts. These preliminary data indicate a good outcome of our NICU graduates. FU till school age will determine whether these promising results will still hold true. Table

Advanced practice nursing in the care of the high-risk infant.

Advanced practice nursing encompasses a range of roles and services. Tertiary care settings such as neonatal intensive care units provide a variety of opportunities for the advanced practice nurse, including direct care, case management, and developmental care. Primary care and community settings may also provide opportunities for advanced practice nursing in the care of high-risk infants. Challenges related to role implementation, control of practice, and reimbursement also exist, however. The article examines the evolution of advanced practice nursing in the care of the high-risk infant as well as current opportunities and challenges.

Ethical Issues in High-Risk Infant Care

Much controversy exists today regarding the "salvaging" of high-risk infants. There are many ethical concerns surrounding these children. The advancement of technology has had a profound effect on the treatment of preterm infants or infants with deformities. In this article the authors address selected ethical concerns regarding personhood, autonomy, beneficence, parental authority, quality of life, sanctity of life, and optional, obligatory, and wrong forms of treatment. The article begins with an overview of the history of infanticide as well as the history of neonatal intensive care units. Financial and legal issues are also discussed. In addition, the nurse's role in working with high-risk infants and their families is briefly explored.

Effects of Formal Support on Mothers' Adaptation to the Hospital-to-Home Transition of High-Risk Infants: The Benefits and Costs of Helping

94 mothers were randomly assigned to a control group or to a group who received a formal support program designed to aid their adaptation to the transition from hospital to home care of high-risk infants. Mothers' predischarge need for support and the severity of infants' predischarge medical problems moderated program effects assessed 6 months after NICU discharge. Positive effects of the program on mothers' sense of competence, perceived control, and responsiveness were evident for mothers who had needed the most support. But at low levels of need for support, participation in the program had negative effects on these outcomes. A similar pattern was found for the effects of the program on mothers' positive mood as a function of the severity of infants' medical problems. Secondary findings suggest why some mothers may benefit from formal support after NICU discharge and others may experience at least temporary disruptions in their adaptation from such support.

Perinatal outreach education: linking hospital and community in the care of high-risk infants.

(Formerly) Lecturer School of Nursing University of Pennsylvania Philadelphia, Pennsylvania Assistant Professor of Nursing Kennesaw College Marietta, Georgia

Home Care for High-Risk Infants

Home Care for High-Risk Infants

Intensive care for high-risk infants in Calcutta. Efficacy and cost.

The efficacy and cost of implementing an intermediate level of newborn intensive care (INIC) was retrospectively evaluated over a four-year period in Calcutta to see if survival could be improved at low cost using indigenous human and material resources. The patient population (94.7% less than or equal to 2500 g) included all infants admitted to the facilities operated by the International Mission of Hope (India) Society. Survival was compared within 250-g increments in 1980 and 1981, when infants with major medical problems were hospitalized in outside facilities (mortality, 100%) and 1982 and 1983, when INIC was provided completely within the facility. Overall survival increased from 37.9% (n = 504) in 1980 and 1981 to 70.5% (n = 581) in 1982 and 1983. Infants weighing 1251 to 2000 g benefited greatly (34.4% [n = 279], 74.8% [n = 322]) from INIC. Survival of infants weighing 1250 g or less, although improved, remained low (5.6% [n = 89] to 23.1% [n = 108]). The average daily cost for the entire period of hospitalization was $7.75. These data indicate that survival in infants of low birth weight can be improved with INIC at modest cost using resources already available within the community. However, the application of this type of program must still be considered in relation to strategies designed to reduce the number of infants of low birth weight as well as to the long-term goals and available financial resources in non-industrialized countries.

Perceived social support and maternal adaptation during the transition from hospital to home care of high-risk infants

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Playing God in the Nursery

This excellent book is a clear and well-researched presentation of the difficult decisions required in the care of the very immature or handicapped infant. The effects of complex medical technology on all of the involved parties, including the patient, are discussed in a manner recognizable to physicians. The ethical and moral issues are carefully delineated. The presentation of the needs and responsibilities of the parents is particularly well done. Legal issues are clarified by discussion of the implications of the various court decisions in the field. Societal effects of high-risk infant care are included. All individuals who are involved in decisions for seriously disabled infants should benefit by reading this book. This includes physicians, nurses, hospital staff and administrators, lawyers, judges, trustees of hospitals, and politicians. Since the issues presented concern all of our society, any literate person should find this book of interest. Fortunately, it is well written and

PNPs in Follow-Up Care Of High-Risk Infants

DRS. WINGERT, TEBERG, and HODGMAN are on the faculty of the University of Southern California School of Medicine and are pediatricians at the Los Angeles County, University of California Medical Center, MS. BERGMAN was a PNP there. WILLIS A. WINGERT. M.D., is professor of pediatries, community medicine, public health, and emergency medicine; and director, pediatire ambulatory service at the center. ANNABEL J. TEBERG, M.D., is associate clinical professor of pediatrics and director, newborn follow-up clinics at the medical center. RONNIE BERGMAN, R.N., B.S.N., was the supervisor, Small Premature Clinic. Her home is now Evanston, Ill. JOAN HODGMAN, M.D., is professor of pediatrics and director, newborn service at the center. ELLEN DOWD, R.N., M.S.N., was preliminary program manager, Small Premature Follow-Up Program, at the medical center.

PNPs in Follow-up Care of High-Risk Infants

Among infants born with a weight of less than 1,500 gm. during the 1950s, 50 percent or more subsequently were found to have significant physical, neurological, or developmental handicaps(1-3). Improved survival rates in this highrisk group create a need for reliable, long-term data to evaluate the prevalence of significant problems. Through development of a model project with a pediatric nurse practitioner giving primary care and as patient advocate, we hoped to accomplish two goals: 1. To develop a follow-up program with continuity of care that would improve patient-professional relationships and patient satisfaction, compliance, and follow-up. 2. To evaluate the neurological, physical, and developmental status of high-risk infants of low birth weight and the relationship of this status to changes in perinatal

PNPs in Follow-Up Care Of High-Risk Infants

PNPs in Follow-Up Care Of High-Risk Infants

The Role of the Community Hospital in a Regional Program of Obstetrics and Neonatal Care

A regionalized system of perinatal care, which draws on the strengths of individual hospitals and corrects any weaknesses, can enhance the level of performance of the community hospital. Although the care of high risk infants takes priority in this system, concern is expressed that routine perinatal care should also receive additional attention.

A Discharge Planning Tool for Use with Families of High-Risk Infants

The transition from hospital care to home care for high risk infants can be facilitated by the process of discharge planning. A tool designed specifically to coordinate discharge counseling and instruction for parents of high-risk infants has been developed and implemented in a perinatal center. Preliminary results indicate that the tool enables the health team to make an objective, rather than subjective, decision in respect to discharge of infants. Use of the tool also standardizes and documents the nurse's role in discharge planning.

Childbirth, American Style

In June 1971, the House of Delegates of the American Medical Association adopted a statement on "Centralized Community or Regionalized Perinatal Intensive Care." This statement was the product of two years of study and discussion by the Committee on Maternal and Child Care. Its recommendations may be summarized as follows: "Concentration of high-risk infant care programs in hospitals specially staffed and equipped to provide optimal care is a proven life-saving mechanism for infants at risk." Every community should direct attention "to the development and operation of such centralized special care facilities." Goals should include early identification of highrisk infants, transfer of an infant to a more appropriately equipped facility when indicated, and planning for an adequate transport system. The implementation of "regionalized perinatal programs is a responsibility of physicians, government and the public" and inclusion of training programs for the necessary medical and allied personnel is encouraged.

Neonatal intensive care: Planning for services and outcomes following care

C H A N G E S in neonatal care of highrisk infants over the past decade have led to the development of intensive care services which can best be provided in centers and by programs serving communities or regions on an organized basis. Recent findings strongIy suggest that neonatal intensive care has resulted in a decrease in the neonatal mortality rate and in a lower prevalence of serious handicapping conditions among the survivors.

Follow-Up of Low Birth Weight Infants—The Predictive Value of Maternal Visiting Patterns

Present hospital regulations and the facilities for the care of high-risk infants often result in prolonged mother-infant separation, with restricted visiting and minimal physical contact. Reports of cases of child abuse and of infants who fail to thrive in the absence of organic disease reveal a disproportionately high incidence of prematurity. In the failure-to-thrive syndrome, 25 to 41% of the reported infants have been premature. Prematurity or serious illness in the newborn period resulting in maternal-infant separation was a feature in 23 to 31% of the battered infants. With such a high incidence of "mothering disorders" it is important to evaluate the mothers of high-risk infants carefully before discharge. See table in the PDF file

OBG: Intensive care for high-risk infants provided in special newborn unit

OBG: Intensive care for high-risk infants provided in special newborn unit