Infants In Neonatal Intensive Care Unit Research Articles

A cross-sectional analysis of infant-driven and traditional feeding outcomes for neonatal intensive care unit infants.

The goal of this study was to assess the impact of infant-driven feeding (IDF) compared to traditional feeding protocols in promoting earlier successful feeding outcomes. We performed a cross-sectional analysis of infants admitted to a level three neonatal intensive care unit (NICU) over a 2-year period. We compared infants fed with the traditional protocol to those under the IDF protocol. Infants in the IDF group were younger at first feed (p < 0.001). There was no difference in age at nasogastric (NG) tube removal or at discharge, length of stay, or percentage breastfeeding at discharge. There were no differences in outcomes within two subgroups born at <35 and <32 weeks gestation, respectively. The IDF program led to earlier initiation of oral feeding. However, this did not lead to earlier NG tube removal or discharge, a shorter length of stay, or increase in the rates of breastfeeding.

Infant delivery and maternal stress during the COVID-19 pandemic: a comparison of the well-baby versus neonatal intensive care environments.

ObjectiveTo describe impact of COVID-19 pandemic on stress and mood of new mothers, in particular in neonatal intensive care unit (NICU); a secondary objective was to assess whether customary social gender distancing practiced by ultra-religious Jews and Muslims offers built-in anti-stress protection.MethodsCross-sectional, observational survey of mothers of 52 normal newborn nursery (NNB) and 52 NICU infants. In all, 86 filled all the 6 questionnaires (Demographics, COVID-19 virus experience, Mental Health Inventory, Neonatal Satisfaction Survey, Parental Stressor Scale, and Questionnaire of Coping Strategies).ResultsMost mothers stated that COVID-19 pandemic had hurt social and family relationships, maternal role, and expressed stress and loneliness. Mothers of NICU infants had higher degree of helplessness. Religious social distancing was not protective. Background tendency to coping poorly with stress and depression most highly predicted stress.ConclusionCOVID-19 pandemic harms psychosocial well-being of most mothers. Detection of high-risk individuals is necessary to provide appropriate support.

Information Order for Periviable Counseling: Does It Make a Difference?

To examine whether the order of presenting survival vs disability information, with or without the description of infant neonatal intensive care unit (NICU) experiences would influence treatment choice during hypothetical periviable birth counseling. An internet sample of childbearing-aged women (n=839) viewed a pictograph displaying the chances of survival and a pictograph on the chances of disability for a baby resuscitated during the periviable period. The sample was randomized to the order of pictographs and level of description of infant NICU experiences. Participants selected between intensive care or comfort care and reported their personal values. The order of the information influenced treatment choices (P=.02); participants were more likely to choose intensive care if they saw the survival pictograph first (70%) than the disability pictograph first (62%). Level of description of premature infant NICU experiences did not influence treatment choice (P=.92). Participants who valued sanctity of life, autonomy in making decisions, who were more religious, and had adequate health literacy were more likely to choose intensive care. Such participant characteristics had greater explanatory power than the experimental manipulations. Subtle differences in how information is presented may influence critical decisions. However, even among women with the same values, diversity in treatment choice remains.

Maryland's Global Budget Revenue Program: Impact on Neonatal Intensive Care Unit Admissions and Infant Mortality.

In 2014, Maryland implemented the Global Budget Revenue (GBR) program to reduce unnecessary hospital utilization and contain spending. Little is known about its impact on pediatric health outcomes and high-cost services that are primarily financed by payers other than Medicare. The aim was to examine the impact of the GBR program on neonatal intensive care unit (NICU) admission and infant mortality. We conducted a difference-in-differences analysis comparing changes of NICU admissions and infant mortality in Maryland with changes in 20 comparison states (including DC), before and after implementation of the GBR program. Effects were estimated for all infants and for risk groups defined by birthweight and gestation. A total of 11,965,997 newborns in Maryland and the comparison states was identified using US birth certificate data from 2011 to 2017. NICU admissions, the infant mortality rate, and the neonatal mortality rate. The GBR program was associated with a 1.26 percentage points (-16.8%, P=0.03) decline in NICU admissions over three full years of implementation. Reductions were driven by fewer admissions among moderately low to normal birthweight (1500-3999 g) and moderately preterm to term (32-41 wk) infants. The effects for very-low birthweight and very preterm infants were small and not statistically precise. There was no significant change in infant or neonatal mortality rates. Maryland's hospitals reacted to the GBR program by reducing NICU services for infants that did not have clear observed clinical need. Our results suggest that GBR constrained high-cost services, without adversely affecting infant mortality.

Neonatal outcome of small for gestational age infants born at 26-33 weeks' gestation in Chinese neonatal intensive care units.

BackgroundRate and outcomes of small for gestational age (SGA) infants admitted to Chinese neonatal intensive care units (NICU) has been poorly demonstrated. We aimed to describe the rate and outcomes of SGA preterm infants in Chinese NICU, and to evaluate the association of SGA status with neonatal outcomes in different gestational age (GA) and birth weight percentile groups.MethodsThis cohort study included all infants born at 26–33 weeks’ gestation and admitted to 25 tertiary Chinese NICUs from April 2015 to May 2018. SGA was defined as a birthweight <10th percentile for GA based on the Chinese neonatal birth weight curve.ResultsA total of 24,596 infants were included, and 1,867 (7.6%) infants were SGA. SGA infants had significantly higher rates of death or any major morbidity (29.8% vs. 20.5%), mortality (7.0% vs. 4.1%), bronchopulmonary dysplasia (BPD, 17.6% vs. 9.8%), necrotizing enterocolitis (NEC, 4.8% vs. 3.2%) and sepsis (7.3% vs. 4.8%) than non-SGA infants. SGA status was independently associated with increased risk of death or any major morbidity [adjusted odds ratio: 2.37 (2.08–2.71)] as well as increased risks of death, BPD, ROP, death or BPD, death or ROP, NEC and sepsis. The increased risks of adverse outcomes for SGA infants existed across GA groups. The risks of adverse outcomes were highest among infants with a birthweight <3rd percentile.ConclusionsSGA contributes significantly to adverse neonatal outcomes. Specific attentions are warranted when caring for SGA preterm infants.

Mothers’ voices and white noise on premature infants’ physiological reactions in a neonatal intensive care unit: A multi-arm randomized controlled trial

BackgroundA few positive effects of mothers’ voice on physiological outcomes have been studied and limited studies have focused on the level of cortisol. In addition, white noise has recently been found to be beneficial for human sleep, but studies in premature infants were limited and no study has compared the effects of mothers’ voice and white noise on premature infants. ObjectiveTo examine the effects of mothers’ voice and white noise on sleep-wake patterns, salivary cortisol levels, weight gain, heart rate, and oxygen saturation of premature infants in a neonatal intensive care unit (NICU). MethodsThis was a three-group randomized controlled trial. A total of 103 medically stable premature infants in incubators were recruited from the NICU of a women's and children's hospital in China between March and December 2017 and were randomized into three groups: the mothers’ voice group (n = 34), the white noise group (n = 34), and the routine care group (n = 35). Mothers’ voice, white noise, and no voice were provided to the three groups for 20 min at a time, three times a day for four consecutive days. The sound levels of the mothers’ voice and white noise were controlled between 50 and 55 dB. Sleep-wake patterns, salivary cortisol level, and weight were measured at pre-test and post-test whereas heart rate and oxygen saturation were measured every five-minute at 11am, 2pm, 5pm for four-consecutive days. ResultsA group difference was found only in weight gain (p = 0.003), with weight gain in the white noise group being significantly higher than the mothers’ voice group (Z=-3.447, p = 0.001). Significant declines in total sleep time and sleep efficiency and increases in wake time after sleep onset and average awakening time were only found in the routine-care group between the pre-test and post-test (p<0.05). No significant differences were found in the salivary cortisol levels, heart rates, and oxygen saturation levels among the three groups (p>0.05). A significant increase in oxygen saturation during the 20-min intervention was found in white noise group. Non-significant decreases in the heart rate during the 20-min intervention and salivary cortisol levels at post test were noted in all the three groups. ConclusionWhite noise is more useful for encouraging weight gain in preterm infants compared with mothers’ voices. White noise might be introduced for use in the care of premature infants in NICUs, and more high-quality randomized controlled trials are needed to confirm these findings.Trial Registration No: ChiCTR-INR-17012755.

MISSED CARE phenomenon on neonatal intensive CARE unit (NICU)

AimTo evaluate missed nursing care (MNC) phenomenon on Neonatal Intensive Care Units (NICUs) infants. DesignA cross-sectional study. MethodsA sample of 113 eligible Registered Nurses (RNs) and Registered Midwives (RMs) were prospectively recruited at the Neonatal Intensive Care Units (NICUs). The study uses a self -designed authors questionnaire (ADQ) and the Neonatal Extent of Work Rationing Instrument (NEWRI). ResultsMNC evidence was the most significant in the parental support and teaching subscales (M = 2.21, SD = 0.87) and the least in life support and discharge planning (M = 1.19, SD = 0.9). MNC in the care coordination and discharge planning subscales significantly (p < 0.038) depends on the belief that a nurse's family issues affect the quality of their work. MNC in the life support and technology-oriented nursing care domain (p < 0.033) significantly depends on the belief that the ward manager is a good manager and leader.

Implementing Evidence-Informed Discharge Preparedness Tools in the NICU: Parents' Perceptions.

Few studies address preparing parents of neonatal intensive care unit (NICU) infants for infant discharge. Inadequate or ineffective parental preparedness for discharge can result in preventable emergency department and primary care visits. Parents' perceptions are needed to inform development and implementation of effective educational tools to improve parent discharge preparedness in the NICU. To describe the perceptions of parents of recently discharged NICU infants regarding discharge preparedness and implementation of the My Flight Plan for Home parent discharge preparedness tool. We used a qualitative descriptive design to collect individual interview data from 15 parents with infants discharged from a level 4 NICU in the Midwest. Individual interviews were conducted using a semistructured guide and were audio-recorded, transcribed verbatim, and thematically analyzed using the constant comparative method. We identified 5 major themes: (1) family dynamics; (2) parenting in the NICU; (3) discharge preparedness; (4) engaging parents in infant care; and (5) implementation recommendations for the My Flight Plan for Home tool. Minor themes supported each of the major themes. To improve parents' confidence in caring for their infant after discharge, parents suggest nurses must engage parents in discharge education and infant care shortly following NICU admission and use parent-centered discharge preparedness tools. Future studies are needed to develop and test parent-tailored strategies for implementing parent discharge preparedness tools in the NICU.

Kangaroo father care: A pilot feasibility study of physiologic, biologic, and psychosocial measures to capture the effects of father-infant and mother-infant skin-to-skin contact in the Neonatal Intensive Care Unit.

Robust literature supports the positive effects of kangaroo mother care (KMC) on infant physiologic stability and parent-infant bonding in the Neonatal Intensive Care Unit (NICU). Comparatively little is known about kangaroo father care (KFC) in the NICU, and KFC implementation has been limited. Our pilot feasibility study objective was to examine KFC effects on premature infants and fathers as compared to KMC. Parents of preterm NICU infants independently completed a 90-min Kangaroo Care (KC) session on consecutive days. Infant heart rate variability (HRV) and apnea/periodicity measures were compared (pre-KC to KC; KFC to KMC). Additionally, we assessed the feasibility of administering three psychosocial questionnaires to fathers and mothers in the NICU and after discharge. Ten preterm infants completed 20 KC sessions (334/7 -374/7 weeks post-menstrual age). Results demonstrated similar infant physiologic responses between KMC and KFC, including significant differences in measures of HRV (p<.05) between KC and non-KC periods. Eighty-eight percentage of questionnaires administered were completed, supporting the utilization of these instruments in future research of this population. If confirmed, these preliminary results identify an opportunity to objectively assess KFC effects, supporting the development of empirically based KFC programs benefitting NICU families.

Encouraging Parental Reading for High-Risk Neonatal Intensive Care Unit Infants

To assess whether a citywide structured book-sharing program (NICU Bookworms) designed to promote reading to infants while admitted in the neonatal intensive care unit (NICU) would increase parental reading behaviors (≥3-4days/week) in the NICU and after discharge home, including high-risk parents who do not themselves enjoy reading. The NICU Bookworms program comprised staff training, parent education, and building a literacy-rich environment. In this quasi-experimental intervention study, parents of medically high-risk NICU graduates <6months of age were administered a questionnaire at their first NICU follow-up clinic visit. The survey incorporated questions from the StimQ-I READ subscale to assess home reading environment and shared reading practices. A total of 317 infants were enrolled, 187 in an unexposed comparison group and 130 in the intervention group. Parents exposed to Bookworms were significantly more likely to read ≥3-4days per week while in the NICU (34.5% vs 51.5%; P=.002; aOR, 2.2; 95% CI, 1.2-4.0), but reading at home did not differ (67.9% vs 73.1%; P=.28; aOR, 0.99; 95% CI, 0.5-1.8). However, among parents who did not themselves enjoy reading, frequency was significantly higher both in the NICU (18.4% vs 46.1%; P=.009; aOR, 5.0; 95% CI, 1.2-21.5) and at home (36.9% vs 70%; P=.003; aOR, 3.7; 95% CI, 1.1-12.9). A qualitative thematic analysis found that Bookworms decreased parental stress, enhanced bonding, and supported positive parent-infant interactions. A book-sharing intervention in the NICU increased parent-reported reading aloud during hospitalization and among parents disinclined to read for pleasure, both in the NICU and following discharge. This change may have been mediated by enhancement of parent-infant interactions.

Current Situation and Influencing Factors of Preterm Infants Breastfeeding in Jingzhou 3A Hospital

Background: Breast milk is the best source of nutrition for premature infants and a “good medicine” for disease treatment. However, the rate of exclusive breastfeeding of premature infants in China still needs to be improved at present, and the factors affecting breastfeeding are different in different places. Objective: To investigate the current status and influencing factors of preterm infants breastfeeding in Jingzhou 3A hospitals. Methods: A cross-sectional study was conducted to collect breastfeeding information of premature infants in neonatal intensive care unit (NICU) from May to August in 2019 in Jingzhou 3A Hospital, and 152 premature infants’ related information were collected. A questionnaire survey was conducted among the mothers who failed to breastfeed. Results: The rate of exclusive breastfeeding among premature infants in NICU was 9.87%. The rates of first breastfeeding and exclusive breastfeeding at discharge were 13.16% and 32.89% respectively. Not producing enough milk and knowing the right way to pump breast milk contributed a lot to the failure of exclusive breastfeeding. Conclusion: More attention should be paid to the health education and management to improve the rate of breastfeeding in NICU.

NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With Posttraumatic Stress.

This mixed-methods pilot study investigated maternal perceived stress specific to infant neonatal intensive care unit (NICU) hospitalization as a moderator of the relationship between traumatic childbirth appraisal and symptoms of posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via social media 1 to 4 months postpartum for a cross-sectional survey about perinatal experiences. Measures included traumatic childbirth, PTSD Checklist for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results indicated that, only at high levels of stress, women who reported traumatic childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 32.36)]. Qualitative analysis identified additional stressors: maternal emotional well-being, dissatisfaction with care, infant health problems, breastfeeding, and additional characteristics of the NICU environment. Results provide supportive evidence that NICU mothers are at high risk for childbirth-related trauma and PTSD. Perceived stress related to the NICU may be an important intervention target when developing trauma-informed patient care. In addition to the domains captured by the PSS: NICU, maternal emotional well-being, interpersonal relationships with NICU staff, and stress related to breastfeeding are additional areas for improvement in the family-centered NICU.

Catheter-related venous thrombosis in NICU: A case-control retrospective study.

Newborns treated in a neonatal intensive care unit (NICU) are susceptible to several complications one of them being vein thrombosis. The study aims to evaluate risk factors of catheter-related venous thrombosis, clinical manifestations, treatment, and the outcomes of thrombotic events (TE) during the neonatal period. This work is a case-control retrospective study performed on patients in the tertiary NICU between January 2013 and June 2016. The analysis includes data from infants with CVC diagnosed with thrombosis and infants with CVC, not being diagnosed with thrombosis (control group). Statistica 10 software was used for statistical analysis. Vein thrombosis was diagnosed in 19 NICU infants including 16 cases of catheter-related vein thrombosis (84% of complicated cases). Other statistically significant risk factors were asphyxia, infection, and the duration of CVC use. The incidence of thrombosis in our population increased during the study which may result from a statistically significant increase in the number of inserted CVC (294 vs 435), and more frequent diagnosis of incidental thrombosis (1 vs 9). Vein catheterization, asphyxia, infection, and prolonged CVC use are critical risk factors for thrombosis in the neonatal period. Given the hereinbefore mentioned increased number of central line catheterizations in the NICU, it would be useful to conduct a prospective study with a scheduled routine ultrasound protocol applied not only as a tool to diagnose thrombosis but also to prevent it by determining a proper catheter for a particular vein.

The prevalence of hearing loss in infants hospitalized in the neonatal intensive care units

Background and Aim: Studies have shown that several factors affect the hearing loss of infants hospitalized in the neonatal intensive care unit (NICU). These factors include hyperbilirubine­mia, low birth weight, asphyxia, and prematurity. This study aimed to investigate the prevalence of hearing loss and its risk factors in NICU infants. Methods: This is a cross-sectional study. Sam­ples were 159 infants admitted to the NICU in Fatemieh and Shahid Beheshti hospitals in Ham­adan, Iran, who were selected using a conveni­ence sampling method. Their hearing was scree­ned using transient evoked otoacoustic emission (TEOAE) and automated auditory brainstem res­ponse (AABR) tests; in case of failure in these tests, auditory brainstem response (ABR) was performed. Results: Of 159 infants, 9 (5.66%) were iden­tified with different types of hearing loss where 4 (2.51%) had sensory-neural hearing loss, one (0.62%) had auditory neuropathy and 4 (2.51%) had conductive hearing loss. There was a statis­tically significant relationship between hearing loss and birth weight &lt; 1500 g, hyperbilirubine­mia, antibiotic therapy, family history of hearing loss, asphyxia and Apgar score &lt; 5. Conclusion: Prevalence of hearing loss in NICU infants is noticeable so hearing assessment after discharge is necessary. Due to the presence of auditory neuropathy, simultaneous use of TEOAE and AABR tests in these infants is recommended. Keywords: Infant hearing screening; neonatal intensive care unit; auditory brainstem response

Analysis of the Risk Factors Associated with Hearing Loss of Infants Admitted to a Neonatal Intensive Care Unit: A 13-Year Experience in a University Hospital in Korea.

Early detection of hearing loss in neonates is important for normal language development, especially for infants admitted to the neonatal intensive care unit (NICU) because the infants in NICU have a higher incidence of hearing loss than healthy infants. However, the risk factors of hearing loss in infants admitted to the NICU have not been fully acknowledged, especially in Korea, although they may vary according to the circumstances of each country and hospital. In this study, the risk factors of hearing loss in NICU infants were analyzed by using the newborn hearing screening (NHS) and the diagnostic auditory brainstem response (ABR) test results from a 13-year period. A retrospective chart review was performed using a list of NICU infants who had performed NHS from 2004 to 2017 (n = 2404) in a university hospital in Korea. For the hearing loss group, the hearing threshold was defined as 35 dB nHL or more in the ABR test performed in infants with a ‘refer’ result in the NHS. A four multiple number of infants who had passed the NHS test and matched the age and gender of the hearing loss group were taken as the control group. Various patient factors and treatment factors were taken as hearing loss related variables and were analyzed and compared. From the 2404 infants involved, the prevalence of hearing loss was 1.8% (n = 43). A comparison between the hearing loss group (n = 43) and the control group (n = 172) revealed that history of sepsis, peak total bilirubin, duration of vancomycin use, days of phototherapy, and exposure to loop-inhibiting diuretics were significantly different, and can be verified as significant risk factors for hearing loss in NICU infants.

Longitudinal Survey of COVID-19 Burden and Related Policies in U.S. Neonatal Intensive Care Units.

Objective This study aimed to determine the prevalence of confirmed novel coronavirus disease 2019 (COVID-19) disease or infants under investigation among a cohort of U.S. neonatal intensive care units (NICUs). Secondarily, to evaluate hospital policies regarding maternal COVID-19 screening and related to those infants born to mothers under investigation or confirmed to have COVID-19. Study Design Serial cross-sectional surveys of MEDNAX-affiliated NICUs from March 26 to April 3, April 8 to April 19, May 4 to May 22, and July 13 to August 2, 2020. The surveys included questions regarding COVID-19 patient burden and policies regarding infant separation, feeding practices, and universal maternal screening. Results Among 386 MEDNAX-affiliated NICUs, responses were received from 153 (42%), 160 (44%), 165 (45%), 148 (38%) across four rounds representing an active patient census of 3,465, 3,486, 3,452, and 3,442 NICU admitted patients on the day of survey completion. Confirmed COVID-19 disease in NICU admitted infants was rare, with the prevalence rising from 0.03 (1 patient) to 0.44% (15 patients) across the four survey rounds, while the prevalence of patients under investigation increased from 0.8 to 2.6%. Hospitals isolating infants from COVID-19-positive mothers fell from 46 to 20% between the second and fourth surveys, while centers permitting direct maternal breastfeeding increased 17 to 47% over the same period. Centers reporting universal severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) screening for all expectant mothers increased from 52 to 69%. Conclusion Among a large cohort of NICU infants, the prevalence of infants under investigation or with confirmed neonatal COVID-19 disease was low. Policies regarding universal maternal screening for SARS-CoV-2, infant isolation from positive mothers, and direct maternal breastfeeding for infants born to positive mothers are rapidly evolving. As universal maternal screening for SARS-CoV-2 becomes more common, the impact of these policies requires further investigation. Key Points In this cohort, neonatal COVID-19 is rare.Policies regarding isolation and breastfeeding for infants are rapidly evolving.Most hospitals are now providing universal screening for expectant mothers for SARS-CoV-2.

Early-onset sepsis in term infants admitted to neonatal intensive care units (2011-2016).

ObjectivesInvestigate characteristics of term infants culture-evaluated for early-onset sepsis (EOS) in neonatal intensive care units (NICUs), frequencies of organisms causing EOS, and factors associated with EOS.Study designUsing a cohort design, we identified term infants evaluated for EOS with blood, cerebrospinal fluid, or urine cultures in 326 NICUs (2011–2016). Using multivariable logistic regression, we investigated the association between EOS and demographic characteristics.ResultsOf 142,410 infants, 1197 (0.8%) had EOS, most commonly caused by group B Streptococcus (GBS; 40.6%). Lower EOS risk was associated with low Apgar score, Cesarean delivery, small for gestational age, prenatal antibiotic exposure, and positive or unknown maternal GBS screening result. Increased risk was associated with prolonged rupture of membranes, maternal age <19 years, vasopressor treatment, and ventilator support.Conclusion(s)GBS was the most frequent cause of EOS. Early risk factor recognition may help daily management of term infants in NICUs.

Feasibility of Live-Performed Music Therapy for Extremely and Very Preterm Infants in a Tertiary NICU.

Objective: We aimed to investigate the feasibility of live-performed music therapy for extremely and very preterm infants admitted to the neonatal intensive care unit (NICU), and their parents, starting the 1st−2nd week after birth. They may benefit from live-performed music therapy as comforting non-pharmacological intervention.Study Design: We included infants born before 30 weeks' gestation in a single center NICU study. Live-performed music therapy was provided three times per week, tailored to the infant's medical condition. Parents were actively involved. Feasibility was determined as a combination of participation, drop-out, overstimulation (based on COMFORT-Neo scores), and evaluations of the intervention by parents and nurses (using a questionnaire on perceived effects on the parent, their infant and the NICU sound environment).Results: We included 18 infants (90% participation rate), with a gestational age of median 27 weeks (IQR 26–28 weeks), 61% males. One infant (5.6%) dropped-out. Differences of COMFORT-Neo scores during and after sessions compared with before sessions were non-significant; overstimulation by music therapy did not occur. Parents reported high satisfaction (highest score possible of 7) with the interventions and reported improvements in both infant and their own respiratory rates. Nurses also reported high satisfaction with the intervention and perceived a quieter NICU sound environment during and after sessions.Conclusion: Live-performed music therapy for extremely and very preterm infants is feasible and well-tolerated, and is experienced as an added value to developmental care. Future studies should assess both short-term and long-term effects, to determine whether this intervention should be part of routine care at the NICU and whether it is most beneficial to start shortly after birth.

Nurse Perceptions of Babywearing for Neonates With Neonatal Abstinence Syndrome in the Neonatal Intensive Care Unit.

Infants diagnosed with neonatal abstinence syndrome (NAS) often spend several weeks in a neonatal intensive care unit (NICU) and have difficulty being consoled. Infant carriers may be used to help with irritability, while allowing the adult user to be more mobile, through the practice of babywearing (the facilitated holding of an infant using a soft cloth infant carrier worn on the body). To examine the experience of babywearing infants diagnosed with NAS while admitted in the NICU from the perspective of the nurses who care for them. Nurses (N = 18; mean age = 35.44 years, SD = 9.45) were recruited and interviewed using a semistructured interview method from a 38-bed NICU in the Southwestern United States. A thematic content analyses using an open coding scheme yielded 6 themes that fell into 2 categories: (1) benefits of babywearing infants with NAS in the NICU (Infant Consoling, Adult Multitasking, Caregiver-Infant Trust); and (2) suggestions to maximize babywearing in the NICU (Infection Control, Reoccurring Infant Carrier Education, and Reduced Patient Load). Many NICUs incorporate kangaroo care (or skin-to-skin contact) as a treatment option; however, NICU staff cannot participate in kangaroo care. Babywearing is a practical alternative for nurses and support staff. Nurses supported the practice of babywearing as a means to improve the well-being of infants with NAS while also allowing for increased efficiency in nursing tasks. More prospective studies are needed that evaluate the carryover effects and long-term impact of babywearing for infants diagnosed with NAS.

Use of a Smart Pump and Dedicated Medication Line to Reduce Peripherally Inserted Central Catheter Damage.

Neonatal intensive care unit (NICU) infants frequently require peripherally inserted central catheter (PICC) placement for medication and nutrition. The occurrence of leaking catheters led to practice evaluation of manual intravenous (IV) flush and medication push technique in an upper Midwest NICU. A variation in unit practice was revealed. To describe an evidence-based practice change that standardized medication administration, eliminating routine manual IV push medication and flush administration and reducing catheter malfunction. Emergency "code" medication administration was not addressed. A systematic review of the literature was performed. A unit practice investigation ensued to study medication administration techniques and syringe size utilization, understand syringe pressure generated by various sizes of syringes, select optimal IV tubing supplies, review the smart pump library, electronic order sets/documentation, and address staff knowledge and skills. Practice change eliminating IV push and recommendations incorporating best evidence occurred. Moving from a traditional method of manual pushing/flushing medication to use of medication delivery via smart pump can decrease or eliminate PICC damage and potential harm to neonatal patients. Examination of IV push technique may identify opportunities for safer medication administration. Use of an infusion pump and a dedicated medication line can be a feasible option to deliver most IV medication doses in the NICU. Safe medication administration practices for the neonatal population and barriers to that practice.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=41.