Neonatal Intensive Care Unit Professionals Research Articles

Parents' Experience in an Italian NICU Implementing NIDCAP-Based Care: A Qualitative Study.

Background: The birth of a preterm infant and his/her immediate admittance to the Neonatal Intensive Care Unit (NICU) are sudden, unexpected, stressful and painful events for parents. In the last decade, in response to the increased awareness of the stressful experiences of parents, much attention has been paid to Family-Centered Care (FCC) and the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). According to the NIDCAP model, the infant-parents' dyad is the core of the care provided by the NICU professionals to reduce the stress experienced by parents. So far, the literature does not show a clear correlation between parental experiences and the NICU practices according NIDCAP principles. Aims: To explore how parents of preterm infants experienced the NIDCAP-based care from admission to discharge, in particular, their relationships with NICU professionals and with other parents, and the organization of the couple's daily activities during this process. Design: Qualitative exploratory study. Methods: Twelve parents of preterm infants born between January 2018 and December 2020 at the NICU of Modena, with a gestational age at birth of less than 30 weeks and/or a birth weight of less than 1250 g, were recruited. Three couples had twins, and the total number of infants was 15. All infants were followed for up to 24 months post-term age (PTA) for neurological outcomes. Each couple was given a semi-structured online interview about their experience during their infant's hospitalization in the NICU up to discharge. The interview was developed around three time points: birth, hospitalization and discharge. The data analysis was conducted according to the template analysis method. Results: The admission to the NICU was unexpected and extraordinary, and its impact was contained by the skilled staff who were capable of welcoming the parents and making them feel they were involved and active collaborators in the care of their infant. The emotional experience was compared to being in a blender; they were overwhelmed by changing emotions, ranging from terrible fear to extreme joy. The couple's activities of daily life were reorganized after the infant's birth and admission to the NICU. Fathers felt unbalanced and alone in taking care of their partners and their children. Conclusions: This is the first study in Italy to explore parental experience in an NICU implementing NIDCAP-based care. The NIDCAP approach in the NICU of Modena helps parents to be involved early, to develop parental skills, and to be prepared for the transition home; and it also facilitates and enhances the relationship between parents and NICU staff.

Staff Perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A Multicenter Cross-Sectional Study.

Family Centered Care (FCC) in Neonatal Intensive Care Units (NICUs) included family involvement in the care process of newborns and infants. Staff perceptions of FCC may influence clinical practice and management strategies in NICUs, with an impact on quality and humanization of the care. The Family-Centred Care Questionnaire-Revised (FCCQ-R) was adapted for the NICU setting, therefore the FCCQ-R@it-NICU was developed and used for the present study in 32 Italian NICUs. We calculated internal consistency using Cronbach’s alpha correlation between Current and Necessary dimensions of the scale using the Pearson correlation coefficient. Furthermore, we investigated which characteristics could influence staff perceptions of FCC in NICUs. 921 NICU professionals participated in the study. The FCCQ-R@it-NICU revealed good internal consistency (0.96) and good correlation between dimensions (p < 0.05). Statistical and significant differences in Current and Necessary dimensions were found and some demographic characteristics were found predictable on FCC practice. The FCCQ-R@it-NICU is a valid tool to investigate staff perceptions about FCC in NICU settings. Profession, education level and work experience seem to positively influence the perception of what is required for FCC practice within NICUs.

Health Care Professional Perceptions About a Proposed NICU Intervention: The Importance of Community and Aligning With Everyday Occupations

The neonatal intensive care unit (NICU) is a dynamic system with multiple stakeholders and contextual factors impacting the implementation of novel practices. This qualitative study aimed to (a) define health care professionals' perceptions on the feasibility of implementing a sensory intervention to study its efficacy, and (b) elaborate on transactions occurring between NICU health care professionals and the proposed research. Eleven NICU professionals participated in one of three focus groups that were audio-recorded, transcribed, and analyzed thematically in NVivo first descriptively and then interpretively through a transactionalism lens. The health care professionals implied the intervention was feasible, but provided multiple suggestions to enhance implementation. The modification of familiar occupational practices, ingrained habits, and the potential impact on the collective occupational performance of NICU community members arose. Understanding occupations within the NICU as transactional allows for a broader view of occupational engagement and enhances knowledge of the nuances related to implementing clinical changes.

Measuring Collaboration Through Concurrent Electronic Health Record Usage: Network Analysis Study.

BackgroundCollaboration is vital within health care institutions, and it allows for the effective use of collective health care worker (HCW) expertise. Human-computer interactions involving electronic health records (EHRs) have become pervasive and act as an avenue for quantifying these collaborations using statistical and network analysis methods.ObjectiveWe aimed to measure HCW collaboration and its characteristics by analyzing concurrent EHR usage.MethodsBy extracting concurrent EHR usage events from audit log data, we defined concurrent sessions. For each HCW, we established a metric called concurrent intensity, which was the proportion of EHR activities in concurrent sessions over all EHR activities. Statistical models were used to test the differences in the concurrent intensity between HCWs. For each patient visit, starting from admission to discharge, we measured concurrent EHR usage across all HCWs, which we called temporal patterns. Again, we applied statistical models to test the differences in temporal patterns of the admission, discharge, and intermediate days of hospital stay between weekdays and weekends. Network analysis was leveraged to measure collaborative relationships among HCWs. We surveyed experts to determine if they could distinguish collaborative relationships between high and low likelihood categories derived from concurrent EHR usage. Clustering was used to aggregate concurrent activities to describe concurrent sessions. We gathered 4 months of EHR audit log data from a large academic medical center’s neonatal intensive care unit (NICU) to validate the effectiveness of our framework.ResultsThere was a significant difference (P<.001) in the concurrent intensity (proportion of concurrent activities: ranging from mean 0.07, 95% CI 0.06-0.08, to mean 0.36, 95% CI 0.18-0.54; proportion of time spent on concurrent activities: ranging from mean 0.32, 95% CI 0.20-0.44, to mean 0.76, 95% CI 0.51-1.00) between the top 13 HCW specialties who had the largest amount of time spent in EHRs. Temporal patterns between weekday and weekend periods were significantly different on admission (number of concurrent intervals per hour: 11.60 vs 0.54; P<.001) and discharge days (4.72 vs 1.54; P<.001), but not during intermediate days of hospital stay. Neonatal nurses, fellows, frontline providers, neonatologists, consultants, respiratory therapists, and ancillary and support staff had collaborative relationships. NICU professionals could distinguish high likelihood collaborative relationships from low ones at significant rates (3.54, 95% CI 3.31-4.37 vs 2.64, 95% CI 2.46-3.29; P<.001). We identified 50 clusters of concurrent activities. Over 87% of concurrent sessions could be described by a single cluster, with the remaining 13% of sessions comprising multiple clusters.ConclusionsLeveraging concurrent EHR usage workflow through audit logs to analyze HCW collaboration may improve our understanding of collaborative patient care. HCW collaboration using EHRs could potentially influence the quality of patient care, discharge timeliness, and clinician workload, stress, or burnout.

The neonatal assessment manual score (NAME) for improving the clinical management of infants: a perspective validity study

Background and objectivesThe Neonatal Assessment Manual scorE (NAME) was developed to assist in the clinical management of infants in the neonatal ward by assessing their body’s compliance and homogeneity. The present study begins its validation process.MethodsAn expert panel of neonatal intensive care unit (NICU) professionals investigated the NAME face and content validity. Content validity was assessed through the content validity index (CVI). Construct validity was assessed using data collected from 50 newborns hospitalized in the NICU of “Vittore Buzzi” Children Hospital of Milan, Italy. Kendall’s τ and ordinal logistic regressions were used to evaluate the correlation between the NAME scores and infants’ gestational age, birth weight, post-menstrual age, weight at the time of assessment, and a complexity index related to organic complications.ResultsThe CVIs for compliance, homogeneity, and the whole scale were respectively 1, 0.9, and 0.95. Construct validity analysis showed significant positive correlations between the NAME and infants’ weight and age, and a negative correlation between the NAME and the complexity index (τ = − 0.31 [95% IC: − 0.47, − 0.12], p = 0.016 and OR = 0.56 [95% IC: 0.32, 0.94], p = 0.034 for categorical NAME; τ = − 0.32 [95% IC: − 0.48, − 0.14], p = 0.005 for numerical NAME).ConclusionsThe NAME was well accepted by NICU professionals in this study and it demonstrates good construct validity in discriminating the infant’s general condition. Future studies are needed to test the NAME reliability and predictive capacity.

Self-Report and Biological Indexes of Work-Related Stress in Neonatal Healthcare Professionals

Healthcare providers working in neonatal intensive care units (NICUs) are considered at high risk for psychological work-related stress. To evaluate both perceived and biological measures of work-related stress in neonatal healthcare professionals and to compare professionals working in the NICU with their colleagues working in less critical environments (ie, neonatal wards [NWs]). The salivary cortisol level at the beginning (CORT-B) and at the end (CORT-E) of a daily work shift was collected once a week for 6 weeks and a psychological questionnaire was submitted to NW and NICU workers of a tertiary university center. No differences emerged in the overall cortisol secretion between professionals (NW 45 vs NICU 28), but the decrease in the mean cortisol values between CORT-B and CORT-E was less pronounced in NICU professionals (P < .001) who had greater psychological stress (P < .001). Lack of correlation between perceived and biological indexes was observed. NICU professionals reported greater levels of self-perceived psychological stress, especially in terms of professional self-doubt and the complexity of interactions with infants and their parents.The disconnection between psychological and biological indexes raises the issue that work-related stress might be covert to the professionals themselves. Dedicated resources should be developed to address quality of life and the work environment of NICU professionals. The absence of a correlation between perceived and biological indexes highlights the need to incorporate multidimensional physiological and biological measurements in evaluating burnout levels in neonatal healthcare providers.

Lack of knowledge and experience highlights the need for a clear paediatric organ and tissue donation protocol in the Netherlands.

AimThis study explored the attitudes of medical professionals to organ and tissue donation in paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) in the Netherlands. It also examined their compliance with the existing Dutch donation protocol and assessed whether a paediatric donation protocol was needed.MethodsWe invited 966 professionals working in all eight PICUs and the two largest NICUs to complete an online survey from December 2016 until April 2017.ResultsA quarter (25%) took part and they included PICU intensivists, neonatologists, nurses and other health and allied professionals. Most were female and nurses. More than half (54%) of the PICU respondents considered paediatric organ donation to be very important and 53% supported tissue donation. In contrast, only 22% of the NICU respondents believed that both neonatal organ and tissue donation were very important. Familiarity and compliance with the existing national donation protocol were low. PICU nurses had significantly less experience than PICU intensivists and felt less comfortable with the donation process. None of the NICU respondents had prior donation experience.ConclusionPaediatric intensive care units and NICU professionals lack specialised knowledge and experience on organ and tissue donation. A comprehensive and clear paediatric donation protocol is clearly needed.

Healthcare professional perceptions of family-centred rounds in French NICUs: a cross-sectional study

ObjectiveTo assess the perceptions of healthcare professionals (HCPs) regarding parental presence at medical rounds in French neonatal intensive care units (NICUs). We hypothesised that HCPs would perceive barriers against allowing...

Behavioral Responses to Multisensory Stimulation in Preterm Infants

Background: Behavioral responses of preterm infant to sensory stimulation in the Neonatal Intensive Care Unit (NICU) are important to understand. This would enable NICU professionals to be cautious of overloading stimulations and ensure stability in preterm infants. The aim of this study was to describe the range of behavioral responses associated with multisensory (auditory, visual, tactile and vestibular) stimulation in preterm infants.Material and Methods: We recruited twenty-five preterm infants born at 28 to 36 weeks and birth weight of 1000 to 2000 grams for the study using convenience sampling. In the NICU, preterm infants from 32 weeks gestational age received multisensory stimulation session for duration of 12 minutes per day until discharge along with routine NICU care. During the stimulation, the behavioral responses of the preterm infants were observed and documented.Results: Limb activity and yawning were the most frequently observed behaviors. Sixty-five percent of the behavioral responses were observed during tactile stimulation. The frequency of observed behavioral responses decreased with successive stimulation sessions, which could indicate habituation responses in preterm infants to multisensory stimulation.Conclusions: Preterm infants showed behavioral responses indicating improved alertness and ability to integrate sensory stimulus. However, interpretation of preterm behaviors is a challenge because these behavioral responses could also indicate stress in preterm infants when coupled with other physiological and behavioral cues. Further studies are required to provide a detailed evidence for better clarity of infant’s responses to environmental stimuli.J Nepal Paediatr Soc 2016;36(2):110-114

More on professionals’ attitudes on blood-tinged milk: a survey from Italy

We read with interest the only available papers on blood-tinged milk by Phelps et al.1, 2 Although benefits of human milk (HM) to both healthy and high-risk infants are well known,3 it is a common belief that blood-tinged milk may worsen gastrointestinal tolerance and, possibly, lead to unnecessary investigations for gastrointestinal bleeding or necrotizing enterocolitis. In their first work, Phelps et al.1 showed that the amount of blood necessary to tinge milk is very little, with a ratio of 1:10 000 between parts of red blood cells and milk to tinge it faintly pink, a ratio of 1:1000 to tinge it pink and of 1:100 to tinge it red. They showed that 75% of neonatal intensive care unit professionals from 18 hospitals in the western United States would discard milk if pink, raising to 98% if red. The most frequently cited reasons were fear of feeding intolerance and of unnecessary investigations for gastrointestinal bleeding or necrotizing enterocolitis. One year later, the same group2 published a series of 11 patients who were fed blood-tinged milk (including red milk) without any harm.

Staff workload and adverse events during mechanical ventilation in neonatal intensive care units

To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of São Luís, state of Maranhão, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomes.

Identificação dos sinais neurocomportamentais de bebês pré-termo por profissionais que atuam na Unidade de Terapia Intensiva Neonatal (UTIN)

INTRODUCTION: In response to external stimuli intrinsic to the neonatal intensive care unit (NICU), the preterm infant exhibits neurobehavioral signs of avoidance cues or approach behavior. These signs offer tips to the professionals about their interventions. The correct modulation of stimuli leads to a better biological, social and emotional development of preterm infant and the care professionals must be prepared to perceive and evaluate these signs. OBJECTIVE: Investigate the level of identification by NICU professionals, of the neurobehavioral signs of avoidance cues and approach behavior, exhibited by preterm infants and analyze the factors that influence the acquisition of the knowledge about these signs. METHODOLOGICAL PROCEDURES: The data were collected through the applications of The Checklist of The Assessment of the Preterm Infants' Behavior (APIB) (ALS & cols., 1982) to the NICU professionals' and through the analysis of the responses to the open questions included in the instrument. The quantitative data were analyzed by frequency count and the qualitative data by content analysis. RESULTS: Forty-five professionals answered the checklist, 80% from the nursery assistant level and 20% from the graduated level. From the 16 signs of avoidance cues and from the 17 signs of approach behaviors present in the APIB Checklist, the graduate level professionals observed tree signs of avoidance cues and seven signs of approach behavior more than the nursery assistant professionals observed. Through the qualitative analysis, it was verified that the correct identifications of the preterm infants' signs by the professionals is influenced by factors such as a heavy load of work, subtlety of the signs showed by babies, professional experience and the need of continued education.

470 Patient Safety in the Nicu

Background: Patient safety is a spearhead of the University Medical Centre of Utrecht (UMCU), the Netherlands. It recognizes that human error is inevitable. Wherever possible, the system should be (re)designed in such a way that human error is discovered or intercepted before it leads to patient harm. Reporting incidents is part of the patient safety program running in our hospital. The Neonatal Intensive Care Unit (NICU) of the UMCU wanted to have more insight in the incident reports on their unit. By analysing the reports with NICU professionals, the chance of effective improvement on the department would be increased.Aim: Increase of patient safety by incident analyses.Method: Our NICU started a multi disciplinary local report committee. Procedures for analysing reports were made. In the analyses we looked at organisational factors, human errors and technical failures. Moreover we used ‘why questions’ and the ‘barrier analysis’.Implications for practice: Local reporting needs support by management. It is necessary that all disciplines are represented in the committee and that members are approachable and are ambassadors for incident reporting. Regular feedback and presenting results to management and medical and nursing staff, stimulates reporting. Work instructions after exchanging mother milk, a new feeding application form and ongoing attention for the administration of extra oxygen are examples which resulted in fewer incidents.Conclusion: After three years incident reporting became more regular. The reports increased from 37 in 2006 to 138 in 2009. Meanwhile a number of procedures has been adapted and improved, as a result of which patient safety increased.

Attitudes of NICU professionals regarding feeding blood-tinged colostrum or milk

Mothers of neonatal intensive care unit (NICU) patients sometimes bring expressed milk that is blood tinged to the NICU. In certain instances, the blood contamination appears minimal, whereas in others, the milk is quite dark pink. We have observed inconsistencies in practice regarding whether or not to feed blood-tinged colostrum or milk to NICU patients. We know of no evidence that establishes best practice in this area, and thus we sought to determine attitudes of NICU professionals on which to base a potentially best practice. We conducted a web-based anonymous survey of attitudes of NICU professionals at Intermountain Healthcare regarding feeding blood-tinged expressed milk to NICU patients. These professionals included neonatologists, neonatal nurse practitioners, NICU nurses, NICU dieticians and lactation consultants. Survey results were returned from 64% (426 of 667) of those to whom it was sent. A total of 75% of respondents reported that their practice was NOT to feed the blood-tinged milk illustrated in the figure as sample 2, and nearly all respondents (98%) reported that they would NOT feed the milk illustrated as sample 3. The majority of the neonatologists (56%) and the lactation consultants (58%) recommended feeding moderately bloody milk (sample 2), whereas only 22% of the neonatal nurse practitioners (NNPs), NICU nurses and NICU dieticians recommended feeding such samples (<0.001). The most frequently selected reason for NOT feeding blood-tinged milk was that it would likely cause gastrointestinal upset and feeding intolerance (selected by 77%). The majority (87%) overestimated the amount of blood contaminating a milk sample (sample 3). As colostrum and human milk feedings can be of value to NICU patients, evidence should be assembled to document whether feeding blood-tinged samples indeed have the problems listed by the survey respondents. Such evidence is needed to enable informed decisions involving the benefits vs risks of feeding blood-tinged expressed milk to NICU patients.

Percepção materna com o nascimento prematuro e vivência da gravidez com pré-eclampsia

To analyze maternal experiences of preeclampsia pregnancy with premature birth at a neonatal intensive care unit. A qualitative study using the focus group technique was conducted with 28 women in a facility specialized in high-risk pregnancies in the state of Rio Grande do Norte, Northeastern Brazil, in 2004. Mothers included had had preeclampsia during pregnancy and a preterm delivery with consequent hospitalization of their baby at a neonatal intensive care unit. The data were analyzed using thematic content analysis of three thematic nuclei subjects: information about preeclampsia during prenatal care; experiences with the preterm newborn, and their perception of neonatal intensive care unit professionals' attitudes. Maternal reports showed subjects' lack of knowledge with regard to preeclampsia and its association with prematurity. Difficulties inherent to the maternal role of caring for the child in the neonatal intensive care unit were identified, accentuated by communication flaws between health professionals and users. Some difficulties experienced by the mothers, in the context of preeclampsia and prematurity, were aggravated by lack or inadequacy of information provided to the users.

Current parent education on infant feeding in the neonatal intensive care unit: the role of the occupational therapist.

The purpose of this study was to describe current trends in parent education on infant feeding in the neonatal intensive care unit (NICU) and to clarify the role of the occupational therapist in educating parents. Questionnaires were mailed to 190 neonatologists across the United States who were asked to forward it to a NICU occupational therapist. The questionnaire gathered descriptive information about the structure of parent education in the NICU, the role of the occupational therapist in providing parent education, and demographics about respondents and their NICUs. The response rate was 53% (n = 100). All 100 hospitals responding provided parent education in some form, and most included a variety of topics and teaching methods. Occupational therapists were on the NICU team at 74 of the hospitals and were identified third most frequently as a provider of parent education. The occupational therapists were most frequently identified as responsible for teaching about positioning, infant development, and infant states and cues and were highly involved in educating parents about feeding. Current parent education programs in NICUs are comprehensive in scope. Occupational therapists' role in educating parents about infant care and feeding consists of a focus on certain topics where occupational therapists have specialized skills and education. Occupational therapists are recognized by their NICU colleagues as providers of parent education, but this study suggests that the occupational therapists' role may not be clearly understood by other NICU professionals.