Neonatal Intensive Care Unit Units Research Articles

Caring for our caretakers: building resiliency in NICU parents and staff.

The neonatal intensive care unit (NICU) is a high-acuity, stressful unit for both parents and staff. Up to 50% of mothers and partners experience emotional distress (i.e., depression, anxiety, or posttraumatic stress) during NICU hospitalization and 30–60% continue to experience distress after discharge. Similarly, up to 50% of NICU staff report burnout and emotional distress. Although healthcare providers have developed interdisciplinary guidelines to enhance psychosocial resources for parents and staff, standardized psychosocial services are lacking. The purpose of this short communication is to describe: (1) the need for psychosocial interventions for NICU parents and staff; (2) existent psychosocial programs and their gaps and limitations; and (3) future directions for psychosocial care in NICU settings. We reviewed the current literature and propose a new conceptual model to inform psychosocial interventions for the NICU. We argue that brief, evidence-based, resiliency, and relationship-based programs are needed to enhance parent and staff outcomes and, ultimately, child development and the NICU unit culture.Conclusion: Given the lack of standardized psychosocial care, new interventions for NICU families and staff are needed more than ever. Resiliency, relationship-based interventions that leverage multidisciplinary support may be an innovative way to enhance NICU outcomes and care. What is Known:• 40-50% of parents in the NICU report elevated emotional distress and 30-50% of staff report burnout.• Psychosocial interventions for parents and staff are needed, yet lacking.What is New:• Interventions that focus on resiliency and relationships may improve the culture of the NICU.• New multidisciplinary collaborations and approaches are needed to improve implementation.

Rapid exome sequencing: revolutionises the management of acutely unwell neonates.

Diagnosing acutely unwell infants with a potential genetic diagnosis can be challenging for healthcare professionals. Evidence suggests that up to 13% of critically unwell infants on the neonatal intensive care unit (NICU) have an underlying molecular diagnosis and when identified directly affects treatment decisions in 83%. On 1st October 2019, the National Health Service England (NHSE) launched a nationally commissioned service so that rapid whole-exome sequencing can be offered to critically unwell babies and children with a likely monogenic disorder who are admitted to NICU and paediatric intensive care unit (PICU). We present 7 cases from two neonatal units in the West Midlands (UK), where rapid exome sequencing has revealed a genetic diagnosis. Early genetic diagnosis in this cohort has influenced management in all (100%) cases, and in 57% (4 in 7 cases), it has helped in the decision to reorientate care. In some cases, early diagnosis has reduced the need for invasive and unnecessary investigations and avoided the need for post-mortem investigations. The genetic diagnosis has helped in counselling the families regarding the recurrence risk for future pregnancies. In some cases, this has provided parents with the reassurance of a low recurrence. In others, it has resulted in the offer of prenatal diagnosis or assisted conception technologies. What is Known:• Rapid whole-exome sequencing was commissioned in the UK in October 2019.• It is available for critically unwell babies with a likely monogenic aetiology.What is New:• It helps management planning for rare genetic disorders and future pregnancies counselling.• It can reduce the need for invasive investigations and overall intensive care costs.

Cronobacter Sakazakii: A Foodborne Pathogenic Bacterium in Immunocompromised and Hospitalized Patients

Aims: Cronobacter sakazakii (CS) is a member of the Enterobacteriaceae family. It is a genomically heterogeneous, motile, Gram-negative bacillus. It is also an emergent foodborne pathogen associated with the ingestion of infant formula milk that can cause neonatal sepsis, necrotizing enterocolitis, and meningitis. This review is focused on the newest information about the bacterial characteristics of C. sakazakii and human infections causing by this pathogenic bacterium. Methods & Materials: We searched medical databases such as ISI Web of Science, PubMed, Scopus, and other websites. Findings: Cronobacter sakazakii acts as a microbiological hazard in the infant food chain, with historic high mortality in neonates. The International Commission for Microbiological Specifications for Foods has categorized C. sakazakii as a severe hazard bacterium for some individuals, with long duration, substantial chronic sequelae, or life-threatening complications. Although the incidence of C. sakazakii infection is low, the prognosis of the disease is poor, and infection is associated with significant morbidity and mortality. Powdered Infant Formula (PIF) milk products contaminated with C. sakazakii have been epidemiologically linked to several clinical cases. Premature infants, low-birth-weight ones, and patients hospitalized in the Neonatal Intensive Care Units (NICUs) are more at infection risk than older infants. Conclusion: We recommend focusing on simple preventative strategies such as the promotion of breast milk feeding, the inclusion of warnings on the powder infant formula packages that may be contaminated with C. sakazakii, and abstinence from the practice of re-warming of reconstituted formula. Reconstituted dairy products should be avoided in adult immunosuppressed populations. Appropriate barrier precautions should be observed in NICU and intensive care unit settings, where the spread of infection may be more prevalent.

The Mother Baby Comfort Care Pathway: The Development of a Rooming-In-Based Perinatal Palliative Care Program.

Traditionally, the provision of comfort care and support during the dying process for infants born with life-limiting diagnoses has occurred in the neonatal intensive care unit (NICU). A major goal for the families of these infants is often the opportunity to spend as much time as possible with their infant in order to make memories and parent their infant. The objective of the Mother Baby Comfort Care Pathway is to implement a program of family-centered care with logistically flexible care delivery, allowing mothers and their families to share as normal a postpartum care experience as possible with a focus on quality of life, memory making, and time spent together. The program was developed with the nucleus of care coordination and provision on the Mother Baby Unit (postpartum unit), with involvement from the labor and delivery room, NICU, and other units as necessary to provide the postpartum mother, her dying infant, as well as possible additional siblings (in the case of multiple gestation), postpartum care while rooming-in. The program was rolled out with training workshops for postpartum nurses. Nurses who took part in the workshops and the patient care program rated both highly. The Mother Baby Comfort Care Pathway aims to offer a framework for providing multidisciplinary family-centered comfort care to newborns during the postpartum period in a compassionate, evidence-based, and individualized manner in order to maximize quality time together for families with a dying infant.

Implementing a Hospital-Based Safe Sleep Program for Newborns and Infants.

An unsafe sleep environment remains the leading contributor to unexpected infant death. To determine the effectiveness of a quality improvement initiative developed to create a hospital-based safe sleep environment for all newborns and infants. A multidisciplinary team from the well-baby nursery (WBN) and neonatal intensive care unit (NICU) of a 149-bed academic, quaternary care, regional referral center developed and implemented safe sleep environments within the hospital for all prior to discharge. To monitor compliance, the following were tracked monthly: documentation of parent education, caregiver surveys, and hospital crib check audits. On the inpatient general pediatric units, only hospital crib check audits were tracked. Investigators used Plan-Do-Study-Act (PDSA) cycles to evaluate the impact of the initiative from October 2015 through February 2018. Safe sleep education was documented for all randomly checked records (n = 440). A survey (n = 348) revealed that almost all caregivers (95.4%) reported receiving information on safe infant sleep. Initial compliance with all criteria in WBN (n = 281), NICU (n = 285), and general pediatric inpatient units (n = 121) was 0%, 0%, and 8.3%, respectively. At 29 months, WBN and NICU compliance with all criteria was 90% and 100%, respectively. At 7 months, general pediatric inpatient units' compliance with all criteria was 20%. WBN, NICU and general pediatric inpatient unit collaboration with content experts led to unit-specific strategies that improved safe sleep practices. Future studies on the impact of such an initiative at other hospitals are needed.

Design of an IoT-based smart incubator that listens to the baby

In the industrial era 4.0, domestic baby incubator producers are facing the challenge of free trade of foreign products that will compete in innovation with the application of IoT technology. One of the opportunities that arise consciously or unconsciously at the NICU (Neonatal Intensive Care Unit) unit in Hospitals, in general, is that there are no facilities for parents to monitor the baby’s condition inside the incubator directly. The purpose of this research project is to build a prototype of an internet-based baby incubator monitoring system based on things equipped with various sensors that will send data to the server in real-time and mobile apps for monitoring facilities for parents, including the voice of the baby. This study focused on how to develop baby incubators that can listen to baby’s crying, capture the voice, and interpret it using artificial intelligence. More than 40 (forty) voice datasets were used and successfully classified into five possible terms of the baby’s condition: burping, sleepy, hungry, uncomfortable, and pain by energy signal and spectrum analysis. The benefit of this research is as a driver of innovation for baby incubator products that will support the national medical devices manufacturing company.

Blood Component Transfusion in Tertiary Care Neonatal Intensive Care Unit and Neonatal Intermediate Care Unit: An Audit.

BackgroundNeonates admitted in a tertiary neonatal intensive care unit (NICU) require multiple blood transfusions because of extended NICU stay and repeated sampling. The rookie organ systems and miniature blood volumes in the neonate call for regular audits in neonatal blood transfusion practice. Sharing component usage data with the blood bank will prepare them to store components according to demand, thus limiting wastage of components as well as make banks ready to face a shortage in case of ramped up requirements.ObjectiveAuditing neonatal blood transfusion indications and identifying the most commonly used component.MethodologyThis retrospective cohort study was conducted by the department of pediatrics over 22 months from February 20, 2017, to December 30, 2018. Any preterm and term neonates admitted to the NICU and Neonatal Intermediate Care Unit (NIMC) and receiving any transfusion, i.e., fresh frozen plasma (FFP), red cell concentrate (RCC), platelets, and exchange transfusion were included in our study. We collected data from the medical records of NICU and NIMC admitted patients receiving blood component transfusions from 2011 to 2016. Patients were categorized according to the classification of neonatal conditions by the International Classification of Diseases 11th Revision (ICD-11). There were no exclusion criteria. A descriptive statistical analysis was done, and a Chi-square test was applied.ResultsOut of 340 neonates, 249 (73.2%) were low birth weight, 139 (40.9%) were small for gestational age (SGA), and 277 (81.5%) neonates required transfusion during the first week of life. The majority of neonates require multiple transfusions. Fourteen(4.12%) neonates required up to 10 transfusions, two neonates required up to 22 transfusions, and 58 neonates required more than five blood transfusions. The majority required transfusion due to neonatal sepsis, Disseminated intravascular coagulopathy, low birth weight, respiratory distress syndrome, and unconjugated hyperbilirubinemia. Thirty-seven point eighty-two percent (37.82%) transfusions were fresh frozen plasma, 31.34% transfusions were red cell concentrate, 28.14% transfusions were platelet concentrate, and 2.70% were whole blood. Out of 340 neonates, 317 survived and were discharged.ConclusionThe most commonly transfused component was fresh frozen plasma, the indication was neonatal sepsis, and the group was preterm. Whole blood is still being used and needs to be stopped.

A Survey on the Current Status of Neonatal Physical Therapy in South Korea

Purpose: This study aimed to investigate and report the current status of physical therapy (PT) performed in Korean neonatal intensive care units (NICU) to present foundational data that promotes the advances in neonatal PT in Korea. Methods: Based on the Health Insurance Review and Assessment (HIRA) data, we administered a questionnaire survey to 74 hospitals (39 tertiary and 35 general hospitals) in Korea equipped with a NICU and pediatric PT unit. We developed a 32-item questionnaire with reference to previous Korean studies. The questionnaires were distributed and retrieved via regular mail and an online system. Results: Of the 74 hospitals, 58 (78%) practiced neonatal PT and the duration of each session significantly differed according to the hos pital rating. PT was given, depending on clinical symptoms, to infants who were preterm and low birth-weight (96.5%), had brain and spinal cord diseases (84.5%), had pathological tonus (94.8%), with respiratory problems (65.5%), for range of motion exercises (82.8%), for neurodevelopment approaches (72.4%), and for positioning (70.7%). Interdisciplinary meetings were held to share clinical decision-making in 17.2% of the hospitals surveyed and parent-participating education to ensure a family-centered approach was offered in 63.8% of the hospitals. The barriers of neonatal PT included low insurance fees, insufficient awareness of colleagues, and the severity of the patient. Conclusion: This study is the first report of the current status of neonatal PT in Korea. The findings of this study will serve as foundation al data to review the current neonatal PT practice and promote further advances.

1528. Rates of Peripheral Blood Culture Contamination in an Urban Children’s Hospital

BackgroundPositive peripheral blood culture results are essential in guiding antimicrobial therapy in patients with bacteremia. However, false-positive results may frequently pose diagnostic issues in interpreting the test. These results can lead to increased costs and patient harm through the administration of unnecessary antibiotics and prolongation of hospital stay. The maximum acceptable contamination rate for peripheral blood cultures as suggested by the College of American Pathologists is 3%.MethodsWe initiated a longitudinal quality improvement project to monitor peripheral blood contamination rates at our children’s hospital in Brooklyn, NY. We reviewed positive blood culture results on a monthly basis and assessed whether they represented true infections vs. contamination based on review of patient charts. Residents and nurses in the pediatric emergency department (ED), neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), inpatient unit, and newborn nursery were educated on proper skin sterilization techniques using video demonstration; the importance of avoiding palpating the venipuncture site after sterilization and the importance of cleaning the port on the blood culture bottle were reinforced.ResultsThe pediatric ED and the PICU had the highest contamination rates in 2018 at 4.38% and 3.82%, respectively. The newborn nursery had the lowest contamination rate, at 0%. The NICU and pediatric inpatient units had contamination rates that met the goal as well, at 1.25% and 0.72%, respectively.ConclusionThe departments in need of targeted interventions are the pediatric ED and the PICU, both of which had contamination rates greater than the 3% goal rate set for our project. Future interventions currently being considered include re-education of nursing and resident staff as well as the creation of equipment bundles to facilitate adequate skin preparation prior to venipuncture. Disclosures All authors: No reported disclosures.

Nurses' and Physicians' Experiences of the NIDCAP Model Implementation in Neonatal Intensive Care Units in Iran

PurposeThe Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides comprehensive newborn focused family-centered care in the Neonatal Intensive Care Unit (NICU). The purpose of this study was to investigate nurses' and physicians' experiences of implementing the NIDCAP model to optimize its implementation for both caregivers, infants, and families in the NICU. Design & methodsA purposes sample of 11 nurses and four physicians participated in this qualitative study. Data were collected by face-to-face and semi-structured interviews and analysis were guided by principles of thematic analysis as per Graneheim and Lundman (2004). ResultsSix themes and 20 sub-themes were constructed during data analysis. These included; NIDCAP as a milestone, Helping to rebuild the core of the family, Caregiver excellence, Realism towards the feasibility of NIDCAP, Proper managerial position of NIDCAP specialists in the health system, and Caring for the caregiver. ConclusionsThe findings of this study highlight how NIDCAP provides a comprehensive and effective care model for premature infants, with the goal to promote neonatal growth and development while also facilitating the self-efficacy of caregivers. Implementation of the NIDCAP model requires attention to be paid to social context, infrastructure, adjustment of the program according to the facilities and resources of each country, and the needs of caregivers. Practice implicationsHealth care resources are required to sustain NIDCAP specialists and a favorable environment as the necessary conditions for its multidimensional application across NICU units around the world.

Development and implementation of a construction noise and vibration management plan for occupied healthcare facilities

Acoustics and noise management play an integral role in providing an optimum care environment for patients and staff of healthcare facilities. Indoor noise and vibration affect patient comfort and healing, clear communication, operation of sensitive imaging equipment, and overall occupant satisfaction. Construction and demolition activities often occur in occupied hospitals requiring ongoing noise and vibration sensitive operations to remain active. This case study presents the development and implementation of a construction noise and vibration management plan for a neonatal intensive care unit (NICU) expansion project. The expansion included the addition of 23 NICU beds an existing roof level, directly adjacent to an existing NICU unit, Post-Anesthesia Care Unit, operating rooms, and In Vitro Fertilization clinic which remained in operation during demolition and construction. The acoustical design process from establishment of baseline conditions, prediction of project-related noise and vibration, design of mitigation strategies, and development of the management plan will be presented. Monitoring data collected over the 15 month demolition and construction period will be reviewed along with project implementations strategies and lessons learned.

An agent based architecture for high-risk neonate management at neonatal intensive care unit.

BackgroundIn recent years, the use of new tools and technologies has decreased the neonatal mortality rate. Despite the positive effect of using these technologies, the decisions are complex and uncertain in critical conditions when the neonate is preterm or has a low birth weight or malformations. There is a need to automate the high-risk neonate management process by creating real-time and more precise decision support tools.ObjectiveTo create a collaborative and real-time environment to manage neonates with critical conditions at the NICU (Neonatal Intensive Care Unit) and to overcome high-risk neonate management weaknesses by applying a multi agent based analysis and design methodology as a new solution for NICU management.MethodsThis study was a basic research for medical informatics method development that was carried out in 2017. The requirement analysis was done by reviewing articles on NICU Decision Support Systems. PubMed, Science Direct, and IEEE databases were searched. Only English articles published after 1990 were included; also, a needs assessment was done by reviewing the extracted features and current processes at the NICU environment where the research was conducted. We analyzed the requirements and identified the main system roles (agents) and interactions by a comparative study of existing NICU decision support systems. The Universal Multi Agent Platform (UMAP) was applied to implement a prototype of our multi agent based high-risk neonate management architecture.ResultsLocal environment agents interacted inside a container and each container interacted with external resources, including other NICU systems and consultation centers. In the NICU container, the main identified agents were reception, monitoring, NICU registry, and outcome prediction, which interacted with human agents including nurses and physicians.ConclusionManaging patients at the NICU units requires online data collection, real-time collaboration, and management of many components. Multi agent systems are applied as a well-known solution for management, coordination, modeling, and control of NICU processes. We are currently working on an outcome prediction module using artificial intelligence techniques for neonatal mortality risk prediction. The full implementation of the proposed architecture and evaluation is considered the future work.

Antibiotic Prescribing Pattern in Neonates of Seventeen Iranian Hospitals

Background: The association between the use of antibiotics and bacterial resistance has obviously been established and it seems to be a significant problem for public health. It is clear that irrational use and high rates of antibiotic prescription are associated with increased bacterial resistance. As antibiotics are the class of drugs commonly prescribed in neonatal and Neonatal Intensive Care Unit (NICU) wards, neonates are at high risk of opportunistic or nosocomial infections due to prolonged hospitalization and immunosuppressed condition. Objectives: It is essential for antibiotic prescription patterns to be evaluated periodically for rational use. Therefore, the present study was carried out to identify the prescribing patterns of antibiotics in neonatal and NICU wards of 17 different Iranian hospitals. Methods: The study was done during 1 calendar week between January and February 2014. All in-patients admitted to the NICU and neonatal units of 17 Hospitals in 15 Iranian cities were included. Relevant data of all neonates receiving an antibiotic at 8 am on the day of the study was collected by trained members of the study team; age of the patients, type and number of administered antibiotics, route of administration, underlying disease, and indication for use were documented. Results: The total number of neonatal in-patients was 366 on the day of the study. Mean age of infants was 9.2 ± 3.9 days, with 54.4% being male. Overall, 264 patients (72.1%) were being given one or more antimicrobials; the proportion of patients receiving antibiotics ranged from 21.4% to 100% in different neonatal units. Most frequent antibiotics used were ampicillin (25.6%), vancomycin (16.4%), amikacin (10.6%), and cefotaxime (9.74%). Parenteral route was used in 255 cases, (96.6%); 110 (41.7%) antibiotic courses were prescribed for community-acquired infections, 29 (11 %) for hospital-acquired infections, 42 (15.9 %) for pre- or post-operative prophylaxis, and 83 (31.4 %) for medical prophylaxis. Empirical antibiotics were administered to 255 newborns (96.6 %); 96.2% of patients received combination therapy. Conclusions: High use of empirical and prophylactic antibiotics, overuse of vancomycin and third generation cephalosporins are of concern and contrary to recommended therapies. Therefore, guidelines for the use of antibiotics in neonates are required and a larger number of studies are needed.

“Me Against the World”: Parental Uncertainty Management at Home Following Neonatal Intensive Care Unit Discharge

ABSTRACTThis study explored the uncertainty management processes experienced by parents at home following their child’s discharge from the neonatal intensive care unit (NICU). In-depth, semistructured interviews were conducted with 18 mothers and fathers whose children were cared for and “graduated” from NICU units in seven different hospitals from 6 to 183 days (M = 63.58 days). Interviews revealed three types of parental uncertainties: parental role shift, caring through equipment, and adherence to provider advice. Parents relied on three strategies to manage these uncertainties: reorientation, calibrating appropriate responses, and limiting exposure. Findings highlight how parental experiences, communication interactions, and expectations in the NICU complicate parental uncertainties postdischarge and negatively affect parental perceptions of self-efficacy, readiness, and competency. Our findings suggest that family-centered care can be enhanced by redefining discharge as an ongoing process that necessitates distinct uncertainty management practices to negotiate tensions between protecting preterm children and supporting parents.

Supporting Families as They Transition Home

For families who are leaving the neonatal intensive care unit (NICU) or other intensive care and going home with their child, the transition is often accompanied by intense and complex emotions. NICU discharge readiness for infants reflects attainment of physiological maturity. However, discharge readiness for parents is defined as the masterful attainment of technical skills and knowledge, emotional comfort, and confidence with infant care at the time of discharge. Discharge preparation is the process of facilitating comfort and confidence as well as the acquisition of knowledge and skills to successfully transition home. A comprehensive approach to discharge/transition planning that includes psycho-social support and a focus on the caregiver–child relationship offers families the support they need and deserve at a critical time in their lives. After discharge, follow-up should occur in a medical home and be supported by the wide range of programs and services available to babies and families when they leave the NICU or other intensive care unit. It is important for hospital and community programs to establish strong relationships with each other and to be knowledgeable about each other's systems and services so that families can experience a safe and smooth transition home.

Differences in Pediatric Pain Management by Unit Types.

The purpose of this study was to determine differences in pediatric pain management by unit type in hospitals across the United States. The aims were to (a) compare unit-type rates of assessment, intervention, and reassessment (AIR), and (b) describe differences in assessment tools and intervention use by unit type. The study used a cross-sectional design. A secondary analysis of 2013 data from the National Database of Nursing Quality Indicators (NDNQI®) pain AIR cycle indicator was conducted. The sample included 984 pediatric units in 390 hospitals. Data were gathered via retrospective chart review on the pain assessment tool used, presence of pain, interventions, and reassessment. Descriptive statistics and the Kruskal-Wallis one-way analysis of variance test were conducted. Post-hoc analyses included the Wilcoxon-rank sum test with Bonferroni correction. Across all units the mean unit-level percentage of patients assessed for pain was 99.6%. Of those patients assessed, surgical units had the highest average unit-level percentage of patients with pain, while Level 4 neonatal intensive care units (NICUs) had the lowest. The most commonly used assessment tool among all units was the Faces, Legs, Activity, Crying, and Consolability (FLACC) Scale. The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and Neonatal Infant Pain Scale (NIPS) specifically developed for infants were more commonly used across NICU unit types. The mean unit-level percentage of patients with pain receiving an intervention was 89.4%, and reassessment was 83.6%. Overall, pharmacologic methods were the most common pain intervention, while music was the least common. Assessments were performed routinely, yet interventions and reassessments were not. Pain AIR cycle completion varied by unit type. Pain was also widely present across many unit types, and pharmacologic methods were most frequently used. Frontline nurses are instrumental to pain management and have the ability to improve patient care and outcomes by effectively managing pain. A comprehensive understanding of it provides valuable insight into improving our practice to produce the best outcomes for pediatric patients.

Low-tech, high impact: care for premature neonates in a district hospital in Burundi. A way forward to decrease neonatal mortality.

BackgroundDeath among premature neonates contributes significantly to neonatal mortality which in turn represents approximately 40 % of paediatric mortality. Care for premature neonates is usually provided at the tertiary care level, and premature infants in rural areas often remain bereft of care. Here, we describe the characteristics and outcomes of premature neonates admitted to neonatal services in a district hospital in rural Burundi that also provided comprehensive emergency obstetric care. These services included a Neonatal Intensive Care Unit (NICU) and Kangaroo Mother Care (KMC) ward, and did not rely on high-tech interventions or specialist medical staff.MethodsA retrospective descriptive study, using routine programme data of neonates (born at <32 weeks and 32–36 weeks of gestation), admitted to the NICU and/or KMC at Kabezi District Hospital.Results437 premature babies were admitted to the neonatal services; of these, 134 (31 %) were born at <32 weeks, and 236 (54 %) at 32–36 weeks. There were 67 (15 %) with an unknown gestational age but with a clinical diagnosis of prematurity. Survival rates at hospital discharge were 62 % for the <32 weeks and 87 % for the 32–36 weeks groups; compared to respectively 30 and 50 % in the literature on neonates in low- and middle-income countries. Cause of death was categorised, non-specifically, as “Conditions associated with prematurity/low birth weight” for 90 % of the <32 weeks and 40 % of the 32–36 weeks of gestation groups.ConclusionsOur study shows for the first time that providing neonatal care for premature babies is feasible at a district level in a resource-limited setting in Africa. High survival rates were observed, even in the absence of high-tech equipment or specialist neonatal physician staff. We suggest that these results were achieved through staff training, standardised protocols, simple but essential equipment, provision of complementary NICU and KMC units, and integration of the neonatal services with emergency obstetric care. This approach has the potential to considerably reduce overall neonatal mortality.

Neonatal nurses' beliefs, knowledge, and practices in relation to sudden infant death syndrome risk-reduction recommendations.

Sudden infant death syndrome (SIDS) remains the third leading cause of infant death in the United States and the leading cause of death beyond 1 month of age. In 2011, the American Academy of Pediatrics (AAP) released the newest SIDS risk-reduction recommendations, which address healthcare providers in neonatal intensive care units (NICUs). Little is known about neonatal nurses' SIDS prevention strategies since the release of these newest recommendations. To assess neonatal nurses' beliefs, knowledge, and practices regarding SIDS prevention in both the NICU and step-down transitional care unit (TCU). A prospective-descriptive design was used. The 33-item SIDS Risk-Reduction Questionnaire was distributed to a convenience sample of nurses in a level III NICU/TCU in the Midwest. Two hundred questionnaires were distributed; 96 (48%) were returned completed. Fifty-three percent of nurses strongly agreed that SIDS recommendations make a difference in preventing SIDS and 20% strongly believed that parents model SIDS prevention practices employed by staff. A majority of nurses correctly identified 2011 recommendations. Sixty-three percent of nurses often or always gave parents verbal information and 28% often or always gave parents written information regarding SIDS. Differences were seen between NICU and TCU nurses concerning beliefs and practices, suggesting that TCU nurses more consistently follow SIDS recommendations. Increased neonatal nursing and parental education regarding SIDS prevention and updated hospital policies promoting safe sleep are paramount. Larger multicenter studies in level II/III NICUs are needed to provide further data on SIDS attitudes and practices.

Pharmacists as non-medical prescribers: what role can they play? The experience in a neonatal intensive care unit

BackgroundIndependent prescribing by pharmacists is designed to:▸ improve the quality of service to patients without compromising patient safety▸ make it easier for patients to get the medicines they need▸ make...

Implementation of an Electronic Hand Hygiene Monitoring System in Pediatric Long-term Care Facilities

ISSUE: Central Line-Associated Bloodstream Infections (CLABSIs) result in increased morbidity, mortality, and length of stay in Neonatal Intensive Care Unit (NICU) patients. The CLABSI rates in a level II and III NICUwere consistently greater than 5.4 (CLABSI/1000 device days) and peaked at a rate of 10.7 in 2010. To address this problem an “Aim for Zero” task force was created which included nurses, directors, infection control, and physicians, and implemented a central line team. PROJECT: The task force and central line team analyzed all bloodstream infections in the NICU. In September 2010 the line team began training with evidence based practice techniques for the care of all umbilical, peripherally inserted, and operating room inserted central catheters. Daily rounding and assessment of these lines was implemented as well as strict sterile insertion practices, dressing maintenance, daily sterile fluid changes, and a timely removal process. Sterile injection ports were added to all lines and a 30 second scrub with 3% chlorahexadine was performed prior to every access. The line team was officially launched in November, 2010. RESULTS: Immediately after implementing changes CLABSI rates dropped significantly. From December 2010 through November 2013 the NICU units recorded 25,000 central line days and 132,546 patient days and had a CLABSI rate of 0.65. Our longest CLABSI free stretch was 304 days ending in October of 2013. Our peripherally inserted and umbilical lines remain CLABSI free to date. It is important to note that our data is accurate as we do not use any maneuvers to avoid National Healthcare Safety Network (NHSN) CLABSI criteria.