Neonatal Staff Research Articles

Neonatal Noninvasive Ventilation Nasal Mask Interface Pressure and the Inter-Individual Variation of Mask Placement.

The 2014 American Academy of Pediatrics recommendation for CPAP as an alternative to mechanical ventilation for treatment of neonatal respiratory distress prompted a rapid shift to noninvasive ventilation (NIV). Since most patients receive nasal bubble CPAP (a form of NIV), a concomitant increase in nasal pressure injuries followed. This prospective observational study aims to develop strategies to reduce nasal mask pressure injury in neonates by 1.) quantifying CPAP mask-interface pressure and 2.) assessing placement variability. A 1F MEMS Connect pressure sensor (Millar®) was modified for contact pressure measurements with silicone embedding and calibrated. The CPAP generator and interface components were sized for a 24-week neonatal simulator. Thirteen neonatal ICU staff placed the simulator on CPAP at 6 cmH2O and 8 L/min of flow with no humidification. Pressure was measured at three locations (the forehead, nasal bridge, and philtrum) in triplicate (three measurements per site). Descriptive statistics, a location-specific, one-way analysis of variance (ANOVA) with a Tukey post hoc test, and a two-sample paired t-test of the means of the first and last triplicate were performed (Minitab, LLC). Pressure ranged from 12.3 to 377.3 mmHg. The mean (SD) interface pressure at the philtrum was significantly higher than both the nasal bridge and the forehead (philtrum: 173.9 (101.3), nasal bridge: 67.79 (28.9), and forehead 79.02 (36.87), p ˂ 0.001). CPAP fixation varied, including bonnet placement, trunk angle, mask compression, use of hook and loop extenders, and level of vigorous bubble feedback achieved. This study developed a modified pressure sensor for quantifying the pressure exerted by a nasal mask on facial skin. Maximum pressures were higher than those previously reported. Inter-individual differences were present in both quantitative and qualitative measures of pressure. Reduction of NIV-associated pressure injuries may be achieved through NIV fixation technique training and improved nasal mask stability and size increments.

Impact of the Neonatal Resuscitation Video Review program for neonatal staff: a qualitative analysis.

Neonatal resuscitation video review (NRVR) involves recording and reviewing resuscitations for education and quality assurance. Though NRVR has been shown to improve teamwork and skill retention, it is not widely used. We evaluated clinicians' experiences of NRVR to understand how NRVR impacts learning and can be improved. Neonatal Intensive Care Unit (NICU) clinicians with previous NRVR experience were recruited for individual semi-structured interviews. Using a social constructivist viewpoint, five researchers used thematic analysis to analyze participant responses. Twenty-two clinicians (11 nurses, 11 doctors) were interviewed. All participants expressed positive attitudes towards NRVR. Four themes were identified: (1) Learning from reality-exposure to real-life resuscitations was highly clinically relevant. (2) Immersive self-regulation-watching videos aided recall and reflection. (3) Complexities in learner psychological safety-all participants acknowledged viewing NRVR videos could be confronting. Some expressed fear of judgment from colleagues, though the educational benefit of NRVR superseded this. (4) Accessing and learning from diverse vantage points-NRVR promoted group discussion, which prompted participant learning from colleagues' viewpoints. Neonatal clinicians reported NRVR to be an effective and safe method for learning and refining skills required during neonatal resuscitation, such as situational awareness and communication. Neonatal resuscitation video review is not known to be widely used in neonatal resuscitation teaching, and published research in this area is limited. Our study examined clinician attitudes towards an established neonatal resuscitation video review program. We found strong support for teaching using neonatal resuscitation video review among neonatal doctors and nurses, with key benefits including increased situational awareness and increased clinical exposure to resuscitations, while maintaining psychological safety for participants. The results of this study add evidence to support the addition of video review to neonatal resuscitation training.

Immigrant and minority parents' experiences in a neonatal intensive care unit: A meta-ethnography review.

To examine immigrant and minority parents' experiences of having a newborn infant in the neonatal intensive care unit and explore healthcare professionals' experiences in delivering care to immigrant and minority families. A meta-ethnographic review informed by eMERGe guidelines. We conducted a systematic literature review. Studies were included if they explored immigrant or minority parent experiences in neonatal intensive care units and health professional experiences delivering care to immigrant and minority families in neonatal intensive care. Reporting followed ENTREQ guidelines. Database searches included CINAHL, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar. Boolean search strategies were used to identify qualitative studies. No limitations on commencement date; the end date was 23rd August 2022. PRISMA guidelines used for screening and article quality assessed using Joanna Briggs Institute criteria for qualitative studies. Initial search yielded 2468 articles, and nine articles met criteria for inclusion. Three overarching themes were identified: (1) Overwhelming Emotions, (subthemes: Overwhelming Inadequacy; Cultural Expressions of Guilt; Not Belonging), (2) Circles of Support, (subthemes: Individual Level-Spirituality; External Level-Connecting with Family; Structured Peer-to-Peer Support), (3) Negotiating Relationships with Healthcare Professionals (subthemes: Connecting; Disconnected; Linguistic Barriers). Interactions between healthcare professionals and immigrant and minority parents were the strongest recurring theme. There can be a mismatch between immigrant and minority families' needs and the service support provided, indicating improvements in neonatal intensive care are needed. Despite challenges, parents bring cultural and family strengths that support them through this time, and many neonatal intensive care staff provide culturally respectful care. Professionals should be encouraged to identify and work with family strengths to ensure parents feel supported in the neonatal intensive care unit. Findings can inform policy and practice development to strengthen health professionals capabilities to support immigrant and minority families in neonatal units. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists were used to report the screening process.

Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins

BackgroundRespiratory function monitors (RFMs) have been used extensively in manikin and infant studies yet have not become the standard of training. We report the outcomes of a new portable, lightweight...

Providing optimal care in the neonatal care units in India: How Covid-19 exacerbated existing barriers.

Nearly one quarter (600,000) of all neonatal deaths worldwide per year occur in India. To reduce neonatal mortality, the Indian Ministry of Health and Family Welfare established neonatal care units, including neonatal intensive care units and specialized neonatal care units to provide immediate care at birth, resuscitation for asphyxiation, postnatal care, follow up for high-risk newborns, immunization, and referral for additional or complex healthcare services. Despite these efforts, neonatal mortality remains high, and measures taken to reduce mortality have been severely challenged by multiple problems caused by the Covid-19 pandemic. In this qualitative study, we conducted seven focus group discussions with newborn care unit nurses and pediatric residents and 35 key informant interviews with pediatricians, residents, nurses, annual equipment maintenance contractors, equipment manufacturers, and Ministry personnel in the Vidarbha region of Maharashtra between December 2019 and November 2020. The goal of the study was to understand barriers and facilitators to providing optimal care to neonates, including the challenges imposed by the Covid-19 pandemic. Covid-19 exacerbated existing barriers to providing optimal care to neonates in these newborn care units. As a result of Covid-19, we found the units were even more short-staffed than usual, with trained pediatric nurses and essential equipment diverted from newborn care to attend to patients with Covid-19. Regular training of neonatal nursing staff was also disrupted due to Covid-19, leaving many staff without the skills to provide optimate care to neonates. Infection control was also exacerbated by Covid-19. This study highlights the barriers to providing optimal care for neonates were made even more challenging during Covid-19 because of the diversion of critically important neonatal equipment and staff trained to use that equipment to Covid-19 wards. The barriers at the individual, facility, and systems levels will remain challenging as the Covid-19 pandemic continues.

Achieving optimal cord management: a multidisciplinary quality improvement initiative

Optimal cord management (OCM), defined as waiting at least 60 seconds (s) before clamping the umbilical cord after birth, is an evidence-based intervention that improves outcomes for both term and...

Burnout and coping strategies in pediatric and neonatal intensive care staff.

Burnout and coping strategies in pediatric and neonatal intensive care staff.

MHealth Gratitude Exercise Mindfulness App for Resiliency Among Neonatal Intensive Care Unit Staff: Three-Arm Pretest-Posttest Interventional Study.

Health care is highly complex and can be both emotionally and physically challenging. This can lead health care workers to develop compassion fatigue and burnout (BO), which can negatively affect their well-being and patient care. Higher levels of resilience can potentially prevent compassion fatigue and BO. Strategies that enhance resilience include gratitude, exercise, and mindfulness. The purpose of this study was to determine if a 3-week daily resiliency practice, prompted via a gratitude, exercise, and mindfulness smartphone app, impacted the professional quality of life, physical activity, and happiness level of health care workers in a newborn intensive care unit setting. In total, 65 participants from a level III newborn intensive care unit at a regional hospital in the western United States completed this study. The Professional Quality of Life Scale, Physical Activity Vital Sign, and Subjective Happiness Score instruments were used to evaluate the effects of the mobile health (mHealth) intervention. Further, 2-tailed dependent paired t tests were used to evaluate participant pre- and postintervention instrument scores. Multiple imputation was used to predict scores of participants who practiced an intervention but did not complete the 3 instruments post intervention. Dependent t tests using the original data showed that participants, as a whole, significantly improved in BO (t35=2.30, P=.03), secondary trauma stress (STS; t35=2.11, P=.04), and happiness (t35=-3.72, P<.001) scores. Compassion satisfaction (CS; t35=-1.94, P=.06) and exercise (t35=-1.71, P=.10) were trending toward, but did not reach, significance. Using the original data, only the gratitude intervention group experienced significant improvements (CS, BO, and happiness), likely due to the higher number of participants in this group. Analysis using imputed data showed that participants, as a whole, had significant improvements in all areas: CS (t64=-4.08, P<.001), BO (t64=3.39, P=.001), STS (t64=4.08, P<.001), exercise (t64=-3.19, P=.002), and happiness (t64=-3.99, P<.001). Looking at the intervention groups separately using imputed data, the gratitude group had significant improvements in CS, BO, STS, and happiness; the exercise group had significant improvements in STS and exercise; and the mindfulness group had significant improvements in CS and happiness. Phone app delivery of resilience-enhancing interventions is a potentially effective intervention model for health care workers. Potential barriers to mHealth strategies are the technical issues that can occur with this type of intervention. Additional longitudinal and experimental studies with larger sample sizes need to be completed to better evaluate this modality.

Making respiratory care safe for neonatal and paediatric intensive care unit staff: mitigation strategies and use of filters.

Many medical devices in pediatric and newborn intensive care units can potentially expose healthcare workers (HCWs) and others to transmission of respiratory and other viruses and bacteria. Such fomites include ventilators, nebulizers, and monitoring equipment. We report the general, novel approach we have taken to identify and mitigate these risks and to protect HCWs, visitors and patients from exposure while maintaining the optimal performance of such respiratory equipment. The approach combined a high level of personal protective equipment (PPE), strict hand hygiene, air filtration and air conditioning and other relevant viral risk mitigation guidelines. This report describes the experiences from the SARS-CoV-2 pandemic to provide a reference framework that can be applied generally. The steps we took consisted of auditing our equipment and processes to identify risk through sources of potentially contaminated gas that may contain aerosolized virus, seeking advice and liaising with suppliers/manufacturers, devising mitigation strategies using indirect and direct approaches (largely filtering), performing tests on equipment to verify proper function and the absence of negative impacts and the development and implementation of relevant procedures and practices. We had a multidisciplinary team to guide the process. We monitored daily for hospital-acquired infections among staff caring for SARS-CoV-2 patients. Our approach was successful as we have continued to offer optimal intensive care to our patients, and we did not find any healthcare worker who was infected through the course of caring for patients at the bedside. The lessons learnt will be of benefit to future local outbreaks or pandemics.

Neonatal staff perceptions and attitudes towards Family Integrated Care and Fathers: A Multi-site Survey

An anonymous questionnaire study was conducted to explore the attitudes and current practices of neonatal clinical staff to fathers and Family Integrated Care (FICare) in 2 neonatal units (level 2 and level 3).166 (65%) staff members responded. The majority agreed with parents' involvement in their baby's care, including providing skin-to-skin as soon as possible whilst receiving intensive care. Overall, parental presence for non-invasive procedures was welcomed. Staff strongly valued the role of fathers in caring for their baby and supporting the mother. They recognised the impact of the NICU admission on fathers' well-being.The study found a positive attitude towards the involvement of both parents in their baby's care in intensive care. Staff believed that fathers play an important role during a baby's neonatal admission. Further education and training are required to improve knowledge and support practice, particularly with challenging or complex scenarios.

Child development education in the Neonatal Unit: Understanding parent developmental literacy needs, priorities and preferences

ObjectiveTo describe child development knowledge needs, priorities, and preferences for education to enhance developmental literacy among parents with children admitted to the neonatal unit (NNU). MethodsTwo separate cohorts completed a survey; 1) Parents with children graduated from Australian NNUs (n = 316); 2) Parents with infants’ inpatient at two South Australian NNUs (n = 209). ResultsParents considered it extremely important to understand child development (Graduates: 80%; Inpatients: 71%). Inpatient parents reported lower child development knowledge. Almost half (42%) of graduate parents described the child development education provided by neonatal staff as poor or inadequate. There was consistency in preferences for developmental literacy education provision. Parents desired education to commence during NNU and continue post discharge. Priorities included content specific to preterm birth and how to support child development over the first two years of life. Individualised education by a Neonatal Nurse/Midwife was most preferred. ConclusionMothers and fathers value guidance to support their child’s development during NNU admission and early childhood. Our study highlights the importance of improved early developmental literacy education for parents with children admitted to the neonatal unit. Practice implicationsOur findings can be used to inform the creation of future educational resources targeting improved parent developmental literacy.

Is it feasible to avoid suction before spontaneous breathing is established?

Suctioning of the posterior pharynx immediately after birth during neonatal resuscitation can produce a vagal response resulting in bradycardia or apnea. The feasibility of delaying any airway suctioning and avoiding deep suctioning has not been studied. To test the hypothesis that newborn resuscitation is feasible with the following two guidelines: 1) avoiding any suctioning until the infant establishes spontaneous respiration, and 2) avoiding the use of deep suction with catheters. A quality improvement project was implemented using these two guidelines. Infants' mouth was cleaned with a dry cloth. No suction was started until infants establish spontaneous breathing. Then, bulb suction was used to clear secretions from the sides of the mouth and the nose without reaching the back of the pharynx. Deep suction using catheters was not used. Neonatal staff and physicians received biweekly training to support these changes. Resuscitation data before and after the practice change were compared. A total of 999 sequential cases were compared; of them 501 and 498 infants were resuscitated before and after the implementation of the new practice, respectively. Suction before spontaneous breathing occurred in 12.4% in the first cohort. There were no differences between groups except for less use of oxygen with the new guidelines (12.4% vs 4.4%, P < 0.001). Avoidance of any suction prior to spontaneous breathing and not applying deep suction with catheters are feasible during newborn resuscitation. These practices are associated with decreased exposure to oxygen in the delivery room.

Recurrent Harlequin Ichthyosis in a Family: A Case Report

Introduction: Harlequin ichthyosis is a severe form of erythrodermic ichthyosis that manifests in a distinctive and distressing appearance at birth. The newborn baby is covered in thick, plate-like scales with distorted surface features, resulting in limited mobility. Fortunately, this condition is rare, with an estimated incidence of approximately 1 in 300,000 births. It is inherited in an autosomal recessive manner and is caused by a mutation in the adenosine triphosphate binding cassette subfamily A member 12 (ABCA12) gene. This mutation affects lipid transport, and the activity of ABCA12 is crucial to produce long-chain ceramides, which are essential for the development of a normal skin barrier. Methods: We present a case report of a newborn who presented with thick, firmly adherent dense plaques covering the entire body, accompanied by deep fissures that extended into the dermis. The facial features included severe ectropion, conjunctival chemosis, eclabium, tethered ears, and a rudimentary nose. In addition, there was flexion contracture of the arms, legs, and digits, along with hypoplastic nails. Results: The baby experienced respiratory difficulty, poor sucking, and a severe cutaneous infection. Unfortunately, the baby’s condition deteriorated and passed away on the 20th day after delivery. Conclusion: Previously considered universally fatal, harlequin ichthyosis now has reported cases of survivors, although it remains a challenging condition. It is crucial to provide parents and family with comprehensive information about the implications of the condition. They should be encouraged to explore all available options and receive psychological support throughout the process. It is essential for the neonatal intensive care unit staff to be trained in providing specialized care for these babies. In addition, parents should be offered the option of antenatal counseling, particularly in cases where there is a previously affected sibling or a history of consanguinity.

Confidence, not competence: Reframing roles to embed FICare

This paper summarises and critically discusses the successful implementation of Family Integrated Care (FICare) at two Swedish tertiary neonatal intensive care units (Karolinska and Uppsala). The paper is the culmination of a three-day information-finding trip where we observed Swedish neonatal practice on the units and interviewed a range of key staff members regarding their approaches and values to neonatal care. The key findings were that parents are viewed as knowing their babies best and all neonatal staff work towards the ethos of zero separation. This is achieved through promoting confidence in parents to care for their own babies and the concept that neonatal nurses are there to facilitate instead of ‘do’. We propose recommendations for how we can emulate the resource-independent aspects of this model in the UK.

Neonatal organ donation: Retrospective audit into potential donation in a single neonatal unit.

Research has shown that many babies who die in neonatal units could have been potential tissue and/or organ donors. Despite the existence of guidelines supporting its implementation, the incidence of neonatal donation remains rare in the United Kingdom. The aim of this audit was to retrospectively determine potential eligibility for neonatal tissue and/or organ donation referral in infants who died in a single UK tertiary-level neonatal unit between 2012 and 2021. Cause of death and documentation of any discussions held regarding referral for donation were also explored. An audit was undertaken to identify all neonatal deaths at a single tertiary-level NICU in London from 2012-2021. Infants who retrospectively could have been referred as potential tissue and/or organ donors were identified using current NHS Blood and Transplant inclusion and exclusion criteria. A significant missed potential for neonatal tissue and/or organ donation referrals was identified, which is likely not just limited to the unit audited. Causes of death were as expected for a tertiary level neonatal unit and centre for therapeutic cooling of babies born with hypoxic perinatal brain injuries. Only one documented conversation was found regarding neonatal donation. To enable conversations regarding neonatal donation to become a routine part of end-of-life care discussions with families as appropriate, good links between neonatal healthcare professionals and Specialist Nurses in Organ Donation need to be established. This will facilitate the referral of all suitable neonates as potential donors and ensure that neonatal staff feel supported to care for babies identified as potential donors.

Supplemental Material for Burnout and Coping Strategies in Pediatric and Neonatal Intensive Care Staff

Supplemental Material for Burnout and Coping Strategies in Pediatric and Neonatal Intensive Care Staff

Translation and Validation of Maternal Confidence Questionnaire (MCQ) In Iran: Persian Version

ABSTRACT Objective Mother's confidence is defined as the understanding of the mother of her ability to take care of the child and knowing his/her needs. The Maternal Confidence Questionnaire (MCQ) is designed to measure a mother's confidence in a neonatal intensive care unit (NICU). The aim of this study was to validate a Persian version of the MCQ for Iranian mothers. Design The MCQ was translated into Persian using a forward–backward method. Validity was assessed using face, content, and construct validity measures. Results Based on the result of face validity, all items of the scale are appropriate, clear and relevant for using. Bartlett's test (KMO = 0.92, PV<0.001) demonstrates the appropriateness of using factor analysis for our data set. Also, 53% of total variance has been explained by one-factor CFA model that confirmed by goodness of fit indices; GFI = 0.96, CFI = 0.93, RMSEA = 0.07 (0.05, 0.09) as well as p-close = 0.040 and the CMIN = 2.2, p<0.001. The scale has excellent internal consistency (Cronbach's alpha = 0.93). Conclusion The Persian version of MCQ showed adequate reliability and validity for measuring maternal confidence in Iranian mothers. This instrument can be used in future studies to assess confidence in mothers with preterm neonates in Iran. Also, this instrument will help neonatal nurses and medical staff to measure confidence in mothers with preterm neonates and accordingly provide supportive interventions.

Risk factor analyses for intraventricular hemorrhage in preterm infants: A retrospective cohort study.

Very-low-birthweight (VLBW) infants can experience severe intraventricular hemorrhage (IVH) that can lead to life-long disability by impairing neurodevelopment. The aim of this study was to identify the risk and protective factors for severe IVH in VLBW infants. A retrospective, cross-sectional review of VLBW infants born at 22-28 weeks' gestation between January 2003 and December 2012 and listed in the Database of Neonatal Research Network in Japan was performed using a statistical model incorporating an odds ratio (OR) and medical center variation as a center variance ratio (CVR). A two-dimensional analysis using a combination of OR and the CVR described evolving measures of a clinical trial (for OR > 1) and standardization (for CVR > 1) concerning a factor of interest. The noteworthy significant protective factors were antenatal steroids (ANS) with and without premature rupture of membrane (OR: 0.43, CVR: 1.08, and OR: 0.68, CVR: 1.14, respectively) and the number of neonatal beds (OR: 0.94, CVR: 0.99) and staff nurses per neonatal bed (OR: 0.89, CVR: 0.99). Active promotion of ANS administration and consolidation of perinatal medical centers can mitigate the development of severe IVH in VLBW infants.

Implementing infant and family-centred developmental care: Exploring the impact of an innovative educational initiative.

Evidence-based standards for infant and family-centred developmental care are shaping neonatal care. However, the translation of theory and evidence into practice is challenging. This study aimed at exploring the mechanisms by which a structured learning and mentoring model influences the implementation of infant and family-centred developmental care within neonatal practitioners' own clinical practice. The study used a descriptive qualitative design. Five neonatal practitioners participated in semistructured interviews. Interviews were audio-recorded and transcribed for thematic analysis. The qualitative analysis gave rise to four themes and nine subthemes. The four primary themes were motivation and preparedness for FINE 2; learning experiences during FINE 2; post-training reflections and experiences; and anticipating the future. Neonatal practitioners reported positive outcomes from their participation in relation to the development of their knowledge and skills, their performance of their clinical role and the influence on their relationships with other neonatal staff. Being adequately prepared for the programme in terms of managing the time demands, enabling peer support, the role of additional reading and ensuring realistic line management support were identified as important mechanisms for successful engagement and are being used to support further enhancements of the FINE 2 programme.

Medical staff's sentiments on the establishment of quiet time in the NICU.

To explore the sentiments of medical staff in setting quiet time in a tertiary neonatal intensive care unit. Quiet time, which can help create a healing neonatal intensive care unit environment, is increasingly being valued by hospital administrators. Semi-structured interviews were used to interview 12 neonatal intensive care unit staff members, with data analysed using the content analysis method. This study extracted four themes: support, concern, education and teamwork. If quiet time needs to be set up, implemented and maintained in the neonatal intensive care unit, it is necessary to establish a quiet time culture throughout the whole ward, to carry out detailed management of quiet time and to cooperate and communicate with multidisciplinary departments. To keep the ward quiet and minimize handling during quiet time, it is necessary to take adequate steps from a management level. Targeted staff training and education allow staff to appreciate the necessity and urgency of setting quiet time for themselves and babies. It is also necessary to refine the educational content of noise reduction and minimal handling and provide clear guidance on the best means to carry out clinical work during quiet time. Nursing managers need to establish a monitoring system for NICU noise and manage various noise sources made from equipment and people.