Role In Neonatal Care Research Articles

Safety use of high frequency oscillatory ventilation in transport of newborn infants affected by severe respiratory failure: preliminary data in central Tuscany

BackgroundNeonatal Emergency Transport Services play a fundamental role in neonatal care. Stabilization before transport of newborns suffering from severe respiratory failure is often a challenging problem and some critically ill infants may benefit from High Frequency Oscillatory Ventilation (HFOV) as rescue treatment. In these cases, transition to conventional ventilation for transport may cause a deterioration in clinical conditions. HFOV during neonatal transport has been only exceptionally used, due to technical difficulties. Since May 2018, a new neonatal transport unit is available at the Neonatal Protected Transport Service of the Meyer University Hospital in Florence, equipped with a pulmonary ventilator capable of delivering HFOV. Therefore, we conducted an analysis on patients transferred in HFOV to Neonatal Intensive Care Unit (NICU), in order to evaluate the safety and feasibility of its use during neonatal transport.MethodsA retrospective analysis was performed reviewing medical records of the neonates transported by Meyer Children Hospital’s Neonatal Transport Service between May 2018 and December 2020, and newborns treated with HFOV during ground neonatal transport were identified. Safety was assessed by the comparison of vital signs, hemogas-analysis values and pulmonary ventilator parameters, at the time of departure and upon arrival in NICU. The dose of inotropes, the main respiratory complications (air leak, dislocation or obstruction of the endotracheal tube, loss of chest vibrations) and the number of deaths and transfer failures were recorded.ResultsOut of the approximate 400 newborns transported during the analysis period, 9 were transported in HFOV. We did not find any statistically significant difference in vital parameters, hemogas-analytical values and pulmonary ventilator settings recorded before and after neonatal transport of the nine patients’ parameters (p > 0,05). No patient required additional inotropes during transport. No transport-related deaths or significant complications occurred during transport.ConclusionsThe interest of our report is in the possibility of using HFOV during inter-hospital neonatal transfer. As far as our experience has shown, HFOV appears to be safe for the transportation of newborns with severe respiratory failure. Nevertheless, further larger, prospective and multicentre studies are needed to better evaluate the safety and efficacy of HFOV during neonatal transport.

A literature review of systemic to pulmonary collaterals in preterm infants to emphasise their existence and clinical importance.

Cardiorespiratory physiology plays an important role in neonatal care with increasing utility of point-of-care ultrasound. This review is to bring to light the importance of systemic to pulmonary collaterals (SPCs) in the preterm population without congenital heart disease (CHD) and provide a useful diagnostic tool to the neonatologist performing a cardiac ultrasound. Medline, PubMed, EMBASE and the Internet were searched up to November 2017 for articles in English which included SPCs in preterm infants without CHD. This comprised title, abstract and full-text screening of relevant data. A total of 10 studies which included case reports, retrospective observational studies and one small prospective cohort study were identified and analysed in detail. The studies had varying focus such as variable incidence, clinical presentation, association with chronic lung disease, pathophysiology and clinical importance of SPCs. SPCs were overall thought to be prevalent, underdiagnosed and of clinical significance in preterm infants. Systemic to pulmonary collaterals are a potential left-to-right shunt in preterm infants and may contribute to worsening chronic lung disease (CLD) or heart failure. They should be carefully looked for when performing bedside cardiac ultrasound as the findings can mimic those seen in patent ductus arteriosus (PDA).

Religion, Spirituality and Folk Medicine/Superstition in a Neonatal Unit.

Beliefs and practices surrounding religion and spirituality (RS) feature in neonatal units, although healthcare professionals and families hold different views on their role in neonatal care. Descriptive study performed at the Neonatology Unit of Santa Lucía University Hospital, Cartagena. Separate forms concerning spirituality, religion and folk medicine were administered to professionals ascribed to the unit (n=70) and parents (n=93). 70% of professionals and 60.2% of parents perceive RS as playing a relevant role in neonatal care; however, 45% of professionals prefer that parents do not express their RS beliefs. Actual use of prayer by parents while in the unit was 55.9%, compared to the staff's estimation of 20.8% (p<0.001); parents believe that RS affects outcomes indirectly, mediating through caregivers, contrary to the staff perception that parents turn to RS for a direct effect on outcomes (p<0.001); professionals, unlike parents, found RS to be of little benefit to children (p<0.001) or in reducing parental anxiety (p<0.001). Amulets were found alongside 26.6% of children. Up to 40% of parents believe in magic concepts such as evil eye. Many families express RS while a member is hospitalized and, while staff recognize its importance, they often fail to respond correctly. The use of amulets and ritual objects is still common and can express the need for emotional and psychological support. Caregivers need to be aware of the medical, psychological and emotional implications of these practices.

Neonatal Health Care Services in India

Newborn health is key to child survival. India contributes to nearly one-third of the global neonatal deaths. Quality of health care services influences neonatal survival. The quality of neonatal care in India varies from no care to highly advanced care comparable to any centers in the world. The health system includes health care facilities providing Level I, Level II and level III neonatal care in public and private sectors. Problems like lack of uniformity in the system, lack/delay in recognition of illness, delay/inadequate care seeking, poor organization of referral and transport, poor quality of care, inadequate infrastructure and training of staff and lack of regionalization of care exists in the country. Neonatal care if strengthened at all levels, with integration of public and private sectors and regionalization will help our country to improve upon the status of newborns. Setting up a system of primary health care and referral, conducting meticulous monitoring and accreditation at all levels of health care, improving access to health services, prioritizing health interventions provided at various levels, facilitating better utilization of health services, promoting community participation and ownership and establishing an efficient neonatal transport system could possibly help to improve the health care delivery to neonates. Nurses play a very crucial role in neonatal care at all levels: level I, II, and III. Improving nurse's skills in neonatal care is a challenge. Nurse educators should take up the responsibility for appropriate training to ensure that future nurses would be efficient to take care of neonate at all levels of care. In order to improve the neonatal survival quality nursing care should be ensured for neonates at all levels of care.

Knowledge and practice of nursing personnnel regarding the care of neonates under phototherapy at Paropakar Shree Panch Indra Rajyalaxmi Devi Prasuti Griha, Thapathali, Kathmandu

Background: High neonatal mortality is a reflection of very poor neonatal care. Hence a specialist should be able to take up leadership role in neonatal care to prevent high mortality and morbidity rate. The study was carried out to determine the knowledge and practice of the nursing personnel regarding the care of neonates with phototherapy. Objectives: To assess the knowledge and skills/practice of nurses regarding the care of neonates with phototherapy. Methods: Descriptive and exploratory research design was adopted for the study from 15th to 30th April, 2007 for two weeks at Paropakar Shree Panch Indra Rajyalaxmi Devi Prasuti Griha, Thapathali, Kathmandu. A semistructured questionnaire was designed to collect the data from 50 respondents working in different wards and they were selected by using Purposive sampling technique. The data collected were analysed and interpreted based on descriptive and inferential statistics. The level of knowledge score was converted into percentage and overall adequacy of knowledge was graded according to the following criteria:- If score &gt; 75% highly knowledgeable If score 50 % to 75% moderate knowledge If score &lt;50% inadequate knowledge1. Results: The findings revealed that the majority of the respondents 28 (56%) were highly knowledgeable (the knowledge level of the respondents more than 75 %) and 22 (44%) respondents were with average knowledge (more than 50% and less than75%). No respondents were below 50% level (below 50%). Conclusion: The study attempts to determine the knowledge and practice of nursing staffs regarding the care of neonates with phototherapy. According to the data and information of the respondents the nursing personnel should be provided with in-service education training in relation to care of neonates with phototherapy. This study will be helpful for providing information about existing knowledge and practices of nursing personnel regarding phototherapy. It will help to provide knowledge about the strength and weakness of the services provided by the hospital regarding phototherapy for future researcher. DOI: http://dx.doi.org/10.3126/jkmc.v2i2.10631 Journal of Kathmandu Medical College, Vol. 2, No. 2, Issue 4, Apr.-Jun., 2013, page: 84-88

Clinicians' perceptions of telemedicine for remote neonatal consultation.

Telemedicine may have a useful role in neonatal care, particularly in regionalised health care systems where there may be impediments to access. Following the development of a system for neonatal teleconsultation, we assessed its efficacy, usability and preliminary effectiveness. While results were positive, uptake in routine clinical use was less than expected. The study described in this paper examined aspects of clinicians' perceptions of telemedicine in neonatal care. Overall, clinicians had positive perceptions of telemedicine. Further work is required to understand the negative perceived usefulness of telemedicine held by some clinicians and to determine whether this may be overcome.

Current scenario of neonatal nursing in India and the way forward

Nurses play a crucial role in neonatal care at all the three levels of care. Auxiliary Nurse Midwife (ANM) is the key functionary in the rural areas who is responsible for delivery of the package of services for mothers and babies at the community level, SC's and PHC's.