Swedish Neonatal Intensive Care Unit Research Articles

A Staff Educational Intervention to Increase the Time of Skin-to-Skin Care in a Swedish NICU: A Quality Improvement Project.

Skin-to-skin contact (SSC) is crucial in neonatal intensive care unit (NICU) care; yet, challenges exist in its implementation. This study addresses a knowledge gap by examining the most effective ways to introduce SSC in the NICU, emphasizing the need to seamlessly integrate this practice for optimal infant and parent care. One way, among many, to implement SSC is to increase staff's knowledge and awareness about SSC. To describe the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life. A pre- and postinterventional study design was used to determine the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life. The prevalence of infants receiving SSC during their first 24 hours of life, the number of SSC sessions per day, and the duration of each SSC session increased after the intervention, and these effects persisted over 2 years. Our study highlights the impact of staff education and reflective discussions on SSC in the NICU. Integrating these with practical training, parental education, and NICU environment modifications is pivotal for enhancing and sustaining optimal SSC practices, benefiting both infants and parents.

Parent-infant closeness and care practices during therapeutic hypothermia in Swedish neonatal intensive care units

ObjectivesThe aim of this study was to investigate care practices among Neonatal Intensive Care Units (NICU) providing Therapeutic hypothermia (TH), and more specific to investigate staff’s experiences of parental participation, presence, and possibilities of being close with their infant during TH. MethodsA descriptive, qualitative, and quantitative study. All Swedish NICUs providing TH (n = 10) participated. Data were collected during January–April 2021 via a questionnaire followed by a semi-structured interview with the registered nurse and the neonatologist responsible for TH at each unit. Descriptive statistics were calculated, and a qualitative content analysis was performed. ResultsAll NICUs allowed parents unlimited stay with their infants and were keen to support parental presence, which was a prerequisite for promoting parent-infant closeness. Standardized routines regarding the infants’ care space and course of action were described as time-efficient and staff-saving, which freed up time to focus on the families. ConclusionStandardized routines regarding the care space setup and the medical and caring approach, as well as the NICU environment and practices around the families, can promote or curb the possibilities of parent-infant closeness. Well-established care practices and good environmental conditions with flexibility regarding the family’s needs are therefore required.

#848 Influence of nutrition and other factors on preterm newborns’ kidney development

Abstract Background and Aims According to WHO, in 2020, preterm newborns represented around 10% of all newborns in the world. Premature birth is deeply connected with the risk of developing a chronic kidney disease later in life. This is caused by defects in kidney development (primarily the lower number of nephrons) that are often difficult to identify in the complicated clinical picture of premature babies. Our study aims at providing knowledge on the relationship between preterm infant kidney development and morbidities, nutrition, and blood biomarkers. Method Creatinine was measured in 130 extremely preterm newborns (less than 28 weeks of gestation) enrolled in a randomized controlled trial (Mega Donna Mega) in two Swedish neonatal intensive care units. Creatinine was measured in whole blood or serum with the enzymatic method. Individuals with 4 or more serum creatinine measurements (n = 92) were shortlisted for eGFR calculation. eGFR was calculated with the Wilhelm-Bals weight-based equation due to the lack of length measurements. The patients were divided in 3 groups based upon their kidney development status. This was indirectly assessed using the exponential regression curve describing the eGFR trends as model and the doubling time as discriminating parameter. Data about morbidity, treatment, nutrition, blood lipidomics and proteomics were also collected during the MegaDonnaMega trial and has been used to investigate the differences between the three groups. A linear model adjusted for sex and gestational age was used to analyse lipidomics and proteomics data in relation to eGFR. The omics analysis used average data from the first month of age. Data analysis was performed in R, SPSS, SAS and GraphPad statistical programs. Results Subjects were divided in 3 groups from best to worst kidney function development. The parameter used, doubling time, is inversely correlated to eGFR and kidney development. Subjects in group 1 reached the normal at-term birth eGFR (40 ml/min/1.73 m2) at around 50 days of age, whereas the other two groups were delayed (66 days for group 2, 78 for group 3). Subjects in group 2 and 3 were characterized by longer stay at the NICU, lower weight and length in respect to infants in group 1. Subjects in groups 2 and 3 also showed more co-morbidities in respect to group 1. Regarding nutrition, subjects administered with maternal milk had shorter doubling times when compared to those administered with donor or mixed milk. Six serum fatty acids correlated with the eGFR trends: heptadecanoic (FA 17:0) showed a negative correlation, while palmitoleic (16:1n-7), gamma-linolenic (18:3n-6), erucic (22:1n-9) docosapentaenoic (22:5n-6) and tricosanoic (23:0) acid showed positive correlations. 45 serum proteins correlated with the eGFR trends, in particular, inflammatory and proliferative pathways showed an inverse correlation with eGFR. Conclusion We have detected differences in the eGFR trends of preterm newborns that could be traced back to nutrition and other factors. Moreover, we identified several serum fatty acids and proteins that correlated with eGFR and therefore kidney development. The data indicates that postnatal kidney development may be important to consider in the clinical care of preterm newborns.

Molecular Epidemiology of Neonatal-Associated Staphylococcus haemolyticus Reveals Endemic Outbreak.

Staphylococcus haemolyticus is a major cause of late-onset sepsis in neonates, and endemic clones are often multidrug-resistant. The bacteria can also act as a genetic reservoir for more pathogenic bacteria. Molecular epidemiology is important in understanding bacterial pathogenicity and preventing infection. To describe the molecular epidemiology of S. haemolyticus isolated from neonatal blood cultures at a Swedish neonatal intensive care unit (NICU) over 4 decades, including antibiotic resistance genes (ARGs), virulence factors, and comparison to international isolates. Isolates were whole-genome sequenced, and single nucleotide polymorphisms in the core genome were used to map the relatedness. The occurrence of previously described ARGs and virulence genes were investigated. Disc diffusion and gradient tests were used to determine phenotypic resistance. The results revealed a clonal outbreak of S. haemolyticus at this NICU during the 1990s. Multidrug resistance was present in 28 (82%) of all isolates and concomitant resistance to aminoglycoside and methicillin occurred in 27 (79%). No isolates were vancomycin resistant. Genes encoding ARGs and virulence factors occurred frequently. The isolates in the outbreak were more homogenous in their genotypic and phenotypic patterns. Genotypic and phenotypic resistance combinations were consistent. Pathogenic traits previously described in S. haemolyticus occurred frequently in the present isolates, perhaps due to the hospital selection pressure resulting in epidemiological success. The clonal outbreak revealed by this study emphasizes the importance of adhering to hygiene procedures in order to prevent future endemic outbreaks. IMPORTANCE This study investigated the relatedness of Staphylococcus haemolyticus isolated from neonatal blood and revealed a clonal outbreak in the 1990s at a Swedish neonatal intensive care unit. The outbreak clone has earlier been isolated in Japan and Norway. Virulence and antibiotic resistance genes previously associated with clinical S. haemolyticus were frequently occuring in the present study as well. The majority of the isolates were multidrug-resistant. These traits should be considered important for S. haemolyticus epidemiological success and are probably caused by the hospital selection pressure. Thus, this study emphasizes the importance of restrictive antibiotic use and following the hygiene procedures, to prevent further antibiotic resistance spread and future endemic outbreaks.

The Swedish approach to nurturing extremely preterm infants and their families: A nursing perspective

Nurturing extremely premature infants is a complicated task that not only necessitates a systematic approach to the immature physiology and its medical management, but also to the needs of the family. Infants born at 22-24 weeks require many weeks of intensive care including a long duration of mechanical ventilation, numerous stressful medical interventions, and for the parents to spend a lot of time in the Neonatal Intensive Care unit (NICU). This paper aims to outline the Swedish nursing approach to nurturing these infants and their families. The nursing care is structured so the parents are the primary caregivers supported by the staff and is based on: timely expression and provision of mother's own breast milk, early and prolonged skin-to-skin contact and close collaboration with the family. While this presentation is based on a single-center's experience, it well represents the general features of nursing provided to extremely preterm infants in Swedish NICUs.

Developing the Preterm Breastfeeding Attitudes Instrument: A tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive care

ObjectiveThe aim of this study was to develop an instrument that measures health care professionals' (HCPs) attitudes to breastfeeding and skin-to-skin contact in relation to the Baby-Friendly Hospital Initiative for neonatal intensive care. DesignThe study was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding for both full-term and preterm infants. The study had a pre-test/post-test design using online questionnaires distributed by email before and after a training programme. Setting and participantsA total of 70 specialist registered nurses, registered nurses, assistant nurses and physicians working at a Swedish neonatal intensive care unit answered 55 breastfeeding attitudes questions online before the training. The Preterm Breastfeeding Attitudes Instrument (PreBAI) consists of twelve of these 55 items/questions, selected using exploratory factor analysis. Measurements and findingsHigher scores indicated more positive attitudes and the median total PreBAI score was 42 points (out of 48), on both the pre- and the post-test questionnaires, showing no significant difference. In the pre-test questionnaire, the majority of HCPs (84%) stated that they needed further breastfeeding training. They also stated that they perceived breastfeeding as very important, scoring a median of 10 (range 5-10) points on a 10-point scale. Three separate underlying dimensions were identified in the questionnaire, indicating different attitudes: Facilitating (five items), Regulating (four items), and Breastfeeding- and skin-to-skin contact-friendly (three items). A positive correlation was found between how many years the HCPs had worked in neonatal care, and their PreBAI score (rs = 0.383, p = 0.001). Those who had previously received extra breastfeeding education scored higher on the instrument. Key conclusions and implications for practiceNeonatal intensive care units need to increase their efforts to support breastfeeding. An important factor for mothers when establishing breastfeeding is support from well-trained professionals with a positive attitude to breastfeeding. The PreBAI could be a useful tool for identifying attitudes among HCPs before and after attending a breastfeeding training programme.

Perioperative nutrition in extremely preterm infants undergoing surgery for patent ductus arteriosus

Summary Background and aims Patent ductus arteriosus is a common neonatal morbidity affecting more than half of infants born extremely preterm. Suboptimal nutrition in extremely preterm infants in general has been demonstrated in recent studies. The aim of this study was to describe perioperative nutritional practices in Swedish neonatal intensive care units caring for extremely preterm infants undergoing surgery for patent ductus arteriosus. Methods Daily enteral and parenteral nutritional intakes during the perioperative week starting three days prior and ending three days after surgery were retrospectively evaluated in five University hospitals caring for infants born Results In total, 132 infants and data from 912 perioperative days were included. Mean daily energy intakes during the perioperative week (range 78–105 kcal/kg/day) varied significantly between hospitals, with the lowest intakes on the day of surgery (range 54–87 kcal/kg/day). Mean daily protein intakes during the perioperative week did not vary (range 2.3–2.6 g/kg/day) but did differ on the day of surgery (range 1.5–2.4 g/kg/day). Median parenteral (range 33–99 mL/kg/day) and enteral (range 34–123 mL/kg/day) fluid intakes during the perioperative week, as well as median parenteral contents of energy and protein, varied significantly between hospitals. Conclusions Current recommended nutritional goals for extremely preterm infants were not met in the studied neonatal intensive care units. Suboptimal nutrition may have implications for short and long-term outcomes. Improved adherence to nutritional guidelines is warranted for these patients.

Pain Assessment and Management in Swedish Neonatal Intensive Care Units

AimsTo investigate registered nurses' (RNs') and physicians’ knowledge, attitudes, and experiences regarding assessing and managing pain in infants at seven level III neonatal intensive care units (NICUs) in Sweden. DesignDescriptive and explorative study using an online questionnaire. MethodsA researcher-developed online questionnaire with 34 items about knowledge, attitudes, and experiences regarding pain assessment and management was emailed to 306 RNs and 79 physicians working at seven neonatal intensive care units (NICUs) in Sweden. ResultsMost NICUs had pain assessment guidelines, but there was a discrepancy regarding interprofessional discussions of pain assessments. A total of seven different pain assessment instruments were reported from the included NICUs and RNs were reportedly those who usually performed the pain assessments. Most respondents expressed a positive attitude toward pain assessment but recognized a lack of intervention after the assessment. Forty-six percent (n = 11) of the physicians said they had sufficient knowledge of assessing pain using pain assessment instruments, versus 75% (n = 110) of the RNs. Difficulties assessing pain in certain populations of infants, such as the most premature infants and infants receiving sedative medicines, were recognized. ConclusionsRNs in this study reported that their pain assessments did not lead to appropriate pain management interventions. They were thus discouraged from further pain assessments or advocating for ethical pain management. An interprofessional team effort is needed to effectively assess and manage pain in neonates.

Genomic analysis of Staphylococcus capitis isolated from blood cultures in neonates at a neonatal intensive care unit in Sweden

Emergence of a genetically distinct, multidrug-resistant Staphylococcus capitis clone (NRCS-A) present in neonatal intensive care units has recently been extensively reported. The aims of the present study were to investigate which clones of S. capitis isolated from blood in a Swedish neonatal intensive care unit (NICU) have been present since 1987 and to investigate whether the NRCS-A clone has disseminated in Sweden. All S. capitis isolates from blood cultures of neonates (≤ 28 days of age) between 1987 and 2017 (n = 46) were whole-genome sequenced, and core genome multilocus sequence typing (cgMLST) was performed. Single-nucleotide polymorphism (SNP)-based phylogenetic relationships between the S. capitis isolates and in silico predictions of presence of genetic traits specific to the NRCS-A clone were identified. Furthermore, antibiotic susceptibility testing, including screening for heterogeneous glycopeptide-intermediate resistance, was performed. Thirty-five isolates clustered closely to the isolates previously determined as belonging to the NRCS-A clone and had fewer than 81 core genome loci differences out of 1063. Twenty-one of these isolates were multidrug resistant. The NRCS-A clone was found in 2001. Six pairs of isolates had differences of fewer than two SNPs. Genetic traits associated with the NRCS-A clone such as nsr, ebh, tarJ, and CRISPR were found in all 35 isolates. The increasing incidence of S. capitis blood cultures of neonates is predominantly represented by the NRSC-A clone at our NICU in Sweden. Furthermore, there were indications of transmission between cases; adherence to basic hygiene procedures and surveillance measures are thus warranted.

Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit.

There are many challenges to providing care to infants in need of ventilator therapy. Yet, few studies describe the practical handling of the ventilator circuit during nursing care. To describe neonatal intensive care unit (NICU) nurses' decision making regarding whether or not to disconnect the ventilator circuit when changing the infant's position and to investigate the grounds for their decisions. A descriptive questionnaire study with both quantitative and qualitative elements was conducted. In 2015, a convenience sample of nurses working in an NICU completed a questionnaire including both closed-ended and open-ended, free-text questions. Answers to the closed-ended questions were analyzed with descriptive statistics, whereas answers to the free-text questions were analyzed using qualitative content analysis. Nurses' decisions on whether to disconnect or keep the ventilator circuit closed were based on the infant's needs for ventilator support. The nurses gave several reasons and motivations both for why they disconnected the circuit and for why they did not. The handling of the circuit and the reasons and motivations given were inconsistent among the nurses. This study highlights the need for continuous, repetitive education and training for NICU nurses, as well as demonstrating the importance of clear and distinct guidelines and working methods regarding the care of infants on ventilator support. Future research should continue to find ways of working and handling an infant on ventilator support that are least harmful to the infant.

Improved nutrition for extremely preterm infants – A population based observational study

Extremely preterm (EPT) infants are at high risk for malnutrition due to immaturity and medical complications and they often accumulate nutritional deficits and experience growth faltering during treatment at neonatal intensive care units (NICUs). Enhanced intake of energy and protein during the first weeks of life improves weight gain and head circumference growth. The optimal nutritional strategy for these infants' health and long-term development remains unknown. Nutritional regiments have been identified as a potential area for improvement in Swedish NICUs. The aim of this study was to evaluate changes in nutritional intake over time during the first 56 postnatal days in EPT (<27 gestational weeks; n=316) infants, who were treated in NICUs during 2004-2011 in Stockholm, using a population-based study approach. Several different nutritional interventions were implemented over the 8-year period. Nutrition and growth data were obtained retrospectively from hospital records. All intakes of enteral and parenteral nutrients were retrieved daily during the first 28 postnatal days and on days 35, 42, 49 and 56. Energy intake (median) increased from 77kcal/kg/d during the 2004-2005 period to 98kcal/kg/d during the 2010-2011 period on days 4-6. Median protein intake increased from 2.4g/kg/d during 2004-2005 to 3.6g/kg/d during 2010-2011. Energy and protein intake during postnatal days 0-6 increased continuously over the 8 years and protein intake increased during all 56 postnatal days. Full enteral feeds were reached earlier and the proportion of enteral feeds during the first week was higher during 2008-2009 compared to all other years. A significant improvement in growth was primarily noted by comparing the 2004-2005 period to subsequent years. Neonatal nutrition improved significantly in Stockholm from 2004 to 2011. Above all, parenteral nutrition was initiated more promptly during the first week and was provided at higher quantities. However, many of the EPT infants born during the later years still did not reach the recommended macronutrient intake levels. A significant weight gain improvement was observed between 2004-2005 and 2006-2011.

Parents experiences of discharge readiness from a Swedish neonatal intensive care unit.

AimThe aim of this study was to describe how parents experienced the support at, and preparation for discharge from, the NICU and how they experienced the first time at home.DesignA qualitative design with quantitative elements was applied.MethodsA questionnaire study. Data were analysed using qualitative content analysis with quantitative elements.ResultsThe majority of included parents felt adequately prepared for going home and sufficiently supported during the first period home. Negative experiences were related to lack of time for preparation, lack of support and information, especially about the infant's food intake, breastfeeding, and tube feeding, and lack of follow‐up counselling post discharge. This study supports that parents who are closely involved in their infant's care at the NICU, and who stay with the infant at the NICU around the clock, are well prepared for the transition to home.

Highlights in this issue

Björn Lundberg et al report that hospital-assisted home care after early discharge from a Swedish neonatal intensive care unit (NICU) between 2002 and 2011 was safe for the vast majority of infants (94.8%) 1. However, Gorm Greisen, who recently published experiences from an early discharge programme in Denmark 2, expresses his concerns in the accompanying editorial 3. Two cases of sudden infant death syndrome out of a combined total of 2000 infants suggest that there may be a problem. Readers may also be interested to see the paper by Charlotta Robinson et al 4, who report that using telemedicine to help care for newborn infants after their NICU discharge reduced the need for hospital visits. Drowning has been described as a secret epidemic in Bangladesh. Mosharaf Hossain et al held focus groups with parents and community leaders in rural Bangladesh in an attempt to develop an intervention package that prevented children under the age of five from drowning. Most drownings occurred around lunchtime and the risk factors included children not being able to swim, unfilled ditches, lack of medical facilities and lack of parental awareness. The authors concluded that a safety education programme could be effective in increasing knowledge and changing attitudes among parents and reduce the number of young children drowning in the country 5. Stephanie Kukora and Naomi Laventhal suggest that adults who refuse the influenza vaccine should not receive extracorporeal membrane oxygenation (ECMO) during influenza epidemics if resources are scarce. The authors share their own experiences from a cold night in January 2013, when a severely ill newborn baby risked being refused ECMO as the H1N1 flu epidemic meant that the pressure on equipment and staffing levels had reached breaking point 6. Tracy K Koogler and Michael Broomé discuss the ethical dilemma of medical decision-making in times of scarce technological and human resources 7, 8. Children with refractory or high-risk malignancies frequently suffer from poor quality of life during palliative care. In this Finnish study by Mikaela Porkholm et al, 17 children with end-stage malignancies achieved a significantly better quality of life when they received low daily doses of chemotherapy 9. However, 76% of the patients experienced serious adverse events, emphasising the need for careful patient selection to minimise the risk of toxicity. Nicolas Andre et al comment on the findings 10. Distraction is a useful intervention for venipuncture pain in children, but there is no evidence of which distraction technique is the most useful. This randomised controlled trial by Franca Crevatin et al compared the efficacy of children playing the Angry Bird game on a hand-held computer with nurse-led distraction in a blood drawing centre in Italy. Only one in six children in the computer game group reported pain during venipuncture, which was as effective as being distracted by nurses 11.

Using telemedicine in the care of newborn infants after discharge from a neonatal intensive care unit reduced the need of hospital visits.

AimThis study examined the use of telemedicine as a means to follow up infants discharged from a Swedish neonatal intensive care unit to home health care.MethodsFamilies were randomised to either a control group receiving standard home health care (n = 42 families) or a telemedicine group receiving home health care with telemedicine support (n = 47 families) after discharge from the hospital. Both groups had follow‐up hospital appointments with the neonatal nurse. In the telemedicine group, appointments were supplemented by the use of a specially designed web page and video calls.ResultsThe use of the web page and video calls decreased the number of emergency visits to the hospital (p = 0.047). In the telemedicine group, 26% of the families felt they had more scheduled appointments than necessary, whereas only 6% of the families in the control group thought so (p = 0.037). The parents were highly satisfied with the use of telemedicine. Although the nurses were favourable to using telemedicine, the rigid organisation of the home healthcare programme and the nurses’ schedules and work routines prevented its optimal use.ConclusionThe use of telemedicine decreased the need of hospital visits. Organisational adaptations would be necessary to make the best use of telemedicine.

Hospital‐assisted home care after early discharge from a Swedish neonatal intensive care unit was safe and readmissions were rare

It is common in Sweden to discharge infants early from a neonatal intensive care unit (NICU) and provide hospital-assisted neonatal home care (HANHC), as an alternative to hospital care, for infants with a persisting need for specialised care. This study assessed the safety of HANHC by reviewing hospital readmissions. We retrospectively reviewed the files of all 1410 infants enrolled in HANHC at the NICU at Sachs' Children's Hospital, Stockholm, from 2002 to 2011 up until hospital readmission or their discharge from HANHC. Each readmitted infant was matched to the next HANHC infant who was not readmitted. Predictors and reasons for readmission were investigated in a retrospective nested case-control study. We readmitted 74 (5.2%) of the 1410 infants in HANHC. Extremely preterm infants, born at less than 28 weeks, were readmitted more frequently than other infants, with an odds ratio of 6.07 (range 2.06-17.8). The most common symptoms were respiratory symptoms (55%), and viral respiratory tract infections were the most common reason (28%) for readmission. HANHC was safe for the vast majority of infants (94.8%). Extremely preterm birth was identified as a predictor for hospital readmission. Further studies investigating the safety of HANHC in other settings would be valuable.

Neonatal Intensive Care Nurses' Perceptions of Parental Participation in Infant Pain Management: A Comparative Focus Group Study.

This comparative focus group study explored nurses' experiences and perceptions regarding parental participation in infant pain management in the neonatal intensive care unit (NICU). A total of 87 nurses from 7 NICUs in Finland, Sweden, and the United States participated in focus-group interviews (n = 25). Data were analyzed using deductive and inductive thematic analysis. Nurses' experiences and perceptions varied considerably, from nurses being in control, to nurses sharing some control with parents, to nurse-parent collaboration in infant pain management. When nurses controlled pain management, parents were absent or passive. In these cases, the nurses believed this led to better pain control for infants and protected parents from emotional distress caused by infant pain. When nurses shared control with parents, they provided information and opportunities for participation. They believed parent participation was beneficial, even if it caused nurses or parents anxiety. When nurses collaborated with parents, they negotiated the optimal pain management approach for an individual infant. The collaborative approach was most evident for the nurses in the Swedish NICUs and somewhat evident in the NICUs in Finland and the United States. Further research is needed to address some nurses' perceptions and concerns and to facilitate greater consistency in the application of evidence-based best practices.

‘Being in a womb’ or ‘playing musical chairs’: the impact of place and space on infant feeding in NICUs

BackgroundBecoming a parent of a preterm baby requiring neonatal care constitutes an extraordinary life situation in which parenting begins and evolves in a medical and unfamiliar setting. Although there is increasing emphasis within maternity and neonatal care on the influence of place and space upon the experiences of staff and service users, there is a lack of research on how space and place influence relationships and care in the neonatal environment. The aim of this study was to explore, in-depth, the impact of place and space on parents’ experiences and practices related to feeding their preterm babies in Neonatal Intensive Care Units (NICUs) in Sweden and England.MethodsAn ethnographic approach was utilised in two NICUs in Sweden and two comparable units in England, UK. Over an eleven month period, a total of 52 mothers, 19 fathers and 102 staff were observed and interviewed. A grounded theory approach was utilised throughout data collection and analysis.ResultsThe core category of ‘the room as a conveyance for an attuned feeding’ was underpinned by four categories: the level of ‘ownership’ of space and place; the feeling of ‘at-homeness’; the experience of ‘the door or a shield’ against people entering, for privacy, for enabling a focus within, and for regulating socialising and the; ‘window of opportunity’. Findings showed that the construction and design of space and place was strongly influential on the developing parent-infant relationship and for experiencing a sense of connectedness and a shared awareness with the baby during feeding, an attuned feeding.ConclusionsIf our proposed model is valid, it is vital that these findings are considered when developing or reconfiguring NICUs so that account is taken of the influences of spatiality upon parent’s experiences. Even without redesign there are measures that may be taken to make a positive difference for parents and their preterm babies.

Strengths and weaknesses of parent–staff communication in the NICU: a survey assessment

BackgroundParents of infants hospitalized in the neonatal intensive care unit (NICU) find themselves in a situation of emotional strain. Communication in the NICU presents special challenges due to parental stress and the complexity of the highly technologized environment. Parents’ need for communication may not always be met by the NICU staff. This study aimed to describe strengths and weaknesses of parent–nurse and parent–doctor communication in a large level III NICU in Sweden in order to improve our understanding of parents’ communication needs.MethodsParents were asked to complete a survey consisting of sixteen questions about their experiences of communication with nurses and doctors in the NICU. In each question the parents evaluated some aspect of communication on a five- or six-point Likert scale. They also had the opportunity on each question to comment on their experiences in their own words. Data were analyzed using IBM SPSS Statistics 20.0 and qualitative manifest content analysis.Results270 parents (71.4%) completed the survey. Parents generally rated communication with the staff in the NICU positively and appreciated having received emotional support and regular information about their child´s care. Although a large majority of the parents were satisfied with their communication with doctors and nurses, only about half of the parents felt the nurses and doctors understood their emotional situation very well. Some parents would have desired easier access to conversations with doctors and wanted medical information to be given directly by doctors rather than by nurses. Parents’ communication with the staff was hampered when many different nurses were involved in caring for the infant or when the transfer of information in connection with shift changes or between the maternity ward and NICU was poor. Parents also desired to be present during doctors’ rounds on their infant.ConclusionsTraining both doctors and nurses in communication skills, especially in how to meet parents’ emotional needs better, could make communication at the NICU more effective and improve parental well-being. Creating a framework for the parents of what to expect from NICU communication might also be helpful. In addition, our results support the use of primary nurse teams to improve continuity of care and thereby promote successful communication.

Becoming a parent to a child with birth asphyxia—From a traumatic delivery to living with the experience at home

The aim of this study is to describe the experiences of becoming a parent to a child with birth asphyxia treated with hypothermia in the neonatal intensive care unit (NICU). In line with the medical advances, the survival of critically ill infants with increased risk of morbidity is increasing. Children who survive birth asphyxia are at a higher risk of functional impairments, cerebral palsy (CP), or impaired vision and hearing. Since 2006, hypothermia treatment following birth asphyxia is used in many of the Swedish neonatal units to reduce the risk of brain injury. To date, research on the experience of parenthood of the child with birth asphyxia is sparse. To improve today's neonatal care delivery, health-care providers need to better understand the experiences of becoming a parent to a child with birth asphyxia. A total of 26 parents of 16 children with birth asphyxia treated with hypothermia in a Swedish NICU were interviewed. The transcribed interview texts were analysed according to a qualitative latent content analysis. We found that the experience of becoming a parent to a child with birth asphyxia treated with hypothermia at the NICU was a strenuous journey of overriding an emotional rollercoaster, that is, from being thrown into a chaotic situation which started with a traumatic delivery to later processing the difficult situation of believing the child might not survive or was to be seriously affected by the asphyxia. The prolonged parent–infant separation due to the hypothermia treatment and parents’ fear of touching the infant because of the high-tech equipment seemed to hamper the parent–infant bonding. The adaption of the everyday life at home seemed to be facilitated by the follow-up information of the doctor after discharge. The results of this study underline the importance of family-centered support during and also after the NICU discharge.

Initiation and extent of skin‐to‐skin care at two Swedish neonatal intensive care units

To describe initiation and extent of parents' application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units. The duration of SSC was recorded in 104 infants' medical charts during their hospital stay, and the parents answered a questionnaire. Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 24-78 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p < 0.001). The earlier the SSC was initiated, the longer the infant was cared for skin-to-skin per day during his/her hospital stay (p < 0.001). The median daily duration of SSC was 403 min. Early initiation of SSC had positive impact on the extent of parents' application of SSC. Even though the infants in this study were cared for skin-to-skin to a high extent, there is a potential for extended use of SSC in this type of hospital setting for reducing separation between infants and parents.