NICU Nurses

Neonatal care has gotten increasingly complex over the past decade. The concept of trauma to describe the neonatal intensive care unit (NICU) journey for the infant, family, and care providers has brought a new and different understanding to care practices in the NICU. Trauma-informed care speaks to the impact of the NICU environment and needed medical treatments and procedures for the infant who is often premature and critically ill, and the impact on his or her family who is dealing with the unexpected NICU admission after the birth of their infant.
The concept of trauma, as it relates to neonates and families, is clinically relevant to all neonatal care providers. Understanding the impact the NICU environment and treatment plans have on the developing infant and new family will have long-term implications in improving outcomes in this fragile population. Combining the core measures for age-appropriate care in the NICU and the principles of trauma-informed care within evidence-based clinical practice guidelines will lead to a standardization of practice, with the goal of improving neonatal and family outcomes.
Within this text, Mary Coughlin discusses clinically relevant, transdisciplinary practice guidelines within the five core measures, which include the importance of a healing environment, protection from pain and stress, time for protected sleep for the infant while continuing to provide for the daily care and treatment for the infant, and the integration of the family throughout the course of treatment in the NICU. Use of current scientific research along with explanations of the clinical rationale and the association with both short- and long-term outcomes make this an important resource for all involved in neonatal care. The guidelines include implementation strategies to support practice improvement, as well as sample competencies and teaching tools to support the changes that may be needed within the NICU.
Integration of families at the very beginning of the NICU journey is vital to improve positive family outcomes. It is recognized that the families require assistance in dealing with this difficult situation and the NICU environment. They need to identify their roles as parents, when others are often providing the daily hands-on care for their infant. The understanding of parent–clinical partnerships is important in the improvement of positive family outcomes.
But it is not only infants and their families that deal with the trauma of the NICU. Care providers need to understand issues within their work environment and workplace dynamics in addition to how the NICU environment and caring for critically ill infants can affect them individually, and what resources may be available for self-care and making healthy choices.
This text is a crucial resource for all neonatal care providers as a way to improve quality care to infants and families when faced with starting family life in the NICU. I would encourage all neonatal care providers to have this as a resource as we continue to develop new care technologies for the very smallest and critically ill infants who are in the NICU.
Cheryl Ann Carlson, PhD, APRN, NNP-BC
National Association of Neonatal Nurses President, 2012–2015

I would like to START by thanking all the tape companies that have reacted to my questions regarding the use of their brand tape in the NICU. Nurse practitioners are the professional that have been monitoring the skin condition of the very young closely for many years. They are THE experts on the use of any tape or bandage especially in the NICU. After having read a lot on the topic, I decided to ask the various tape manufacturers if they considered their tape to be safe on the skin of the premature infant. As I have stated earlier https://www.academia.edu/31331942/Clinical_Notes_2_ETT-Ped_taping_pre-term_infants_NICU_and_new-borns._Best_Practice I think it wise not to use tape until the baby is at least 29 days post gestational age. At that moment the skin is adapted to dry surroundings. After reading this article http://journals.lww.com/advancesinneonatalcare/Fulltext/2016/10001/Extremely_Preterm_Infant_Skin_Care__A.5.aspx I asked the various tape companies the following questions: 1. Do you know if the glue is pH-neutral? 2. Do you recommend using your tape brand on the premature skin? Regarding the first question. I have come to understand during this survey that the pH of a solid substance does not exist. We can therefore ask ourselves if this question was really relevant. The skin of a premature baby is pH 7, but this lowers rapidly. Regarding the second question about safely and suitability of brands to be applied to skin of premature born children, we have some interesting answers and comments. ALL ANSWERS AND THE COMPANY'S COMMENTS ARE STATED IN THIS TABLE BELOW:

newborn in the neonatal intensive care unit (NICU), the differences between their
posttraumatic stressors, the factors that affect posttraumatic stress, and the
experiences of parents. Methods: The parents of 66 newborn infants (66 mothers
and 66 fathers) in the NICU were the sampling group, and a descriptive design
was used. The sociodemographic traits of parents were identified using a data
collection form, and posttraumatic stress experiences of parents were identified by
using the Impact of Events Scale-Revised (IES-R). Analysis of variance and
t-test for two independent groups were used for the comparisons, and a
chi-square test was used. Results: The mean of the total scale scores (mothers
43.61 ± 14.98; fathers 36.26 ± 17.01), mean of the intrusion scores (mothers
18.17 ± 6.25; fathers 15.13 ± 7.14), and mean of the avoidance scores
(mothers 11.21 ± 4.94; fathers 9.17 ± 5.17) were high. When the scores for the
IES-R and subscale scores of parents were compared, mothers scored 20 higher
than fathers, a statistically significant difference. When the cut-off point was 30,
81.8% of mothers and 66.7% of fathers experienced posttraumatic stress.
Conclusion: In light of these findings, it is recommended that health professionals
monitor all parents with a newborn in the NICU for symptoms of posttraumatic
stress and that parents are informed about their newborns.

Background: Incentives play an important role in organizations as it influences a variety of work-related behavior, as well as the motivation of employees. Aims of the study: The present study was conducted in the main Assiut University Hospital to assess nurse's awareness and satisfaction regarding the incentives system. Subjects and Methods: This study included 271 nurses who randomly selected from all units at the main Assiut University Hospital. The study included both quantitative and qualitative methods for data collection. Results: High percent of the participants reported that the most important incentives are fair remuneration, bounces, appropriate working hours, and different services (health/ education) (69.7%, 60.9%, 60.5, % 60.5%, respectively). The promotion, appreciation of work efforts, good relations with colleagues and superior encouragement were the most important morale incentives reported by (77.1 %, 71.2 %, 66.8 %, 64.6%) respectively. This is confirmed by the results of Focus group discussions as about half of the participants especially female nurses considered the morale incentives are more important than the financial one especially the good dealing and the respect from the physicians. Conclusion and Recommendations: In conclusion, this study indicates that nurses know what they want from incentives. Attention to priorities and flexible incentives system may help to create the cohesive work environment that nurses seek. Determine the objectives are the most important factors to increase the effectiveness of the incentive system.

This study assesses the results of implementation of a software program that allows for input of admission/discharge summary data (including cost) in a neonatal intensive care unit (NICU) in Greece, based on the establishment of a baseline statistical database for infants treated in a NICU and the statistical analysis of epidemiological and resource utilization data thus collected. A software tool was designed, developed, and implemented between April 2004 and March 2005 in the NICU of the LITO private maternity hospital in Athens, Greece, to allow for the first time for step-by-step collection and management of summary treatment data. Data collected over this period were subsequently analyzed using defined indicators as a basis to extract results related to treatment options, treatment duration, and relative resource utilization. Data for 499 babies were entered in the tool and processed. Information on medical costs (e.g., mean total cost +/- SD of treatment was euro310.44 +/- 249...

Respiratory distress syndrome is a common health problem in preterm due to immaturity of lungs with deficiency of surfactant. Surfactant reduces surface tension in the alveoli, thereby preventing collapse of the lungs during expiration. Bubble continuous positive airway pressure (CPAP) is a low cost intervention that provides continuous distending pressure to the alveoli so that they will not collapse during expiration.

This study presents, for the first time, empirical data on practices regarding bioethical decision-making in treatment of preterm and ill newborns in Greece. The aim of the study was to: (a) record self-reported practices and involvement of Greek physicians in decisions of withholding and withdrawing neonatal intensive care, and (b) explore the implication of cultural, ethical, and professional parameters in decision-making. Methods: 71 physicians, employed fulltime in all public Neonatal Intensive Care Units (NICUs) (n = 17) in Greece, completed an anonymous questionnaire between May 2009 and May 2011. Results: One-third of the physicians in our sample admitted that they have, at least once in the past, decided the limitation of intensive care of a newborn close to death (37.7%) and/or a newborn with unfavorable neurological prognosis (30.8%). The higher the physicians’ support towards the value of quality of human life, the more probable it was that they had taken a decision to wi...

Hasta hace apenas 30 años se consideraba a los
niños prematuros como muy frágiles y débiles por lo
que se aconsejaba “tocarlos” y “manejarlos” lo menos
posible. Al conocerse los efectos de la deprivación
materna, se especuló que la falta de estímulos
podría ser una de las tantas causantes de este
serio problema; así nació el enfoque de “estimulación
adicional”. Actualmente sabemos que las Unidades
de Cuidados Intensivos Neonatales están saturadas
de estímulos ambientales (como ruidos e iluminación)
los que podrían constituir un serio problema
para los bebés internados. El dilema entonces es
cómo y cuándo intervenir. En esta revisión bibliográfica
se incluyen en primer lugar, criterios sobre crecimiento
cerebral, y características neurofisiológicas
y conductuales. En segundo término se dan pautas
sobre el cuidado de los bebés internados, que podrían
ser punto de partida de normas y técnicas
recomendadas para la atención y cuidado de los
prematuros.

The SUPPORT study, a large multicenter study of EOL care in adult ICUs, showed that, even for very high-risk patients, doctors were unlikely to discuss DNR orders until 24-48h prior to death. We wondered whether there were similar patterns in discussions about EOL care or DNR orders in NICUs.METHODS: Babies were eligible for the study if they met ≥1 of the following criteria: <750g, congenital anomalies, grade IV IVH, asphyxia, chronic lung disease. We asked MDs to estimate each baby's chance of survival, anticipated quality of life on a 1-10 scale, and likelihood of developing cognitive or motor problems. We then asked whether there had been a discussion about DNR or EOL care prior to the baby's last day of life. RESULTS: 260/1204 (21%) admissions to the NICU met eligibility criteria. These babies accounted for 97% of deaths. We interviewed MDs in 138 (53%) of these cases. MDs had discussed EOL care prior to the last day of life in 46(33%) cases. Comparing babies about whom there was or was not such a discussion, there was no difference in MD assessments of the baby's likelihood of survival to discharge, of developing cognitive or motor problems, or of anticipated quality of life. 24/138 (17%) babies died. 17 (71%) babies who died did not receive CPR at the time of death. 76% of babies about whom there was a discussion of EOL options survived. There was discussion about EOL options about 11/24 (46%) of babies who died. CONCLUSIONS: For most babies who don't get CPR, there hasn't been discussion of DNR prior to the last day of life. Most babies about whom there is some discussion of DNR don't die. Prognostic estimates do not correlate well with discussions of EOL care in these 2 NICUs. In deciding which parents should discuss EOL treatment options, prognostic assessments are only part of the puzzle. Other factors seem to drive many such decisions.

epsis adalah komplikasi yang sering diketemukan pada unit perawatan intensif, hal tersebut terjadi pada bayi kecil terutama bayi prematur. Pada umumnya gejala klinik tidak khas dan sulit ditemukan. 1,2,3 Angka kematian bayi (AKB) di negara-negara berkembang seperti India/Asia Tenggara/Pasifik sekitar 10-63 per 1000 kelahiran Latar belakang. Latar belakang. Latar belakang. Latar belakang. Latar belakang. Angka kematian bayi masih tinggi yang umumnya disebabkan infeksi atas septikemia, hal ini terutama pada bayi dengan berat badan lahir rendah. Tujuan. Tujuan. Tujuan. Tujuan. Tujuan. Untuk mengetahui angka kematian pada bayi baru lahir dengan berat badan normal serta berat lahir rendah dan untuk mengetahui angka kematian pada bayi risiko tinggi berdasarkan rujukan. Metoda. Metoda. Metoda. Metoda. Metoda. Penelitian potong lintang terhadap seluruh bayi yang dirawat di NICU (level III) dan ruang perawatan (level II) dari Januari sampai dengan Desember 2004. Datadata bayi yang diambil antara lain temperatur, frekuensi nafas, frekuensi nadi & denyut jantung, aktivitas menyusui & menangis, umur kehamilan dan berat badan, lama dari ketuban pecah dini, warna cairan ketuban, cairan lambung, darah lengkap termasuk neutropil granulotoksik, C-reactive protein, outcome/keluaran. Hasil. Hasil. Hasil. Hasil. Hasil. Angka case fatality rate (CFR) pada BBLR di NICU (yang dicurigai infeksi) adalah 20,3% sedangkan di level II sebesar 8,5% CFR di NICU, untuk BBLR sebesar 15,6% dan di level II sebesar 3,8%. Angka kematian bayi berdasarkan berat lahir antara bayi yang dirujuk dari luar dan tidak, terdapat perbedaan yaitu angka kematian lebih tinggi di dapat pada bayi yang dirujuk untuk bayi dengan BBL < 1500 gr, angka kematian pada bayi yang dirujuk 8,8 %o (non rujukan=3,1%o), BBL 1500-2400 gr sebesar 47,1%o (non rujukan 4,7%o) dan BBL > 2500 gr sebesar 170,1%o (non rujukan 3,1%o). Kesimpulan. Kesimpulan. Kesimpulan. Kesimpulan. Kesimpulan. Angka kematian lebih tinggi ditemukan pada bayi yang datang dari luar rumah sakit (rujukan)

The objective of this study was to describe our NICU’s (neonatal intensive care unit) experience with mobile surgical team and to demonstrate its effectiveness. Method: We analyzed the data of 17 consecutive very low birth weight and extremely low birth weight infants over 3 years who underwent 22 procedures (19 emergency and 3 elective). The gestational age at birth was a median of 25 weeks (range 24 - 39), and the median birth weight was 613 g (range from 340 g to 1100 g). The infants received their operations during their first 2 weeks of life (median 7 days, range from 1 to 14). Results: The spectrum of primary surgical diagnoses included spontaneous intestinal perforations (n = 8), gastric perforations (n = 3), necrotizing enterocolitis (n = 2), meconium ileus (n = 2), and miscellaneous (n = 2). An emergency laparotomy with either a bowel or a gastric procedure was performed in 16 cases. Postoperatively, all infants required mechanical ventilation from 1 to 43 days (median 6.5 days). Complications included a metachronous small bowel perforation, an ileostomy retraction, a prolapsed stoma, and impaired wound healing; we had one postoperative death. Two infants died later in the NICU (mortality 3 of 16; 19%). Conclusion: Off-site surgery for preterm infants in the NICU is feasible. This approach prevents the risks of transportation, and parents and neonatologists alike feel comfortable with this regimen. However, biases may exist regarding the surgeon’s decision to operate, the choice of procedure, and the follow-up.

This study presents, for the first time, empirical data on practices regarding bioethical decision-making in treatment of preterm and ill newborns in Greece. The aim of the study was to: (a) record self-reported practices and involvement of Greek physicians in decisions of withholding and withdrawing neonatal intensive care, and (b) explore the implication of cultural, ethical, and professional parameters in decision-making. Methods: 71 physicians, employed fulltime in all public Neonatal Intensive Care Units (NICUs) (n = 17) in Greece, completed an anonymous questionnaire between May 2009 and May 2011. Results: One-third of the physicians in our sample admitted that they have, at least once in the past, decided the limitation of intensive care of a newborn close to death (37.7%) and/or a newborn with unfavorable neurological prognosis (30.8%). The higher the physicians’ support towards the value of quality of human life, the more probable it was that they had taken a decision to wi...

A recent multicenter study in adult ICUs showed that doctors often fail to talk with patients about advance directives, prognosis, or the patients' pain. We assessed how well MDs and RNs in 2 NICUs communicate with parents.METHODS: We identified a subpopulation of high risk babies(<750g, Grade IV IVH, congenital anomaly, chronic lung disease) in 2 NICUs, and interviewed MDs, RNs, and parents biweekly. We asked parents from whom they received infor-mation, and asked MDs and RNs how often they had met parents. RESULTS: During the 9 month study, 260/1204 admissions to the NICUs met study criteria. We were able to interview parents of 147(57%)babies. UC had more babies with birthweight <750 (27 v 17% p<0.01) and with chronic lung disease (39 vs. 15% p<0.01). UA had more babies with congenital anomalies (59 v 19% p<0.001). At UC, a higher percentage of parents hadn't visited the NICU (29% v 14%, p<0.01) and there were more cases in which the MD or RN caring for the baby at the time of the interview had not met parents (42% v 16% p<0.01). Parents in both NICUs more often said that RNs, not MDs, were their primary source of information (45% vs 23% p<0.01). Discontinuity of care was the norm. Among doctors, it resulted from attendings going on [Illegible Text] off service or call. Doctors in both NICUs were responsible for >35 babies, and generally focused on the sicker ones. Among RNs, discontinuities resulted from staffing patterns. They were often assigned to different babies each day. Parents of babies who died seldom identified an MD by name. They often remembered a particular RN.CONCLUSIONS: At 2 NICUs, in different countries, serving different populations of patients, there were pervasive problems with communication and continuity of care by MDs and RNs. Similar problems are found in adult ICUs. They seem inherent to the staffing models in tertiary care academic ICUs.

Pre-axial upper limb skeletal deformities involving thumb and radial bones are commonly associated with congenital cardiac defects. The common deformities are hypoplasia or aplasia of thumbs and radial bones. Skeletal involvement may be unilateral or bilateral. Atrial septal defect of ostium secundum is the most commonly associated congenital cardiac defect. Other possible cardiac defects are ostium primum variety of atrial septal defect, ventricular septal defects, patent foramen ovale and electric cardiac conduction abnormalities. The incidence is 1 in 1,00,000 live births. This syndrome involves TBX5 gene defect on long arm of chromosome 12. The most common inheritance pattern is autosomal dominant variety. New mutations are common. Antenatal detection by midtrimester anomaly scan is possible. Recently, we detected three cases of Holt Oram Syndrome at our health care facility during 2016-2019. These cases were presented with full spectrum of skeletal and cardiac defects in one case, near total expression in one case and partial expression of physical features in another case. Thumb abnormalities and cardiac defects involving atrial septal defect were found in all cases. All cases underwent second trimester anomaly scans but missed antenatal detection and lost potential antenatal counselling with parents.

North-American and Western European societies are multicultural. This affects hospital and outpatient organizations: the hospitalizations of patients coming from totally different cultural contexts are becoming more and more frequent. Among the hospitalized patients, there are also newborns and infants. Unfortunately, some of them do not survive. The importance of this phenomenon should not be underestimated.1
Ways of dealing with death and mourning are closely related to collective and cultural characteristics of a society, which possesses its own collective language to express emotions. It is also known that, in every age and cultural setting, there is always a potential for individual emotional variability, which also depends on the sexual gender of the grieving person.
At first glance, the reactions to the death of a child and the stages of the grieving process do not show substantial dissimilarities in people that belong to and/or embrace cultures or religions that are totally different from one another. Many foreign parents seem to have deserted their ancestral death rituals replacing them with those of Western origin. But if we look beyond appearances, we are able to discover that this phenomenon is just the (superficial) result of a process of adaptation to the Western cultural environment into which the parents of the hospitalized child have immigrated. Foreign parents do adapt (probably worrying about being judged) to Western culture, but these adopted reactions to death as well as the modes and taboos of mourning, manifest themselves in ways that do not belong to them. It is therefore possible to state that beneath this ‘westernized’ appearance lies a quintessentially different reality, one deeply infused with the beliefs and precepts of the culture of origin.
To make it possible for professionals to create for the parents a sufficiently suitable environment in which to deal with the loss of their child and begin the work of mourning, they must acquire specific knowledge about the customs and traditions of the parents’ culture of origin. This is not a task to be regulated or standardized on the basis of protocols and precedents. It must be ‘customized’ to fit each specific case.