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Neonatal comfort care

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https://www.readbyqxmd.com/read/28092282/neonatal-palliative-care
#1
Elvira Parravicini
PURPOSE OF REVIEW: A significant number of newborns are affected by life-limiting or life-threatening conditions. When prolongation of survival is no longer a goal, or prognosis is uncertain, a plan of care focused on the infant's comfort is essential. The aim of this article is to review the most recent and relevant literature regarding neonatal palliative care (NPC). RECENT FINDINGS: A variety of perinatal and NPC programs are described, but most programs focus exclusively on end-of-life care...
January 13, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28064099/an-enhanced-recovery-programme-after-caesarean-delivery-increases-maternal-satisfaction-and-improves-maternal-neonatal-bonding-a-case-control-study
#2
Anne Laronche, Luiza Popescu, Dan Benhamou
OBJECTIVES: Enhanced recovery programmes (ERP) have been shown to improve postoperative outcomes. The aim of our study was to investigate the impact of an ERP after caesarean delivery on maternal feelings and satisfaction towards mother-child bonding initiation, in comparison with traditional postoperative care. STUDY DESIGN: A comparative, prospective and multicentre study was conducted in three maternity units of the Paris area: one applied traditional postoperative care while the two others applied an ERP, were included patients after elective or emergency caesarean delivery who had given birth to full-term healthy singleton newborns...
December 30, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28009334/challenges-successes-and-opportunities-for-reducing-readmissions-in-a%C3%A2-referral-based-children-s-hospital-nicu
#3
R Bapat, R McClead, E Shepherd, G Ryshen, T Bartman
AIM: To evaluate readmission data in a level IV neonatal intensive care unit (NICU) to identify patient characteristics and process failures which serve as drivers for readmission. METHODS: Our center is a primary referral center in Central and Southeast Ohio, providing us a unique opportunity to evaluate readmissions. We studied our current discharge process, caregiver perception of discharge readiness, parental comfort and the pre-discharge and post-discharge characteristics of infants...
2016: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/28007511/-neonatal-palliative-care-at-home-contribution-of-the-regional-pediatric-palliative-care-team
#4
N Cojean, C Strub, P Kuhn, L Calvel
The "patients' rights and end-of-life care" act, known as the Leonetti law, has allowed implementation of palliative care in neonatology as an alternative to unreasonable therapeutic interventions. A palliative care project can be offered to newborns suffering from intractable diseases. It must be focused on the newborn's quality of life and comfort and on family support. Palliative care for newborns can be provided in the delivery room, in the neonatal unit, and also at home. Going home is possible but requires medical support...
December 19, 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/27915463/the-our-hope-approach-for-ethics-and-communication-about-neonatal-neurological-injury
#5
REVIEW
Eric Racine, Emily Bell, Barbara Farlow, Steven Miller, Antoine Payot, Lisa Anne Rasmussen, Michael I Shevell, Donna Thomson, Pia Wintermark
Predicting neurological outcomes of neonates with acute brain injury is an essential component of shared decision-making, in order to guide the development of treatment goals and appropriate care plans. It can aid parents in imagining the child's future, and guide timely and ongoing treatment decisions, including shifting treatment goals and focusing on comfort care. However, numerous challenges have been reported with respect to evidence-based practices for prognostication such as biases about prognosis among clinicians...
February 2017: Developmental Medicine and Child Neurology
https://www.readbyqxmd.com/read/27759567/smartphone-and-internet-preferences-of-parents-information-needs-and-desired-involvement-in-infant-care-and-pain-management-in-the-nicu
#6
Talia Orr, Marsha Campbell-Yeo, Britney Benoit, Brenda Hewitt, Jennifer Stinson, Patrick McGrath, Donna Dowling
BACKGROUND: Despite an abundance of research that identifies the benefits for both parent and child when parents are actively involved in their infant's care, challenges related to the best methods to engage families persist. PURPOSE: To conduct a feasibility study that aims to understand the preferences of smartphone and Internet use by parents of infants admitted to the neonatal intensive care unit (NICU) related to information seeking and active participation in infant care, with a focus on pain management interventions...
October 18, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/27735929/international-variations-in-application-of-the-best-interest-standard-across-the-age-spectrum
#7
N Laventhal, A A E Verhagen, T W R Hansen, E Dempsey, P G Davis, G A Musante, A Wiles, W Meadow, A Janvier
OBJECTIVE: Ethically and legally, assertions that resuscitation is in a patient's best interest should be inversely correlated with willingness to forego intensive care (and accept comfort care) at the surrogate's request. Previous single country studies have demonstrated a relative devaluation of neonates when compared with other critically ill patients. STUDY DESIGN: In this international study, physicians in Argentina, Australia, Canada, Ireland, The Netherlands, Norway and the United States were presented with eight hypothetical vignettes of incompetent critically ill patients of different ages...
October 13, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27729502/a-retrospective-study-of-sedation-and-analgesic-requirements-of-pediatric-patients-on-extracorporeal-membrane-oxygenation-ecmo-from-a-single-center-experience
#8
Pilar Anton-Martin, Vinai Modem, Donna Taylor, Donald Potter, Cindy Darnell-Bowens
INTRODUCTION: The purpose of this study is to describe the sedative and analgesic requirements identifying factors associated with medication escalation in neonates and children supported on ECMO. METHOD: Observational retrospective cohort study in a tertiary pediatric intensive care unit from June 2009 to June 2013. RESULTS: One hundred and sixty patients were included in the study. Fentanyl and midazolam were the first line agents used while on ECMO...
October 10, 2016: Perfusion
https://www.readbyqxmd.com/read/27729254/opioid-dependence-and-pregnancy-minimizing-stress-on-the-fetal-brain
#9
REVIEW
John J McCarthy, Martin H Leamon, Loretta P Finnegan, Catherine Fassbender
Increase in the number of opioid-dependent pregnant women delivering babies at risk for neonatal abstinence syndrome prompted a US Government Accountability Office report documenting deficits in research and provider knowledge about care of the maternal/fetal unit and the neonate. There are 3 general sources of dependence: untreated opioid use disorder, pain management, and medication-assisted treatment with methadone or buprenorphine. A survey of methadone patients' experiences when telling a physician of their pregnancy and opioid dependence demonstrated physician confusion about proper care, frequent negative interactions with the mother, and failures to provide appropriate referral...
October 8, 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27701379/hypoplastic-left-heart-syndrome-from-comfort-care-to-long-term-survival
#10
REVIEW
Mouhammad Yabrodi, Christopher W Mastropietro
The management of hypoplastic left heart syndrome (HLHS) has changed substantially over the past four decades. In the 1970s, children with HLHS could only be provided with supportive care. As a result, most of these unfortunate children died within the neonatal period. The advent of the Norwood procedure in the early 1980s has changed the prognosis for these children, and the majority now undergoing a series of three surgical stages that can support survival beyond the neonatal period and into early adulthood...
November 2, 2016: Pediatric Research
https://www.readbyqxmd.com/read/27672453/short-term-effects-of-hydrokinesiotherapy-in-hospitalized-preterm-newborns
#11
Welcy Cassiano de Oliveira Tobinaga, Cirlene de Lima Marinho, Vera Lucia Barros Abelenda, Paula Morisco de Sá, Agnaldo José Lopes
Background. In the neonatal intensive care unit (NICU) environment, preterm newborns are subject to environmental stress and numerous painful interventions. It is known that hydrokinesiotherapy promotes comfort and reduces stress because of the physiological properties of water. Objective. To evaluate the short-term effects of hydrokinesiotherapy on reducing stress in preterm newborns admitted to the NICU. Materials and Methods. Fifteen preterm newborns underwent salivary cortisol measurement, pain evaluation using the Neonatal Infant Pain Scale (NIPS), and heart rate, respiratory rate, and peripheral oxygen saturation measurements before and after the application of hydrokinesiotherapy...
2016: Rehabilitation Research and Practice
https://www.readbyqxmd.com/read/27643592/perspectives-on-the-care-and-advances-in-the-management-of-children-with-trisomy-13-and-18
#12
John C Carey, Tomoki Kosho
The trisomy 13 and trisomy 18 syndromes are important and relatively common chromosome conditions each consisting of a recognizable pattern of multiple congenital anomalies, an increased neonatal and infant mortality, and a marked cognitive and motor disability in older children. Because of the medically serious nature of the outcomes, the traditional approach to management in the newborn and early infancy periods has been to withhold technological support and surgery. In the last decade a rich dialogue has emerged in the literature; one view makes the case for pure comfort care for the benefit of the child while the other view supports full intervention in appropriate situations...
September 2016: American Journal of Medical Genetics. Part C, Seminars in Medical Genetics
https://www.readbyqxmd.com/read/27638112/antenatal-palliative-care-consultation-implications-for-decision-making-and-perinatal-outcomes-in-a-single-centre-experience
#13
Stephanie Kukora, Nathan Gollehon, Naomi Laventhal
BACKGROUND: Some pregnant patients with complex fetal anomalies meet with paediatric palliative care subspecialists prior to delivery, but referral to antenatal palliative care consultation (APCC) is not standard. Little is known about its role in perinatal decision-making. METHODS: A single-centre retrospective cohort study was undertaken for patients referred for outpatient antenatal counselling by a neonatologist over a two-and-half-year period. Patients also receiving APCC were compared with infants with similar prognoses who did not...
January 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/27636693/nicu-culture-of-care-for-infants-with-neonatal-abstinence-syndrome-a-focused-ethnography
#14
Monica Marie Nelson
PURPOSE: The purpose of this focused ethnography was to describe the culture of care and nonpharmacologic nursing interventions performed by NICU nurses for infants with neonatal abstinence syndrome (NAS). METHOD: Roper and Shapira's framework for the analysis included participant observation, individual interviews, and examination of existing documents. SAMPLE: Twelve full-time nurses were observed and interviewed. RESULTS: Results described the culture of care provided to infants with NAS by NICU nurses as evidenced by six themes: learn the baby (routine care, comfort care, environment, adequate rest and sleep, feeding), core team relationships (support, interpersonal relationships), role satisfaction (nurturer/comforter, becoming an expert), grief, making a difference (wonderful insanity, critical to them), and education and care of the mother...
2016: Neonatal Network: NN
https://www.readbyqxmd.com/read/27557275/shared-decision-making-and-the-pathways-approach-in-the-prenatal-and-postnatal-management-of-the-trisomy-13-and-trisomy-18-syndromes
#15
Sasha E Andrews, Ann G Downey, David Scott Showalter, Heather Fitzgerald, Vivian P Showalter, John C Carey, Peter Hulac
The medical management of infants with the trisomy 13 and trisomy 18 syndromes is challenging and controversial. Both conditions have high neonatal and infant mortality, and surviving children display significant cognitive and motor disabilities. Currently, there exists a tension in the neonatal and perinatal communities regarding care. One view holds that management should consist solely of comfort care, while another opinion recommends offering medical and surgical intervention in appropriate situations. The purpose of this manuscript is to present a model for the care of fetuses and infants with trisomy 13 and 18 during the prenatal, perinatal, and postnatal periods...
September 2016: American Journal of Medical Genetics. Part C, Seminars in Medical Genetics
https://www.readbyqxmd.com/read/27557031/-parental-roles-and-needs-in-neonatal-intensive-care-a-review-of-portuguese-guidelines
#16
Mariana Amorim, Elisabete Alves, Henrique Barros, Susana Silva
The scope of this article is to analyze the parental roles and needs included in Neonatal Intensive Care Unit guidelines. Thematic content analysis was conducted of 33 guidelines (28 consensuses and 5 documents directed to parents) freely available on the Portuguese Pediatrics Society website in August 2014. These documents deal mainly with information needs, child care activities performed by the parents and the respective responsibilities in decision making with respect to the health of children. Furthermore, parental and family characteristics were mentioned as risk factors for prematurity and perinatal diseases...
August 2016: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/27550159/parental-hopes-interventions-and-survival-of-neonates-with-trisomy-13-and-trisomy-18
#17
Annie Janvier, Barbara Farlow, Keith J Barrington
Trisomy 13 and 18 are life-limiting conditions for which a palliative approach is frequently recommended. The objective of this study was to examine parental goals/decisions, the length of life of their child and factors associated with survival. Parents of children who lived with trisomy 13 or 18 that were part of English-speaking social networks were invited to participate in a questionnaire study. Participants answered questions about their hopes/goals, decisions regarding neonatal interventions, and the duration of their children's lives...
September 2016: American Journal of Medical Genetics. Part C, Seminars in Medical Genetics
https://www.readbyqxmd.com/read/27532363/heated-humidified-high-flow-nasal-cannula-vs-nasal-continuous-positive-airway-pressure-for-respiratory-distress-syndrome-of-prematurity-a-randomized-clinical-noninferiority-trial
#18
Anna Lavizzari, Mariarosa Colnaghi, Francesca Ciuffini, Chiara Veneroni, Stefano Musumeci, Ivan Cortinovis, Fabio Mosca
Importance: Heated, humidified high-flow nasal cannula (HHHFNC) has gained increasing popularity as respiratory support for newborn infants thanks to ease of use and improved patient comfort. However, its role as primary therapy for respiratory distress syndrome (RDS) of prematurity needs to be further elucidated by large, randomized clinical trials. Objective: To determine whether HHHFNC provides respiratory support noninferior to nasal continuous positive airway pressure (nCPAP) or bilevel nCPAP (BiPAP) as a primary approach to RDS in infants older than 28 weeks' gestational age (GA)...
August 8, 2016: JAMA Pediatrics
https://www.readbyqxmd.com/read/27531225/delivery-room-deaths-of-extremely-preterm-babies-an-observational-study
#19
Xavier Durrmeyer, Claire Scholer-Lascourrèges, Laurence Boujenah, Pierre Bétrémieux, Olivier Claris, Micheline Garel, Monique Kaminski, Laurence Foix-L'Helias, Laurence Caeymaex
OBJECTIVE: Many extremely preterm neonates die in the delivery room (DR) after decisions to withhold or withdraw life-sustaining treatments or after failed resuscitation. Specific palliative care is then recommended but sparse data exist about the actual management of these dying babies. The objective of this study was to describe the clinical course and management of neonates born between 22 and 26 weeks of gestation who died in the DR in France. DESIGN, SETTING, PATIENTS: Prospective study including neonates, who were liveborn between 22(+0) and 26(+6) weeks of gestation and died in the DR in 2011, among infants included in the EPIPAGE-2 study at the 18 centres participating in this substudy of extremely preterm neonates...
August 16, 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/27502105/social-emotional-factors-increase-risk-of-postpartum-depression-in-mothers-of-preterm-infants
#20
Katheleen Hawes, Elisabeth McGowan, Melissa O'Donnell, Richard Tucker, Betty Vohr
OBJECTIVE: To examine the association of maternal mental health, perceptions of readiness at neonatal intensive care unit (NICU) discharge, and social risk factors with depressive symptoms 1 month postdischarge in mothers of early (<32 weeks), moderate (32-33 weeks), and late (34-36 weeks) preterm infants. A secondary objective was to compare depressive symptoms among mothers in all preterm groups. STUDY DESIGN: Mothers (n = 734) of preterm infants cared for >5 days in the NICU and participating in a Transition Home Program completed the Fragile Infant Parent Readiness Evaluation prior to discharge for perceptions of NICU staff support, infant well-being, maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant)...
August 5, 2016: Journal of Pediatrics
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